Fighting vessel dysmorphia to improve glioma chemotherapy

High-grade gliomas are aggressive and abundantly vascular tumors, and as in most cancer types, blood vessels in advanced lesions are highly abnormal. Poor perfusion and vascular leakage in tumor tissue resulting in hypoxia, necrosis, and high interstitial fluid pressure can hamper the efficient delivery of chemotherapy. Tumor angiogenesis is known to be supported by host leukocytes recruited to the tumor microenvironment, but the mechanisms leading to dysfunctional vascular network formation are incompletely understood. In this issue of EMBO Molecular Medicine, Mathivet et al (2017) present an elegant study, where longitudinal intravital imaging gives new insight on how recruitment and polarization of tumor-associated macrophages regulate aberrant angiogenesis in experimental gliomas. They show that macrophage targeting results in vessel normalization and improved chemotherapy response, suggesting that the combination of these therapeutic modalities could improve the outcome of glioma treatment in the clinic.Non peer reviewe

Quality of care and access to care at birth in low- and middle-income countries

Over two million newborns die at birth or during their first week of life every year. The majority of early neonatal deaths occur in low- and middle-income countries (LMICs) and could be prevented with high-quality care at birth. This thesis studied quality of care and geographic and socioeconomic inequalities in access to care at birth in LMICs. Furthermore, the aim was to elucidate whether birth in a facility improves newborn survival. Quality of emergency obstetric and newborn care, routine care and non-medical care were studied through a health facility assessment in seven districts of Brong Ahafo region in Ghana. Clinical vignettes were used to assess competence of health professionals in managing obstetric emergencies. The effects of two distal determinants (distance to a health facility and socioeconomic inequalities) on early neonatal mortality and on facility delivery were studied; Distance effects were studied using Demographic and Health Survey (DHS) data from rural Malawi and Zambia and Health Facility Census data from both countries. Socioeconomic inequalities were quantified using DHS data on 679,818 live births from 72 LMICs. Hospitals and large health centres provided the highest quality of care, managed the most patients and employed the most competent staff among the 64 delivery facilities in Brong Ahafo region. Quality of care was poor in the smallest facilities. Although coverage of facility delivery was fairly high at 68%, coverage of high-quality care was only 18%. Lack of health provider competence limited emergency care more than shortages of necessary drugs and equipment for management of these emergencies. Although distance to a health facility was a strong barrier to delivery care in rural Malawi and Zambia, proximity to a delivery facility was not associated with lower early neonatal mortality. Similarly, while socioeconomic inequalities in coverage of delivery care were found to be large in the 72 countries studied, inequalities in early neonatal mortality by wealth and education were small in most countries and compared with inequalities in facility delivery and postneonatal infant mortality. The findings of this thesis point to insufficient quality of care at birth in the seven districts of Brong Ahafo region in Ghana, in Malawi and Zambia and in many DHS countries. Early neonatal mortality remains a global health problem that has not been solved by increasing coverage with institutional deliveries. Improving quality of care should be prioritised in the future.Maailmassa kuolee vuosittain yli kaksi miljoonaa lasta synnytyksen tai ensimmäisen elinviikon aikana. Kuolleisuus on suurinta matalan tulotason ja keskitulotason maissa Afrikassa ja Aasiassa. Suurin osa varhaisen vastasyntyneisyyskauden kuolemista voitaisiin kuitenkin estää, jos synnytyksen hoito olisi korkealaatuista. Väitöskirjassa tutkittiin synnytyksen hoidon laatua ja saatavuutta 64 synnytyssairaalassa Brong Ahafon alueella Ghanassa, Malawissa ja Sambiassa sekä laajassa 72 matalan ja keskitulotason maata kattavassa analyysissä, jossa oli mukana yhteensä 679 818 syntymää. Väitöskirjassa verrattiin sosioekonomisia ja maantieteellisiä eroja hoidon saatavuudessa ja varhaisessa vastasyntyneisyyskuolleisuudessa. Tavoitteena oli arvioida, pelastaako synnytyksen hoito synnytyssairaalassa vastasyntyneiden henkiä. Synnytysten hoidon laatu oli matala kaikilla hoidon neljällä osa-alueella eli perushoidossa, synnyttäjän ja vastasyntyneen hätätilanteiden hoidossa sekä ei-lääketieteellisessä hoidossa Brong Ahafon alueella. Lääkärit, kätilöt ja sairaanhoitajat saivat korkeammat pisteet hätätilanteiden hoidon osaamista kartoittavissa potilastapauksissa kuin pienissä sairaaloissa työskentelevät henkilöt. Puutteet henkilökunnan osaamisessa saattoivatkin rajoittaa hätätilanteiden hoitoa enemmän kuin puutteet hoitovälineiden tai lääkkeiden saatavuudessa. Lyhyt maantieteellinen etäisyys kotoa synnytyssairaalaan lisäsi laitossynnytyksen todennäköisyyttä Malawissa ja Sambiassa. Lyhyempi etäisyys ei kuitenkaan vähentänyt varhaista vastasyntyneisyyskuolleisuutta. Analyysit koskien 72 matalan tulotason ja keskitulotason maata osoittivat, että sosioekonomiset erot vastasyntyneisyyskuolleisuudessa olivat pieniä verrattuna eroihin laitossynnytyksissä ja vastasyntyneisyyskauden jälkeisessä imeväiskuolleisuudessa. Tulokset viittaavat siihen, että syntymä sairaalassa ei useimmiten parantanut vastasyntyneen ennustetta kotona syntyneeseen lapseen verrattuna. Synnytyksen hoidon laatu oli puutteellista valtaosassa tutkimukseen osallistuneista synnytyssairaaloista Brong Ahafon alueella Ghanassa, Malawissa ja Sambiassa sekä useissa matalan tulotason ja keskitulotason maassa. Varhainen vastasyntyneisyyskuolleisuus on maailmanlaajuinen ongelma, jota synnytyssairaaloiden ja laitossynnytysten määrän lisääminen ei ole valitettavasti ratkaissut. Tämän vuoksi maiden, joissa on korkea vastasyntyneiden kuolleisuus, tulisi laitossynnytysten määrän lisäämisen sijaan keskittyä synnytysten hoidon laadun varmistamiseen ja parantamiseen

Aneurysmaattiseen lukinkalvonalaiseen verenvuotoon sairastuneen potilaan tehohoito

Teema : neuroanestesiologi

Healthy workplaces : Factors of importance for employee health and organizational production

The overall aim of the thesis was to investigate one aspect of healthy workplaces; namely, how psychosocial work factors affect employees general health and organizational production. The aim of Study I was to identify psychosocial factors at work that promote positive changes in employee health and factors that prevent negative changes in employee health. Specifically, we wanted to see if certain changes in the work environment would have a positive or negative impact on changes in the general health of the employee. The results showed that if employees perception of leadership and social climate improved, their health would also improve. A decrease in employees perception of leadership, organizational commitment and experiencing job strain were related to a decrease in their health. The aim of Study II was to investigate whether there is a relationship between psychosocial work environment factors and production loss, and if a potential relationship is mediated by employee health. Organizational commitment, social climate, job demands, job control and role compatibility were directly or indirectly related to production loss through employee health. The aim of Study III was to further develop a work capacity index including both qualitative and quantitative aspects of the ability to perform at work by including factors in the psychosocial work environment. A further aim was to evaluate the effects of a workplace intervention by estimating the change in the work capacity index. The results showed that the intervention had an effect in terms of more employees who were healthy and healthier employees, measured as improvement in the work capacity index, among the companies that worked actively with the intervention. The company that put less effort into the method did not have the same positive effect as the others did. Improvements in employee health and decreased production loss are related to improvements in psychosocial work factors. A good work environment contributes to improved employee health, which in turn affects organizational production. Creating a healthy workplace is not achieved by a single intervention. Instead, it is a process that needs to be maintained and constantly preserved. This focus must be part of the organizational culture, structure and climate. The results of the research done here, as well as of previous research, suggest that a healthy workplace is not only of value to companies, but also to the people who work for those companies

Comparing socioeconomic inequalities between early neonatal mortality and facility delivery: Cross-sectional data from 72 low- and middle-income countries

Facility delivery should reduce early neonatal mortality. We used the Slope Index of Inequality and logistic regression to quantify absolute and relative socioeconomic inequalities in early neonatal mortality (0 to 6 days) and facility delivery among 679,818 live births from 72 countries with Demographic and Health Surveys. The inequalities in early neonatal mortality were compared with inequalities in postneonatal infant mortality (28 days to 1 year), which is not related to childbirth. Newborns of the richest mothers had a small survival advantage over the poorest in unadjusted analyses (−2.9 deaths/1,000; OR 0.86) and the most educated had a small survival advantage over the least educated (−3.9 deaths/1,000; OR 0.77), while inequalities in postneonatal infant mortality were more than double that in absolute terms. The proportion of births in health facilities was an absolute 43% higher among the richest and 37% higher among the most educated compared to the poorest and least educated mothers. A higher proportion of facility delivery in the sampling cluster (e.g. village) was only associated with a small  decrease in early neonatal mortality. In conclusion, while socioeconomically advantaged mothers had much higher use of a health facility at birth, this did not appear to convey a comparable survival advantage

Rifampin Reduces the Plasma Concentrations of Oral and Intravenous Hydromorphone in Healthy Volunteers

Peer reviewe

Glymfaattinen järjestelmä avaa aivojen padot

Peer reviewe

Distance to Care, Facility Delivery and Early Neonatal Mortality in Malawi and Zambia

Peer reviewe

The cost of illness of the working-age population in the Nordic countries in 2012 : A comparison to 1991

The cost of illness in 2012 of the working-age population for four Nordic countries was calculated in monetary terms, and compared with equivalent data for 1991. On average, the costs have slightly increased in two decades, calculated as euro per labor force per year. The costs of mental helth problems in particular have increased, whereas the costs of musculoskeletal and circulatory diseases have fallen. The observed general increase in early retirement costs may be due to methodological differences. The highest increase in early retirement costs were observed in Denmark. Norway has the highest cost level

Impact of results-based financing on effective obstetric care coverage : evidence from a quasi-experimental study in Malawi

Background: Results-based financing (RBF) describes health system approaches addressing both service quality and use. Effective coverage is a metric measuring progress towards universal health coverage (UHC). Although considered a means towards achieving UHC in settings with weak health financing modalities, the impact of RBF on effective coverage has not been explicitly studied. Methods: Malawi introduced the Results-Based Financing For Maternal and Neonatal Health (RBF4MNH) Initiative in 2013 to improve quality of maternal and newborn health services at emergency obstetric care facilities. Using a quasi-experimental design, we examined the impact of the RBF4MNH on both crude and effective coverage of pregnant women across four districts during the two years following implementation. Results: There was no effect on crude coverage. With a larger proportion of women in intervention areas receiving more effective care over time, the overall net increase in effective coverage was 7.1%-points (p = 0.07). The strongest impact on effective coverage (31.0%-point increase, p = 0.02) occurred only at lower cut-off level (60% of maximum score) of obstetric care effectiveness. Design-specific and wider health system factors likely limited the program's potential to produce stronger effects. Conclusion: The RBF4MNH improved effective coverage of pregnant women and seems to be a promising reform approach towards reaching UHC. Given the short study period, the full potential of the current RBF scheme has likely not yet been reached.Peer reviewe