Vaimse tervise murega patsient perearstipraksises Kivimäe perearstikeskuse näitel

Eesti Arst 2022; 101(1):17–1

Gaining trust advantage for the vaccination certificate platform

Purpose: In the conventional international health and safety policy design the decision makers rarely think in terms of business models. As an example, the yellow paper-based vaccination certificates, initiated by the WHO already in 1969, have not changed very much since then. In 2020, the Covid-19 crisis accelerated innovation, particularly digitalization, in many sectors, and the sense of urgency to have a digital immunisation certificate was voiced by many governments, as well as corporations. The new solution must enable international interoperability, but it is a challenging task because the setup of health registries varies across countries, and also because the common actions have been hindered due to the lack of trust – the trust deficit. Approach: In this article the case is discussed in the platform business model framework, and the role of trust in gaining competitive advantage – the trust advantage – in its fast and widespread adoption is particularly exemplified. The case was written in parallel with the actual development and piloting of the vaccination certificate platform, not ex post, as common in business model literature. Findings: The solution that could be capable of overcoming the privacy and security concerns that have been brought up in the international discourse can be described as a decentralised multi-sided platform, which has a distributed management system. The platform’s standardisation would ease its global uptake, and the strategic partnerships with countries, organisations, and firms that are already considered trustworthy (possess trust credit) will have the opportunity to gain trust advantage. Limitations: This paper is written having the managerial perspective in mind, hence, it does not go deeply into all technical and legal aspects affecting the implementation of the digital vaccination certificate platform

Eestis on arstiabi liiga hästi kättesaadav

Eesti Arst 2022; 101(8):40

Vaktsiini kõrvaltoime: rõõm

Eesti Arst 2021; 100(1):3 &nbsp

Energy Intensity in Northern Europe’s Economic Development – Curse or Bless?

It has been proven that a country’s development level increases with greater access to and use of electricity. However this holds true for lower levels of development – in the light of increasing political commitments for environmental concerns and global warming it is much harder to pinpoint best energy consumption pattern for sustainable economic development. Authors of this article measure energy intensity of the Nordic and Baltic countries by observing returns to GDP from amount of electricity used; comparing this to existing electricity production opportunities and cost. Findings demonstrate that low energy-intensiveness is economically more preferred but not ultimately necessary. Countries with well developed energy supply chains can maintain energy-intensive structure of the economy if the effectiveness of the structure is optimised

Ausbildung von Jugendlichen mit einer Autismus-Spektrum-Störung

Jugendliche mit einer Autismus-Spektrum-Störung (ASS) sind aufgrund ihrer autistischen Besonderheiten überdurchschnittlich oft mit beruflichen Herausforderungen und Schwierigkeiten konfrontiert. Aufgrund einer veränderten Wahrnehmung und Einschränkungen in der Kommunikation und der sozialen Aktion benötigen sie oft Hilfestellungen zur Bewältigung einer Ausbildung. Dies, obwohl sie auch viele Ressourcen und Charaktereigenschaften mitbringen, die für ein erfolgreiches Bestehen einer Ausbildung förderlich sind. Ausbildungsbetriebe und deren Mitarbeitende sind oft überfordert im Umgang mit Jugendlichen mit ASS und es bestehen grosse Unsicherheiten bei der Ausbildung. Jeder fünfte Lehrvertrag wird bei der jugendlichen Allgemeinbevölkerung gemäss Bundesamt für Statistik (o. J.) aufgelöst. Bei jugendlichen Auszubildenden mit ASS dürfte die Zahl deutlich höher sein, entsprechende Zahlen existieren jedoch nicht für die Schweiz. Die vorliegende Arbeit hat zum Ziel herauszufinden, welche Erfolgsfaktoren und Hilfestellungen den Ausbildungserfolg von Jugendlichen mit ASS erhöhen und welche Informationen und Empfehlungen für Ausbildungsbetriebe hilfreich sind. In einem ersten Schritt werden theoretische Grundlagen geschaffen, durch Sichtung von aktueller Literatur zu den Themen ASS und Ausbildung. Auf dieser Grundlage wird ein Interviewleitfaden erstellt und die Stichprobe für die Befragung definiert. Ein qualitatives Verfahren in Form von Expert:innen-Interviews findet Anwendung, indem spezialisierte Coaches und erfahrene Berufsbildner aus der Praxis befragt werden. Sie werden befragt zu den Themen Berufswahl, Anforderungen und Herausforderungen von Auszubildenden und Ausbildungsbetrieben und möglichen Hilfestellungen für den Umgang mit Jugendlichen mit ASS während einer Ausbildung. Sämtliche Interviewpartner:innen können auf einen breiten Erfahrungsschatz bei der Ausbildung und Begleitung von Menschen mit ASS zurückgreifen. Die Resultate zeigen klar, dass Menschen mit ASS vor, während und nach einer Ausbildung verschiedenen Herausforderungen begegnen und diese oft abgebrochen werden. Es zeigt sich aber auch, dass durch passende Hilfestellungen bei der Berufswahl, beim Rekrutierungsverfahren und bei der Arbeit im Betrieb durchaus Verbesserungen erreicht werden können, welche für einen Lehrabschluss förderlich sind. Eine adäquate Berufswahl, welche Interessen, Fähigkeiten, Ressourcen, aber auch Einschränkungen der Jugendlichen berücksichtigt sowie ein ruhiges Arbeitsumfeld bei einem informierten und verständnisvollen Ausbildungsbildungsbetrieb sind wichtige Faktoren im Hinblick auf eine erfolgreiche Ausbildung von Jugendlichen mit ASS

Liver pathology in rural south-west Cameroon

In a prospective study, 102 hospital patients with liver disease were evaluated in West Cameroon, Africa. Blood donors, pregnant women and patients without liver disease served as controls. A total of 757 individuals were tested for markers of hepatitis A, B, C and D and for immunological markers (autoantibodies, procollagen III, α-foetoprotein, CA50 antigen, α-1-antitrypsin and antibodies to human immunodeficiency virus types 1 and 2). One-third of the liver disease patients had focal lesions on ultrasound examination. Histologically, 20 cases of cirrhosis, 14 cases of chronic hepatitis, 15 hepatocellular carcinomas and 17 cases of acute hepatitis were detected. All hepatic patients and virtually all controls had had a previous hepatitis A virus infection. Over 85% of adult patients and controls had at least one marker of hepatitis B virus infection. Over 30% of patients with liver disease had markers of possible hepatitis B virus replication. Antihepatitis C virus antibody was present in 18% of hepatic patients and in 6% of controls. Hepatitis C virus infection seems to play an important role in the development of chronic liver pathology; 40% of cirrhotic patients had a combined hepatitis B and C virus infection, Serum autoantibodies were frequently found and were not correlated with the presence of autoimmune liver diseas

Nematode microRNAs can Individually Regulate Interferon Regulatory Factor 4 and mTOR in Differentiating T Helper 2 Lymphocytes and Modulate Cytokine Production in Macrophages

Parasitic nematodes are masterful immunomodulators. This class of pathogens has evolved a spectrum of sophisticated strategies to regulate and evade host immune responses, mediated through the release of various molecules. In this context, the release of microRNAs (miRNAs), short post-transcriptional regulators of gene expression, has been of particular interest in the host-parasite interplay. Evidence that parasite-derived miRNAs modulate host innate and adaptive immune responses has become increasingly compelling. However, since miRNAs are usually contained in extracellular vesicles containing other mediators, it is difficult to assign an observed effect on host cells to miRNAs specifically. Here, the effects of some abundantly secreted miRNAs by nematodes used as models of gastrointestinal infections (Heligmosomoides polygyrus bakeri, Trichuris muris and Ascaris suum) were evaluated, addressing the potential of parasite miRNAs to impair in vitro differentiation of two important types of immune cells in the context of helminth infections, Th2 lymphocytes and macrophages. Mimicking a continuous exposure to low concentrations of nematode miRNAs, the interferon gamma signaling, the IL-2/STAT5 signaling, and the mTOR signaling pathways were identified as downregulated by Hpo-miR-71-5p. Interferon regulatory factor 4 (Irf4) was validated as a target of Hpo-miR-71-5p, while Mtor is targeted by Asu-miR-791-3p, abundant in the T. muris secretions. By trend, Hpo-miR-71-5p impacts mildly but consistently on the amounts of inflammatory cytokines in unpolarized macrophages but leads to slightly increased IL-10 level in alternatively activated cells. In addition, our data suggests that transfected miRNAs remain for days in recipient cells, and that Hpo-miR-71-5p can incorporate into mouse Argonaute protein complexes. Nematode miRNAs can impair both innate and adaptive arms of host immunity. Hpo-miR-71-5p in particular, absent in mammals, interacts with host genes and pathways with crucial involvement in anthelmintic immune responses. This report brings new insights into the dynamics of miRNA-driven immunomodulation and highlights putative targeted pathways. Although the absolute repression is subtle, it is expected that the dozens of different miRNAs released by nematodes may have a synergistic effect on surrounding host cells