Common Inflammation-Related Candidate Gene Variants and Acute Kidney Injury in 2647 Critically Ill Finnish Patients

Acute kidney injury (AKI) is a syndrome with high incidence among the critically ill. Because the clinical variables and currently used biomarkers have failed to predict the individual susceptibility to AKI, candidate gene variants for the trait have been studied. Studies about genetic predisposition to AKI have been mainly underpowered and of moderate quality. We report the association study of 27 genetic variants in a cohort of Finnish critically ill patients, focusing on the replication of associations detected with variants in genes related to inflammation, cell survival, or circulation. In this prospective, observational Finnish Acute Kidney Injury (FINNAKI) study, 2647 patients without chronic kidney disease were genotyped. We defined AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We compared severe AKI (Stages 2 and 3, n = 625) to controls (Stage 0, n = 1582). For genotyping we used iPLEX(TM) Assay (Agena Bioscience). We performed the association analyses with PLINK software, using an additive genetic model in logistic regression. Despite the numerous, although contradictory, studies about association between polymorphisms rs1800629 in TNFA and rs1800896 in IL10 and AKI, we found no association (odds ratios 1.06 (95% CI 0.89-1.28, p = 0.51) and 0.92 (95% CI 0.80-1.05, p = 0.20), respectively). Adjusting for confounders did not change the results. To conclude, we could not confirm the associations reported in previous studies in a cohort of critically ill patients.Peer reviewe

Heme oxygenase-1 repeat polymorphism in septic acute kidney injury

Acute kidney injury (AKI) is a syndrome that frequently affects the critically ill. Recently, an increased number of dinucleotide repeats in the HMOX1 gene were reported to associate with development of AKI in cardiac surgery. We aimed to test the replicability of this finding in a Finnish cohort of critically ill septic patients. This multicenter study was part of the national FINNAKI study. We genotyped 300 patients with severe AKI (KDIGO 2 or 3) and 353 controls without AKI (KDIGO 0) for the guanine-thymine (GTn) repeat in the promoter region of the HMOX1 gene. The allele calling was based on the number of repeats, the cut off being 27 repeats in the S-L (short to long) classification, and 27 and 34 repeats for the S-M-L2 (short to medium to very long) classification. The plasma concentrations of heme oxygenase-1 (HO-1) enzyme were measured on admission. The allele distribution in our patients was similar to that published previously, with peaks at 23 and 30 repeats. The S-allele increases AKI risk. An adjusted OR was 1.30 for each S-allele in an additive genetic model (95% CI 1.01-1.66; p = 0.041). Alleles with a repeat number greater than 34 were significantly associated with lower HO-1 concentration (p<0.001). In septic patients, we report an association between a short repeat in HMOX1 and AKI risk

A Genome-Wide Association Study of Diabetic Kidney Disease in Subjects With Type 2 Diabetes

dentification of sequence variants robustly associated with predisposition to diabetic kidney disease (DKD) has the potential to provide insights into the pathophysiological mechanisms responsible. We conducted a genome-wide association study (GWAS) of DKD in type 2 diabetes (T2D) using eight complementary dichotomous and quantitative DKD phenotypes: the principal dichotomous analysis involved 5,717 T2D subjects, 3,345 with DKD. Promising association signals were evaluated in up to 26,827 subjects with T2D (12,710 with DKD). A combined T1D+T2D GWAS was performed using complementary data available for subjects with T1D, which, with replication samples, involved up to 40,340 subjects with diabetes (18,582 with DKD). Analysis of specific DKD phenotypes identified a novel signal near GABRR1 (rs9942471, P = 4.5 x 10(-8)) associated with microalbuminuria in European T2D case subjects. However, no replication of this signal was observed in Asian subjects with T2D or in the equivalent T1D analysis. There was only limited support, in this substantially enlarged analysis, for association at previously reported DKD signals, except for those at UMOD and PRKAG2, both associated with estimated glomerular filtration rate. We conclude that, despite challenges in addressing phenotypic heterogeneity, access to increased sample sizes will continue to provide more robust inference regarding risk variant discovery for DKD.Peer reviewe

Proteomic Changes of Alveolar Lining Fluid in Illnesses Associated with Exposure to Inhaled Non-Infectious Microbial Particles

Peer reviewe

Verkon dokumentointi

Työn tavoitteena oli tehdä Etelä-Pohjanmaan sairaanhoitopiirille (EPSHP) verkkodokumentteja EPSHP:n verkosta. Dokumentteja voidaan käyttää apuna verkon ylläpidossa ja vianetsinnässä sekä ne voi toimia apuvälineenä verkon tuleville muutossuunnitteluille. Dokumentit tehtiin vanhojen verkkodokumenttien pohjalta ja annettujen käsintehtyjen piirrosten pohjalta Microsoft Visio-ohjelmistolla. Verkkodokumentoinnista luotiin ohje, joka auttaa jatkossa ylläpitämään ja luomaan uusia vastaavanlaisia dokumentteja. Verkkodokumentoinnin ohje on toteutettu Microsoft Visio 2010 -ohjelmistolle. Työn teoriaosuus kertoo lähiverkosta ja sen keskeisimmistä laitteista sekä dokumentoinnista yleisesti. Tässä työssä käytetyssä dokumentointiohjelmasta, Microsoft Visio 2010, on myös pienimuotoinen esittelyosuus.The aim of this thesis was to make South Ostrobothnia Hospital District (EPSHP) network documents of their network. The documents can be used in network maintenance and troubleshooting. As well, they can work as a tool for network change planning in the future. The documents were made by Microsoft Visio software on the basis of old documents and handmade drawings. Based on the network documentation was created a guide that will help to sustain and create new, similar documents in the future. Network documentation guide has been implemented for the Microsoft Visio 2010 software. The theoretical part of this work tells about the local network and its main devices, as well as documentation in general. There is also a small-scale presentation of the documentation program Microsoft Visio 2010 in this work

Lapsipotilas magneettitutkimuksessa : potilasohje Keski-Pohjanmaan sosiaali- ja terveyspalvelukuntayhtymä Soitelle

Lasten magneettitutkimukset ovat kasvussa, sillä magneettikuvauksessa ei aiheudu terveydelle haitallista röntgensäteilyä. Samaan aikaan vanhempien tietämys ja heille suunnattu ohjaus lapsille tehtävästä magneettitutkimuksesta on vielä vähäistä. Magneettitutkimuksen ja sairaalan henkilökunnan etuna kuitenkin on, että potilasohjeen avulla potilas ja hänen omaiset saavat totuudenmukaisen kuvan tutkimuksesta ja sen kulusta. Opinnäytetyö toteutettiin projektina yhteistyössä Keski-Pohjanmaan sosiaali- ja terveyspalvelukuntayhtymä Soiten kanssa. Projektin konkreettisena tuotoksena on yhteistyökumppanin toiveiden mukainen potilasohje. Opinnäytetyön tarkoituksena on tuottaa Keski-Pohjanmaan keskussairaalan lastenosastolle sekä magneettiyksikön odotusaulaan kirjallinen potilasohje seinälle sijoitettavan posterin muodossa. Posteri on suunnattu magneettitutkimukseen tuleville lapsipotilaille ja heidän vanhemmilleen. Potilasohjeen avulla lapset voivat vanhempiensa kanssa käydä etukäteen läpi tutkimuksen kulkua ja valmistautua tutkimukseen. Posterissa on kuvattu magneettitutkimusprosessi pelilaudan muodossa. Potilasohje toteutettiin sekä suomeksi että ruotsiksi. Opinnäytetyön tavoitteena on potilasohjeen avulla antaa tietoa lapselle ja hänen vanhemmilleen Keski-Pohjanmaan keskussairaalan magneettiyksikössä tehtävästä magneettitutkimuksesta. Potilasohjeen tavoitteena on vähentää lapsen pelkoa magneettitutkimusta kohtaan ja edesauttaa magneettikuvauksen onnistumista ja positiivisen kokemuksen syntymistä lapselle ja hänen vanhemmilleen. Keski-Pohjanmaan keskussairaalan magneettihoitajat tutustuivat posteriin ja antoivat palautetta jo suunnitteluvaiheessa. Kehitysehdotusten pohjalta teimme posteriin haluttuja muutoksia ja kehitimme posteria yhteistyökumppanin toivomuksia vastaavaksi. Opinnäytetyön tavoitteiden saavuttamista mitattiin asettamalla potilasohjeelle laatukriteerit. Jatkokehitysmahdollisuutena opinnäytetyölle on tehdä esittelyvideo magneettipotilaan hoitopolusta. Video voisi olla esillä magneettiyksikön odotusaulassa sekä nähtävillä myös verkkosivuilla. Videon voisi suunnitella sekä lapsille että aikuisille.Children’s magnetic resonance imaging (MRI) examinations are becoming increasingly common because MRI scans do not involve radiation and thus do not pose a health hazard. At the same time, parents’ awareness about children’s MRIs remains limited, as does the guidance offered to them. The MRI examination and hospital staff would, however, both benefit if patients and their families had a patient guide explaining the procedure and the steps involved. This project was carried out in collaboration with Soite, the Central Ostrobothnia Joint Municipal Authority for Social and Health. The outcome of the project is an MRI patient guide designed according to the collaboration partner’s wishes. The purpose of this final project was to produce a written patient guide in the form of a poster to hang in the lobbies of the paediatric ward and the MRI unit of the Central Ostrobothnia Central Hospital. The poster was designed for children having an MRI scan and their parents. With the help of this patient guide, parents can walk their children through the procedure and prepare for the scan. The poster describes the MRI process in the form of a board game and is available both in Finnish and in Swedish. The purpose of the project was to create a patient guide to provide children and their parents information about the MRI examination conducted at the MRI unit of the Central Ostrobothnia Central Hospital. The objective of the patient guide is to reduce children’s fear of the MRI scan, ensure a successful procedure and create a positive experience for the children and their families. The radiology nurses at the Central Ostrobothnia Central Hospital reviewed the poster and provided feedback throughout the design process. Based on their feedback, we amended the poster and thus tailored it to better suit our partner’s needs. We also set quality criteria for the patient guide to measure how well the project met its objectives. As a possible further development, the patient guide could be complemented with an introductory video of an MRI patient’s care path. The video could be played at the MRI unit lobby and accessed on the hospital website. Separate videos could be designed for children and adults

Wellbeing mentoring : the Vantaa lifestyle service

Hyvinvointimentorointi on toimintamalli, johon terveydenhuoltohenkilöstö ohjaa elintapaohjauksen tarpeessa olevia kuntalaisia potilastietojärjestelmän avulla. Toimintamalli vastaa monilla tavoin elämäntapaohjauksen kehittämistarpeisiin; se on konkreettinen tapa järjestää riskiryhmille tarjottavia palveluita terveydenhuollon ja kunnan hyte-palveluiden yhteistyönä. Toimeenpanossa yhdistyy onnistuneesti elämäntapaohjaus ja konkreettinen ohjaus liikkumisen lisäämiseen. Jatkuvuuden osalta on tarpeen suunnata huomio mm. mallin johtamiseen ja valittujen digitaalisten alustojen hyödynnettävyyteen myös tulevaisuudessa. Vaikuttavuudesta on rohkaisevia havaintoja ja tutkimusnäyttöä tarvitaan lisää. Må bra-service är praxis, där personalen inom hälso- och sjukvården hänvisar kommuninvånare som är i behov av livsstilsvägledning till modellen med hjälp av patientdatasystemet. Praxisen svarar på många sätt på behoven av att utveckla livsstilsvägledning: Konkret sätt att ordna tjänster som erbjuds riskgrupperna i samarbete mellan hälso- och sjukvården och de kommunala tjänsterna för främjande av hälsa och välfärd. I genomförandet kombineras livsstilsvägledning och konkret handledning för att öka motionen på ett lyckat sätt. När det gäller kontinuiteten är det nödvändigt att uppmärksamma bland annat ledningen av modellen och att de digitala plattformar som valts kan användas även i framtiden. Det har gjorts uppmuntrande observationer om effektiviteten och behövs mer forskningsbaserad evidens. Wellbeing mentoring is a practice to which health care personnel refer municipal residents in need of lifestyle counselling using the patient records system. The practice meets the development needs of lifestyle counselling in many ways; it serves as a concrete way of organising services offered to risk groups in cooperation between health care and municipal health and wellbeing services. The implementation succeeds in combining lifestyle counselling and concrete guidance to increase physical activity. Regarding continuity, it is necessary to pay attention to issues such as managing the practice and also ensuring the usability of selected digital platforms in the future. There are encouraging observations of effectiveness and a need for more research evidence

Mediating effects of motor performance, cardiorespiratory fitness, physical activity, and sedentary behaviour on the associations of adiposity and other cardiometabolic risk factors with academic achievement in children

We investigated the associations of cardiometabolic risk factors with academic achievement and whether motor performance, cardiorespiratory fitness, physical activity, or sedentary behaviour mediated these associations. Altogether 175 children 6–8 years-of-age participated in the study. We assessed body fat percentage (BF%), waist circumference, insulin, glucose, triglycerides, HDL cholesterol, and systolic and diastolic blood pressure, leptin, alanine aminotransferase, and gamma-glutamyltransferase (GGT). Reading fluency, reading comprehension, and arithmetic skills were assessed using standardized tests. Speed/agility, balance, and manual dexterity test results were used to calculate motor performance score and physical activity was assessed by combined heart rate and movement sensor and cardiorespiratory fitness by maximal cycle ergometer test. In boys, BF% was inversely associated with reading fluency (β = −0.262, P = 0.007) and reading comprehension (β = −0.216, P = 0.025). Motor performance mediated these associations. Leptin was inversely related to reading fluency (β = −0.272, P = 0.006) and reading comprehension (β = −0.287, P = 0.003). The inverse association of leptin with reading fluency was mediated by motor performance. In girls, GGT was inversely associated with reading fluency independent of confounders (β = −0.325, P = 0.007). The inverse association of BF% with academic achievement among boys was largely explained by motor performance. Leptin in boys and GGT in girls were inversely associated with academic achievement independent of confounding factors.peerReviewe