Päihdeongelmaisen potilaan kivunhoito : Opas hoitohenkilökunnalle

Tämän opinnäytetyön tarkoituksena oli tehdä opas hoitohenkilökunnalle päihdeongelmaisen potilaan kivunhoidosta. Tehtävinä oli kertoa päihteen vaikutuksesta kivun tuntemiseen sekä kipulääkkeen valintaan, antaa välineitä kivun arvioimiseen ja päihdeongelmaisen potilaan tunnistamiseen. Tehtävät valikoituivat kyselyn perusteella, jossa selvitettiin hoitohenkilökunnan tiedontarvetta aiheesta. Menetelmänä tähän työhön oli tuotokseen painottuva opinnäytetyö. Opinnäytetyön tuotoksena syntyi opas yhteistyössä erään Tampereen kaupungin erikoissairaanhoidon sisätautiosaston kanssa. Opas sisältää tietoa päihdeongelmaisen potilaan tunnistamisesta, kivunhoidosta sekä kivun arvioinnista. Lisäksi oppaassa kerrotaan, mitä erityispiirteitä voi olla alkoholiongelmaisen potilaan lääkkeellisessä kivunhoidossa, oppaassa on myös tieto alkoholin aiheuttamista muutoksista elimistössä. Oppaassa on pyritty selventämään teoriatietoa erilaisilla kuvioilla ja taulukoilla. Opas tehtiin sähköiseen muotoon, jotta sen käyttäminen on mahdollisimman vaivatonta ja jotta sitä voi tarvittaessa helposti päivittää. Opinnäytetyön tavoitteena oli tuottaa tietoa, joka auttaa hoitohenkilökuntaa päihdeongelmaisen potilaan kivunhoidossa. Työn hyöty tuli ilmi työn edetessä, sillä ilmeni että aiheeseen liittyviä kotimaisia tutkimuksia on tehty vähän, siten työn tarpeellisuus on korostunut. Jatkossa voitaisiin selvittää, onko tästä työstä syntynyttä opasta käytetty hoitotyössä ja opasta voitaisiin kehittää tarvittavaan suuntaan.The objective for this study was to provide a nursing staff with a guidebook on pain management in patients with substance abuse. The study explains how long-term substance abuse affects the efficiency of pain management. Substance abuser has been defined to mean alcohol abuser. To define the contents of guidebook we made a short survey for the nursing staff about what kind of troubles they have had with substance abusers and what kind of information they need on the subject. The guidebook contains information on measuring pain, for example whether there are some differences in pain management among moderate consumers and substance abusers. There is also information about recognition of an alcohol abuser. The guidebook is in electronic form, nursing staff can print it out if they want to or they can read it on screen. The objective of this thesis was to increase the nursing staff's knowledge about the pain management for substance abusers. A suggestion for the future study could be for someone to examine whether this guidebook has helpful for the nursing staff in pain management of substance abusers.Opasta ei ole saatavilla verkkojulkaisuna

The Sample Type used Affects the Levels of Gelatinases (MMP-2 and -9) and their Inhibitors (TIMP-1 and -2) in Circulating Blood of Healthy Controls and Breast Cancer Patients

New potential tumor markers such as matrix metalloproteinases and their inhibitors have been extensively studied during the last decades. The aim is to find prognostic markers that are measurable in easily available samples, such as serum or plasma. The proper sample type to use when measuring the levels of gelatinases and their inhibitors from blood samples is currently under critical evaluation. In this study, the effect of sample type is studied in 26 healthy controls, and the result is confirmed in a series of 80 breast carcinoma patients

Development of the ammonia emission inventory in Finland. Revised model for agriculture

Agriculture is the main source of ammonia (NH3) emissions in Finland comprising ca. 90% of the total emissions annually. Agriculture is also an important source of nitrous oxide (N2O), a greenhouse gas for which agriculture is responsible for ca. 50% of emissions. The main source for ammonia is livestock manure whereas for N2O its importance is much smaller. However, the same activity data are needed to assess both NH3 and direct N2O emissions from animal husbandry. In addition to this, indirect emissions of N2O are calculated based on NH3 and NO emissions. NH3 and N2O emissions are annually reported according to international reporting classifications. The aims of the study were 1) to construct a calculation model for gaseous agricultural nitrogen emissions thereby developing and updating the emission calculation procedure to better reflect the development of these emissions in Finland, and 2) to improve correspondence of the emission inventory reporting with the reporting classifications. In 2007, the Finnish emissions of ammonia from agricultural sources totalled 30,686 tonnes, of which more than 60% originated from cattle manure. Time series for ammonia emissions from agriculture show that there have been no large changes in the total emissions during the last two decades. Despite the decreased number of cattle during that period the emissions have remained near the present level, mainly because of the increased nitrogen excretion of cattle. Emission projections for the years 2008–2050 show no significant changes in emissions in the future. As for ammonia, no significant changes for nitrous oxide emissions from animal husbandry have taken place, and no big changes can be expected in the future as long as there are no drastic alterations in animal production. Despite the development of emission modelling, the emission estimates still include significant sources of uncertainty, which is mainly related to information on the distribution of manure management systems and the use of different manure application methods as well as to information on ammonia evaporation in different manure management phases in Finland

Risk factors for development of personal protective equipment induced headache : e-survey of medical staff in Baltic states

Funding Information: The authors received no financial support for the research, authorship, and publication of this article. We would like to thank all the medical personnel who participated in this study. Publisher Copyright: © 2022, The Author(s).Background: The COVID-19 pandemic led to an unprecedented increase in the use of personal protective equipment (PPE) among medical personnel. The goal of this study was to determine the risk factors and frequency of PPE-induced headache during the COVID-19 pandemic. Methods: From January 25 to March 1, 2021, an anonymous online survey was undertaken in the Baltic states. Results: In total, 2132 individuals participated. 52.3% experienced a PPE-induced headache. Usual onset time was between 2–3 h, lasting up to 1 h after PPE removal. The most common localization was in temporal and frontal regions. Headache usually occurred 2 to 3 days per week with an average pain score of 5.04 ± 1.80 points. Higher risk was associated with discomfort/pressure OR = 11.55, heat stress OR = 2.228, skin conditions OR = 1.784, long PPE use (duration 10-12 h) OR = 2,18, headache history prior PPE use OR = 1.207. Out of 52.3% respondents with PPE-induced headache, 45.5% developed de novo headache, whereas 54.5% had headache history. Statistically significant differences of PPE-induced headache between respective groups included severity (4.73 vs 5.29), duration (≥ 6 h 6.7% vs 8.2%), accompanying symptoms (nausea (19.3% vs 25.7%), photophobia (19.1% vs 25.7%), phonophobia (15.8% vs 23.5%), osmophobia (5.3% vs 12.0%)) and painkiller use (43.0% vs 61.7%). Conclusions: Over half of the medical personnel reported headache while using PPE. The risk was higher in individuals with headache history, increased duration of PPE use and discomfort while using PPE. Predisposed individuals reported PPE-induced headache which persisted longer, was more intense and debilitating than in the respondents with de novo headache.publishersversionPeer reviewe

Mortality of asthma, COPD, and asthma-COPD overlap during an 18-year follow up

Background: We studied asthma, COPD, and asthma-COPD overlap (ACO) to predict mortality in a cohort of Finnish adults with an 18-year follow up.Methods: A national health examination survey representing Finnish adults aged ≥30 years was performed in 2000-2001. The study cohort included 5922 participants (73.8% of the sample) with all relevant data, including a comprehensive clinical examination and spirometry. These participants were followed continuously from baseline until end of 2018 for total, cardiovascular, cancer, and respiratory mortality through a record linkage. Asthma, COPD, and ACO were defined based on the survey data, including spirometry and register data. There were three separate groups of obstructive subjects (one definition excluding the others).Results: Asthma and COPD were significantly associated with higher total mortality in Cox's model adjusted for sex, age, smoking, education level, BMI, leisure time physical activity, cardiovascular disease, diabetes, and hypertension. Hazard ratios (HR) (95% confidence interval [CI]) for asthma, COPD, and ACO were 1.29 (1.05-1.58), 1.50 (1.20-1.88), and 1.26 (0.97-1.65), respectively. Additionally, asthma (HR 1.47, 95% CI 1.09-1.97) and COPD (HR 1.53, 95% CI 1.08-2.16) were associated with cardiovascular mortality. Although ACO did not predict mortality in the whole cohort, there was a significant association with mortality risk among those with hs-CRP 1-2.99 mg/l.Conclusions: Asthma or COPD predicts higher total mortality and premature death from cardiovascular diseases.</p

Complete Atrioventricular Septal Defect : Evolution of Results in a Single Center During 50 Years

Background. Operative mortality after complete atrioventricular septal defect (cAVSD) repair has improved vastly. Less improvement has been demonstrated regarding late mortality and reoperation rates, however. There is evident lack of comprehensive population-based studies analyzing the history and progress of the ever-changing operative results. Methods. This is a 5-million population-based retrospective study of consecutive 388 cAVSD patients operated in Finland between 1962 and 2014. Data were collected using Children's Cardiac Surgical Registry of Children's Hospital at the Helsinki University Hospital, Finland. Mortality data and reoperation rates were analyzed on a decade-by-decade basis. Results. During the early era, overall mortality was 17.4%, operative mortality constituting 10.9%. The operative results have improved significantly over the decades, and eventually, the last decade showed no mortality. A total of 23 late deaths occurred; of these, 20 were directly heart-related. Half of the late mortality occurred during the first postoperative year. The only significant risk factor for overall mortality was an earlier decade of operation (p <0.001). Reoperation rates have not decreased but slightly increased over decades (p = 0.621), and reoperations have been performed mainly during the first year after the primary operation. Actuarial freedom from left side atrioventricular valve reoperation at 15 years was 90.9%. Conclusions. There has been an outstanding improvement in surgical results through the years even though the general operative approach has remained the same. Rates of reoperation have not been declining, but the reoperations are dated to early childhood years. The improvement in results has been ongoing. (C) 2019 by The Society of Thoracic SurgeonsPeer reviewe

Kalan elintarvikejalostuksen sivutuotevirtojen jalostaminen kalaöljyksi

Tässä työssä selvitettiin mahdollisuuksia hyödyntää kalanjalostusteollisuuden elintarvikelaatuisia sivutuotevirtoja kalaöljyn tuotannossa, öljyn markkinoita ja arvioitiin toiminnan kannattavuutta. Maailmalla tuotetaan kalaöljyä noin miljoonaa tonnia vuodessa. Valtaosa kalaöljystä on peräisin valtameristä pyydetyistä kaloista ja määrästä noin neljännes saadaan elintarvikekäyttöön menevien kalojen sivutuotevirroista. Kalaöljystä eristettyjen EPA- ja DHA-rasvahappojen kokonaismäärän arvioidaan olevan 200 tuhatta tonnia. Nykyisin kalanviljely käyttää kolme neljäsosaa ja ihmiset yhden neljäsosan tuotetusta kalaöljystä. Kalaöljymarkkinoiden suurin ja kasvava markkinasegmentti on terveystuotteet: ravintolisät ja terveysvaikutteiset elintarvikkeet. Lisäksi kalaöljyä käytetään lääkkeiden sekä imeväisikäisten ravinnon ja lemmikkieläinten rehun valmistamiseen. Suomen kalaöljypohjaisia ravintolisämarkkinoita on vaikea arvioida, sillä kattavia myyntilukuja ei tilastoida. Markkinoilla on lukuisia kalaöljypohjaisia ravintolisätuotteita ja niiden sisältämän öljyn laadussa (EPA + DHA-pitoisuus) ja öljyn vähittäismyyntihinnassa (€/kg) on paljon vaihtelua. Suomen kalanjalostusteollisuuden jalostama kalamäärä oli vuonna 2015 73 miljoonaa kiloa, josta kasvatetun kalan osuus oli 54 miljoonaa kiloa. Kasvatetun kirjolohen ja lohen jalostustoiminnasta muodostui elintarvikekelpoisia sivutuotteita (selkäruodot, pää ja vatsalieve) noin 11 miljoonaa kiloa. Tässä työssä tutkittiin eri prosessiolosuhteiden vaikutusta sivutuotevirroista saatavan öljyn määrään ja laatuun. Kokeissa testattiin uuttolämpötilan, uuttoajan ja lisätyn entsyymin määrän ja laadun vaikutuksia öljysaantoon. Lähtömateriaalina käytettiin kalanjalostuslaitokselta saatuja lohen ja kirjolohen sivutuotteita ja uutot tehtiin laboratotio- ja pilottimittakaavassa. Vatsaliepeiden öljypitoisuus oli tutkituista sivutuotteista korkein (45–50 %) eikä sivutuotteiden välillä ollut eroja EPA ja DHA pitoisuuksissa. Tämän vuoksi jatkotyöt tehtiin vatsaliepeillä. Prosessiolosuhteet eivät vaikuttaneet kalaöljyn rasvahappokoostumukseen, joten periaatteessa kaikki testatut entsyymit soveltuvat kalaöljyn tuottamiseen, koska niillä saadaan vähintään 75 % öljysaanto 60 minuutissa alhaisella entsyymikonsentraatiolla (0,05 %) käyttäen matalia lämpötiloja (50–55 °C). Näissä prosessiolosuhteissa tuotettu kalaöljy on myös korkealaatuista (alhaiset PL- ja AL-arvot) entsyymin inaktivoinnista huolimatta. Koska inaktivointi alentaa eristetyn öljyn laatua hieman, niin kalaöljyn laadun optimoinniksi öljy kannattaisi eristää hydrolysaatista ennen entsyymin inaktivointia. Lohen ja kirjolohen vatsaliepeet sisältävät runsaasti (45–50 %) rasvaa soveltuen siten erittäin hyvin kalaöljyn raaka-aineeksi. Tehdyissä pilotointikokeissa öljyn saanto oli 75–80 %. Saantoa on mahdollista parantaa menetelmien optimoinnilla. Tuore kalaöljy oli laadultaan erinomaista täyttäen ihmiskäyttöön tarkoitetun korkealaatuisen kalaöljyn kriteerit. Myös öljynerotusprosessin sivutuotteena syntyvät vesifaasi ja sakka ovat potentiaalisia lisäarvotuotteita. Vaikka pelkkään kuumennuskäsittelyyn perustuvalla öljyn eristysmenetelmällä on mahdollista tuottaa korkealaatuista kalaöljyä ihmiskäyttöön, niin entsymaattiseen hydrolyysiin perustuva menetelmällä on enemmän kaupallista potentiaalia, koska sen avulla on mahdollista tuottaa bioaktiivisia peptidejä. Mahdollisissa jatkohankkeissa tulisi pyrkiä optimoimaan eristysmenetelmiä paremman öljysaannon lisäksi myös vesifaasin/sakan sisältämien bioaktiivisten ominaisuuksien suhteen. Öljysaantoa on mahdollista kasvattaa myös ottamalla talteen myös vesifaasin sisältämä öljy esimerkiksi keraamisten kalvosuodattimien avulla. Suomessa syntyy vuosittain noin 13,7 mijoonaa kiloa kirjolohi- ja lohijalostusteollisuuden sivuvirtaa, josta 2,1 miljoonaa kiloa on vatsaliepeitä. Jo 1 miljoonasta kilosta vatsaliepeitä voidaan eristää 360–400 tonnia kalaöljyä, joka puolestaan sisältää 25–28 tonnia EPA- ja DHA-rasvahappoja.201

Genomics of asthma, allergy and chronic rhinosinusitis : novel concepts and relevance in airway mucosa

Funding Information: The study was supported in part by research grants from Finnish Medical Foundation, the Finnish Society of Allergology and Immunology, the Jane and Aatos Erkko Foundation, the Finnish Cultural Foundation, Hospital District of Helsinki and Uusimaa (TYH2018103, TYH2019322), Paulo Foundation, the Tampere Tuberculosis Foundation, the Väinö and Laina Kivi Foundation, the Finnish ORL-HNS Foundation. Acknowledgements Publisher Copyright: © 2020, The Author(s).Genome wide association studies (GWASs) have revealed several airway disease-associated risk loci. Their role in the onset of asthma, allergic rhinitis (AR) or chronic rhinosinusitis (CRS), however, is not yet fully understood. The aim of this review is to evaluate the airway relevance of loci and genes identified in GWAS studies. GWASs were searched from databases, and a list of loci associating significantly (p <10(-8)) with asthma, AR and CRS was created. This yielded a total of 267 significantly asthma/AR-associated loci from 31 GWASs. No significant CRS -associated loci were found in this search. A total of 170 protein coding genes were connected to these loci. Of these, 76/170 (44%) showed bronchial epithelial protein expression in stained microscopic figures of Human Protein Atlas (HPA), and 61/170 (36%) had a literature report of having airway epithelial function. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) annotation analyses were performed, and 19 functional protein categories were found as significantly (p <0.05) enriched among these genes. These were related to cytokine production, cell activation and adaptive immune response, and all were strongly connected in network analysis. We also identified 15 protein pathways that were significantly (p <0.05) enriched in these genes, related to T-helper cell differentiation, virus infection, JAK-STAT signaling pathway, and asthma. A third of GWAS-level risk loci genes of asthma or AR seemed to have airway epithelial functions according to our database and literature searches. In addition, many of the risk loci genes were immunity related. Some risk loci genes also related to metabolism, neuro-musculoskeletal or other functions. Functions overlapped and formed a strong network in our pathway analyses and are worth future studies of biomarker and therapeutics.Peer reviewe

A three-feature prediction model for metastasis-free survival after surgery of localized clear cell renal cell carcinoma

After surgery of localized renal cell carcinoma, over 20% of the patients will develop distant metastases. Our aim was to develop an easy-to-use prognostic model for predicting metastasis-free survival after radical or partial nephrectomy of localized clear cell RCC. Model training was performed on 196 patients. Right-censored metastasis-free survival was analysed using LASSO-regularized Cox regression, which identified three key prediction features. The model was validated in an external cohort of 714 patients. 55 (28%) and 134 (19%) patients developed distant metastases during the median postoperative follow-up of 6.3 years (interquartile range 3.4-8.6) and 5.4 years (4.0-7.6) in the training and validation cohort, respectively. Patients were stratified into clinically meaningful risk categories using only three features: tumor size, tumor grade and microvascular invasion, and a representative nomogram and a visual prediction surface were constructed using these features in Cox proportional hazards model. Concordance indices in the training and validation cohorts were 0.755 +/- 0.029 and 0.836 +/- 0.015 for our novel model, which were comparable to the C-indices of the original Leibovich prediction model (0.734 +/- 0.035 and 0.848 +/- 0.017, respectively). Thus, the presented model retains high accuracy while requiring only three features that are routinely collected and widely available.Peer reviewe

Birch pollen allergen immunotherapy reprograms nasal epithelial transcriptome and recovers microbial diversity

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