Matka ja muutos : ruumiillinen kokemus ja transsendenssin mahdollisuus Terrence Malickin elokuvakerronnassa

Teemanumero: Terrence Malick.

Johdon tehtävien merkitys muutosprosessin toteuttamisessa työntekijöiden kokemana - Case: Forssan seudun hyvinvointikuntayhtymä

Sosiaali- ja terveyspalveluiden järjestämisessä Suomessa ollaan muutoksen äärellä. Muutoksilla pyritään palvelujen saatavuuden ja saavutettavuuden turvaamiseen sekä lähipalveluiden varmistamiseen. Nämä muutokset haastavat sosiaali- ja terveydenhuollon johtamistyön muutosprosessien hallintaan. Muutosjohtamisen keskiössä ovat muutosjohtamisen tehtävät ja muutosprosessien onnistuminen, jotta toivotut muutokset saadaan käytäntöön. Tämän tapaustutkimuksen tavoitteena oli selvittää, miten muutosprosessissa johtamisen erilaiset tehtävät ovat yhteydessä muutoksen toteutumiseen, miten tiedottaminen onnistuu muutosprosessissa ja miten työntekijät ovat kokeneet muutosjohtamisen muutosprosessin aikana. Tutkimustapauksena toimi 1.1.2014 Forssan seudun hyvinvointikuntayhtymässä toteutettu organisaatiomuutos. Tutkimuksen kohdejoukkona olivat kliinistä työtä tekevät hoitotyöntekijät. Tutkimus toteutettiin sekä kvantitatiivista että kvalitatiivista tutkimusotetta käyttäen. Empiirinen tutkimusaineisto kerättiin kyselylomakkeella. Kysely lähetettiin 12 eri yksikön hoitotyöntekijöille (N=440) Forssan seudun hyvinvointikuntayhtymässä ja vastausprosentiksi saatiin 44 %. Kvantitatiivinen aineisto kerättiin kyselylomakkeella strukturoiduilla väittämillä ja kvalitatiivinen aineisto kerättiin kyselylomakkeen avoimilla ja puolistrukturoiduilla kysymyksillä. Strukturoidut kysymykset analysoitiin SPSS -ohjelman avulla ja avoimet ja puolistrukturoidut kysymykset analysointiin sisällönanalyysillä. Tutkimuksen tulokset osoittivat, että työntekijöiden kokemukset johdon ja esimiesten toiminnasta muutosprosessissa olivat samansuuntaisia. Työntekijät pitivät tärkeänä, että muutoksen välttämättömyys perustellaan hyvin ja muutoksen tavoitteet esitellään selkeästi. Muutokseen valmistautumiseen tulee varata riittävästi aikaa ja muutos tulee suunnitella hyvin. Työntekijöiden näkemyksen mukaan osallistavien ryhmien kautta olisi ollut mahdollista osallistua muutoksen tekemiseen ja kokea vastuuta muutoksen tekemisestä. Työntekijät odottivat, että johto ja esimiehet palkitsevat heitä muutosprosessissa joustavuudesta ja jaksamisesta. Tulosten perusteella tiedottamisessa ja viestinässä muutosprosessissa tulee kiinnittää huomiota tiedon oikea-aikaisuuteen sekä sen sisältöön. Lisäksi on tärkeää järjestää mahdollisuus lisäinformaation antamiseen. Tiedottamisen ja viestinnän muutosprosessissa koettiin olevan erittäin tärkeä tiedon siirtymisen ja muutosmyönteisyyden kannalta. Tehdyn tapaustutkimuksen perusteella voidaan todeta, että johtamisen tehtävillä voidaan selittää lähes puolet muutoksen onnistumisesta sekä johtajuuden tehtävillä lähes neljännes muutoksen onnistumisesta. Johtamisen tehtävillä on enemmän vaikutusta muutoksen onnistumiseen kuin johtajuuden tehtävillä.

Stasi-tutkimus Suomessa : vastine Kimmo Elon artikkeliin

Vastine dosentti Kimmo Elon artikkeliin "Tapaus Pakaslahti" ja tiedustelututkimuksen metodiikka" (HAik 2/2014).

Causal relationship between obesity and vitamin D status: bi-directional mendelian randomization analysis of multiple cohorts

BACKGROUND: Obesity is associated with vitamin D deficiency, and both are areas of active public health concern. We explored the causality and direction of the relationship between body mass index (BMI) and 25-hydroxyvitamin D [25(OH)D] using genetic markers as instrumental variables (IVs) in bi-directional Mendelian randomization (MR) analysis. METHODS AND FINDINGS: We used information from 21 adult cohorts (up to 42,024 participants) with 12 BMI-related SNPs (combined in an allelic score) to produce an instrument for BMI and four SNPs associated with 25(OH)D (combined in two allelic scores, separately for genes encoding its synthesis or metabolism) as an instrument for vitamin D. Regression estimates for the IVs (allele scores) were generated within-study and pooled by meta-analysis to generate summary effects. Associations between vitamin D scores and BMI were confirmed in the Genetic Investigation of Anthropometric Traits (GIANT) consortium (n = 123,864). Each 1 kg/m(2) higher BMI was associated with 1.15% lower 25(OH)D (p = 6.52×10⁻²⁷). The BMI allele score was associated both with BMI (p = 6.30×10⁻⁶²) and 25(OH)D (-0.06% [95% CI -0.10 to -0.02], p = 0.004) in the cohorts that underwent meta-analysis. The two vitamin D allele scores were strongly associated with 25(OH)D (p≤8.07×10⁻⁵⁷ for both scores) but not with BMI (synthesis score, p = 0.88; metabolism score, p = 0.08) in the meta-analysis. A 10% higher genetically instrumented BMI was associated with 4.2% lower 25(OH)D concentrations (IV ratio: -4.2 [95% CI -7.1 to -1.3], p = 0.005). No association was seen for genetically instrumented 25(OH)D with BMI, a finding that was confirmed using data from the GIANT consortium (p≥0.57 for both vitamin D scores). CONCLUSIONS: On the basis of a bi-directional genetic approach that limits confounding, our study suggests that a higher BMI leads to lower 25(OH)D, while any effects of lower 25(OH)D increasing BMI are likely to be small. Population level interventions to reduce BMI are expected to decrease the prevalence of vitamin D deficiency.

A genome-wide association meta-analysis identifies new childhood obesity loci

Multiple genetic variants have been associated with adult obesity and a few with severe obesity in childhood; however, less progress has been made in establishing genetic influences on common early-onset obesity. We performed a North American, Australian and European collaborative meta-analysis of 14 studies consisting of 5,530 cases (≥95th percentile of body mass index (BMI)) and 8,318 controls (<50th percentile of BMI) of European ancestry. Taking forward the eight newly discovered signals yielding association with P < 5 × 10(-6) in nine independent data sets (2,818 cases and 4,083 controls), we observed two loci that yielded genome-wide significant combined P values near OLFM4 at 13q14 (rs9568856; P = 1.82 × 10(-9); odds ratio (OR) = 1.22) and within HOXB5 at 17q21 (rs9299; P = 3.54 × 10(-9); OR = 1.14). Both loci continued to show association when two extreme childhood obesity cohorts were included (2,214 cases and 2,674 controls). These two loci also yielded directionally consistent associations in a previous meta-analysis of adult BMI(1).

Association of vitamin D status with arterial blood pressure and hypertension risk: a mendelian randomisation study

BACKGROUND: Low plasma 25-hydroxyvitamin D (25[OH]D) concentration is associated with high arterial blood pressure and hypertension risk, but whether this association is causal is unknown. We used a mendelian randomisation approach to test whether 25(OH)D concentration is causally associated with blood pressure and hypertension risk. METHODS: In this mendelian randomisation study, we generated an allele score (25[OH]D synthesis score) based on variants of genes that affect 25(OH)D synthesis or substrate availability (CYP2R1 and DHCR7), which we used as a proxy for 25(OH)D concentration. We meta-analysed data for up to 108 173 individuals from 35 studies in the D-CarDia collaboration to investigate associations between the allele score and blood pressure measurements. We complemented these analyses with previously published summary statistics from the International Consortium on Blood Pressure (ICBP), the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium, and the Global Blood Pressure Genetics (Global BPGen) consortium. FINDINGS: In phenotypic analyses (up to n=49 363), increased 25(OH)D concentration was associated with decreased systolic blood pressure (β per 10% increase, -0·12 mm Hg, 95% CI -0·20 to -0·04; p=0·003) and reduced odds of hypertension (odds ratio [OR] 0·98, 95% CI 0·97-0·99; p=0·0003), but not with decreased diastolic blood pressure (β per 10% increase, -0·02 mm Hg, -0·08 to 0·03; p=0·37). In meta-analyses in which we combined data from D-CarDia and the ICBP (n=146 581, after exclusion of overlapping studies), each 25(OH)D-increasing allele of the synthesis score was associated with a change of -0·10 mm Hg in systolic blood pressure (-0·21 to -0·0001; p=0·0498) and a change of -0·08 mm Hg in diastolic blood pressure (-0·15 to -0·02; p=0·01). When D-CarDia and consortia data for hypertension were meta-analysed together (n=142 255), the synthesis score was associated with a reduced odds of hypertension (OR per allele, 0·98, 0·96-0·99; p=0·001). In instrumental variable analysis, each 10% increase in genetically instrumented 25(OH)D concentration was associated with a change of -0·29 mm Hg in diastolic blood pressure (-0·52 to -0·07; p=0·01), a change of -0·37 mm Hg in systolic blood pressure (-0·73 to 0·003; p=0·052), and an 8·1% decreased odds of hypertension (OR 0·92, 0·87-0·97; p=0·002). INTERPRETATION: Increased plasma concentrations of 25(OH)D might reduce the risk of hypertension. This finding warrants further investigation in an independent, similarly powered study.

High intestinal cholesterol absorption is associated with cardiovascular disease and risk alleles in ABCG8 and ABO: evidence from the LURIC and YFS cohorts and from a meta-analysis.

OBJECTIVES This study sought to determine whether high intestinal cholesterol absorption represents a cardiovascular risk factor and to link ABCG8 and ABO variants to cardiovascular disease (CVD). BACKGROUND Plant sterol-enriched functional foods are widely used for cholesterol lowering. Their regular intake yields a 2-fold increase in circulating plant sterol levels that equally represent markers of cholesterol absorption. Variants in ABCG8 and ABO have been associated with circulating plant sterol levels and CVD, thereby suggesting atherogenic effects of plant sterols or of cholesterol uptake. METHODS The cholestanol-to-cholesterol ratio (CR) was used as an estimate of cholesterol absorption because it is independent of plant sterols. First, we investigated the associations of 6 single nucleotide polymorphisms in ABCG8 and ABO with CR in the LURIC (LUdwisghafen RIsk and Cardiovascular health study) and the YFS (Young Finns Study) cohorts. Second, we conducted a systematic review and meta-analysis to investigate whether CR might be related to CVD. RESULTS In LURIC, the minor alleles of rs4245791 and rs4299376 and the major alleles of rs41360247, rs6576629, and rs4953023 of the ABCG8 gene and the minor allele of rs657152 of the ABO gene were significantly associated with higher CR. Consistent results were obtained for rs4245791, rs4299376, rs6576629, and rs4953023 in YFS. The meta-analysis, including 6 studies and 4,362 individuals, found that CR was significantly increased in individuals with CVD. CONCLUSIONS High cholesterol absorption is associated with risk alleles in ABCG8 and ABO and with CVD. Harm caused by elevated cholesterol absorption rather than by plant sterols may therefore mediate the relationships of ABCG8 and ABO variants with CVD.

Genome-wide association study on dimethylarginines reveals novel AGXT2 variants associated with heart rate variability but not with overall mortality.

AIMS The purpose of this study was to identify novel genetic variants influencing circulating asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) levels and to evaluate whether they have a prognostic value on cardiovascular mortality. METHODS AND RESULTS We conducted a genome-wide association study on the methylarginine traits and investigated the predictive value of the new discovered variants on mortality. Our meta-analyses replicated the previously known locus for ADMA levels in DDAH1 (rs997251; P = 1.4 × 10(-40)), identified two non-synomyous polymorphisms for SDMA levels in AGXT2 (rs37369; P = 1.4 × 10(-40) and rs16899974; P = 1.5 × 10(-38)) and one in SLC25A45 (rs34400381; P = 2.5 × 10(-10)). We also fine-mapped the AGXT2 locus for further independent association signals. The two non-synonymous AGXT2 variants independently associated with SDMA levels were also significantly related with short-term heart rate variability (HRV) indices in young adults. The major allele (C) of the novel non-synonymous rs16899974 (V498L) variant associated with decreased SDMA levels and an increase in the ratio between the low- and high-frequency spectral components of HRV (P = 0.00047). Furthermore, the SDMA decreasing allele (G) of the non-synomyous SLC25A45 (R285C) variant was associated with a lower resting mean heart rate during the HRV measurements (P = 0.0046), but not with the HRV indices. None of the studied genome-wide significant variants had any major effect on cardiovascular or total mortality in patients referred for coronary angiography. CONCLUSIONS AGXT2 has an important role in SDMA metabolism in humans. AGXT2 may additionally have an unanticipated role in the autonomic nervous system regulation of cardiac function.