Sairaanhoitajien kokemuksia alkutilanteen kartoittamisesta masennuksen hoitoprosessissa

Tiivistelmä Masennusta sairasti vuonna 2012 noin 250 000 suomalaista, masennuksen on uskottu nousevan vuonna 2020 maailmanlaajuisesti sijalle kaksi vakavimpien sairauksien jouk-koon. Masennukseen voi liittyä erilaisia epätarkkarajaisia oireita, kuten surua tai alavi-reisyyttä. Kuitenkin näiden oireiden jatkuessa kaksi viikkoa tai pidempään puhutaan masennustilasta, joka on psykiatrinen mielialahäiriö. Tässä vaiheessa esiintyy yleensä jo selkeää mielialanlaskua ja ahdistusta, mikä monesti vaikuttaa masentuneen lähei-siinkin. Masennuksen hoidon alkukartoituksessa sairaanhoitajan tekemä hoitotyö on merkittä-vää, koska sairaanhoitaja on monesti ensimmäinen masentunutta hoitava taho. Sai-raanhoitaja luo potilaaseen hoitosuhteen, joka perustuu luottamukseen ja vuorovaiku-tukseen. Hoitosuhteessa sairaanhoitaja voi tukea potilasta omassa roolissaan. Tämän opinnäytetyön tutkimuksen tarkoituksena oli kuvata sairaanhoitajien kokemuk-sia alkutilanteen kartoittamisessa masennuksen hoitoprosessissa. Laadullinen tutkimus toteutettiin teemahaastattelulla ja aineisto analysoitiin luokittelu ja teemoittelumenetel-mällä. Tutkimuksessa tuli ilmi psyykkisten, fyysisten ja sosiaalisten asioiden tärkeä mer-kitys alkutilanteessa. Hoitosuhteen merkitys perustui tuloksien mukaan sairaanhoitajan ja potilaan väliseen vuorovaikutukseen, jonka kautta myös luottamusta rakennetaan. Nämä asiat toimivat koko hoitoprosessin yhdistävänä tekijänä.Abstract In 2012 about 250 000 Finns suffered from depression. The number of depression cases is believed to rise in 2020 so much that it would reach the second highest rank-ing of the most serious diseases. Depression may be associated with a variety of more diffuse symptoms such as sadness or gloom determination. However, if these symp-toms continue for two weeks or longer, we can talk about depression, which is a psy-chiatric disorder. This stage usually causes visible decrease of mood. Person can also suffer from increasing anxiety. These changes in the mood and anxiety often affect the close ones of depressed person. During the initial charting of depression, nurse's work is significant because the nurse is often the first one to help the depressed person. The nurse provides therapeutic re-lationship to the patient. This relationship is based on trust and interaction. In a thera-peutic relationship nurses can be in their own role and support patients. This thesis study was meant to describe registered nurses' experiences in charting of initial situation during the treatment process of depression. The qualitative research was carried out by using theme interviews and data which were analyzed by using classification and thematising method. The study revealed the importance of psycho-logical, physical, and social issues in the initial situation. According to the results the importance of the therapeutic relationship was based on the interaction between nurse and patient through which the trust is built. These things work throughout the treatment process as a unifying factor

Disentangling the effects of phonation and articulation: Hemispheric asymmetries in the auditory N1m response of the human brain

BACKGROUND: The cortical activity underlying the perception of vowel identity has typically been addressed by manipulating the first and second formant frequency (F1 & F2) of the speech stimuli. These two values, originating from articulation, are already sufficient for the phonetic characterization of vowel category. In the present study, we investigated how the spectral cues caused by articulation are reflected in cortical speech processing when combined with phonation, the other major part of speech production manifested as the fundamental frequency (F0) and its harmonic integer multiples. To study the combined effects of articulation and phonation we presented vowels with either high (/a/) or low (/u/) formant frequencies which were driven by three different types of excitation: a natural periodic pulseform reflecting the vibration of the vocal folds, an aperiodic noise excitation, or a tonal waveform. The auditory N1m response was recorded with whole-head magnetoencephalography (MEG) from ten human subjects in order to resolve whether brain events reflecting articulation and phonation are specific to the left or right hemisphere of the human brain. RESULTS: The N1m responses for the six stimulus types displayed a considerable dynamic range of 115–135 ms, and were elicited faster (~10 ms) by the high-formant /a/ than by the low-formant /u/, indicating an effect of articulation. While excitation type had no effect on the latency of the right-hemispheric N1m, the left-hemispheric N1m elicited by the tonally excited /a/ was some 10 ms earlier than that elicited by the periodic and the aperiodic excitation. The amplitude of the N1m in both hemispheres was systematically stronger to stimulation with natural periodic excitation. Also, stimulus type had a marked (up to 7 mm) effect on the source location of the N1m, with periodic excitation resulting in more anterior sources than aperiodic and tonal excitation. CONCLUSION: The auditory brain areas of the two hemispheres exhibit differential tuning to natural speech signals, observable already in the passive recording condition. The variations in the latency and strength of the auditory N1m response can be traced back to the spectral structure of the stimuli. More specifically, the combined effects of the harmonic comb structure originating from the natural voice excitation caused by the fluctuating vocal folds and the location of the formant frequencies originating from the vocal tract leads to asymmetric behaviour of the left and right hemisphere

Methods for Analyzing the Structure of Creases in Heat Sealed Paperboard Packages

Press-forming of paperboard has been previously studied by several authors. A point of interest regarding gas tight heat sealing of the packages are the creases in the package. The objective of this article was to study and compare different microscopic imaging methods to research an optimal imaging method for the formation of creases in the press-forming process of polymer coated paperboard trays. The studied methods were: Scanning electrode microscopy (SEM), X-ray Microtomography, Optical light microscopy and Polarized light microscopy. All four tested methods delivered clear images. Casting of the samples in an acrylic resin and light microscope imaging was found to be the most suitable method for the analysis of heat sealed creases and leakage detection

Interdisciplinary Collaboration in Studying Newspaper Materiality

Peer reviewe

Adapting a Phage to Combat Phage Resistance

Phage therapy is becoming a widely recognized alternative for fighting pathogenic bacteria due to increasing antibiotic resistance problems. However, one of the common concerns related to the use of phages is the evolution of bacterial resistance against the phages, putatively disabling the treatment. Experimental adaptation of the phage (phage training) to infect a resistant host has been used to combat this problem. Yet, there is very little information on the trade-offs of phage infectivity and host range. Here we co-cultured a myophage FCV-1 with its host, the fish pathogen Flavobacterium columnare, in lake water and monitored the interaction for a one-month period. Phage resistance was detected within one day of co-culture in the majority of the bacterial isolates (16 out of the 18 co-evolved clones). The primary phage resistance mechanism suggests defense via surface modifications, as the phage numbers rose in the first two days of the experiment and remained stable thereafter. However, one bacterial isolate had acquired a spacer in its CRISPR (Clustered Regularly Interspaced Short Palindromic Repeat)-Cas locus, indicating that also CRISPR-Cas defense was employed in the phage-host interactions. After a week of co-culture, a phage isolate was obtained that was able to infect 18 out of the 32 otherwise resistant clones isolated during the experiment. Phage genome sequencing revealed several mutations in two open reading frames (ORFs) likely to be involved in the regained infectivity of the evolved phage. Their location in the genome suggests that they encode tail genes. Characterization of this evolved phage, however, showed a direct cost for the ability to infect several otherwise resistant clones—adsorption was significantly lower than in the ancestral phage. This work describes a method for adapting the phage to overcome phage resistance in a fish pathogenic system

Are patient-related pre-operative factors influencing return to work after total knee arthroplasty

Background: Osteoarthritis is one of the leading causes of disability in working-age patients. The total number of working-age patients undergoing total-knee arthroplasty (TKA) is continuously increasing. The purpose of this study was to identify predictive factors related to general health, health risk behaviors and socioeconomic status influencing the rate of return to work after a TKA. Methods: Overall there were 151,901 patients included in the Finnish Public Sector (FPS) study. The response rate varied between 65 and 73% during the study period. We used Cox proportional hazard models to examine patient-related predictive factors that may influence the rate of return to work after TKA in a cohort of patients (n = 452; n = 362 female; mean age 56.4 years). Predictive factors were measured on average 3.6 years before the operation. Results: Of the patients, 87% returned to work within one year after TKA at a mean of 116 calendar days. In multivariate analysis, patients at sick-leave 30 days of sick-leave. Compared with patients in manual work, those in higher or lower level non-manual work showed a 2.6-fold (1.95-3.52) and 1.5-fold (1.15-1.92) increased probability of returning to work. Age, sex, health risk behaviors, obesity, physical comorbidities, common mental disorders, and other studied health-related factors were not associated with the rate of return to work. Conclusions: Non-manual job, good self-rated general health and preoperative sick leavePeer reviewe

A National Public Sphere? Analysing the Language, Location and Form of Newspapers in Finland, 1771–1917

Peer reviewe

Return to work after primary total hip arthroplasty : a nationwide cohort study

Background and purpose While the number of working-age patients undergoing total hip arthroplasty (THA) is increasing, the effect of the surgery on patients' return to work (RTW) is not thoroughly studied. We aimed to identify risk factors of RTW after THA among factors related to demographic variables, general health, health risk behaviors, and socioeconomic status.Patients and methods We studied 408 employees from the Finnish Public Sector (FPS) cohort (mean age 54 years, 73% women) who underwent THA. Information on demographic and socioeconomic variables, preceding health, and health-risk behaviors was derived from linkage to national health registers and FPS surveys before the operation. The likelihood of return to work was examined using Cox proportional hazard modeling.Results 94% of the patients returned to work after THA on average after 3 months (10 days to 1 year) of sickness absence. The observed risk factors of successful return to work were: having <30 sick leave days during the last year (HR 1.8; 95% CI 1.4-2.3); higher occupational position (HR 2.2; CI 1.6-2.9); and BMI <30 (HR 1.4; CI 1.1-1.7). Age, sex, preceding health status, and health-risk behaviors were not correlated with RTW after the surgery.Interpretation Most employees return to work after total hip arthroplasty. Obese manual workers with prolonged sick leave before the total hip replacement were at increased risk of not returning to work after the surgery.Peer reviewe

On solving generalized convex MINLP problems using supporting hyperplane techniques

Solution methods for convex mixed integer nonlinear programming (MINLP) problems have, usually, proven convergence properties if the functions involved are differentiable and convex. For other classes of convex MINLP problems fewer results have been given. Classical differential calculus can, though, be generalized to more general classes of functions than differentiable, via subdifferentials and subgradients. In addition, more general than convex functions can be included in a convex problem if the functions involved are defined from convex level sets, instead of being defined as convex functions only. The notion generalized convex, used in the heading of this paper, refers to such additional properties. The generalization for the differentiability is made by using subgradients of Clarke’s subdifferential. Thus, all the functions in the problem are assumed to be locally Lipschitz continuous. The generalization of the functions is done by considering quasiconvex functions. Thus, instead of differentiable convex functions, nondifferentiable f ∘  f∘ -quasiconvex functions can be included in the actual problem formulation and a supporting hyperplane approach is given for the solution of the considered MINLP problem. Convergence to a global minimum is proved for the algorithm, when minimizing an f ∘  f∘ -pseudoconvex function, subject to f ∘  f∘ -pseudoconvex constraints. With some additional conditions, the proof is also valid for f ∘  f∘ -quasiconvex functions, which sums up the properties of the method, treated in the paper. The main contribution in this paper is the generalization of the Extended Supporting Hyperplane method in Eronen et al. (J Glob Optim 69(2):443–459, 2017) to also solve problems with f ∘  f∘ -pseudoconvex objective function.</p