Svenskt, finskt och ryskt : nationens, språkets och historiens dimensioner hos E. G. Ehrström 1808–1835

Avhandlingen handlar om hur E.G. Ehrström (1791–1835) under tidsperioden 1808–35 förhöll sig till finskt, svenskt och ryskt. Då Finland år 1809 förvandlades från svensk riksdel till ryskt storfurstendöme tvingades finländarna att i den nya situationen reflektera över hur man skulle definiera nation, språk och historia. Det fanns inget givet svar på vad Finlands invånare hade blivit genom den geopolitiska omvälvningen. E.G. Ehrström var en individ som i ovanligt många sammanhang var tvungen att brottas med de nationella frågorna. Som ung student deltog han i finska kriget år 1808 och år 1812 studerade han som stipendiat i Moskva. År 1815 blev han lektor i ryska vid akademin i Åbo och som romantiker betonade han samtidigt det finska språkets roll som Finlands enda nationalspråk. Åren 1826–35 var han slutligen kyrkoherde i den svenska församlingen i S:t Petersburg. I alla de olika rollerna och kontexterna måste han anpassa sina nationella ställningstaganden till den specifika situation och roll i vilken han verkade. Avhandlingens syfte är att dra slutsatser om de faktorer som gör att en individ i olika sammanhang betonar olika aspekter av det nationella. I det allmänna medvetandet uppfattas nationella identiteter ofta som stabila och enhetliga, medan den teoretiska litteraturen i dag lyfter fram att de i själva verket är föränderliga och flytande. Finland strax efter 1809 är intressant att studera ur detta perspektiv. Eftersom det var oklart vad Finland och dess invånare hade blivit, var man tvungen att skapa ett innehåll för den nya enheten. En analys av hur man resonerade i sammanhanget kan lära oss något hur nationella identiteter skapas och fungerar också i dag.

Vammaisuus ja epäreilu etu urheilussa

Oscar Pistorius on eteläafrikkalainen vammaisurheilija, jonka molemmat jalat on amputoitu polven alapuolelta. Hänen lajinaan on 400 metrin juoksu. Juoksemaan Pistorius kykenee hiilikuituproteeseilla, ja hän on kilpaillut sekä vammaisurheilijoita että terveitä urheilijoita vastaan. Pistoriuksen osallistumista tavalliseen urheiluun on kuitenkin vastustettu. On väitetty, että proteesit antavat epäreilua etua. Tarkastelen, mitä epäreilu etu tarkoittaa. Menetelmänä on filosofinen käsiteanalyysi. Tutkielma edustaa samalla kulttuurista terveys- ja hyvinvointitutkimusta. Arvioin aluksi, saako Pistorius etua. Käsittelen sen jälkeen erilaisia kriteerejä, joiden perusteella etua voitaisiin pitää epäreiluna. Näitä ovat epätasainen saatavuus, ansaitsemattomuus, epäluonnollisuus, sääntöjen rikkominen, sopimuksen rikkominen, paheellisuus, huijaaminen ja käytännön tarkoituksesta poikkeaminen. Pohdittuani epäreiluudelle esitettyjä kriteereitä kiinnitän huomioni epäreilun etuun laajemmassa yhteydessä. Tarkastelen, mitä seuraisi, jos Pistorius saisi epäreilua etua. Olisiko se riittävä peruste kieltää häntä kilpailemasta terveitä urheilijoita vastaan? Johtopäätökseni on, että epäreilun etuun liittyy Pistoriuksen tapauksessa monia ongelmia. Pelkästään sen perusteella Pistoriukselta ei tule kieltää kilpailemista.

A formação na graduação dos profissionais de saúde e a educação para o cuidado de pacientes fora de recursos terapêuticos de cura

Este estudo trata de algumas questões fundamentais relacionadas com a filosofia dos Cuidados Paliativos (CP) e propõe uma educação dos alunos de graduação por meio de cursos de CP com o objetivo de criar uma atitude humanitária nos futuros profissionais em relação àquele que está morrendo. A esperança está na intervenção sobre a formação dos profissionais da saúde, na reformulação curricular que contemple esta visão antropológica, para além da formação tecnocientífica necessária, e na implementação da filosofia de CP. Buscaram-se na literatura discussões sobre a formação destes profissionais e o cuidado do paciente fora de recursos de cura, porém não fora de recursos sintomáticos. A metodologia adotada combina revisão da literatura nacional e internacional com pesquisa empírica, por meio da aplicação de questionário a uma equipe multiprofissional, atuante em CP numa instituição de ensino. O estudo foi desenvolvido com abordagem qualitativa. Desvelou-se na área da saúde a necessidade de capacitar os profissionais de saúde a enfrentarem o cuidado destes pacientes por meio de uma educação continuada, fundamentada no conhecimento do processo de morte e morrer.

Kohti kielentutkimusta

Kirjallisuusarvostelu

A compreensão do residente médico em reumatologia no atendimento aos pacientes com fibromialgia

Este estudo busca a compreensão do residente médico em reumatologia no atendimento ao fibromiálgico. A síndrome é de difícil diagnóstico, e a dor é o fator mais importante. OBJETIVOS: Entender como o residente compreende o atendimento; desvendar o que este atendimento gera. MÉTODOS: Estudo qualitativo baseado na fenomenologia hermenêutica, com entrevista individual, gravada, sobre o tema da interrogação: "O que é isto para você: atender o fibromiálgico?". São feitas análises das significações dos residentes. O estudo foi realizado em três hospitais-escola públicos, com todos os residentes médicos do segundo ano. RESULTADOS: O atendimento causa frustração, traz sentimento de impotência e gera indignação; o paciente sofre preconceito devido a idiossincrasias, a componentes sociais e à não adesão ao tratamento; o médico necessita de preparo emocional para atender - são requisitos necessários: saber ouvir e compreender a relação paciente-doença; o diagnóstico é marcado pela falta de comprovação laboratorial e subjetividade da anamnese; o médico necessita do apoio da psicologia, e o tratamento requer uma equipe multidisciplinar. CONCLUSÃO: O atendimento é frustrante e gera sentimento de impotência, sendo preciso maior preparo psicológico na formação médica e uma atuação mais integrada entre medicina, psicologia e fisioterapia.

Experience with an internet-based course for ophthalmology residents

OBJECTIVE: To describe the first experience of an Internet-based course for ophthalmology residents. METHOD: Twenty-three residents were invited to participate in the study; however, only 13 (56.52%) took part, performing the proposed activities and answering a questionnaire. RESULTS: Of the 13 participants, only five (38.46%) completed 100% of the tasks, three (23.07%) completed between 70 and 90%, two (15.38%) completed between 50 and 60% and three (23.07%) completed less than 10% of the tasks. Regarding the use of computers and the Internet in general, all the participants reported using the Internet daily. All of them also affirmed they use the internet to study or to conduct research. CONCLUSION: Despite the advantages of the Internet, medical residents are still very reluctant to its use. Considering the context of information and communication technologies, there is a pressing need to reformulate continuing medical education in order to meet the demand of this new developing world.

Vascular Function in Chronic Kidney Disease and in Renovascular Disease

Cardiovascular mortality is 15 to 30 times higher in patients with chronic kidney disease than in the age-adjusted general population. Even minor renal dysfunction predicts cardiovascular events and death in the general population. In patients with atherosclerotic renovascular disease the annual cardiovascular event and death rate is even higher. The abnormalities in coronary and peripheral artery function in the different stages of chronic kidney disease and in renovascular disease are still poorly understood, nor have the cardiac effects of renal artery revascularization been well characterized, although considered to be beneficial. This study was conducted to characterize myocardial perfusion and peripheral endothelial function in patients with chronic kidney disease and in patients with atherosclerotic renovascular disease. Myocardial perfusion was measured with positron emission tomography (PET) and peripheral endothelial function with brachial artery flow-mediated dilatation. It has been suggested that the poor renal outcomes after the renal artery revascularization could be due to damage in the stenotic kidney parenchyma; especially the reduction in the microvascular density, changes mainly evident at the cortical level which controls almost 80% of the total renal blood flow. This study was also performed to measure the effect of renal artery stenosis revascularization on renal perfusion in patients with renovascular disease. In order to do that a PET-based method for quantification of renal perfusion was developed. The coronary flow reserve of patients with chronic kidney disease was similar to the coronary flow reserve of healthy controls. In renovascular disease the coronary flow reserve was, however, markedly reduced. Flow-mediated dilatation of brachial artery was decreased in patients with chronic kidney disease compared to healthy controls, and even more so in patients with renovascular disease. After renal artery stenosis revascularization, coronary vascular function and renal perfusion did not improve in patients with atherosclerotic renovascular disease, but in patients with bilateral renal artery stenosis, flow-mediated dilatation improved. Chronic kidney disease does not significantly affect coronary vascular function. On the contrary, coronary vascular function was severely deteriorated in patients with atherosclerotic renovascular disease, possibly because of diffuse coronary artery disease and/or diffuse microvascular disease. The peripheral endothelial function was disturbed in patients with chronic kidney disease and even more so in patient with atherosclerotic renovascular disease. Renal artery stenosis dilatation does not seem to offer any benefits over medical treatment in patients with renovascular disease, since revascularization does not improve coronary vascular function or renal perfusion.

Tuulivoiman vaikutus Suomen sähköjärjestelmän tehotasapainoon vuonna 2020

Tämän tutkimuksen aiheena oli tuulivoiman vaikutus Suomen sähköjärjestelmän tehotasapainoon vuonna 2020. Aihe on ajankohtainen, sillä yhtenä EU:n ilmasto- ja energiastrategian ilmasto- ja energiapoliittisiin linjauksiin ja velvollisuuksiin pohjautuvana tavoitteena on edistää uusiutuvaa energiaa jäsenmaissa. Suomessa yksi näistä toimenpiteistä on hallituksen suunnittelema syöttötariffijärjestelmä tuulivoimalle, joka rahoitetaan sähkön kuluttajilta kerättävällä maksulla. Tämän myötä monet toimijat alkoivat suunnitella tuulivoimahankkeita ympäri Suomea ja tammikuuhun 2011 mennessä hankkeita oli julkaistu yli 6000 megawatin edestä. Julkaistujen hankkeiden tietojen ja tuulitilastojen avulla laskettiin arvio tuulivoiman vuosituotoksi vuodelle 2020 sekä tarkasteltiin kuinka tuulivoiman lisäys vaikuttaa sähköjärjestelmän tehotasapainoon. Laskennan perusteella 2500 MW installoitua tuulivoimaa tuottaisi vuositasolla sähkötehoa 6,9 TWh, hallituksen arvion ollessa 2500 MW tuulivoimakapasiteetille 6 TWh vuodessa. Hallituksen arvio lisäsäädön tarpeesta 2500 MW tuulivoimaosuudelle on 250–400 MW ja suurin osa säädöstä toteutettaneen vesivoimalla. Tuulivoiman tuotantodiagrammien havainnollistama tuotannon tehon vaihtelu tukee käsitystä riittävän vara- ja tehonsäätökapasiteetin tarpeellisuudesta sekä tuulituotannon ennustamisen tärkeydestä koko sähköjärjestelmän kannalta.

Pharmacokinetics of Oxycodone and Paracetamol in the Elderly. Clinical Pharmacokinetic Study on Orthopaedic Surgical Patients and Healthy Volunteers

The proportion of elderly people over 65 years of age in Finland is expected to grow to over 25% by the 2025. It has been estimated that elderly people today consume nearly 40% of all drugs. Age brings about number of physiological changes that may affect the disposition, metabolism and excretion of drugs. The function of heart, lungs, liver and kidneys decreases even in healthy people, as they get older. The proportion of total body water decreases and the relative fat percentage increases. Also several other factors such as concurrent diseases, concomitant medication and nutritional factors have an effect on drug therapy in elderly. Age increases the risk of adverse drug reactions, which most often are dose-dependent. Despite all this there are not enough studies involving the elderly people and the elderly are most often excluded from clinical trials. Oxycodone is a strong opioid analgesic, which is used to treat moderate or severe pain. Paracetamol is a widely used nonopioid analgesic, which has become popular in the treatment of pain in many patient groups. In this series of studies the pharmacokinetics of oral and intravenous oxicodone as well as intravenous paracetamol in the elderly and young adult patients were investigated. Also a study investigating the interaction of oral antibiotic clarityhromycin, a known cytochrome P450 (CYP) 3A4 inhibitor, with oxycodone pharmacokinetics and pharmacodynamics in elderly and young healthy volunteers was carried out. The pharmacokinetics of oxycodone showed a clear age depency. Patients over 70 years had 50-80% higher mean exposure to oral oxycodone and a twofold greater plasma concentration than young adults 12 h after ingestion of the drug. Elderly patients had 40-80% greater exposure to intravenous oxycodone and patients over 80 years had over twofold greater plasma concentrations 8 h post dose than the young adults. The elderly patients had also greater exposure to intra venous paracetamol compared to young adults. Clarithromycin increased the exposure to oral oxycodone in both young and elderly volunteers. The elderly had marked interindividual variation in the pharmacokinetics and pharmacodynamics when clarithromycin was given concomitantly with oxycodone. Because the pharmacokinetics of oxycodone and intravenous paracetamol depend on the age of the subject, it is important to titrate the analgesic dose individually in the elderly.