Korkeakouluopettajien itsensä johtamisen kokemukset hybridityössä

Tämän tutkielman tavoitteena on kuvata korkeakouluopettajien kokemuksia ja kehittämisehdotuksia itsensä johtamisesta hybridityön aikana. Tutkielman tavoitteena on tuottaa korkeakouluopettajien kokemuksellista tietoa ja kehittämisehdotuksia itsensä johtamisesta hybridityössä. Tutkielman tehtävinä oli vastata seuraaviin kysymyksiin: Millaisia kokemuksia korkeakouluopettajilla on itsensä johtamisesta hybridityössä? Millaisia kehittämisehdotuksia korkeakouluopettajilla on itsensä johtamiseen hybridityössä? Tätä korkeakouluopettajien kokemuksellista tietoa voidaan hyödyntää suunniteltaessa, toteutettaessa ja kehitettäessä korkeakoulujen opettajien itsensä johtamista hybridityössä. Tutkielman tietoperusta muodostuu korkeakouluopettajuudesta, hybridityöstä ja itsensä johtamisesta. Tutkielma on laadullinen tutkimus, jonka aineisto koostuu kuuden korkeakouluopettajan teemahaastatteluista. Aineisto on analysoitu aineistolähtöistä sisällönanalyysia käyttäen. Korkeakouluopettajien kokemuksista ja kehittämisehdotuksista muodostui seuraavat viisi pääluokkaa, jotka ovat opettajan omien arvojen mukainen toiminta, opettajan oman osaamisen kehittäminen, opettajan ajanhallinta, opettajan hyvinvointi sekä vuorovaikuttaminen ja kommunikaatio verkko-opetuksessa. Tutkielman tulosten mukaan voidaan todeta, että työelämässä tapahtunut muutos hybridityön tekemiseen siirtymisestä on yhteydessä korkeakouluopettajien itsensä johtamiseen niin sitä vahvistaen kuin sitä heikentäen. Hybridityö on tutkielman tulosten mukaan vahvistanut korkeakouluopettajien työtä suhteessa opettajien omien arvojen mukaiseen toimintaan. Hybridityö on myös vaikuttanut korkeakouluopettajien hyvinvointikokemuksiin kahtiajakoisesti, jonka lisäksi se on muuttanut opettajan osaamisen vaatimuksia ja opetustapoja. Korkeakouluopettajien kehittämisehdotukset itsensä johtamisesta hybridityössä painottuivat sosiaalisen hyvinvoinnin kehittämiseen. Tuloksilla on hyödynnettävyyttä esimerkiksi opettajan työtä tekeville sekä kouluorganisaatioille, jotka luovat ja suunnittelevat hybridityötä ja sen kehittämistä. Tulosten avulla on mahdollista laajentaa ymmärrystä korkeakouluopettajan työstä hybridityössä ja sen edellyttämistä vaatimuksista

A Nationwide Study of Campylobacter jejuni and Campylobacter coli Bacteremia in Finland Over a 10-Year Period, 1998–2007, With Special Reference to Clinical Characteristics and Antimicrobial Susceptibility

Campylobacter jejuni and Campylobacter coli bacteremia patients were mainly young and without severe underlying diseases. The bacterial isolates were typically susceptible to antimicrobial agents. The outcome was usually good, regardless of appropriate or inappropriate antimicrobial treatment given at the hospital

Rettskartleggingsprosessen i Finnmark i lys av Norges internasjonale forpliktelser. Betydningen av EMDs innfortolkning av prosessuelle garantier i materielle bestemmelser for rettskartlegging i Finnmark

Betydningen av EMDs innfortolkning av prosessuelle garantier i materielle bestemmelser for rettskartleggingen i Finnmark

Severe Campylobacter infections in Finland

Campylobacter jejuni and C. coli are among the most important bacterial enteropathogens worldwide, and the last decade Campylobacter infections in the European Union (EU) have shown a rising trend in incidence. The most commonly reported zoonosis in the EU, campylobacteriosis, can be transmitted to humans from a wide variety of wild birds, as well as from domestic and pet animals. Eating or handling raw or undercooked meat, particularly poultry, is considered the primary risk factor for Campylobacter infection, followed by other risk factors such as drinking unpasteurized milk or contaminated water, contact with domestic pets, and swimming in natural water sources. The enteric disease caused by C. jejuni or C. coli is characterized by profuse watery diarrhea, fever, abdominal pain, nausea, and sometimes bloody stools. The disease usually lasts from a few days up to one week, and although Campylobacter infection usually resolves spontaneously without antimicrobial treatment, prolonged symptomatic periods and relapses do occur. A complication that commonly follows and is attributed to Campylobacter infection is reactive arthritis, which occurs in approximately 1 to 10% of the patients. Closely associated with C. jejuni infection is also the more rarely encountered serious inflammatory polyneuropathy Guillain-Barré syndrome. Bacteremia due to C. jejuni or C. coli has been estimated to develop in 0.1 to 1% of patients with campylobacteriosis, and hematogenously spread disease is considered more common in older patients and those with severe underlying diseases. The bacterial characteristics of C. jejuni or C. coli which could lead to a more severe course of disease, to bacteremia, or to post-infectious complications are not well understood. Certain putative virulence factors have been suggested to be of importance for either the invasiveness or the colonization potential of C. jejuni, some examples of which are the plasmid pVir, Campylobacter invasion antigen, and γ-glutamyl transpeptidase (GGT). Other examples of putative virulence factors include those suspected to affect the bacterium s iron uptake, survival or metabolism. Moreover, because of the seriousness of Guillain-Barré syndrome, development of post-infectious adverse immune responses has been subject to specific focus, and structural differences in the lipooligosaccharide in the outer membrane of C. jejuni have been under extensive study. The relevance of these bacterial factors to the actual clinical disease outcome has yet to be explained, however, possibly with the exception of the relatively clear association between sialylated lipooligosaccharides and the development of the Guillain-Barré syndrome. The primary goal of this PhD study was therefore to try to define which bacterial factors could lead to a more severe outcome of Campylobacter infection. Two sets of patient data, along with the corresponding bacterial isolates of those patients, were included. The first was questionnaire-based, and collected from the Uusimaa region in southern Finland during July through December, 2006. The 192 patients included had been diagnosed as stool culture-positive for C. jejuni or C. coli, and all returned their questionnaires along with their informed consent. The second set of data was retrospective, nationwide, and register-based, and included 76 patients diagnosed with C. jejuni or C. coli bacteremia during a 10-year period in Finland, 1998-2007. The isolates from patients with enteritis were tested for antimicrobial susceptibility, the presence of putative virulence factor genes, and the production of GGT. Multilocus sequence typing (MLST) as well as determination of susceptibility to normal human serum was performed on the isolates from the patients with bacteremia. All C. jejuni isolates were tested for production of GGT, and in addition, the presence of the following putative virulence factor genes was tested by polymerase chain reaction (PCR) for all isolates; ceuE, ciaB, cj0486, and virB11, and additionally the gene cluster cdtABC and the genes cgtB, pldA, and wlaN for the enteritis isolates. For the bacteremia isolates, PCR analyses allowed determination of the MLST profiles and lipooligosaccharide (LOS) locus classes of the isolates. Results of multivariate analyses revealed bacterial differences based on the origin of infection among the enteritis isolates, as domestically acquired infections were significantly associated with the production of GGT, while imported infections were significantly associated with ceuE and cj0486. Susceptibilities of the bacterial isolates were tested for those antimicrobial agents most commonly used in the treatment of Campylobacter infections, and when these data were compared with the clinical information, some interesting findings emerged. First, among the patients with enteritis, bacterial resistance to ciprofloxacin did not seem to lead to more severe disease outcome. Instead, this was specifically attributed more to those isolates highly susceptible to ciprofloxacin. Second, the majority of the bacteremia isolates were susceptible to all tested antimicrobial agents. Third, among the patients with bacteremia, appropriate and empirical antimicrobial treatment affected neither patients duration of hospitalization nor the mortality attributable to the infection, to any greater extent. The C. jejuni and C. coli bacteremia patients were moderately young (median age, 46 years) and according to the Charlson weighted index of comorbidity, underlying diseases regarded as comorbidities significantly affecting disease outcome affected only 30%. Among the bacteremia isolates, MLST revealed the clonal complexes ST-677, ST-45, and ST-21 to be the most prevalent, accounting for 48%, 16%, and 14%, of the isolates. All the isolates of the ST-677 complex originated from patients diagnosed with C. jejuni bacteremia during the seasonal peak in May through August; these isolates were significantly more serum resistant than were all other isolates, and all isolates of the ST-677 complex had nonsialylated LOS. Isolates of the ST-45 complex were associated with production of GGT and were significantly more serum sensitive than were all other isolates, and all the ST-45 complex isolates had nonsialylated LOS. Isolates of the ST-21 complex were associated with the gene cj0486, and all these isolates had sialylated LOS.Från ett världsomfattande perspektiv är Campylobacter jejuni och C. coli viktiga bakteriella enteropatogener, och under början av 2000-talet har incidensen av Campylobacter infektioner inom den Europeiska unionen varit stigande. Campylobacterenterit är den vanligast förekommande zoonosen inom EU, och sjukdomen överförs till människor från ett flertal olika husdjur, boskap, sällskapsdjur och vilda fåglar. Vanliga smittoriskfaktorer är förtäring och hantering av rått, eller otillräckligt tillrett, kött. I synnerhet anses kyckling vara förknippat med sjukdomen, och övriga riskfaktorer av betydelse är bl.a. opastöriserad mjölk, förorenat vatten, kontakt med sällskapsdjur, och simning i sötvattendrag. Typiska symptom under campylobacterenterit orsakad av C. jejuni eller C. coli är vattnig diarré, feber, magvärk, illamående och, i vissa fall, blod i avföringen. Sjukdomen varar vanligen från några dagar upp till en vecka, och fastän tillfriskningen i allmänhet är spontan även utan antibiotikabehandling så förekommer även förlängda sjukdomstillstånd och relapser. Reaktiva artriter har visat sig vara förknippade till campylobacterenterit, och hos uppskattningsvis 1 till 10% av patienterna utvecklas dylika tillstånd. Det betydligt mera sällsynta Guillain-Barré syndromet, en allvarlig form av inflammatorisk polyneuropati, har dessutom visat sig vara förknippat till infektioner orsakade av C. jejuni. Bakteremi orsakad av C. jejuni eller C. coli förekommer hos uppskattningsvis 0.1 till 1% av patienter med campylobacterenterit, och hematogen spridning anses vara vanligare dels bland äldre patienter och dels bland patienter med svåra grundsjukdomar. Man känner dåligt till vilka bakteriella egenskaper hos C. jejuni eller C. coli som leder till att vissa infektioner har en svårare utgång, eller till att bakteremi eller senare komplikationer uppkommer. En mängd möjliga virulensfaktorer, som kunde vara av betydelse för invasions- eller koloniseringsförmågan hos C. jejuni, har föreslagits: exempelvis plasmiden pVir, Campylobacter invasion antigen och γ-glutamyl transpeptidas (GGT). Faktorer som påverkar bakteriens järnupptag, överlevnad eller ämnesomsättning är även potentiella virulensfaktorer. Strukturella variationer i lipooligosackariderna (LOS) i det yttre membranet av C. jejuni har undersökts ingående eftersom ofördelaktiga immunologiska reaktioner mot dessa har förknippats till Guillain-Barré syndromet. Målsättningen i detta avhandlingsarbete var att försöka utreda vilka bakteriella faktorer som kunde leda till sämre utgång av Campylobacter infektioner. Två insamlingar av patientinformation utfördes. Den första utfördes så att enkätformulär skickades till samtliga patienter för vilka diagnosen campylobacterenterit hade ställts inom Nyland under den senare hälften av år 2006. Denna studie innefattade alltsomallt 192 patienter med avföringsodlingar positiva för antingen C. jejuni eller C. coli, och dessa patienters svarsblanketter fanns också tillgängliga. Den andra insamlingen var landsomfattande och registerbaserad, och innefattade 76 patienter för vilka någondera diagnosen C. jejuni eller C. coli bakteremi hade ställts under en 10-årsperiod, 1998-2007, i Finland. Bakterieisolaten från patienterna med campylobacterenterit undersöktes för antibiotikakänslighet, förekomst av potentiella virulensfaktorgener och produktion av GGT. Multilocus sequence typing (MLST) och känslighet till normalt människoserum utfördes vidare för bakterieisolaten från bakteremipatienterna. Alla C. jejuni isolat blev testade för produktion av GGT, och med polymerase chain reaction (PCR) undersöktes alla isolat för förekomst av generna ceuE, ciaB, cj0486 och virB11. Därtill utfördes PCR av enteritisolatens DNA för att upptäcka förekomst av generna cdtABC, cgtB, pldA och wlaN, och vidare utfördes PCR analyser för att påvisa MLST profiler och LOS klasser av bakteremi-isolaten. Resultaten från multivariatanalyser påvisade bakteriella skillnader med avseende på ursprunget av infektionen bland enteritisolaten. Bakterierna som orsakade inhemska infektioner var förknippade med produktion av GGT, och bakterierna som orsakade inhemska importerade infektioner var förknippade med ceuE och cj0486. Bakterieisolatens känslighet till de antimikrobiella medel som används mest i behandlingen av campylobacterenterit fastställdes, och några intressanta fynd framkom när dessa uppgifter jämfördes med den kliniska informationen. Bland enteritisolaten verkade det som att de isolat som var motståndskraftiga mot ciprofloxacin inte gav upphov till en svårare sjukdomsbild, tvärtom så tyder resultaten på att en svårare sjukdomsbild snarare var förknippad med de isolat som var ytterst ciprofloxacinkänsliga. Största delen av bakteremi-isolaten var känsliga mot alla de antimikrobiella medel som testades, men trots det verkade antibiotikabehandlingen inte ha någon större inverkan på varken längden av sjukhusvistelse, eller dödligheten, hos patienter som hade C. jejuni eller C. coli bakteremi. Dessa patienter var relativt unga (åldersmedian 46 år), och de flesta hade inga svåra grundsjukdomar. Bland bakteremi-isolaten påvisade MLST att de klonala komplexen ST-677, ST-45 och ST-21 var vanligast. En överrepresentation av ST-677 kunde konstateras, alla isolaten som hörde till detta klonala komplex hade icke-sialylerat LOS, och dessa isolat var betydligt mera motståndskraftiga mot normalt människoserum jämfört med alla andra isolat. Isolaten från ST-45 klonala komplexet var också icke-sialylerade men ytterst känsliga för normalt människoserum

Severe diarrhoea caused by highly ciprofloxacin-susceptible Campylobacter isolates

AbstractThe impact of fluoroquinolone resistance of Campylobacter jejuni and Campylobacter coli isolates on the outcome of the disease in sporadic Campylobacter infections of Finnish individuals was studied. Questionnaires were sent, during a 6-month study period, to patients who were stool culture-positive for Campylobacter spp. In total, 192 returned questionnaires were analysed and assessed, together with the susceptibility data of the respective bacterial isolates. Only one (2%) of the domestic, but half of the imported, Campylobacter isolates were resistant to ciprofloxacin. Ciprofloxacin resistance was not associated with particularly severe infection. Instead, ciprofloxacin-susceptible Campylobacter isolates, as compared to ciprofloxacin-resistant isolates, showed a tendency to cause more severe infections, characterized by bloody stools and hospitalization

Role of alcohol and smoking for vascular complications in type 1 diabetes

Background Moderate alcohol consumption is associated with a decreased risk of coronary heart disease (CHD). However, the association between alcohol and microvascular disease entities is less studied and largely unclear. Previous studies have linked smoking with an increased risk of micro- and macrovascular complications in people with type 1 diabetes. However, these studies have often combined current and former smokers and neglect the effect of smoking cessation. In addition, most previous studies have not included dose-dependent measures of smoking. Aims The aim of this thesis was to study the effect of alcohol consumption on the risk of diabetic nephropathy and severe diabetic retinopathy in people with type 1 diabetes. The effect of smoking on the development of diabetic nephropathy, CHD, and stroke was also addressed. In addition, the combined effect of smoking and a known genetic variant on the development of the end-stage renal disease (ESRD) was investigated. Subjects and methods All people included in the study were participants in the ongoing nationwide, multicenter Finnish Diabetic Nephropathy Study (FinnDiane), the aim of which is to identify risk factors of vascular complications in people with type 1 diabetes. This thesis is based on four studies. Study I (n=3608) is cross-sectional in nature and Study II (n=3613), Study III (n=2621), and Study IV (n=4506) are prospective. Information regarding micro- and macrovascular complications is based on data from FinnDiane visits and national data from the Finnish Care Register for Health Care and the Cause of Death Register. Results Compared with light consumers, people who have never consumed alcohol have a higher risk of both diabetic nephropathy and severe diabetic retinopathy. People who have given up using alcohol have the highest risk of diabetic nephropathy and retinopathy. The risk of diabetic nephropathy is increased in spirit-drinking men, and the risk of severe diabetic retinopathy is increased in all spirit drinkers compared with wine drinkers. Compared with never smokers, current smokers have a higher risk of diabetic nephropathy. Former smokers have a similar risk of diabetic nephropathy compared to never smokers. Compared with never smokers, current smokers have an increased risk of CHD, heart failure, and stroke, and former smokers have an increased risk of heart failure in the whole study population and an increased risk of stroke in men. In both current and former smokers, the risk of each cardiovascular event increases with increasing cumulative smoking and increasing intensity of smoking. The rare variant of allele rs4972593, previously known to increase the risk of ESRD in women, is associated with a decreased risk of ESRD in non-smoking men. Conclusions Abstaining from alcohol or previous alcohol consumption and the consumption of spirits are associated with a higher risk of diabetic nephropathy and severe retinopathy. Current smoking is associated with a higher risk of diabetic nephropathy, CHD, heart failure and stroke in a dose-dependent manner. After smoking cessation, the risk of diabetic nephropathy and CHD is decreased and approaches the risk seen in never smokers. However, the risk of heart failure and stroke remains higher in former smokers. Contrary to the previous findings in women, the rare allele rs4972593 seems to have a protective effect in relation to the risk of ESRD in men.Taustaa Kohtuullisella alkoholin käytöllä on todettu sepelvaltimotaudilta suojaava vaikutus. Alkoholinkäytön vaikutus diabeettiseen silmänpohjatautiin ja munuaistautiin on kuitenkin pitkälti selvittämättä. Aiemmat tutkimukset ovat osoittaneet, että tupakointi lisää riskiä sairastua diabeteksen lisäsairauksiin. Nämä tutkimukset ovat kuitenkin usein jättäneet selvittämättä tupakoinnin lopetuksen ja tupakoinnin määrän ja keston osallisuuden diabeteksen lisäsairauksien kehittymisessä. Tavoitteet Väitöskirjan tavoitteena oli tarkastella alkoholinkäytön vaikutusta diabeettisen silmänpohjasairauden ja munuaistaudin riskiin tyypin 1 diabeetikoilla. Lisäksi tutkittiin tupakoinnin vaikutusta diabeettisen munuaistaudin, sepelvaltimotaudin, sydämen vajaatoiminnan ja aivotapahtuman ilmaantuvuuteen. Tavoitteena oli myös tarkastella tupakoinnin ja aiemmin löydetyn loppuvaiheen diabeettisen munuaistaudin riskiin liitetyn geenivariantin yhteisvaikutusta. Tutkimusaineisto ja menetelmät Tutkimus on osa FinnDiane (Finnish Diabetic Nephropathy Study) tutkimusta, joka on koko Suomen kattava monikeskustutkimus, jonka päämääränä on kartoittaa lisäsairauksien riskitekijöitä tyypin 1 diabeetikoilla. Väitöskirja koostuu neljästä osatyöstä. Osatyö I on poikkileikkaustutkimus (n=3608) ja osatutkimukset II (n=3613), III (n=2621) ja IV (n=4509) ovat luonteeltaan seurantatutkimuksia. Tiedot lisäsairauksien kehittymisestä saatiin yhdistämällä FinnDiane-aineisto valtakunnalliseen sosiaali- ja terveydenhuollon hoitoilmoitusjärjestelmään ja kuolinsyyrekisteriin. Tulokset Henkilöillä, jotka eivät koskaan olleet käyttäneet alkoholia, oli suurempi vaikean diabeettisen silmänpohjataudin ja munuaistaudin riski verrattuna alkoholia kohtalaisen vähän käyttäviin. Suurin riski oli henkilöillä, jotka olivat lopettaneet alkoholin käytön. Väkevien alkoholijuomien käyttöön liittyi kohonnut vaikean silmänpohjataudin riski viininjuontiin verrattuna ja miehillä myös kohonnut munuaistaudin riski. Tupakointi lisäsi diabeettisen munuaistaudin riskiä, mutta tupakoinnin lopettaneilla riski oli samaa tasoa kuin tupakoimattomilla. Tupakointi lisäsi myös sepelvaltimotaudin, sydämen vajaatoiminnan ja aivotapahtumien riskiä, joka oli sitä suurempi, mitä suurempi oli tupakoinnin aiempi altistus (askivuodet) ja päivittäisen tupakoinnin määrä (aski/vrk). Tupakoinnin lopettaneilla havaittiin suurentunut riski sairastua sydämen vajaatoimintaan ja aivotapahtumiin. Aiemmassa tutkimuksessa löydetty loppuvaiheen munuaistaudin riskiä naisilla lisäävä geenivariantti rs4972593 vähensi loppuvaiheen munuaistautia tupakoimattomilla miehillä. Johtopäätökset Alkoholiabstinenssi, aiempi alkoholinkäyttö ja väkevien juomien kulutus lisää diabeettisen silmänpohjataudin ja munuaistaudin riskiä tyypin 1 diabeetikoilla. Tupakointi lisää riskiä sairastua diabeettiseen munuaistautiin, sepelvaltimotautiin, sydämen vajaatoimintaan ja aivotapahtumiin. Tupakoinnin lopettaneilla diabeettisen munuaistaudin ja sepelvaltimotaudin riski lähestyy tupakoimattomien riskiä, mutta sydämen vajaatoiminnan ja aivotapahtumien riski säilyy korkeampana tupakoimattomiin verrattuna. Toisin kuin naisilla rs4972593 geenivariantti vaikuttaisi suojaavan tupakoimattomia miehiä loppuvaiheen munuaistaudilta

Lipooligosaccharide locus class of Campylobacter jejuni : sialylation is not needed for invasive infection

Peer reviewe

Patient-Derived Organoids for Precision Cancer Immunotherapy

Cancer immunotherapy has revolutionized the way tumors are treated. Nevertheless, efficient and robust testing platforms are still missing, including clinically relevant human ex vivo tumor assays that allow pretreatment testing of cancer therapies and selection of the most efficient and safe therapy for a specific patient. In the case of immunotherapy, this testing platform would require not only cancer cells, but also the tumor microenvironment, including immune cells. Here, we discuss the applications of patient-derived tumor organoid cultures and the possibilities in using complex immune-organoid cultures to provide preclinical testing platforms for precision cancer immunotherapy.Peer reviewe

Campylobacter jejuni isolates in Finnish patients differ according to the origin of infection

<p>Abstract</p> <p>Background</p> <p><it>Campylobacter jejuni </it>is a significant cause of bacterial enteritis worldwide. Very little is known about the pathogenicity mechanisms and virulence factors of this important enteropathogen. <it>C. jejuni </it>isolates from 166 Finnish patients, collected from July to December in 2006, were studied for the presence of putative virulence factors and susceptibility to antimicrobials. Isolates were tested for production of γ-glutamyltransferase (GGT) as well as the presence of genes <it>ceuE</it>, <it>cgtB</it>, <it>ciaB</it>, <it>cj0486</it>, <it>pldA</it>, <it>virB11</it>, <it>wlaN</it>, and the gene cluster <it>cdtABC</it>. Bacterial characteristics were compared to information on foreign travel history as well as information on the course and the symptoms of disease obtained from questionnaires returned by patients.</p> <p>Results</p> <p>Except for one domestic isolate, antimicrobial resistance was only detected in isolates of foreign origin. Univariate analyses showed association between bloody stools and both GGT production (p = 0.025) and the presence of <it>cgtB </it>(p = 0.034). Multivariate analysis verified that GGT production was more prevalent in domestic isolates (p < 0.0001), while the genes <it>cj0486 </it>(p < 0.0001) and <it>ceuE </it>(p < 0.0001) were associated with <it>C. jejuni </it>isolates of foreign origin.</p> <p>Conclusions</p> <p>The results indicate that imported and domestic <it>C. jejuni </it>isolates differ significantly in several aspects from each other.</p

The Long-Term Incidence of Hospitalization for Ketoacidosis in Adults with Established T1D-A Prospective Cohort Study

CONTEXT: The long-term natural history of diabetic ketoacidosis (DKA) and its risk factors are poorly understood. OBJECTIVE: To determine the long-term incidence and predictors of DKA in adults with longstanding type 1 diabetes (T1D). DESIGN: All hospitalizations and deaths due to DKA between 1996 and 2016 were identified in 4758 adults with T1D from the Finnish Diabetic Nephropathy Study (FinnDiane), and a cohort of 16 224 adults with T1D from the Finnish general population. RESULTS: Between 1996 and 2015, there were 1228 DKA events in the FinnDiane participants (1.4/100 person-years) and 4914 DKA events (1.8/100 person-years) in adults with T1D from the general population. The majority were hospitalized only once. There was a modest increase in the frequency of DKA in the FinnDiane over the follow-up (~2.4%/year [95% CI, 0.3-4.5%]; P = 0.03). Predictors of DKA were glucose control, CSII, smoking and alcohol consumption, and raised high-density lipoprotein cholesterol and triacylglycerides. Diabetic nephropathy and renal impairment were associated with DKA; patients with end-stage renal disease, macroalbuminuria, and microalbuminuria had 2.09-fol (95% CI, 1.40-3.12), 1.65-fold (95% CI, 1.23-2.19), and 0.87-fold (95% CI, 0.61-1.24) risk of DKA compared with patients with normal albumin excretion rate, respectively. Patients with an estimated glomerular filtration ratePeer reviewe