Browsing by Subject "World Health Organization"

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  • Svanström, Maria Elisabeth (2005)
    Avhandlingen är ett normativt arbete om global deliberativ demokrati. Deliberativ demokrati framhäver kommunikationens betydelse i demokratiska processer och innebär i praktiken att demokratiska beslut fattas utgående från en diskussion som äger rum både i institutionella organ och i medborgarsamhällets offentligheter. Demokratimodellen diskuteras i förhållande till tre andra normativa demokratimodeller: den liberala demokratin, vars förespråkare ser demokrati främst i termer av att summera ihop enskilda individers preferenser, den republikanska demokratin, där det primära politiska subjektet utgörs av ett kollektiv samt den agonistiska demokratin, vars förespråkare ser det politiska som en kamp. Anförandet följer Jürgen Habermas' och Seyla Benhabibs indelning av de normativa demokratiteorierna. Fokuset ligger på frågor om det politiska subjektet. I avhandlingen konstateras att globaliseringen lett till att allt fler beslut fattas på global nivå utan att globala demokratiska strukturer existerar, vilket motiverar till att dryfta frågor om demokrati på global nivå. I avhandlingen konstateras också att det politiska subjektet som den liberala demokratimodellen utgår ifrån – det vill säga en transcendental individ med förmågan att välja – inte motsvarar de flesta individers verklighet. Istället föreslås att den ontologiska utgånspunkten för demokratin bör vara en individ, vars preferenser uttalat är beroende av andra människor och som inkluderar alla de identiteter som verkligheten av i dag omfattar. Avhandlingens andra normativa implikation är att demokratiska procedurers mål bör vara att genom deliberation komma fram till konsensus, men att detta inte får ske på bekostnad av att olika synpunkter exkluderas från beslutsfattningen. Förutom Habermas' och Benhabibs tänkande har Iris Marion Youngs teori om deliberativ demokrati, Chantal Mouffes postmoderna kritik mot deliberativ demokrati och Tuija Pulkkinens diskussion om ontologier fungerat som centrala inspirationskällor för arbetet. I slutet av avhandlingen konstrueras en konkret utopi – det vill säga ett reformförslag, vars möjligheter till politiskt stöd tagits i beaktande – för Värlshälsoorganisationen WHO. I avhandlingen konstateras att WHO:s mål om att uppnå världsomfattande fysisk, psyksisk och social hälsa skulle stödjas av att organisationen skulle definiera sin uppfattning om demokrati i deliberativa termer. Den partikulära kontexten visar också var det finns glapp mellan den normativa teorin och verkligheten. Avhandlingen hör till den feministiska traditionen i forskningen i världspolitik.
  • Ristola, Matti (2021)
    • HIV-tartuntojen määrä on maailmanlaajuisesti pienentynyt sen jälkeen, kun hyvä hoitojärjestelmä ja lääkityksen rajoitukseton saatavuus ymmärrettiin olennaisiksi tartuntojen ehkäisyssä. • Tavoitteena on, että 90 % HIV-positiivisista on tietoisia tartunnastaan, tietoisista 90 % saa HIV-lääkitystä ja 90 % saa lääkityksellä hyvän hoitotuloksen. WHO ja Euroopan tartuntatautivirasto ECDC seuraavat aktiivisesti, miten tavoitteet toteutuvat. • HIV-epidemian aiheuttama työtaakka terveydenhuollolle on lisääntynyt ennusteen parantuessa, mutta tulevaisuudessa se vähenee, kunhan aktiivista työtä jatketaan.
  • Roininen, Nelli; Takala, Sari; Haapasaari, Kirsi-Maria; Jukkola-Vuorinen, Arja; Mattson, Johanna; Heikkilä, Päivi; Karihtala, Peeter (2017)
    Background: Breast carcinomas with neuroendocrine features (NEBC) are a very rare entity of mammary neoplasms, WHO classification of which has recently been revised. There are very limited data available about the clinical behaviour and treatment options of NEBC. Methods: We collected retrospectively patients with NEBC from Oulu and Helsinki University Hospitals in 2007-2015. There were 43 NEBC cases during the period. Results: The incidence of NEBC from all breast cancers varied from 0.1% in Helsinki to 1.3% in Oulu. The mean tumor size was 2.2 cm and 23 patients (55.8%) had no lymph node metastases when diagnosed. In total, 4 patients (9.3%) had distant metastases at the time of diagnosis. High estrogen receptor (ER) expression was observed in 41 (97.7%) patients. When non-metastatic NEBC were compared to a prospective set of ductal carcinomas (n = 506), NEBC were more often HER2 negative (p = 0.046), ER positive (p = 0.0062) and the NEBC patients were older (p <0.0005) than patients with ductal carcinomas. Plasma chromogranin A correlated only to higher age at diagnosis (p = 0. 0028). Relapse-free survival (p = 0.0013), disease-free survival (p = 0.024) and overall survival (p = 0.0028) favoured ductal carcinomas compared to NEBC, while no difference was observed in distant disease-free survival or in breast cancer-specific survival. Conclusions: There is remarkable variation in the incidence of NEBC in Finland, which is likely to be explained by differences in the use of neuroendocrine marker immunostainings. Poor local control and worse overall survival may be linked to the more aggressive biology of the disease, despite its association with apparently indolent prognostic factors.
  • Jernman, Juha (2015)
    Neuroendocrine tumors of the rectum were regarded as benign, when Oberndorfer originally described the entity in 1907. Later, he acknowledged that some neuroendocrine tumors (or carcinoids, the term at that time) behave in a more aggressive manner, and a few of them even had the potential to metastasize with poor outcome. In the novel World Health Organization (WHO) classification launched in 2010, all neuroendocrine tumors of the gastrointestinal (GI) tract are malignant. In this classification, tumors of every part of the GI tract are graded uniformly according to proliferation index and mitotic frequency, whereas the TNM-classification (tumor, node, metastasis) is specific for each site. Around 10% of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) occur in the rectum. The tumor series comprised 73 rectal NETs, with the main objective being to study the prognostic value of the WHO 2010 classification in rectal NETs: additionally, as the WHO classification has been used for a rather short time, tumor markers were tested to find a good, reliable prognostic tool. The WHO 2010 had excellent prognostic significance; none of the G1- NETs (grade 1) metastasized, whereas G2-NETs were often disseminated, some of them at initial presentation. Metastatic NETs have a poor prognosis. Cell-cycle antigen cyclin A also correlated with prognosis, and G2-NETs with high cyclin A expression were all metastatic. Transcription factor prospero homeobox 1 (PROX1) was immunohistochemically positive in a significant proportion of rectal NETs, and showed a correlation with metastatic potential and survival. It was also possible to conclude that the novel stem cell-associated factor HES77 (human embryonic stem cell factor 77) correlated well with rectal NETs metastatic potential and prognosis. These results support the validity of the WHO 2010 classification in rectal NETs. In view of this study, for patients with a rectal G1-NET, one follow-up endoscopy to exclude local recurrence might suffice. Intensive follow-up does not seem indicated, as metastatic potential is very low. As to G2-NETs, a thorough work-up is recommended, since most of these tumors disseminate eventually, some after several years, and a standard 5-year follow-up may not suffice. PROX1-positivity suggests that colorectal adenocarcinoma and rectal NET may, to some extent, share the same pathway in oncogenesis, which could lead to future therapeutic applications.
  • Hellman, Matilda (2020)
  • Kivimäki, Mika; Virtanen, Marianna; Nyberg, Solja T.; Batty, G. David (2020)
    Working hours is a ubiquitous exposure given that most adults are employed, and one that is modifiable via legislative change if not always through individual-level choice. According to a recent report from the World Health Organization (WHO) and International Labour Organization (ILO), there is currently sufficient evidence to conclude that long working hours (i.e., >= 55 h per week) elevate the risk of fatal and non-fatal ischaemic heart disease to a clinically meaningful extent. After assessing the data used by the ILO/WHO, we feel that the expert group has not correctly applied their own framework for assessing the strength of the evidence. In the meta-analysis of observational studies in the report, the association between long working hours and incident heart disease appeared stronger in lower quality cohort studies with a high risk of bias (minimally-adjusted hazard ratio 1.20, 95% CI 1.01-1.41, compared to standard 35-40 weekly hours) than in the superior-quality studies with a lower risk of bias for which the estimate was not significantly different from the null (1.08, 95% CI 0.93-1.25). There was also marked effect modification, such that there was no increase in ischaemic heart disease for those working long hours in high socioeconomic status occupations, a finding also reported in analyses of a recent census-based cohort study which was not included in the report. Our meta-analysis of all these studies confirm that the findings are not consistent but differ between subgroups and that the summary age- and sex-adjusted hazard ratio for long working hours in high socioeconomic status occupations does not support excess risk: 0.85, 95% CI 0.63-1.13 (Pinteraction = 0.005, total N = 451,982). For these and other reasons detailed in this commentary, we advance a more cautious interpretation of the existing evidence. The conclusions should be restricted to low socioeconomic status occupations only and more research is still needed to confirm or refute harmfulness and determine clinical relevance.