Työn fyysinen ja psyykkinen kuormittavuus vanhustenhoidossa - seurantatutkimus ergonomisen kehittämistyön tuloksista

Tutkimuksen tarkoituksena oli analysoida vanhusten ympärivuorokautisen hoidon yksiköissä työskentelevien työntekijöiden työn fyysistä ja psyykkistä kuormittavuutta ja työhön liittyviä fyysisiä riskejä. Lisäksi haluttiin selvittää, millaisia vaikutuksia fyysisen kuormittavuuden vähentämistä tavoitelleella ergonomisella kehittämisinterventiolla saadaan aikaan. Tutkimuksessa hyödynnettiin Turun kaupungin vanhuspalveluissa vuosina 2010–2012 toteutuneessa ergonomisessa kehittämisinterventiossa (47 työyksikköä) kertynyttä ja vuosien 2010 ja 2012 Kunta10-kyselyn (120 työyksikköä) tuottamaa tietoa. Intervention ydin oli Työterveyslaitoksen Fyysisten riskien hallintamalli hoitoalalla -mallin käyttööotto. Käytetyt mittarit olivat seuraavat: Työn kuormitus- ja työtyytyväisyyskysely työntekijöille, asiakkaiden toimintakykyä mittaava RAVATM -indeksi, fyysistä kuormitusta ja työn riskejä mittava Care ThermometerTM-menetelmä, potilassiirtojen turvallisuusjohtamisen (PHOQS) arviointi sekä esimies- ja ergonomiavastaavien kysely. Lisäksi käytössä olivat Kunta10-kyselyn tulokset valittujen muuttujien osalta kaikista tutkimukseen osallistuvista kaupungeista sekä ympärivuorokautisen hoidon asiakkaita ja hoitohenkilöstöä kuvaavia tilastoja. Työ vanhusten ympärivuorokautisessa hoidossa on fyysisesti ja psyykkisesti kuormittavaa. Interventiotoimenpiteistä huolimatta koettu fyysinen ja psyykkinen kuormittavuus kasvoivat, tosin fyysinen psyykkistä vähemmän. Kuormittavuus vaihteli toimintamuodoittain ja ammattiryhmittäin. Fyysisesti kuormittavimmaksi työ koettiin pitkäaikaissairaanhoidossa, psyykkinen kuormitus kasvoi eniten tehostetussa palveluasumisessa. Vanhainkodit sijoittuivat näiden väliin. Lähihoitajat kokivat työnsä fyysisesti kuormittavimmaksi, kun taas sairaanhoitajien työ oli psyykkisesti lähihoitajien työtä kuormittavampaa. Ergonomiakoulutus vähensi eniten koettua fyysistä kuormittavuutta. Kehityskeskustelut ja aiempaa paremmaksi arvioitu työkyky vähensivät mutta tyytymättömyys työhön lisäsi koettua fyysistä ja psyykkistä kuormittavuutta. Työntekijöiden ikä, RAVATM -indeksi, Care ThermometerTM -mittaukset ja PHOQS-pisteet eivät olleet tilastollisesti merkitsevästi yhteydessä kuormittavuuden muutoksiin. Työn kuormittavuuden vähentäminen ja turvallisen työskentelyn edistäminen vaativat pitkäkestoista toimintaa ja hyvää johtamista erityisesti lähiesimiehiltä. Fyysisten riskien hallintamallin käyttöönotto ja ergonomiavastaavien toiminnan vakiinnuttaminen tukevat tavoitteiden saavuttamista.

Cardiorespiratory adaptations induced by aerobic training in middle-aged men: the importance of a decrease in sympathetic stimulation for the contribution of dynamic exercise tachycardia

We investigated the effects of aerobic training on the efferent autonomic control of heart rate (HR) during dynamic exercise in middle-aged men, eight of whom underwent exercise training (T) while the other seven continued their sedentary (S) life style. The training was conducted over 10 months (three 1-h sessions/week on a field track at 70-85% of the peak HR). The contribution of sympathetic and parasympathetic exercise tachycardia was determined in terms of differences in the time constant effects on the HR response obtained using a discontinuous protocol (4-min tests at 25, 50, 100 and 125 watts on a cycle ergometer), and a continuous protocol (25 watts/min until exhaustion) allowed the quantification of the parameters (anaerobic threshold, VO2 AT; peak O2 uptake, VO2 peak; power peak) that reflect oxygen transport. The results obtained for the S and the T groups were: 1) a smaller resting HR in T (66 beats/min) when compared to S (84 beats/min); 2) during exercise, a small increase in the fast tachycardia (D0-10 s) related to vagal withdrawal (P<0.05, only at 25 watts) was observed in T at all powers; at middle and higher powers a significant decrease (P<0.05 at 50, 100 and 125 watts) in the slow tachycardia (D1-4 min) related to a sympathetic-dependent mechanism was observed in T; 3) the VO2 AT (S = 1.06 and T = 1.33 l/min) and VO2 peak (S = 1.97 and T = 2.47 l/min) were higher in T (P<0.05). These results demonstrate that aerobic training can induce significant physiological adaptations in middle-aged men, mainly expressed as a decrease in the sympathetic effects on heart rate associated with an increase in oxygen transport during dynamic exercise.

Increased training prevents the impairing effect of intra-amygdala infusion of the non-NMDA receptor antagonist CNQX on inhibitory avoidance expression

Intra-amygdala infusion of the non-N-methyl-D-aspartate (NMDA) receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) prior to testing impairs inhibitory avoidance retention test performance. Increased training attenuates the impairing effects of amygdala lesions and intra-amygdala infusions of CNQX. The objective of the present study was to determine the effects of additional training on the impairing effects of intra-amygdala CNQX on expression of the inhibitory avoidance task. Adult female Wistar rats bilaterally implanted with cannulae into the border between the central and the basolateral nuclei of the amygdala were submitted to a single session or to three training sessions (0.2 mA, 24-h interval between sessions) in a step-down inhibitory avoidance task. A retention test session was held 48 h after the last training. Ten minutes prior to the retention test session, the animals received a 0.5-µl infusion of CNQX (0.5 µg) or its vehicle (25% dimethylsulfoxide in saline). The CNQX infusion impaired, but did not block, retention test performance in animals submitted to a single training session. Additional training prevented the impairing effect of CNQX. The results suggest that amygdaloid non-NMDA receptors may not be critical for memory expression in animals given increased training.

Effect of training on the ability of dual-task coordination

Within the framework of the working memory model proposed by A. Baddeley and G. Hitch, a dual-task paradigm has been suggested to evaluate the capacity to perform simultaneously two concurrent tasks. This capacity is assumed to reflect the functioning of the central executive component, which appears to be impaired in patients with dysexecutive syndrome. The present study extends the investigation of an index ("mu"), which is supposed to indicate the capacity of coordination of concurrent auditory digit span and tracking tasks, by testing the influence of training on the performance in the dual task. The presentation of the same digit sequence lists or always-different lists did not differently affect the performance. The span length affected the mu values. The improved performance in the tasks under the dual condition closely resembled the improvement in the single-task performance. So, although training improved performance in the single and dual conditions, especially for the tracking component, the mu values remained stable throughout the sessions when the single tasks were performed first. Conversely, training improved the capacity of dual-task coordination throughout the sessions when dual task was performed first, addressing the issue of the contribution of the within-session practice to the mu index.

Training graduate students to be teachers

Pedagogic education of graduate students, when and where it exists, is restricted to theoretical courses or to the participation of the students as teachers' assistants. This model is essentially reproductive and offers few opportunities for any significant curriculum innovation. To open an opportunity for novelty we have introduced a new approach in "Biochemistry Teaching", a course included in the Biochemistry Graduate Program of the Biochemistry Department (Universidade Estadual de Campinas and Universidade de São Paulo). The content of the course consists of a) choosing the theme, b) selecting and organizing the topics, c) preparing written material, d) establishing the methodological strategies, e) planning the evaluation tools and, finally, f) as teachers, conducting the course as an optional summer course for undergraduate students. During the first semester the graduate students establish general and specific educational objectives, select and organize contents, decide on the instructional strategies and plan evaluation tools. The contents are explored using a wide range of strategies, which include computer-aided instruction, laboratory classes, small group teaching, a few lectures and round table discussions. The graduate students also organize printed class notes to be used by the undergraduate students. Finally, as a group, they teach the summer course. In the three versions already developed, the themes chosen were Biochemistry of Exercise (UNICAMP), Biochemistry of Nutrition (UNICAMP) and Molecular Biology of Plants (USP). In all cases the number of registrations greatly exceeded the number of places and a selection had to be made. The evaluation of the experience by both graduate and undergraduate students was very positive. Graduate students considered this experience to be unique and recommended it to their schoolmates; the undergraduate students benefited from a more flexible curriculum (more options) and gave very high scores to both the courses and the teachers.

Effect of inhibitory avoidance training on [3H]-glutamate binding in the hippocampus and parietal cortex of rats

Glutamate receptors have been implicated in memory formation. The aim of the present study was to determine the effect of inhibitory avoidance training on specific [3H]-glutamate binding to membranes obtained from the hippocampus or parietal cortex of rats. Adult male Wistar rats were trained (0.5-mA footshock) in a step-down inhibitory avoidance task and were sacrificed 0, 5, 15 or 60 min after training. Hippocampus and parietal cortex were dissected and membranes were prepared and incubated with 350 nM [3H]-glutamate (N = 4-6 per group). Inhibitory avoidance training induced a 29% increase in glutamate binding in hippocampal membranes obtained from rats sacrificed at 5 min (P<0.01), but not at 0, 15, or 60 min after training, and did not affect glutamate binding in membranes obtained from the parietal cortex. These results are consistent with previous evidence for the involvement of glutamatergic synaptic modification in the hippocampus in the early steps of memory formation.

Effects of exercise training on autonomic and myocardial dysfunction in streptozotocin-diabetic rats

Several investigators have demonstrated that diabetes is associated with autonomic and myocardial dysfunction. Exercise training is an efficient non-pharmacological treatment for cardiac and metabolic diseases. The aim of the present study was to investigate the effects of exercise training on hemodynamic and autonomic diabetic dysfunction. After 1 week of diabetes induction (streptozotocin, 50 mg/kg, iv), male Wistar rats (222 ± 5 g, N = 18) were submitted to exercise training for 10 weeks on a treadmill. Arterial pressure signals were obtained and processed with a data acquisition system. Autonomic function and intrinsic heart rate were studied by injecting methylatropine and propranolol. Left ventricular function was assessed in hearts perfused in vitro by the Langendorff technique. Diabetes (D) bradycardia and hypotension (D: 279 ± 9 bpm and 91 ± 4 mmHg vs 315 ± 11 bpm and 111 ± 4 mmHg in controls, C) were attenuated by training (TD: 305 ± 7 bpm and 100 ± 4 mmHg). Vagal tonus was decreased in the diabetic groups and sympathetic tonus was similar in all animals. Intrinsic heart rate was lower in D (284 ± 11 bpm) compared to C and TD (390 ± 8 and 342 ± 14 bpm, respectively). Peak systolic pressure developed at different pressures was similar for all groups, but +dP/dt max was decreased and -dP/dt max was increased in D. In conclusion, exercise training reversed hypotension and bradycardia and improved myocardial function in diabetic rats. These changes represent an adaptive response to the demands of training, supporting a positive role of physical activity in the management of diabetes.

Customer orientation of sales personnel: Implications for service quality

Prior customer orientation research has concentrated mainly on studying the economical potential of customer orientation to companies. Service quality research instead has concentrated on emphasizing the evaluation of service quality from the customer’s perspective. This means that the service providers lack important information regarding customer orientation and service quality they would need for managerial purposes such as selecting and training employees. Therefore, there is an emerging need to study how customer orientation and service quality relate to company processes, policies and employees, and this study answers to those calls. The objective of this study was to examine what is the role of sales personnel’s’ customer orientation in quality of service delivery and what features support the development of customer orientation among sales personnel. Also the components customer orientation were studied extensively in order to understand how they relate to service quality. The empiric part of the study was conducted as a qualitative research by interviewing seven sales people from operative, tactical and strategic levels of the case corporation in order to get a broader view for customer orientation. The findings propose that both organizational factors and individual factors are affecting customer orientation construct inseparably. Organizational factors are bundled in this study under standards, support and systems, whereas individual factors are formed of employees’ personal attributes, motivation and self-perceived decision making authority. The findings suggest that in the service delivery process at an operative level, customer orientation appears largely in the employees’ individualistic characteristics. Their social and technical skills and motivation to serve customers are the most identifiable factors for customer orientation and consequently, quality service. However, organizational standards, support and systems are strongly dictating the frames the operative sales people operate in, having an influence on how the employees are experiencing their decision making authority and in the end, customer orientation. When looking at the service delivery process at tactical and strategic levels, customer orientation is affecting mainly in the organizational constructs through setting standards, support and systems. However, tactical and strategic level employees influence the operative level through individual customer orientation components as well. The findings indicate that their emotion and personal interaction skills are affecting the overall service delivery process mainly through supervisor support and motivation of the operative level employees. Based on this study it can be argued that an organization can operate as a facilitator and create certain frames for customer oriented sales behavior through standards, support and systems. However, as the impact of individual customer orientation factors on sales people’s service quality seems decisive, from an organizational perspective it puts pressures on the recruitment.

Pursuit of change versus organizational inertia: a study on strategic renewal in the Finnish broadcasting company

This doctoral dissertation explores the intra-organizational dynamics of a strategic renewal process. The main research question is how the pursuit of change and organizational inertia co-exist, intertwine, and collide in organizational cognition and capabilities during the strategic renewal. It is a comprehensive study on how organizational capabilities, organizational cognition, and structure enhance and inhibit change. Theoretically, the study is positioned in the modern tradition of strategy research, using the dynamic capability view and the organizational and managerial cognition research tradition as the main theoretical frames. Empirically, the study is a longitudinal case study of the Finnish Broadcasting Company (Yle), following the organizational changes during the years of 2011-1014. The analysis is based on both quantitative and qualitative data, which was collected during the research process using surveys, interviews, and archives. The main theoretical contribution is the application of the two theoretical approaches in one study. Empirically, the study contributes to operationalization of the concepts related to the dynamic capability view and organizational cognition, in a media context that is going through drastic changes due to digitalization. Furthermore, the case of a public broadcasting company extends the application of the theoretical concepts to the context of public management. The results suggest that renewal is a complex process, in which an organization’s perceptions intertwine with the strategic actions and decision-making. The change evolves pathdependently: the past experiences, routines, and organizational structures tend to dictate the future visions, desires, and actions. The study also reveals how the public nature of an organization adds to the tensions between change and organizational inertia, and hampers the decision-making. The doctoral dissertation consists of six research papers, each of which explores the phenomenon under study from a different perspective.

Organizing for Systemic Innovations – Research on Knowledge, Interaction and Organizational Interdependencies

Systemic innovation has emerged as an important topic due to the interconnected technological and sociotechnical change of our current complex world. This study approaches the phenomenon from an organizing perspective, by analyzing the various actors, collaborative activities and resources available in innovation systems. It presents knowledge production for innovation and discusses the organizational challenges of shared innovation activities from a dynamic perspective. Knowledge, interaction, and organizational interdependencies are seen as the core elements of organizing for systemic innovations. This dissertation is divided into two parts. The first part introduces the focus of the study and the relevant literature and summarizes conclusions. The second part includes seven publications, each reporting on an important aspect of the phenomenon studied. Each of the in-depth single-case studies takes a distinct and complementary systems approach to innovation activities – linking the refining of knowledge to the enabling of organizations to participate in shared innovation processes. These aspects are summarized as theoretical and practical implications for recognizing innovation opportunities and turning ideas into innovations by means of using information and organizing activities in an efficient manner. Through its investigation of the existing literature and empirical case studies, this study makes three main contributions. First, it describes the challenges inherent in utilizing information and transforming it into innovation knowledge. Secondly, it presents the role of interaction and organizational interdependencies in innovation activities from various novel perspectives. Third, it highlights the interconnection between innovations and organizations, and the related path dependency and anticipatory aspects in innovation activities. In general, the thesis adds to our knowledge of how different aspects of systems form innovations through interaction and organizational interdependencies. It highlights the continuous need to redefine information and adjust organizations and networks based on ongoing activities – stressing the emergent, systemic nature of innovation.

Effects of aerobic exercise training on heart rate variability during wakefulness and sleep and cardiorespiratory responses of young and middle-aged healthy men

The purpose of the present study was to evaluate the effects of aerobic physical training (APT) on heart rate variability (HRV) and cardiorespiratory responses at peak condition and ventilatory anaerobic threshold. Ten young (Y: median = 21 years) and seven middle-aged (MA = 53 years) healthy sedentary men were studied. Dynamic exercise tests were performed on a cycloergometer using a continuous ramp protocol (12 to 20 W/min) until exhaustion. A dynamic 24-h electrocardiogram was analyzed by time (TD) (standard deviation of mean R-R intervals) and frequency domain (FD) methods. The power spectral components were expressed as absolute (a) and normalized units (nu) at low (LF) and high (HF) frequencies and as the LF/HF ratio. Control (C) condition: HRV in TD (Y: 108, MA: 96 ms; P<0.05) and FD - LFa, HFa - was significantly higher in young (1030; 2589 ms²/Hz) than in middle-aged men (357; 342 ms²/Hz) only during sleep (P<0.05); post-training effects: resting bradycardia (P<0.05) in the awake condition in both groups; VO2 increased for both groups at anaerobic threshold (P<0.05), and at peak condition only in young men; HRV in TD and FD (a and nu) was not significantly changed by training in either groups. The vagal predominance during sleep is reduced with aging. The resting bradycardia induced by short-term APT in both age groups suggests that this adaptation is much more related to intrinsic alterations in sinus node than in efferent vagal-sympathetic modulation. Furthermore, the greater alterations in VO2 than in HRV may be related to short-term APT.

Johtajan jäljillä – Johtaminen varhaiskasvatuksen hajautetuissa organisaatioissa laadun ja pedagogisen tuen näkökulmasta

Tutkimus sijoittuu varhaiskasvatuksen hajautetun organisaation kontekstiin, mutta tulokset ovat siirrettävissä muihinkin suomalaisiin kasvatus- ja opetustoimen organisaatioihin. Hajautettujen organisaatioiden tutkimus on ollut varhaiskasvatuksen kentällä vielä vähäistä, vaikka organisaatiomallin vaikutukset johtajuuden toteuttamiselle ovat merkittävät. Hajautetulla organisaatiolla varhaiskasvatuksessa tarkoitetaan sitä, että yhden johtajan alaisuudessa on monta eri päiväkotia tai erilaisia päivähoitomuotoja. Tämä organisaatiomalli on yhä enenevässä määrin kasvava suomalaisessa varhaiskasvatuksessa. Varhaiskasvatuksen hajautettujen organisaatioiden tutkimuksessa on aiemmin tarkasteltu johtajan ja työntekijöiden ja työntekijöiden keskinäisiä ammatillisia suhteita. Tässä tutkimuksessa näkökulma painottuu johtamiseen ja työskentelyyn hajautetuissa organisaatiossa sinänsä sekä myös laadunarviointiin sekä pedagogiikkaan. Viitekehyksenä tutkimuksessa on LMX-teoria (leader-member-exchange, johtajuuden vaihtoteoria), jossa tarkastellaan esimies-alaissuhdetta ja siihen kiinteästi liittyvää luottamuksen käsitettä. Luottamuksen merkitys hajautetuissa organisaatioissa korostuu, koska esimies ei ole fyysisesti päivittäin läsnä työntekijöiden arjessa. Tutkimuksessa tarkastellaan hajautetuissa varhaiskasvatuksen organisaatioissa työskentelyä seuraavien tutkimuskysymysten avulla: 1) Mitkä ovat varhaiskasvatuksen hajautettujen organisaatioiden johtamisen erityispiirteet? 2) Miten eri työntekijäryhmät kokevat hajautetussa organisaatiossa työskentelyn? 3) Millaisia kokemuksia esimiehillä ja työntekijöillä on heidän yksiköissään toteutetusta laadunarvioinnista? 4) Millaiseksi työntekijät ja esimiehet kokevat esimieheltään saadun tuen? Tutkimuksessa oli kolme eri aineistoa. Ensimmäinen aineisto koostui 11 hajautetun organisaation johtajan haastattelusta. Toinen aineisto (n = 223) sisälsi haastateltujen esimiesten lomakevastausten lisäksi heidän alaisuudessaan toimivien työntekijöiden, 10 esimieskoulutukseen osallistuneen johtajan sekä kolmen erillisyksikön työntekijöiden vastaukset. Kolmas aineisto oli kerätty pääkaupunkiseudulta varhaiskasvatuksen johtajilta lomakekyselynä (n = 112). Aineistoa on analysoitu teorialähtöisen ja aineistolähtöisen sisällönanalyysin ja tilastollisten analyysien avulla Tulokset osoittavat, että johtajat kokivat hallinnollisten töiden vievän paljon aikaa. Esimiehen kanssa eri työpaikassa työskentelevät työntekijät hahmottivat koko organisaation selkeämmin kuin esimiehen kanssa fyysisesti samassa paikassa työskentelevät. Esimiesten käsitysten mukaan laadunarviointia suoritettiin enemmän kuin mitä työntekijöiden mukaan. Työntekijät kaipasivat esimiehiltään tukea yhteistyöhön ja vuorovaikutukseen, pedagogiseen ohjaukseen, kehittämiseen ja toiminnan resursseihin liittyen. Erillisyksikössä työskentelevät kokivat saavansa enemmän tukea kuin esimiehen kanssa fyysisesti samassa yksikössä työskentelevät työntekijät. Sekä esimieheltä saadun pedagogisen tuen että luottamuksen kokemukset kiinnittävät tämän tutkimuksen tulosten mukaan huomion rakenteiden merkitykseen hajautetuissa organisaatioissa. Arviointiin, pedagogiseen tukeen ja tiedonkulkuun liittyvien rakenteiden huomioiminen helpottaa hajautetussa organisaatiossa johtamista. Edellisten lisäksi johtajan selkeä visio omasta johtamistyöstään ja jaetun johtajuuden hyödyntäminen edesauttavat työn hallinnan kokemuksia.

Understanding organizational wrongdoing

The topic is white collar crime in its organizational form. The research question is why otherwise law-abiding people engage in wrongful behavior within legitimate organizations and what kinds of dynamics are involved in wrongful organizational processes. This is a theoretical inquiry the method of which is to bring together relevant literature on organizational behavior regardless of the branch of science. In addition to criminological and sociolegal writings, I mostly refer to works of social psychology and organization theory. At first, I discuss the terminological multiplicity related to organizational white collar crime. In conclusion from a critical analysis of the dominant terms and definitions, I argue for the concept of organizational wrongdoing. The approach of organizational wrongdoing captures unethical, illegal and criminal organizational behavior. Thus, it is not retricted by legislative categories but ethical reasoning. The approach aims at grasping a behavioral entity, and state law crimes do not constitute an ontology of behavior. In order to understand organizational wrongdoing, the dominant criminological theories applied to white collar crime are discussed. To a surprisingly large extent, they lack a sophisticated organizational perspective and do not offer viable frameworks for building a plausible theory of organizational white collar crime. In order to fill the gap, I incorporate the social psychological dynamics of organizational behavior and present several findings on collective behavior that criminological theorization must come to terms with. ------ This publication has been first presented and accepted as a master's thesis at the Faculty of Law, University of Turku. It has been published on the series: Criminal Law and Judicial Procedure, Series B: 15, in print format. The publication was digitized in 2015 and published online.

Effects of losartan combined with exercise training in spontaneously hypertensive rats

We investigate whether combined treatment with losartan, an angiotensin II receptor blocker, and exercise training (ET) in spontaneously hypertensive rats (SHR) would have an additive effect in reducing hypertension and improving baroreflex sensitivity when compared with losartan alone. Male SHR (8 weeks old) were assigned to 3 groups: sedentary placebo (SP, N = 16), sedentary under losartan treatment (SL, N = 11; 10 mg kg-1 day-1, by gavage), and ET under losartan treatment (TL, N = 10). ET was performed on a treadmill 5 days/week for 60 min at 50% of peak VO2, for 18 weeks. Blood pressure (BP) was measured with a catheter inserted into the carotid artery, and cardiac output with a microprobe placed around the ascending aorta. The baroreflex control of heart rate was assessed by administering increasing doses of phenylephrine and sodium nitroprusside (iv). Losartan significantly reduced mean BP (178 ± 16 vs 132 ± 12 mmHg) and left ventricular hypertrophy (2.9 ± 0.4 vs 2.5 ± 0.2 mg/g), and significantly increased baroreflex bradycardia and tachycardia sensitivity (1.0 ± 0.3 vs 1.7 ± 0.5 and 2.0 ± 0.7 vs 3.2 ± 1.7 bpm/mmHg, respectively) in SL compared with SP. However, losartan combined with ET had no additional effect on BP, baroreflex sensitivity or left ventricular hypertrophy when compared with losartan alone. In conclusion, losartan attenuates hypertension and improves baroreflex sensitivity in SHR. However, ET has no synergistic effect on BP in established hypertension when combined with losartan, at least at the dosage used in this investigation.