Lasten krooninen B- ja C-hepatiitti Helsingin ja Uudenmaan sairaanhoitopiirissä vuosina 1996-2006

Tutkimuksen tarkoituksena oli kartoittaa Helsingin ja Uudenmaan sairaanhoitopiirin (HUS) sairaaloissa hoidettujen lasten kroonisten B- ja C-hepatiittien tartuntareittejä ja tartunnan riskitekijöitä sekä selvittää, miten hepatiittien seuranta ja hoito on HUS-piirissä toteutunut. Tutkimusaineisto kerättiin retrospektiivisesti strukturoitua tiedonkeruulomaketta käyttäen HUS-piirin sairaaloiden ja HUSLAB:n arkisto- ja sairauskertomustiedostoja. Potilaiden valintakriteereinä olivat alle 16 vuoden ikä ja laboratoriotutkimuksin varmennettu krooninen B- tai C-hepatiitti vuosien 1996-2006 aikana. B-hepatiittia sairastavista lapsista 61/66 oli syntynyt Suomen ulkopuolella, ja valtaosa heidän tartunnoistaan todettiin maahantulotarkastuksen yhteydessä. C-hepatiittia sairastavista lapsista 28/40 oli syntynyt Suomessa. Maahantulotarkastus sekä päihteiden käyttöön liittyvä seulonta olivat tärkeimmät diagnoosiin johtaneet tutkimustilanteet. Antiviraalisesta lääkehoidosta hyötyi 6/13 B-hepatiittia ja 2/4 C-hepatiittia sairastavista lapsista. HUS-piirissä B-hepatiittia esiintyy lähinnä maahanmuuttajataustaisilla lapsilla. Krooninen C-hepatiitti liittyi lapsen tai hänen vanhempiensa huumeiden käyttöön. Tutkimus korostaa lasten B- ja C-hepatiitin seulonta-, seuranta- ja hoitokäytäntöjä selkeyttävän ohjeistuksen tarvetta

Opettajien ammatillinen toimijuus opetussuunnitelmauudistuksen kontekstissa

Aikaisemman tutkimuksen perusteella opettajilla voidaan katsoa olevan tärkeä rooli onnistuneessa opetussuunnitelmauudistuksessa. Suomessa opettajat osallistetaan vahvasti opetussuunnitelmatyöhön. Muutoksen ja haasteiden edessä opettajilla on mahdollisuus saavuttaa ammatillisen toimijuuden kokemus työyhteisössä. Toimijuus ymmärretään tässä opettajan oppimiseen suuntautuvana ja koostuu motivaatiosta, pystyvyysuskomuksista ja oppimisen taidoista. Toimijuus nähdään kontekstisidonnaisena ja relationaalisena, joka konstruoidaan aina uudelleen yhteisöissä. Tämä tutkimus pyrkii kartoittamaan toimijuuden kokemusta ammatillisissa yhteisöissä kansallisen opetussuunnitelmauudistuksen kontekstissa. Tutkimus tavoitteena on myös selvittää ammatillisen toimijuuden ja opetussuunnitelman uudistustyön sekä koulun kehittämisen välisiä suhteita. Tässä kvantitatiivisessa tutkimuksessa analysoitiin laajassa Koululla on väliä – hankkeessa kerättyä aineistoa. Aineisto edusti suomalaisia peruskoulunopettajia varsin hyvin. Vastauksia kyselyyn on 1531 opettajalta 73 koulusta. Koulut edustivat eri paikkakuntia, kokoja, kou-lutyyppejä sekä sosioekonomista luokitusta. Kyselyssä käytettiin kahta aikaisemmin validoitua mittaria sekä opettajien taustatietoja. Toimijuuden kokemuksia ja toimijuuden ja uudistuksen vaikutusten arvioinnin yhteyksiä tarkasteltiin klusterianalyysin, erotteluanalyysin, varianssianalyysin sekä khiin neliö- testien avulla. Tulosten perusteella opettajat voitiin jakaa korkean, keskitason ja matalan toimijuuden ryhmiin. Matalan toimijuuden ryhmä oli selvästi vähemmistössä. Toimijuuden kokemus oli samankaltaista sen tasosta riippumatta. Taustamuuttujat eivät pääosin vaikuttaneet toimijuuden kokemukseen, mutta miespuoliset opettajat olivat vahvemmin edustettuina matalan toimijuuden ryhmässä. Opettajien kollektiiviset pystyvyysuskomukset näyttäytyivät toimijuuden heikoimpana osana kaikissa ryhmissä. Opettajat, jotka kokivat toimijuutta korkealla tasolla arvioivat myös uudistuksen vaikutukset myönteisemmin. Vastaavasti matalan toimijuuden ryhmän opettajien näkemys uudistuksesta oli kielteisempi ja vähemmän vaikuttava työyhteisön kehittämisen näkökulmasta. Tulokset syventävät tietoa opettajien toimijuudesta ja esittävät lupaavan käsitteellisen välineen tutkimukseen suomalaisesta opettajuudesta.Previous research indicates that teachers have a crucial role in the success of a curriculum reform. Teachers can be considered to be on the frontlines of curriculum reform in Finland, where a participatory strategy of reform implementation is employed. To respond to the challenges and changes within the reform, teachers can achieve agency within the professional community. Agency is defined as an object of teacher learning and is characterized by a teachers will, skills and efficacy beliefs for learning. Agency is considered contextual and relational, and it is continuously constructed and evolving. This study aims to examine variation of Finnish teachers’ agency in the professional community within the context of large-scale national curriculum reform. Furthermore, this study aims to explore the relation between the experience of agency in the professional community and views towards curriculum reform and school development. This quantitative study examines a dataset collected from a representative sample of Finnish comprehensive school teachers. Data was collected in 2016 as part of a research project from 74 schools in Finland, representing urban and rural schools, smaller and larger schools as well as schools with a different socioeconomic index. The total number of respondents was 1531. The survey used two validated measures for professional agency and reform school impact in addition to background information on the teachers. Variation in experienced agency and the interrelations of agency and reform were examined using cluster analysis, discriminant function analysis, ANOVAs and Chi-square tests. Results indicate that the teachers could be grouped into high, medium and low agency clusters. Teachers in the low cluster were a pronounced minority. The experience of agency was similar through all clusters even if levels differed. Background variables did not contribute to the variation, but male teachers were found to be more likely to experience low agency. The teachers’ agency also displayed a similar level of low collective efficacy across all clusters. Teachers with high levels of agency had a more positive view on the reform’s impact. These results deepen the concept of teacher professional agency and offer new conceptual understanding into research on Finnish teachers as professionals

The Immunogenetic Conundrum of Preeclampsia

Pregnancy is an immunological challenge to the mother. The fetal tissues including the placenta must be protected from activation of the maternal immune system. On the other hand, the placental tissue sheds into the maternal circulation and must be adequately identified and phagocytized by the maternal immune system. During a healthy pregnancy, numerous immunosuppressive processes take place that allow the allograft fetus to thrive under exposure to humoral and cellular components of the maternal immune system. Breakdown of immune tolerance may result in sterile inflammation and cause adverse pregnancy outcomes such as preeclampsia, a vascular disease of the pregnancy with unpredictable course and symptoms from several organs. Immunological incompatibility between mother and fetus is strongly indicated in preeclampsia. Recently, genetic factors linking immunological pathways to predisposition to preeclampsia have been identified. In this mini-review genetic variation in immunological factors are discussed in the context of preeclampsia. Specifically, we explore immunogenetic and immunomodulary mechanisms contributing to loss of tolerance, inflammation, and autoimmunity in preeclampsia

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The Immunogenetic Conundrum of Preeclampsia

Pregnancy is an immunological challenge to the mother. The fetal tissues including the placenta must be protected from activation of the maternal immune system. On the other hand, the placental tissue sheds into the maternal circulation and must be adequately identified and phagocytized by the maternal immune system. During a healthy pregnancy, numerous immunosuppressive processes take place that allow the allograft fetus to thrive under exposure to humoral and cellular components of the maternal immune system. Breakdown of immune tolerance may result in sterile inflammation and cause adverse pregnancy outcomes such as preeclampsia, a vascular disease of the pregnancy with unpredictable course and symptoms from several organs. Immunological incompatibility between mother and fetus is strongly indicated in preeclampsia. Recently, genetic factors linking immunological pathways to predisposition to preeclampsia have been identified. In this mini-review genetic variation in immunological factors are discussed in the context of preeclampsia. Specifically, we explore immunogenetic and immunomodulary mechanisms contributing to loss of tolerance, inflammation, and autoimmunity in preeclampsia.Peer reviewe

Searching for a paternal phenotype for preeclampsia

Introduction Preeclampsia (PE) is a heterogeneous disorder and research to date has principally focused on maternal factors. In this study, however, we considered the associations between background factors and preeclampsia in men who fathered preeclamptic and non-preeclamptic pregnancies. Material and methods From 2008 to 2011, participants in the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort completed a questionnaire on their background information. Questionnaire data were available from 586 men who had fathered a preeclamptic pregnancy (PE fathers) and 660 control men who had fathered a non-preeclamptic pregnancy. Two different control groups were established: Group 1: healthy controls (n = 457), which consisted of fathers whose current partners were healthy women with uncomplicated pregnancies; Group 2: other controls (n = 203), which also included fathers whose current partners had other pregnancy complications. Results The PE fathers more often reported preeclampsia in a previously fathered pregnancy (p < 0.05 for all). The PE and control fathers were similar in age, body mass index, smoking, and preexisting medical conditions. There were no differences in the socioeconomic background or health history of the PE and control fathers or their parents. Conclusions In the FINNPEC study cohort, the occurrence of preeclampsia in a previously fathered pregnancy was more common among the men who had fathered a preeclamptic pregnancy; other paternal phenotypic and lifestyle characteristics did not play a significant role in preeclampsia susceptibility of their partners.Peer reviewe

Finger tracking and hand recognition technologies in virtual reality maritime safety training applications

The competitiveness and development of the maritime sector together with the continuous effort on increasing operations performance while reducing operations costs, drives the needs for on-board effective and qualitative training safety related issues. Virtual reality (VR) has been considered by classification societies and training organizations as a technology that can significantly improve seafarer's performance and competence with the adaptation of maritime applications developed for design simulation and gaming. This paper presents the evolution of the MarSEVR (Maritime Safety Education with VR) technology as a new concept and technology by integrating finger tracking and hand recognition technologies that increase immersiveness and user engagement within the MarISOT technology, a Green Ocean innovation composed of VR safety applications. The paper approaches this integration by addressing game design, pedagogic and cognitive neuroscience principles and challenges on the use of hand recognition and finger tracking in the MarSEVR learning episodes

No association in maternal serum levels of TMAO and its precursors in pre-eclampsia and in non-complicated pregnancies

Only a few studies have explored the role of microbiota-dependent metabolite trimethylamine N-oxide (TMAO) in non-complicated pregnancy and in pre-eclampsia (PE). We enrolled 139 PE and 29 healthy pregnant women in a nested case control study. We hypothesized that elevated levels of circulating TMAO and its precursors choline and glycine betaine in the late second or in third trimester might contribute to the PE and are associated with the onset of the disease and clinical features such as elevated blood pressure. The association with a few available lifestyle factors (use of fish and physical activity) was also evaluated. In contrast with the previous findings, there was no difference in TMAO concentration between PE and healthy women. In addition, TMAO concentration was not associated with any of the PE related clinical features, angiogenic or inflammatory markers. In future, it is crucial to obtain longitudinal data on TMAO in both non-complicated and in PE pregnancies before we could have more detailed understanding of TMAO.Peer reviewe

Toe pressure and toe brachial index are predictive of cardiovascular mortality regardless of the most diseased arterial segment in symptomatic lower-extremity artery disease—A retrospective cohort study

Objective Although lower extremity arterial disease (LEAD) is most often multisegmental, the predominant disease location and risk factors differ between patients. Ankle-brachial index (ABI), toe-brachial index (TBI), and toe pressure (TP) are predictive of outcome in LEAD patients. Previously, we reported a classification method defining the most diseased arterial segment (MDAS); crural (CR), femoropopliteal (FP), or aortoiliac (AOI). Current study aimed to analyze the associations between MDAS, peripheral pressure measurements and cardiovascular mortality. Materials and methods We reviewed retrospectively 729 consecutive LEAD patients (Rutherford 2–6) who underwent digital subtraction angiography between January, 2009 to August, 2011 and had standardized peripheral pressure measurements. Results In Cox Regression analyses, cardiovascular mortality was associated with MDAS and noninvasive pressure indices as follows; MDAS AOI, TP 1.30 (HR 6.71, 95% CI 1.89–23.8), and MDAS CR, TP <30 mmHg (HR 4.26, 95% CI 2.19–8.27), TBI <0.25 (HR 7.71, 95% CI 1.86–32.9), and ABI <0.25 (HR 2.59, 95% CI 1.15–5.85). Conclusions Symptomatic LEAD appears to be multisegmental with severe infrapopliteal involvement. Because of this, TP and TBI are strongly predictive of cardiovascular mortality and they should be routinely measured despite the predominant disease location or clinical presentation.Peer reviewe