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Objectives. Recent results of both animal and human studies suggest that intestinal microbiota, i.e. microorganisms inhabiting the gastrointestinal system, may be connected to their host’s cognition. However, the diverse effects of intestinal microbiota are still poorly understood and especially knowledge of its associations with normative childhood cognitive development is very scarce. The purpose of the current study was to examine the possible associations between infant intestinal microbial composition, richness and diversity and cognitive performance in early childhood. Methods. The current study sample consisted of the children taking part in Finnish Health and Early Life Microbiota (HELMi) longitudinal birth cohort study. The cognitive abilities of 424 children were assessed at 2 years of age with Bayley Scales of Infant and Toddler Development, using cognitive, receptive language and expressive language subscales. Of 424 tested children, those from whom microbiota analysis for at least one fecal sample was available at the time of the start of this study, were included. Fecal samples were collected when infants were 3, 6 and 12 weeks old and 6, 9 and 12 months old, and the bacterial composition, richness and diversity were analyzed with 16S rRNA- amplicon sequencing method. Results and conclusions. Intestinal microbial composition in infancy was found to be related to cognitive abilities of the children, more specifically, receptive language skills and expressive language skills. A higher abundance of the genus Finegoldia at 12 weeks of age and the genus Serratia at 6 months of age were related to worse receptive language performance at 2 years of age. A higher abundance of the family Enterococcaceae at 12 weeks of age and the genus Alistipes at 6 months of age, were associated with worse expressive language skills. In addition, the children who scored in lowest 20th percentile in the receptive language tasks, had richer intestinal microbiota at 3 weeks and 6 months of age. Conclusions cannot yet be drawn based on these preliminary findings, but the results suggest that infant intestinal microbiota may be one of the factors influencing cognitive, especially verbal, development in early childhood.

Objective. Depression is associated with increased risk of chronic disease, which may be at least partly due to poor health behaviors. Growing body of evidence has associated depression with unhealthy diet. However, the association of depression with diet quality in the long run is not well known. Furthermore, it is unclear if dietary interventions could mitigate the harmful association of depression with diet. This study examined the association of depression with diet both cross-sectionally and longitudinally in a population-based prospective cohort. The effectiveness of an early-onset dietary intervention in modifying these associations was investigated. Methods. The sample (n = 457) was from The Special Turku Coronary Risk Factor Intervention Project (STRIP). The intervention group (n = 209) had undergone a dietary intervention lasting from age of 7 months until age of 20 years. Depression was measured at age 20 using Beck Depression Inventory II (BDI-II). Diet quality was assessed at ages 20 and 26 using a diet score calculated based on food diaries. Missing values were replaced using multiple imputation by chained equations. Linear regression analyses were used to analyze the association of depression at age 20 with diet at ages 20 and 26, as well as the modifying effect of intervention group on these associations. Results. No cross-sectional association was found for depression and diet at age 20. Depression at age 20 was longitudinally associated with worse diet quality at age 26. The associations did not differ between intervention and control groups at either of the time points. Conclusions. Contrary to previous research, this study did not find cross-sectional association for depression with diet. However, this study offers novel information on longitudinal associations, suggesting that depression may have effects on diet quality that can manifest after several years. Dietary intervention was not found effective in modifying these associations. Since long-term effects on diet may be an important factor explaining the association of depression with chronic diseases, ways to mitigate the adverse consequences of depression for diet should be explored further.

Immunophenotyping by flow cytometry (FC) is an established practice to identify immune cells and their cellular changes at the single-cell level. Since preserving the structural integrity of cellular epitopes is vital for immunophenotyping, samples should be processed shortly after being collected. However, the requirements of complex facilities and trained personnel for flow cytometry make it challenging to handle samples immediately. Fixation and cryopreservation extend sample shelf life and allow analysing longitudinal samples simultaneously while minimizing technical variation. Nevertheless, usage of whole blood cryopreservation in flow cytometry is limited due to challenges in preserving epitope structures during fixation and detecting dim antigens. This thesis investigates the performances of four commercial whole blood cryopreserving kits; 1) Cytodelics, 2) Stable-Lyse V2 and Stable-Store V2 (SLSS-V2), 3) Proteomic stabiliser (PROT-1), and 4) Transfix. Peripheral blood samples were processed with these stabilising buffers immediately after the collection and cryopreserved until further analysis by flow cytometry. Here, we measured the stability of major immune lineages, T cell subpopulations, and activated neutrophil profiles in samples treated with these commercial whole blood stabilisers. Our flow cytometry data showed that PROT-1, Transfix and Cytodelics maintained the distribution of major leukocyte subsets – granulocytes, T cells, natural killer cells and B cells, comparable to unpreserved samples despite the attenuation of fluorescence intensities. Moreover, these three stabilisers also preserved phenotypes of activated neutrophils upon stimulation with N-Formylmethionyl-leucyl-phenylalanine and Lipopolysaccharides. The upregulation of adhesion molecules (CD11b), Fc receptors (CD16) and granule proteins (CD66b) as well as the shedding of surface L-selectin (CD62L) on activated neutrophils was conserved most efficiently in PROT-1, followed by Cytodelics. On the other hand, none of the stabilisers provided a reliable detection of CCR7 for accurate quantification of T cell subpopulations. COVID-19 is caused by a highly transmissible and pathogenic coronavirus, so-called severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). To test the potential of whole blood cryopreservation kits for flow cytometry in COVID-19 research, we studied the detectability of major leukocyte lineages and granulocyte subsets in longitudinal patient samples processed with Cytodelics. High dimensional analysis with Uniform Manifold Approximation and Projection (UMAP) and Self-Organising Maps (FlowSOM) clustering revealed remarkable stability of CD3, CD15, and CD14 expression in samples stored with Cytodelics. It allowed the detection of lymphopenia and emergency granulopoiesis often found during the acute phase of severe SARS-COV-2 infection. Nonetheless, we could not determine signatures of granulocyte subsets, notably suppressive neutrophils, during the acute and convalescent phases of COVID-19. Variable detection of lowly expressed markers and diminished fluorescence intensities in Cytodelics - preserved samples might have hindered the analysis. In conclusion, this study demonstrates that PROT-1, Transfix, and Cytodelics enabled reliable detection of highly expressed leukocyte markers, whereas SLSS-V2 preservation resulted in the most inaccurate identification of studied markers. Notably, our results show that Cytodelics can be applied in COVID-19 studies to immunophenotype major immune lineages by flow cytometry. Nevertheless, more optimisation is needed for less abundant or fixation-sensitive epitopes to enhance the efficacy of whole blood cryopreservation for flow cytometry.

Objectives Few studies have focused on the association between childhood and young adulthood cancers and cancer screening attendance. Our aim was to assess the effect of cancer diagnosed before the age of 30 years on first-time cervical screening attendance. Methods Using the nation-wide and population-based Finnish Cancer Registry and the Mass Screening Registry, we identified 4,491 cancer patients born between years 1961 and 1988 and diagnosed with cancer before age 30 and alive at the time of first cervical cancer screening invitation at age 25 or 30 years. Attendance probability to screening was compared between individuals with and without a prior cancer diagnosis. Results Compared to women with no previous cancer (attendance probability of 58% in study period), difference in attendance to first-time screening invitation was observed among women with previous cervical cancer (24%), other malignant gynaecologic cancer (43%) and borderline ovarian tumours (48%). Attendance among women with other previous cancer types did not differ from women with no previous cancer. Differences in the attendance probability of cancer survivors and cancer free individuals also varied between catchment areas. Conclusions The low cervical cancer screening attendance among survivors of previous gynecologic cancers and borderline ovarian tumors calls for further exploration on the reasons. As attendance probability differed among survivors of gynecological and other types of cancer significantly only if the invitation came <5 years after the cancer diagnosis, one likely explanation is ongoing oncologic follow-up. Regional differences underline the importance of national guidelines.

Vaccine uptake has been low for some vaccines in the Pietarsaari region in Finland. Among health care workers vaccine uptake has been low for the influenza vaccine. This qualitative study intends to answer questions about what kind of attitudes and thoughts health care workers have towards vaccination and which factors affect the attitudes. This study consists of 23 semi-structured interviews and three focus-group interviews with health care workers in the Pietarsaari region. The interviews were conducted in June-July 2017 and were analyzed with qualitative content analysis. The general attitude towards vaccination is positive amongst the health care workers. Vaccines are seen as fundamental protection against diseases and are an important part of health prevention. Many informants trust the authorities and research conducted about vaccines. Yet some informants are hesitant about certain vaccines. Vaccines, which are called unnecessary or risky, varies between the informants. Reasons for refusing vaccines are preference of natural immunity, negative experiences of vaccination, for example adverse effects, or the attitude that ”we can ́t vaccinate against everything”. Furthermore, the concerns about vaccines have increased since 2009, when the swine flu vaccination was associated with severe adverse effects. Health care workers also oppose the compulsory vaccination of the influenza vaccine.

Tutkielma on kirjallisuuskatsaus, jonka tavoitteena on löytää oikeanlaisia tapoja kohdata hammashoidon lapsipotilaita, joilla on autismikirjon häiriö tai ADHD (Attention Deficit Hyperactivity Disorder) eli aktiivisuuden ja tarkkaavuuden häiriö. Tutkielmassa pyritään selvittämään, miten lapsen kehityksellinen neuropsykiatrinen häiriö kannattaa ottaa huomioon hammashoidossa, miten ADHD- tai autismikirjon lapsen kanssa toimitaan mahdollisimman oikealla tavalla toimenpiteitä suorittaessa ja miten lasta tuetaan hoidon aikana.Tavoitteena on parantaa lasten kokemusta ja helpottaa hammaslääkärien työskentelyä erityislapsipotilaiden kanssa. ADHD ja autismikirjon häiriöt ovat molemmat kehityksellisiä neuropsykiatrisia häiriöitä. Näiden taustalla on neurobiologinen häiriö, joka aiheuttaa psykiatrisia oireita. ADHD- tai autismikirjon lapsen erityistarpeet on tärkeää ottaa huomioon hammashoidossa. Näin vältytään turhilta ongelmilta ja hoito etenee mahdollisimman sujuvasti. Erilaisia vuorovaikutusmenetelmiä on mahdollista käyttää helpottamaan toimenpiteitä. Lapsilla, joilla on ADHD tai autismikirjon häiriö esiintyy enemmän käytöspulmia ja stressiä hammashoidossa, kuin normaalisti kehittyvillä lapsilla. Hammashoidon tukena voidaan käyttää kerro-näytä-tee-menetelmää tai kuvia hammashoitotilanteesta. Lisäksi kehut ja palkinnot sekä ulkoisten ärsykkeiden minimointi helpottavat vuorovaikutusta näiden lasten kanssa. Lapsilla, joilla on ADHD tai autismikirjon häiriö saattaa olla kohonnut kariesriski ja huonompi suuhygienia kuin tavallisesti kehittyvillä lapsilla. Hoitotilannetta tukee hammaslääkärin hyvä tietotaso ADHD:sta ja autismikirjon häiriöstä sekä lapsen erityistarpeista. Vuorovaikutus ADHD- ja autismikirjon potilaan kanssa hammashoidossa on prosessi, jossa tarvitaan hoitohenkilökunnalta vuorovaikutustaitoja ja kykyä kohdata jokainen lapsi yksilönä.

Objectives. Autism spectrum disorder (ASD) is a neurobiological developmental disorder that involves challenges in social interaction and restricted/repetitive behaviors. Since generalization and maintenance of acquired skills is essential in the rehabilitation of ASD, it is important to integrate interventions into the home environment by parental guidance. There has been some research on the rehabilitation of children with ASD in Finland, but no research has been conducted on the guidance of parents from the perspective of speech therapist. The purpose of this study is to find out the views of parental guidance from speech therapists who rehabilitate children with ASD. Interviews with speech therapists will clarify the ways in which parents of children with ASD are guided through speech therapy and the challenges and contributing factors in parental guidance. Methods.The research method was a semi-structured interview. Five speech pathologists with experience in the rehabilitation of ASD were interviewed. The interviews were recorded and transcribed. The data was analyzed by content analysis. Results and conclusion. Parental guidance of children with ASD was divided into information sharing, interaction & discussion and direct guidance. The challenges were parental strain, parent attitude and in some cases multiculturalism. Contributing factors appeared in training practices and home conditions. Challenges and benefits were influenced by the individuality of families. Speech therapists hoped for more opportunities to arrange separate parental guidance sessions so that they would be able to discuss deeper about the methods and family situation without the child’s presence. Speech therapists considered parental guidance important in the rehabilitation of children with ASD because, with the guidance of parents it helped to increase skills in everyday life and guaranteed training intensity. As parental strain was identified as a challenge in this study, it would be important to explore how they could be more effectively supported during rehabilitation. In addition, it could be explored whether separate parental guidance sessions should be increased or whether the number of parental guidance sessions has been adapted through the development of new working practices.

Autism spectrum disorder (ASD) is a condition that affects social interaction, communication and behavior. Since effective communication and interaction is a prerequisite for learning, the use of augmentative and alternative communication (AAC) methods has been considered necessary in study environments. The education professionals' perspectives and attitudes towards the use of AAC methods have been linked to the extent to which they support the development of communication skills of their pupils using communication aids. The purpose of this study is to describe the experiences of autism classroom teachers and classroom assistants in the use of AAC methods. This topic is examined based on the benefits and challenges that autism education professionals associate with the use of communication aids, the number of factors contributing to the successful use of the AAC methods as well as the development of the students' communication skills. In this study nine education professionals who worked in autism education classrooms and school's afternoon activities in Helsinki were interviewed. The interviews were conducted as semi-structured individual interviews, which discussed the use of AAC methods for students with ASD. The interviews were recorded, transcribed and analyzed by using inductive thematic analysis approach. Finally, the themes of each research question were compared with each other. Based on the results of this study, AAC methods are particularly useful not only for communication between students and education professionals, but also for the students' ability to express themselves, to develop better social skills and to become more independent in their everyday lives. The challenges of using AAC methods related to usability factors, students' developmental abnormalities, education professionals' practices and various resource issues. Professional co-operation, motivation, favorable usability factors of the AAC methods, and factors related to the activities and roles of education professionals were seen to influence the successful use of the AAC methods and to improve the students' communication skills. In addition, the interviewees strongly emphasized the importance of students' spontaneous communication and speech development in the motivation and work satisfaction of education professionals. The autism classroom teachers' and classroom assistants' experiences in the use of AAC methods emphasize the importance of training and multiprofessional co-operation in support of the use of communication aids and development of students' communication skills. Based on the results of this study, the speech therapists' counseling activities can be regarded as significant for the development and maintenance of the education professionals' AAC skills and for constituting positive attitudes related to the use of AAC methods. This study highlights the importance of further research focusing particularly on more specific identification of challenges related to the use of AAC methods in autism classroom education.

Aim: Oral infections up-regulate a number of systemic inflammatory reactions that, in turn, play a role in the development of systemic diseases. We investigated the association between oral health and autoimmune diseases in a cohort of Swedish adults. Hypothesis was that poor oral health associates with incidence of autoimmune diseases. Materials and Methods: Overall 1676 subjects aged 30–40 years old from Stockholm County (Sweden) participated in this study in 1985. Subjects were randomly selected from the registry file of Stockholm region and were followed-up for 30 years. Their hospital and open health care admissions (World Health Organization ICD 9 and 10 codes) were recorded from the Swedish national health registers. The association between the diagnosed autoimmune disease and the oral health variables were statistically analyzed. Results: In all, 50 patients with autoimmune diagnoses were detected from the data. Plaque index was significantly higher in the autoimmune disease group (≥median 35 (70%) vs. under median 872 (54%), p = 0.030). No statistical difference was found in gingival index, calculus index, missing teeth, periodontal pockets, smoking or snuff use between patients with and without autoimmune disease. Conclusions: Our study hypothesis was partly confirmed. The result showed that subjects with a higher plaque index, marker of poor oral hygiene, were more likely to develop autoimmune diseases in 30 years.

Iän myötä ajaminen saattaa vaikeutua kognitiivisten, sensoristen ja motoristen taitojen heiketessä. Useimmissa Euroopan maissa on siksi käytössä autonkuljettajien ikäkausitarkastukset, joiden ajatuksena on seuloa liikenteestä pois kaikkein suurimman onnettomuusriskin omaavat kuljettajat. Tutkimukset ovat kuitenkin kyseenalaistaneet tarkastusten aikana suoritettavien testien tehon. Tutkielman tavoitteena oli selvittää, vähentävätkö autonkuljettajien ikäkausitarkastukset liikenneonnettomuuksia, sekä arvioida iäkkäiden mahdollisesti korkeampaan onnettomuusriskiin vaikuttavia tekijöitä. Tätä varten tehtiin laaja kirjallisuuskatsaus ja vertailtiin kahdentoista Euroopan maan liikennekuolemia vuosilta 2019–21, samalla huomioiden, mikäli kyseisissä maissa on käytössä ikäkausitarkastukset vai ei. Lisäksi perehdyttiin myös mahdollisiin ikäkausitarkastuksista aiheutuviin haittoihin, liikenneonnettomuustilastojen tulkintaan liittyviin harhoihin, sekä niistä aiheutuviin suoriin ja epäsuoriin kustannuksiin. Tulosten perusteella voidaan todeta, ettei autonkuljettajien ikäkausitarkastuksilla vaikuta olevan liikenneonnettomuuksia merkittävästi vähentävää vaikutusta ja että tietyissä tapauksissa ne ovat saattaneet johtaa iäkkäiden suojaamattomien tienkäyttäjien (pyöräilijät, kävelijät, moottoripyöräilijät) liikennekuolemien merkitsevään kasvuun. Muutamassa tutkimuksessa ajokortin uusiminen paikan päällä (esimerkiksi tieliikenneviranomaisen luona) ja näöntarkastukset olivat yhteydessä iäkkäiden vähäisempiin auto-onnettomuuksiin. Yhdessäkään tutkimuksessa ei kuitenkaan osoitettu, että lääkärintarkastuksilla olisi iäkkäiden liikenneonnettomuuksia vähentävää vaikutusta. Ikäkausitarkastusten arvioitiin maksavan Suomen veronmaksajille noin 6 000 000 euroa vuodessa, minkä lisäksi on huomioitava rajalliset lääkäriresurssit. Näistä syistä johtuen ainakaan lääkärien suorittamat autonkuljettajien ikäkausitarkastukset eivät ole perusteltuja.