Maankäytön vaikutukset jokien kuormitukseen

Tiivistelmä. Tämän työn tavoitteena oli tutkia valuma-alueen maankäyttöjakauman ja vastaavan valuma-alueen purkupisteen kuormituslukujen mahdollista yhteyttä. Maankäyttöjakaumat haettiin Ympäristökeskuksen ylläpitämästä VALUE-tietokannasta, ja vedenlaatutiedot Hertta-tietokannasta. Tarkasteltaviksi kuormitustekijöiksi valittiin typpi, fosfori, orgaaninen hiili ja kiintoaine. Tarkasteltava ajanjakso oli 2008–2018. Tarkasteltavat valuma-alueet pyrittiin valitsemaan tasaisesti pitkin rannikkoa, ja tarkasteluun valittiin kahdeksan valuma-aluetta. Tarkastelu suoritettiin laskemalla jokaiselle kuormitustekijälle hehtaarikohtainen kuormitusluku, ja vertaamalla eri valuma-alueiden vastaavia kuormituslukuja niiden maankäyttöjakaumaan. Tulosten perusteella ei voitu nähdä yhteyttä hehtaarikohtaisten kuormituslukujen ja maankäyttöjakauman välillä, esimerkiksi maatalouden tai teollisuuden kohdalla, nitraattityppeä lukuun ottamatta. Hehtaarikohtaiseen kuormitukseen maankäyttöjakaumaa enemmän vaikuttavia tekijöitä ovat todennäköisesti muun muassa sateiden voimakkuus ja ajoittuminen, maaperän eroosioherkkyys ja topografia. Työssä tarkasteltiin valuma-aluekohtaisesti vain yhtä purkupistettä lähellä merta, josta hehtaarikohtainen kuormitus laskettiin. Tämä tarkastelu ei ota huomioon valuma-alueiden erilaisia taustakuormituksia ja sitä, kuinka merkittävästi vedenlaatu muuttuu esimerkiksi viljelysmaakeskittymien kohdalla.The effects of land use on river loads. Abstract. The scope of this thesis was to study the possible correlation between the land use of a drainage basin and the load values of its extraction point to sea. The land use distribution values were from VALUE-database and load values from Hertta-database. The load factors used in this thesis were nitrogen, phosphorus, organic carbon and solid. The time period studied was from 2008 to 2018. The studied drainage basins were chosen evenly along the coastline, and 8 drainage basins were chosen for this study. The study was carried out by calculating load value per hectare for each load factor, and by comparing these values to the distribution of land use. Based on these calculations, there wasn’t clear correlation between load values per hectare and the land use distribution, for example for agriculture or industry. Probably the factors affecting more to load values per hectare are for example intensity and timing of rain, the sensitivity of soil to erosion and the topography of drainage basin. In this study, the load per hectare was calculated by using only the extraction point near the sea. This analysis ignores the difference in background loads and how much the water quality changes for example after cluster of fields

Performance of Surgical Stress Index during Sevoflurane-Fentanyl and Isoflurane-Fentanyl Anesthesia

The performance of recently introduced Surgical Stress Index (SSI), based on heart rate and photoplethysmography, was estimated during sevoflurane-fentanyl and isoflurane-fentanyl anesthesia during surgical procedures. Forty ASA I–III patients were enrolled. Anesthesia was induced with fentanyl 2 μg kg−1 and thiopentone 3–5 mg kg−1. Tracheal intubation was performed 5 minutes after fentanyl bolus. Patients were randomly allocated to receive sevoflurane (n = 20) or isoflurane (n = 20) in 30% oxygen/air. State entropy was kept at 40–60, target being 50. During surgery, fentanyl boluses 1.5 μg kg−1 were given at 30–40-minute intervals. SSI increased significantly after intubation. During surgery, the decrease of SSI after fentanyl boluses was similar in sevoflurane and isoflurane groups but SSI values were higher in sevoflurane than in isoflurane group. Tracheal intubation, skin incision, and surgical stimuli increased SSI from baseline, indicating that nociceptive stimuli increase SSI. Fentanyl boluses during surgery decreased SSI, indicating that increasing analgesia decreases SSI

Motivation and characterization of Finnish meat inspection veterinarians

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Rahapelaamisen tiheys on yhteydessä terveysriskeihin työikäisillä suomalaisilla

Tutkimuksessa tarkasteltiin, miten rahapelaamisen tiheys oli yhteydessä päivittäiseen tupakointiin sekä alkoholin viikkokulutukseen ja humalajuomiseen työikäisillä suomalaisilla. Suomalaisen aikuisväestön terveyskäyttäytyminen ja terveys (AVTK) -postikyselytutkimuksen vuoden 2008 vastausaktiivisuus oli 64 prosenttia (n=3216, otoskoko 5000). Täman tutkimuksen aineiston koko oli 3203. Menetelminä käytettiin ristiintaulukointeja ja logistisia regressiomalleja, joiden avulla tutkittiin miten rahapeleihin osallistuminen ja rahapelaamisen tiheyden eri tasot olivat yhteydessä päivittäiseen tupakointiin, alkoholin suurkulutukseen, humalajuomiseen ja itsearvioituun terveyteen. Pelanneet olivat pelaamattomia useammin päivittäisiä tupakoitsijoita, mutta alkoholin suurkulutuksessa ei ollut eroa. Rahapelejä pelanneilla (68 % vastaajista) päivittäinen tupakointi ja alkoholin suurkulutus olivat sitä yleisempiä mitä tiheämmin henkilö pelasi. Runsasta rahapelaamista onkin syytä tarkastella kansanterveydellisenä huolenaiheena

Automated text message enhanced monitoring versus routine monitoring in early rheumatoid arthritis: a randomized trial

OBJECTIVE:Frequent monitoring of early rheumatoid arthritis (RA) patients is required for achieving good outcomes. We studied the influence of text message (SMS) enhanced monitoring on early RA outcomes.METHODS:We randomized 166 early, disease-modifying antirheumatic drug naive RA patients to SMS-enhanced follow-up or routine care. All patients attended visits at 0, 3, and 6 months, and a follow-up visit at 12 months. Treatment was at the physicians' discretion. The intervention included 13 SMSs during weeks 0-24 with questions concerning medication problems (yes/no) and disease activity (patient global assessment [PGA], scale 0-10). If response SMSs indicated medication problems or PGA exceeded predefined thresholds the patients were contacted. Primary outcome was 6-month Boolean remission (no swollen or tender joints, normal CRP). Quality of life (QOL, Short Form 36) and 28-joint disease activity scores (DAS28) were assessed.RESULTS:Six and 12-month follow-up data were available for 162 and 157 patients. In the intervention group, 47% (38/82) of the patients reported medication problems and 49% (40/82) of the patients reported SMS-PGAs above the alarm limit. Remission rates in the intervention and control groups were 51% and 42% at 6 months (p=0.34); and 57% and 43% at 12 months (p=0.17). The respective DAS28 scores were 1.92±1.12 and 2.22±1.11 at 6 months (p=0.09); and 1.79±0.91 and 2.08±1.22 at 12 months (p=0.28). No differences in QOL were observed.CONCLUSION:The study failed the primary outcome despite a trend favoring the intervention group. This may be explained by the notably high overall remission rates. This article is protected by copyright. All rights reserved.</p

Centralized repeated resectability assessment of patients with colorectalliver metastases during first-line treatment : prospective study

Y Background: Metastasectomy is probably underused in metastatic colorectal cancer. The aim of this study was to investigate the effect of centralized repeated assessment on resectability rate of liver metastases. Methods: The prospective RAXO study was a nationwide study in Finland. Patients with treatable metastatic colorectal cancer at any site were eligible. This planned substudy included patients with baseline liver metastases between 2012 and 2018. Resectability was reassessed by the multidisciplinary team at Helsinki tertiary referral centre upfront and twice during first-line systemic therapy. Outcomes were resectability rates, management changes, and survival. Results: Of 812 patients included, 301 (37.1 per cent) had liver-only metastases. Of these, tumours were categorized as upfront resectable in 161 (53.5 per cent), and became amenable to surgery during systemic treatment in 63 (20.9 per cent). Some 207 patients (68.7 per cent) eventually underwent liver resection or ablation. At baseline, a discrepancy in resectability between central and local judgement was noted for 102 patients (33.9 per cent). Median disease-free survival (DFS) after first resection was 20 months and overall survival (OS) 79 months. Median OS after diagnosis of metastatic colorectal cancer was 80, 32, and 21 months in R0-1 resection, R2/ablation, and non-resected groups, and 5-year OS rates were 68, 37, and 9 per cent, respectively. Liver and extrahepatic metastases were present in 511 patients. Of these, tumours in 72 patients (14.1 per cent) were categorized as upfront resectable, and 53 patients (10.4 per cent) became eligible for surgery. Eventually 110 patients (21.5 per cent) underwent liver resection or ablation. At baseline, a discrepancy between local and central resectability was noted for 116 patients (22.7 per cent). Median DFS from first resection was 7 months and median OS 55 months. Median OS after diagnosis of metastatic colorectal cancer was 79, 42, and 17 months in R0-1 resection, R2/ablation, and non-resected groups, with 5-year OS rates of 65, 39, and 2 per cent, respectively. Conclusion: Repeated centralized resectability assessment in patients with colorectal liver metastases improved resection and survival rates.Peer reviewe

Immunogenicity of subcutaneous TNF inhibitors and its clinical significance in real-life setting in patients with spondyloarthritis

Key messages Considerable proportion of patients with SpA have been immunized to the subcutaneous anti-TNF drug they are using. Concomitant use of MTX protects from immunization, whereas SASP does not. Patients with SpA using subcutaneous anti-TNF drugs can benefit from monitoring of the drug trough levels. Immunization to biological drugs can lead to decreased efficacy and increased risk of adverse effects. The objective of this cross-sectional study was to assess the extent and significance of immunization to subcutaneous tumor necrosis factor (TNF) inhibitors in axial spondyloarthritis (axSpA) patients in real-life setting. A serum sample was taken 1-2 days before the next drug injection. Drug trough concentrations, anti-drug antibodies (ADAb) and TNF-blocking capacity were measured in 273 patients with axSpA using subcutaneous anti-TNF drugs. The clinical activity of SpA was assessed using the Bath AS Disease Activity Index (BASDAI) and the Maastricht AS Entheses Score (MASES). ADAb were found in 11% of the 273 patients: in 21/99 (21%) of patients who used adalimumab, in 0/83 (0%) of those who used etanercept, in 2/79 (3%) of those who used golimumab and in 6/12 (50%) of those who used certolizumab pegol. Use of methotrexate reduced the risk of formation of ADAb, whereas sulfasalazine did not. Presence of ADAb resulted in decreased drug concentration and reduced TNF-blocking capacity. However, low levels of ADAb had no effect on TNF-blocking capacity and did not correlate with disease activity. The drug trough levels were below the consensus target level in 36% of the patients. High BMI correlated with low drug trough concentration. Patients with low drug trough levels had higher disease activity. The presence of anti-drug antibodies was associated with reduced drug trough levels, and the patients with low drug trough levels had higher disease activity. The drug trough levels were below target level in significant proportion of patients and, thus, measuring the drug concentration and ADAb could help to optimize the treatment in SpA patients.Peer reviewe

Glycoprotein YKL-40: A potential biomarker of disease activity in rheumatoid arthritis during intensive treatment with csDMARDs and infliximab. Evidence from the randomised controlled NEO-RACo trial

ObjectiveYKL-40, a chitinase-like glycoprotein associated with inflammation and tissue remodeling, is produced by joint tissues and recognized as a candidate auto-antigen in rheumatoid arthritis (RA). In the present study, we investigated YKL-40 as a potential biomarker of disease activity in patients with early RA at baseline and during intensive treatment aiming for early remission.MethodsNinety-nine patients with early DMARD-naive RA participated in the NEO-RACo study. For the first four weeks, the patients were treated with the combination of sulphasalazine, methotrexate, hydroxychloroquine and low dose prednisolone (FIN-RACo DMARD combination), and subsequently randomized to receive placebo or infliximab added on the treatment for further 22 weeks. Disease activity was evaluated using the 28-joint disease activity score and plasma YKL-40 concentrations were measured by immunoassay.ResultsAt the baseline, plasma YKL-40 concentration was 57 +/- 37 ( mean +/- SD) ng/ml. YKL-40 was significantly associated with the disease activity score, interleukin-6 and erythrocyte sedimentation rate both at the baseline and during the 26 weeks' treatment. The csDMARD combination decreased YKL-40 levels already during the first four weeks of treatment, and there was no further reduction when the tumour necrosis factor-alpha antagonist infliximab was added on the combination treatment.ConclusionsHigh YKL-40 levels were found to be associated with disease activity in early DMARD-naive RA and during intensive treat-to-target therapy. The present results suggest YKL-40 as a useful biomarker of disease activity in RA to be used to steer treatment towards remission