Skeleti-lihasvalud õdedel: levimus, ohutegurid ja sekkumine

Väitekirja elektrooniline versioon ei sisalda publikatsiooneSkeleti-lihasvalud (SLVd) on kõige levinum ja jätkuvalt lahendamata probleem kogu Euroopa töötajaskonna hulgas, ohustades kõige enam haiglatöötajaid sh õdesid. SLVd halvendavad oluliselt õdede tööga toimetulekut ja elukvaliteeti, põhjustades füüsilisi, psühholoogilisi ja sotsiaalseid probleeme. Õdede töövõime langus ja töölt puudumine ägeda või kroonilise SLV tõttu tekitab märkimisväärseid töövõimetusega seotud kulusid ning on oluliseks finantskoormuseks vananeva elanikkonnaga Eesti majandusele. Käesoleva doktoritöö eesmärk oli välja selgitada SLVde esinemine ja võimalikud ohutegurid õdedel ning hinnata koduvõimlemisel põhineva treeningteraapia mõju õdede lülisamba kaela- ja nimmepiirkonna liikuvusulatusele, et ennetada või vähendada SLVsid. Andmed koguti Tartu Ülikooli Kliinikumi 686 õelt kolme uuringu käigus, millest esimene toimus rahvusvahelise uuringu raames. Kõikide uuringute tulemused publitseeriti rahvusvahelistes teadusajakirjades. Uuringud näitasid, et SLV esinemissagedus õdede hulgas on kõrge (70–85%), hõlmates kõige sagedamini alaselja- (56–57%) ja kaelapiirkonda (52–56%). Kahes ja enamas kehapiirkonnas koges SLVsid umbes 60–61% õdedest. Vanus ja halb tervis olid seotud SLV esinemisega ühes või mitmes kehapiirkonnas. Stress, läbipõlemine ja psühhosomaatilised sümptomid suurendasid SLV esinemise tõenäosust. Olulisemad tööga seotud ohutegurid SLVde tekkeks olid raskuste tõstmine ja töötamine sundasendis. Suurimad psühhosotsiaalsed riskid olid kiire töötempo ja emotsionaalsed nõudmised. Rahulolematus tööga ja töö-pereelu konflikt tõstsid samuti valude riski. Sekkumisuuringu tulemused näitasid, et koduvõimlemisel põhinev treeningteraapia parandas oluliselt õdede lülisamba kaela- ja nimmeosa liikuvusulatust. Treeningteraapia mõjul suurenes lülisamba kaelaosa liikuvusulatus kõikides liikumissuundades ning lülisamba nimmeosa liikuvusulatus painutamisel ette. Kõige suurem efekt saavutati lülisamba kaelaosa liikuvusulatuses painutamisel ette (26%). Käesoleval doktoritööl on oluline praktiline väärtus, kuna SLVdega seotud riske on võimalik leevendada ennetavate tegevustega. Antud uurimistööle tuginedes tuleks jälgida ja reguleerida õdede töökoormust, töötempot ja emotsionaalset koormust ning arendada juhtimise kvaliteeti. Sekkumisuuringu positiivsed tulemused julgustavad koduvõimlemist kasutama õdede SLVde ennetamiseks ja vähendamiseks.Musculoskeletal pain (MSP) is the most prevalent and unresolved problem amongst European workforce, with the highest risk being among hospital staff, including nurses. MSP impairs how nurses manage their work and reduces their quality of life significantly, causing physical, psychological, and social problems. A decrease in nurses’ working ability and absenteeism as a result of acute or chronic MSP are costly. Nurses’ incapacity to work causes a substantial financial strain on Estonian economy, which has an ageing population. The aim of this doctoral thesis is to explain the prevalence and possible risk factors of MSP among nurses, and to estimate the effect of home based exercise training therapy. Home based exercises training therapy specifically targets the range of motion of the vertebral column in the neck and lumbar the regions, in order to prevent or decrease MSP among nurses. Data was collected from 686 nurses of the Tartu University Hospital, Estonia, during three studies. The first study was carried out in the framework of an international study. The results from all studies are published in international scientific journals. The studies show that the prevalence of MSP among nurses is high (70–85%). The most common being in the lower back (56–57%) and neck (52–56%) regions. 60–61% of nurses experienced MSP in two or more body regions. Nurses’ age and poor health were related with the prevalence of MSP in one or multiple regions. Stress, burn outs, and psychosomatic symptoms increased the probability of MSP. The most significant risk factors for developing MSP were carrying weights and working in a forced position. The most important psychosocial risk factors were attributed to the fast pace and emotional demands of the work. Dissatisfaction with work and e.g. work-family life conflict also raised the risk of pain. The results of the intervention show that the home based exercise training therapy improved the range of motion of nurses’ vertebral column in the neck and lumbar regions significantly. In addition, the home based exercise training therapy increased the range of motion in the neck region of the vertebral column in all movement directions and in the lumbar region when bending forward. The largest effect in the range of motion in the neck region of the vertebral column was achieved when flexing forward (26%). This doctoral thesis has an important practical value as risks associated with MSP can be reduced with precautionary activities. Based on the given research, the workload, working pace and emotional load of nurses should be monitored, and the quality of leadership should be improved. Positive results from the interventional studies encourage using home based exercise training therapy in order to prevent and reduce MSP

Peptiidse tranfektsioonivektori disain nukleiinhapete transpordiks in vivo tingimustes

Väitekirja elektrooniline versioon ei sisalda publikatsiooneNukleiinhappeid saab kasutada geeniteraapiaks, et reguleerida haigust esilekutsuvaid geene. Nõnda on võimalik parandada mitmesuguseid raskeid geneetilisi haigusi, nagu näiteks tsüstiline fibroosi, Duchenne'i lihasdüstroofiat ning pahaloomulisi kasvajaid. Kahjuks takistab nukleiinhapete sisenemist rakku, ning seega ka nende efektiivset kasutamist geeniteraapias, nukleiinhapete laeng ning suurus. Selleks, et suurendada nukleiinhapete terapeutilist efekti on vajalik kasutada nende transpordiks (transfektsiooniks) rakku tranfektsioonivektoreid. Üheks tranfektsioonivektoriks on rakku sisenevad peptiidid (RSP). RSP-d on tavaliselt kuni 30 aminohappe pikkused katioonsed ja/või amfipaatsed peptiidid, mis suudavad viia rakku mitmesuguseid biomolekule. Peamiseks probleemiks RSP kasutamisel on nende peptiidide vähene transfektsiooni efektiivsus in vivo. Lisaks on RSP tavaliselt vaja modifitseerida, et muuta neid selektiivseks konkreetse koe ja rakutüübi suhtes, et vähendada võimalike kõrvalmõjude teket. Samuti on oluline kontrollida moodustatud RSP-nukleiinhappe osakeste füsiko-keemilisi omadusi, sest ka sellest sõltub osakeste distributsioon organismis. Antud töö eesmärgiks oli tegeleda peamiste RSP kasutamist takistavate probleemidega. Käesolevas töös disainiti uus NF55 peptiid efektiivsemaks in vivo DNA transfekstiooniks. Seejärel kasutati uut formulatsiooni meetodi, et valmistada väiksema läbimõõdu ning kindla suurusjaotusega RSP-DNA osakesi selektiivsemaks ning efektiivsemaks in vivo manustamiseks. Viimaks lisati RSP-nukleiinhappe osakestele magnetilisi rauaoksiidi partikleid, et muuta RSP-nukleiinhapete osakeste bioloogilist aktiivsust veelgi selektiivsemaks. Kokkuvõttes arendati antud töös formulatsiooni meetod, millega on võimalik valmistada palju efektiivsemaid nanopartikleid spetsiifiliselt in vivo manustamiseks.Various serious genetic diseases, such as cystic fibrosis, Duchenne muscular dystrophy and cancer can be treated with gene therapy. Gene therapy can be utilized to regulate the expression of disease causing genes by using therapeutic nucleic acids. Due to their size and cationic nature, these nucleic acids need vectors to enhance their delivery into the diseased tissue. Although impressive results have been accomplished with virus-derived gene delivery vectors their utilization is not without risks and increasingly more effort has been applied into the research of non-viral vectors. Cell penetrating peptides are one group of non-viral delivery vectors. Cell penetrating peptides (CPP) are short cationic and/or amphipathic peptides than are shown to significantly improve the delivery of various biomolecules in vitro and in vivo. The main hindrances of using CPPs are the lack of transfection efficacy and selectivity in vivo. In addition, the size and heterogenous size distribution of prepared CPP-DNA particles also alters the bio-distribution of particles and can cause side-effects. In this thesis we aimed to tackle these previously mentioned main problems of utilization of CPPs. We designed a novel effective CPP NF55 for the systemic delivery of DNA. Thereafter we developed a novel method to prepare stable and uniformly sized particles for systemic gene delivery in vivo. Subsequently, we used incorporation of magnetic iron oxide particles to further increase the efficacy and specificity of the peptide vectors. Taken together, we designed more efficient and safer formulations of CPP/nucleic acid particles for the systemic in vivo delivery of nucleic acids

Patsiendiohutus ning ohu- ja kahjujuhtumite käsitlemine Tartu Ülikooli Kliinikumis

Eesti Arst 2021; 100(1):9–11 &nbsp

Kuidas toetada ja võimestada tervisekriisist kurnatud õendustöötajaid?

Eesti Arst 2021; 100(8):410–41

Where are they now? tracking the longitudinal evolution of environmental businesses from the 1990s

In 1991 Steven Bennett published one of the first major publications on the concept of ecopreneurship, business opportunities resulting from the emerging environmental agenda of the late 1980s and early 1990s (Ecopreneuring: the Complete Guide to Small Business Opportunities From the Environmental Revolution. Wiley: New York). Since then a body of literature has developed that explores the idea of the intersection of entrepreneurship with environmentally and socially responsible behaviour. Many of the business cases presented by Bennett represent early adopters of green products, services and emerging eco-markets. Given the current emphasis on the transformation of business practices towards a more sustainable paradigm it is timely to review these 94 early ecopreneurial examples and consider their status two decades on from the original publication. This paper explores the definitions of environmental and social enterprise, and considers the longitudinal survival of these companies and the emerging trends in consolidation and failure of the sampled companies. © 2010 John Wiley & Sons, Ltd and ERP Environment

Work-Related Psychosocial Factors and Mental Health Problems Associated with Musculoskeletal Pain in Nurses: A Cross-Sectional Study

Background. Musculoskeletal pain is the most common cause of incapacity among nurses. This study aimed to report the prevalence of musculoskeletal pain among hospital nurses and to explore the associations of work-related psychosocial factors and mental health problems with musculoskeletal pain. Methods. A cross-sectional survey was carried out among registered nurses at Tartu University Hospital during April and May 2011. Binary logistic regression was used to assess the associations between dependent and independent variables. Results. Analysis was based on 404 nurses (45% of the hospital’s nursing population). The overall prevalence of MSP was 70% in the past year and 64% in the past month. Lower back (57%) and neck (56%) were the body areas most commonly painful in the past year. Higher quantitative and emotional demands, work pace, low justice and respect in the workplace, influence on work organisation, and role conflicts were significantly associated with musculoskeletal pain among nurses (p<0.05). All mental health problems and most strongly somatic stress symptoms were associated with musculoskeletal pain. Conclusions. Work-related psychosocial risk factors and mental health problems, especially somatic stress symptoms, have an important impact on the occurrence of musculoskeletal pain among university hospital nurses

Gründungen wie andere auch?

Der Weg von der Idee zum Unternehmen ist bei grünen Gründern oft schwieriger als bei konventionellen Geschäftsideen. Die Gründungsberatung ist auf nachhaltige Geschäftsideen nicht vorbereitet, die Berater sehen im grünen Anspruch oft mehr ein Hindernis als den Schlüssel zum Erfolg

Glacial and periglacial floodplain sediments regulate hydrologic transfer of reactive iron to a high arctic fjord

The transport of reactive iron (i.e. colloidal and dissolved) by a glacier-fed stream system draining a high relief periglacial landscape in the high Arctic archipelago of Svalbard is described. A negative, non-linear relationship between discharge and iron concentration is found, indicative of increased iron acquisition along baseflow pathways. Because the glaciers are cold-based and there are no intra- or sub-permafrost groundwater springs, baseflow is principally supplied by the active layer and the colluvial and alluvial sediments in the lower valley. Collectively, these environments increase the flux of iron in the stream by 40% over a floodplain length of just 8km, resulting in 6kg Fe km-2a-1 of reactive iron export for a 20% glacierized watershed. We show that pyrite oxidation in shallow-groundwater flowpaths of the floodplain is the most important source of reactive iron, although it is far less influential in the upper parts of the catchment where other sources are significant (including ironstone and secondary oxide coatings). Microbial catalysis of the pyrite oxidation occurs in the floodplain, enabling rapid, hyporheic water exchange to enhance the iron fluxes at high discharge and cause the non-linear relationship between discharge and reactive iron concentrations. Furthermore, because the pyrite oxidation is tightly coupled to carbonate and silicate mineral weathering, other nutrients such as base cations and silica are also released to the stream system. Our work therefore shows that high Arctic floodplains should be regarded as critically important regulators of terrestrial nutrient fluxes to coastal ecosystems from glacial and periglacial sources

Der überforderte Stakeholder

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