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Management of fracture risk in CKD-traditional and novel approaches
Get PDFThe coexistence of osteoporosis and chronic kidney disease (CKD) is an evolving healthcare challenge in the face of increasingly aging populations. Globally, accelerating fracture incidence causes disability, impaired quality of life and increased mortality. Consequently, several novel diagnostic and therapeutic tools have been introduced for treatment and prevention of fragility fractures. Despite an especially high fracture risk in CKD, these patients are commonly excluded from interventional trials and clinical guidelines. While management of fracture risk in CKD has been discussed in recent opinion-based reviews and consensus papers in the nephrology literature, many patients with CKD stages 3–5D and osteoporosis are still underdiagnosed and untreated. The current review addresses this potential treatment nihilism by discussing established and novel approaches to diagnosis and prevention of fracture risk in patients with CKD stages 3–5D. Skeletal disorders are common in CKD. A wide variety of underlying pathophysiological processes have been identified, including premature aging, chronic wasting, and disturbances in vitamin D and mineral metabolism, which may impact bone fragility beyond established osteoporosis. We discuss current and emerging concepts of CKD–mineral and bone disorders (CKD-MBD) and integrate management of osteoporosis in CKD with current recommendations for management of CKD-MBD. While many diagnostic and therapeutic approaches to osteoporosis can be applied to patients with CKD, some limitations and caveats need to be considered. Consequently, clinical trials are needed that specifically study fracture prevention strategies in patients with CKD stages 3–5D.</p
Suunnittelematon synnytys sairaalan ulkopuolella
Get PDFSuomessa lähes kaikki lapset syntyvät sairaalassa. Suunnittelemattomat sairaalan ulkopuoliset synnytykset etenevät tyypillisesti nopeasti, ja komplikaatiot ovat harvinaisia. Nopeaa synnytystä ennustavat aiempi nopeasti edennyt synnytys ja uudelleensynnyttäjän tiheät supistukset. Ensihoidon hoitomahdollisuudet ongelmatilanteissa ovat rajalliset. Ensihoito pyrkiikin arvioimaan, ehditäänkö synnyttäjä kuljettamaan sairaalaan vai hoidetaanko synnytys kohteessa valmistautuen mahdollisten hätätilanteiden, kuten huonokuntoisen vastasyntyneen tai synnyttäjän suuren verenvuodon hoitoon. Ponnistusvaihe hoidetaan sairaalan ulkopuolella samoin periaattein kuin sairaalassakin. Poikkeavat ulosauttotilanteet, kuten perätilasynnytys, ovat sairaalan ulkopuolella erittäin harvinaisia
Student teachers’ learning-to-teach patterns: connecting teaching approaches, teacher intentions, and self-perceived instructional impact
Get PDFThis study introduces a comprehensive learning-to-teach (LTT) framework that incorporates three previously unconnected domains: teaching approaches, teacher intentions, and self-perceived instructional impact. The framework is used in research that was conducted in a Finnish comprehensive school setting involving 45 student teachers (STs) during their practicum. STs’ critical teaching incidents and stimulated recall interviews (f = 90) were analyzed through the three LTT domains. The results revealed four key LTT patterns: effective curriculum portrayal through direct teaching approaches, difficulties in student behavior management with one-way teaching approaches, and mixed outcomes in student participation and personal needs accommodation through multi-way direct teaching approach. The study offers insights into diverse LTT patterns. It underscores that STs demonstrate potential in employing interactive direct teaching approach, whereas greater emphasis should be placed on classroom management when using constructivist teaching approaches. The LTT framework is suggested as a promising tool to enhance STs’ learning to teach.</p
Residential mobility and strength of social ties: Regional analysis in Finland
Get PDFMultiple factors can influence the rates of residential mobility flows between differentsubregions of a country. Studies have often focused on demographic and economic factors,but social conditions may be relevant as well. We examined whether the strength of socialties (i.e., social support, loneliness, social trust, community and cultural activities, andmeeting other people) were associated with population migration rates across 299municipalities of Finland. Data for the social characteristics were derived from the largeRegional Health and Wellbeing study (n=100,750 respondents) aggregated to the level ofmunicipalities using multilevel regression with post-stratification. Residential mobility rateswere derived from census data. Municipalities with higher levels of social support, highersocial trust, more cultural activities, and more frequent social contacts had higher netmigration rates, that is, more people moving in than out of the municipality.Social support and cultural activities were more strongly associated with (higher) inmigrationthan with out-migration rates. Social trust and frequency of meeting people weremore strongly associated with (lower) out-migration than with in-migration. The findingsprovide empirical support for the hypothesis that regions with stronger social ties are moreattractive destinations for within-country residential mobility</p
Mental well-being and fear: Examining the association between affective well-being and affective fear of crime in Finland
Get PDFThere is a dearth of knowledge regarding the association between mental well-being and fear of crime. This study utilises several measures of well-being and fear to examine how poorer affective well-being is associated with affective fear of crime in Finland. In addition, the article explores the extent to which feelings of unsafety and generalised distrust moderate this association. The research comprised 2020 survey data representing the Finnish-speaking population in mainland Finland. Descriptive methods, median regression, and interaction terms are used for the analyses. These results indicate that poorer affective well-being is positively associated with a stronger affective fear of crime in Finland. Furthermore, feelings of unsafety and generalised distrust were found to moderate the considered association. This indicates that the perceived risk of victimisation facilitates the association between poorer affective well-being and stronger affective fear of crime in Finland.</p
Research Handbook on Sustainable Project Management
Get PDFTo date, we lack an understanding of how to manage the global transition towards carbon neutrality in a coordinated way. Building on transition management and portfolio management, we examined how actors from ministries, agencies, cities, firms and NGOs across three countries organized their projects to address climate change. Our empirical work based on 30 interviews revealed six organizational challenges: (1) global ambition; (2) national complexity; (3) coordination across project portfolios; (4) governance of project portfolios; (5) continuously changing context; and (6) ownership. Underlining these challenges is the need of connections between climate projects. We propose a novel way of conceiving project portfolio management as an approach to make these connections that coordinates across multiple levels of analysis and loosely connected organizational settings. Going forward, we call for more research on cross-organizational project portfolio management to lead societal transitions.</p
Pregestational overweight and obesity are associated with differences in gut microbiota composition and systemic inflammation in the third trimester
Get PDFThe obesity epidemic is a global challenge, and the velocity of propagation is high in the population at reproductive age. Overweight and obesity during pregnancy have been associated with high birth weight and an increased risk of childhood obesity, reinforcing the risk of other non-communicable diseases. Obesity involves chronic low-grade systemic inflammation. New biomarkers for early detection of obesity risk are urgently required. The aim of this study was to identify the connection between pregestational BMI (pre-BMI) status and inflammatory biomarkers during the third trimester of pregnancy and their association with intestinal microbiota composition. Fifty-four pregnant women were classified according to pre-pregnancy BMI as normoweight, overweight, or obese. Weight gain, inflammatory biomarkers (hs_CRP, haptoglobin, and suPAR), and microbiota composition were assessed during the third trimester. A significant lower weight gain for obese mothers and a positive correlation between pre-BMI and inflammatory biomarkers were detected (Spearman's correlation). Haptoglobin levels were significantly higher in overweight and obese mothers. Higher Firmicutes levels and a higher ratio Firmicutes/Bacteroidetes were observed in the overweight and obese subjects. High hs_CRP and haptoglobin levels were also correlated with decreased microbiota diversity (Shannon index), whereas haptoglobin and hs_CRP values were correlated with several microbiota components, such as Ruminococcus gnavus and Faecalibacterium, and with specific phyla in the normoweight and overweight mothers; no significant associations with microbiota were found for suPAR. In conclusion, haptoglobin and hs_CRP reflected pregestational BMI status and related microbiota components, but haptoglobin was a better biomarker for microbiota associated with overweight. suPAR was associated with low grade inflammation dependent on pre-pregnancy BMI, but it was not related to deviated microbiota profiles
Ruokariippuvuusoireiden esiintyvyys ja yhteydet psykiatrisiin oireisiin FinnBrain-syntymäkohortissa
Get PDFLÄHTÖKOHDAT : Tietyillä ruuilla on esitetty olevan riippuvuuspotentiaalia, vaikka ruokariippuvuus on käsitteenä kiistanalainen. Tavoitteenamme oli selvittää mahdollisten ruokariippuvuusoireiden koettua esiintyvyyttä suomalaisilla sekä ruokariippuvuuden yhteyksiä mielenterveysoireisiin ja painoindeksiin. MENETELMÄT : Tutkimusjoukon muodostivat 377 FinnBrain-syntymäkohortin osatutkimuksen vanhempaa. Taustamuuttujina kysyttiin ikää, painoindeksiä ja koulutustasoa sekä masennus- ja ahdistusoireita. Ruokariippuvuutta mitattiin Yale Food Addiction Scale (YFAS) -kyselyllä. TULOKSET : Ruokariippuvuuden kynnysarvon ylitti 1,5 \% miehistä ja 6,6 \% naisista, ja heistä suurempi osa oli ylipainoisia (85 \% vs 48 \%, p = 0,009) tai lihavia (46 \% vs 15 \%, p = 0,003) verrattuna tutkittaviin, joilla ruokariippuvuuden kynnysarvo ei ylittynyt. Heillä oli myös enemmän masennus- ja ahdistusoireita. Vaikeuksia vähentää tai välttää tiettyjen ruokien syömistä esiintyi 50 \%:lla tutkittavista. PÄÄTELMÄT : Kyseessä on ensimmäinen suomalaisten ruokariippuvuusoireita kartoittava tutkimus. Ruokariippuvuusoireet ovat huomattavan yleinen koettu ongelma ja mahdollisesti oleellinen tekijä väestön ylipainon kehittymisessä.</p
Synaptic proteome perturbations after maternal immune activation : Identification of embryonic and adult hippocampal changes
Get PDFBackground Maternal immune activation (MIA) triggers neurobiological changes in offspring, potentially reshaping the molecular synaptic landscape, with the hippocampus being particularly vulnerable. However, critical details regarding developmental timing of these changes and whether they differ between males and females remain unclear. Methods We induced MIA in C57BL/6J mice on gestational day nine using the viral mimetic poly(I:C) and performed mass spectrometry-based proteomic analyses on hippocampal synaptoneurosomes of embryonic (E18) and adult (20 ± 1 weeks) MIA offspring. Results In the embryonic synaptoneurosomes, MIA led to lipid, polysaccharide, and glycoprotein metabolism pathway disruptions. In the adult synaptic proteome, we observed a dynamic shift toward transmembrane trafficking, intracellular signalling cascades, including cell death and growth, and cytoskeletal organisation. In adults, many associated pathways overlapped between males and females. However, we found distinct sex-specific enrichment of dopaminergic and glutamatergic pathways. We identified 50 proteins altered by MIA in both embryonic and adult samples (28 with the same directionality), mainly involved in presynaptic structure and synaptic vesicle function. We probed human phenome-wide association study data in the cognitive and psychiatric domains, and 49 of the 50 genes encoding these proteins were significantly associated with the investigated phenotypes. Conclusions Our data emphasise the dynamic effects of viral-like MIA on developing and mature hippocampi and provide novel targets for study following prenatal immune challenges. The 22 proteins that changed directionality from the embryonic to adult hippocampus, suggestive of compensatory over-adaptions, are particularly attractive for future investigations.</p
Blood metabolomic profiling reveals new targets in the management of psychological symptoms associated with severe alcohol use disorder
Get PDFBACKGROUND:Alcohol use disorder (AUD) is a global health problem with limited therapeutic options. The biochemical mechanisms that lead to this disorder are not yet fully understood, and in this respect, metabolomics represents a promising approach to decipher metabolic events related to AUD. The plasma metabolome contains a plethora of bioactive molecules that reflects the functional changes in host metabolism but also the impact of the gut microbiome and nutritional habits.METHODS:In this study, we investigated the impact of severe AUD (sAUD), and of a 3-week period of alcohol abstinence, on the blood metabolome (non-targeted LC-MS metabolomics analysis) in 96 sAUD patients hospitalized for alcohol withdrawal.RESULTS:We found that the plasma levels of different lipids ((lyso)phosphatidylcholines, long-chain fatty acids), short-chain fatty acids (i.e. 3-hydroxyvaleric acid) and bile acids were altered in sAUD patients. In addition, several microbial metabolites, including indole-3-propionic acid, p-cresol sulfate, hippuric acid, pyrocatechol sulfate, and metabolites belonging to xanthine class (paraxanthine, theobromine and theophylline) were sensitive to alcohol exposure and alcohol withdrawal. 3-Hydroxyvaleric acid, caffeine metabolites (theobromine, paraxanthine, and theophylline) and microbial metabolites (hippuric acid and pyrocatechol sulfate) were correlated with anxiety, depression and alcohol craving. Metabolomics analysis in postmortem samples of frontal cortex and cerebrospinal fluid of those consuming a high level of alcohol revealed that those metabolites can be found also in brain tissue.CONCLUSIONS:Our data allow the identification of neuroactive metabolites, from interactions between food components and microbiota, which may represent new targets arising in the management of neuropsychiatric diseases such as sAUD.</p