Current Care Guidelines for Cardiopulmonary Resuscitation : Implementation, skills and attitudes

Background: The national resuscitation guidelines were published in Finland in 2002 and are based on international guidelines published in 2000. The main goal of the national guidelines, available on the Internet free of charge, is early defibrillation by nurses in an institutional setting. Aim: To study possible changes in cardiopulmonary resuscitation (CPR) practices, especially concerning early defibrillation, nurses and students attitudes of guideline implementation and nurses and students ability to implement the guideline recommendations in clinical practices after publication of the Current Care (CC) guidelines for CPR 2002. Material and methods: CPR practices in Finnish health centres; especially concerning rapid defibrillation programmes, as well as the implementation of CC guidelines for CPR was studied in a mail survey to chief physicians of every health centre in Finland (Study I). The CPR skills using an automated external defibrillator (AED) were compared in a study including Objective stuctured clinical examination (OSCE) of resuscitation skills of nurses and nursing students in Finnish and Swedish hospital and institution (Studies II, III). Attitudes towards CPR-D and CPR guidelines among medical and nursing students and secondary hospital nurses were studied in surveys (Studies IV, V). The nurses receiving different CPR training were compared in a randomized trial including OSCE of CPR skills of nurses in Finnish Hospital (Study VI). Results: Two years after the publication, 40.7% of Finnish health centres used national resuscitation guidelines. The proportion of health centres having at least one AED (66%) and principle of nurse-performed defibrillation without the presence of a physician (42%) had increased. The CPR-D training was estimated to be insufficient regarding basic life support and advanced life support in the majority of health centres (Study I). CPR-D skills of nurses and nursing students in two specific Swedish and Finnish hospitals and institutions (Study II and III) were generally inadequate. The nurses performed better than the students and the Swedish nurses surpassed the Finnish ones. Geriatric nurses receiving traditional CPR-D training performed better than those receiving an Internet-based course but both groups failed to defibrillate within 60 s. Thus, the performance was not satisfactory even two weeks after traditional training (Study VI). Unlike the medical students, the nursing students did not feel competent to perform procedures recommended in the cardiopulmonary resuscitation guidelines including the defibrillation. However, the majority of nursing students felt confident about their ability to perform basic life support. The perceived ability to defibrillate correlated significantly with a positive attitude towards nurse-performed defibrillation and negatively with fear of damaging the patient s heart by defibrillation (Study IV). After the educational intervention, the nurses found their level of CPR-D capability more sufficient than before and felt more confident about their ability to perform defibrillation themselves. A negative attitude toward defibrillation correlated with perceived negative organisational attitudes toward cardiopulmonary resuscitation guidelines. After CPR-D education in the hospital, the majority (64%) of nurses hesitated to perform defibrillation because of anxiety and 27 % hesitated because of fear of injuring the patient. Also a negative personal attitude towards guidelines increased markedly after education (Study V). Conclusions: Although a significant change had occurred in resuscitation practices in primary health care after publication of national cardiopulmonary resuscitation guidelines the participants CPR-D skills were not adequate according to the CPR guidelines. The current way of teaching is unlikely to result in participants being able to perform adequate and rapid CPR-D. More information and more frequent training are needed to diminish anxiety concerning defibrillation. Negative beliefs and attitudes toward defibrillation affect the nursing students and nurses attitudes toward cardiopulmonary resuscitation guidelines. CPR-D education increased the participants self-confidence concerning CPR-D skills but it did not reduce their anxiety. AEDs have replaced the manual defibrillators in most institutions, but in spite of the modern devices the anxiety still exists. Basic education does not provide nursing students with adequate CPR-D skills. Thus, frequent training in the workplace has vital importance. This multi-professional program supported by the administration might provide better CPR-D skills. Distance learning alone cannot substitute for traditional small-group learning, tutored hands-on training is needed to learn practical CPR-D skills. Standardized testing would probably help controlling the quality of learning. Training of group-working skills might improve CPR performance.

Maan magneettikentän dipolimallin toimivuus inklinaatiojakauman perusteella

The magnetic field of the Earth is 99 % of the internal origin and generated in the outer liquid core by the dynamo principle. In the 19th century, Carl Friedrich Gauss proved that the field can be described by a sum of spherical harmonic terms. Presently, this theory is the basis of e.g. IGRF models (International Geomagnetic Reference Field), which are the most accurate description available for the geomagnetic field. In average, dipole forms 3/4 and non-dipolar terms 1/4 of the instantaneous field, but the temporal mean of the field is assumed to be a pure geocentric axial dipolar field. The validity of this GAD (Geocentric Axial Dipole) hypothesis has been estimated by using several methods. In this work, the testing rests on the frequency dependence of inclination with respect to latitude. Each combination of dipole (GAD), quadrupole (G2) and octupole (G3) produces a distinct inclination distribution. These theoretical distributions have been compared with those calculated from empirical observations from different continents, and last, from the entire globe. Only data from Precambrian rocks (over 542 million years old) has been used in this work. The basic assumption is that during the long-term course of drifting continents, the globe is sampled adequately. There were 2823 observations altogether in the paleomagnetic database of the University of Helsinki. The effect of the quality of observations, as well as the age and rocktype, has been tested. For comparison between theoretical and empirical distributions, chi-square testing has been applied. In addition, spatiotemporal binning has effectively been used to remove the errors caused by multiple observations. The modelling from igneous rock data tells that the average magnetic field of the Earth is best described by a combination of a geocentric dipole and a very weak octupole (less than 10 % of GAD). Filtering and binning gave distributions a more GAD-like appearance, but deviation from GAD increased as a function of the age of rocks. The distribution calculated from so called keypoles, the most reliable determinations, behaves almost like GAD, having a zero quadrupole and an octupole 1 % of GAD. In no earlier study, past-400-Ma rocks have given a result so close to GAD, but low inclinations have been prominent especially in the sedimentary data. Despite these results, a greater deal of high-quality data and a proof of the long-term randomness of the Earth's continental motions are needed to make sure the dipole model holds true.

Tammen alueellisen levinneisyyden rajoitteet : Tapaustutkimus Länsi-Turunmaalla

Elinympäristön vaikutusta eliölajien esiintymiseen voidaan tutkia habitaattimallinnuksen keinoin. Havainnot lajin esiintymisestä ja puuttumisesta eri kohdissa maisemaa suhteutetaan tilastollisen mallin avulla ympäristötekijöihin, jolloin saadaan kuva lajin elinympäristövaatimuksista. Tällöin oletetaan, että laji esiintyy kaikkialla siellä, missä sen elinympäristövaatimukset täyttyvät. Metapopulaatioteorian valossa näin ei kuitenkaan aina ole: maisemassa voi olla runsaasti lajille soveltuvia mutta asuttamattomia kasvupaikkoja, koska uusien yksilöiden leviäminen ja vanhojen häviäminen eivät välttämättä ole yksittäisten kasvupaikkojen tasolla tasapainossa. Siten myös lajin leviämiskyky vaikuttaa siihen, millaiseksi sen levinneisyyskuvio maisematasolla muodostuu. Tässä työssä keskityn tammen (Quercus robur) alueellisen levinneisyyden mallintamiseen. Tammen suhteellinen harvinaisuus Suomessa sekä sen rooli luonnon monimuotoisuuden merkittävänä tukipilarina tekevät siitä mielenkiintoisen kohdelajin ekologiselle tutkimukselle. Tutkimuskohteekseni valitsin Wattkastin saaren, n. 5 km2:n alueen Länsi-Turunmaalta. Wattkastissa on tutkittu kahdeksan vuoden ajan tammella elävien hyönteisyhteisöjen rakennetta ja kannanvaihteluita, ja saaressa kasvaa yli 1800 luonnonvaraista tammea, joiden tarkat sijainnit tiedetään. Tässä ympäristössä tutkin, rajoittaako tammen alueellista levinneisyyttä ensisijaisesti sopivien elinympäristöjen tilajakauma vai pikemminkin sen leviämiskyky. Yhdistin tammen esiintymiskuviota kuvaavaan habitaattimalliin kokeellisen aineiston, jonka avulla arvioin tammen paikallisen esiintymiskuvion ja tammelle soveltuvien elinympäristöjen tilajakauman vastaavuutta. Kokeellisen aineiston muodostivat 104 Wattkastiin vuonna 2004 istutettua pikkutammea, joiden selviytymisen ja kasvupaikkaolot kartoitin syksyllä 2009. Tutkin yleistetyillä lineaarisilla malleilla puiden menestymiseen siis selviytymiseen ja kuntoon vaikuttavia tekijöitä. Etsin potentiaalisia selittäjiä tammen menestymiselle kasvupaikan ympäristötekijöistä sekä istutetun puun sijainnista suhteessa luontaisiin tammikasvustoihin. Lisäksi tutkin habitaattimallin avulla, selittävätkö ympäristötekijät tammen nykyisen esiintymiskuvion Wattkastissa. Havaitsin, että istutetut puut olivat selviytyneet keskimäärin hyvin ja ettei niiden menestyminen riippunut sijainnista suhteessa luontaisiin tammikasvustoihin. Habitaattimallin selitysaste oli vain 19 %, eli kasvupaikkatekijät selittivät heikosti tammen nykyisen esiintymiskuvion Wattkastissa. Tulosten perusteella tammen paikallinen esiintymiskuvio ei vastaa sille soveltuvien elinympäristöjen jakaumaa maisemassa, joten tammen levinneisyyttä Wattkastissa rajoittaa ilmeisesti sen leviämiskyky. Tulokseni viittaavat siihen, ettei tammen elinympäristön laadussa ole suuria vaihteluita Wattkastin sisällä, koska sopivia kasvupaikkoja on tarjolla tammen nykyesiintymiseen nähden runsaasti. Tämä on tammihyönteistutkimusten kannalta kiinnostava tulos, koska se tarkoittaa, että aiemmat havainnot isäntäpuun sijainnin ja hyönteisten kannanvaihteluiden välisestä yhteydestä edustavat todellisia, tilaan sidottuja populaatioprosesseja eivätkä isäntäpuun välittämiä eroja elinympäristön laadussa. Lisäksi tutkimukseni osoittaa, että yhdistämällä habitaattimallinnukseen kokeellinen lähestymistapa saadaan realistisempi kuva lajin levinneisyyttä rajoittavista tekijöistä kuin tutkimalla pelkästään ympäristötekijöiden vaikutusta lajin esiintymiseen. Jos lajin rajoittunut leviämiskyky on vaikuttanut sen esiintymiskuvion syntyyn, pelkästään ympäristötekijöihin perustuva levinneisyysmalli liioittelee levinneisyyttä. Kokeellisen tutkimuksen avulla on tällaisessa tapauksessa mahdollista paljastaa myös leviämiskyvyn rooli esiintymiskuvion taustalla.

Mass spectrometry and n-in-one analytics in early drug discovery: Combinatorial chemistry libraries, lipophilicity and absorption screening

This thesis describes current and past n-in-one methods and presents three early experimental studies using mass spectrometry and the triple quadrupole instrument on the application of n-in-one in drug discovery. N-in-one strategy pools and mix samples in drug discovery prior to measurement or analysis. This allows the most promising compounds to be rapidly identified and then analysed. Nowadays properties of drugs are characterised earlier and in parallel with pharmacological efficacy. Studies presented here use in vitro methods as caco-2 cells and immobilized artificial membrane chromatography for drug absorption and lipophilicity measurements. The high sensitivity and selectivity of liquid chromatography mass spectrometry are especially important for new analytical methods using n-in-one. In the first study, the fragmentation patterns of ten nitrophenoxy benzoate compounds, serial homology, were characterised and the presence of the compounds was determined in a combinatorial library. The influence of one or two nitro substituents and the alkyl chain length of methyl to pentyl on collision-induced fragmentation was studied, and interesting structurefragmentation relationships were detected. Two nitro group compounds increased fragmentation compared to one nitro group, whereas less fragmentation was noted in molecules with a longer alkyl chain. The most abundant product ions were nitrophenoxy ions, which were also tested in the precursor ion screening of the combinatorial library. In the second study, the immobilized artificial membrane chromatographic method was transferred from ultraviolet detection to mass spectrometric analysis and a new method was developed. Mass spectra were scanned and the chromatographic retention of compounds was analysed using extract ion chromatograms. When changing detectors and buffers and including n-in-one in the method, the results showed good correlation. Finally, the results demonstrated that mass spectrometric detection with gradient elution can provide a rapid and convenient n-in-one method for ranking the lipophilic properties of several structurally diverse compounds simultaneously. In the final study, a new method was developed for caco-2 samples. Compounds were separated by liquid chromatography and quantified by selected reaction monitoring using mass spectrometry. This method was used for caco-2 samples, where absorption of ten chemically and physiologically different compounds was screened using both single and nin- one approaches. These three studies used mass spectrometry for compound identification, method transfer and quantitation in the area of mixture analysis. Different mass spectrometric scanning modes for the triple quadrupole instrument were used in each method. Early drug discovery with n-in-one is area where mass spectrometric analysis, its possibilities and proper use, is especially important.

Muuttoliike ja vetovoimatekijät Helsingissä : - Kyselyaineiston analyysi

This thesis explores migration and the attractiveness of urban living in the Greater Helsinki region. The aim of the thesis is to explore the attractiveness of the city of Helsinki in terms of regional migration and to identify what characterizes migration to Helsinki. The study focuses in particular on housing, which is a key factor influencing migration decisions in the region. Other central themes in the study are housing policy and regional competition among municipalities. This study focuses solely on households moving within Finnish borders excluding international migration. Migration is examined by comparing in- and out-migration in Helsinki, as well as studying migration to the city s inner and outer areas. The primary research material in the study is a questionnaire data collected by the National Consumer Research Centre. In this thesis the data is used for studying migrants aged 25 45. The main research method is analyzing the data statistically using the SPSS software. Methods include frequency analysis, cross tabulation, factor analysis and descriptive analysis. Additionally, statistical data is used to complement the questionnaire data. The research results indicate that Helsinki s in- and out-migration differs both in terms of the type of households that migrate as well as in the reasons why they migrate. Furthermore, differences can also be detected between migration to the inner and outer parts of Helsinki. According to the research results, a household s current phase of life is crucial in determining where and why they move within the Greater Helsinki region. A household s set of values on the other hand, seems to have a lesser impact on migration within the region, even though households moving to Helsinki seem to value a somewhat more urban lifestyle than the ones moving out of the city. The research also shows a direct correlation between the values of migrants and their current phase of life. Decisions of migrating are heavily influenced by wider societal issues. In the Greater Helsinki region the labor and housing market appear to have a great influence on the direction of migration streams. According to the results, households move to and from Helsinki for different reasons. The primary reasons for moving to Helsinki are related to the city s diverse labor market and to the working careers of households. Issues related to urban living and an urban lifestyle seem to be relevant although not the main reason why people move to Helsinki. The research material indicates that Helsinki s urban environment is both a pull and a push factor affecting the decisions of migrants. The city attracts those seeking urban living, but on the contrary does not appeal to households seeking more space and wishing to live closer to nature. According to the research, Helsinki with its densely built urban environment mainly attracts singles and childless couples, whereas the city region s other municipalities are more attractive for families with children. Housing policy is one of the main reasons determining where people move within the Helsinki region. As for the city of Helsinki, improving the city s attractiveness seems to be closely linked to how well the city manages to execute its future housing policies and how well alternative living preferences can be taken into account in planning.

Infliximabi-infuusioiden akuuttien haittavaikutusten esto asetyylisalisyylihapolla lapsipotilaiden IBD- ja reumasairauksien hoidossa

IBD- ja reumasairaudet ovat elämänlaatua merkittävästi heikentäviä, kroonisia tulehduksellisia sairauksia, joiden keskivaikeiden ja vakavien muotojen hoidossa suoneen annettava biologinen TNF-alfa -tulehdustekijän vasta-aine infliksimabi (Remicade®) on vankassa asemassa. Infliksimabin hyvän tehon kääntöpuolena esiintyy yleisesti haittoja, joista infuusion aikana tai pian sen jälkeen ilmenevät allergistyyppiset reaktiot ovat hoitoa hankaloittava ja jopa vaarallinen alaluokka. Infuusioreaktioiden estoon ei nykyisellään ole todistettavasti tehokkaita keinoja. Parasetamoli ja setiritsiini osoittautuivat tässä käyttötarkoituksessa tehottomiksi. HUS:n Lasten ja nuorten sairaalassa aloitettiin 11.3.2009 hoitokokeilu asetosalisyylihapolla (ASA, Disperin®), annosteltuna painonmukaisesti per os, päämääränä selvittää prospektiivisesti ASA:n käyttömahdollisuudet infuusioreaktioiden ehkäisyssä. Tämän tutkielman aineisto kerättiin esilääkekokeilun alun ja 24.6.2010 välisellä ajalla (yhteensä 67 viikkoa) infliksimabi-infuusiossa Lasten ja nuorten sairaalan osasto 2:lla käyneiden IBD- ja reumapotilaiden asiakirjoista. Vain 1 (0,2 %) ASA:n kanssa annetuista infuusioista johti infuusioreaktioon kun aiemmin parasetamolin ja setiritsiinin kanssa todettiin 11 (2,9 %) reaktiota. GraphPad Prism 5 -ohjelmistolla tehdyn tilastoanalyysin perusteella tulokset osoittavat ASA:n olevan erittäin lupaava infuusioreaktioiden estolääke.

Canopy processes, fluxes and microclimate in a pine forest

Interaction between forests and the atmosphere occurs by radiative and turbulent transport. The fluxes of energy and mass between surface and the atmosphere directly influence the properties of the lower atmosphere and in longer time scales the global climate. Boreal forest ecosystems are central in the global climate system, and its responses to human activities, because they are significant sources and sinks of greenhouse gases and of aerosol particles. The aim of the present work was to improve our understanding on the existing interplay between biologically active canopy, microenvironment and turbulent flow and quantify. In specific, the aim was to quantify the contribution of different canopy layers to whole forest fluxes. For this purpose, long-term micrometeorological and ecological measurements made in a Scots pine (Pinus sylvestris) forest at SMEAR II research station in Southern Finland were used. The properties of turbulent flow are strongly modified by the interaction between the canopy elements: momentum is efficiently absorbed in the upper layers of the canopy, mean wind speed and turbulence intensities decrease rapidly towards the forest floor and power spectra is modulated by spectral short-cut . In the relative open forest, diabatic stability above the canopy explained much of the changes in velocity statistics within the canopy except in strongly stable stratification. Large eddies, ranging from tens to hundred meters in size, were responsible for the major fraction of turbulent transport between a forest and the atmosphere. Because of this, the eddy-covariance (EC) method proved to be successful for measuring energy and mass exchange inside a forest canopy with exception of strongly stable conditions. Vertical variations of within canopy microclimate, light attenuation in particular, affect strongly the assimilation and transpiration rates. According to model simulations, assimilation rate decreases with height more rapidly than stomatal conductance (gs) and transpiration and, consequently, the vertical source-sink distributions for carbon dioxide (CO2) and water vapor (H2O) diverge. Upscaling from a shoot scale to canopy scale was found to be sensitive to chosen stomatal control description. The upscaled canopy level CO2 fluxes can vary as much as 15 % and H2O fluxes 30 % even if the gs models are calibrated against same leaf-level dataset. A pine forest has distinct overstory and understory layers, which both contribute significantly to canopy scale fluxes. The forest floor vegetation and soil accounted between 18 and 25 % of evapotranspiration and between 10 and 20 % of sensible heat exchange. Forest floor was also an important deposition surface for aerosol particles; between 10 and 35 % of dry deposition of particles within size range 10 30 nm occurred there. Because of the northern latitudes, seasonal cycle of climatic factors strongly influence the surface fluxes. Besides the seasonal constraints, partitioning of available energy to sensible and latent heat depends, through stomatal control, on the physiological state of the vegetation. In spring, available energy is consumed mainly as sensible heat and latent heat flux peaked about two months later, in July August. On the other hand, annual evapotranspiration remains rather stable over range of environmental conditions and thus any increase of accumulated radiation affects primarily the sensible heat exchange. Finally, autumn temperature had strong effect on ecosystem respiration but its influence on photosynthetic CO2 uptake was restricted by low radiation levels. Therefore, the projected autumn warming in the coming decades will presumably reduce the positive effects of earlier spring recovery in terms of carbon uptake potential of boreal forests.

Maankäytön konfliktit ja niiden ratkaisumahdollisuudet

Katsaus on osa ympäristöministeriön rahoittamaa tutkimusta Maankäytön konfliktit ja niiden ratkaisumahdollisuudet kaavoituksessa, jonka tavoitteena on selvittää suomalaisten maankäytön konfliktien piirteitä ja ratkaisumahdollisuuksia maankäytön suunnittelussa. Katsauksessa esitellään konflikteihin ja niiden ratkaisuun ja hallintaan liittyvää tutkimusta. Tavoitteena on löytää maankäytön konflikteja jäsentäviä määritelmiä ja näkökulmia, joiden pohjalta voidaan lähestyvä käytännöllisiä konfliktinratkaisun ongelmia. Omissa luvuissaan käsitellään maankäytön konfliktien erityispiirteitä ja konfliktien ratkaisun ja hallinnan malleja. Konfliktien ratkaisu ja hallinta on ajankohtainen aihe. Maankäyttö- ja rakennuslain pyrkimys vuorovaikutuksen lisäämiseen korostaa paikallisten toimijoiden valmiuksia ja keskinäisten suhteiden merkitystä kaavoituksessa. Vuorovaikutus voi kuitenkin merkitä paitsi yhteistyön helpottumista myös jännitteiden ja ristiriitojen puhkeamista konflikteiksi. Tästä syystä erilaisia konfliktien ratkaisun ja hallinnan keinoja tarvitaan maankäytön suunnittelussa entistä kipeämmin.

Leuconostoc spoilage of refrigerated, packaged foods

Leuconostoc spp. are lactic acid bacteria (LAB) implicated in food spoilage, especially on refrigerated, modified atmosphere packaged (MAP) meats. The overall aim of this thesis was to learn more about Leuconostoc spp. as food spoilage organisms with a focus on commercial products where LAB spoilage is considered a problem and the main factor limiting shelf-life. Therefore, we aimed to identify Leuconostoc spp. involved in food spoilage, as well as to characterise the spoilage reactions they caused and their contamination sources during poultry meat processing. In addition, we examined the distribution of strains of Leuconostoc gasicomitatum in different food commodities. Finally, we analysed the genome content of L. gasicomitatum LMG 18811 with a special focus on metabolic pathways related to food spoilage. The findings show that Leuconostoc gelidum and L.gasicomitatum were responsible for the discoloration and off-odours developed in beef steaks. Together with Leuconostoc mesenteroides, these Leuconostoc spp., also cause spoilage of vegetable sausages. In contrast, we showed that Leuconostoc spp. are not important for the shelf-life or quality of non-marinated broiler products although, in marinated broiler fillet products, Leuconostoc spp., L.gasicomitatum in particular, are considered spoilage organisms. Furthermore, the findings of the contamination survey we carried out in a poultry processing plant indicated that spoilage Leuconostoc spp. are derived from the processing environment rather than from the broilers, and that air movement distributes psychrotrophic spoilage LAB, including leuconostocs, and has an important role in meat contamination during poultry processing. Pulsed-field gel electrophoresis (PFGE) based genotyping of L. gasicomitatum strains demonstrated that certain genotypes are common in various meat products. In contrast, genotypes associated with meat were not recovered in vegetable-based sources. This suggests that these two food categories either become contaminated with, or favour the growth of different genotypes. Furthermore, the results indicated that the meat processing environment contributes to L. gasicomitatum contamination as certain genotypes were repeatedly identified from products of the same processing plant. Finally, the sequenced and annotated genome of L.gasicomitatum LMG 18811 allowed us to identify the metabolic pathways and reactions resulting in food spoilage.

Sense of Coherence : Determinants and consequences

ABSTRACT Sense of coherence (SOC) is a core concept within Antonovsky s salutogenic theory and is argued to be a psychological determinant of health. The present social-epidemiological study explores the associations between a wide range of generalized resistance resources of SOC among Finnish- and Swedish-speaking women and men with a view to gaining deeper insight into its developmental circumstances and determinants. Secondly, a five-year follow-up study was conducted in order to assess the stability of SOC in difficult life events. Finally the role and effect of SOC in the intentions to retire early was investigated in a prospective study. The above studies were based on two data sets: the Finnish 'Survey on Living Conditions' (ELO-94) conducted in 1994 by means of personal face-to-face interviews (N=6506), and a prospective postal survey of the 15-year Health and Social Support (HeSSup) study for which the baseline data was collected in 1998 (N=25 898) and the follow-up in 2003. The present study reveals that the level of SOC in adulthood is strongly dependent on close and successful social relationships during both childhood and adulthood, and that there is a strong association with qualitative work features. Not having a partner as well as being unable to use one s skills at work proved to threaten men s SOC in particular, whereas a lack of social support did the same for women. Otherwise, the association with generalized resistance resources turned out to be quite similar in both genders. Swedish-speaking Finns appear to have a slightly stronger SOC due to the better psycho-emotional circumstances in the childhood home and work circumstances in adulthood, in other words higher levels of generalized resistance resources compared to Finnish speakers. These language group differences did not concern any social-life factors included in the present study. The results of the five-year follow-up study suggest that SOC is not stable, and that the level clearly decreases after a negative life event. Even a strong SOC decreased during the follow-up period and, furthermore, was no more stable than a mediocre or weak SOC. There seems to be a clear and independent association with the intentions to retire early among both men and women following full adjustment. Swedish speakers appear to be less inclined to retire early than Finnish speakers. In the light of the present study, it seems that SOC is determined not only by socio-economic factors but also by close and successful social relationships during both childhood and adulthood. This applied to both genders and language groups. Interventions aimed at promoting the health of the disadvantaged should therefore focus on families with children, and extend later also to other than socio-economic spheres of life. SOC theory could also be applied in efforts to inhibit early retirement: management practices aimed at providing employees with a work environment and tasks that are comprehensible, manageable and meaningful could potentially decrease the intentions to retire early.

Identifying Genetic Risk Factors in Canine Autoimmune Disorders

Autoimmune diseases are more common in dogs than in humans and are already threatening the future of some highly predisposed dog breeds. Susceptibility to autoimmune diseases is controlled by environmental and genetic factors, especially the major histocompatibility complex (MHC) gene region. Dogs show a similar physiology, disease presentation and clinical response as humans, making them an excellent disease model for autoimmune diseases common to both species. The genetic background of canine autoimmune disorders is largely unknown, but recent annotation of the dog genome and subsequent development of new genomic tools offer a unique opportunity to map novel autoimmune genes in various breeds. Many autoimmune disorders show breed-specific enrichment, supporting a strong genetic background. Furthermore, the presence of hundreds of breeds as genetic isolates facilitates gene mapping in complex autoimmune disorders. Identification of novel predisposing genes establishes breeds as models and may reveal novel candidate genes for the corresponding human disorders. Genetic studies will eventually shed light on common biological functions and interactions between genes and the environment. This study aimed to identify genetic risk factors in various autoimmune disorders, including systemic lupus erythematosus (SLE)-related diseases, comprising immune-mediated rheumatic disease (IMRD) and steroid-responsive meningitis arteritis (SMRA) as well as Addison s disease (AD) in Nova Scotia Duck Tolling Retrievers (NSDTRs) and chronic superficial keratitis (CSK) in German Shepherd dogs (GSDs). We used two different approaches to identify genetic risk factors. Firstly, a candidate gene approach was applied to test the potential association of MHC class II, also known as a dog leukocyte antigen (DLA) in canine species. Secondly, a genome-wide association study (GWAS) was performed to identify novel risk loci for SLE-related disease and AD in NSDTRs. We identified DLA risk haplotypes for an IMRD subphenotype of SLE-related disease, AD and CSK, but not in SMRA, and show that the MHC class II gene region is a major genetic risk factor in canine autoimmune diseases. An elevated risk was found for IMRD in dogs that carried the DLA-DRB1*00601/DQA1*005011/DQB1*02001 haplotype (OR = 2.0, 99% CI = 1.03-3.95, p = 0.01) and for ANA-positive IMRD dogs (OR = 2.3, 99% CI = 1.07-5.04, p-value 0.007). We also found that DLA-DRB1*01502/DQA*00601/DQB1*02301 haplotype was significantly associated with AD in NSDTRs (OR = 2.1, CI = 1.0-4.4, P = 0.044) and the DLA-DRB1*01501/DQA1*00601/DQB1*00301 haplotype with the CSK in GSDs (OR=2.67, CI=1.17-6.44, p= 0.02). In addition, we found that homozygosity for the risk haplotype increases the risk for each disease phenotype and that an overall homozygosity for the DLA region predisposes to CSK and AD. Our results have enabled the development of genetic tests to improve breeding practices by avoiding the production of puppies homozygous for risk haplotypes. We also performed the first successful GWAS for a complex disease in dogs. With less than 100 cases and 100 controls, we identified five risk loci for SLE-related disease and AD and found strong candidate genes involved in a novel T-cell activation pathway. We show that an inbred dog population has fewer risk factors, but each of them has a stronger genetic risk. Ongoing studies aim to identify the causative mutations and bring new knowledge to help diagnostics, treatment and understanding of the aetiology of SLE-related diseases.

Kuviteltu aatelismies : Aateluus viholliskuvana ja itseymmärryksenä 1800-luvun Suomessa

An imagined nobleman Nobility as an enemy image and in-group identity in nineteenth-century Finland The focal point of this study is the difficult relationship between two seemingly very different 19th-century elite groups, the upwardly mobile bourgeois intelligentsia and the slowly declining traditional nobility. In the thinking of the bourgeois contender the two emerged as exact opposites, styled as conflicting ideal types: an outdated, exclusive, degenerate hereditary aristocracy versus a dynamic and progressive new force in society, recruited solely on the basis of personal merit, originating from the common people and representing the nation. The appearance of an important 19th-century novelty, print publicity, coincided with the emergence of the bourgeois intelligentsia. The institutions of the developing publishing industry were manned by the aspiring new group. The strengthening flow of progressive, democratic, nationalist ideas distributed via the printing presses carried an undercurrent of self-promotion. It transmitted to the developing readership the self-image of the new cultural bourgeoisie as the defender and benevolent educator of the nation. Having won the contest over the media, the intelligentsia was free to present its predecessor and rival as an enemy of the people. In its politics the nobility emerged as an ideal scapegoat, represented as the source for existing social evils, all if which would promptly go away after its disappearance. It also served as a black backcloth, against which the democratic, national, progressive bourgeois intelligentsia would shine more brightly. In order to shed light on the 19th-century process of (re)modelling the image of nobility as a public enemy I have used four different types of source materials. These include three genres of print publicity, ranging from popular historical and contemporary fiction to nonfictional presentations of national history and the news and political commentaries of the daily papers, complemented by another, originally oral type of publicity, the discussion protocols of the Finnish four-estate parliament. To counterpoint these I also analysed the public self-image of the nobility, particularly vis-à-vis the nationalist and democratic ethos of the modernising politics.

Aspiraatiobiopsianäytteen herkkyys kohdunrungonsyövän diagnostiikassa

Tutkimukseni tarkoituksena oli tutkia aspiraatiobiopsianäytteen herkkyyttä kohdunrungonsyövän diagnostiikassa suomalaisessa potilasaineistossa. Tutkimusaineistoni koostui potilaista, joilla on todettu kohdunrungonsyöpä hysterektomiassa 5.4.2006- 16.12.2008 välisenä aikana ja otettu aspiraatiobiopsianäyte vuoden sisällä ennen kohdunpoistoa. Potilastiedot hain Patologian laitoksen Q-Pati tietokannasta. Biopsian diagnoosin perusteella jaoin potilasaineiston kolmeen ryhmään: karsinooma, kompleksi atyyppinen hyperplasia ja karsinooman suhteen negatiivinen vastaus. Näissä ryhmissä tarkastelin edelleen, oliko biopsianäyte johtanut leikkaushoitoon tai jatkotutkimuksiin. Tutkimukseni mukaan biopsianäytteiden vastauksena oli 61% tapauksista karsinooma. Suoraan hysterektomiaan biopsianäytteen perusteella johtaneita tapauksia oli 82%, eli tapaukset joiden PAD-vastauksena oli karsinooma sekä kompleksit atyyppiset hyperplasiatapaukset, joissa epäiltiin karsinoomaa. Lopullinen herkkyys oli kuitenkin 97% sillä perusteella, että näissä tapauksissa biopsian vastaus johti hysterektomiaan joko suoraan tai jatkotutkimusten jälkeen kohtuullisen ajan (2kk) sisällä. Tutkimukseni mukaan aspiraatiobiopsia on luotettava testi epäiltäessä kohdunrungonsyöpää. Tulosten perusteella jatkotutkimukset ovat tarpeen, mikäli biopsian vastauksena on niukka näyte tai pyometra.

Vanhustenhoitajan ammatillinen rooli – avain vanhusten hyvinvointiin ja hoitajien työssä jaksamiseen

Suomessa väestön rakenne on muuttumassa ja hoitoa tarvitsevien määrä nousee jatkuvasti. Vanhustenhoito on muuttunut henkisesti ja fyysisesti yhä kuormittavammaksi ja vanhustenhoidon imago huonoksi. Tavoitteita asetetaan, mutta resurssit näiden saavuttamiseen ovat tiukassa. Tutkimuksen keskiössä olivat vanhustenhoitajien kokemukset ammatillisesta roolista. Tutkimuksen teoreettisina tukipilareina toimivat rooliteoria sekä näkemykset tunnetyöstä ja totaalisista laitoksista. Menetelmänä toimi IPA:a, jonka avulla voidaan päästä käsiksi siihen, miten tutkittavat jäsentävät maailmaansa − tässä tapauksessa ammatillista rooliaan vanhustyöntekijöinä. Tutkimuksen aineistona toimivat 8 haastattelua, jotka on kerätty vuonna 2009. Aineistosta nousi päällimmäisenä esiin hoitajan ja asukkaan välinen vuorovaikutus ja se, kuinka hoitajan on oltava ammatillisessa roolissa. Tätä vuorovaikutussuhdetta kuvattiin kaikissa kahdeksassa haastattelussa ja sitä pidettiin ammattitaidon oleellisimpana osana. Ensimmäisellä tutkimuskysymyksellä selvitettiin millaisia rooliodotuksia vanhustenhoitajat asettavat toiminnalleen. Oleellisimmat odotukset rakentuivat sen ympärille, miten vanhuksen kanssa ollaan vuorovaikutuksessa. Tilanteissa hoitajan tulisi osata oikeanlaiset tiukat, mutta toisaalta lempeät otteet, jotta vanhukset eivät passivoituisi. Nämä otteet nähtiin vanhuksen edun mukaisina, sillä ilman jämäkkää hoito-otetta vanhukset saattoivat heittäytyä täysihoitoon ja lakata pitämästä yllä päivittäisiä toimintojaan, kuten hampaiden pesua. Toinen tutkimuskysymys paneutui siihen, kokevatko vanhustenhoitajat roolinmukaisuuden tärkeäksi työssään. Lisäksi perehdyttiin siihen, miksi roolinmukaisuus koetaan tärkeänä. Haastatellut vanhustenhoitajat toivat esiin, että työstä on suoriuduttava tietyllä tavalla. Omista murheista tai mieltymyksistä huolimatta työt piti saada tehtyä. Työhön oltiin tultu vanhuksen edun vuoksi ja se oli pidettävä mielessä koko ajan. Kun hoitajat onnistuivat toimimaan rooliodotusten mukaisesti, säilyi tunnelma osastolla rauhallisena ja lääkkeitä kului vähemmän. Kolmas tutkimuskysymys pureutui siihen, voiko vanhustenhoitaja vapautua ammatillisesta roolistaan työpäivän aikana. Hoitajat kokivat, että roolista vapautuminen oli mahdollista työpäivän aikana, mutta sille annettiin tiukat rajat. Vanhusten nähden hoitajan tuli pysytellä tiukasti roolinmukaisessa odotettavassa käytöksessä. Vanhustenhoitajilla oli selkeästi erilaiset käyttäytymissäännöt niihin tilanteisiin kun oltiin osastolla potilaiden näkyvillä kuin niihin tilanteisiin joissa oltiin yksin tai kollegoiden kanssa. Tässä voidaan nähdä selkeä yhteys Goffmanin rooliteoriaan, jossa hän tuo esiin, että esityksissä on näyttämö ja takatila. Vanhainkodin tapauksessa näyttämö on osasto, jossa vanhukset ja omaiset seuraavat hoitajien toimintaa. Takatiloina sen sijaan toimivat hoitajien omat työhuoneet, taukotilat ja henkilökunnan wc, jossa työnaamio voitiin riisua hetkellisesti pois. Tärkeimmät lähteet ovat: Goffman, E. (1971). Arkielämän roolit. Oikeille jäljille rooliviidakossa ja Smith, J., Flowers, P., Larkin, M. (2009). Interpretative Phenomenological Analysis. Theory, method and research.

Avoimesti sitoutuneena : Lähetystyö kristillisessä kasvatuksessa ja vapaaehtoistyössä

In this study the junction of Christian mission, Christian education and voluntary work are examined in the Christian student voluntary association Opiskelijain Lähetysliitto (OL), which is the Finnish successor to the Student Volunteer Movement. The main subjects are the structure and content of the mission education as one aspect of Lutheran education and the reasons for expressing the mission interest through voluntary work. The research questions are as follows: What kind of organization has the OL been? What has mission education been like in the OL? Why have the former chairpersons participated in the OL? How have purposiveness and intentionality arisen among the former chairpersons? The study is empirical despite having a historical and retrospective view, since the OL is explored during the period 1972 2000. The data consists of the OL s annual reports, membership applications (N=629) and interviews of all 25 former chairmen. Data is analysed by qualitative and quantitative content analysis in a partly inductive and partly deductive manner. The pedagogical framework arises from situational learning theory (Lave - Wenger 1991), which was complemented with the criteria for meaningful learning (Jonassen 1995), the octagon model of volunteer motivation (Yeung 2004) and the definitions of intentionality and purposiveness in the theory of teachers pedagogical thinking (Kansanen et al. 2000). The analysis of the archive data showed that the activities of the OL are reminiscent of those of the missions of the Finnish Evangelical Lutheran Church congregations. The biggest difference was that all OL participants were young adults, the age group that is the greatest challenge to the Church. The OL is therefore an interesting context in which to explore mission education and mission interest. The key result of the study was the forming of a model of mission educa-tion. The model has three educational components: values, goals and methods. The gist of the model is formed by the goals. The main goal is the arousing and strengthening of mission interest which has emotional, cognitive and practical aspects. The subgoals create the horizontal vertical and inward outward dimensions of the model, which are the metalevels of mission education. The subgoals reveal that societal and religious education may embody a missionary dimension when they are understood as missionary training. Further, a distinction between mission education and missionary training was observed. The former emphasizes the main goal of the model and the latter underlines the subgoals. Based on the vertical dimension of the model the study suggests that the definition of religious competence needs to be complemented with missional competence. Reasons for participating in the OL were found to be diverse as noted in other studies on volunteering and motivating factors, and were typical to young people such as the importance of social relations. The study created new motivational themes that occurred in the middle of the continuity newness and the distance proximity dimensions, which were not found in Yeung s research. Mission interest as voluntary work appeared as oriented towards one s own spirituality or towards the social community. On the other hand, mission interest was manifested as intentional education in order to either improve the community or to promote the Christian mission. In the latter case the mission was seen as a purpose in life and as a future profession. Keywords: mission, Christian education, voluntary work, mission education, mission interest, stu-dent movement