Expression, Function, and Regulation of the K-Cl Cotransporter KCC2 isoforms in the Central Nervous System

The potassium-chloride cotransporter KCC2 is a key regulator of chloride homeostasis in neurons of the central nervous system (CNS) and it is critical for the development of fast hyperpolarizing synaptic inhibition. Two full-length isoforms of KCC2, KCC2a and KCC2b, differing by their amino termini have been described. Both isoforms have similar expression levels in neonatal mice, but KCC2b is strongly upregulated in cortical areas during postnatal development, resulting in a developmental shift of GABAergic responses. In contrast to the well-studied KCC2b isoform, the importance of the KCC2a isoform has not yet been demonstrated. My thesis work focuses on characterizing the transcriptional regulation, expression and function of the KCC2 isoforms and a central aim is to elucidate the isoform-specific differences. The molecular mechanisms underlying the regulation of KCC2 gene expression are not yet well understood. Both isoforms show a largely neuron-specific expression pattern and their expression is tightly regulated in development. The KCC2b isoform is also known to be regulated by both normal and pathological neuronal activity. One aim of the present thesis work was to explore the functionality of a conserved E-box site in the KCC2b promoter. Results suggest that the E-box site functions as a binding site for the upstream stimulating factors 1 and 2 (USF1, USF2), two basic helix-loop-helix transcription factors with potentially important roles in brain. Binding of USF proteins to the E-box motif contributes to the upregulation of KCC2b gene expression in immature cortical neurons. Another aim of this study was to compare the postnatal expression patterns of KCC2a and KCC2b proteins in various regions of mouse CNS using immunohistochemistry and isoform-specific antibodies. The cellular expression patterns of KCC2a and KCC2b were largely similar in developing and neonatal mouse. In mature brain, KCC2a is detected in the basal forebrain, hypothalamus, and many areas of the brainstem and spinal cord, but its expression is very low in cortical regions. At the subcellular level, immunoreactivities of the isoforms are only partially colocalized, and KCC2a immunoreactivity, in contrast to KCC2b, is not clearly detected at the neuronal soma surface in most brain areas. Biotinylation experiments suggest that the N-terminal KCC2a epitope might be masked. Results of this thesis work also indicate that the KCC2a isoform, similar to KCC2b, can function as a chloride transporter and decrease the intracellular chloride concentration in cultured neurons. The unique N-terminus of KCC2a includes a SPAK kinase binding site, and the importance of this site and the WNK-SPAK signaling pathway is also explored. Our results indicate that the SPAK kinase is able to bind the KCC2a isoform and to regulate the transport activity of KCC2a more than that of KCC2b.Keskushermostossa esiintyvä kloridinkuljetusproteiini KCC2 on keskinen hermosolujen kloridi-homeostaasin säätelijä, ja sen toiminta on välttämätöntä hyperpolarisoivan inhibition toiminnalle. KCC2:sta tunnetaan kaksi täyspitkää isoformia, KCC2a ja KCC2b, jotka eroavat toisistaan aminoterminaalisen pään osalta. Molempien proteiinimuotojen ilmentyminen vastasyntyneillä hiirillä on saman tasoista, mutta KCC2b:n ilmentymisen taso kasvaa voimakkaasti kortikaalisilla aivoalueilla postnataalisen kehityksen aikana, ja sen seurauksena tapahtuu GABAA reseptori-vasteen muutos depolaroivasta hyperpolaroivaksi. KCC2b isoformia on tutkittu verrattain paljon, mutta KCC2a muodon merkitys on sen sijaan vielä tuntematon. Tässä väitöskirjatyössä olen selvittänyt KCC2 isoformien transkription säätelyä, ilmentymistä ja toimintaa, tavoitteena erityisesti selvittää isoformien välisiä eroavaisuuksia. KCC2 geenin ilmentymiseen liittyvät molekyylitason mekanismit tunnetaan vielä varsin huonosti. Molemmat isoformit ilmentyvät pääasiallisesti hermosoluissa, ja ilmentyminen on tarkasti säädeltyä kehityksen aikana. KCC2b isoformin ilmentymisestä tiedetään myös, että siihen vaikuttaa niin hermosolujen normaali kuin patologinenkin aktiivisuus. Yksi tämän tutkimuksen tavoitteista oli selvittää KCC2b:n promoottorialueella sijaitsevan E-box DNA-elementin merkitystä. Tulokset viittaavat siihen, että E-box toimii sitoutumiskohtana USF1 ja USF2 (upstream stimulating factors 1 and 2) transkriptiotekijöille. USF transkriptiotekijät kuuluvat basic helix-loop-helix –perheeseen, ja niillä on osoitettu olevan tärkeä tehtävä aivoissa. Tulosten perusteella USF proteiinit vaikuttavat aktivoivasti KCC2b geenin ilmentymisen epäkypsissä kortikaalisissa hermosoluissa. Toinen tutkimuksen tavoitteista oli verrata KCC2a ja KCC2b proteiinien postnataalista ilmentymistä solutasolla hiiren keskushermoston eri alueilla immunohistokemian menetelmin. Tulosten perusteella KCC2a ja KCC2b isoformit ilmentyvät hiirillä pääosin samoilla keskushermoston alueilla varhaisen kehityksen aikana. Aikuisilla hiirillä KCC2a muotoa havaittiin lähinnä etuaivon basaaliosassa sekä hypotalamuksen, aivorungon ja selkäytimen alueilla, mutta ilmentyminen iso- ja pikkuaivojen kortikaalisilla alueilla oli hyvin vähäistä. Lisäksi immunovärjäyksissä havaittiin, että isoformien subsellulaarinen lokalisaatio ei ollut täysin päällekkäinen hermosoluissa, ja KCC2a muoto ei myöskään tyypillisesti näkynyt soomaosien solukalvolla. Biotinylaatiokokeiden perusteella KCC2a isoformi kuitenkin sijaitsee myös solukalvolla viitaten siihen, että KCC2a muodon aminoterminaalinen epitooppi olisi piilossa. Tämän työn tulokset osoittavat myös, että KCC2a isoformi voi toimia kloridinkuljetuksessa KCCC2b isoformin tavoin, ja se pystyy alentamaan solunsisäistä kloriditasoa viljellyissä hermosoluissa. KCC2a isoformin aminoterminaalisessa osassa on sitoutumiskohta SPAK-kinaasille (mikä puuttuu KCC2b isoformista). Tulosten perusteella SPAK kinaasi pystyy sitoutumaan KCC2a isoformiin, ja näyttäisi säätelevän enemmän KCC2a- kuin KCC2b-muodon aktiivisuutta

Stress and Tinnitus; Transcutaneous Auricular Vagal Nerve Stimulation Attenuates Tinnitus-Triggered Stress Reaction

Introduction Tinnitus can become a strong stressor for some individuals, leading to imbalance of the autonomous nervous system with reduction of parasympathetic activity. It can manifest itself as sleep disturbances, anxiety and even depression. This condition can be reversed by bioelectrical vagal nerve stimulation (VNS). Conventional invasive VNS is an approved treatment for epilepsy and depression. Transcutaneous VNS (taVNS) stimulating the auricular branch of the vagus nerve has been shown to activate the vagal pathways similarly as an implanted VNS. Therefore, taVNS might also be a therapeutic alternative in health conditions such as tinnitus-related mental stress (TRMS). This retrospective study in 171 TRMS patients reports the clinical features, psychophysiological characteristics, and results of the heart rate variability (HRV) tests before and after test-taVNS. This study also reports the therapy outcomes of 113 TRMS patients treated with taVNS, in combination with standard tinnitus therapy. Methods Diagnostic tinnitus and hearing profiles were defined. To detect possible cardiac adverse effects, test-taVNS with heart rate monitoring as well as pre- and post-stimulation HRV tests were performed. Daily taVNS home therapy was prescribed thereafter. To assess therapeutic usefulness of taVNS, 1-year follow-up outcome was studied. Results of HRV tests were retrospectively analyzed and correlated to diagnostic data. Results The large majority of patients with TRMS suffer from associated symptoms such as sleep disturbances and anxiety. Baseline HRV data showed that more than three quarters of the 171 patients had increased sympathetic activity before test-taVNS. Test-taVNS shifted mean values of different HRV parameters toward increased parasympathetic activity in about 80% of patients. Test-taVNS did not cause any cardiac or other side effects. No significant adverse effects were reported in follow-up questionnaires. Conclusion TRMS is an example of a stress condition in which patients may benefit from taVNS. As revealed by HRV, test-taVNS improved parasympathetic function, most efficiently in patients with a low starting HRV level. Our tinnitus treatment program, including taVNS, effectively alleviated tinnitus stress and handicap. For wider clinical use, there is a great need for more knowledge about the optimal methodology and parameters of taVNS.Peer reviewe

Role of the K+-Cl- Cotransporter KCC2a Isoform in Mammalian Respiration at Birth

In central respiratory circuitry, synaptic excitation is responsible for synchronizing neuronal activity in the different respiratory rhythm phases, whereas chloride-mediated inhibition is important for shaping the respiratory pattern itself. The potassium chloride cotransporter KCC2, which serves to maintain low intraneuronal Cl- concentration and thus render chloride-mediated synaptic signaling inhibitory, exists in two isoforms, KCC2a and KCC2b. KCC2 is essential for functional breathing motor control at birth, but the specific contribution of the KCC2a isoform remains unknown. Here, to address this issue, we investigated the respiratory phenotype of mice deficient for KCC2a. In vivo plethysmographic recordings revealed that KCC2a-deficient pups at P0 transiently express an abnormally low breathing rate and a high occurrence of apneas. Immunostainings confirmed that KCC2a is normally expressed in the brainstem neuronal groups involved in breathing (pre-Botzinger complex, parafacial respiratory group, hypoglossus nucleus) and is absent in these regions in the KCC2a(-/-) mutant. However, in variously reduced in vitro medullary preparations, spontaneous rhythmic respiratory activity is similar to that expressed in wild-type preparations, as is hypoglossal motor output, and no respiratory pauses are detected, suggesting that the rhythm-generating networks are not intrinsically affected in mutants at P0. In contrast, inhibitory neuromodulatory influences exerted by the pons on respiratory rhythmogenesis are stronger in the mutant, thereby explaining the breathing anomalies observed in vivo. Thus, our results indicate that the KCC2a isoform is important for establishing proper breathing behavior at the time of birth, but by acting at sites that are extrinsic to the central respiratory networks themselves.Peer reviewe

Implications of the N-terminal heterogeneity for the neuronal K-Cl cotransporter KCC2 function

Peer reviewe

Finnish Version of the Eating Assessment Tool (F-EAT-10) : A Valid and Reliable Patient-reported Outcome Measure for Dysphagia Evaluation

Our aim was to validate a Finnish version of the Eating Assessment Tool (F-EAT-10) for clinical use and to test its reliability and validity in a multicenter nationwide study. Normative data were acquired from 180 non-dysphagic participants (median age 57.0 years, 62.2% female). Dysphagia patients (n = 117, median age 69.7 years, 53.0% female) referred to fiberoptic endoscopic evaluation of swallowing (FEES) completed F-EAT-10 before the examination and after 2 weeks. Patients underwent the 100-ml water swallow test (WST) and FEES was evaluated using the following three scales: the Yale Pharyngeal Residue Severity Rating Scale, Penetration-Aspiration Scale, and the Dysphagia Outcome Severity Scale. An operative cohort of 19 patients (median age 75.8 years, 57.9% female) underwent an endoscopic operation on Zenker's diverticulum, tight cricopharyngeal muscle diagnosed in videofluorography, or both. Patients completed the F-EAT-10 preoperatively and 3 months postoperatively. The cut-off score for controls was = 3 is abnormal. Re-questionnaires for test-retest reliability analysis were available from 92 FEES patients and 123 controls. The intraclass correlation coefficient was excellent for the total F-EAT-10 score (0.93, 95% confidence interval 0.91-0.95). Pearson correlation coefficients were strong (p < 0.001) for each of the questions and the total score. Internal consistency as assessed by Cronbach's alpha was excellent (0.95). Some correlations between findings in FEES and 100-ml WST with F-EAT-10 were observed. The change in subjective symptoms of operative patients paralleled the change in F-EAT-10. F-EAT-10 is a reliable, valid, and symptom-specific patient-reported outcome measure for assessing dysphagia among Finnish speakers.Peer reviewe

Finnish Version of the Eating Assessment Tool (F-EAT-10): A Valid and Reliable Patient-reported Outcome Measure for Dysphagia Evaluation

Our aim was to validate a Finnish version of the Eating Assessment Tool (F-EAT-10) for clinical use and to test its reliability and validity in a multicenter nationwide study. Normative data were acquired from 180 non-dysphagic participants (median age 57.0 years, 62.2% female). Dysphagia patients (n = 117, median age 69.7 years, 53.0% female) referred to fiberoptic endoscopic evaluation of swallowing (FEES) completed F-EAT-10 before the examination and after 2 weeks. Patients underwent the 100-ml water swallow test (WST) and FEES was evaluated using the following three scales: the Yale Pharyngeal Residue Severity Rating Scale, Penetration-Aspiration Scale, and the Dysphagia Outcome Severity Scale. An operative cohort of 19 patients (median age 75.8 years, 57.9% female) underwent an endoscopic operation on Zenker's diverticulum, tight cricopharyngeal muscle diagnosed in videofluorography, or both. Patients completed the F-EAT-10 preoperatively and 3 months postoperatively. The cut-off score for controls was = 3 is abnormal. Re-questionnaires for test-retest reliability analysis were available from 92 FEES patients and 123 controls. The intraclass correlation coefficient was excellent for the total F-EAT-10 score (0.93, 95% confidence interval 0.91-0.95). Pearson correlation coefficients were strong (p < 0.001) for each of the questions and the total score. Internal consistency as assessed by Cronbach's alpha was excellent (0.95). Some correlations between findings in FEES and 100-ml WST with F-EAT-10 were observed. The change in subjective symptoms of operative patients paralleled the change in F-EAT-10. F-EAT-10 is a reliable, valid, and symptom-specific patient-reported outcome measure for assessing dysphagia among Finnish speakers

Integration or discrimination: opportunities and barriers to appropriate paid employment for healthcare professional refugees in Finland

This thesis looks at the opportunities and barriers to appropriate employment for healthcare professional refugees in Finland. Moving beyond a simplistic dichotomy between employment and unemployment, this study seeks to identify the factors that , may inhibit, or potentially enhance, healthcare professional refugees' ability. to reestablish their careers in Finland. This research is built' on a notion that a strategy enabling more effective integration of healthcare professional refugees'skills into the Finnish workforcecould benefit both refugees and Finnish society. Previous research suggests that a profession is often the main axi~ of highly educated refugees' ,identity, and being forced to abandon one's profession thus means a loss of identity as well as a loss of income and social statils. Although paid labour market participation is now widely recognised as one of the main factors _,hat facilitate , successful resettlement and social integration, the requirements set by the Finnish authorities make formal recognition ofoverseas qualifications difficult to achieve. In the case of refugees, this problem is exacerbated by the 'victimisation' of refugees and integration practices that do not meet the needs of highly educated refugees. Approaching the topic'from a constructivist standpoint, this thesis focuses on healthcare professional refugees' personal accounts of their experiences. In addition to 13 interviews with healthcare professional refugees, 10 interviews were conducted with key respondents from relevant professional associations and the institutional sector. The findings suggest that healthcare professional refugees' skills remain largely underutilised. An examination of the effects of different inhibiting and enhancing factors on healthcare professional refugees' career prospects in Finland indicates that the positive effects ofthe enhancing factors are effectively outweighed by the inhibiting factors. While an established qualification recognition procedure makes it possible for refugee doctors to obtain official recognition for their overseas qualifications, the training that is intended to prepare them for the examinations is inadequate. _In the absence of a suitable qualification recognition-procedure, refugee nurses are commonly advised to forget their aspirations of returning to nursing, and encouraged to fe-educate themselves for the loweer)-paid pr~fession ofa healthcare assistant.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Järvisedimentin kestävän käyttötavan kehittäminen nurmen tuotannon kasvualustaksi

Maataloudesta peräisin olevien ravinteiden kertyminen vesistöjen pohjasedimenttiin on merkittävä syy vesiekosysteemien rehevöitymiseen. Sedimenttiä poistamalla saadaan tehokkaasti vähennettyä järvien sisäistä ravinnekuormaa ja edesautettua vesistön kuntoutumista. Kierrättämällä ravinteet takaisin kasvintuotantoon, voidaan vähentää mineraalilannoitteiden tarvetta ja neitseellisten materiaalien käyttöön liittyvää ympäristökuormitusta. Tietoa kuitenkin kaivataan parhaista sedimentin käyttötavoista peltomittakaavassa, jotka mahdollistaisivat tehokkaan ravinteiden hyödynnyksen ja minimoisi huuhtoutumisen takaisin vesistöön. Tutkielmassa kokeiltiin korkeafosforista järvisedimenttiä nurmikasvien kasvualustana peltoolosuhteissa Virossa. Kasvien kasvua, ravinteiden ottoa, maaperän ravinnetilaa sekä rikkaruohojen runsautta ja lajikoostumusta analysoitiin neljän kasvukauden ajan neljässä kerranteessa. Sedimenttiä käytettiin sellaisenaan (Sed) sekä siten, että sen pintakerrokseen lisättiin biohiiltä joko pelkästään (Sed+BC) tai seoksena peltomaan kanssa (Sed+Soil+BC). Verrokkina toimi niukkafosforinen pellon pintamaa-aines (Soil). Sedimenttikäsittelyjen satotaso oli keskimäärin parempi verrattuna paikallisiin keskivertosatoihin, ja typen- sekä fosforin poistumat maanpäällisen biomassan mukana olivat suurempia kuin keskimäärin kansainvälisesti nurmilla havaitut tasot. Sedimentti kasvualustana ei merkittävästi lisännyt tai heikentänyt maanpäällisessä biomassassa mitattua satoa verrattuna kontrolliin. Sedimentti ei myöskään vaikuttanut rikkaruohojen kokonaismäärään, mutta rikkalajistossa havaittiin sekä ohimeneviä muutoksia että mahdollisesti pidemmällä aikavälillä havaittavaksi tulevia muutoksia monivuotisten rikkakasvien, tarkemmin isonokkosen runsastumisen suhteen. Kaikki sedimenttikäsittelyt toimivat runsaana fosforin lähteenä kasveille neljän vuoden ajan. Liukoisen fosforin määrä sedimentissä oli korkeampi kuin peltomaassa, mutta kasvien fosforipitoisuudessa erot olivat vähäisemmät. Biohiilen vaikutus havaittiin lähinnä kohonneessa liukoisen kaliumin saatavuudessa etenkin kokeen alussa. Sadon lisäystä olisi voitu odottaa sekä sedimentin että kasvisolukon hyvän fosfori- rikki- kalsium- ja kaliumpitoisuuksien perusteella, mutta eroja kontrolliin vähensi kontrollimaan pääosin riittävä ravinnetila. Sedimentin peltolevitystä voisi korkean ravinnesaatavuuden vuoksi ja ravinteiden ylimäärän välttämiseksi suositella jatkossa kokeiltavaksi laajemmalle peltoalueelle, kasvikohtaisesti tarkistetun typpilannoituksen kanssa.Anthropogenic activities have resulted in huge accumulation of plant nutrients in lake sediments. These nutrients can be recycled back to the overlying water and sustain eutrophication. The release of phosphorus (P) from sediments, i.e. internal P loading, has often been a reason for delay in improvement of lake water quality, after reduced external nutrient loading. By removing the sediment, the internal lake nutrient load can be effectively reduced, and it is widely used in lake water quality restoration. By redirecting the reclaimed nutrients back to primary agricultural production, the need for using mineral fertilizers and virgin materials can be reduced. Currently there is, however, a lack of field-scale experiments and determination of best practices to enable efficient nutrient uptake and minimized nutrient leaching back into the lakes. A field experiment was conducted to study the effects of using P-rich lake sediment in different application methods for growing a mixture of forage grasses. The study focused on soil fertility, plant growth and nutrition, and species composition over a period of four growing seasons in central Estonia. Treatments for reducing nutrient losses included applying the sediment alone (Sed), with surface-incorporated biochar (Sed+BC), and as incorporated with surface-mixed biochar-topsoil mixture (Sed+Soil+BC). A treatment consisting of sandy loam topsoil was set up as control (Soil). The mean dry mass yield in the sediment treatments exceeded the local average grass yields and the N and P uptake rates in above-ground biomass (AGB) exceeded the international estimates for grasses. The sediment had no significant effect on AGB yield in comparison to the control. Similarly, no effect was observed in the yield of weeds, but temporary changes in weed species composition and an increasing trend particularly in nettle abundance on the sediment treatments were recorded. Apart from a transient increase in the amount of soluble potassium, no relevant effects were induced by the incorporated biochar. In conclusion, the sediment performed well and served as a plentiful source of P for grasses for four years. Based on the sufficient concentrations of P, sulphur, calcium and potassium in the plant tissue, yield increase could have been expected but most likely the good fertility of the control topsoil evened out yield differences between growing medium treatments. Based on this study, similar lake sediments can be advised to be used as soil amendments on grass cultivation on an agricultural field. Due to high nutrient concentrations, a lower rate could be applied on a wider field area to control excess in nutrient supply, given that the need of nitrogen fertilization is ensured to match plant-specific requirements

Lappeenrannan Liikuntamaan kehittäminen asiakaspalautteen pohjalta

Lappeenrannan alueella toimii 1–12-vuotiaille lapsille tarkoitettu Liikuntamaa, johon lapset voivat tulla aikuisten kanssa. Liikuntamaa toimii vuoroviikoin Joutsenohallissa ja Kourulan palloiluhallissa aina sunnuntaisin. Tämä opinnäytetyö oli kehittämistyö, jossa luotiin palautekysely Liikuntamaan käyttäjille. Tarkoituksena oli saada Liikuntamaan käyttäjien palautetta Lappeenrannan Liikuntamaan toiminnasta sen kehittämistä varten ja antaa kehitysideoita Liikuntatoimelle. Yhteistyökumppanina tässä opinnäytetyössä toimi Lappeenrannan Liikuntatoimi. Opinnäytetyön aiheeksi valikoitui asiakaspalautteen keräämisen lisäksi myös vanhempien kokema hyöty Liikuntamaassa liikkumisesta lapsen liikunta-aktiivisuuteen ja motorisiin taitoihin. Teoriaosuuteen koottiin tietoa lapsen motorisista taidoista ja palvelun kehittämisestä kirjallisuudesta ja tutkimuksista. Opinnäytetyön tutkimusaineisto kerättiin haastatteluilla ja internetissä täytettävällä Webropol-kyselyllä. Kyselylomake ja haastatteluiden kysymykset tehtiin opinnäytetyön tutkimuskysymysten ja Liikuntatoimen toiveiden perusteella. Kyselylomakkeen ja haastatteluiden vastauksista koottiin yhteen tulokset opinnäytetyöhön sekä lisäksi kehitysideoita. Opinnäytetyön avulla Lappeenrannan Liikuntatoimi voi kehittää Liikuntamaata asiakkaiden toiveiden mukaisesti ja siten vastata kysyntään. Kyselyn ja haastattelun perusteella Liikuntamaa on pidetty ja tarpeellinen palvelu. Suurimmiksi kehityskohteiksi nousivat Liikuntamaan ajankohta, kesto ja paikka. Liikuntamaassa käyvien lasten ikä on 1-12 vuoden välillä, joten kehityskohteiksi nousivat toiveet ajan jakamisesta pienten ja isompien lapsien kesken. Myös monipuolisempaa välineistöä, ohjattua toimintaa ja yhteisiä sääntöjä toivottiin. Näiden tuloksien ja meidän esittämien ehdotusten avulla Liikuntatoimi voi kehittää Liikuntamaata vielä asiakaslähtöisemmäksi. Tulevaisuudessa voitaisiin tutkia esimerkiksi sitä, miten mahdolliset muutokset ovat vaikuttaneet Liikuntamaan käyttäjien mielipiteisiin Liikuntamaan toiminnasta.A sports activity centre for children between the ages of one and twelve years, Liikuntamaa, operates in the Lappeenranta area. The children are accompanied by adults and are able to attend regularly, as Liikuntamaa is open every Sunday, alternately in the district of Joutseno and the suburb of Kourula. The aim of this study, commissioned by the Sports Services Department of the City of Lappeenranta(Lappeenrannan Liikuntatoimi), was to ascertain customer views about Lappeenranta’s Liikuntamaa so that the Sports Services Department can develop the service further. This thesis is a report of the development project, during which a questionnaire was created for Liikuntamaa’s customers and the results of the survey analysed. The goal of the Bachelor´s thesis was not only to collect customer feedback but also to gather parents’ opinions about the perceived benefits to their children’s physical activity and motor skills from attending Liikuntamaa. The theoretical part of the work includes information about the development of motor skills in children and background information about the Liikuntamaa service. In the empirical part, data for the study were collected by interview and with an electronic questionnaire. The questions on the questionnaire and the questions used in the interviews were constructed based on the research questions considered in the thesis and the wishes of the Sports Services Department of the City of Lappeenranta. The results from the questionnaire and interviews are discussed and ideas for further development of Liikuntamaa presented. Based on the questionnaire and interviews Liikuntamaa is a popular and necessary service. The most important areas requiring development are time, duration and location of Liikuntamaa activities. The age of children in Liikuntamaa is from one to twelve years, so parents hope that younger and older children could attend Liikuntamaa at different times. In addition, a wider selection of equipment, guided activities and common rules were desired. Findings from the study will enable the Liikuntamaa service to be developed according to customers' wishes, thus enabling it to meet customer demands better. Future research might consider how any changes made affect the number of the visitors and their opinions of Liikuntamaa

ELÄ TÄYSILLÄ - AUTA OIKEIN : ensiavun ja hätäensiavun koulutus Liikuntakeskus Club Feeniks Oy:n henkilökunnalle

Markkanen Sanna-Marika & Paananen Pekka. ELÄ TÄYSILLÄ – AUTA OIKEIN, Ensiavun ja hätäensiavun koulutus Liikuntakeskus Club Feeniks Oy:n henkilökunnalle. Helsinki, Kevät 2015. 55 s., 3 liitettä. Diakonia-ammattikorkeakoulu, Hoitotyön koulutusohjelma, Sairaanhoitaja (AMK) Hankkeen tavoitteena ja tarkoituksena oli lisätä, kerrata sekä edistää Liikuntakeskus Club Feeniks Oy:n henkilökunnan ensiavun ja hätäensiavun valmiuksia. Lisäksi heille oli tarkoituksena tuottaa laadukas ensiavun ja hätäensiavun perehdytysmateriaali. Hanke toteutettiin toiminnallisena opinnäytetyönä. Ensiavun ja hätäensiavun teoreettinen ja toiminnallinen koulutuspäivä pidettiin Liikuntakeskus Club Feeniks Oy:n henkilökunnalle 28.1.2015 Järvenpäässä. Toiminnallisesta päivästä saatu palaute oli erittäin positiivista ja koulutukselle nähtiin yksiselitteisesti olevan säännöllistä tarvetta tulevaisuudessa. Hankkeen ensiavun ja hätäensiavun materiaali suunniteltiin yhteistyössä liikuntakeskuksen henkilökunnan kanssa, jossa heidän toiveensa otettiin huomioon. Yhteistyötahon pyynnöstä teoreettiseen koulutus- ja perehdytysmateriaaliin lisättiin tietoa epilepsiasta ja diabeteksesta. Sekä hankkeen teoreettisessa että käytännöllisessä osuudessa on käytetty ainoastaan voimassa olevia Käypä hoito-suosituksia sekä luotettavia lähteitä.Markkanen Sanna-Marika and Paananen Pekka. LIVE TO THE FULLEST – HELP RIGHT, first aid and emergency first aid training for the employees of gym Club Feeniks Oy. 55 pages, 3 appendices. Language: Finnish. Helsinki Spring 2015. Diaconia University of Applied Sciences. Degree Programme in Nursing, Option in Nursing. Degree: Nurse. The target and the purpose of this project was to increase, to rehearse and to improve first aid and emergency first aid preparedness of the employees of the gym Club Feeniks. In addition, the aim was to produce a quality introduction material of those matters for the gym to use as introduction material when training new employees. The project was executed as a functional thesis. The theoretical and functional training day for the employees of Club Feeniks was held on 28th of January 2015 in Järvenpää. The feedback from the training was very positive. There was a definite unity on the opinions regarding the need for similar education and training days in the future. The education material concerning first aid and emergency first aid was designed in co-operation with the gyms staff and taking in consideration their wishes on the matter. At the request from the collaboration associate, the theoretical education and introduction material was added with information about epilepsy and diabetes. For the gathering of the projects theoretical and functional information was used only Käypä hoito- (current Finnish care guidelines) recommendations and reliable sources