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Uni ja kardiometabolia : vaihdevuosi-ikäisten naisten unen laadun yhteys sokeri- ja rasva-aineenvaihduntaan ja leptiinitasoihin
No full textUnen laatu heikkenee vaihdevuosien aikana. Heikentynyt unen laatu on yhteydessä sokeri- ja rasva-aineenvaihdunnan häiriöihin. Tämän pro gradu-tutkielman tarkoituksena oli selvittää vaihdevuosi-ikäisten naisten unen laadun yhteyttä kardiometabolisiin riskitekijöihin.
Tutkielma perustuu Estrogeeni, vaihdevuodet ja toimintakyky (ERMA) -tutkimuksen aineistoon. Osallistujat poimittiin satunnaisotannalla väestörekisteristä Jyväskylän ja sen lähikuntien 47–54 -vuotiaista naisista (n=6886). Mukaan valittiin ne sisäänottokriteerit täyttävät naiset, jotka vastasivat tutkimuksen alkumittauskyselyyn ja joilta terveydentilaa selvittävän haastattelun sekä laboratoriomittausten jälkeen saatiin luotettavasti mitattua seerumin leptiini (n=679).
Unen laatua arvioitiin kysymyksillä koetusta unen laadusta, unen pituudesta sekä päiväaikaisesta väsymyksestä. Kardiometabolisista riskitekijöistä tarkasteltiin verensokeria, kolesteroleja, triglyseridejä sekä leptiinitasoja. Tutkittavat jaettiin vaihdevuosivaiheen mukaan premenopaussi-, perimenopaussi- ja postmenopaussiryhmiin. Ryhmien eroja unen ja kardiometabolisten riskitekijöiden suhteen tarkasteltiin χ2-testillä sekä yksisuuntaisella varianssianalyysillä. Unen ja kardiometabolisten riskitekijöiden yhteyttä selvitettiin Spearmanin korrelaatioanalyysillä. Lisäksi yhteyksiä tarkasteltiin monimuuttujaisella lineaarisella regressiolla. Multinomiaalista logistista regressiomallinnusta käytettiin unen ja kardiometabolisista riskitekijöistä muodostettun summamuuttujan välisten yhteyksien tarkasteluun.
Vaihdevuosiryhmien välillä oli eroja koetussa unen laadussa (p=0.011) ja unen kestossa (p=0.001). Unen laatu heikkeni ja unen kesto lyheni vaihdevuosien edetessä. Kardiometabolisista riskitekijöistä kolesterolit olivat postmenopaussiryhmässä muita korkeammalla tasolla (p<0.001). Perimenopaussiryhmän leptiinitasot olivat korkeat muihin verrattuna (p=0.045). Koettu päiväaikainen väsymys oli heikosti yhteydessä leptiinitasoihin (r=0.099, p<0.05). Lineaarisessa regressiomallissa kehonpainoindeksi osoittautui kuitenkin väsymystä (β=0.428, p<0.001) paremmin leptiinitasoa selittäväksi tekijäksi. Multinomiaalisessa regressiomallissa havaittiin postmenopausaalisilla naisilla olevan premenopaussiryhmää merkittävämpi riski kardiometabolisten riskitekijöiden kertymiseen.
Vaikka työssä käytetty poikittaisasetelma ei mahdollista suorien kausaalipäättelyiden tekemistä, vaikuttaa koettu unen laatu heikkenevän ja unen kesto lyhenevän vaihdevuosien aikana. Myös rasva-aineenvaihdunnassa tapahtuu muutoksia, joiden seurauksena kolesterolien määrä verenkierrossa nousee. Leptiinin määrä verenkierrossa saattaa nousta perimenopaussin aikana, mutta postmenopausaalisilla naisilla se on lähes samalla tasolla kuin premenopausaalisilla. Postmenopaussi lisää kardiometabolisten riskitekijöiden kertymisen riskiä. Unen laatu ei tämän tutkielman perusteella ole suoraan yhteydessä kardiometabolisen riskin suurenemiseen. Unella on kuitenkin yhteys kehonpainoindeksiin, jonka merkitys välittävänä tekijänä tulee huomioida.Menopause is known to decrease the quality of sleep. The impaired sleep quality is associated with disorders in glucose and lipid metabolism. The purpose of this study was to investigate the interactions between sleep quality and cardiometabolic risk factors on menopausal women.
This study is based on the data of Estrogenic Regulation of Muscle Apoptosis (ERMA) -study. The participants were a random sample of 47–55 -year women living in Jyväskylä area gleaned from the Finnish population register (n=6886). The study sample was limited to wom-en who had responded to the initial survey measurement of ERMA -study and who had un-dergone the interview considering the state of health and laboratory measurements. The final sample consisted of the women whose leptin levels were being reliably measured (n=679).
The quality of sleep was evaluated with questionnaire considering perceived sleep quality, duration of sleep and daytime sleepiness. Blood glucose, cholesterols, triglycerides and leptin levels were examined as cardiometabolic risk factors. The participants were divided into three groups according to the status of the menopause: premenopausal-, perimenopausal- and post-menopausal groups. Differences between groups in the quality of sleep and cardiometabolic risk factors were tested with χ2-test and one-way analysis of variance. The association be-tween sleep quality and cardiometabolic risk factors was tested with Spearman correlation analysis and multiple linear regression. Finally, a sum variable was formed from the cardi-ometabolic risk factors. The association of sleep quality with the sum variable was tested with multinomial logistic regression.
This study found differences between the menopause groups in the perceived quality of sleep (p=0.011) and duration of sleep (p=0.001). The quality of sleep declined and the duration of sleep shortened during the menopause. Cholesterols were higher in the postmenopausal group than in the two other groups (p<0.001). Leptin levels were highest in the perimenopausal group (p=0.045). Daytime sleepiness was weakly associated with higher leptin levels (r=0.099, p<0.05). However, in the linear regression model, body mass index turned out to explain the leptin levels better than daytime sleepiness (β=0.428, p<0.001). Multinomial regression model showed that women in postmenopause have greater risk of cumulative cardiometabolic risk than women in premenopause.
Because of the cross-sectional research frame, making any assumptions of causality is not pos-sible. However, it seems that the quality of sleep decreases and the duration of sleep shortens during the menopause. Changes in the lipid metabolism seem to cause the rise of cholesterol levels in the circulation. The leptin levels may temporarily rise during the perimenopause, but in postmenopause they return near the same level of premenopausal women. Postmenopause is increasing the risk of cumulating cardiometabolic risk factors. According to this study, sleep quality is not directly associated with an increase in cardiometabolic risk. Sleep has, however, a connection on body mass index, which may act as an intermediator in the association with cardiometabolic risk.unknown accessibilityei tietoa saavutettavuudest
Palliatiivinen hoito pitäisi kytkeä paremmin iäkkäiden palveluihin
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Miten palliatiivisen hoidon suositukset auttavat iäkkäiden elämän loppuvaiheen hoidossa?
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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