Liikkuva koulu -ohjelma alakoulujen liikunnallisen toimintakulttuurin edistäjänä

Tiivistelmä. Tämän kandidaatin tutkielman tarkoituksena oli selvittää, kuinka Liikkuva koulu -ohjelma toimii liikunnallisen toimintakulttuurin edistäjänä suomalaisissa alakouluissa. Kirjallisuuskatsauksessa tutkitaan Liikkuva koulu -hankkeen käynnistymistä pilottivaiheesta valtakunnalliseksi ohjelmaksi. Tutkielmassa avataan hankkeen kehitysvaiheita, sen laajentumista ohjelmaksi ja aiheeseen liittyvää tärkeää käsitteistöä sekä kuvataan koulun toimintakulttuurin merkitystä Liikkuva koulu -kontekstissa. Lisäksi tutkielmassa kootaan yhteen luokanopettajien kokemuksia ja näkemyksiä pilottivaiheen toteutumisesta heidän kouluissaan. Tutkielma osoittaa, että Liikkuva koulu -hanke on saavuttanut tavoitteensa valtakunnallisesti sen päästessä osaksi hallitusohjelman 2016–2018 kärkihanketta. Vuoden 2018 lopussa 93 % Suomen kunnista oli rekisteröityneitä Liikkuva koulu -kunniksi. Tutkielman perusteella voidaan sanoa, että koulun toimintakulttuurin vaikutus oppilaiden ja henkilökunnan aktiivisuuteen ja kouluviihtyvyyteen on merkittävä. Toimintakulttuurin vaikutus näkyy koko koulupäivän aikana muun muassa oppitunneilla, välitunneilla, koulumatkaliikuntana sekä erilaisena kerhotoimintana. Johtopäätöksenä voidaan todeta, että luokanopettajien kokemukset Liikkuvan koulun toteutumisesta kouluissaan ovat olleet pääosin positiivisia. Hankkeissa mukana olleiden koulujen hankevastaavien haastatteluista nousi esille useita teemoja, joissa oli koettu onnistumisia. Muun muassa opettajien positiivinen suhtautuminen hankkeeseen sekä myönteisen ilmapiirin lisääntyminen, koulupäivän aikana tapahtuvan liikkumisen mahdollisuuksien lisääminen, koulun toimintakulttuurin muuttuminen, oppilaiden levottomuuden vähentyminen sekä yhteistyön lisääntyminen mainittiin haastatteluissa useaan kertaan. Kehittämisen kohteina haastattelujen perusteella voidaan nähdä koulujen henkilökunnan asenteiden muutokset. Valtaosa opettajista näki toimintakulttuurin muutoksen lisänneen oppilaiden liikkumista ja parantaneen yleistä ilmapiiriä, mutta osa opettajista ei nähnyt vaikutuksia henkilökunnan asenteissa liikkumista kohtaan

Lymphatic endothelium stimulates melanoma metastasis and invasion via MMP14-dependent Notch3 and b1-integrin activation

Lymphatic invasion and lymph node metastasis correlate with poor clinical outcome in melanoma. However, the mechanisms of lymphatic dissemination in distant metastasis remain incompletely understood. We show here that exposure of expansively growing human WM852 melanoma cells, but not singly invasive Bowes cells, to lymphatic endothelial cells (LEC) in 3D co-culture facilitates melanoma distant organ metastasis in mice. To dissect the underlying molecular mechanisms, we established LEC co-cultures with different melanoma cells originating from primary tumors or metastases. Notably, the expansively growing metastatic melanoma cells adopted an invasively sprouting phenotype in 3D matrix that was dependent on MMP14, Notch3 and β1-integrin. Unexpectedly, MMP14 was necessary for LEC-induced Notch3 induction and coincident β1-integrin activation. Moreover, MMP14 and Notch3 were required for LEC-mediated metastasis of zebrafish xenografts. This study uncovers a unique mechanism whereby LEC contact promotes melanoma metastasis by inducing a reversible switch from 3D growth to invasively sprouting cell phenotype

24-h urinary sodium excretion and the risk of adverse outcomes

Aims: The objective was to evaluate whether sodium intake, assessed with the gold standard 24-h urinary collections, was related to long-term incidence of death, cardiovascular disease (CVD) and diabetes mellitus (DM). Methods:A cohort of 4630 individuals aged 25-64 years collected 24-h urine samples in 1979-2002 and were followed up to 14 years for the incidence of any CVD, coronary heart disease (CHD), stroke, heart failure (HF) and DM event, and death. Cox proportional hazards models were used to estimate the association between the baseline salt intake and incident events and adjusted for baseline age, body mass index, serum cholesterol, prevalent DM, and stratified by sex and cohort baseline year. Results: During the follow-up, we observed 423 deaths, 424 CVD events (288 CHD events, 142 strokes, 139 HF events) and 161 DM events. Compared with the highest quartile of salt intake, persons in the lowest quartile had a lower incidence of CVD (hazard ratio [HR] 0.70; 95% confidence interval [CI], 0.51-0.95,p = .02), CHD (HR 0.63 [95% CI 0.42-0.94],p = .02) and DM (HR 0.52 [95% CI 0.31-0.87],p = .01). The results were non-significant for mortality, HF, and stroke. Conclusion: High sodium intake is associated with an increased incidence of CVD and DM.Peer reviewe

Personalized text message and checklist support for initiation of antihypertensive medication: the cluster randomized, controlled check and support trial

Objective: To assess whether the use of a checklist combined with text message support improves systolic blood pressure (SBP) control. Design and setting: A cluster randomized controlled trial in Finnish primary care. Interventions: Personalized text message support and a checklist for initiation of antihypertensive medication. Patients: 111 newly diagnosed hypertensive patients aged 30-75 years. Main outcome measures: The proportion of patients achieving 1) the office SBP target Results: 28% (n = 16) and 31% (n = 17) of patients in the intervention and control groups met the office SBP target, respectively (p = 0.51). The corresponding proportions were 36% (n = 18) and 42% (n = 21) for the home SBP target (p = 0.21). Office SBP decreased 23 mmHg (95% CI: 29-17) in the intervention group and 21 mmHg (95% CI: 27-15) in the control group (p = 0.61). Medication changes, number of antihypertensives at 12 months and health care utilization were similar in both study groups. Patients considered checklist and text message support useful and important. Conclusion: Only a small proportion of patients in the intervention and control groups reached their treatment target despite multiple health care contacts and medication changes. The study interventions did not improve SBP control. However, this study demonstrates new information about hypertension control, antihypertensive medication and health service utilization during the first treatment year.</div

Effect of Inhaled Xenon on Cerebral White Matter Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

IMPORTANCE: Evidence from preclinical models indicates that xenon gas can prevent the development of cerebral damage after acute global hypoxic-ischemic brain injury but, thus far, these putative neuroprotective properties have not been reported in human studies. OBJECTIVE: To determine the effect of inhaled xenon on ischemic white matter damage assessed with magnetic resonance imaging (MRI). DESIGN, SETTING, AND PARTICIPANTS: A randomized single-blind phase 2 clinical drug trial conducted between August 2009 and March 2015 at 2 multipurpose intensive care units in Finland. One hundred ten comatose patients (aged 24-76 years) who had experienced out-of-hospital cardiac arrest were randomized. INTERVENTIONS: Patients were randomly assigned to receive either inhaled xenon combined with hypothermia (33°C) for 24 hours (n = 55 in the xenon group) or hypothermia treatment alone (n = 55 in the control group). MAIN OUTCOMES AND MEASURES: The primary end point was cerebral white matter damage as evaluated by fractional anisotropy from diffusion tensor MRI scheduled to be performed between 36 and 52 hours after cardiac arrest. Secondary end points included neurological outcome assessed using the modified Rankin Scale (score 0 [no symptoms] through 6 [death]) and mortality at 6 months. RESULTS: Among the 110 randomized patients (mean age, 61.5 years; 80 men [72.7%]), all completed the study. There were MRI data from 97 patients (88.2%) a median of 53 hours (interquartile range [IQR], 47-64 hours) after cardiac arrest. The mean global fractional anisotropy values were 0.433 (SD, 0.028) in the xenon group and 0.419 (SD, 0.033) in the control group. The age-, sex-, and site-adjusted mean global fractional anisotropy value was 3.8% higher (95% CI, 1.1%-6.4%) in the xenon group (adjusted mean difference, 0.016 [95% CI, 0.005-0.027], P = .006). At 6 months, 75 patients (68.2%) were alive. Secondary end points at 6 months did not reveal statistically significant differences between the groups. In ordinal analysis of the modified Rankin Scale, the median (IQR) value was 1 (1-6) in the xenon group and 1 (0-6) in the control group (median difference, 0 [95% CI, 0-0]; P = .68). The 6-month mortality rate was 27.3% (15/55) in the xenon group and 34.5% (19/55) in the control group (adjusted hazard ratio, 0.49 [95% CI, 0.23-1.01]; P = .053). CONCLUSIONS AND RELEVANCE: Among comatose survivors of out-of-hospital cardiac arrest, inhaled xenon combined with hypothermia compared with hypothermia alone resulted in less white matter damage as measured by fractional anisotropy of diffusion tensor MRI. However, there was no statistically significant difference in neurological outcomes or mortality at 6 months. These preliminary findings require further evaluation in an adequately powered clinical trial designed to assess clinical outcomes associated with inhaled xenon among survivors of out-of-hospital cardiac arrest. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00879892

Early Onset Hypertension Is Associated With Hypertensive End-Organ Damage Already by MidLife

Early onset hypertension confers increased risk for cardiovascular mortality in the community. Whether early onset hypertension also promotes the development of target end-organ damage (TOD), even by midlife, has remained unknown. We studied 2680 middle-aged CARDIA (coronary artery risk development in young adults) Study participants (mean age 50±4 years, 57% women) who underwent up to 8 serial blood pressure measurements between 1985 and 2011 (age range at baseline 18-30 years) in addition to assessments of echocardiographic left ventricular hypertrophy, coronary calcification, albuminuria, and diastolic dysfunction in 2010 to 2011. Age of hypertension onset was defined as the age at first of 2 consecutively attended examinations with blood pressure ≥140/90 mm Hg or use of antihypertensive medication. Participants were divided in groups by hypertension onset age (<35 years, 35-44 years, ≥45 years, or no hypertension). While adjusting for TOD risk factors, including systolic blood pressure, we used logistic regression to calculate odds ratios for cases (participants with TOD) versus controls (participants without TOD) to examine the relation of hypertension onset age and hypertensive TOD. Compared with normotensive individuals, hypertension onset at age <35 years was related to odds ratios of 2.29 (95% CI, 1.36-3.86), 2.94 (95% CI, 1.57-5.49), 1.12 (95% CI, 0.55-2.29), and 2.06 (95% CI, 1.04-4.05) for left ventricular hypertrophy, coronary calcification, albuminuria, and diastolic dysfunction, respectively. In contrast, hypertension onset at age ≥45 years was not related to increased odds of TOD. Our findings emphasize the importance of assessing age of hypertension onset in hypertensive patients to identify high-risk individuals for preventing hypertensive complications