Syöpää sairastavan potilaan palliatiivinen hoito -opas potilaalle

Tämä opinnäytetyö on kehittämistyö, jonka tarkoituksena on suunnitella ja tehdä opas palliatiivisesta hoidosta syöpää sairastavalle potilaalle. Oppaan tavoitteena on antaa potilaalle tietoa ja lisätä hänen ymmärrystään palliatiivisesta hoidosta sekä hoitomahdollisuuksista. Palliatiivisella hoidolla tarkoitetaan parantumatonta sairautta sairastavan potilaan aktiivista ja kokonaisvaltaista hoitoa. Palliatiivisella hoidolla pyritään lievittämään ja hoitamaan sairauden tuomia oireita. Hoidon tarkoituksena on parantaa ja pitää yllä potilaiden elämänlaatua. Palliatiivisen hoidon suurimman hoitoa tarvitsevan ryhmän muodostavat syöpää sairastavat potilaat, tosin myös muitakin sairauksia sairastavat potilaat voivat olla palliatiivisessa hoidossa. Tämä opinnäytetyö on rajattu koskemaan syöpää sairastavan potilaan palliatiivista hoitoa. Suomessa sairastuu syöpään vuosittain yli 30000 ihmistä. Yleisimmät suomessa sairastettavat syöpätaudit ovat eturauhas- ja rintasyöpä. Joka kolmas suomalainen sairastuu syöpään jossakin elämänsä vaiheessa. Kuolleisuus vaihtelee suuresti eri syöpätyyppien välillä ja vaikka kuolleisuus on vähentynyt parantuneiden hoitomahdollisuuksien myötä, on syöpä edelleen Suomessa toiseksi yleisin kuolinsyy. Palliatiivisessa hoidossa olevalla syöpäpotilaalla oireet voivat olla hyvin monenlaisia. Yleisimpiä oireita ovat kipu, hengenahdistus, väsymys, pahoinvointi, ruokahaluttomuus, unettomuus, ummetus, masennus/ahdistuneisuus ja laihtuminen. Potilaan oireita voidaan kartoittaa oirekyselyillä, joista yleisimmin käytetty on Edmontonin oirekysely (Edmonton Symptom Assessment Scale) eli ESAS (Liite 1). Kuopion yliopistollisen sairaalan palliatiivisen hoidon poliklinikalla on käytössä myös kyseinen oirekysely. Opas on tuotettu Kuopion yliopistollisen sairaalaan syöpäosaston ja palliatiivisen hoidon poliklinikan käyttöön. Opas sisältää tietoa palliatiivisesta hoidosta sekä syöpäsairauden aiheuttamista yleisimmistä oireista ja hoitomahdollisuuksista.This thesis is a development work the purpose of which is to design and make a guidebook about palliative treatment of a cancer patient. The aim is to give information for the patient and increase his understanding of palliative care as well as treatment options. Palliative care refers to an active and holistic treatment for a patient with incurable disease. Palliative care aims to relieve and treat the symptoms caused by the disease. The aim of the treatment is to improve and maintain the patient's quality of life. Cancer patients make up the major group which need a palliative care, but also other patients with such conditions may be in palliative treatment. This thesis is related to the cancer patient´s palliative care. Every year in Finland more than 30,000 people will get cancer, it means that every third Finn will get a cancer at some point of their lives. Prostate- and breast cancers are the most common cancers in Finland. Mortality varies widely between different types of cancers, although mortality has decreased because of improved treatment, still cancer remains the second most common cause of death in Finland. Cancer patients in the palliative care can have diverse symptoms. The most common symptoms are pain, shortness of breath, fatigue, nausea, a loss of appetite, insomnia, constipation, depression/anxiety and weight loss. The patient's symptoms can be mapped by symptom questionnaires. The most commonly used questionnaire is Edmonton Symptom Assessment Scale, ESAS (Appendix 1), which is also in use at Kuopio University Hospital´s outpatient clinic of palliative care. This guidebook is produced for use of the Kuopio University hospital´s oncology department and outpatient clinic for palliative care. The guide contains information about palliative care, most common symptoms of cancer and treatment options

Los diálogos entre el contenido y la lengua: cautelas y retos en la emergencia de un programa de educación bilingüe

This paper presents a set of ideas about the basics for developing interdisciplinary dialogues between content (science) and language (English) in bilingual educational processes, under the premise that a satisfactory relationship between those elements help guarantee successful content-based instruction (CBI) in its form known as sheltered instruction. Additionally, a practical example (based on a science curriculum) is presented to demonstrate some principles that inform approaches to teaching such content. Finally, based on the authors’ interdisciplinary work and pedagogical experiences, some recommendations on teaching content and language in bilingual settings are presented in the form of cautions (a balance of actions) and challenges (prospects).Este artículo presenta un conjunto de ideas fundamentales para llevar a cabo diálogos interdisciplinarios entre contenido (ciencias naturales) y lengua (inglés) en procesos de educación bilingüe, bajo premisa de que un vínculo satisfactorio entre ambos elementos ayuda a garantizar una instrucción basada en contenidos (CBI) exitosa, particularmente, en su forma de instrucción amparada. En adición, un ejemplo práctico (basado en un currículo de ciencias naturales) se presenta para demostrar algunos principios que dan cuenta de algunos enfoques para enseñar dicho contenido. Finalmente, con base en el trabajo interdisciplinario y la experiencia pedagógica de sus autores, se presentan algunas recomendaciones sobre la enseñanza de contenido y lengua en ambientes bilingües, a manera de cautelas (balance de acciones) y retos (prospectivas)

Game-based situation awareness training for child and adult cyclists

Safe cycling requires situation awareness (SA), which is the basis for recognizing and anticipating hazards. Children have poorer SA than adults, which may put them at risk. This study investigates whether cyclists’ SA can be trained with a video- based learning game. The effect of executive working memory on SA was also studied. Thirty-six children (9–10 years) and 22 adults (21–48 years) played the game. The game had 30 video clips filmed from a cyclist’s perspective. Each clip was suddenly masked and two or three locations were presented. The player’s task was to choose locations with a potential hazard and feedback was given for their answers. Working memory capacity (WMC) was tested with a counting span task. Children’s and adults’ performance improved while playing the game, which suggests that playing the game trains SA. Adults performed better than children, and they also glanced at hazards more while the video was playing. Children expectedly had a lower WMC than adults, but WMC did not predict performance within the groups. This indicates that SA does not depend on WMC when passively viewing videos.Peer reviewe

Longitudinal trends of per- and polyfluoroalkyl substances in children's serum

Studies suggest negative health impacts from early life exposure to per- and polyfluoroalkyl substances (PFASs). However, information on longitudinal exposure to PFASs during childhood is scarce for background-exposed individuals. This study sought to fill this gap by investigating children's longitudinal exposure trends through measurement of PFAS serum concentrations and calculation of body burdens (mu g, total in body). Blood of 54 Finnish children was sampled 2005-2015 and analyzed for 20 PFASs at 1, 6 and 10.5 years of age. The body burden was calculated by multiplying the serum concentration by the volume of distribution and the bodyweight for each individual. Associations between serum concentrations or body burdens and parameters, such as sex, breastfeeding duration, body mass index as well as indoor dust and air PFAS concentrations, were evaluated. Serum concentrations of perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA) and perfluorohexane sulfonic acid (PFHxS) decreased significantly (p <0.001) with age. In contrast to serum concentrations, body burdens stayed unchanged or even increased significantly (p <0.05), except for PFOA in female children. Breastfeeding duration was positively correlated (p <0.001) with serum concentrations of PFHxS, PFOS, PFOA and PFNA at 1 year of age. Some associations were found at 10.5 years with sex and indoor PFAS concentrations. Observations of longitudinal decreasing trends of serum concentrations can be misleading for understanding exposure levels from external media during childhood, as the serum concentration is influenced by parallel temporal changes and growth dilution. Body burdens account for growth dilution and thus better reflect differences in early-life to adolescence exposure than serum concentrations.Peer reviewe

Estimated PCDD/F TEQ and total TEQ concentrations in the serum of 7-10 year old Finnish children

Polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) and polychlorinated biphenyls (PCBs) are persistent organic pollutants that have detrimental health effects. As people are exposed to them mainly through the diet, EU has set maximum food dioxin and PCBs levels. EFSA CONTAM Panel made new risk assessment in 2018 that lowered the tolerable weekly intake (TWI) from 14 pg-TEQ/kg bw/week to 2 pgTEQ/kg bw/week. Critical effect was decreased semen count at the age of 18-19 years if serum total TEQ at the age of 9 years exceeded the No Observed Adverse Effect Level (NOAEL) of 7 pg/g lipid. However, it is largely unknown to what extent NOAEL is exceed in European boys currently. We thus measured PCBs from small volume of serum in 184 Finnish children 7-10 years of age. To estimate the TEQ levels of children from measured PCB levels, we used our existing human milk PCDD/F and PCB concentrations to create a hierarchical Bayesian regression model that was used to estimate TEQs from measured PCBs. For quality control (QC), three pooled blood samples from 18 to 20 year old males were measured for PCDD/Fs and PCBs, and estimated for TEQs. In QC samples measured and estimated TEQs agreed within 84% -106%. In our estimate for 7-10 year old children, PCDD/F TEQ exceeded NOAEL only in 0.5% and total TEQ in 2.7% of subjects. Risk management following the decreased TWI proposed by the CONTAM Panel should be carefully considered if total TEQ in children is already largely below the NOAEL. (C) 2020 Elsevier Ltd. All rights reserved.Peer reviewe

Increased B-Type Natriuretic Peptide Concentration Is Associated with Reduced Coronary Vasoreactivity in Patients with Dilated Cardiomyopathy but Not in Healthy Young Subjects

Background/Aims. Natriuretic peptides are associated with the cardiovascular disease risk under a range of different circumstances. However, less is known about whether this association is found also in young healthy subjects. Methods. 9 patients with dilated cardiomyopathy and 26 healthy young subjects were studied. The myocardial blood flow measurements were performed basally and during adenosine infusion using PET. Results. S-proBNP concentrations were significantly higher (2153 ± 1964 versus 28 ± 17 ng/L, P = .000002) and adenosine-stimulated flow lower (1.6 ± 0.8 versus 3.6 ± 1.1 mL·g−1·min−1, P = .00001) in patients with dilated cardiomyopathy when compared to healthy subjects. S-proBNP concentration was inversely associated with adenosine stimulated flow in patients with dilated cardiomyopathy (r = −0.75, P = .019) but not in healthy subjects (r = −0.06, P = .84). Conclusions. Natriuretic peptides are inversely associated with coronary vasoreactivity in patients with dilated cardiomyopathy but not in healthy young subjects. Since reduced coronary vasoreactivity seems to be one of the earliest abnormalities in the development of coronary artery disease, this might indicate that natriuretic peptides are not predictor of cardiovascular disease risk in healthy young subjects