Differences in cervical test coverage by age, socioeconomic status, ethnic origin and municipality type - A nationwide register-based study

An invitational organized cervical cancer screening together with widely spread opportunistic testing has coexisted for decades in Finland. The aim of this study was to examine the coverage of cervical tests by age, socioeconomic status, ethnicity and municipality type within and outside the organized screening program. We had a cohort of women of whom 1,2 million were in the target age range of screening and residing in Finland in 2010-2014. Data on Pap and/or HPV-tests within and outside the screening program were collected from the Mass Screening Registry, the pathology laboratories and the health insurance reimbursement registry and fiveyear population coverages of tests were reported. The total test coverage was 86.0%; 95% CI, (85.8-86.1), and was notably lower for those with an unknown socioeconomic status and pensioners (68.8%; 95% CI, (67.9-69.6) and 77.1%; 95% CI, (76.5-77.6), respectively) compared to upper-level employers (89.8%; 95% CI, (89.5-90.2)). Coverage was also lower for non-native speaking women (72.4%; 95% CI, (71.8-73.0)) compared to native speakers (86.9%; 95% CI, (86.7-87.0)) and for women living in urban municipalities (85.5%; 95% CI, (85.3-85.7)) compared to semi-urban (87.4%; 95% CI, (87.0-87.8)). Although overall coverage was high, tests within and outside the program seemed to concentrate on women with presumably good access to health services. Tests outside the program were especially common among young women who are at a low risk of invasive cervical cancer. Efforts should be made to reduce excessive opportunistic testing and to increase attendance at the program among hard-to-reach populations.Peer reviewe

Effectiveness of cervical cancer screening at age 65-A register-based cohort study

Most cervical cancer deaths in Finland occur after the termination of the national screening program, targeted at women aged 30 to 64 years. The purpose of this study was to examine the effectiveness of screening at age 65 in reducing cervical cancer mortality. A register-based cohort study was performed with a follow-up period between 1991 and 2014. Mortality risk ratios for incident cervical cancer cases diagnosed at age 65 or older were compared between women invited and not invited for screening. The background risk difference between the studied areas was accounted for by using a reference cohort. The relative risk of death for women invited for cervical cancer screening at the age of 65 was 0.52 (95% CI: 0.29-0.94). The relative risks for women not attending and attending to screening with respect to the uninvited were 1.28 (CI: 0.65-2.50) and 0.28 (CI: 0.13-0.59), respectively. Inviting 65-year-old women for screening has been effective in reducing cervical cancer mortality.Peer reviewe

Poikkeavien tulosten elämänaikainen todennäköisyys kohdunkaulasyövän seulonnassa

English summaryPeer reviewe

Poikkeavien tulosten elämänaikainen todennäköisyys kohdunkaulasyövän seulonnassa

English summaryPeer reviewe

Aminopeptidase Expression in Multiple Myeloma Associates with Disease Progression and Sensitivity to Melflufen

Multiple myeloma (MM) is characterized by extensive immunoglobulin production leading to an excessive load on protein homeostasis in tumor cells. Aminopeptidases contribute to proteolysis by catalyzing the hydrolysis of amino acids from proteins or peptides and function downstream of the ubiquitin–proteasome pathway. Notably, aminopeptidases can be utilized in the delivery of antibody and peptide-conjugated drugs, such as melflufen, currently in clinical trials. We analyzed the expression of 39 aminopeptidase genes in MM samples from 122 patients treated at Finnish cancer centers and 892 patients from the CoMMpass database. Based on ranked abundance, LAP3, ERAP2, METAP2, TTP2, and DPP7 were highly expressed in MM. ERAP2, XPNPEP1, DPP3, RNPEP, and CTSV were differentially expressed between relapsed/refractory and newly diagnosed MM samples (p < 0.05). Sensitivity to melflufen was detected ex vivo in 11/15 MM patient samples, and high sensitivity was observed, especially in relapsed/refractory samples. Survival analysis revealed that high expression of XPNPEP1, RNPEP, DPP3, and BLMH (p < 0.05) was associated with shorter overall survival. Hydrolysis analysis demonstrated that melflufen is a substrate for aminopeptidases LAP3, LTA4H, RNPEP, and ANPEP. The sensitivity of MM cell lines to melflufen was reduced by aminopeptidase inhibitors. These results indicate critical roles of aminopeptidases in disease progression and the activity of melflufen in MM

Aminopeptidase Expression in Multiple Myeloma Associates with Disease Progression and Sensitivity to Melflufen

Multiple myeloma (MM) is characterized by extensive immunoglobulin production leading to an excessive load on protein homeostasis in tumor cells. Aminopeptidases contribute to proteolysis by catalyzing the hydrolysis of amino acids from proteins or peptides and function downstream of the ubiquitin–proteasome pathway. Notably, aminopeptidases can be utilized in the delivery of antibody and peptide-conjugated drugs, such as melflufen, currently in clinical trials. We analyzed the expression of 39 aminopeptidase genes in MM samples from 122 patients treated at Finnish cancer centers and 892 patients from the CoMMpass database. Based on ranked abundance, LAP3, ERAP2, METAP2, TTP2, and DPP7 were highly expressed in MM. ERAP2, XPNPEP1, DPP3, RNPEP, and CTSV were differentially expressed between relapsed/refractory and newly diagnosed MM samples (p < 0.05). Sensitivity to melflufen was detected ex vivo in 11/15 MM patient samples, and high sensitivity was observed, especially in relapsed/refractory samples. Survival analysis revealed that high expression of XPNPEP1, RNPEP, DPP3, and BLMH (p < 0.05) was associated with shorter overall survival. Hydrolysis analysis demonstrated that melflufen is a substrate for aminopeptidases LAP3, LTA4H, RNPEP, and ANPEP. The sensitivity of MM cell lines to melflufen was reduced by aminopeptidase inhibitors. These results indicate critical roles of aminopeptidases in disease progression and the activity of melflufen in MM

Potilasturvallisuus ja vaaratapahtumien ehkäiseminen perioperatiivisessa hoitotyössä

Perioperatiivinen hoito on monivaiheinen prosessi, joka on altis erehdyksille, väärinkäsityksille ja yksilön, tiimityön, kommunikaation ja hoitoprosessin virheille sekä vaaratapahtumille, jotka vaarantavat potilasturvallisuuden. Inhimillinen toiminta, korkeasti kehittynyt teknologia sekä äkillisesti muuttuvat tilanteet ja olosuhteet ovat ominaista perioperatiiviselle hoitotyölle. Potilaiden hoidon turvallisuus ja hoitotyön riskit ovat usein yhteydessä edellä mainittuihin tekijöihin ja monimutkaisiin hoitotyön prosesseihin. Useissa maissa on tutkimuksiin pohjautuen todettu, että noin 10-20% sairaalahoidossa olevista potilaista kokee jonkinlaisen vaara- tai haittatapahtuman hoidon aikana. Nykyaikaiselle ja modernille terveydenhuollon järjestelmälle potilasvahinkoilmoitusten luvut ovat kustannusten ja kärsimysten kannalta huomattavia ja tilanteen parantamiselle on selkeä tarve. Opinnäytetyön tarkoituksena on kuvailla narratiivisen kirjallisuuskatsauksen keinoin, mitä potilasturvallisuus ja vaaratapahtumat ovat ja kuinka vaaratapahtumia ehkäistään perioperatiivisessa hoitotyössä. Narratiivisen katsauksen tehtävä on kertoa ja kuvata aiheeseen liittyviä aikaisempia ja viimeaikaisia tutkimuksia, niiden laajuutta, syvyyttä ja määrää. Haut rajattiin vuosille 2000-2018 ja julkaisuja haettiin kolmesta tietokannasta. Julkaisuja valikoitui 15 kappaletta (n=15). Opinnäytetyön tavoitteena on edistää työn tekijöiden, sairaanhoitajaopiskelijoiden ja perioperatiivisen hoitotyön ammattilaisten tietoutta potilasturvallisuudesta sekä vaara- ja haittatapahtumien ehkäisemisestä. Vaaratapahtumien tarkastelussa näkökulmaa on laajennettava yksittäisestä tekijästä menettelytapoihin, toimintakulttuuriin ja organisaation rakenteisiin. Vaaratapahtumien ehkäisemiseksi on ymmärrettävä niiden syntyyn vaikuttavat yksittäiset sekä laaja-alaiset tekijät. Ennakoivaa ajattelutapaa on sovellettava ja tavoitteena on tunnistaa ja hallita riskejä. Jokainen hoidon vaihe sisältää erilaisia käytäntöjä, menetelmiä ja protokollia, jotka vaihtelevat pre-, intra- ja postoperatiivisesti. Kaikkia vaiheita yhdistää se, että niiden tarkoituksena ja tavoitteena on ehkäistä ja välttää vaaratapahtumia. Perioperatiivisen hoitotyön toteutus on vahvaa tiimityötä moniammatillisessa työyhteisössä ja vaaratapahtumien ehkäisy lähtee liikkeelle jo yksilötasolla. On selvää, että ihmiset ovat erehtyväisiä, jonka takia vaaratapahtumia syntyy. Inhimillisten virheiden välttämiseksi on kehitetty suojauksia, joilla pyritään estämään mahdollisten virheiden syntymistä. Jatkossa tutkimuksia voisi tehdä esimerkiksi pre- ja postoperatiivisista vaaratapahtumista ja niiden ehkäisemisestä sairaanhoitajan näkökulmasta.Perioperative treatment is a multistage process that is sensitive for errors, misunderstandings and mistakes in individual level, teamwork, communication and treatment process and as well as patient safety incidents that endangers patient safety. Human activity, highly advanced technology and quickly changing situations and circumstances are characteristic of perioperative nursing. Patient safety and nursing risks are often related to the beforementioned factors and to complicated processes of nursing. In several countries, based on studies, it has been found that about 10-20% of patients in hospital treatment experience some kind of patient safety incident or adverse event during their treatment. For the present and modern healthcare system these figures for patient injury reports are significant for costs and suffering and there is a clear need for improving the situation. The purpose of this thesis is to describe, what patient safety and risk events are, and how the perils are prevented in perioperative nursing. This thesis is a narrative literary review. The task of the narrative literature review is to narrate and describe previous and recent studies related to the topic, and their extent, depth and amount. The search was limited to year from 2000 to 2018 and publications were searched for from three databases. 15 publications were selected (n =15). The aim of the thesis is to promote the knowledge of the writers, nursing students and perioperative nursing professionals about patient safety and the prevention of patient safety incidents and adverse events. In reviewing the incidents, the perspective must be extended from one single factor to the procedures, the operating culture and the organization's structures. In order to prevent the occurrence of patient safety incidents, it is necessary to understand the individual and wideranging factors that affect them. Predictive thinking has to be applied and the aim is to identify and manage the risks. Each stage of treatment includes different practices, methods and protocols that vary pre-, intra- and postoperative. All phases are combined with the purpose and aim of preventing and avoiding patient safety incidents. Implementation of perioperative nursing is strong team work in a multiprofessional work community and the prevention of patient safety incidents starts at the individual level of a person. It is clear that people are fallible, which is why patient safety incidents occur. To avoid human error, barriers and defences have been developed to prevent possible errors. In future studies could be done, for example about pre- and postoperative patient safety incidents and their prevention from a nurse's point of view

What is published about early childhood education in the news? : News headlines in Helsingin Sanomat and Yle Uutiset in 2022

Tutkielmassa selvitetään, mitä varhaiskasvatuksesta uutisoidaan. Aiemmat tutkimukset ovat osoittaneet, että suomalaiset pääosin luottavat erityisesti johtaviin valtakunnallisiin uutismedioihin, Helsingin Sanomiin ja Yleen. Lisäksi tutkimuksessa selvitetään ja pohditaan sitä, miten uutisilla voidaan vaikuttaa yleisöön. Tutkimuksessa analysoidaan uutisotsikoiden aiheita sekä kieltä. Tutkielma on laadullinen sisällönanalyysi, jossa tarkastellaan Helsingin Sanomien ja Yle Uutisten julkaisemia uutisotsikoita verkossa. Diskurssianalyysin keinoin tutkin myös uutisotsikoiden kieltä ja niiden tuottamia merkityksiä ja mielikuvia. Tutkimuksessa selvitettiin, mitä ja miten varhaiskasvatuksesta uutisoidaan Ylen ja Helsingin Sanomien uutisoinneissa vuonna 2022. Keskityn tutkimuksessani 194 uutisotsikkoon, jotka on julkaistu ajalla 1.4.2022-14.12.2022. Kriteerinä sisältyäkseen aineistooni oli se, että uutisotsikossa tuli olla mainittuna sana varhaiskasvatus tai päiväkoti. Luokittelin aineiston neljään luokkaan: kriisi, kannanotto, neutraali ja positiivinen. Tulokset osoittavat, että aineistossani oli eniten neutraaleja uutisotsikoita. Kriisiuutisointeja oli seuraavaksi eniten ja määrällinen ero positiivisiin uutisiin oli merkittävän suuri. Positiivisia uutisotsikoita oli vain 12 koko aineistosta. Uutisotsikoiden aiheet liittyivät pääosin työvoimapulaan ja kevään 2022 lakosta tiedottamiseen. Kriisiuutisotsikot koskivat pääosin työvoimapulaa ja otsikoissa käytettiin paljon sanaa kriisi. Neutraalit uutisotsikot oli ilmaistu selkeästi käyttämättä voimakkaita sanavalintoja tai tuoden muuten vahvoja mielipiteitä esiin, ja ne liittyivät pääosin aiheeltaan lakosta tiedottamiseen tai uuden päiväkodin rakentamiseen. Erityisesti kriisi- ja kannanottouutisotsikoissa käytettiin lainauksia tai kommentteja, jotka olivat lähinnä ministereiden tai tutkijoiden ilmaisemia. Tutkielma herättää pohtimaan, mikä vaikutus uutisotsikoilla on alan houkuttelevuuteen sekä yleiseen mielipiteeseen varhaiskasvatuksesta.The purpose of this research is to find out what is published about early childhood education in the news. Previous studies have shown that Finns mainly trust the leading national news media, Helsingin Sanomat and Yle. In addition, the research find out and think about how news can influence the public. The research analyzes the topics and language of the news headlines. The research was conducted by the qualitative method, which consists of content analysis that examined online news headlines published by Helsingin Sanomat and Yle news. Through discourse analysis, I also studied the language of news headlines as well as the meanings and images they produce. The research figured out what kind of topics and how early childhood education will be reported in Yle's and Helsingin Sanomat's news in 2022. I will focus on 194 news headlines in the research that was published between the first of April and December 14th, 2022. The research material was selected by including the words early childhood education or daycare that had to be mentioned in the news title. I classified the research material into four categories: crisis, statement, neutral and positive. The results showed that my material consisted of the most of neutral news headlines. Crisis news had the next highest number, and the quantitative difference in positive news was remarkably large. There were only 12 positive news headlines from the entire material. The topics of the news headlines were mainly related to the labor shortage and informing about the spring 2022 strike. Crisis news headlines mainly related to the labor shortage and the word crisis was used a lot in the headlines. Neutral news headlines were expressed without using strong dictions or otherwise bringing out strong opinions. They were mainly related to informing about the strike or like building a new kindergarten. In particular, crisis and statement headlines used quotes or comments that were mostly expressed by ministers or researchers. The research makes me think about what kind of effect news headlines have on the attractiveness and on public opinion of the industry of early childhood education