Distriktssköterskans roll vid empowerment hos äldre individer med diabetes typ 2 : Systematisk Litteraturstudie

Distriktssköterskans roll är av stor betydelse vid införandet av ett empowerment baserat förhållningssätt gentemot den äldre individen med diabetes typ 2. Empowerment är ett begrepp som uppkommit i samband den humanistiska människosynen och används i syfte att öka patienternas egenvårdsförmåga och självstyre i skötseln av sin diabetes. Livskvalitén ökar av individens delaktighet och självbestämmande, att själv kunna ansvara för sin sjukdom med stöd av distriktssköterskan. Empowerment baserad utbildning i grupp vid återkommande träffar för att få riklig kunskap om diabetes typ 2, med möjlighet till individuella träffar där individerna skapar sina egna mål är av största vikt för att bedriva egenvård. Lagar och författningar som styr distriktssköterskans arbete genomsyras av humanism. Distriktssköterskan behöver få utbildning i att använda sig av ett empowerment baserat arbetssätt och de behöver arbetsledningens stöd då det krävs ökade resurser vid införandet av ett nytt arbetssätt. Empowerment baserad grupputbildning ger en ökad förbättring av den glykemiska kontrollen för äldre individer. Diabetes typ 2 är en sjukdom som ökar i takt med att befolkningen blir äldre. Studien har genomförts som systematisk litteraturstudie.

Växa och verka i Dalarna - Om ett projekt för att stärka positionen för individer som stått utanför arbetsmarknaden under en längre tid

Projektet Växa och verka i Dalarna har genomförts under perioden januari 2006 till och med november 2007. Verksamheten har riktat sig till arbetslösa, inskrivna vid arbetsförmedlingen som var eller riskerade att bli långtidsarbetslösa. Aktiviteterna var inriktade på att deltagarna själva aktivt skulle ”undersöka sina möjligheter att skapa sin egen försörjning, att ha flera ben att stå på, /…/” (Projektplanen). Detta krävde att deltagarna i projektet hade en ”stark vilja, god disciplin och en bra dos av entreprenörskap.” (Projektplanen) Projektet lyckades väl i sin måluppfyllelse, sålunda gick 74 procent till arbete, fortsatte studera, eller startade eget företag. Resultatet kan jämföras med att målet var 60 procent, vilket sannolikt också blivit än högre om man inte hade behövt bredda målgruppen som en effekt av att det var svårt att rekrytera tillräckligt med deltagare utifrån de kriterier som hade ställts upp. En del av resultatet kan därför sannolikt förklaras av att det var en särskilt motiverad målgrupp som projektet arbetade med. Projektet Växa och verka i Dalarna har visat på att det finns en grupp arbetslösa, även bland dem som har gått arbetslösa länge, där det är möjligt att underlätta deras återinträde på arbetsmarknaden med gott resultat. Detta kan ske genom att de tränas och tillåts att vara aktiva och ta ett eget ansvar för sin situation, d.v.s. att de ges frihet att agera och inte bara tvingas att söka det ena arbetet efter det andra. Genom regelbundna kontakter mellan deltagare och coacher var det tämligen enkelt att upptäcka om någon deltagare försökte ”gå den lätta vägen”. Projektet visade även att gruppen arbetslösa är heterogen och att det krävs olika typer av åtgärder riktade mot olika grupper, d.v.s. beroende på individernas bakgrund och tidigare erfarenheter. Det visade sig relativt snart, eftersom det blev mer eller mindre omöjligt att rekrytera deltagare som svarade upp mot de kriterier som ställts upp.

Mentorskap & kompetensutveckling - En utvärderande studie av ett projekt omcoaching av arbetslösa och sjukskrivna individer som länge stått utanför arbetsmarkanden

Projektet Mentorskap & kompetensutveckling har genomförts under perioden september 2006 till oktober 2007. ABF Gästrikebygden har varit projektägare och verksamheten har bedrivits i samarbete med Arbetsförmedlingen och Försäkringskassan i Gävle som ett Växtkraft Mål-3-projekt inom Europeiska Socialfonden. Syftet med projektet formuleradesbåde med kvalitativa och kvantitativa mål, i vilka angavs vad deltagarna skulle ha uppnått när de lämnade projektet.Målgrupper har dels varit personer som varit långvarigt arbetslösa, vilka anvisats via Arbetsförmedlingen, eller också har de varit långtidssjukskrivna och då anvisats via Försäkringskassan.Studien syftar till att beskriva de resultat och erfarenheter som projektet har gett upphov till. Resultatet tolkas och bedöms i första hand i relation till uppsatta mål, men också till andra upplevda effekter. Det övergripande syftet är att utvärdera hur ett arbetsmarknadspolitiskt projekt kan stödja långtvarigt arbetslösas och sjukskrivnas inträde på arbetsmarknaden.Resultatet visar att projektet i flera avseenden har haft påvisbara effekterför deltagarna som går bortom de rent arbetsmarknadspolitiska, d.v.s. det har på ett direkt och påtagligt sätt påverkat de involverade aktörerna i deras vardag. För många konfronterades deras livssituation på ett sätt som kan uppfattas som påfrestande, men att det samtidigt kunde vara en vändpunkt i livet.

Faktorer som har betydelse för välbefinnande hos individer med KOL : - en litteraturstudie

Abstrakt Bakgrund: Kronisk obstruktiv lungsjukdom (KOL) är en kronisk inflammatorisk sjukdom där tobaksröken är den främsta orsaken till uppkomsten. Det är en sjukdom som ofta utvecklas under lång tid innan den uppmärksammas och den har en dödlig utgång. Syfte: Denna litteraturstudies syfte var att belysa faktorer av betydelse för välbefinnandet hos individer med KOL, se vilka copingstrategier de använder sig av, samt vad sjuksköterskan kan göra för att stödja dessa individer. Metod: Litteraturstudien baserades på 19 internationellt publicerade vetenskapliga studier. Innehållsanalysen ledde fram till sju teman. Resultat: Fynden i denna litteraturstudie visar att faktorer som att klara saker själv och socialt stöd hade en positiv inverkan på välbefinnandet. Med copingstrategier som att ha en positiv attityd, ta hjälp av professionella, ta kontroll och fokusera på andra saker kunde individen känna välbefinnande trots sin sjukdom. Det var viktigt att sjuksköterskan hade kunskap inom området och ett professionellt förhållningssätt. Slutsats: Om sjuksköterskan ger relevant information och stödjer dessa patienter i ett tidigt skede, kan individen känna välbefinnande trots sin sjukdom. Vidare forskning inom området med fokus på hur anhöriga påverkas av sjukdomen skulle vara intressant.

Den fysiska miljöns påverkan på individer med demenssjukdom

Demens är en neurodegenerativ sjukdom där kognitiv och funktionell nedsättning uppstår. Det finns inget botemedel för demenssjukdom utan målet är att förbättra och stödja livet för individerna som drabbats, vilket kan tillämpas genom anpassning av den fysiska miljön. Syftet med litteraturstudien var att belysa den fysiska miljöns påverkan på individer med demenssjukdom utifrån vårdpersonal och forskares uppfattningar. Metoden som tillämpades var en litteraturstudie enligt Polit och Becks (2012) nio-stegsmodell med datainsamling genom databaserna Cinahl och PubMed. Artiklarna genomgick Polit och Becks (2012) granskningsmallar för kvalitativa respektive kvantitativa studier. Detta resulterade i 12 vetenskapliga artiklar som bearbetades till olika teman. Resultatet redovisades med fem olika teman: minskad agitation, ökad orienteringsförmåga, ökat engagemang och uppmärksamhet, ökad social interaktion och ökat välbefinnande. Slutsatsen var att individerna med demenssjukdom påverkades av den fysiska miljön genom att den utbringade lugn, autonomi, trygghet, självständighet, frihet, värdighet och en känsla av att ha kontroll och att känna sig hemma. Detta samtidigt som personalen kunde få mer tid till att umgås och/eller utföra aktiviteter med individerna.

Analys av NIR hårdvaruuppsättning samt metod för fotografering av individer i fordon

Abstract Purpose – To study the possibility of using a NIR hardware solution to photograph individuals in a private vehicle as well as an analysis of its images. Method – A study of existing theories around the NIR-method’s performance in selected conditions and individual tests were performed to examine if the literature statements were valid for this study. Two empirical tests have been carried out, the first was carried out at Kapsch test track and the other outside the test track in a single stationary test. An interview which formed the basis for the assessment on the quality of empirical data with a focus on computer-based detection of the number of individuals in the vehicle. Findings – The results have demonstrated the potential of the NIR method’s performance in a fully automated detection system for the number of individuals inside the vehicle. Empirical data indicates that the method can depict individuals inside vehicles of sufficiently high quality, but it is greatly affected by reflections, weather and light conditions. Implications – Result supports the assumption that the NIR method using an external light source can be used to image the interior through a varying number of weather and lightning conditions. The study originated until the results suggested that a NIR-based hardware setup can create images with high enough quality for the human eye to be able to detect the number of individuals inside the vehicle.If the overall performance into account, it suggests that the main problem with the use of the hardware set is to maintain the quality of the whole sample and that the crucial variables for the method’s performance is the influence of light and reflection conditions. Limitations – The major limitations have been that we limited ourselves to a subjective analysis of the selection and assessment on the image features for computer-based detection of the number of individuals in the vehicle. We were limited to two tests, one in tough conditions where only the driver was in the vehicle and the second stationary test, where the focus was on the number of people in vehicles and light sources impact on the result.

Att bekämpa det onda eller främja det goda : Fyra verksamhetsperspektiv på individer i våldsbejakandemiljöer samt preventionsarbete runt dessa

To fight evil or promote good: Four organizational perspectives on individuals inviolent environments and prevention work around them. The purpose of this article is to examine organizational understandings and perceptions that can affect the current work with defectors from and members in violent and extremist environments. The empirical material consists primarily of answers to open questions in a survey, where professionals from four organizations are represented: social services, school, police and politics. The material is analyzed with direct qualitative content analysis and shows two contradict approaches to the problem; one that argues for ”fighting the evil” and another that argues for ”promoting the good”. The theoretical framework presented is Erving Goffmans’ frame analysis, Howard S. Beckers’ labelling process and Ingrid Sahlins’ discussion about different kinds of prevention strategies. The results show how organizational understandings and perceptions are far from uniform but rather disparate, and also that assumptions made by professionals have wide implications – often related to morally based approaches grounded on notions of good and evil.

Lagöversättning som process och produkt : Revideringar och institutioner vid lagöversättning till svenska i Finland

The thesis studies the translation process for the laws of Finland as they are translated from Finnish into Swedish. The focus is on revision practices, norms and workplace procedures. The translation process studied covers three institutions and four revisions. In three separate studies the translation process is analyzed from the perspective of the translations, the institutions and the actors. The general theoretical framework is Descriptive Translation Studies. For the analysis of revisions made in versions of the Swedish translation of Finnish laws, a model is developed covering five grammatical categories (textual revisions, syntactic revisions, lexical revisions, morphological revisions and content revisions) and four norms (legal adequacy, correct translation, correct language and readability). A separate questionnaire-based study was carried out with translators and revisers at the three institutions. The results show that the number of revisions does not decrease during the translation process, and no division of labour can be seen at the different stages. This is somewhat surprising if the revision process is regarded as one of quality control. Instead, all revisers make revisions on every level of the text. Further, the revisions do not necessarily imply errors in the translations but are often the result of revisers following different norms for legal translation. The informal structure of the institutions and its impact on communication, visibility and workplace practices was studied from the perspective of organization theory. The results show weaknesses in the communicative situation, which affect the co-operation both between institutions and individuals. Individual attitudes towards norms and their relative authority also vary, in the sense that revisers largely prioritize legal adequacy whereas translators give linguistic norms a higher value. Further, multi-professional teamwork in the institutions studied shows a kind of teamwork based on individuals and institutions doing specific tasks with only little contact with others. This shows that the established definitions of teamwork, with people co-working in close contact with each other, cannot directly be applied to the workplace procedures in the translation process studied. Three new concepts are introduced: flerstegsrevidering (multi-stage revision), revideringskedja (revision chain) and normsyn (norm attitude). The study seeks to make a contribution to our knowledge of legal translation, translation processes, institutional translation, revision practices and translation norms for legal translation. Keywords: legal translation, translation of laws, institutional translation, revision, revision practices, norms, teamwork, organizational informal structure, translation process, translation sociology, multilingual.

Molecular mechanisms of cancer predisposition in HNPCC/Lynch syndrome

Hereditary non-polyposis colorectal carcinoma (HNPCC; Lynch syndrome) is among the most common hereditary cancers in man and a model of cancers arising through deficient DNA mismatch repair (MMR). It is inherited in a dominant manner with predisposing germline mutations in the MMR genes, mainly MLH1, MSH2, MSH6 and PMS2. Both copies of the MMR gene need to be inactivated for cancer development. Since Lynch syndrome family members are born with one defective copy of one of the MMR genes in their germline, they only need to acquire a so called second hit to inactivate the MMR gene. Hence, they usually develop cancer at an early age. MMR gene inactivation leads to accumulation of mutations particularly in short repeat tracts, known as microsatellites, causing microsatellite instability (MSI). MSI is the hallmark of Lynch syndrome tumors, but is present in approximately 15% of sporadic tumors as well. There are several possible mechanisms of somatic inactivation (i.e. the second hit ) of MMR genes, for instance deletion of the wild-type copy, leading to loss of heterozygosity (LOH), methylation of promoter regions necessary for gene transcription, or mitotic recombination or gene conversion. In the Lynch syndrome tumors carrying germline mutations in the MMR gene, LOH was found to be the most frequent mechanism of somatic inactivation in the present study. We also studied MLH1/MSH2 deletion carriers and found that somatic mutations identical to the ones in the germline occurred frequently in colorectal cancers and were also present in extracolonic Lynch syndrome-associated tumors. Chromosome-specific marker analysis implied that gene conversion, rather than mitotic recombination or deletion of the respective gene locus accounted for wild-type inactivation. Lynch syndrome patients are predisposed to certain types of cancers, the most common ones being colorectal, endometrial and gastric cancer. Gastric cancer and uroepithelial tumors of bladder and ureter were observed to be true Lynch syndrome tumors with MMR deficiency as the driving force of tumorigenesis. Brain tumors and kidney carcinoma, on the other hand, were mostly MSS, implying the possibility of alternative routes of tumor development. These results present possible implications in clinical cancer surveillance. In about one-third of families suspected of Lynch syndrome, mutations in MMR genes are not found, and we therefore looked for alternative mechanisms of predisposition. According to our results, large genomic deletions, mainly in MSH2, and germline epimutations in MLH1, together explain a significant fraction of point mutation-negative families suspected of Lynch syndrome and are associated with characteristic clinical and family features. Our findings have important implications in the diagnosis and management of Lynch syndrome families.

Adult-type hypolactasia: Genotype-phenotype correlation

Adult-type hypolactasia (primary lactose malabsorption, lactase non-persistence) is the most common enzyme deficiency worldwide, and manifests with symptoms of lactose intolerance such as abdominal pain, gas formation and diarrhea. In humans with adult-type hypolactasia, lactase activity is high at birth, but declines during childhood to about one-tenth of the activity at birth. In 2002, a one base polymorphism C/T-13910, located 14 kilobases from the starting codon of the lactase-phlorizin hydrolase (LPH) gene was observed to be associated with the persistence of lactase activity. The T-13910 allele (C/T-13910 and T/T-13910 genotypes) associates with persistence of lactase activity throughout life, whereas the C/C-13910 genotype associates with adult-type hypolactasia. In this thesis work, the timing and mechanism of decline of lactase enzyme activity during development was studied using the C/T-13910 polymorphism as a molecular marker. We observed an excellent correlation between low lactase activity and the C/C-13910 genotype in all subjects > 12 years of age, irrespective their ethnicity. In children of African origin, the lactase activity declined somewhat earlier than among Finnish children. Furthermore, we observed an increasing imbalance in the relative lactase mRNA expression from the C-13910 and T-13910 alleles in Finnish children beginning from five years of age. The genetic test for adult-type hypolactasia showed a sensitivity of 93% and a specificity of 100% in the Finnish children and adolescents > 12 years of age. The relation of milk consumption and the milk-related abdominal complaints to the C/T-13910 genotypes associated with lactase persistence/non-persistence was studied by a questionnaire-based approach in > 2100 Finns. Both Finnish children and adults with the C/C-13910 genotype consumed significantly less dairy products compared to those with the C/T-13910 and T/T-13910 genotypes. Flatulence was the only of the abdominal symptoms of lactose intolerance that subjects with the C/C-13910 genotype reported significantly more often than those with the C/T-13910 and T/T-13910 genotypes. A minor proportion (<10%) of subjects with the C/C-13910 genotype, nevertheless, reported drinking milk without any symptoms afterwards. There was no association between cow's milk allergy starting as a newborn and adult-type hypolactasia. In an association study an increased risk of colorectal cancer was observed among those with molecular diagnosis of adult-type hypolactasia. It warrants further studies to clarify whether the increased risk observed in the Finnish population is associated with lactose or decreased intake of dairy products in these subjects.

Campylobacter Infections of Domestic Origin in Finland

Campylobacter jejuni and C. coli are the leading causes of human bacterial gastroenteritis in developed countries. Most human Campylobacter infections are sporadic and a seasonal peak in the distribution of infections can be seen in the summer months in several countries, including Finland. A variety of risk factors for Campylobacter infections have been identified; handling and eating poultry, drinking unpasteurized milk, contact with domestic animals, and travelling abroad. However, the relative importance of the different risk factors in sporadic cases of Campylobacter infection remains unknown. In most cases, the infection is self-limiting and no specific treatment is required. Campylobacter enteritis can cause a wide range of complications, including reactive arthritis (ReA) that is reported in 1-5% of the cases. Seven clinical microbiology laboratories serving different geographical areas of Finland, participated in this multi-centre study, conducted during a seasonal peak in 2002. In a matched case-control study, domestically-acquired sporadic Campylobacter infections from three geographical areas were collected. The final study comprised 100 cases and 137 controls. Risk factors for sporadic domestically-acquired Campylobacter infections were identified on the basis of a questionnaire; swimming in natural waters was found to be a novel risk factor for Campylobacter infection. Other independent risk factors were tasting or eating raw or undercooked meat and drinking untreated water from a dug well. The role of bacterial strain and host characteristics are not fully understood in Campylobacter infections. Exposure factors, demographical characteristics, and the serotype of the Campylobacter isolate may affect the severity of the enteritis. This cross-sectional study comprised 114 patients with C. jejuni enteritis, diagnosed in three clinical microbiology laboratories; most of the patients had participated in the previous case-control study. Swimming was associated with age ≤ 5 years and serotype Pen 6,7 was found significantly more often among patients reporting swimming. The geographical distribution among serotypes varied; serotype Pen 4-complex appeared more often in patients from urban areas and serotype Pen 21 among patients from more rural areas. Thus, risk factors and sources of infection for C. jejuni infection may vary among individuals depending on age and geographical location. The in vitro susceptibilities of C. jejuni and C. coli strains isolated from patients infected abroad (85 strains) or domestically (393 strains) revealed that susceptibility to erythromycin is still high, even among isolates of foreign origin. However, the novel antimicrobial agent telithromycin did not offer any advantage over erythromycin; isolates with high minimal inhibitory concentrations (MICs) for erythromycin also showed reduced susceptibility to telithromycin. Reduced susceptibility to fluoroquinolones was detected almost exclusively among isolates of foreign origin and half of these isolates with high MICs for fluoroquinolones also showed elevated MICs for doxycycline. Questionnaires concerning complications associated with C. jejuni enteritis were sent to patients two months after becoming ill; 201 patients from seven different geographical areas were included in the study. Musculoskeletal complications after C. jejuni infection were commonly reported by patients (39%). The incidence of classical ReA was 4% and that of Achilles enthesopathy and/or heel pain 9%. Other C. jejuni-associated reactive joint symptoms were commonly reported, however, due to their milder nature seldom seen and diagnosed by a physician. The severity of the enteritis may predict further complications; stomach ache during enteritis was connected to the development of later joint pain. Early antimicrobial treatment, within two days from the start of symptoms, shortened the duration of diarrhoea by two days but did not prevent later musculoskeletal complications. Campylobacter is an important human enteropathogen and causes a significant burden of illness. As the incidence of Campylobacter infections is high, the importance of the infection and the occurrence of complications will increase. This stresses the importance of understanding the risk factors for acquiring Campylobacter infection and how bacterial strain and host characteristics may affect the risk for infection. The role of antimicrobial treatment for acute Campylobacter enteritis seems to be marginal and should be used restrictively.

Individuals on the Move : Body Condition Dependent Dispersal and Quasi-Local Competition in Metapopulations

Individual movement is very versatile and inevitable in ecology. In this thesis, I investigate two kinds of movement body condition dependent dispersal and small-range foraging movements resulting in quasi-local competition and their causes and consequences on the individual, population and metapopulation level. Body condition dependent dispersal is a widely evident but barely understood phenomenon. In nature, diverse relationships between body condition and dispersal are observed. I develop the first models that study the evolution of dispersal strategies that depend on individual body condition. In a patchy environment where patches differ in environmental conditions, individuals born in rich (e.g. nutritious) patches are on average stronger than their conspecifics that are born in poorer patches. Body condition (strength) determines competitive ability such that stronger individuals win competition with higher probability than weak individuals. Individuals compete for patches such that kin competition selects for dispersal. I determine the evolutionarily stable strategy (ESS) for different ecological scenarios. My models offer explanations for both dispersal of strong individuals and dispersal of weak individuals. Moreover, I find that within-family dispersal behaviour is not always reflected on the population level. This supports the fact that no consistent pattern is detected in data on body condition dependent dispersal. It also encourages the refining of empirical investigations. Quasi-local competition defines interactions between adjacent populations where one population negatively affects the growth of the other population. I model a metapopulation in a homogeneous environment where adults of different subpopulations compete for resources by spending part of their foraging time in the neighbouring patches, while their juveniles only feed on the resource in their natal patch. I show that spatial patterns (different population densities in the patches) are stable only if one age class depletes the resource very much but mainly the other age group depends on it.

Cooperation and conflict in conspecific brood parasitism : an alternative reproductive tactic

Interactions among individuals give rise to both cooperation and conflict. Individuals will behave selfishly or altruistically depending on which gives the higher payoff. The reproductive strategies of many animals are flexible and several alternative tactics may be present from which the most suitable one is applied. Generally, alternative reproductive tactics may be defined as a response to competition from individuals of the same sex. These alternative reproductive tactics are means by which individuals may fine-tune their fitness to the reigning circumstances and which are shaped by the environment individuals are occupying as well as by the behaviour of other individuals sharing the environment. By employing such alternative ways of achieving reproductive output, individuals may alleviate competition from others. Conspecific brood parasitism (CBP) is an alternative reproductive strategy found in several egg laying animal groups, and it is especially common among waterfowl. Within this alternative reproductive strategy, four reproductive options can be identified. These four options represent a continuum from low reproductive effort coupled with low fitness returns, to high reproductive effort and consequently high benefits. It may not be evident how individuals should allocate reproductive effort between eggs laid in their own nest vs. in nests of others, however. Limited fecundity will constrain the number of eggs donated by a parasite, but also the tendency for hosts to accept parasitic eggs may affect the allocation decision. Furthermore, kinship, individual quality and the costs of breeding may play a role in complicating the allocation decision. In this thesis, I view the seemingly paradoxical effects of kinship on conflict resolution in the context of alternative reproductive tactics, examining the resulting features of cooperation and conflict. Conspecific brood parasitism sets the stage for investigating these questions. By using both empirical and theoretical approaches, I examine the nature of CBP in a brood parasitic duck, the Barrow's goldeneye (Bucephala islandica). The theoretical chapter of this thesis gives rise to four main conclusions. Firstly, variation in individual quality plays a central role in shaping breeding strategies. Secondly, kinship plays a central role in the evolution of CBP. Thirdly, egg recognition ability may affect the prevalence of parasitism. If egg recognition is perfect, higher relatedness between host and parasite facilitates CBP. Finally, I show that the relative costs of egg laying and post-laying care play a so far underestimated role in determining the prevalence of parasitism. The costs of breeding may outweigh possible inclusive fitness benefits accrued from receiving eggs from relatives. Several of the patterns brought out by the theoretical work are then confirmed empirically in the following chapters. Findings include confirmation of the central role of relatedness in determining the extent of parasitism as well as inducing a counterintuitive host clutch reduction. Furthermore, I demonstrate a cost of CBP inflicted on hosts, as well as results suggesting that host age reflects individual quality, affecting the ability to overcome costs inflicted by CBP. In summary, I demonstrate both theoretically and empirically the presence of cooperation and conflict in the interactions between conspecific parasites and their hosts. The field of CBP research has traditionally been divided, but the first steps have now been taken toward the acceptance of the opposite side of the divide. Especially the theoretical findings of chapter 1 offer the possibility to view seemingly contrasting results of various studies within the same framework, and may direct future research toward more general features underlying differences in the patterns of CBP between populations or species.

Kin selection, social polymorphism, and reproductive allocation in ants

Social groups are common across animal species. The reasons for grouping are straightforward when all individuals gain directly from cooperating. However, the situation becomes more complex when helping entails costs to the personal reproduction of individuals. Kin selection theory has offered a fruitful framework to explain such cooperation by stating that individuals may spread their genes not only through their own reproduction, but also by helping related individuals reproduce. However, kin selection theory also implicitly predicts conflicts when groups consist of non-clonal individuals, i.e. relatedness is less than one. Then, individual interests are not perfectly aligned, and each individual is predicted to favour the propagation of their own genome over others. Social insects provide a solid study system to study the interplay between cooperation and conflict. Breeding systems in social insects range from solitary breeding to eusocial colonies displaying complete division of reproduction between the fertile queen and the sterile worker caste. Within colonies, additional variation is provided by the presence of several reproductive individuals. In many species, the queen mates multiply, which causes the colony to consist of half-sib instead of full-sib offspring. Furthermore, in many species colonies contain multiple breeding queens, which further dilutes relatedness between colony members. Evolutionary biology is thus faced with the challenge to answer why such variation in social structure exists, and what the consequences are on the individual and population level. The main part of this thesis takes on this challenge by investing the dynamics of socially polymorphic ant colonies. The first four chapters investigate the causes and consequences of different social structures, using a combination of field studies, genetic analyses and laboratory experiments. The thesis ends with a theoretical chapter focusing on different social interactions (altruism and spite), and the evolution of harming traits. The main results of the thesis show that social polymorphism has the potential to affect the behaviour and traits of both individuals and colonies. For example, we found that genetic polymorphism may increase the phenotypic variation between individuals in colonies, and that socially polymorphic colonies may show different life history patterns. We also show that colony cohesion may be enhanced even in multiple-queen colonies through patterns of unequal reproduction between queens. However, the thesis also demonstrates that spatial and temporal variation between both populations and environments may affect individual and colony traits, to the degree that results obtained in one place or at one time may not be applicable in other situations. This opens up potential further areas of research to explain these differences.

Invasive pneumococcal infections in Finland before routine use of conjugate vaccines : opportunities for prevention

Streptococcus pneumoniae is a leading cause of pneumonia, meningitis and bacteremia worldwide. The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for adults less than 65 years old with certain chronic medical conditions and for all elderly persons because of high rates of invasive pneumococcal infections (IPI) and increased risk of death. This study provides a comprehensive picture of the epidemiology of pneumococcal infections in Finland before the introduction of childhood pneumococcal conjugate vaccines, focusing on disease rates, risk factors, clinical outcome, and healthcare associated infections. This study was based on national, population-based laboratory surveillance for IPI. Information on all episodes of IPI was collected from the primary diagnostic laboratory. A case with IPI was defined as the isolation of S. pneumoniae from blood or cerebrospinal fluid during 1995-2002. Information on comorbidities and underlying conditions for IPI patients was obtained by linking the IPI surveillance database to other national, population-based health registries using each patient’s unique national identity code. In total, 4357 cases of IPI were identified. The overall annualized IPI incidence increased by 35% during the study period and was 10.6 per 100 000 population. The temporal increase in disease rates was associated with higher blood culturing rates over time. In working age adults, two-thirds of severe infections and one half of fatal cases occurred in persons with no recognized PPV23 indication. Persons with asthma were at increased risk for IPI and this new risk factor accounted for 5% of the overall disease burden. One tenth of pneumococcal bacteremias were healthcare-associated, and mortality among these patients was over twice as high as among patients with community-associated bacteremia. Most patients with nosocomial infections had underlying conditions for which PPV23 is recommended. The incidence of IPI in Finland has increased and the overall disease burden is higher than previously reported. The findings of this study underscore the urgent need for improved prevention efforts against pneumococcal infections in Finland through increased use of PPV23 in adult risk groups and introduction of childhood immunization with pneumococcal conjugate vaccine.