Mies mukaan ehkäisyneuvontaan : Raskauden ehkäisyn aloituksen ja ehkäisyneuvonnan toimintamalli opiskeluterveydenhuollossa

Koulu- ja opiskeluterveydenhuolto ovat keskeisessä asemassa nuorten seksuaalikasvatuksen toteutumisessa. Seksuaalikasvatukseen kuuluu olennaisena osana ehkäisyneuvonnan antaminen. Ehkäisyneuvonta tulisi kohdentaa kaikille tasapuolisesti, sukupuoleen katsomatta. Opinnäytetyön tavoitteena on edistää seksuaalineuvonnan kehittämistä ja sukupuolten tasa-arvoa ehkäisyneuvonnassa. Opinnäytetyön tehtävänä oli luoda opiskeluterveydenhuoltoon ehkäisyneuvonnan toimintamalli, jossa huomioidaan miesten mukaan ottaminen ehkäisyneuvontaan yhdessä naisen kanssa. Toiminnallinen opinnäytetyö toteutettiin Joensuun kaupungin toimeksiantona. Toimintamallin haluttiin palvelevan mahdollisimman hyvin käytännön työelämää. Lähtötilanne toimintamallia varten kartoitettiin kyselyillä. Kyselyihin vastasi 30 miesopiskelijaa sekä 4 terveydenhoitajaa. Toimintamallin sisältö koottiin teoriatiedon sekä kyselyiden vastausten pohjalta yhteistyössä toimeksiantajan kanssa. Toimintamallia on tarkoitus käyttää raskauden ehkäisyn aloituksessa terveydenhoitajan työvälineenä opiskeluterveydenhuollossa. Sen tavoitteena on saada pariskunta yhdessä vastaanotolle saamaan tietoa ja päättämään raskaudenehkäisymenetelmästä. Toimintamalli on toteutettu kuviona, jossa on esitetty ehkäisyneuvonnan kulku vastaanotolla.School and student health care are in a key position when it comes to sexual education for adolescents. Contraceptive advice is an integral part of sexual education. Contraceptive advice should be given equally, despite the gender. The main idea of this thesis was to promote the development of sexual education and the equality between men and women in contraceptive advice. The target of this practice-based thesis was to produce a working model of contraceptive advice for student health nurses. The focus of this working model was to involve men more in contraceptive advice with women. This thesis was commissioned by student health care of the city of Joensuu. The aim was that the working model would serve the working life as well as possible. The starting point for the working model was charted with inquiries. A total of 30 male students and four public health nurses responded to the questionnaire. The content of the work-ing model was compiled based on both theory and the results of the inquiries in collaboration with the commissioner. The working model is meant to be used as a tool in student health care when students are starting contraception. Its aim is to motivate the couple to come to the nurse’s reception together to receive information and to choose a contraceptive method that suits them. The working model is executed as a figure, in which the progress of contraceptive advice at the reception is illustrated

Anaesthetising a bitch for caesarean section and resuscitation of neonatal puppies : a review

Peer reviewe

Comparison of the effects of methadone and butorphanol combined with acepromazine for canine gastroduodenoscopy

Objective To evaluate the feasibility of gastroduodenoscopy in dogs premedicated with acepromazine in combination with butorphanol or methadone. Study design Prospective, randomized, double-blinded clinical trial. Animals A group of 40 client-owned dogs. Methods Dogs were randomly allocated to one of two groups and give intramuscular acepromazine 0.02 mg kg(-1) combined with either butorphanol 0.3 mg kg(-1) (group ACEBUT) or methadone 0.2 mg kg(-1) (group ACEMET). General anaesthesia was induced with propofol and ketamine and maintained with sevoflurane (2.3%) in oxygen. Cardiopulmonary variables were recorded at 5 minute intervals during anaesthesia. Feasibility of the entire gastroduodenoscopy was evaluated with a visual analogue scale (VAS) from 0 (best) to 100 (worst) (primary outcome of the study). Lower oesophageal sphincter dilatation and duodenal intubation were scored. Pylorus diameter was measured with standard endoscopic inflatable balloons. Overall cardiovascular stability was assessed during anaesthesia, using a VAS (0-100), as was the presence of fluid in the oesophagus, regurgitation, need for mechanical ventilation, and intraoperative and postoperative rescue analgesia (secondary outcomes of the study). Differences between treatments were analysed with Mann-Whitney U, Student t test, Fisher exact test or mixed model analysis of variance as appropriate. Subsequently, feasibility VAS of the gastroduodenoscopy was assessed for noninferiority between groups. The noninferiority margin was set as -10. Results All gastroduodenoscopies were successfully completed in both groups using an endoscope tip diameter of 12.8 mm in all but one dog. Feasibility of gastroduodenoscopy was evaluated as 2.9 +/- 5.6 in group ACEBUT and 5.1 +/- 5.8 in group ACEMET. No significant differences between groups were detected in any measured or assessed variables, and noninferiority was confirmed. Conclusion and clinical relevance In our study population, the effects of methadone and butorphanol when combined with acepromazine were comparable.Peer reviewe

Mismatches in Gene Deletions and Kidney-related Proteins as Candidates for Histocompatibility Factors in Kidney Transplantation

Publisher Copyright: © 2022 International Society of NephrologyIntroduction: The genomic mismatch level between donor and recipient may be associated with the risk of rejection and graft survival. We determined the association of genome-level matching with acute rejection in deceased-donor kidney transplantation. Methods: The study cohort consists of 1025 recipient-donor pairs transplanted in a single center from 2007 to 2017 in Helsinki. The associations between the sums of whole-genome missense variant mismatches and missense mismatches in transmembrane, secretory, and kidney-related proteins, with acute rejection were estimated using Cox model. In addition, we analyzed 40 deletion-tagging variants using Cox model. Results: The association analysis between mismatch sums of kidney-related proteins and acute rejection resulted in an unadjusted hazard ratio (HR) of 1.15 (95% confidence interval [CI], 1.01–1.30; P = 0.029) and adjusted HR of 1.13 (95% CI, 0.99–1.28; P = 0.071). In deletion analysis, a mismatch in rs7542235 genotype GG tagging a homozygous deletion at the complement factor H-related (CFHR), proteins locus, predisposed to acute rejection with an unadjusted HR of 3.10 (95% CI, 1.53–6.29; P = 0.002) and adjusted HR of 2.97 (95% CI, 1.46–6.05; P = 0.003). Conclusion: In conclusion, analyses of genome-level mismatches may be useful tools in prediction of transplantation outcome. The relative importance differs between populations, because we found evidence for CFHR deletion but could not replicate the finding of previously reported LIMS1 deletion.Peer reviewe

A comparison of sedative effects of xylazine alone or combined with levomethadone or ketamine in calves prior to disbudding

Objective To compare the sedative effects of intramuscular xylazine alone or combined with levomethadone or ketamine in calves before cautery disbudding. Study design Randomized, blinded, clinical trial. Animals A total of 28 dairy calves, aged 21 +/- 5 days and weighing 61.0 +/- 9.3 kg (mean +/- standard deviation). Methods Calves were randomly allocated to three groups: xylazine (0.1 mg kg(-1)) and levomethadone (0.05 mg kg(-1); group XL), xylazine (0.1 mg kg(-1)) and ketamine (1 mg kg(-1); group XK) and xylazine alone (0.2 mg kg(-1); group X). Local anaesthesia (procaine hydrochloride) and meloxicam were administered subcutaneously 15 minutes after sedation and 15 minutes before disbudding. The calves' responses to the administration of local anaesthesia and disbudding were recorded. Sedation was assessed at baseline and at intervals up to 240 minutes postsedation. Times of recumbency, first head lift and first standing were recorded. Drug plasma concentrations were measured. Results Data were obtained from 27 animals. All protocols resulted in sedation sufficient to administer local anaesthesia and to perform disbudding. Sedation scores significantly correlated with drug plasma concentrations (p Conclusions and clinical relevance Levomethadone or ketamine with a low dose of xylazine produced short but sufficient sedation for local anaesthesia and disbudding with minimum resistance.Peer reviewe

Effects of vatinoxan on xylazine-induced pulmonary alterations in sheep

It was hypothesized that premedication with vatinoxan, a peripheral alpha(2)-adrenoceptor antagonist, would mitigate xylazine-induced pulmonary alterations in sheep. Fourteen adult sheep were allotted into two equal groups and premedicated with either vatinoxan (750 mu g/kg IV) or saline and sedated 10 min later with xylazine (500 mu g/kg IV). Arterial oxygen saturation (SpO(2)) was measured and respiratory rate (RR) counted at intervals. The sheep were euthanized with IV pentobarbital 10 min after xylazine administration. The severity of pulmonary parenchymal alterations was assessed and graded grossly and histologically and correlations of the morphological changes with SpO(2) evaluated. Following xylazine injection, SpO(2) was significantly higher and RR significantly lower with vatinoxan than with saline and the sheep administered vatinoxan exhibited significantly smaller quantities of tracheal foam than those receiving saline. No significant differences in macroscopic oedema scores were detected between treatments. In contrast, the vatinoxan-treated animals exhibited significantly graver microscopic interstitial alveolar oedema and haemorrhage than saline-treated animals. The histological severity scores did not correlate with changes in SpO(2). In conclusion, xylazine induced a marked reduction in SpO(2) which was abolished by the prior administration of vatinoxan. The histologically detected alterations after pentobarbital euthanasia with vatinoxan premedication need to be studied further.Peer reviewe

Concentrations of vatinoxan and xylazine in plasma, cerebrospinal fluid and brain tissue following intravenous administration in sheep

Objectives To investigate the extent of vatinoxan distribution into sheep brain, and whether vatinoxan influences brain concentrations of xylazine; and to examine the utility of cerebrospinal fluid (CSF) as a surrogate of brain tissue concentrations for vatinoxan and xylazine. Study design Randomised, blinded, experimental study. Animals A total of 14 adult female sheep. Methods Sheep were randomly allocated into two equal groups and premeditated with either intravenous (IV) vatinoxan (750 mu g kg(-1), VX) or saline (SX) administered 10 minutes before IV xylazine (500 mu g kg(-1)). Sedation was subjectively assessed at selected intervals before and after treatments. At 10 minutes after xylazine administration, a venous blood sample was collected and the sheep were immediately euthanised with IV pentobarbital (100 mg kg(-1)). Plasma, CSF and brain tissues were harvested, and concentrations of vatinoxan and xylazine were quantified using liquid chromatography-tandem mass spectrometry. Drug ratios were then calculated and the data were analysed as appropriate. Results The brain-to-plasma and CSF-to-plasma ratios of vatinoxan were 0.06 +/- 0.013 and 0.05 +/- 0.01 (mean +/- standard deviation), respectively. Xylazine brain concentrations were not significantly different (835 +/- 262 versus 1029 +/- 297 ng g(-1) in groups VX and SX, respectively) and were approximately 15-fold higher than those in plasma. The CSF-to-brain ratio of vatinoxan was 0.8 +/- 0.2, whereas xylazine concentrations in the brain were approximately 17-fold greater than those in CSF, with and without vatinoxan. Conclusions and clinical relevance Vatinoxan did not significantly affect sedation with xylazine or the concentrations of xylazine in the brain. CSF is not a good predictor of xylazine concentrations in the brain, whereas vatinoxan concentrations were concordant between the brain and CSF, using the dosages in this study.Peer reviewe

Gastric mucosal pathology in Belgian Shepherd dogs with and without clinical signs of gastric disease

Gastric carcinoma (GC) is uncommon in dogs, except in predisposed breeds such as Belgian Shepherd dogs (BSD) of the Tervuren and Groenendael varieties. When GC is diagnosed in dogs it is often late in the disease, resulting in a poorer prognosis. The aim of this prospective clinical study was to investigate possible associations of gastric mucosal pathologies with clinical signs, laboratory test results and GC in BSD. An online survey gathered epidemiological data to generate potential risk factors for vomiting as the predominant gastric clinical sign, and supported patient recruitment for endoscopy. Canine Chronic Enteropathy Clinical Activity Index (CCECAI) score and signs of gastroesophageal reflux (GER) were used to allocate BSD older than five years to either Group A, with signs of gastric disease, or Group B, without signs. Findings in the clinical history, laboratory tests and gastric histopathology of endoscopic biopsies were statistically analysed in search of associations.Peer reviewe

Efficacy of lumbosacral and sacrococcygeal epidural ropivacaine in dogs undergoing surgery for perineal hernia

Epidural anesthesia is commonly administered as part of balanced anesthesia for perioperative analgesia. The main goal of this randomized clinical trial was to compare the efficacy of two epidural approaches in dogs undergoing surgery for a perineal hernia. A secondary aim was to compare motor blockade. Intact ASA 1 and 2 male dogs, weighing ≤25 kg with no previous surgery for perineal hernia were enrolled. After premedication with IM acepromazine 0.02 mg/kg and butorphanol 0.3 mg/kg, general anesthesia was induced with propofol and maintained with sevoflurane in oxygen. Dogs were randomly allocated to receive either a lumbosacral (LS, n = 30) or a sacrococcygeal (SC, n = 26) epidural injection with ropivacaine 1% (0.2 mL/kg) under computed tomography guidance. Successful analgesia was defined as no need of intraoperative rescue analgesia (fentanyl 3 μg/kg IV). Clinical failure was defined as the need of more than two boluses of fentanyl/h each dog received meloxicam 0.2 mg/kg IV at the end of the surgery. The Glasgow Composite Pain Scale short form (GCPS-SF), tactile sensitivity, pressure pain thresholds and motor blockade were assessed at 4, 6, 8, and 24 h after the epidural injection. Methadone (0.2 mg/kg, IV) was administered if the GCPS-SF was ≥6/24 points. Differences between groups were analyzed with the Mann–Whitney U test, Student’s t-test or Fisher’s Exact test, as appropriate. Success rate was assessed for non-inferiority between groups. The non-inferiority margin was set at −10%. Epidural analgesia was successful in 24 dogs in group LS and 17 dogs in group SC (p = 0.243), resulting in success rates of 80 and 65% in LS and SC groups, respectively. The non-inferiority of group SC versus group LS was confirmed. Clinical failure was recorded in two dogs in group LS and one dog in group SC. No significant differences between groups were detected in the GCPS-SF score, tactile sensitivity, pressure pain thresholds, need of post-operative methadone, or motor blockade. Both epidural techniques are valuable analgesic options for perineal hernia repair in dogs

Sublingual administration of detomidine to calves prior to disbudding: a comparison with the intravenous route.

Objective: To study the effects of oromucosal detomidine gel administered sublingually to calves prior to disbudding, and to compare its efficacy with intravenously administered detomidine. Study design: Randomised, prospective clinical study. Animals: Twenty dairy calves aged 12.4 ± 4.4 days (mean ± SD), weight 50.5 ± 9.0 kg. Methods: Detomidine at 80 μg kg-1 was administered to ten calves sublingually (GEL) and at 30 μg kg-1 to ten control calves intravenously (IV). Meloxicam (0.5 mg kg-1) and  local anaesthetic (lidocaine 3 mg kg-1) were administered before heat cauterization of horn buds. Heart rate (HR), body temperature and clinical sedation were monitored over  240 minutes. Blood was collected during the same period for drug concentration  analysis. Pharmacokinetic variables were calculated from the plasma detomidine  concentration-time data using non-compartmental methods.  Results: The maximum plasma detomidine concentration after GEL was 2.1 ± 1.2 ng  mL-1 (mean ± SD) and the time of maximum concentration was 66.0 ± 36.9 minutes. The bioavailability of detomidine was approximately 34% with GEL. Similar sedation  scores were reached in both groups after administration of detomidine, but maximal sedation was reached earlier in the IV group (10 minutes) than in the GEL group (40 minutes). HR was lower after IV than GEL from 5 to 10 minutes after administration. All animals were adequately sedated, and we were able to administer local anaesthetic without resistance to all of the calves before disbudding. Conclusions and clinical relevance: Oromucosally administered detomidine is an  effective sedative agent for calves prior to disbudding.Peer reviewe