Health-related quality-of-life instruments for Alzheimer's disease and mixed dementia

BACKGROUND: Over the last 20 years, a number of instruments developed for the assessment of health-related quality of life (HRQL) in dementia have been introduced. The aim of this review is to synthesize evidence from published reviews on HRQL measures in dementia and any new literature in order to identify dementia specific HRQL instruments, the domains they measure, and their operationalization. METHODS: An electronic search of PsycINFO and PubMed was conducted, from inception to December 2011 using a combination of key words that included quality of life and dementia. RESULTS: Fifteen dementia-specific HRQL instruments were identified. Instruments varied depending on their country of development/validation, dementia severity, data collection method, operationalization of HRQL in dementia, psychometric properties, and the scoring. The most common domains assessed include mood, self-esteem, social interaction, and enjoyment of activities. CONCLUSIONS: A number of HRQL instruments for dementia are available. The suitability of the scales for different contexts is discussed. Many studies do not specifically set out to measure dementia-specific HRQL but do include related items. Determining how best to operationalize the many HRQL domains will be helpful for mapping measures of HRQL in such studies maximizing the value of existing resources.

Exposure to Tobacco Smoke and Markers of Subclinical Atherosclerosis in Children and Adolescents. The STRIP Study.

Background: Measurement of serum cotinine, a major metabolite of nicotine, provides a valid marker for quantifying exposure to tobacco smoke. Exposure to tobacco smoke causes vascular damage by multiple mechanisms, and it has been acknowledged as a risk factor for atherosclerosis. Multifactorial atherosclerosis begins in childhood, but the relationship between exposure to tobacco smoke and arterial changes related to early atherosclerosis have not been studied in children. Aims: The aim of the present study was to evaluate exposure to tobacco smoke with a biomarker, serum cotinine concentration, and its associations with markers of subclinical atherosclerosis and lipid profile in school-aged children and adolescents. Subjects and Methods: Serum cotinine concentration was measured using a gas chromatographic method annually between the ages 8 and 13 years in 538-625 children participating since infancy in a randomized, prospective atherosclerosis prevention trial STRIP (Special Turku coronary Risk factor Intervention Project). Conventional atherosclerosis risk factors were measured repeatedly. Vascular ultrasound studies were performed among 402 healthy 11-year-old children and among 494 adolescents aged 13 years. Results: According to serum cotinine measurements, a notable number of the school aged children and adolescents were exposed to tobacco smoke, but the exposure levels were only moderate. Exposure to tobacco smoke was associated with decreased endothelial function as measured with flow-mediated dilation of the brachial artery, decreased elasticity of the aorta, and increased carotid and aortic intima-media thickness. Longitudinal exposure to tobacco smoke was also related with increased apolipoprotein B and triglyceride levels in 13-year-old adolescents, whose body mass index and nutrient intakes did not differ. Conclusions: These findings suggest that exposure to tobacco smoke in childhood may play a significant role in the development of early atherosclerosis. Key Words: arterial elasticity, atherosclerosis, children, cotinine, endothelial function, environmental tobacco smoke, intima-media thickness, risk factors, ultrasound

Estudi sobre la qualitat de vida de les persones amb demència ateses a la Unitat d'avaluació de deteriorament cognitiu de l'Hospital de la Santa Creu

OBJECTIU: determinar la qualitat de vida de les persones amb demència ateses en una unitat avaluadora de deteriorament cognitiu. MÈTODE: estudi descriptiu transversal amb una mostra consecutiva no probabilística, formada per 42 persones amb demència tipus Alzheimer lleu o moderada i els seus cuidadors. La Qualitat de Vida (QV) es va avaluar amb el qüestionari QoL-AD (Quality of Life Alzheimer’s Disease) en les versions per al pacient (QoL-ADp) i per al cuidador (QoL-ADc). RESULTATS: la mitjana de puntuació del QoL-ADp va ser de 35,38 punts (DE = 5,24) i del QoL-Adc, de 30,60 (DE 5,33). La diferència entre aquests resultats és significativa (p<0,001). Els pacients amb simptomatologia depressiva i els seus cuidadors van puntuar significativament més baix el QoL-AD (p<0,001). En les freqüències per ítems del QoL-ADp s’observa que: més del 75% van valorar com a bona/excel·lent les condicions de vida, família, matrimoni/relació estreta, vida social, situació financera i vida en general; el 61% valoraren bona/excel·lent la capacitat per realitzar tasques a casa; prop del 50% pensava que l’estat d’ànim, l’energia, la salut física, la capacitat per fer coses per diversió i la visió de si mateixos era dolenta/regular, i el 85,7% opinava que la seva memòria era dolenta/regular. CONCLUSIONS: els resultats obtinguts en el QoL-AD no difereixen dels obtinguts en altres investigacions. Suggereixen que les intervencions que genera l’avaluació de la QV en la pràctica clínica inclouen aspectes centrats pròpiament en la malaltia i aspectes vinculats amb les relacions socials.

Hipertextos fragmentados: Una propuesta para trabajar la competencia lectoliteraria en la formación inicial de docentes

El canon para la formación literaria y la educación literaria en primaria son algunos de los contenidos principales de la asignatura 'Didáctica de la literatura infantil y juvenil" que se imparte en el grado de Educación Primaria de la Universitat de Barcelona. La propuesta de innovación educativa que presentamos consiste en el diseño e implementación de una secuencia formativa dirigida a estos alumnos para ampliar el intertexto lector mediante la lectura y análisis de un corpus de minificciones hipertextuales (Zavala, 2007; Landow, 2009) relacionadas con la literatura de base folklórica y de autor del canon de educación primaria de primeras lenguas. El corpus elegido pertenece al libro Catàleg de monstres (2012) de Masó, minificciones que apelan a la intertextualidad mediante la combinación de múltiples recursos literarios. Palabras clave: Formación inicial de maestros, competencia lectoliteraria, minificción, literatura infantil y juvenil. ENGLISH SUMMARY Fragmented Hypertexts: a proposal to develop literacy competence in initial teacher training Literary canon for primary children and literature education are some of the main contents of the subject 'Teaching of Children's Literature' taught in the Primary Education degree at the University of Barcelona. The proposed educational innovation we present is the design of a teaching sequence targeted to these students to expand their reader intertextuality by reading and analysing hypertext mini fictions (Zavala, 2007; Landow, 2009) related to basic folk literature from the primary school literary canon. The corpus chosen is from the book Catàleg de monstres (2012), written by Masó, selected mini fictions constantly appealing to intertextuality through the combination of multiple literarcy resources. Key words: Folk literature, teacher training of primary education, hypertext mini fictions, literary competence.

Cistectomia radical laparoscópica com reservatório ileal

Worldwide experience with laparoscopic radical cystectomy is increasing in the last few years. We describe a 29-year-old female who underwent a laparoscopic radical cystectomy with ileal reservoir for a bladder sarcoma. Operative time was 405 minutes and estimated blood loss was 500 mL. She had an uneventful postoperative course and was discharged in the fifth postoperative day. Key-words: bladder, cystectomy, laparoscopy, urinary diversion, bladder neoplasms.

Application of social media and ICT-tools in new and small business ventures.

The current research emphasizes on various questions raised and deliberated upon by different entrepreneurs. It provides a valuable contribution to comprehend the importance of social media and ICT-applications. Furthermore, it demonstrates how to support and implement the management consulting and business coaching start-ups with the help of social media and ICT-tools. The thesis presents a literary review from different information systems science, SME and e-business journals, web articles, as well as, survey analysis reports on social media applications. The methodology incorporated into a qualitative research method in which social anthropological approaches were used to oversee the case study activities in order to collect data. The collaborative social research approach was used to shelter the action research method. The research discovered that new business start-ups, as well as small businesses do not use social media and ICT-tools, unlike most of the large corporations use. At present, the current open-source ICT-technologies and social media applications are equally available for new and small businesses as they are available for larger companies. Successful implementation of social media and ICT-applications can easily enhance start-up performance and overcome business hassles. The thesis sheds some light on effective and innovative implementation of social media and ICT-applications for new business risk takers and small business birds. Key words

Strategic outsourcing of R&D: The location-specific advantages of India to the pharmaceutical industry

Companies are increasingly under pressure to be more efficient both in terms of costs and overall performance and thus, they seek new ways to develop their products and innovate. For pharmaceutical industry it can take several decades to launch a new drug to the markets. Since pharmaceutical industry is one of the most research-intensive industries, is outsourcing one way to enhance the R&D processes of such companies. It is said that outsourcing to offshore locations is vastly more challenging and complicated than any other exporting activity or inter-company relationship that has evoked a lot of discussion. By outsourcing strategically, companies must also thoroughly focus on transaction costs and core competences. Today, the suppliers are looked for beyond national boundaries and furthermore, the location of the outsourcing activity must also be thoroughly considered. Consequently, the purpose of this study is to analyze what is known of strategic outsourcing of pharmaceutical R&D to India. In order to meet the purpose of the study, this study tries to answer three sub-questions set to it: first, what is strategic outsourcing, second, why pharmaceutical companies utilize strategic outsourcing of R&D and last, why pharmaceutical companies select India as the location for outsourcing their R&D. The study is a qualitative study. The purpose of the study was approached by a literature review with systematic elements and sub-questions were analyzed through different relevant theories, such as theory of transaction costs, core competences and location advantages. Applicable academic journal articles were comprehensively included in the study. The data was collected from electronic journal article databases using key words and almost only peer-reviewed, as new as possible articles were included. Also both the reference list of the included articles and article recommendations from professionals generated more articles for inclusion. The data was analyzed through thematization that resulted in themes that illuminate the purpose of the study and sub-questions. As an outcome of the analysis, each of the theory chapters in the study represents one sub-question. The literature used in this study revealed that strategic outsourcing of R&D is increasingly used in pharmaceutical industry and the major motives to practice it has to do with lowering costs, accessing skilled labor, resources and knowledge and enhancing their quality while speeding up the introduction of new drugs. Mainly for the above-mentioned motives India is frequently chosen as the target location for pharma outsourcers. Still, the literature is somewhat incomplete in this complex phenomenon and more research is needed.

From reactive to proactive banking : connecting with customers with context-aware mobile technology

Mobile technology has been employed in banking for already two decades. However, its significance this far has been modest. It is expected that the industry will change a lot in the future. Elements of this change include tightening of competition, considering customer’s individual and changing needs, becoming involved in customer’s life and being where customers are. The goal of this study is to explore these fields with regard to Finnish banking as well as investigate selected consumers’ views towards this kind of new service approach. It can be divided into three questions: • What kinds of mobile services does the Finnish banking industry currently offer for consumers and what expectations do experts and consumers have towards them? o What is consumers’ attitude towards a context-aware service approach in the banking industry and what are the suggested tools for it? o What factors define clients’ adoption intentions towards the new context-aware service approach? Which factors do they consider most important? In order to create the framework for the study, both Finnish and foreign scientific and professional literature considering evolution of the industry and innovation adoption has been used. The empirical part of the study consists of 11 interviews, including 6 expert interviews and 5 consumer interviews. The results show that the selected consumers reacted very positively to the suggested new service approach that considers them as a person and aims at simplifying their banking. The consumers appreciated especially solutions that simplified their everyday banking. Also proactive actions from a bank was considered important especially in everyday banking, as long as the customer was able to define the amount and way of contacts he received. According to the findings banks should aim at supporting their customers more than they do now. However, they also need to pay attention to not irritate their customers by excessive contacts. Banks should also open-mindedly introduce new technologies to their customers. Key words

USING ATHLETE ENDORSEMENT IN BRAND POSITIONING – An insight from multinational sports goods companies

It has become a popular method in marketing campaigns to use well-known and admired personalities to promote products. A famous person can draw attention to the brand and change consumers’ perceptions of the brand. The research problem of this study was to offer guidelines on how to use athlete endorsement effectively in brand positioning. This research tried to illustrate how athlete endorsement is a vital brand building factor. Athletes have been found to have special credibility, so this research concentrated on the sports goods industry. Furthermore, athlete endorsement has become a natural part of communicating a sports brand. Athletes highlight the performance of the brand to the consumers. The study was conducted as a qualitative research applying case study method. The two case companies selected for this study were Adidas and Puma. The main findings of the empirical research corresponded to the theoretical framework of the study. Brand positioning strategies in the sports goods industry often include athlete endorsement to some extent. Large multinational companies try to attract the best athletes to promote their brand. The key to successful brand positioning is to have a good product with the right personalities to promote it. However, large multinational companies may face difficulties in localizing their marketing efforts. As a result, global campaigns may not be lucrative everywhere. The role of an expert in an athlete’s sport has resulted in increasing credibility in promoting brands. Creating a superior product in consumers’ minds creates competitive advantage. A top athlete may be linked with superior equipment. After considering the goals of the positioning strategy, companies need to plan their brand awareness process, brand image and brand values. Then, athletes need to be selected based on their characteristics to meet the criteria. Sport sponsorship is a way to support the message delivered through athlete endorsement. Athlete endorsement and sport sponsorship complement the marketing communications mix of a brand. Additionally, companies raise brand awareness and communicate brand image through the athlete. Thus, athletes may earn more money through the sponsorship deals and even feature the advertisements after their professional career. Key words

Asiantuntijuuden hyödyntäminen pk-yritysten hallitustyössä

TIIVISTELMÄ Tekijä: Kirsi Mikkilä Tutkielman nimi: Asiantuntijuuden hyödyntäminen pk-yritysten hallitustyössä Tiedekunta: Kauppatieteellinen tiedekunta Pääaine: Yrittäjyys ja pk-yrityksen johtaminen Vuosi: 2014 Pro gradu -tutkielma: Lappeenrannan teknillinen yliopisto 103 sivua, 9 kuvioa ja 2 liitettä. Tarkastajat: KTT, prof. Timo Pihkala ja KTT, prof. Markku Ikävalko Hakusanat: hallitus, pk-yritys, asiantuntijuus Pk-yrityksen hallitustyö on yksi keskeisimmistä johtamisen välineistä, jonka avulla yritys voi mahdollistaa kasvunsa ja tuottaa omistajien sijoittamalle pääomalle parempaa tuottoa. Tämän tutkimuksen tavoitteena oli tarkastella asiantuntijuuden käyttöä pk-yritysten hallitustyöskentelyssä. Tutkimuksella etsittiin vastauksia kysymyksiin, missä yrityksen kehitysvaiheissa asiantuntijuutta lisätään hallituksessa, mitä sillä halutaan saavuttaa ja miten prosessiin valmistaudutaan. Tavoitteena oli täydentää tietämystä pk-yrityksen hallitustyön muuttumisen ja hallituksen laajenemisen mahdollisuuksista ja syistä. Tutkimus toteutettiin haastattelututkimuksena. Tutkimuksen kohdeorganisaatioiksi valittiin viisi teollisuudenalan koneiden, laitteiden ja tuotteiden toimittajayritystä Päijät-Hämeen alueelta. Tutkimusaineisto kerättiin keväällä 2014 teemahaastatteluina. Tutkimus vahvisti resurssiperustaisen näkökulman nousevan vahvasti esiin pk-yrityksien muutosvaiheista. Hallitustyö ja hallituksen jäsenten osaaminen korostui kasvuhakuisuuden lisääntyessä. Agenttiteoria sai vahvistusta omistajajäsenten valvonnan tarpeen painottuessa ja stewardship -teorian mukaisesti hallitusammattilaiset katsoivat osaamisensa hyödyntämisen olevan palkitsemista tärkeämpää.

Chemotherapy versus support cancer treatment in advanced gastric cancer: a meta-analysis

The aim of the present study was to compare the efficacy of chemotherapy and support treatment in patients with advanced non-resectable gastric cancer in a systematic review and meta-analysis of randomized clinical trials that included a comparison of chemotherapy and support care treatment in patients diagnosed with gastric adenocarcinoma, regardless of their age, gender or place of treatment. The search strategy was based on the criteria of the Cochrane Base, using the following key words: 1) randomized clinical trials and antineoplastic combined therapy or gastrointestinal neoplasm, 2) stomach neoplasm and drug therapy, 3) clinical trial and multi-modality therapy, 4) stomach neoplasm and drug therapy or quality of life, 5) double-blind method or clinical trial. The search was carried out using the Cochrane, Medline and Lilacs databases. Five studies fulfilled the inclusion criteria, for a total of 390 participants, 208 (53%) receiving chemotherapy, 182 (47%) receiving support care treatment and 6 losses (1.6%). The 1-year survival rate was 8% for support care and 20% for chemotherapy (RR = 2.14, 95% CI = 1.00-4.57, P = 0.05); 30% of the patients in the chemotherapy group and 12% in the support care group attained a 6-month symptom-free period (RR = 2.33, 95% CI = 1.41-3.87, P < 0.01). Quality of life evaluated after 4 months was significantly better for the chemotherapy patients (34%; RR = 2.07, 95% CI = 1.31-3.28, P < 0.01) with tumor mass reduction (RR = 3.32, 95% CI = 0.77-14.24, P = 0.1). Chemotherapy increased the 1-year survival rate of the patients and provided a longer symptom-free period of 6 months and an improvement in quality of life.

Efficacy of cognitive behavioral therapy in reducing psychiatric symptoms in patients with implantable cardioverter defibrillator: an integrative review

This article is a systematic review of the available literature on the benefits that cognitive behavioral therapy (CBT) offers patients with implanted cardioverter defibrillators (ICDs) and confirms its effectiveness. After receiving the device, some patients fear that it will malfunction, or they remain in a constant state of tension due to sudden electrical discharges and develop symptoms of anxiety and depression. A search with the key words “anxiety”, “depression”, “implantable cardioverter”, “cognitive behavioral therapy” and “psychotherapy” was carried out. The search was conducted in early January 2013. Sources for the search were ISI Web of Knowledge, PubMed, and PsycINFO. A total of 224 articles were retrieved: 155 from PubMed, 69 from ISI Web of Knowledge. Of these, 16 were written in a foreign language and 47 were duplicates, leaving 161 references for analysis of the abstracts. A total of 19 articles were eliminated after analysis of the abstracts, 13 were eliminated after full-text reading, and 11 articles were selected for the review. The collection of articles for literature review covered studies conducted over a period of 13 years (1998-2011), and, according to methodological design, there were 1 cross-sectional study, 1 prospective observational study, 2 clinical trials, 4 case-control studies, and 3 case studies. The criterion used for selection of the 11 articles was the effectiveness of the intervention of CBT to decrease anxiety and depression in patients with ICD, expressed as a ratio. The research indicated that CBT has been effective in the treatment of ICD patients with depressive and anxiety symptoms. Research also showed that young women represented a risk group, for which further study is needed. Because the number of references on this theme was small, further studies should be carried out.

Influence of population and exercise protocol characteristics on hemodynamic determinants of post-aerobic exercise hypotension

Due to differences in study populations and protocols, the hemodynamic determinants of post-aerobic exercise hypotension (PAEH) are controversial. This review analyzed the factors that might influence PAEH hemodynamic determinants, through a search on PubMed using the following key words: “postexercise” or “post-exercise” combined with “hypotension”, “blood pressure”, “cardiac output”, and “peripheral vascular resistance”, and “aerobic exercise” combined only with “blood pressure”. Forty-seven studies were selected, and the following characteristics were analyzed: age, gender, training status, body mass index status, blood pressure status, exercise intensity, duration and mode (continuous or interval), time of day, and recovery position. Data analysis showed that 1) most postexercise hypotension cases are due to a reduction in systemic vascular resistance; 2) age, body mass index, and blood pressure status influence postexercise hemodynamics, favoring cardiac output decrease in elderly, overweight, and hypertensive subjects; 3) gender and training status do not have an isolated influence; 4) exercise duration, intensity, and mode also do not affect postexercise hemodynamics; 5) time of day might have an influence, but more data are needed; and 6) recovery in the supine position facilitates systemic vascular resistance decrease. In conclusion, many factors may influence postexercise hypotension hemodynamics, and future studies should directly address these specific influences because different combinations may explain the observed variability in postexercise hemodynamic studies.

Effects of Obesity and Weight Loss Following Bariatric Surgery on Brain Function, Structural Integrity and Metabolism

Obesity is one of the key challenges to health care system worldwide and its prevalence is estimated to rise to pandemic proportions. Numerous adverse health effects follow with increasing body weight, including increased risk of hypertension, diabetes, hypercholesterolemia, musculoskeletal pain and cancer. Current evidence suggests that obesity is associated with altered cerebral reward circuit functioning and decreased inhibitory control over appetitive food cues. Furthermore, obesity causes adverse shifts in metabolism and loss of structural integrity within the brain. Prior cross-sectional studies do not allow delineating which of these cerebral changes are recoverable after weight loss. We compared morbidly obese subjects with healthy controls to unravel brain changes associated with obesity. Bariatric surgery was used as an intervention to study which cerebral changes are recoverable after weight loss. In Study I we employed functional magnetic resonance imaging (fMRI) to detect the brain basis of volitional appetite control and its alterations in obesity. In Studies II-III we used diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) to quantify the effects of obesity and the effects of weight loss on structural integrity of the brain. In study IV we used positron emission tomography (PET) with [18F]-FDG in fasting state and during euglycemic hyperinsulinemia to quantify effects of obesity and weight loss on brain glucose uptake. The fMRI experiment revealed that a fronto-parietal network is involved in volitional appetite control. Obese subjects had lower medial frontal and dorsal striatal brain activity during cognitive appetite control and increased functional connectivity within the appetite control circuit. Obese subjects had initially lower grey matter and white matter densities than healthy controls in VBM analysis and loss of integrity in white matter tracts as measured by DTI. They also had initially elevated glucose metabolism under insulin stimulation but not in fasting state. After the weight loss following bariatric surgery, obese individuals’ brain volumes recovered and the insulin-induced increase in glucose metabolism was attenuated. In conclusion, obesity is associated with altered brain function, coupled with loss of structural integrity and elevated glucose metabolism, which are likely signs of adverse health effects to the brain. These changes are reversed by weight loss after bariatric surgery, implicating that weight loss has a causal role on these adverse cerebral changes. Altogether these findings suggest that weight loss also promotes brain health.Key words: brain, obesity, bariatric surgery, appetite control, structural magnetic resonance

Improving oral healthcare in Scotland with special reference to sustainability and caries prevention

Brett Duane Improving oral healthcare in Scotland with special reference to sustainability and caries prevention University of Turku, Faculty of Medicine, Institute of Dentistry, Community Dentistry, Finnish Doctoral Program in Oral Sciences (FINDOS-Turku), Turku, Finland Annales Universitatis Turkuensis, Sarja- Ser. D, Medica-Odontologica. Painosalama Oy, Turku, Finland, 2015. Dentistry must provide sustainable, evidence-based, and prevention-focused care. In Scotland oral health prevention is delivered through the Childsmile programme, with an increasing use of high concentration fluoride toothpaste (HCFT). Compared with other countries there is little knowledge of xylitol prevention. The UK government has set strict carbon emission limits with which all national health services (NHS) must comply. The purpose of these studies was firstly to describe the Scottish national oral health prevention programme Childsmile (CS), to determine if the additional maternal use of xylitol (CS+X) was more effective at affecting the early colonisation of mutans streptococci (MS) than this programme alone; secondly to analyse trends in the prescribing and management of HCFT by dentists; and thirdly to analyse data from a dental service in order to improve its sustainability. In all, 182 mother/child pairs were selected on the basis of high maternal MS levels. Motherswere randomly allocated to a CS or CS+X group, with both groups receiving Childsmile. Theintervention group consumed xylitol three times a day, from when the child was 3 months until 24 months. Children were examined at age two to assess MS levels. In order to understand patterns of HCFT prescribing, a retrospective secondary data analysis of routine prescribing data for the years 2006-2012 was performed. To understand the sustainability of dental services, carbon accounting combined a top-down approach and a process analysis approach, followed by the use of Pollard’s decision model (used in other healthcare areas) to analyse and support sustainable service reconfiguration. Of the CS children, 17% were colonised with MS, compared with 5% of the CS+X group. This difference was not statistically significant (P=0.1744). The cost of HCFT prescribing increased fourteen-fold over five years, with 4% of dentists prescribing 70% of the total product. Travel (45%), procurement (36%) and building energy (18%) all contributed to the 1800 tonnes of carbon emissions produced by the service, around 4% of total NHS emissions. Using the analytical model, clinic utilisation rates improved by 56% and patient travel halved significantly reducing carbon emissions. It can be concluded that the Childsmile programme was effective in reducing the risk for MS transmission. HCFT is increasing in Scotland and needs to be managed. Dentistry has similar carbon emissions proportionally as the overall NHS, and the use of an analytic tool can be useful in helping identify these emissions. Key words: Sustainability, carbon emissions, xylitol, mutans streptococci, fluoride toothpaste, caries prevention.