Characterization of low-density granulocytes in COVID-19

Author summary The emergence of SARS-COV-2 and the ensuing COVID-19 disease has revealed an unprecedented need to understand the pathological mechanisms of acute respiratory infections in more detail. Granulocytes are highly abundant cells of the innate immunity, and thus first responders towards acute infections. However, their excessive activation can cause unwanted tissue damage and detrimental effects in humans. This study identifies a population of low-density granulocytes (LDGs) in COVID-19 patient samples, which has been poorly described in the context of acute infections so far. These cells were subclassified and found to be mainly of immature phenotypes. Further characterization revealed COVID-19 LDGs as a phenotypically diverse population with immunosuppressive characteristics, which seemed to be in line with an elevated recruitment and activation of granulocytes. Altogether, these findings suggest LDG may play a role in COVID-19 disease progression. Severe COVID-19 is characterized by extensive pulmonary complications, to which host immune responses are believed to play a role. As the major arm of innate immunity, neutrophils are one of the first cells recruited to the site of infection where their excessive activation can contribute to lung pathology. Low-density granulocytes (LDGs) are circulating neutrophils, whose numbers increase in some autoimmune diseases and cancer, but are poorly characterized in acute viral infections. Using flow cytometry, we detected a significant increase of LDGs in the blood of acute COVID-19 patients, compared to healthy controls. Based on their surface marker expression, COVID-19-related LDGs exhibit four different populations, which display distinctive stages of granulocytic development and most likely reflect emergency myelopoiesis. Moreover, COVID-19 LDGs show a link with an elevated recruitment and activation of neutrophils. Functional assays demonstrated the immunosuppressive capacities of these cells, which might contribute to impaired lymphocyte responses during acute disease. Taken together, our data confirms a significant granulocyte activation during COVID-19 and suggests that granulocytes of lower density play a role in disease progression.Peer reviewe

Real-life clinical sensitivity of SARS-CoV-2 RT-PCR test in symptomatic patients

Background Understanding the false negative rates of SARS-CoV-2 RT-PCR testing is pivotal for the management of the COVID-19 pandemic and it has implications for patient management. Our aim was to determine the real-life clinical sensitivity of SARS-CoV-2 RT-PCR. Methods This population-based retrospective study was conducted in March-April 2020 in the Helsinki Capital Region, Finland. Adults who were clinically suspected of SARS-CoV-2 infection and underwent SARS-CoV-2 RT-PCR testing, with sufficient data in their medical records for grading of clinical suspicion were eligible. In addition to examining the first RT-PCR test of repeat-tested individuals, we also used high clinical suspicion for COVID-19 as the reference standard for calculating the sensitivity of SARS-CoV-2 RT-PCR. Results All 1,194 inpatients (mean [SD] age, 63.2 [18.3] years; 45.2% women) admitted to COVID-19 cohort wards during the study period were included. The outpatient cohort of 1,814 individuals (mean [SD] age, 45.4 [17.2] years; 69.1% women) was sampled from epidemiological line lists by systematic quasi-random sampling. The sensitivity (95% CI) for laboratory confirmed cases (repeat-tested patients) was 85.7% (81.5-89.1%) inpatients; 95.5% (92.2-97.5%) outpatients, 89.9% (88.2-92.1%) all. When also patients that were graded as high suspicion but never tested positive were included in the denominator, the sensitivity (95% CI) was: 67.5% (62.9-71.9%) inpatients; 34.9% (31.4-38.5%) outpatients; 47.3% (44.4-50.3%) all. Conclusions The clinical sensitivity of SARS-CoV-2 RT-PCR testing was only moderate at best. The relatively high false negative rates of SARS-CoV-2 RT-PCR testing need to be accounted for in clinical decision making, epidemiological interpretations, and when using RT-PCR as a reference for other tests.Peer reviewe

The phylodynamics of SARS-CoV-2 during 2020 in Finland

Finland has had a low incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infections as compared to most European countries. Here we report the origins and turnover of SARS-CoV-2 lineages circulating in Finland in 2020. SARS-CoV-2 introduced to Finland in January 2020 and spread rapidly across southern Finland during spring. We observed rapid turnover among Finnish lineages during this period. Clade 20C became the most prevalent among sequenced cases and was replaced by other strains in fall 2020. Bayesian phylogeographic reconstructions suggested 42 independent introductions into Finland during spring 2020, mainly from Italy, Austria, and Spain, which might have been the source for a third of cases. The investigations of the original introductions of SARS-CoV-2 to Finland during the early stages of the pandemic and of the subsequent lineage dynamics could be utilized to assess the role of transboundary movements and effects of early intervention and public health measures.Peer reviewe

Ikäihmisen omahoitoa tukeva ohjaus yleisimpien lääkkeiden ja alkoholin yhteiskäytön vaaroista : Opas sosiaali- ja terveydenhuollon ammattihenkilöstölle

Opinnäytetyömme on toiminnallinen ja se on toteutettu työelämälähtöisesti. Tuo-toksena syntyi opas sosiaali- ja terveydenhuollon ammattilaisille. Opas koostuu ikäihmisten alkoholin ja lääkkeiden käytön ohjauksesta. Aineisto kerättiin syste-maattista kirjallisuuskatsausta mukaillen ja sisällöt oppaaseen valittiin induktiivisella sisällönanalyysilla. Ikäihmisten alkoholinkäytön ja monilääkityksen lisääntyminen vaativat sosiaali- ja terveydenhuollon ammattihenkilöstöltä entistä enemmän tietoutta alkoholin ja lääkkeiden yhteisvaikutuksista. Oppaan tarkoituksena on tukea puheeksiottoa ikäihmisen alkoholin ja lääkkeiden yhteiskäytöstä. Oppaassa on esitetty sosiaali- ja terveydenhuollon ammattihenkilöstön ohjauksen tueksi muutosvaihemallin ja motivoivan haastattelun mukainen ohjaus. Muutosvaihemallissa on viisi vaihetta, joiden perusteella sosiaali- ja terveydenhuollon ammattihenkilöstö tunnistaa ikäihmisen tilanteen ja osaa antaa oikeanlaista ohjausta. Mini-interventio eli lyhytneuvonta on keskeinen menetelmä alkoholinkäyttöön puuttumisessa. Jo lyhyelläkin ohjauksella voidaan saada aikaan muutoksia alkoholin käytössä. Laaja-alaisen mini-intervention käytön on todettu kohentavan koko väestön terveydentilaa ja elämänlaatua.This is a functional and work-oriented thesis. The products are the thesis and a guide leaflet for social- and healthcare professionals. The leaflet consists of sub-stance abuse counselling for the elderly. Data were collected from a systematic literature review and the contents of the guide were chosen using an inductive content analysis. Elderly people’s alcohol consumption and use of multiple medications have in-creased. Social and healthcare professionals need more awareness of alcohol and drug interactions. The purpose of the leaflet is support social and healthcare professionals to discuss the issue of alcohol and medicine consumption with elderly people The leaflet presents the transtheoretical model of stages of change and motiva-tional interview. The transtheoretical model has five stages of change. The levels help social and healthcare professionals to identify the situation of elderly people; therefore, they are more able to provide the right kind of guidance. A mini-intervention is a key method of tackling alcohol use. The results of mini-interventions are improvements on the population's health status and quality of life

SARS-CoV-2-viruksen RT-PCR-testin todellinen kliininen herkkyys oireisissa potilaissa

COVID-19-pandemian alussa SARS-CoV-2-viruksen RTPCR-testi osoittautui tärkeäksi työkaluksi tartunnanjäljityksessä ja uusien infektioiden estämisessä. Valmistajat olivat määrittäneet testin herkkyyden hyväksi, mutta tiedossa oli kuitenkin tapauksia, joissa RT-PCR-testi ei ollut osoittanut kliinisesti ilmeistä infektiota. Tämän tutkimuksen tavoitteena oli määrittää RT-PCR-testin kliininen herkkyys, jotta kliinikot saisivat tietoa testin luotettavuudesta. Tutkimukseen sisällytettiin 3008 HUSLAB:issa testattua potilasta marras-huhtikuussa 2020. Näistä 1194 oli sairaalahoidettuja potilaita HUS:in koronakohorttiosastoilla ja 1814 oli valikoitu kotihoitoisten potilaiden joukosta (joka viides potilas kaikkien testattujen potilaiden listalta). Kliiniset tiedot kerättiin jälkikäteen potilastietojärjestelmästä. Arvioimme herkkyyttä kahdella menetelmällä. Ensimmäisenä tarkastelimme useaan kertaan testattuja potilaita, joilla vähintään ensimmäinen RT-PCR-testi oli ollut negatiivinen. Tällä menetelmällä arvioimme herkkyydeksi sairaalapotilailla 85,7 % (81,5- 89,1 %), kotihoitoisilla potilailla 95,5 % (92,2-97,5 %) ja kaikilla yhteensä 89,9 % (88,2- 92,1 %). Toisessa menetelmässä muodostimme jokaiselle potilaalle kliinisten tietojen perusteella arvion COVID-19-infektion todennäköisyydestä. Vertasimme potilaita, joilla oli vahva kliininen epäily infektiosta mutta ei positiivista RT-PCR-testiä niihin potilaisiin, joilla oli positiivinen testi. Tällä menetelmällä herkkyys oli sairaalapotilailla 67,5 % (62-9-71,9 %), kotihoitoisilla potilailla 34,9 % (31,4-38,5 %) ja kokonaisuudessaan 47,3 % (44,4-50,3 %). Näiden tulosten perusteella SARS-CoV-2-RT-PCR-testin herkkyys vaikuttaa korkeintaan kohtalaiselta, ja tämä tuleekin ottaa huomioon kliinisessä päätöksenteossa.Background: Understanding the false negative rates of SARS-CoV-2 RT-PCR testing is pivotal for the management of the COVID-19 pandemic and it has implications for patient management. Our aim was to determine the real-life clinical sensitivity of SARS-CoV-2 RT-PCR. Methods: This population-based retrospective study was conducted in March–April 2020 in the Helsinki Capital Region, Finland. Adults who were clinically suspected of SARS-CoV-2 infection and underwent SARS-CoV-2 RT-PCR testing, with sufficient data in their medical records for grading of clinical suspicion were eligible. In addition to examining the first RTPCR test of repeat-tested individuals, we also used high clinical suspicion for COVID-19 as the reference standard for calculating the sensitivity of SARS-CoV-2 RT-PCR. Results: All 1,194 inpatients (mean [SD] age, 63.2 [18.3] years; 45.2% women) admitted to COVID-19 cohort wards during the study period were included. The outpatient cohort of 1,814 individuals (mean [SD] age, 45.4 [17.2] years; 69.1% women) was sampled from epidemiological line lists by systematic quasi-random sampling. The sensitivity (95% CI) for laboratory confirmed cases (repeat-tested patients) was 85.7% (81.5–89.1%) inpatients; 95.5% (92.2–97.5%) outpatients, 89.9% (88.2–92.1%) all. When also patients that were graded as high suspicion but never tested positive were included in the denominator, the sensitivity (95% CI) was: 67.5% (62.9–71.9%) inpatients; 34.9% (31.4– 38.5%) outpatients; 47.3% (44.4–50.3%) all. Conclusions: The clinical sensitivity of SARS-CoV-2 RT-PCR testing was only moderate at best. The relatively high false negative rates of SARS-CoV-2 RT-PCR testing need to be accounted for in clinical decision making, epidemiological interpretations, and when using RT-PCR as a reference for other tests

Minä näytöllä : dramaturginen lähestymistapa videovälitteiseen teknostressiin

COVID-19 pandemian myötä monissa organisaatioissa on siirrytty tekemään etätyötä. Etätyön myötä vuorovaikutus on siirtynyt fyysisestä vuorovaikutuksesta yhä enemmän teknologiaväliteiseksi, kun neuvottelut pidetään käyttäen erilaisia etätyösovelluksia. Etenkin videokonferenssit ovat aiheuttaneet yksilöille jännitystä esiintymisestä sekä lisääntyneen IT:n käytön vuoksi myös teknologiasta aiheutuvaa stressiä eli teknostressiä. Etätyön johdosta yksilö voi kokea videoyhteyden välityksellä esiintymisstressiä eri tavoin kuin sitä koettaisiin fyysisesti samassa tilassa tapahtuvissa neuvotteluissa. Tässä pro gradu- työssä tarkastellaan sitä, kuinka etätyöhön liittyvää teknostressiä voidaan käsitteellistää, tutkia ja ymmärtää esiintymiseen liittyvien teoreettisten käsitteiden avulla. Lisäksi tutkitaan, millaisia stressin lievennyskeinoja etätyöstä aiheutuvaan stressiin on syntynyt ja miten niitä voidaan ymmärtää esiintymiskontekstin kautta. Taustateoriana toimii teknostressin käsitteistön lisäksi Erving Goffmanin (1959) klassinen tutkimus ihmisten sosiaalisista rooleista ja itsensä esittämisestä. Goffmanin teoria pohjautuu dramaturgiaan ja teoriassa väitetään, että ihminen esittää jatkuvasti itseään eri tilanteisiin sopivissa rooleissa. Tämä dramaturginen viitekehys tarjoaa mahdollisuuden tarkastella etätyöhön liittyvää esiintymistä ja siihen liittyviä stressitekijöitä uudella tavalla. Tutkimus toteutettiin laadullisena tutkimuksena. Tutkimuksen empiirisessä osiossa tarkastellaan keskustelufoorumeille kirjoitettuja kommentteja etätyöstä, joita analysoidaan sisällönanalyysin keinoin.With the COVID-19 pandemic, many organizations have switched to telecom-muting. With telework, interaction has shifted from physical interaction to increasingly technology mediated as negotiations are conducted using a varie-ty of telework applications. Videoconferencing has caused individuals excitement about appearing and, due to the increased use of IT, also technological stress, i.e., technostress. As a result of teleworking, an individual may experience performance stress over a video connection in a different way than would be experienced physically in negotiations in the same space. This master's thesis examines how technostress related to teleworking can be conceptualized and understood using performance-related theoretical concepts. In addition, it is investigated what kind of stress mitigation measures have been created for the stress caused by telework and how they can be understood through the context of occurrence. In addition to the concept of technostress, Erving Goffman's (1959) classical study of people's social roles and self-presentation serves as a background theory. Goffman’s theory is based on dramaturgy and the theory argues that man constantly presents himself in roles appropriate to different situations. This dramaturgical framework provides an opportunity to look at telecommuting-related occurrence and related stressors in a new way. The study was conducted as a qualitative study. The empirical part of the study examines comments written on discussion forums about telework, which are analyzed by means of content analysis

The phylodynamics of SARS-CoV-2 during 2020 in Finland.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused millions of infections and fatalities globally since its emergence in late 2019. The virus was first detected in Finland in January 2020, after which it rapidly spread among the populace in spring. However, compared to other European nations, Finland has had a low incidence of SARS-CoV-2. To gain insight into the origins and turnover of SARS-CoV-2 lineages circulating in Finland in 2020, we investigated the phylogeographic and -dynamic history of the virus.MethodsThe origins of SARS-CoV-2 introductions were inferred via Travel-aware Bayesian time-measured phylogeographic analyses. Sequences for the analyses included virus genomes belonging to the B.1 lineage and with the D614G mutation from countries of likely origin, which were determined utilizing Google mobility data. We collected all available sequences from spring and fall peaks to study lineage dynamics.ResultsWe observed rapid turnover among Finnish lineages during this period. Clade 20C became the most prevalent among sequenced cases and was replaced by other strains in fall 2020. Bayesian phylogeographic reconstructions suggested 42 independent introductions into Finland during spring 2020, mainly from Italy, Austria, and Spain.ConclusionsA single introduction from Spain might have seeded one-third of cases in Finland during spring in 2020. The investigations of the original introductions of SARS-CoV-2 to Finland during the early stages of the pandemic and of the subsequent lineage dynamics could be utilized to assess the role of transboundary movements and the effects of early intervention and public health measures