Urban nitrous-oxide fluxes measured using the eddy-covariance technique in Helsinki, Finland

Peer reviewe

Ikääntyneiden potilaiden kotiutuksen tietojen kirjaaminen Riihimäen terveyskeskuksen päivystyksessä

Tämän opinnäytetyön tarkoituksena oli selvittää ikääntyneen potilaan kotiutukseen liittyvää kirjaamista Riihimäen terveyskeskuspäivystyksessä. Kohteeksi valittiin yleistilalaskupotilaat. Tavoitteena oli kuvata, millaisia asioita päivystyksen hoitohenkilökunta kirjaa ja millaisia asioita akuuttiosaston henkilökunta toivoo päivystyksessä kirjattavan. Työn tilaaja oli Riihimäen terveyskeskuspäivystys, jossa haluttiin selvittää, mitä asioita päivystyksen hoitajat selvittävät iäkkäästä potilaasta hänen tullessaan päivystykseen ja mitä he kirjaavat potilaasta HOITO-lehdelle. Akuuttiosaston hoitohenkilökunnan toiveita päivystyksen kotiutukseen liittyvästä kirjaamisesta selvitettiin haastattelemalla. Tutkimus tehtiin sekä määrällisellä että laadullisella tutkimusmenetelmällä. HOITO-lehdiltä selvitettiin, mitä ikääntyneen potilaan kotiutukseen liittyviä asioita oli kirjattu. Tulokset analysoitiin SPSS-tilasto-ohjelmalla. Lisäksi teemahaastatteluilla selvitettiin hoitohenkilökunnan kirjaamista päivystyksessä ja akuuttiosaston hoitohenkilökunnan toiveita kirjaamisesta. Teemahaastattelut perustuivat ennalta kirjoitettuun teoriaan ja tulokset esitettiin sisällönanalyysiä käyttäen. Keskeisimpänä tutkimustuloksena selvisi, että ikääntyneestä potilaasta kirjattiin usein tulosyy ja oireet. Tärkeinä asioina pidettiin lääkehoitoon, toimintakykyyn, kotiolosuhteisiin, tiedonkulkuun ja jatkohoitoon liittyviä kirjauksia, joita löytyi myös HOITO-lehdiltä. Akuuttiosaston toive oli, että fyysisen toimintakyvyn lisäksi potilaan hoitoon liittyvä tiedonkulku ja keskustelut omaisten kanssa on hyvä kirjata päivystyksessä. Toiveena oli, että kaikki selvitetyt tiedot kirjataan HOITO-lehdelle. Päivystystyössä keskitytään ensisijaisesti potilaan oireiden selvittämiseen sekä hoitamiseen. Oirekeskeisyys näkyy kirjaamisessa. Selkeä ja kattava kirjaaminen potilaan tilanteesta helpottaa hoitohenkilökunnan työtä akuuttiosastolla.The purpose of this thesis was to find out what information about elderly patients is looked into when they have an emergency and come into Riihimaki Health Centre and what exact information is actually written down and mentioned in patient files about them, especially information which relates to their later discharge.The target group was elderly patients whom have some kind of decrease in their general condition and receive follow up treatment at health centres acute ward. The idea of this study came from health centre's emergency unit where they wanted to know what kind of information nursing staff find out about elderly patients in an emergency, and which of these findings they mention in patient files. Another purpose of this thesis was to find out what kind of information health centre's nursing staff at an acute ward need, when elderly patients are coming from emergency to their care, so that they can then discharge these same patients successfully later. The study was conducted by quantitative and qualitative research. In quantitative research the purpose was to examine the actual records of patient files and what kind of information nursing staff have written down about elderly patients, especially information which relates to their later discharge. The results were analyzed in the SPSS statistics program. In qualitative research the purpose was to survey nursing staff involved with emergency situations and also from an acute ward. The meaning was to examine what kind of information nursing staff in an emergency situation say they mention in patient files and what information acute ward nurses would like there to be. Surveys were drawn up from actual theory about this subject and after surveys were performed, results were analyzed in more detail. Results in the quantitative research show that the reason why elderly patients came to the emergency unit and their symptoms was often mentioned in studied patient files. Nursing staff at the emergency unit thought that medication, ability to function, home life, flow of information and patients follow up treatment are the most important issues to mention in patient files. Studied files generally included these things. Nursing staff at the acute ward thought that the physical ability to function, flow of information and also conversations with patient relatives should be mentioned in patient files. They also thought that any kind of relevant information should be written down. At the emergency unit they primarily focus on taking care of patients’ symptoms and writing down all information related to these things. Although their work is busy, all details mentioned in patient files are valuable and help follow-up treatment. Clear and extensive information about patients’ situations helps nursing staff to do their work at the acute ward

Longitudinal Metabolome-Wide Signals Prior to the Appearance of a First Islet Autoantibody in Children Participating in the TEDDY Study

Children at increased genetic risk for type 1 diabetes (T1D) after environmental exposures may develop pancreatic islet autoantibodies (IA) at a very young age. Metabolic profile changes over time may imply responses to exposures and signal development of the first IA. Our present research in The Environmental Determinants of Diabetes in the Young (TEDDY) study aimed to identify metabolome-wide signals preceding the first IA against GAD (GADA-first) or against insulin (IAA-first). We profiled metabolomes by mass spectrometry from children's plasma at 3-month intervals after birth until appearance of the first IA. A trajectory analysis discovered each first IA preceded by reduced amino acid proline and branched-chain amino acids (BCAAs), respectively. With independent time point analysis following birth, we discovered dehydroascorbic acid (DHAA) contributing to the risk of each first IA, and γ-aminobutyric acid (GABAs) associated with the first autoantibody against insulin (IAA-first). Methionine and alanine, compounds produced in BCAA metabolism and fatty acids, also preceded IA at different time points. Unsaturated triglycerides and phosphatidylethanolamines decreased in abundance before appearance of either autoantibody. Our findings suggest that IAA-first and GADA-first are heralded by different patterns of DHAA, GABA, multiple amino acids, and fatty acids, which may be important to primary prevention of T1D

Analgesic antipyretic use among young children in the TEDDY study : No association with islet autoimmunity

Background: The use of analgesic antipyretics (ANAP) in children have long been a matter of controversy. Data on their practical use on an individual level has, however, been scarce. There are indications of possible effects on glucose homeostasis and immune function related to the use of ANAP. The aim of this study was to analyze patterns of analgesic antipyretic use across the clinical centers of The Environmental Determinants of Diabetes in the Young (TEDDY) prospective cohort study and test if ANAP use was a risk factor for islet autoimmunity. Methods: Data were collected for 8542 children in the first 2.5 years of life. Incidence was analyzed using logistic regression with country and first child status as independent variables. Holm's procedure was used to adjust for multiplicity of intercountry comparisons. Time to autoantibody seroconversion was analyzed using a Cox proportional hazards model with cumulative analgesic use as primary time dependent covariate of interest. For each categorization, a generalized estimating equation (GEE) approach was used. Results: Higher prevalence of ANAP use was found in the U.S. (95.7%) and Sweden (94.8%) compared to Finland (78.1%) and Germany (80.2%). First-born children were more commonly given acetaminophen (OR 1.26; 95% CI 1.07, 1.49; p = 0.007) but less commonly Non-Steroidal Anti-inflammatory Drugs (NSAID) (OR 0.86; 95% CI 0.78, 0.95; p = 0.002). Acetaminophen and NSAID use in the absence of fever and infection was more prevalent in the U.S. (40.4%; 26.3% of doses) compared to Sweden, Finland and Germany (p < 0.001). Acetaminophen or NSAID use before age 2.5 years did not predict development of islet autoimmunity by age 6 years (HR 1.02, 95% CI 0.99-1.09; p = 0.27). In a sub-analysis, acetaminophen use in children with fever weakly predicted development of islet autoimmunity by age 3 years (HR 1.05; 95% CI 1.01-1.09; p = 0.024). Conclusions: ANAP use in young children is not a risk factor for seroconversion by age 6 years. Use of ANAP is widespread in young children, and significantly higher in the U.S. compared to other study sites, where use is common also in absence of fever and infection

Early probiotic supplementation and the risk of celiac disease in children at genetic risk

Abstract Probiotics are linked to positive regulatory effects on the immune system. The aim of the study was to examine the association between the exposure of probiotics via dietary supplements or via infant formula by the age of 1 year and the development of celiac disease autoimmunity (CDA) and celiac disease among a cohort of 6520 genetically susceptible children. Use of probiotics during the first year of life was reported by 1460 children. Time-to-event analysis was used to examine the associations. Overall exposure of probiotics during the first year of life was not associated with either CDA (n = 1212) (HR 1.15; 95%CI 0.99, 1.35; p = 0.07) or celiac disease (n = 455) (HR 1.11; 95%CI 0.86, 1.43; p = 0.43) when adjusting for known risk factors. Intake of probiotic dietary supplements, however, was associated with a slightly increased risk of CDA (HR 1.18; 95%CI 1.00, 1.40; p = 0.043) compared to children who did not get probiotics. It was concluded that the overall exposure of probiotics during the first year of life was not associated with CDA or celiac disease in children at genetic risk