MRI in the earliest phases of rheumatoid arthritis

This thesis focussed on inflammation observed on magnetic resonance imaging (MRI) in the early phases of rheumatoid arthritis (RA) and was divided into two parts. In the first part we explored the prevalence of inflammation and erosions detected on MRI in the general population. In the second part, we studied the early phases of RA and assessed factors which could be associated with radiographic joint damage or local inflammation detected on MRI.LUMC / Geneeskund

Kokemuksia Oman muotoinen koti -hankkeesta nuorten silmin

Opinnäytetyön tilaaja on Helsingin kaupungin nuorisoasiainkeskuksen Oman muotoinen koti -hanke. Hanke on aloitettu 2015 ja se tarjoaa nuorille eri asumiskokeilujen avulla ratkaisua haastaviin asumistilanteisiin Helsingissä. Oman muotoinen koti -hankkeessa nuoret muuttivat 2017 vuoden alussa asumaan Kannelmäkeen. Asunnon lisäksi nuorille avautui mahdollisuus tehdä töitä 20 tuntia kuukaudessa yhdessä mietittyjen tehtävien parissa. Opinnäytetyön idea oli seurata neljän nuoren alkuvaihetta Oman muotoinen koti -hankkeessa. Opinnäytetyöni tavoite oli keskittyä nuorten kokemusten taltiointiin hankkeen edetessä, mistä saatu tieto auttaisi hankkeen kehittämisessä tilaajaa. Sain tilaajalta vapaat kädet opinnäytetyön toteuttamiseen. Valitsin nuorten kokemusten taltioimiseen teemahaastattelun menetelmän. Haastateltavien keski-ikä oli 20 vuotta, joista osa oli maahanmuuttajataustaisia ja osa kantasuomalaisia. Kaikki haastateltavat olivat erilaisia, tein haastatteluun kysymysrungon, mutta annoin tilaa haastattelussa nuorille kertoa valitsemasta aiheesta enemmän. Äänitin haastattelut ja litteroin ne. Haastattelun teemat vaihtelivat haastateltavan kanssa. Vaikka kysymykset olivat samat, tunsi osa nuorista tarvetta puhua enemmän toisesta teemasta. Tein haastattelut hankkeen alkuvaiheessa, joten haastattelujen tulokset puhuvat vain hankkeen alkuvaiheen tunnelmista. Opinnäytetyön teoreettisessa viitekehyksessä käsittelen asunnottomuuden lisäksi nuorten työllisyyttä. Pohdin mikä motivoi nuoria työllistymiseen ja mitkä keinot auttavat nuoria löytämään sopivaa työtä ja mitkä asiat voivat vaikuttaa nuorten työllistymiseen. Aineiston analyysiosiossa avaan nuorten ajatuksia hankkeesta ja työnteosta. Yhdistän teoreettista viitekehystä omaan pohdintaan. Oman muotoinen koti hankkeen alkuvaiheen aineiston analyysin perusteella, hankkeelle on kova tarve ja sitä olisi hyvä laajentaa isommaksi eri puolille pääkaupunkiseutua. Hanke tukee nuorten hankalaa asumistilannetta ja työllistymistä alati muuttuvassa työelämässä.The thesis focuses on City of Helsinki’s youth Departments Home That Fits Project. The project started at the beginning of 2015 and its objective is to provide solution for the housing crisis among the youth population in Helsinki. Home That Fits project’s youth moved to shared apartment in Kannelmäki at the beginning of 2017. Apart from housing the youth were provided with opportunity to work 20 hours a month in a agreed contract between all the partners involved. The thesis goal was to follow four young people in the project’s early stage. The main focus was to understand on how the project can be develop through the experiences of the young participants in the Home That Fits project. From the young people’s experiences I did choose with the cooperation of the parties involved a particular themes that we could base our questions on. The interviewee’s average age was early 20’s. All the participants shared their experiences differently. The interview’s theme changed from time to time although the questions stayed the same. Some of the youth felt the need to talk more about other subject than the agreed themes. The interviews were conducted at the early stages of the project. Therefore the results are based on that. The Thesis theory part deals with the youth's employment: What motivates young people to seek employment , what are the mechanisms that have been created to help the youth find the right work and the issues that can affect youth employment. The findings shows that there is a certain need for Home That Fits project in the Helsinki area of Kannelmäki and it could expand to other parts of Helsinki metropolitan area

Seeding Change by Visioning Good Anthropocenes

Although we are surrounded by dystopian stories about the age of the Anthropocene, the future does not have to be bleak. Seeds of alternative good futures occur in many places around the world and we can use these to help us think more creatively about pathways to more desirable futures in the Anthropocene. This paper describes the Seeds of Good Anthropocenes (SOGA) project that aims to identify where elements of Good Anthropocenes (‘seeds’) currently exist on the planet and how they can be used to help us envision pathways towards new, positive futures for the Earth and humanity. Each of the seeds is a potential solution that could help to shift us onto a more sustainable trajectory that will ensure both planetary and human wellbeing. The project has developed and combined novel visioning tools that engage a broad set of stakeholders in identifying potentially game-changing seed initiatives, and exploring how these could develop and combine to create radically alternative futures. This new scenario approach has been used in intergovernmental processes such as the UN Environment’s Global Environment Outlook (GEO) and the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES). By tapping into creativity and ingenuity, the SOGA scenario process provides a set of methodological tools through which we can think in new ways about how to navigate towards more desirable futures, starting with the pockets of these futures that are already with us in the present

What is the prevalence of MRI-detected inflammation and erosions in small joints in the general population? A collation and analysis of published data

Introduction: MRI sensitively depicts erosions, bone marrow edema (BME) and synovitis in rheumatoid arthritis (RA). Recently developed European League Against Rheumatism (EULAR) recommendations stated that MRI is valuable to improve the certainty of a considered diagnosis and to detect structural damage at an early time point. However, these recommendations were mainly based on the data of patients with RA; prevalences of MRI features in the general population were not extensively explored. We reviewed the literature on MRI studies including symptom-free persons to assess the occurrence of MRI features.Methods: Medical literature databases up to September 2013 were systematically reviewed for symptom-free persons with MRI data on metacarpophalangeal, wrist and metatarsophalangeal joints. Data were extracted and summarised. When allowed because of comparable scanning and scoring protocols, a mean frequency of features was calculated.Results: Of the 338 articles screened, 31 studies evaluated MRI findings in symptom-free persons (n=516 in total). Both the imaging techniques (= 1 T, with/without contrast enhancement) and the scoring methods (non-validated or RA MRI score (RAMRIS)) varied widely, prohibiting direct comparisons of the results of many studies. 15 studies scored data according to RAMRIS; combining data of similar joint regions showed that erosions (RAMRIS >= 1) were present in 33-52% of symptom-free persons. Similarly, synovitis was present in 27% and BME in 0-16% of symptom-free persons. The prevalence of MRI-detected erosions increased with age.Conclusions: MRI features, erosions in particular, occur frequently in symptom-free persons. Before MRI can be implemented in the diagnostic process, larger studies should be conducted determining the degree and combination of MRI features that are disease specific

Moderate use of alcohol is associated with lower levels of C reactive protein but not with less severe joint inflammation: a cross-sectional study in early RA and healthy volunteers

Imaging- and therapeutic targets in neoplastic and musculoskeletal inflammatory diseas

Functional limitations in the phase of clinically suspect arthralgia are as serious as in early clinical arthritis; a longitudinal study

Introduction A phase of arthralgia may precede the emergence of rheumatoid arthritis (RA). Although several studies have focused on biomarkers, the relevance of this phase for patients is less studied. It is unknown if patients already have functional limitations and if this is correlated to the extent of subclinical inflammation. Therefore, we assessed functional disability in patients with clinically suspect arthralgia (CSA), its association with MRI-detected subclinical inflammation and its course during progression to clinical arthritis.Methods From April 2012 to March 2015, 241 patients had arthralgia for Results The median HAQ score at presentation with CSA was 0.50. Higher MRI-inflammation scores were associated with higher HAQ scores (β=0.017, 95% CI=0.004 to 0.030). During median 103 weeks follow-up, 44 patients progressed to clinical arthritis. HAQ scores ≥1.0 were associated with arthritis development (HR=2.50, 95% CI=1.03 to 6.10). Within converters, median HAQ scores did not increase from presentation with CSA to arthritis development (0.88 and 0.75, p=0.36). Conclusions HAQ scores ≥1.0 at presentation were associated with the development of clinical arthritis. Functional limitations in the prearthritis phase of CSA were as serious as in the early clinical phase, demonstrating the relevance of CSA from patients’ perspectivesImaging- and therapeutic targets in neoplastic and musculoskeletal inflammatory diseas

9 Dimensions for evaluating how art and creative practice stimulate societal transformations

There is an urgent need to engage with deep leverage points in sustainability transformations—fundamental myths, paradigms, and systems of meaning making—to open new collective horizons for action. Art and creative practice are uniquely suited to help facilitate change in these deeper transformational leverage points. However, understandings of how creative practices contribute to sustainability transformations are lacking in practice and fragmented across theory and research. This lack of understanding shapes how creative practices are evaluated and therefore funded and supported, limiting their potential for transformative impact. This paper presents the 9 Dimensions tool, created to support reflective and evaluative dialogues about links between creative practice and sustainability transformations. It was developed in a transdisciplinary process between the potential users of this tool: researchers, creative practitioners, policy makers, and funders. It also brings disciplinary perspectives on societal change from evaluation theory, sociology, anthropology, psychology, and more in connection with each other and with sustainability transformations, opening new possibilities for research. The framework consists of three categories of change, and nine dimensions: changing meanings (embodying, learning, and imagining); changing connections (caring, organizing, and inspiring); and changing power (co-creating, empowering, and subverting). We describe how the 9 Dimensions tool was developed, and describe each dimension and the structure of the tool. We report on an application of the 9 Dimensions tool to 20 creative practice projects across the European project Creative Practices for Transformational Futures (CreaTures). We discuss user reflections on the potential and challenges of the tool, and discuss insights gained from the analysis of the 20 projects. Finally, we discuss how the 9 Dimensions can effectively act as a transdisciplinary research agenda bringing creative practice further in contact with transformation research

The use of erlotinib in daily practice: a study on adherence and patients' experiences

<p>Abstract</p> <p>Background</p> <p>Adherence to pharmacological therapy is a complex and multi-factorial issue that can substantially alter the outcome of treatment. It has been shown that cancer patients, especially when using long-term medication, have similar adherence rates to those of patients with other diseases. The consequences of poor adherence are poor health outcomes and increased health care costs. Only few studies have focused on the use of oral anticancer agents in daily practice. Information about the reasons for non-adherence is essential for the development of interventions that may increase adherence. This paper presents the CAPER-erlotinib protocol, which is designed to study the relationship between adherence to erlotinib and both the plasma concentration and side-effects in patients with NSCLC. Further, the relationships between patient characteristics, disease characteristics, side-effects, quality of life, patient beliefs and attitude towards disease and medication, dose adjustments, reasons for discontinuation and plasma concentration of erlotinib will be explored.</p> <p>Methods/Design</p> <p>In this prospective observational cohort study 65 NSCLC patients of 18 years or older starting treatment with erlotinib will be followed for a period up to 16 weeks. The main study parameters are adherence, the plasma concentration of erlotinib and the number and grade of side-effects. At baseline and on erlotinib treatment in weeks 3-4, 8-9, 12 and 15-16, patients will be asked to fill out a questionnaire. In weeks 3-4, 8-9 and 15-16 blood samples are collected, which will be analysed for plasma concentration of erlotinib. Adherence will be measured using a medication event monitoring system.</p> <p>Discussion</p> <p>The present study aims to get more insight into patients' experiences with the use of erlotinib in daily practice and the various aspects that govern adherence. We hypothesize that side-effects play an important role in the way patients use erlotinib. We expect that the present study will provide valuable knowledge which will be useful for health care professionals to develop interventions to support patients. This approach will improve the adherence and persistence with the use of erlotinib in order to derive optimal benefit from the medication.</p> <p>Trial Registration</p> <p><a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1830">NTR1830</a></p