Nurses' required end-of-life care competence in health centres inpatient ward - a qualitative descriptive study

Background Studies of nurses' required competence in EOL care in health centres are rare. It is important to produce information about experienced nurses' perceptions of the competence they consider important in their practical work.Aim The aim of this study was to describe nurses' required competence in EOL care in health centre inpatient wards as experienced by nurses.Method A descriptive qualitative study using four semi-structured group interviews (20 nurses) and inductive descriptive content analysis.Results Five categories describing nurses' required competence in EOL care in a health centre inpatient ward were identified: (1) ethics and courage in action, (2) support for the patient, (3) support for the family, (4) care planning and (5) physical care. Factors promoting nurses' competence in EOL care comprised two categories: (1) professional development in EOL care and (2) an organisation that supports EOL care.Conclusions End-of-life care in health centre inpatient wards requires wide and complex competence from nurses. Nurses' experiences of required competence are associated with holistic care of the patient, encountering the family and multiprofessional cooperation. Nurses' competence in EOL care could be enhanced with postgraduate education, and educational planning should be given more attention in the future

Local treatment of pressure ulcers in long-term care: a correlational cross-sectional study

Objective:To analyse the treatment of pressure ulcers (PU) in long-term care.Method:In this correlational cross-sectional study, data was collected between November 2015 and January 2016 from older people with PUs in private and public long-term care facilities in Finland. Data collection was conducted by trained nurses using the Pressure Ulcer Patient Instrument (PUP-Ins). Outcomes measured were: prevalence and localisation of PU, local PU treatment, frequency (how often/week/day) and duration (minutes/week or day) of PU treatment.Results:In total, 112 patients with 158 PUs were identified (a prevalence rate of 5%). PUs were located most often on the heel (38%), hip (13%), buttocks (10%) and lateral malleolus (9.5%). The most frequently used PU treatment was skin protecting agents and local wound care products. The most typical treatment in category I, II and III PUs were foam dressings. In category III PUs, ribbon gauze dressings were also used. The most typical products for category IV PUs were complex dressings. Category I PUs received more treatment per day or week than other categories of PUs.Conclusion:PU treatment is inconsistent and often conducted with varying methods and products. Holistic patient care must be the focus. Nurses in long-term care settings might benefit from in-depth in-service education focusing on the treatment of PUs. More research is needed about nurses' competence in PU treatment.</p

Spermatogenesis and sertoli cell activity in mice lacking Sertoli cell receptors for follicle stimulating hormone and androgen

Spermatogenesis in the adult male depends on the action of FSH and androgen. Ablation of either hormone has deleterious effects on Sertoli cell function and the progression of germ cells through spermatogenesis. In this study we generated mice lacking both FSH receptors (FSHRKO) and androgen receptors on the Sertoli cell (SCARKO) to examine how FSH and androgen combine to regulate Sertoli cell function and spermatogenesis. Sertoli cell number in FSHRKO-SCARKO mice was reduced by about 50% but was not significantly different from FSHRKO mice. In contrast, total germ cell number in FSHRKO-SCARKO mice was reduced to 2% of control mice (and 20% of SCARKO mice) due to a failure to progress beyond early meiosis. Measurement of Sertoli cell-specific transcript levels showed that about a third were independent of hormonal action on the Sertoli cell, whereas others were predominantly androgen dependent or showed redundant control by FSH and androgen. Results show that FSH and androgen act through redundant, additive, and synergistic regulation of spermatogenesis and Sertoli cell activity. In addition, the Sertoli cell retains a significant capacity for activity, which is independent of direct hormonal regulation

Keinot edistää sää- ja ilmastoriskien hallintaa

ELASTINEN-tutkimushankkeessa selvitettiin sää- ja ilmastoriskien hallinnan tilaa Suomessa ja arvioitiin riskienhallintakeinoja sekä eri toimijoiden roolia. Lisäksi tarkasteltiin, miten riskienhallinnan kustannuksia ja hyötyjä arvioidaan sekä miten riskienhallinta voidaan kääntää liiketoiminnaksi. Yhteiskunnan toimivuuden ja turvallisuuden ylläpitäminen edellyttää aktiivista varautumista sään ääriilmiöihin. Hankkeen tulosten mukaan suomalaiset organisaatiot eivät usein arvioi sää- ja ilmastoriskejä systemaattisesti. Varautumisessa tulee ottaa huomioon, että ilmastonmuutos voi muuttaa sään ääri-ilmiöitä, niiden esiintymistiheyttä ja voimakkuutta. Näin varautuminen sään ääri ilmiöihin on myös osa sopeutumista ilmastonmuutokseen. ELASTINEN-hanke esittää kolme suositusta, joilla sää- ja ilmastoriskien hallintaa voitaisiin parantaa ja sopeutumistyötä tukea: 1) monipuolistetaan tiedon tuottoa ja käyttöä, 2) vahvistetaan yhteistyötä ja kehitetään toimintatapoja sekä 3) kehitetään palveluita ja liiketoimintamahdollisuuksia. Suositusten toteuttamiseksi esitetään toimenpide-ehdotuksia, minkä lisäksi on tunnistettu toimien toteuttajatahoja. Nykyistä monipuolisempi ja helpommin saatavilla oleva tieto parantaisi mahdollisuuksia arvioida ja hallita sää- ja ilmastoriskejä sekä kykyä sopeutua ilmastonmuutoksen vaikutuksiin. Suomessa tulisi myös arvioida säännöllisesti Suomen ulkopuolella tapahtuvia ilmastonmuutoksen vaikutuksia, jotka voivat heijastua Suomeen. Sää- ja ilmastoriskien hallintatoimia tulisi valita ja arvioida myös taloudellisen tehokkuuden näkökulmasta

Detecting parent of origin and dominant QTL in a two-generation commercial poultry pedigree using variance component methodology

<p>Abstract</p> <p>Introduction</p> <p>Variance component QTL methodology was used to analyse three candidate regions on chicken chromosomes 1, 4 and 5 for dominant and parent-of-origin QTL effects. Data were available for bodyweight and conformation score measured at 40 days from a two-generation commercial broiler dam line. One hundred dams were nested in 46 sires with phenotypes and genotypes on 2708 offspring. Linear models were constructed to simultaneously estimate fixed, polygenic and QTL effects. Different genetic models were compared using likelihood ratio test statistics derived from the comparison of full with reduced or null models. Empirical thresholds were derived by permutation analysis.</p> <p>Results</p> <p>Dominant QTL were found for bodyweight on chicken chromosome 4 and for bodyweight and conformation score on chicken chromosome 5. Suggestive evidence for a maternally expressed QTL for bodyweight and conformation score was found on chromosome 1 in a region corresponding to orthologous imprinted regions in the human and mouse.</p> <p>Conclusion</p> <p>Initial results suggest that variance component analysis can be applied within commercial populations for the direct detection of segregating dominant and parent of origin effects.</p

Accuracy of echocardiographic area-length method in chronic myocardial infarction: comparison with cardiac CT in pigs

Background: We evaluated echocardiographic area-length methods to measure left ventricle (LV) volumes and ejection fraction (EF) in parasternal short axis views in comparison with cardiac computed tomography (CT) in pigs with chronic myocardial infarction (MI).Methods: Male farm pigs with surgical occlusion of the left anterior descending coronary artery (n = 9) or sham operation (n = 5) had transthoracic echocardiography and cardiac-CT 3 months after surgery. We measured length of the LV in parasternal long axis view, and both systolic and diastolic LV areas in parasternal short axis views at the level of mitral valve, papillary muscles and apex. Volumes and EF of the LV were calculated using Simpson's method of discs (tri-plane area) or Cylinder-hemiellipsoid method (single plane area).Results: The pigs with coronary occlusion had anterior MI scars and reduced EF (average EF 42 +/- 10%) by CT. Measurements of LV volumes and EF were reproducible by echocardiography. Compared with CT, end-diastolic volume (EDV) measured by echocardiography showed good correlation and agreement using either Simpson's method (r = 0.90; mean difference -2, 95% CI -47 to 43 mL) or Cylinder-hemiellipsoid method (r = 0.94; mean difference 3, 95% CI -44 to 49 mL). Furthermore, End-systolic volume (ESV) measured by echocardiography showed also good correlation and agreement using either Simpson's method (r = 0.94; mean difference 12 ml, 95% CI: -16 to 40) or Cylinder-hemiellipsoid method (r = 0.97; mean difference: 13 ml, 95% CI: -8 to 33). EF was underestimated using either Simpson's method (r = 0.78; mean difference -6, 95% CI -11 to 1%) or Cylinder-hemiellipsoid method (r = 0.74; mean difference -4, 95% CI-10 to 2%).Conclusion: Our results indicate that measurement of LV volumes may be accurate, but EF is underestimated using either three or single parasternal short axis planes by echocardiography in a large animal model of chronic MI

Physical Fitness and Frailty in Males after Allogeneic Hematopoietic Stem Cell Transplantation in Childhood: A Long-Term Follow-Up Study

Simple Summary The prevalence of frailty is increased among young adult childhood cancer survivors and is associated with early morbidity and mortality. The aim of our study was to analyze physical fitness, physical activity and the prevalence of frailty in male long-term survivors of pediatric allogeneic hematopoietic stem cell transplantation. We observed significantly lower muscle strength and muscle endurance in the hand-grip and sit-to-stand tests compared to the age and sex matched normative reference values of the tests. Furthermore, 30% of the survivors were considered pre-frail or frail. Chronic graft-versus-host disease, shorter stature, higher body fat mass and hazardous drinking predicted prefrail/frail status. Common cardiovascular risk factors were associated with poor physical fitness and low physical activity level. These results indicate a need for cardiometabolic follow up as well as health education in the decades following HSCT. Purpose and methods: To analyze physical fitness, physical activity and the prevalence of frailty in male long-term survivors of pediatric allogeneic hematopoietic stem cell transplantation (HSCT). We performed a Nordic two-center study of 98 male survivors (mean age 28.7 years, range 18.5-47.0) treated with pediatric allogeneic hematopoietic stem cell transplantation (HSCT) 1980-2010 in denmark or finland. physical fitness was evaluated by the dominant hand grip-strength, timed up-and-go, sit-to-stand, gait speed and two-minute walk tests. Results: Survivors presented significantly lower muscle strength and muscle endurance in the dominant hand-grip strength (median Z-score -0.7, range -4.3-3.9) and sit-to-stand tests (median Z-score -1.5, range -3.5-2.5) compared to age and sex matched normative values of the tests. However, mobility and gait speed were not affected on a group level. The prevalence of frailty (pre-frail 20% or frail 10%) was high among the survivors. In multiple regression analysis, chronic graft-versus-host disease, shorter stature, higher body fat mass and hazardous drinking predicted prefrail/frail status. Common cardiovascular risk factors, such as increased levels of serum triglycerides, higher resting heart rate and diastolic blood pressure, were associated with lower physical fitness. Conclusion: Low muscle strength and a high incidence of frailty were observed in survivors of pediatric HSCT. There is a predominant risk of cardiovascular and metabolic diseases in the long-term.</p

Mediation and the Best Interests of the Child from the Child Law Perspective

What is the best interests of the child in family mediation and is mediation in the best interests of the child? In this article, I use child law and the United Nations Convention on the Rights of the Child combined with mediation theory to discuss these questions. Both mediation and the best interests of the child are open for multiple interpretations. Using facilitative and evaluative mediation theory and the legal concept ‘the best interests of the child’, I explore and compare the understandings of these concepts as they apply to family mediation. This includes a discussion of the advantages and disadvantages of facilitative as well as evaluative mediation orientations in terms of protecting the best interests of the child. Finnish court-connected family mediation is a combination of both mediation orientations, and the mediator is obliged to secure the best interests of the child. From a theoretical point of view, this seems to be a challenging combination.Peer reviewe

Proposed Role for COUP-TFII in Regulating Fetal Leydig Cell Steroidogenesis, Perturbation of Which Leads to Masculinization Disorders in Rodents

Reproductive disorders that are common/increasing in prevalence in human males may arise because of deficient androgen production/action during a fetal ‘masculinization programming window’. We identify a potentially important role for Chicken Ovalbumin Upstream Promoter-Transcription Factor II (COUP-TFII) in Leydig cell (LC) steroidogenesis that may partly explain this. In rats, fetal LC size and intratesticular testosterone (ITT) increased ∼3-fold between e15.5-e21.5 which associated with a progressive decrease in the percentage of LC expressing COUP-TFII. Exposure of fetuses to dibutyl phthalate (DBP), which induces masculinization disorders, dose-dependently prevented the age-related decrease in LC COUP-TFII expression and the normal increases in LC size and ITT. We show that nuclear COUP-TFII expression in fetal rat LC relates inversely to LC expression of steroidogenic factor-1 (SF-1)-dependent genes (StAR, Cyp11a1, Cyp17a1) with overlapping binding sites for SF-1 and COUP-TFII in their promoter regions, but does not affect an SF-1 dependent LC gene (3β-HSD) without overlapping sites. We also show that once COUP-TFII expression in LC has switched off, it is re-induced by DBP exposure, coincident with suppression of ITT. Furthermore, other treatments that reduce fetal ITT in rats (dexamethasone, diethylstilbestrol (DES)) also maintain/induce LC nuclear expression of COUP-TFII. In contrast to rats, in mice DBP neither causes persistence of fetal LC COUP-TFII nor reduces ITT, whereas DES-exposure of mice maintains COUP-TFII expression in fetal LC and decreases ITT, as in rats. These findings suggest that lifting of repression by COUP-TFII may be an important mechanism that promotes increased testosterone production by fetal LC to drive masculinization. As we also show an age-related decline in expression of COUP-TFII in human fetal LC, this mechanism may also be functional in humans, and its susceptibility to disruption by environmental chemicals, stress and pregnancy hormones could explain the origin of some human male reproductive disorders

Sää- ja ilmastoriskit Suomessa - Kansallinen arvio

Tähän raporttiin on koottu ajantasainen arvio sään ja ilmaston aiheuttamista riskeistä eri toimialoille Suomessa. Arviossa otettiin huomioon sekä muuttuvan ilmaston että yhteiskunnallisen kehityksen vaikutus riskin muodostumiseen nykyhetkessä ja tulevaisuudessa. Sää- ja ilmastoriskejä pyrittiin hahmottamaan vaaratekijän (riskiä aiheuttava sääilmiö), altistumisen (riskin kohteen sijainti) ja haavoittuvuuden (riskin kohteen ominaisuudet) yhdistelmänä. Sääilmiöt aiheuttavat Suomessa riskejä jo nykyilmastossa. Muun muassa rajuilmat, helleaallot ja rankkasateet aiheuttavat taloudellisia ja terveydellisiä vaikutuksia sekä yleistä haittaa. Tulevaisuudessa riskit muuttuvat ilmastonmuutoksen muuttaessa haitallisia sääilmiöitä. Ilmastonmuutos tuo vähitellen kasvavia riskejä erityisesti ekosysteemeille ja infrastruktuurille. Muualla maailmalla tapahtuvat ilmastonmuutoksen vaikutukset voivat heijastua epäsuorasti Suomeen globaalien tavara-, energia-, raha- ja ihmisvirtojen kautta. Näiden riskien systemaattinen arviointi on vasta aloitettu. Raportin tavoitteena on tukea yhteiskunnan riskeihin varautumista ja ilmastonmuutokseen sopeutumista eri hallinnon tasoilla ja toimialoilla. Arvio perustuu pääosin kirjallisuudesta löytyviin tutkimuksiin ja selvityksiin sekä asiantuntija-arvioihin. Työ tehtiin “Sää- ja ilmastoriskien arviointi ja toimintamallit” (SIETO)- hankkeessa vuosina 2017–2018