Uncertain Influences: Genetics, Pathology, and Alzheimer’s Disease

Alzheimer’s disease (AD) is a progressive neurodegenerative disease that primarily affects individuals above the age of 65 and is often associated with memory loss, one of its chief symptoms. Although it was first discovered by Alois Alzheimer in 1906, AD has only recently garnered attention proportionate to the impact it is expected to have as the world’s population ages at increasing rates. Despite the certainty of this its importance, there is much the medical and scientific communities do not know about the etiology of this disease. This paper will discuss a few of the reasons for this lack of knowledge by specifically describing the definite but unclear influence of genetics and pathology on the clinical symptoms of AD

Kenkien ostoprosessin rakentuminen nuorten aikuisten kertomuksissa

Tutkimuksen tarkoituksena on luoda ymmärrystä siitä, miten nuorten aikuisten, 18–30 -vuotiaiden, kenkien ostoprosessi tapahtuu digitalisoituvassa yhteiskunnassa. Kyseistä sukupolvea voidaan kuvailla joukoksi individualisteja, jotka ovat kasvaneet vuosituhannen vaihteen teknohuumassa. Mikä nykypäivänä motivoi näitä nuoria, teknologian edelläkävijöitä, tulemaan kenkäliikkeeseen, kun digitalisaatio mahdollistaa tiedon etsimisen ja kenkien tilaamisen myös verkosta? Entä tuleeko perinteinen kivijalkamyymälä ehkäpä väistymään kokonaan digitaalisesti tapahtuvan verkko-ostamisen tieltä? Pohdinnat ovat tutkimusongelman ratkaisemisen kannalta mielekkäitä ja luovat pohjan aiheen tarkastelulle. Tutkimuksen teoreettinen viitekehys rakentaa ymmärrystä tarkasteltavan haastemaailman luonteesta. Nuoret kuluttajat, ostokäyttäytyminen ja olemassa oleva tarjontarakennekonteksti muodostavat kolmikulmaisen mallin, jonka viitekehyksessä kenkien ostamisen prosessia tässä tutkimuksessa tarkastellaan. Tutkimuksen empiirisessä osassa nuoret aikuiset kuvailevat viimeisimmän kenkien ostoprosessin ja tuovat näin esille omaan kulutukseensa liittyviä tapahtumia ja käytäntöjä kenkiä hankittaessa. Havainnointi toisena tutkimusmenetelmänä tukee kertomusten avulla hankittua informaatiota ja parantaa näin tutkimuksen luotettavuutta. Kertomusten rakenteita ja merkityksiä tarkastelemalla tunnistettiin kolme erilaista mallia nuorten aikuisten käyttäytymisestä kenkiä ostettaessa, jotka nimettiin seuraavalla tavalla: impulsiivista shoppailua leimaava prosessi, kiirettä leimaava prosessi ja omnichannel pohjainen, digitalisaation mahdollisuuksia aktiivisesti hyödyntävä, prosessi. Huomattiin, että digitalisaation vaikutus on merkittävin kolmannessa, omnichannel pohjaisessa, prosessissa, jossa digitalisaation tuomia mahdollisuuksia hyödynnetään etenkin tietoa ostopäätöksen tueksi etsittäessä ja vaihtoehtoja vertailtaessa. Kivijalkamyymälällä näyttäisi olevan kuitenkin merkittävä rooli kenkien ostopaikkana kaikissa tunnistetuissa prosesseissa – ainakin vielä tällä hetkellä.fi=Opinnäytetyö kokotekstinä PDF-muodossa.|en=Thesis fulltext in PDF format.|sv=Lärdomsprov tillgängligt som fulltext i PDF-format

Työssä jaksamista tukeva toimintamalli dialyysiosastolle

Kehittämisprojektin tavoitteena oli kehittää dialyysiosastolle jaksamista tukeva toimintamalli ja tarkoituksena oli tukea hoitajien työssä jaksamista. Kehittämisprojekti toteutettiin Turun yliopistollisen sairaalan (TYKS) kahdella hemodialyysiosastolla. Kehittämisprojektiin osallistui sairaanhoitajia ja perushoitajia (N = 21). Kehittämisprojektiin liittyvän soveltuvan tutkimuksen osuuden tavoitteena oli selvittää hoitajien kokemuksia jaksamisesta ja siihen vaikuttavista tekijöistä sekä miten jaksamista voidaan tukea. Tarkoituksena oli löytää jaksamiseen ja sen tukemiseen liittyvät tekijät toimintamallin rakentamista varten. Aineisto kerättiin kahdessa eri osiossa. Ensimmäisessä osiossa hoitajat kirjoittivat reflektointipäiväkirjaa kolme viikon ajan työpäivän päätteeksi. Toisessa vaiheessa aineistoa syvennettiin pienryhmätyöskentelyllä aivoriihimenetelmällä. Aineisto analysoitiin soveltaen sisällön analyysiä. Kehittämisprojektin tulosten mukaan ammatillinen osaaminen, toimiva työyhteisö, hyvä työn organisointi ja sujuvuus, hoitajaan liittyvät yksilölliset tekijät ja potilastyytyväisyys edistivät hoitajan työssä jaksamista. Jaksamista estävät tekijät muodostuivat vähäisestä osaamisesta, toimimattomasta työyhteisöstä, huonosta työn organisoinnista ja sujuvuudesta, työympäristöstä, hoitajaan liittyvistä yksilöllisistä tekijöistä ja työhön liittyvistä psyykkisistä tekijöistä. Hoitajien jaksamisen arvosana oli 7.5 kouluarvosana- asteikolla mitattuna. Kehittämisprojektin tuotoksena syntyi työssä jaksamisen tukemisen toimintamalli. Se on esimiehen konkreettinen työkalu työssä jaksamisen tukemiseen tutkimukseen osallistuvalla osastolla. Toimintamallin avulla tuetaan hoitajien ja esimiehen jaksamista. Työssä jaksamisen tukeminen ja kehittäminen vaatii työpanosta työyhteisön jokaiselta jäseneltä sekä hoitajilta että esimiehiltä.The aim of this development project was to develop an operations model which will support managing and well-being in nurses´ work in a dialysis unit. This project was carried out in Turku University Hospital. The target group were nurses (N=21) who work at two different hemodialysis units. The data were collected in two phases by using two different methods. In the first phase nurses kept a diary for three weeks, during working hours. In the second phase, a development afternoon was organized, in which the received material was discussed in teams. The data were analyzed by applying a qualitative content analysis. The results of this development project showed that occupational knowledge, a good working community, a good organization and fluency of work, nurse´s personal factors and satisfied patients supported nurse´s well-being at work. Nurses received social support, help with daily tasks, occupational guidance from each other and worked in teams. Haste, limited occupational knowledge, lack of staff in a shift with too many patients, as well as poor organizing of work prevented nurse´s well-being. The results indicated that a good working environment, opportunities to develop one´s own occupational knowledge, and good leadership create the basis for nurse’s work well-being. To achieve well-being at work, the effort of everyone working in the unit is needed

Pregnancy outcomes in women with a prior cervical intraepithelial neoplasia grade 3 diagnosis : a nationwide population-based cohort study with sibling comparison design

Background: Treatment of cervical intraepithelial neoplasia grade 3 (CIN3) removes or destroys part of the cervix and might subsequently influence pregnancy outcomes. Objective: To investigate pregnancy outcomes in women diagnosed with CIN3. Design: Population- and sibling-matched cohort study. Setting: Sweden, 1973-2018. Participants: General population comparison included 78 450 singletons born to women diagnosed with CIN3 and 784 500 matched singletons born to women in the general population who had no CIN3 diagnosis; sibling comparison included 23 199 singletons born to women diagnosed with CIN3 and 28 135 singletons born to their sisters without a CIN3 diagnosis. Measurements: Preterm birth, including spontaneous or iatrogenic preterm birth; Infection-related outcomes, including chorioamnionitis and infant sepsis; and early neonatal death, defined as death during the first week after birth. Results: Compared with the matched general population, women previously diagnosed with CIN3 were more likely to have a preterm birth especially extremely preterm (22-28 weeks; OR, 3.00; 95% CI, 2.69-3.34) and spontaneous preterm (OR, 2.12; 95% CI, 2.05-2.20) birth, infection-related outcomes including chorioamnionitis (OR, 3.23; 95% CI, 2.89-3.62) and infant sepsis (OR, 1.72; 95% CI, 1.60-1.86), and early neonatal death (OR, 1.83; 95% CI, 1.61-2.09). Sibling comparison analyses rendered largely similar results. Over time the risk difference attenuated for all outcomes and disappeared for early neonatal death. Limitations: Lack of data on CIN3 treatment and spontaneous abortion. Conclusion: Prior history of CIN 3 is associated with adverse pregnancy outcomes even after accounting for familial factors. Decreasing risk estimates over time suggest that adverse pregnancy outcomes among women diagnosed with CIN3 may be minimized by improving treatment modalities.Swedish Research Council, 2018-02547Swedish Cancer Society, 19 0266Swedish Research Council for Health, Working Life and Welfare, 2016-00081 and 2018-00877Zhejiang University through the Hundred Talents ProgramManuscrip

Associations between cervical intraepithelial neoplasia during pregnancy, previous excisional treatment, cone-length and preterm delivery: a register-based study from western Sweden

BACKGROUND: Excisional treatment of cervical intraepithelial neoplasia (CIN) has been associated with increased risk of preterm delivery (PTD), although the underlying mechanism is as yet unclear. Studies on formalin-fixed excised tissue indicate that the risk increases with cone-length, but the magnitude of increase is uncertain, especially in case of minor excisions (≤10 mm), as well compared to women with untreated CIN during pregnancy. This study assesses the impact of cone-length at previous treatment for CIN as well as diagnosis of CIN during pregnancy on the risk of PTD. METHODS: A register-based cohort study in western Sweden linking cervical cytology, histology, and treatment data from the Swedish National Cervical Screening Registry to data on obstetric outcomes in singleton pregnancies 2008-2016 from the Swedish Medical Birth Registry. These groups were compared for PTD and other obstetric outcomes: (1) women with one excisional treatment (n=3250, including a subgroup (n=2408) with cone-length measured before fixation; (2) women with untreated CIN diagnosed during pregnancy (n=1380); and (3) women with normal cytology (n=42,398). Logistic regression analyses were adjusted for socioeconomic and health-related confounders. RESULTS: Treated women had increased risk of PTD (adjusted odds ratio (aOR) 1.60, 95% confidence interval (CI) 1.21-2.12), spontaneous PTD (aOR 1.95, 95% CI 1.40-2.72) and preterm prelabor rupture of membranes (pPROM) (aOR 2.74, 95% CI 1.66-4.51) compared to the CIN during pregnancy group. ORs were similar when compared to the normal cytology group. Risks of these outcomes increased with cone-length. Mean cone-length was 9.1 mm. Cone-length ≤10 mm was associated with increased risk of PTD (aOR 1.41, 95% CI 1.02-1.94), spontaneous PTD (aOR 1.73, 95% CI 1.18-2.54), and pPROM (aOR 2.44, 95% CI 1.40-4.28), compared to the CIN during pregnancy group. The PTD risk was similar for cone-lengths 3-10 mm, thereafter increasing by 15% with each additional millimeter. CONCLUSIONS: This study suggests that all excisional treatment, including small cones, are associated with increased risk of PTD and pPROM. Risks increase further with cone-length. In women of reproductive age, clinicians should aim to remove all CIN but minimal healthy cervical tissue. Cone-length should be recorded at treatment, for future prenatal risk estimation

Defining management units for cetaceans by combining genetics, morphology, acoustics and satellite tracking

Managing animal units is essential in biological conservation and requires spatial and temporal identification of such units. Since even neighbouring populations often have different conservation status and face different levels of anthropogenic pressure, detailed knowledge of population structure, seasonal range and overlap with animals from neighbouring populations is required to manage each unit separately. Previous studies on genetic structure and morphologic separation suggests three distinct populations of harbour porpoises with limited geographic overlap in the North Sea (NS), the Belt Sea (BS) and the Baltic Proper (BP) region. In this study, we aim to identify a management unit for the BS population of harbour porpoises. We use Argos satellite data and genetics from biopsies of tagged harbour porpoises as well as acoustic data from 40 passive acoustic data loggers to determine management areas with the least overlap between populations and thus the least error when abundance and population status is estimated. Discriminant analysis of the satellite tracking data from the BS and NS populations showed that the best fit of the management unit border during the summer months was an east–west line from Denmark to Sweden at latitude 56.95°N. For the border between BS and BP, satellite tracking data indicate a sharp decline in population density at 13.5°E, with 90% of the locations being west of this line. This was supported by the acoustic data with the average daily detection rate being 27.5 times higher west of 13.5°E as compared to east of 13.5°E. By using this novel multidisciplinary approach, we defined a management unit for the BS harbour porpoise population. We recommend that these boundaries are used for future monitoring efforts of this population under the EU directives. The boundaries may also be used for conservation efforts during the summer months, while seasonal movements of harbour porpoises should be considered during winter

Role of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment : systematic review and meta-analysis

Publisher Copyright: © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Objective: To explore the efficacy of human papillomavirus (HPV) vaccination on the risk of HPV infection and recurrent diseases related to HPV infection in individuals undergoing local surgical treatment. Design: Systematic review and meta-analysis Data sources: PubMed (Medline), Scopus, Cochrane, Web of Science, and ClinicalTrials.gov were screened from inception to 31 March 2021. Review methods: Studies reporting on the risk of HPV infection and recurrence of disease related to HPV infection after local surgical treatment of preinvasive genital disease in individuals who were vaccinated were included. The primary outcome measure was risk of recurrence of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) after local surgical treatment, with follow-up as reported by individual studies. Secondary outcome measures were risk of HPV infection or other lesions related to HPV infection. Independent and in duplicate data extraction and quality assessment were performed with ROBINS-I and RoB-2 tools for observational studies and randomised controlled trials, respectively. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was implemented for the primary outcome. Observational studies and randomised controlled trials were analysed separately from post hoc analyses of randomised controlled trials. Pooled risk ratios and 95% confidence intervals were calculated with a random effects meta-analysis model. The restricted maximum likelihood was used as an estimator for heterogeneity, and the Hartung-Knapp-Sidik-Jonkman method was used to derive confidence intervals. Results: 22 articles met the inclusion criteria of the review; 18 of these studies also reported data from a non-vaccinated group and were included in the meta-analyses (12 observational studies, two randomised controlled trials, and four post hoc analyses of randomised controlled trials). The risk of recurrence of CIN2+ was reduced in individuals who were vaccinated compared with those who were not vaccinated (11 studies, 19 909 participants; risk ratio 0.43, 95% confidence interval 0.30 to 0.60; I2=58%, τ2=0.14, median follow-up 36 months, interquartile range 24-43.5). The effect estimate was even stronger when the risk of recurrence of CIN2+ was assessed for disease related to HPV subtypes HPV16 or HPV18 (six studies, 1879 participants; risk ratio 0.26, 95% confidence interval 0.16 to 0.43; I2=0%, τ2=0). Confidence in the meta-analysis for CIN2+ overall and CIN2+ related to HPV16 or HPV18, assessed by GRADE, ranged from very low to moderate, probably because of publication bias and inconsistency in the studies included in the meta-analysis. The risk of recurrence of CIN3 was also reduced in patients who were vaccinated but uncertainty was large (three studies, 17 757 participants; 0.28, 0.01 to 6.37; I2=71%, τ2=1.23). Evidence of benefit was lacking for recurrence of vulvar, vaginal, and anal intraepithelial neoplasia, genital warts, and persistent and incident HPV infections, although the number of studies and participants in each outcome was low. Conclusion: HPV vaccination might reduce the risk of recurrence of CIN, in particular when related to HPV16 or HPV18, in women treated with local excision. GRADE assessment for the quality of evidence indicated that the data were inconclusive. Large scale, high quality randomised controlled trials are required to establish the level of effectiveness and cost of HPV vaccination in women undergoing treatment for diseases related to HPV infection. Systematic review registration: PROSPERO CRD42021237350.Peer reviewe

Screening and cervical cancer cure: population based cohort study

Objective To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death