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Objective Pregnancy disorders are health problems that arise during the pregnancy, such as pre-eclampsia, gestational hypertension, obesity, overweight and gestational diabetes. Pregnancy disorders can effect on both mother’s and baby’s health and therefore pregnancy disorders can influence on mother-child interaction and on how mothers perceive their parenting. The parenting sense of competence assesses parental perceptions on efficacy and satisfaction in parenthood. The aim of the current study was to examine the relation between pregnancy disorders and parental competence and whether specific factors concerning parenthood have an effect on the relation. Methods The data of this thesis came from the PREDO-study. The sample consisted of 999 mothers who had pregnancy disorder (case mothers) and 1466 mothers who didn’t have any pregnancy disorder (control mothers). All mothers that were included in this study assessed their parental competence with the Parenting Sense of Competence (PSOC) scale. The relation between pregnancy disorders and the PSOC scales (parental efficacy and parental satisfaction) were analysed using regression analyses in three different models. The models were adjusted for child’s age as PSOC was assessed, child’s gender, gestational age and birth weight, mother’s education, whether the mother had also older children already or not, mother’s smoking and drinking during pregnancy and whether another parent lives at the same household. Results and conclusions It was found that only pre-eclampsia predicted lower satisfaction in parenthood, however the difference in satisfaction was small. Results remained the same when adjusted for potential confounders. This study was one of the first studies to examine connections between pregnancy disorders in disorder groups and parental competence. More research about relation between pregnancy disorders and parenthood altogether is needed.

Korkeat aterianjälkeiset veren glukoosipitoisuushuiput ovat haitallisia verisuonille jo ennen varsinaisten diabeteskriteerien täyttymistä. Valitsemalla alhaisen glykemiaindeksin (GI) hiilihydraatteja ruokavalioon, voidaan veren glukoosipitoisuutta alentaa diabeetikoilla. Tyypin 2 diabeteksen lisääntymisen takia on tarpeellista etsiä keinoja ehkäistä sairauden puhkeamista riskiryhmissä. Glukoosimonitorilla on mahdollista seurata aiempaa tarkemmin glykemiaindeksin vaikutusta veren glukoosipitoisuuteen. Tavoitteet Selvittää, miten korvaamalla ruokavalion tavanomaiset hiilihydraatit joko korkean tai alhaisen GI:n hiilihydraateilla voidaan vaikuttaa vuorokauden keskiglukoosipitoisuuteen. Lisäksi tavoitteena oli selvittää, voidaanko vain hiilihydraattien laatua muuttamalla, puuttumatta niiden määrään tai muuhun ruokavalioon, vaikuttaa glukoosiaineenvaihduntaan henkilöillä, joilla on heikentynyt glukoosin sieto. Tutkittavat ja menetelmät Tutkimus toteutettiin satunnaistettuna vaihtovuorokokeena, jossa tutkittavina oli 56 51-73-vuotiasta henkilöä, joista naisia oli 41 ja miehiä 15. Tutkittavilla oli heikentynyt glukoosinsieto tai ruokavaliohoitoinen tyypin 2 diabetes. Tutkittavat korvasivat ruokavalionsa päähiilihydraatit 7-10 vuorokauden ajaksi glykemiaindeksiltään joko alhaiseksi (GI = 38) tai korkeaksi (GI = 72) arvioiduilla tutkimushiilihydraateilla. Kolmen viimeisen vuorokauden ajaksi tutkittaville asennettiin glukoosimonitoriin kytketty ihonalainen sensori, joka mittasi kudosnesteen glukoosipitoisuutta ja tutkimusjaksojen lopuksi tutkittaville tehtiin oraalinen glukoosirasituskoe. Tulokset Alhaisen GI:n ruokavaliolla kahden vuorokauden glukoosikäyrien alainen pinta-ala oli pienempi kuin korkean GI:n ruokavaliolla (16487 vs. 17270 mmol/l*48h, p = 0,009, n = 47). Vastaavasti kahden vuorokauden keskiglukoosipitoisuudet olivat 5,7 mmol/l ja 6,0 mmol/l, p = 0,009, n = 47. Glykosyloitunut hemoglobiini oli alhaisen GI:n ruokavalion jälkeen pienempi (5,33% vs. 5,38 %, p = 0,017, n = 53). Tutkittavien paino pieneni kummallakin ruokavaliolla, alhaisen GI:n ruokavaliolla 1,02 kg ja korkean GI:n ruokavaliolla 0,31 kg (p < 0,001, n = 56). Vaikutusta plasman paastoglukoosiin ja seerumin paastoinsuliiniin ei ollut. Johtopäätökset Korvaamalla ruokavalion päähiilihydraatit alhaisen GI:n hiilihydraateilla, voidaan pitkäaikaista glukoositasoa pienentää ja näin ollen mahdollisesti ehkäistä heikentyneen glukoosinsiedon kehittymistä tyypin 2 diabetekseksi. Koska paastoglukoosipitoisuus ja paastoinsuliinipitoisuus eivät muuttuneet, lienee erityisesti aterianjälkeisillä glukoosihuipuilla merkitystä elimistön pitkäaikaiselle glukoositasolle henkilöillä, joilla on heikentynyt glukoosinsieto

Background: Understanding the false negative rates of SARS-CoV-2 RT-PCR testing is pivotal for the management of the COVID-19 pandemic and it has implications for patient management. Our aim was to determine the real-life clinical sensitivity of SARS-CoV-2 RT-PCR. Methods: This population-based retrospective study was conducted in March–April 2020 in the Helsinki Capital Region, Finland. Adults who were clinically suspected of SARS-CoV-2 infection and underwent SARS-CoV-2 RT-PCR testing, with sufficient data in their medical records for grading of clinical suspicion were eligible. In addition to examining the first RTPCR test of repeat-tested individuals, we also used high clinical suspicion for COVID-19 as the reference standard for calculating the sensitivity of SARS-CoV-2 RT-PCR. Results: All 1,194 inpatients (mean [SD] age, 63.2 [18.3] years; 45.2% women) admitted to COVID-19 cohort wards during the study period were included. The outpatient cohort of 1,814 individuals (mean [SD] age, 45.4 [17.2] years; 69.1% women) was sampled from epidemiological line lists by systematic quasi-random sampling. The sensitivity (95% CI) for laboratory confirmed cases (repeat-tested patients) was 85.7% (81.5–89.1%) inpatients; 95.5% (92.2–97.5%) outpatients, 89.9% (88.2–92.1%) all. When also patients that were graded as high suspicion but never tested positive were included in the denominator, the sensitivity (95% CI) was: 67.5% (62.9–71.9%) inpatients; 34.9% (31.4– 38.5%) outpatients; 47.3% (44.4–50.3%) all. Conclusions: The clinical sensitivity of SARS-CoV-2 RT-PCR testing was only moderate at best. The relatively high false negative rates of SARS-CoV-2 RT-PCR testing need to be accounted for in clinical decision making, epidemiological interpretations, and when using RT-PCR as a reference for other tests.

Introduction: When the decision of admitting a patient into an inpatient ward has been made but the patient remains waiting in the emergency department, the term boarding is used to describe this phenomenon. Boarding is associated with higher mortality, prolonged length of stay and increased hospital expenditure. The objective of this study is to examine the patient transfer conventions used for adult, non-ICU-bound ED patients and to uncover specific targetable causes of patient boarding. The study hospital emergency department treats internal medicine, neurological and surgical adult patients. The information provided by this study is to be used to improve the study hospital’s practices. Methods: The methods for this study were both qualitative and quantitative. The study was conducted in June and July of 2018 by directly observing the practices of the study ED and by measuring the time used for completing the steps relating to patient transfer to inpatient wards from the emergency department. The perceived reasons for delays during the transfer process were observed and logged. Results: The study hospital uses a patient transfer system where nurses communicate directly with each other. Patients could be moved to the wards only after a ward nurse approved it. The observed mean duration of the entire patient transfer process was 106 minutes. Most of this time was spent waiting for the go-ahead to transfer the patient and the mean for time for this part of the transfer process was 64 minutes. Nurses from the inpatient wards did not usually specify the exact cause for delays from their side. Discussion: Some limitations of this study included the small sample size and the fact that the operation of the ED was mostly observed during office hours on weekdays. Most of the boarding time consisted of waiting for the ward’s go-ahead to bring a patient in. To alleviate the problem of boarding in the study hospital, we think that giving the ED nurses a more active role in the admitting process is a key solution. Communication between the ED and the wards should also be improved.

Refeeding-syndrooma on ravitsemushoidon aloitukseen liittyvä komplikaatio potilailla, joilla on pitkään jatkunut tai vaikea vajaaravitsemustila. Se ilmenee veren elektrolyyttien, kuten fosfaatin-, kaliumin- ja/tai magnesiumin pitoisuuksien laskuna. Refeeding-syndrooman vaihtelevat oireet, mm. lihasheikkous, sydämen rytmihäiriöt, hengenahdistus ja neurologiset komplikaatiot, johtuvat veren elektrolyyttipitoisuuksien muutoksista ja voivat pahimmillaan kehittyä hengenvaarallisiksi. Tässä tutkielmassa arvioidaan refeeding-syndrooman yleisyyttä suusyöpäpotilailla leikkauksen jälkeen. Esiintyvyyttä arvioidaan fosfaattiarvojen perusteella, sillä fosfaattipitoisuuden laskua esiintyy suurimmassa osassa refeeding-syndroomatapauksista. Raja-arvona käytetään fosfaattitason (P-Pi) laskua alle 0,50 mmol/l. Refeeding-oireyhtymän yleisyyttä ei tarkalleen tiedetä, sillä oireyhtymälle ei ole yleisesti hyväksyttyä määritelmää ja esiintyvyys vaihtelee tutkimuspopulaation mukaan. Tutkielmassa oletetaan, että refeeding-syndrooma on verrattain yleinen suusyöpäpotilailla. Tulosten mukaan 13 % suusyöpäpotilaista oli refeeding-syndrooma leikkauksen jälkeen. Suusyöpäpotilailla sairaus itsessään sekä sen hoitomuodot lisäävät refeeding-oireyhtymän riskiä. On tärkeää, että suusyöpäleikkaukseen tulevien potilaiden refeeding-syndrooman riski arvioidaan ennen ravitsemushoidon aloitusta, jotta pystytään ennaltaehkäisemään oireyhtymän kehittyminen.

γ-Aminobutyric acid type A (GABAA) receptors are ligand gated ion channels mediating most inhibitory signals in the brain. GABAA receptor consists of five subunits, and there are 16 different subunits known. This forms base to pharmacological diversity of GABAA receptors. In this study autoradiography on subunit gene knock out mouse models was used to visualize the meaning of different subunits in forming GABAA receptors exhibiting special kinds of pharmacology, ie. GABA-insensitive [35S]TBPS-binding and high-affinity [3H]muscimol binding. In receptors exhibiting GABA-insensitive TBPS-binding GABA fails to cause full dissociation of TBPS from the ionophore, which means that the receptors are not fully activated by GABA. This study revealed, that contrary to what was previously believed, the forebrain GABA-insensitive [35S]TBPS binding is most likely caused by GABAA receptors consisting of α1 and β subunits or α1, β and δ subunits. High-affinity muscimol binding in the α1 KO mice was found to be unaltered, whereas α4 KO, δ KO and α4 + δ KO mice exhibited diminished high-affinity [3H]muscimol binding. Contrary to what was previously considered, this study points out that α1β GABAA receptors are mediating GIS-binding in the forebrain. Changes in high-affinity [3H]muscimol binding has also been found to correlate with changes of muscimols effects in vivo in knock out mouse models.

Purpose The association of bulimic symptoms with sensation seeking is uncertain; however, both behaviors have been linked to alcohol problems. We assessed in a longitudinal, community-based setting whether sensation seeking in adolescence is associated with bulimic symptoms in early adulthood, also accounting for alcohol problems. Methods Finnish men (N = 2000) and women (N = 2467) born between 1974–1979 completed Zuckerman’s sensation seeking scale (SSS) at age 18. Alcohol problems (Malmö-modified Michigan alcoholism screening test (Mm-MAST) and bulimic symptoms [eating disorder inventory-2, bulimia subscale (EDI-Bulimia), population and clinical scoring systems] were defined at age 22–27. We examined relationships between SSS, Mm-MAST, and EDI-Bulimia using Pearson’s correlation coefficient (r) and linear regression. Results Alcohol problems were moderately correlated with sensation seeking and bulimic symptoms (population scoring) among women and men (r = 0.21–0.31). The correlation between sensation seeking and bulimic symptoms (population scoring) was weak among men (r = 0.06, p = 0.006) and even weaker and non-significant among women (r = 0.03, p = 0.214). Adjustment for alcohol problems removed the association between sensation seeking and bulimic symptoms among men. Furthermore, there were no significant correlations between sensation seeking and bulimic symptoms when assessing EDI-Bulimia clinical scoring. Conclusion Sensation seeking and bulimic symptoms were not associated among women. The association between sensation seeking and bulimic symptoms among men was entirely attributable to increased alcohol problems among those with higher sensation seeking. While this association may be important on the population level, its clinical significance may be minor.

Objectives: From the viewpoint of public safety and offender rehabilitation, there is a constant need for a development of more effective recidivism prevention programs. Religion has been offered as a solution to prevent recidivism and at the moment, many religious programs are run in the offender population. The objective of thesis is to examine the associations of religion on recidivism and whether this association is mediated by antisocial peer influence. Methods: This thesis utilizes a comprehensive longitudinal Pathways to Desistance data, in which participants were followed for seven years. The sample used in this thesis includes 1354 juvenile offenders, convicted of a serious offence, from Phoenix and Philadelphia, United States. The recidivism was examined with Self-Reported Offending (SRO) measure, and for the purposes of this thesis, both 1- year and 2-year measurements were used. The extent of religious beliefs and the frequency of church attendance were assessed with Importance of Spirituality scale. The associations of both religious beliefs and church attendance with recidivism in 1-year and 2-year measurements, and the mediating effects of antisocial peer influence, were assessed via binary logistic regression. Results and conclusions: It was found that religious beliefs predicted a decrease in recidivism two years after the religious beliefs were measures, but that association was not present in the 1-year follow-up. Higher church attendance was associated with a higher amount of recidivism at both 1-year and 2-year follow-ups after religious beliefs, antisocial peer influence and demographic variable were controlled for. Also, contrary to the framework of the social control theory, it was found that the association of religious beliefs or church attendance with recidivism was not mediated by the antisocial peer influence. In addition, the association of the religious beliefs on recidivism was not moderated by church attendance and vice versa. Overall, the body of literature on this subject is still very limited, with mixed results and with different types of measurements used. The findings of this thesis add to the evidence base and suggest that the effect of religion on recidivism is small at best, and that it is dependent on the constructs and measurements used. The development of recidivism prevention programs should focus on elements that have more empirical evidence and have been proven to work.

Reniini-angiotensiinijärjestelmän (RAS) merkitys verenpaineen säätelyssä on kiistaton. Sen komponenttien on osoitettu ilmentyvän sydämen ja verenkiertoelimistön lisäksi myös muun muassa ruoansulatuskanavassa, haimassa, aivoissa ja silmissä, mikä on herättänyt ajatuksen siitä, että RAS:n merkitys elimistön toiminnalle voi olla huomattavasti nykykäsitystä monimuotoisempi. Ruoansulatuskanavassa sen vaikutuksia voivat olla verisuonten ja suolen sileän lihaskudoksen supistuksen säätely, muutokset suolen limakalvon läpäisevyydessä tai toimiminen ruoansulatusentsyyminä.

Yli puolet sukukypsistä naisista käyttävät nykyaikaisia ehkäisymenetelmiä. Näillä ehkäisyvalmisteilla on kuitenkin monia tunnettuja haittavaikutuksia, jotka puolestaan vaikuttavat käyttömyöntyvyyteen. Tämän tutkimuksen tarkoituksena on kuvata naisten kokemia ehkäisyvalmisteista johtuvia haittavaikutuksia ja etsiä yhteyttä naisten ominaisuuksien ja ilmoitettujen haittavaikutusten välillä. Yhteyden löytäminen mahdollistaisi haittojen ennustamisen ja tämän kautta paremmin yksilöidyn ehkäisyneuvonnan. Tutkimuksen aineisto on kerätty sähköisellä kyselylomakkeella Vantaan ehkäisy- ja perhesuunnitteluneuvoloissa sekä HUS naistentautien raskaudenkeskeytyspoliklinikalla. Kyselylomakkeella kartoitettiin naisten tietämystä, odotuksia ja kokemuksia eri ehkäisymenetelmistä. Yhteensä 1006 naista vastasivat kyselyyn. Naisten ominaisuuksien ja ilmoitettujen haittavaikutusten yhteyden tutkimiseksi naiset jaettiin ryhmiin iän, synnyttäneisyyden ja käytettyjen ehkäisymenetelmien lukumäärän perusteella. Vanhempi ikä, synnyttäneisyys ja suurempi käytettyjen ehkäisymenetelmien lukumäärä lisäsivät todennäköisyyttä, että nainen ilmoittaa kokeneensa enemmän haittavaikutuksia. Merkittävä osa naisista ilmoittavat kokeneensa mielialaan tai seksuaalitoimintoihin liittyviä haittavaikutuksia. Naiset, jotka ovat kokeilleet vähintään viittä eri ehkäisymenetelmää, ilmoittavat huomattavasti enemmän haittavaikutuksia verrattuna muihin ryhmiin. Kirjallisuudessa tutkimustulokset hormonaalisen ehkäisyn vaikutuksista mielialaan ja seksuaalitoimintoihin ovat ristiriitaisia. Tästä huolimatta merkittävä osa vastanneista naisista koki hormonaalisen ehkäisyn vaikuttaneen kielteisesti heidän mielialaansa tai seksuaalitoimintoihin. Tätä kokemusta tulee kuunnella, sillä naisten kokemukset ovat ratkaisevassa asemassa naiskeskeisen ehkäisyneuvonnan kehittämisessä.