"Yks päivä on valosampi, toinen on taas raskaampi ja synkempi" : naisten kokemuksia hoivatyöstä dementoituneiden vanhusten omaishoitajina

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.Olen tarkastellut tutkielmassani naisten tekemää hoivatyötä dementoituneiden vanhusten omaishoitajien kokemana. Väestön vanhetessa dementoituneiden vanhusten ja heidän omaistensa hyvinvoinnin turvaaminen on sosiaali- ja terveydenhuollon tärkeimpiä haasteita. Omaisten rooli kotona asuvien vanhusten auttajina on hyvin merkittävä hoivan yhteiskunnallistumisesta huolimatta. On tärkeää tietää, millaisissa olosuhteissa omaiset vanhuksiaan hoitavat, ja miten he oman tilanteensa kokevat. Omaishoitajien kokemusten avulla pyrin tuomaan esille, millaista on vanhuksen ja omaishoitajan arki ja millaisten ratkaisujen avulla omaishoitajat pyrkivät hoivatyön sitovuutta helpottamaan. Omaishoitaja rakentaa toiminnallaan läheiselleen vanhuutta; vanhuksen hoivantarve puolestaan antaa omaishoitajan tekemälle hoivatyölle sisällön siinä ihmissuhteessa, joka heidän välillään on. Yhteiskunta luo edellytyksiä kotona tehtävälle hoivatyölle ja vanhuuden toteutumiselle harjoittamallaan vanhuspolitiikalla. Empiirisen aineistoni olen kerännyt teemahaastattelujen avulla haastattelemalla kahdeksaa naista eli kolmea vaimoa, neljää tytärtä ja yhtä ystävää. Heidän kokemuksensa vanhusten hoivasta vaihtelevat noin vuodesta 15 vuoteen. Haastattelujen pääpaino on ollut nykyhetken tilanteessa, mutta ne sisältävät myös viittauksia sekä menneisyyteen että tulevaisuuteen. Omaishoitajien kertomukset ovat keskeneräisiä, kullakin omassa kohdassaan, mutta samalla ne ovat koko ajan eteenpäin kulkevia kertoen hoivatyön dynaamisesta luonteesta. Tutkielmassani tulee esiin, että kotona hoidetaan runsaasti apua tarvitsevia vanhuksia, jotka eivät enää selviytyisi yksin ilman omaistensa tai muiden henkilöiden antamaa apua. Perheiden elämäntilanteet ovat hyvin yksilöllisiä. Haastattelemani omaishoitajat ovat luoneet oman tapansa huolehtia vanhuksesta niissä olosuhteissa, joissa he elävät, ja jotkut heistä etsivät uusia tapoja, jotka vastaisivat paremmin sekä heidän itsensä että vanhuksen tarpeita. Kutsun haastateltaviani ensisijaisiksi omaishoitajiksi, jotka jakavat hoivavastuuta muiden epävirallisten tai/ja virallisten auttajien kanssa. Omaishoitajat ovat tehtäväänsä hyvin sitoutuneita. Heidän näkemyksissään korostuvat tunnesiteet ja vahva velvollisuudentunne. Hoivatyö sitoo omaishoitajia ajallisesti, paikallisesti ja tunnetasolla. Ilman ulkopuolista apua kodista tulee taukoamattoman työn paikka, jossa omaishoitajalla ei ole työaikaa eikä työtovereita. Lähiyhteisön apu ja vanhustenhuollon palvelut ovat heille tärkeitä, mutta eivät aina riittäviä, ja toisaalta hoivavastuun jakaminen ei ole omaishoitajalle välttämättä helppoa. Hoivatyön psyykkinen sitovuus tulee esiin tilanteissa, joissa hoivatyöhön tulee tauko esimerkiksi vanhuksen lyhytaikaishoidon ajaksi. Jotkut omaishoitajat toivoivatkin, että palveluja tuotaisiin mieluummin kotiin, koska vanhuksen vieminen palvelujen luokse on sekä vanhukselle että omaishoitajalle vaikeaa. Omaishoitajan jaksamisen turvaamiseksi hengähdystauot ovat välttämättömiä

How strong is the evidence that gut microbiota composition can be influenced by lifestyle interventions in a cardio-protective way?

Alterations in composition and function of the gut microbiota have been demonstrated in diseases involving the cardiovascular system, particularly coronary heart disease and atherosclerosis. The data are still limited but the typical altered genera include Roseburia and Faecalibacterium. Plausible mechanisms by which microbiota may mediate cardio-protective effects have been postulated, including the production of metabolites like trimethylamine (TMA), as well as immunomodulatory functions. This raises the question of whether it is possible to modify the gut microbiota by lifestyle interventions and thereby improve cardiovascular health. Nevertheless, lifestyle intervention studies that have involved modifications of dietary intake and/or physical activity, as well as investigating changes in the gut microbiota and subsequent modifications of the cardioprotective markers, are still scarce, and the results have been inconclusive. Current evidence points to benefits of consuming high-fibre foods, nuts and an overall healthy dietary pattern to achieve beneficial effects on both gut microbiota and serum cardiovascular markers, primarily lipids. The relationship between physical exercise and gut microbiota is probably complex and may be dependent on the intensity of exercise. In this article, we review the available evidence on lifestyle, specifically diet, physical activity and smoking as modifiers of the gut microbiota, and subsequently as modifiers of serum cardiovascular health markers. We have attempted to elucidate the plausible mechanisms and further critically appraise the caveats and gaps in the research

A healthy dietary pattern with a low inflammatory potential reduces the risk of gestational diabetes mellitus

Purpose An optimal diet for lowering the risk of gestational diabetes mellitus (GDM) is still to be defined, but may comprise of nutrient intakes, dietary patterns, diet quality, and eating frequency. This study was designed to investigate the contribution of diet in developing GDM in a comprehensive way. Methods The dietary intake of overweight or obese women, a risk group for GDM (n = 351), was assessed using 3-day food diaries and diet quality questionnaires in early pregnancy. Eating frequency and nutrient intakes were calculated, and dietary patterns identified using principal component analysis. The inflammatory potential of the diet was determined by calculating the dietary inflammatory index (DII(R)) and energy-adjusted DII (E-DII (TM)). GDM was diagnosed with an oral glucose tolerance test at 24-28 gestational weeks. Results Higher adherence to 'healthier dietary pattern' characterized by consumptions of vegetables and rye bread associated with a reduced risk of GDM (adjusted OR 0.27, 95% CI 0.11-0.70). Higher E-DII score, indicating pro-inflammatory diet, was associated with a 27% higher risk of GDM (adjusted OR 1.27; 95% CI 1.08-1.49) for each E-DII point. In the evaluation of nutrient intakes, total fat, saturated fatty acids (SFAs), and trans fatty acids were higher and fiber lower in women developing GDM compared to women not developing GDM (all p < 0.05). Intakes of total fat, SFAs, and trans fatty acids were also significant predictors for GDM (all p < 0.05). Conclusions The results emphasize the importance of an overall healthy diet and limitation of foods with SFAs, and other nutrients with a high inflammatory potential in reducing the risk of GDM.Peer reviewe

Iodine status in pregnant women and infants in Finland

Purpose: Iodine insufficiency during pregnancy may adversely influence fetal growth and development. There is a lack of information on iodine status in pregnant women and infants in many countries including Finland. The aim of this study is to determine dietary intake of iodine and the iodine status in a population of Finnish pregnant women and their infants.Methods: Urine samples were collected from women participating in a mother-child clinical study at early (n = 174) and late pregnancy (n = 186) and at three months of postpartum (n = 197), when infant samples were also collected (n = 123). Urine iodine concentration was measured using inductively coupled plasma mass spectrometry. Cutoffs for iodine insufficiency were Results: Increased risk of insufficiency, based on urinary iodine concentrations, was observed in the groups investigated in this study. Of the women studied, 66% had urinary iodine concentrations indicating insufficient intakes and iodine insufficiency at early pregnancy, 70% at late pregnancy and 59% at three months of postpartum. This was also the case in 29% of the three-month-old infants. Estimation of iodine intake revealed that iodine insufficient women had lower intakes of iodine from the diet, from food supplements and from diet plus supplements than iodine sufficient women in early pregnancy and at three months of post-partum. In late pregnancy, this difference was seen for iodine intake from supplements.Conclusion: The majority of the women manifested with low urine iodine concentrations both during and after pregnancy. Similarly, one-third of the infants presented with iodine insufficiency. Maternal iodine intake data support these findings. These observations may have implications for optimal child cognitive development.pport these findings. These observations may have implications for optimal child cognitive development.</p

A healthy dietary pattern with a low inflammatory potential reduces the risk of gestational diabetes mellitus

Purpose: An optimal diet for lowering the risk of gestational diabetes mellitus (GDM) is still to be defined, but may comprise of nutrient intakes, dietary patterns, diet quality, and eating frequency. This study was designed to investigate the contribution of diet in developing GDM in a comprehensive way.Methods: The dietary intake of overweight or obese women, a risk group for GDM (n = 351), was assessed using 3-day food diaries and diet quality questionnaires in early pregnancy. Eating frequency and nutrient intakes were calculated, and dietary patterns identified using principal component analysis. The inflammatory potential of the diet was determined by calculating the dietary inflammatory index (DII®) and energy-adjusted DII (E-DII™). GDM was diagnosed with an oral glucose tolerance test at 24-28 gestational weeks.Results: Higher adherence to 'healthier dietary pattern' characterized by consumptions of vegetables and rye bread associated with a reduced risk of GDM (adjusted OR 0.27, 95% CI 0.11-0.70). Higher E-DII score, indicating pro-inflammatory diet, was associated with a 27% higher risk of GDM (adjusted OR 1.27; 95% CI 1.08-1.49) for each E-DII point. In the evaluation of nutrient intakes, total fat, saturated fatty acids (SFAs), and trans fatty acids were higher and fiber lower in women developing GDM compared to women not developing GDM (all p Conclusions: The results emphasize the importance of an overall healthy diet and limitation of foods with SFAs, and other nutrients with a high inflammatory potential in reducing the risk of GDM.</p

Liikenteen ja muiden toimintojen turvallisuuden vertailu 1988-1990

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Tuntiliikenteen vaikutus liikenneturvallisuuteen

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