Läsnäoloa luonnossa : motivoivan ja henkisyyttä koskettavan toimintamuodon kehittäminen muistisairaille

Kehittämistyö on osa Turun ammattikorkeakoulun hallinnoimaa Neuroliikkuja paikallistasolla 2013–2015 –projektia, jonka keskeisimpänä tavoitteena oli luoda neurologisille liikkujille soveltuvia monipuolisia liikuntaryhmiä. Tämän kehittämistyön tavoitteena oli kehittää matalan kynnyksen liikuntamuoto muistisairaille yhdistämällä kävely, luonto ja mindfulness käytännössä toimivaksi kokonaisuudeksi. Työ toteutettiin muistisairaille suunnatun Läsnäoloa luonnossa ryhmän kautta, joka järjestettiin kolmena kertana erilaisissa luontoympäristöissä Luonnon ja mindfulnessin avulla pyrimme koskettamaan osallistujien henkisyyttä ja näin lisäämään motivaatiota liikkumiseen. Henkisyys voidaan lyhyesti määritellä olevan ihmisen tarvetta kokea merkityksen ja tarkoituksen tunnetta elämässä, sekä yhteyttä suurempaan voimaan. Osallistujille suunnattujen haastattelujen tulosten pohjalta muodostimme viisi teemaa, jotka olivat yhteneviä luontoa ja mindfulnessia käsitteleviin aikaisempiin tutkimustuloksiin sekä dementiaa sairastavien henkisiin tarpeisiin. Nämä teemat olivat rauhallisuus/hyvä olo, muistot ja historia, luonnon antamat opetukset ja luonnon ihmeellisyyden kokeminen, elämän voimavarat sekä itseilmaisun tärkeys. Tulosten perusteella onnistuimme saavuttamaan tavoitteemme, eli kehittämään motivoivan matalan kynnyksen liikkumismuodon muistisairaille. Motivaatio näkyi korkeana osallistumisprosenttina ryhmäkerroilla ja osallistujien halukkuutena ottaa osaa vastaavanlaiseen ryhmätoimintaan jatkossakin. Tulosten perusteella merkittävänä motivoivana tekijänä toimi luonnon ja mindfulnessin kautta tapahtunut henkisyyden voimistuminen. Kehittämistyössä saadun kokemuksen perusteella tärkeintä läsnäolevassa luontoryhmässä on ohjaajan rauhallisuus, riittävän ajan antaminen harjoitteisiin, tekemisen hidastaminen ja kaikkien tasapuolinen huomioiminen. Harjoitukset eivät saa olla liian meditaatiopohjaisia, vaan ennemminkin luonnon ihmettelyä ja aistimista. Kokemuksemme mukaan sekä toiminnalliset, että läsnäolevat harjoitteet toimivat hyvin. Läsnäoleva luontokävely on sovellettavissa jokaiselle niin toimintakykyiselle kuin toimintarajoitteiselle henkilölle. Erityisen hyvin luontomeditaatio voisi kirjallisuuden perusteella toimia mielenterveyskuntoutujilla ja lapsilla.This thesis is part of the “Neuroliikkuja paikallistasolla 2013-2015” project by Turku University of Applied Sciences, aiming to create diversified exercise groups suitable for neurological exercisers. The goal of the thesis was to develop a low-threshold form of exercise for people with memory disorders, by successfully combining walking, nature and mindfulness. With the help of nature and mindfulness, we aimed to touch the spirituality of the members of the group, thus increasing their motivation to exercise. Spirituality can briefly be defined as the person’s need to experience a sense of meaning and significance in their life, and a connection to a higher power. Based on our observations and on the feedback we received from the interviews of exercise group members, we raised five themes that were congruent with the results of earlier, related studies, and with the spiritual needs of people with dementia. These five themes were calmness/wellbeing, memories and history, learning from and wondering nature, resources of life, and importance of self-expression. The results show that we were able to reach our goal in creating a motivating, low-threshold form of exercise for people with memory disorders. The motivation was revealed in the high group participation rate and in the willingness expressed by all members to continue with similar group activities. The results show that the strengthening of spirituality, which happened through nature and mindfulness, was an important motivator. Based on our thesis, the most important factors in a mindful nature group are the calm manner of the instructor, enough time given for the exercises, slowing down, and paying equal amount of attention to all members. We discovered that the exercises shouldn’t be based too much on meditation, but on wondering nature in its different forms. Both the active exercises and mindfulness exercises work equally well. A mindful walk in the nature is adaptable for people with both full and limited functional abilities. Literature further suggests that nature meditation could be especially beneficial for mental health rehabilitation patients and young people

Long-term follow-up after ESS and balloon sinuplasty : Comparison of symptom reduction and patient satisfaction

Conclusion This is the first controlled study of balloon sinuplasty's long-term efficacy with the follow-up time over 5 years. The results are in accordance with a previous 2-year-follow-up study. Both techniques retained the efficacy and patient satisfaction on average 6 years after the surgery. Background Endoscopic sinus surgery (ESS) and balloon sinuplasty are considered as a treatment for chronic rhinosinusitis (CRS) after a failure of conservative therapy. High cost and lack of long-term follow-up studies restrain the use of balloon sinuplasty. Objective The aim of this study was to compare long-term efficacy and satisfaction in CRS patients who had undergone maxillary sinus operation with either balloon sinuplasty or ESS technique. Previous or additional sinonasal operations were exclusion criteria. Materials and methods Study patients were recruited from 208 CRS-patients who underwent either ESS or balloon sinuplasty. Patients with nasal polyposis (gradus >= 2), previous sinonasal surgery, unilateral disease, or immune deficiency were excluded. Altogether 45 patients in the ESS group and 40 patients in the balloon group were included. Of these, 30 and 28, respectively, answered to a phone interview held on average 6 years after primary surgery. Symptom reduction and long-term satisfaction were evaluated by using symptom scores of 19 parameters altogether. Results Both groups experienced improvement in symptoms and were equally satisfied with the operation. The number of patient-reported acute exacerbations was higher among the balloon dilated patients. Also, the reduction of thick nasal discharge was less evident in the balloon sinuplasty group. Four patients in the balloon sinuplasty group underwent revision surgery. There were no revisions in the ESS group.Peer reviewe

Sleep apnoea is a risk factor for severe COVID-19

Background Obstructive sleep apnoea (OSA) is associated with higher body mass index (BMI), diabetes, older age and male gender, which are all risk factors for severe COVID-19.We aimed to study if OSA is an independent risk factor for COVID-19 infection or for severe COVID-19.Methods OSA diagnosis and COVID-19 infection were extracted from the hospital discharge, causes of death and infectious diseases registries in individuals who participated in the FinnGen study (n=260 405). Severe COVID-19 was defined as COVID-19 requiring hospitalisation. Multivariate logistic regression model was used to examine association. Comorbidities for either COVID-19 or OSA were selected as covariates. We performed a meta-analysis with previous studies.Results We identified 445 individuals with COVID-19, and 38 (8.5%) of them with OSA of whom 19 out of 91 (20.9%) were hospitalised. OSA associated with COVID-19 hospitalisation independent from age, sex, BMI and comorbidities (p-unadjusted=5.13×10−5, OR-adjusted=2.93 (95% CI 1.02 to 8.39), p-adjusted=0.045). OSA was not associated with the risk of contracting COVID-19 (p=0.25). A meta-analysis of OSA and severe COVID-19 showed association across 15 835 COVID-19 positive controls, and n=1294 patients with OSA with severe COVID-19 (OR=2.37 (95% 1.14 to 4.95), p=0.021).Conclusion Risk for contracting COVID-19 was the same for patients with OSA and those without OSA. In contrast, among COVID-19 positive patients, OSA was associated with higher risk for hospitalisation. Our findings are in line with earlier works and suggest OSA as an independent risk factor for severe COVID-19

Evidence of a causal effect of genetic tendency to gain muscle mass on uterine leiomyomata

Uterine leiomyomata (UL) are the most common tumours of the female genital tract and the primary cause of surgical removal of the uterus. Genetic factors contribute to UL susceptibility. To add understanding to the heritable genetic risk factors, we conduct a genome-wide association study (GWAS) of UL in up to 426,558 European women from FinnGen and a previous UL meta-GWAS. In addition to the 50 known UL loci, we identify 22 loci that have not been associated with UL in prior studies. UL-associated loci harbour genes enriched for development, growth, and cellular senescence. Of particular interest are the smooth muscle cell differentiation and proliferation-regulating genes functioning on the myocardin-cyclin dependent kinase inhibitor 1A pathway. Our results further suggest that genetic predisposition to increased fat-free mass may be causally related to higher UL risk, underscoring the involvement of altered muscle tissue biology in UL pathophysiology. Overall, our findings add to the understanding of the genetic pathways underlying UL, which may aid in developing novel therapeutics.Peer reviewe

Genetic architecture of human plasma lipidome and its link to cardiovascular disease

Abstract Understanding genetic architecture of plasma lipidome could provide better insights into lipid metabolism and its link to cardiovascular diseases (CVDs). Here, we perform genome-wide association analyses of 141 lipid species (n = 2,181 individuals), followed by phenome-wide scans with 25 CVD related phenotypes (n = 511,700 individuals). We identify 35 lipid-species-associated loci (P <5 ×10−8), 10 of which associate with CVD risk including five new loci-COL5A1, GLTPD2, SPTLC3, MBOAT7 and GALNT16 (false discovery rate<0.05). We identify loci for lipid species that are shown to predict CVD e.g., SPTLC3 for CER(d18:1/24:1). We show that lipoprotein lipase (LPL) may more efficiently hydrolyze medium length triacylglycerides (TAGs) than others. Polyunsaturated lipids have highest heritability and genetic correlations, suggesting considerable genetic regulation at fatty acids levels. We find low genetic correlations between traditional lipids and lipid species. Our results show that lipidomic profiles capture information beyond traditional lipids and identify genetic variants modifying lipid levels and risk of CVD

FinnGen provides genetic insights from a well-phenotyped isolated population.

Population isolates such as those in Finland benefit genetic research because deleterious alleles are often concentrated on a small number of low-frequency variants (0.1% ≤ minor allele frequency < 5%). These variants survived the founding bottleneck rather than being distributed over a large number of ultrarare variants. Although this effect is well established in Mendelian genetics, its value in common disease genetics is less explored1,2. FinnGen aims to study the genome and national health register data of 500,000 Finnish individuals. Given the relatively high median age of participants (63 years) and the substantial fraction of hospital-based recruitment, FinnGen is enriched for disease end points. Here we analyse data from 224,737 participants from FinnGen and study 15 diseases that have previously been investigated in large genome-wide association studies (GWASs). We also include meta-analyses of biobank data from Estonia and the United Kingdom. We identified 30 new associations, primarily low-frequency variants, enriched in the Finnish population. A GWAS of 1,932 diseases also identified 2,733 genome-wide significant associations (893 phenome-wide significant (PWS), P < 2.6 × 10-11) at 2,496 (771 PWS) independent loci with 807 (247 PWS) end points. Among these, fine-mapping implicated 148 (73 PWS) coding variants associated with 83 (42 PWS) end points. Moreover, 91 (47 PWS) had an allele frequency of <5% in non-Finnish European individuals, of which 62 (32 PWS) were enriched by more than twofold in Finland. These findings demonstrate the power of bottlenecked populations to find entry points into the biology of common diseases through low-frequency, high impact variants