Browsing by Subject "BARRIERS"

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  • Kujala, Sari; Ammenwerth, Elske; Kolanen, Heta; Ervast, Minna (2020)
    Background: The number of public eHealth services that support patient self-management is rapidly increasing. However, the implementation of these eHealth services for self-management has encountered challenges. Objective: The purpose of this paper was to analyze the challenges and opportunities of implementing eHealth services for self-management by focusing on the fit between the technical solution and clinical use. Methods: We performed in-depth interviews with 10 clinical project coordinators and managers who were responsible for developing and implementing various eHealth services for self-management interventions in five university hospitals in Finland The results were analyzed using content analysis and open coding. The Fit between Individuals, Task, and Technology (FITT) framework was used to interpret the findings. Results: The implementation of self-management services involved many challenges related to technical problems, health professional acceptance, patient motivation, and health organization and management. The implementers identified practices to manage the identified challenges, including improving the design of the technology, supporting health professionals in the adoption of the eHealth services, changing the work processes and tasks, involving patients, and collectively planning the implementation inside an organization. The findings could be mostly attributed to the dimensions of the FITT framework. Conclusions: The FITT framework helped to analyze the challenges related to the implementation, and most of them were related to poor fit. The importance of patients as stakeholders in eHealth services for patient self-management needs to be highlighted. Thus, we propose that patients should be added as a different type of individual dimension to the FITT framework. In addition, the framework could be extended to include organization and management in a new context dimension.
  • Balotari-Chiebao, Fabio; Valkama, Jari; Byholm, Patrik (2021)
    Wind-energy expansion raises concerns over its potential impacts on bird populations. Birds may be affected directly via collision with turbines or indirectly via habitat loss or displacement due to disturbance. Species with long generation times, low reproductive output or high habitat specialisation are more likely to be impacted. Using national-scale breeding bird distributions, we applied a quantitative prioritisation method to assess the vulnerability of species to onshore wind-energy developments in Finland. We assessed 214 species that regularly breed in the country. Each species was assigned a priority score based on a combination of life-history traits, habitat specialisation, exposure to wind energy and conservation status. We found that the priority scores varied markedly between species, allowing a distinction between a minority of high-ranked species and a majority of low-ranked species. High-ranked species included terns (e.g., Sternula albifrons), raptors (e.g., Aquila chrysaetos), gulls (e.g., Larus fuscus), some forest-dwelling passerines (e.g., Poecile montanus) and ducks (e.g., Aythya ferina). Low-ranked species included woodpeckers (e.g., Picus canus) and many passerines. Our results indicate that the priority species are not limited to the more highly regarded large raptors, and that wind-energy impact assessments need to pay special attention to high-ranked species inhabiting coastal areas.
  • Gatej, Alexandra-Raluca; Lamers, Audri; van Domburgh, Lieke; Crone, Matty; Ogden, Terje; Rijo, Daniel; Aronen, Eeva; Barroso, Ricardo; Boomsma, Dorret I.; Vermeiren, Robert (2019)
    Background: Severe behavioural problems (SBPs(1)) in childhood are highly prevalent, impair functioning, and predict negative outcomes later in life. Over the last decade, clinical practice guidelines for SBPs have been developed across Europe to facilitate the translation of scientific evidence into clinical practice. This study outlines the results of an investigation into academic experts' perspectives on the current prevalence, implementation, and utility of clinical guidelines for SBPs in children aged 6-12 across Europe. Methods: An online semi-structured questionnaire was completed by 28 psychiatry and psychology experts from 23 countries. Results: Experts indicated that approximately two thirds of the included European countries use at least an unofficial clinical document such as textbooks, while nearly half possess official guidelines for SBPs. Experts believed that, although useful for practice, guidelines' benefits would be maximised if they included more specific recommendations and were implemented more conscientiously. Similarly, experts suggested that unofficial clinical documents offer a wide range of treatment options to individualise treatment from. However, they stressed the need for more consistent, evidence-based clinical practices, by means of developing national and European clinical guidelines for SBPs. Conclusions: This study offers a preliminary insight into the current successes and challenges perceived by experts around Europe associated with guidelines and documents for SBPs, acting as a stepping stone for future systematic, in-depth investigations of guidelines. Additionally, it establishes experts' consensus for the need to develop official guidelines better tailored to clinical practice, creating a momentum for a transition towards European clinical guidelines for this population. (c) 2019 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
  • Syyrilä, Tiina; Vehviläinen-Julkunen, Katri; Härkänen, Marja (2020)
    Abstract Aim To identify the types and frequencies of communication issues (communication pairs, person related, institutional, structural, process, and prescription-related issues) detected in medication incident reports and to compare communication issues that caused moderate or serious harm to patients. Background Communication issues have been found to be amongst the main contributing factors of medication incidents, thus necessitating communication enhancement. Design A sequential exploratory mixed-method design. Methods Medication incident reports from Finland (n=500) for the year 2015 in which communication was marked as a contributing factor were used as the data source. Indicator phrases were used for searching communication issues from free texts of incident reports. The detected issues were analysed statistically, qualitatively, and considering the harm caused to the patient. Citations from free texts were extracted as evidence of issues and were classified following main categories of indicator phrases. The EQUATOR?s SRQR checklist was followed in reporting. Results Twenty-eight communication pairs were identified, with nurse-nurse (68.2%; n=341), nurse-physician (41.6%; n=208), and nurse-patient (9.6%; n=48) pairs being the most frequent. Communication issues existed mostly within unit (76.6%, n=383). The most commonly identified issues were digital communication (68.2%; n=341), lack of communication within a team (39.6%; n=198), false assumptions about work processes (25.6%; n=128) and being unaware of guidelines (25.0%; n=125). Collegial feedback, and communication from patients and relatives were the preventing issues. Moderate harm cases were often linked with lack of communication within the unit, digital communication and not following guidelines. Conclusions The interventions should be prioritized to (a) enhancing communication about work-processes, (b) verbal communication about digital prescriptions between professionals, (c) feedback among professionals, and (f) encouraging patients to communicate about medication. Relevance to clinical practice Upon identifying the most harmful and frequent communication issues, interventions to strengthen medication safety can be implemented.
  • Sorsa, Minna Anneli; Kylmä, Jari; Bondas, Terese Elisabet (2021)
    Perinatal psychological distress (PPD) may cause delays in help-seeking in the perinatal period, which is crucial for families with small children. Help-seeking theories focus on rational processes of behavior wherein 'help-seeking' is viewed as a decision-making process, in which action is preceded by recognizing a problem. We identified the phase prior to actual help-seeking actions as a life situation and a phenomenon through which to gain a deeper understanding from women's own perspectives. The aim of this study was to integrate and synthesize knowledge of women's experiences of contemplating seeking help for PPD. We chose interpretative meta-ethnography by Noblit and Hare (1988) and implemented eMERGe guidelines in reporting. The search was performed systematically, and the 14 included studies were evaluated with Critical Appraisal Skills Programme checklist (CASP). We identified seven themes and a metaphor in a lines-of-argument synthesis, showing that contemplating help-seeking is a multidimensional phenomenon. We did not observe a straightforward and linear process (as previous research suggests) but instead a complex process of contemplating help-seeking. A clinical implication is that service providers should work with outreach and develop their tools to connect with mothers with PPD. Another suggestion is to improve training in mental health literacy prior to or during pregnancy.
  • Pankakoski, Maiju; Heinävaara, Sirpa; Anttila, Ahti; Sarkeala, Tytti (2020)
    An invitational organized cervical cancer screening together with widely spread opportunistic testing has coexisted for decades in Finland. The aim of this study was to examine the coverage of cervical tests by age, socioeconomic status, ethnicity and municipality type within and outside the organized screening program. We had a cohort of women of whom 1,2 million were in the target age range of screening and residing in Finland in 2010-2014. Data on Pap and/or HPV-tests within and outside the screening program were collected from the Mass Screening Registry, the pathology laboratories and the health insurance reimbursement registry and fiveyear population coverages of tests were reported. The total test coverage was 86.0%; 95% CI, (85.8-86.1), and was notably lower for those with an unknown socioeconomic status and pensioners (68.8%; 95% CI, (67.9-69.6) and 77.1%; 95% CI, (76.5-77.6), respectively) compared to upper-level employers (89.8%; 95% CI, (89.5-90.2)). Coverage was also lower for non-native speaking women (72.4%; 95% CI, (71.8-73.0)) compared to native speakers (86.9%; 95% CI, (86.7-87.0)) and for women living in urban municipalities (85.5%; 95% CI, (85.3-85.7)) compared to semi-urban (87.4%; 95% CI, (87.0-87.8)). Although overall coverage was high, tests within and outside the program seemed to concentrate on women with presumably good access to health services. Tests outside the program were especially common among young women who are at a low risk of invasive cervical cancer. Efforts should be made to reduce excessive opportunistic testing and to increase attendance at the program among hard-to-reach populations.
  • Laiti, Minna; Pakarinen, Anni; Parisod, Heidi; Salanterä, Sanna; Sariola, Salla (2019)
    Aim: To describe the encounters with sexual and gender minority (SGM) youth in healthcare based on the existing research. Background: The development of sexual orientation and gender identity can create challenges in an SGM youth's life, and they may need support from health professionals. Heteronormativity has been recognised as a barrier to the identification of diversity in sexuality and gender, and no previous literature review has studied heteronormativity thoroughly. Methods: An integrative review following Whittemore and Knafl was conducted. A literature search was systematically undertaken in six databases (PubMed/MEDLINE, CINAHL, Cochrane Library, PsycINFO, Eric, and Academic Search Premier). Finally, 18 research articles were included. Data were analysed deductively with the theoretical framework from Stevi Jackson's (2006) article to understand the role of heteronormativity in the healthcare of SGM youth. Findings: The encounters with SGM youth consisted of two simultaneous themes. Heteronormative care included three elements: (1) the effect of heteronormativity on health professionals' competence to work with SGM youth, (2) false assumptions about SGM youth, and (3) the influence of heteronormativity on encounters with SGM youth. Diversity-affirming care included two elements: (4) the considerateness of health professionals towards SGM youth and (5) inclusive care of SGM youth. Conclusion: This review summarised how SGM youth were encountered in healthcare and how heteronormativity was affecting their healthcare. Furthermore, this review identified elements that supported diversity-affirming care. With diversity-affirming care, SGM youth may access the information and support they need from healthcare. Further research is needed about how diversity-affirming care can be applied to the healthcare of SGM youth and how elements of heteronormative care are occurring globally in the healthcare of SGM youth. The perceptions of transgender and other gender minority youth were under-represented in the studies and research needs to focus more on how they are encountered in healthcare.
  • Kvarnström, Kirsi; Westerholm, Aleksi; Airaksinen, Marja; Liira, Helena (2021)
    Introduction: Medication adherence continues to be a significant challenge in healthcare, and there is a shortage of effective interventions in this area. This scoping review studied the patient-related factors of medication adherence. Methods: We searched Medline Ovid, Scopus, and Cochrane Library from January 2009 to June 2021 to find the most recent original qualitative studies or systematic reviews that addressed the patient-related factors of medication adherence in treating chronic conditions. We used the PRISMA-ScR checklist to ensure the quality of the study. Results: The initial search revealed 4404 studies, of which we included 89 qualitative studies in the scoping review. We inductively organized the patient-related factors causing barriers, as well as the facilitators to medication adherence. The studies more often dealt with barriers than facilitators. We classified the factors as patient-specific, illness-specific, medication-related, healthcare and system-related, sociocultural, as well as logistical and financial factors. Information and knowledge of diseases and their treatment, communication, trust in patient-provider relationships, support, and adequate resources appeared to be the critical facilitators in medication adherence from the patient perspective. Discussion and conclusions: Patients are willing to discuss their concerns about medications. Better communication and better information on medicines appear to be among the critical factors for patients. The findings of this scoping review may help those who plan further interventions to improve medication adherence.
  • Luoma, Päivi H; Penttinen, Esko; Tapio, Petri; Toppinen, Anne (2022)
    Rapid expansion of digitalization and in the volume of data available constitutes a major driver toward circular economy. In the textile industry, with its vast quantities of waste and huge environmental impact, transformation toward such circularity is necessary but challenging. To explore how the use of data could support building sustainability-aligned pathways to circular economy of textiles, a study employing a two-round disaggregative Delphi approach (engaging 33 experts in the first round, in May 2021, and 26 in the second, in June 2021) articulated alternative images of the future. The three images, dubbed Transparency, Conflicting Interests, and Sustainable Textiles, imply that the role for data is intertwined with sustainability aspirations. The results highlight that exploiting data in pursuit of circular economy is a collaborative effort involving business value networks that include consumers and regulators. Availability and sharing of accountability-affording, meaningful data on textiles' life cycle and value network function as a key enabler. By working with the images developed, actors can better assess their circular-economy commitments, planned actions, and the consequences of these. Furthermore, the images provide a tool for mutual discussion of the development desired and of related re-sponsibilities and uncertainties.
  • Roth, Gregory A.; Collaborotors, G. B. D.Causes Death; Abate, Degu; Abate, Kalkidan Hassen; Abay, Solomon M.; Abbafati, Cristiana; Abbasi, Nooshin; Abbastabar, Hedayat; Abd-Allah, Load; Abdela, Jemal; Abdelalim, Ahmed; Abdollahpour, Ibrahim; Abdulkader, Rizwan Suliankatchi; Abebe, Haftom Temesgen; Abebe, Molla; Abebe, Zegeye; Abejie, Ayenew Negesse; Abera, Semaw F.; Abil, Olifan Zewdie; Abraha, Haftom Niguse; Abrham, Aklilu Roba; Abu-Raddad, Laith Jamal; Accrombessi, Manfred Mario Kokou; Acharya, Dilaram; Adamu, Abdu A.; Adebayo, Oladimeji; Adedoyin, Rufus Adesoji; Adekanmbi, Victor; Adookunboh, Olatunii; Adhena, Beyene Meressa; Adib, Mina G.; Admasie, Aniha; Afshin, Ashkan; Agarwal, Gina; Agesa, Karelia M.; Agrawal, Anurag; Agrawal, Sutapa; Ahmadi, Alireza; Ahmadi, Melidi; Ahmed, Muktar Beshir; Ahmed, Sayent; Aichour, Amani Nidhal; Aichour, Ibtihel; Aichour, Miloud Taki Fddine; Akbari, Mohammad Esmaeil; Akinyeniti, Rufus Olusola; Akseer, Nadia; Al-Aly, Ziyad; Al-Eyadhy, Ayman; Al-Raddadi, Rajaa M.; Alandab, Fares; Alam, Khurshid; Alam, Tahiya; Alebel, Animut; Alene, Kefyalew Addis; Alijanzadeh, Mehran; Alizadeh-Navaei, Reza; Aljunid, Syed Mohamed; Alkerwi, Ala'a; Alla, Francois; Allebeck, Peter; Alonso, Jordi; Altirkawi, Khalid; Alvis-Guzman, Nelson; Amare, Azmeraw T.; Aminde, Leopold N.; Amini, Erfan; Ammar, Walid; Amoako, Yaw Ampern; Anber, Nahla Hamed; Andrei, Catalina Liliana; Androudi, Sofia; Animut, Megbaru Debalkie; Anjomshoa, Mina; Ansari, Hossein; Aniha, Mustafa Geleto; Antonio, Carl Abelardo T.; Anwari, Palwasha; Aremu, Olatunde; Arnlov, Johan; Arora, Amit; Arora, Monika; Artaman, Al; Aryal, Krishna K.; Asayesh, Hamid; Asfaw, Ephremi Tsegay; Ataro, Zerihun; Atique, Suleman; Atre, Sachin R.; Ausloos, Marcel; Avokpaho, Euripide F. G. A.; Awasthi, Ashish; Quintattilla, Beatriz Paulina Ayala; Ayele, Yohanes; Ayer, Rakesh; Azzopardi, Peter S.; Babazadeh, Arefeh; Bacha, Umar; Badali, Hamid; Badawi, Alaa; Bali, Ayele Geleto; Ballesteros, Katherine E.; Banach, Maciej; Banerjee, Kajori; Bannick, Marlena S.; Banoub, Joseph Adel Mattar; Barboza, Miguel A.; Barker-Collo, Suzanne Lyu; Barnighausen, Till Winfried; Barquera, Simon; Barrero, Lope; Bassat, Quique; Base, Sanjay; Baune, Bernhard T.; Baynes, Habtamu Wondifraw; Bazargan-Hejazi, Shahrzad; Beth, Neeraj; Beghi, Ettore; Behzadifar, Masoud; Behzadifar, Mcysam; Bejot, Yannick; Bekele, Bayu Begashaw; Belacliew, Abate Bekele; Belay, Ezra; Belay, Yihalem Abebe; Bell, Michelle L.; Bello, Aminu K.; Bennett, Derrick A.; Bensenor, Isabela M.; Berman, Adam F.; Bernabe, Eduardo; Bernstein, Robert S.; Bertolacci, Gregory J.; Beuran, Mircea; Beyranvand, Tina; Bhalla, Ashish; Bhattarai, Suraj; Bhaumik, Sounayadeeep; Bhutta, Zulfiqar A.; Biadgo, Belete; Biehl, Molly H.; Bijani, Ali; Bikbov, Boris; Bilano, Ver; Bililign, Nigus; Bin Sayeed, Muhammad Shandaat; Bisanzio, Donal; Biswas, Tuhin; Blacker, Brigitte F.; Basara, Berrak Bora; Borschmann, Rohan; Bosetti, Cristina; Bozorgmehr, Kayvan; Brady, Oliver J.; Brant, Luisa C.; Brayne, Carol; Brazinova, Alexandra; Breitborde, Nicholas J. K.; Brenner, Hermann; Briant, Paul Svitil; Britton, Gabrielle; Brugha, Traolach; Busse, Reinhard; Butt, Zahid A.; Callender, Charlton S. K. H.; Campos-Nonato, Ismael R.; Rincon, Julio Cesar Canapuzano; Cano, Jorge; Car, Mate; Cardenas, Rosario; Carreras, Giulia; Carrero, Juan J.; Carter, Austin; Carvalho, Felix; Castaneda-Orjuela, Carlos A.; Rivas, Jacqueline Castillo; Castle, Chris D.; Castro, Clara; Castro, Franz; Catala-Lopez, Ferran; Cerin, Ester; Chaiah, Yazan; Chang, Jung -Chen; Chanson, Fiona J.; Chaturvedi, Pankaj; Chiang, Peggy Pei-Chia; Chimed-Ochir, Odgerel; Chisumpa, Vesper Hichilombwe; Chitheet, Abdulaal; Chowdhury, Rajiv; Christensen, Hanne; Christopher, Devasahayam J.; Chiang, Sheng-Chia; Cicuttini, Flavia M.; Ciobanu, Liliana G.; Cirillo, Massimo; Cohen, Aaron J.; Cooper, Leslie Trumbull; Cortesi, Paolo Angelo; Cortinovis, Monica; Cousin, Ewerton; Cowie, Benjamin C.; Criqui, Michael H.; Cromwell, Elizabeth A.; Crowe, Christopher Stephen; Crump, John A.; Cunningham, Matthew; Daba, Alemneh Kabeta; Dadi, Abel Fekadu; Dandona, Lalit; Dandona, Rakhi; Dang, Anh Kim; Dargan, Paul I.; Daryani, Ahmad; Das, Siddharth K.; Das Gupta, Rajat; Das Neves, Jose; Dasa, Tamirat Tesfaye; Dash, Aditya Prasad; Davis, Adrian C.; Weaver, Nicole Davis; Davitoiu, Dragos Virgil; Davletov, Kairat; De La Hoz, Fernando Pio; De Neve, Jan-Walter; Degefa, Meaza Girma; Degenhardt, Louisa; Degfie, Tizta T.; Deiparine, Selina; Demoz, Gebre Teklemariam; Demtsu, Baleen Betsu; Denova-Gutierrez, Edgar; Deribe, Kebede; Dervenis, Nikolaos; Jarlais, Don C. Des; Dessie, Getenet Ayalew; Dey, Subhojit; Dhannaratne, Samath D.; Dicker, Daniel; Dinberu, Mesfin Tadese; Ding, Eric L.; Dirac, M. Ashworth; Djalalinia, Shirin; Dokova, Klara; Ter Doku, David; Donnelly, Christl A.; Dorsey, E. Ray; Doshi, Pratik P.; Douwes-Schultz, Dirk; Doyle, Kerrie E.; Driscoll, Tim R.; Dubey, Manisha; Dubljanin, Eleonora; Duken, Eyasu Ejeta; Duncan, Bruce B.; Duraes, Andre R.; Ebrahimi, Hedyeh; Ebrahimpour, Soheil; Edessa, Dumessa; Edvardsson, David; Eggen, Anne Elise; El Bcheraoui, Charbel; Zaki, Maysaa El Sayed; El-Khatib, Ziad; Elkout, Hajer; Eltinsel, Christian Lycke; Endres, Matthias; Endries, Aman Yesuf; Er, Benjamin; Erskine, Holly E.; Eshrati, Babak; Eskandarieh, Sharareh; Esmaeili, Reza; Esteghamati, Alireza; Fakhar, Mahdi; Fakhim, Hamed; Faramarzi, Mahbobeh; Fareed, Mohammad; Farhadi, Farzaneh; Faninha, Carla Sofia E. Sa; Faro, Andre; Farvid, Maryam S.; Farzadfar, Farshad; Farzaei, Mohammad Hosein; Feign, Valery L.; Feigl, Andrea B.; Fentahun, Netsanet; Eereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Fernandes, Joao C.; Ferrari, Alice J.; Feyissa, Garumma Tolu; Filip, Irina; Finegold, Samuel; Fischer, Florian; Eitzmaurice, Christina; Foigt, Nataliya A.; Foreman, Kyle J.; Fornari, Carla; Frank, Tahvi D.; Fukumoto, Takeshi; Fuller, John E.; Fullman, Nancy; Furst, Thomas; Furtado, Joao M.; Futran, Neal D.; Gallus, Silvano; Garcia-Basteiro, Alberto L.; Garcia-Gordillo, Miguel A.; Gardner, William M.; Gebre, Abadi Kahsu; Gebrehiwol, Tsegaye Tewelde; Gebremedhin, Amanuel Tesfay; Gebremichael, Bereket; Gebremichael, Teklu Gebrehiwo; Gelano, Tilayie Feto; Geleijinse, Johanna M.; Genova-Maleras, Ricard; Geramo, Yilma Chisha Dea; Gething, Peter W.; Gezae, Kebede Embaye; Ghadami, Mohammad Rasoul; Ghadimi, Reza; Falavarjani, Khalil Ghasemi; Ghasemi-Kasman, Maryam; Ghimire, Mamata; Gibney, Katherine B.; Gill, Paramjit Singh; Gill, Tiffany K.; Gillum, Richard F.; Ginawi, Ibrahim Abdelmageed; Giroud, Maurice; Giussani, Giorgia; Goenka, Shifalika; Goldberg, Ellen M.; Goli, Srinivas; Gomez-Dantes, Hector; Gona, Philimon N.; Gopalani, Sameer Vali; Gorman, Taren M.; Goto, Atsushi; Goulart, Alessandra C.; Gnedovskaya, Elena V.; Grada, Aymara; Grosso, Giuseppe; Gugnani, Hanish Chander; Guimaraes, Andre Luiz Sena; Gun, Nailing; Gupta, Prakash C.; Gupta, Rahid; Gupta, Rajenv; Gupta, Tanush; Gutierrez, Reyna Alma; Gyawali, Bishal; Haagsma, Juanita A.; Hafezi-Nejad, Nima; Hagos, Tekleberhan B.; Hailegiyorgis, Tewodros Tesfa; Hailu, Gessessew Bugssa; Haj-Mirzaian, Arvin; Haj-Mirzaian, Arya; Hamadeh, Randall R.; Hamidi, Sinner; Handal, Meads J.; Hankey, Graeme J.; Harb, Hilda L.; Harikrishnan, Sivadasanpillai; Haro, Josep Maria; Hasan, Mehedi; Hassankhani, Hadi; Hassen, Hamid Yimam; Havmoeller, Rasmus; Hay, Roderick J.; Hay, Simon I.; He, Yihua; Hedayatizadeh-Omran, Akbar; Hegazy, Mohamed I.; Heibati, Behzad; Heidari, Mohsen; Hendrie, Delia; Henok, Andualem; Henry, Nathaniel J.; Herteliu, Claudiu; Heydarpour, Fatemeh; Heydarpour, Pouria; Heydarpour, Sousan; Hibstu, Desalegn Tsegaw; Hoek, Hans W.; Hole, Michael K.; Red, Enayatollah Homaie; Hoogar, Praveen; Hosgood, H. Dean; Hosseini, Seyed Mostafa; Hosseinzadeh, Mehdi; Hostiuc, Mihaela; Hostiuc, Sorin; Hotez, Peter J.; Hoy, Damian C.; Hsiao, Thomas; Hu, Guoqing; Huang, John J.; Husseini, Abdullatif; Hussen, Mohammedaman Mama; Hutfless, Susan; Idrisov, Bulat; Ilesanmi, Olayinka Stephen; Iqbal, Usman; Irvani, Seyed Sina Naghibi; Irvine, Caleb Mackay Salpeter; Islam, Nazrul; Islam, Sheikh Mohammed Shariful; Islami, Farhad; Jacobsen, Kathryn H.; Jahangiry, Leila; Jahanmehr, Nader; Jain, Sudhir Kumar; Jakovlievic, Mihajlo; Jalu, Moti Tolera; James, Spencer L.; Javanbakht, Mehdi; Jayatilleke, Achala Upendra; Jeemon, Panniyammakal; Jenkins, Kathy J.; Jha, Ravi Prakash; Jha, Vivekanand; Johnson, Catherine O.; Johnson, Sarah C.; Jonas, Jost B.; Joshi, Ankur; Jozwiak, Jacek Jerzy; Jungari, Suresh Banayya; Jurisson, Mikk; Kabir, Zubair; Kadel, Rajendra; Kahsay, Amaha; Kalani, Rizwan; Karami, Manoochehr; Matin, Behzad Karami; Karch, Andre; Karema, Corine; Karimi-Sari, Hamidreza; Kasaeian, Amir; Kassa, Dessalegn H.; Kassa, Getachew Mullu; Kassa, Tesfaye Dessale; Kassebaum, Nicholas J.; Katikireddi, Srinivasa Vittal; Kaul, Anil; Kazemi, Zhila; Karyani, Ali Kazemi; Kazi, Dhruv Satish; Kefale, Adane Teshome; Keiyoro, Peter Njenga; Kemp, Grant Rodgers; Kengne, Andre Pascal; Keren, Andre; Kesavachandran, Chandrasekharan Nair; Khader, Yousef Saleh; Khafaei, Behzad; Khafaie, Morteza Abdullatif; Khajavi, Alireza; Khalid, Nauman; Khalil, Ibrahim A.; Khan, Ejaz Ahmad; Khan, Muhammad Shahzeb; Khan, Muhammad Ali; Khang, Young-Ho; Khater, Mona M.; Khoja, Abdullah T.; Khosravi, Ardeshir; Khosravi, Mohammad Hossein; Khubchandani, Jagdish; Kiadaliri, Aliasghar A.; Kibret, Getiye D.; Kidanemariam, Zelalem Teklemariam; Kiirithio, Daniel N.; Kim, Daniel; Kim, Young-Eun; Kim, Yun Jin; Kimokoti, Ruth W.; Kinfu, Yohannes; Kisa, Adnan; Kissimova-Skarbek, Katarzyna; Kivimäki, Mika; Knudsen, Ann Kristin Skrindo; Kocarnik, Jonathan M.; Kochhar, Sonali; Kokubo, Yoshihiro; Kolola, Tufa; Kopec, Jacek A.; Koul, Parvaiz A.; Koyanagi, Ai; Kravchenko, Michael A.; Krishan, Kewal; Defo, Barthelemy Kuate; Bicer, Burcu Kinuk; Kumar, G. Anil; Kumar, Manasi; Kumar, Pushpendra; Kutz, Michael J.; Kuzin, Igor; Kyu, Hmwe Hmwe; Lad, Deepesh P.; Lad, Sheetal D.; Lafranconi, Alessandra; Lal, Dharmesh Kumar; Lalloo, Ratilal; Lallukka, Tea; Lam, Jennifer O.; Lami, Faris Hasan; Lansingh, Van C.; Lansky, Sonia; Larson, Heidi J.; Latifi, Amman; Lau, Kathryn Mei-Ming; Lazarus, Jeffrey V.; Lebedev, Georgy; Lee, Paul H.; Leigh, James; Leili, Mostafa; Leshargie, Cheru Tesema; Li, Shanshan; Li, Yichong; Liang, Juan; Lim, Lee-Ling; Lim, Stephen S.; Limenih, Miteku Andualem; Linn, Shai; Liu, Shiwei; Liu, Yang; Lodha, Rakesh; Lansdale, Chris; Lopez, Alan D.; Lorkowski, Stefan; Lotufo, Paulo A.; Lozano, Rafael; Lunevicius, Raimundas; Ma, Stefan; Macarayan, Erlyn Rachelle King; Mackay, Mark T.; MacLachlan, Jennifer H.; Maddison, Emilie R.; Nadotto, Fabiana; Abd El Razek, Hassan Magdy; Abd El Razek, Muhammed Magdy; Maghavani, Dhaval P.; Majdan, Marek; Majdzadeh, Reza; Majeed, Azeem; Malekzadeh, Reza; Malta, Deborah Carvalho; Manda, Ana-Laura; Mandarano-Filho, Luiz Garcia; Manguerra, Helena; Mansournia, Mohammad Ali; Mapoma, Chabila Christopher; Marami, Dadi; Maravilla, Joemer C.; Marcenes, Wagner; Marczak, Laurie; Marks, Ashley; Marks, Guy B.; Martinez, Gabriel; Martins-Melo, Francisco Rogerlandio; Martopullo, Ira; Marz, Winfried; Marron, Melvin B.; Masci, Joseph R.; Lylassenburg, Benjamin Ballard; Mathur, Manu Raj; Mathur, Prashant; Matzopoulos, Richard; Maulik, Pallab K.; Mazidi, Mohsen; McAlinden, Cohn; McGrath, John J.; McKee, Martin; McMahon, Brian J.; Mehata, Suiiesh; Mehndiratta, Man Mohan; Mehrotra, Ravi; Mehta, Kala M.; Mehta, Varshil; Mekonnen, Tefera C.; Melese, Addisu; Melku, Mulugeta; Memiah, Peter T. N.; Memish, Ziad A.; Mendoza, Walter; Mengistu, Desalegn Tadese; Mengistu, Getnet; Mensah, George A.; Mereta, Seid Tiku; Meretoja, Atte; Meretoja, Tuomo J.; Meshovic, Tbmislav; Mezgebe, Haftay Berhane; Miazgowski, Bartosz; Miazgowski, Tomasz; Millear, Anoushka I.; Miller, Ted R.; Katherine, Molly; Petrie, Miller; Mini, G. K.; Mirabi, Parvaneh; Mirarefin, Mojde; Mirica, Andreea; Mirrakhimov, Erkin M.; Misganaw, Awoke Temesgen; Mitiku, Habtamu; Moazen, Babak; Mohammad, Karzan Abdulmuhsin; Mohammad, Moslem; Mohammadifard, Noushin; Mohammed, A. Mohammed; Mohammed, Shafiu; Mohan, Viswanathan; Mokdad, Ali H.; Molokhia, Mariam; Monasta, Lorenzo; Moradi, Ghobad; Moradi-Lakeh, Maziar; Moradinazar, Mehdi; Moraga, Paula; Morawska, Lidia; Velasquez, Ilais Moreno; Morgado-Da-Costa, Joana; Morrison, Shane Douglas; Moschos, Marilita M.; Mouodi, Simin; Mousavi, Seyyed Meysam; Muchie, Kindie Eentahun; Mueller, Ulrich Otto; Mukhopadhyay, Satinath; Muller, Kate; Mumford, John Everett; Musa, Jonah; Musa, Kamand Imran; Mustafa, Ghulam; Muthupandian, Saravanan; Nachega, Jean B.; Nagel, Gabriele; Naheed, Aliya; Nahvijou, Azin; Naik, Gunidatta; Nair, Sanjeev; Najafi, Farid; Naldi, Luigi; Nam, Hae Sung; Nangia, Vinay; Nansseu, Jobert Richie; Nascirnento, Bruno Ramos; Natarajan, Gopalakrishnan; Nearnati, Nahid; Negoi, Ionut; Negoi, Ruxcandra Irina; Nettpane, Subas; Newton, Charles R. J.; Ngalesoni, Frida N.; Ngunjiri, Josephine W.; Anh Quynh Nguyen; Nguyen, Grant; Ha Thu Nguyen; Luong Thanh Nguyen; Long Hoang Nguyen; Minh Nguyen; Trang Huyen Nguyen; Nichols, Emma; Ningnun, Dina Nur Anggraini; Nirayo, Yirga Legesse; Nixon, Molly R.; Nolutshungu, Nomonde; Nomura, Shhhei; Norhelin, Ole F.; Noroozi, Mehdi; Norrving, Bo; Noubiap, Jean Jacques; Nouri, Hamid Reza; Shiadeh, Malihe Nourollahpour; Nowroozi, Mohammad Reza; Nyasulu, Peter S.; Odell, Christopher M.; Ofori-Asenso, Richard; Ogbo, Felix Akpojene; Oh, In-Hwan; Oladimeji, Olanrewaju; Olagunju, Andrew T.; Olivares, Pedro R.; Olsen, Helen Elizabeth; Olusanya, Bolajoko Olubukunola; Olusanya, Jacob Olusegun; Ong, Kanyin L.; Ong, Sok King Sk; Oren, Eyal; Orpana, Heather M.; Ortiz, Alberto; Ortiz, Justin R.; Otstavnov, Stanislav S.; Overland, Simon; Owolabi, Mayowa Ojo; Ozdemir, Raziye; Mahesh, P. A.; Pacella, Rosana; Pakhale, Smita; Pakhare, Abhijit P.; Pakpour, Amir H.; Pana, Adrian; Panda-Jonas, Songhomitra; Pandian, Jeyaraj Durai; Parisi, Andrea; Park, Eun-Kee; Parry, Charles D. H.; Parsian, Hadi; Patel, Shanti; Pati, Sanghamitra; Patton, George C.; Paturi, Vishnupriya Rao; Paulson, Katherine R.; Pereira, Alexandre; Pereira, David M.; Perico, Norberto; Pesudovs, Konrad; Petzold, Max; Phillips, Michael R.; Piel, Frederic B.; Pigott, David M.; Pillay, Julian David; Pirsaheb, Meghdad; Pishgar, Farhad; Polinder, Suzanne; Postma, Maarten J.; Pourshams, Akram; Poustchi, Hossein; Pujar, Ashwini; Prakash, Swayam; Prasad, Narayan; Purcell, Caroline A.; Qorbani, Mostafa; Quintana, Hedley; Quistberg, D. Alex; Rade, Kirankumar Waman; Radfah, Amir; Rafay, Anwar; Rafiei, Alireza; Rahim, Fakher; Rahimi, Kazem; Rahimi-Movaghar, Afarin; Rahman, Mahfuzar; Rahman, Mohammad Hifz Ur; Rahman, Muhammad Aziz; Rai, Rajesh Kumar; Rajsic, Sasa; Ram, Usha; Ranabhat, Chhabi Lal; Ranjan, Prabhat; Rao, Puja C.; Rawaf, David Laith; Rawaf, Salman; Razo-Garcia, Christian; Reddy, K. Srinath; Reiner, Robert C.; Reitsma, Marissa B.; Remuzzi, Giuseppe; Renzaho, Andre M. N.; Resnikoff, Serge; Rezaei, Satar; Rezaeian, Shahab; Rezai, Mohammad Sadegh; Riahi, Seyed Mohammad; Ribeiro, Antonio Luiz P.; Rios-Blancas, Maria Jesus; Roba, Kedir Teji; Roberts, Nicholas L. S.; Robinson, Stephen R.; Roever, Leonardo; Ronfani, Luca; Roshandel, Gholamreza; Rostami, Ali; Rothenbacher, Dietrich; Roy, Ambuj; Rubagotti, Enrico; Sachdev, Perminder S.; Saddik, Basema; Sadeghi, Ehsan; Safari, Hosein; Safdarian, Mahdi; Safi, Sare; Safiri, Saeid; Sagar, Rajesh; Sahebkar, Amirhossein; Sahraian, Mohammad Ali; Salam, Nasir; Salama, Joseph S.; Salamati, Payman; Saldanha, Raphael De Freitas; Saleem, Zikria; Salimi, Yahya; Salvi, Sundeep Santosh; Salz, Inbal; Sambala, Evanson Zondani; Samy, Abdatiah M.; Sanabria, Juan; Sanchez-Nino, Maria Dolores; Santomauro, Damian Francesco; Santos, Itamar S.; Santos, Joao Vasco; Milicevic, Milena M. Santric; Jose, Bruno Piassi Sao; Sarker, Abdur Razzaque; Sarmiento-Suarez, Rodrigo; Sarrafzadegan, Nizal; Sartorius, Benn; Sarvi, Shahabeddin; Sathian, Brijesh; Satpathy, Maheswar; Sawant, Arundhati R.; Sawhney, Monika; Saxena, Sonia; Sayyah, Mehdi; Schaeffher, Elke; Schmidt, Maria Ines; Schneider, Ione J. C.; Schottker, Ben; Schutte, Aletta Elisabeth; Schwebel, David C.; Schwendicke, Falk; Scott, James G.; Sekerija, Mario; Sepanlou, Sadaf G.; Servan-Mori, Edson; Seyedmousavi, Seyedmojtaba; Shabaninejad, Hosein; Shackelford, Katya Anne; Shafieesabet, Azadeh; Shahbazi, Mehdi; Shaheen, Amira A.; Shaikh, Masood Ali; Shams-Beyranvand, Mehran; Shamsi, Mohammadbagher; Shamsizadeh, Morteza; Sharafi, Kiomars; Sharif, Mehdi; Sharif-Alhoseini, Mandi; Sharma, Rajesh; She, Jun; Sheikh, Aziz; Shi, Peilin; Shiferaw, Mekonnen Sisav; Shigematsu, Mika; Shiri, Rahman; Shirkoohi, Reza; Shiue, Ivy; Shokraneh, Farhad; Shrine, Mark G.; Si, Si; Siabani, Soraya; Siddiqi, Tariq J.; Sigfusdottir, Inga Dora; Sigurvinsdottir, Rannveig; Silberberg, Donald H.; Silva, Diego Augusto Santos; Silva, Joao Pedro; Da Silva, Natacha Torres; Silveira, Dayane Bride Alves; Singh, Jasvinder A.; Singh, Narinder Pal; Singh, Prashant Kumar; Singh, Virendra; Sinha, Dhirendra Narain; Sliwa, Karen; Smith, Mari; Sobaih, Badr Hasan; Sobhani, Soheila; Solangwi, Eugene; Soneji, Samir S.; Soofi, Moslem; Sorensen, Reed J. D.; Soriano, Joan B.; Soyiri, Ireneous N.; Sposato, Luciano A.; Sreeramareddy, Chandrashekhar F.; Srinivasan, Vinay; Stanaway, Jeffrey D.; Starodubov, Vladimir I.; Stathopoulou, Vasiliki; Stein, Dan J.; Steiner, Caitlyn; Stewart, Leo G.; Stokes, Mark A.; Subart, Michelle L.; Sudaryanto, Agus; Sufiyan, Mu'awiyyah Babale; Sur, Patrick John; Sutradhar, Ipsita; Sykes, Bryan L.; Sylaja, P. N.; Sylte, Dillon O.; Szoeke, Cassandra E. I.; Tabares-Seisdedos, Rafael; Tabuchi, Takahiro; Tadakamadla, Santosh Kumar; Takahashi, Ken; Tandon, Nikhil; Tassew, Segen Gebremeskel; Taveira, Nuno; Tehrani-Banihashemi, Arash; Tekalign, Tigist Gashaw; Tekle, Merhawi Gebremedhin; Temsah, Mohamad-Hani; Temsah, Omar; Terkawi, Abdullah Sulieman; Teshale, Manaye Yihune; Tesserna, Belay; Tessema, Gizachew Assefa; Thankappan, Kavumpurathu Raman; Thirinavukkarasu, Sathish; Thomas, Nihal; Thrift, Amanda G.; Thurston, George D.; Tilahun, Binyam; To, Quyen G.; Tobe-Gai, Ruoyan; Tonellli, Marcello; Topor-Madry, Roman; Torre, Anna E.; Tortajada-Cirbes, Miguel; Touvier, Mathilde; Tovani-Palone, Marcos Roberto; Bach Xuan Tran, [No Value]; Khah Bao Tran; Tripathi, Suryakant; Troeger, Christopher E.; Truelsen, Thomas Clement; Nu Thi Truong; Tsadik, Afewerki Gebremeskel; Tsoi, Derrick; Car, Lorainne Tudor; Tuzcu, E. Murat; Tyrovolas, Stefanos; Ukwaja, Kingsley N.; Whiff, Irfan; Undurraga, Eduardo A.; Updike, Rachel L.; Usman, Muhammad Shariq; Uthman, Olalekan A.; Uzun, Selen Begum; Vaduganathan, Muthiah; Vaezi, Afsane; Vaidya, Gaurang; Valdez, Pascual R.; Varavikova, Elena; Vasankari, Tommi Juhani; Venketasubramanian, Narayanaswamy; Villafaina, Santos; Violante, Francesco S.; Vladimirov, Sergey Konstantinovitch; Vlassov, Vasily; Vollset, Stein Email; Vos, Theo; Wagner, Gregory R.; Wagnew, Fasil Shiferaw; Waheed, Yasir; Wallin, Mitchell Taylor; Watson, Judd L.; Wang, Yanping; Wang, Yuan-Pang; Wassie, Molla Mesele; Weiderpass, Elisabete; Weintraub, Robert G.; Weldegebreal, Eitsum; Weldegwergs, Kidu Gidey; Werdecker, Andrea; Werkneh, Adhena Ayaliew; West, T. Eoin; Westerman, Ronny; Whiteford, Harvey A.; Widecka, Justyna; Wilner, Lauren B.; Wilson, Shadrach; Winkler, Andrea Sylvia; Wiysonge, Charles Shey; Wolfe, Charles D. A.; Wu, Shouling; Wu, Yun-Chun; Wyper, Grant M. A.; Xavier, Denis; Xu, Gelin; Yadgir, Simon; Yadollahpour, Ali; Jabbari, Seyed Hossein Yahyazadeh; Yakob, Bereket; Yan, Lijing L.; Yano, Yuichiro; Yaseri, Mehdi; Yasin, Yasin Jemal; Yentur, Gokalp Kadri; Yeshaneh, Alex; Yimer, Ebrahim M.; Yip, Paul; Yirsaw, Biruck Desalegn; Yisma, Engida; Yonemoto, Naohiro; Yonga, Gerald; Yoon, Seok-Jun; Yotebieng, Marcel; Younis, Mustafa Z.; Yousefifard, Mahmoud; Yu, Chuanhua; Zadnik, Vesna; Zaidi, Zoubida; Bin Zaman, Sojib; Zamani, Mohammad; Zare, Zohreh; Zeleke, Ayalew Jejaw; Zenebe, Zerihun Menlkalew; Zhang, Anthony Lin; Zhang, Kai; Zhou, Maigeng; Zodpey, Sanjay; Zuhlke, Liesl Joanna; Naghavi, Ntishsen; Murray, Christopher J. L. (2018)
    Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODErn), to generate cause fractions and cause specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NC Ds) comprised the greatest fraction of deaths, contributing to 73.4% (95% uncertainty interval [UI] 72.5-74.1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 186% (17.9-19.6), and injuries 8.0% (7.7-8.2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22.7% (21.5-23.9), representing an additional 7.61 million (7. 20-8.01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7.9% (7.08.8). The number of deaths for CMNN causes decreased by 222% (20.0-24.0) and the death rate by 31.8% (30.1-33.3). Total deaths from injuries increased by 2.3% (0-5-4-0) between 2007 and 2017, and the death rate from injuries decreased by 13.7% (12.2-15.1) to 57.9 deaths (55.9-59.2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118.0% (88.8-148.6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36.4% (32.2-40.6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33.6% (31.2-36.1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respirator}, infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990 neonatal disorders, lower respiratory infections, and diarrhoeal diseases were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.
  • Laukka, Elina; Huhtakangas, Moona; Heponiemi, Tarja; Kujala, Sari; Kaihlanen, Anu-Marja; Gluschkoff, Kia; Kanste, Outi (2020)
    Background: The popularity of web-based patient-professional communication over patient portals is constantly increasing. Good patient-professional communication is a prerequisite for high-quality care and patient centeredness. Understanding health care professionals' experiences of web-based patient-professional communication is important as they play a key role in engaging patients to use portals. More information is needed on how patient-professional communication could be supported by patient portals in health care. Objective: This systematic review of qualitative studies aims to identify how health care professionals experience web-based patient-professional communication over the patient portals. Methods: Abstract and full-text reviews were conducted by 2 reviewers independently. A total of 4 databases were used for the study: CINAHL (EBSCO), ProQuest (ABI/INFORM), Scopus, and PubMed. The inclusion criteria for the reviewed studies were as follows: the examination of health care professionals' experiences, reciprocal communication between patients and health care professionals, peer-reviewed scientific articles, and studies published between 2010 and 2019. The Joanna Briggs Institute's quality assessment criteria were used in the review process. A total of 13 included studies were analyzed using a thematic synthesis, which was conducted by 3 reviewers. Results: A total of 6 analytical themes concerning health care professionals' experiences of web-based patient-professional communication were identified. The themes were related to health care professionals' work, change in communication over patient portals, patients' use of patient portals, the suitability of patient portals for communication, the convenience of patient portals for communication, and change in roles. Conclusions: Health care professionals' experiences contain both positive and negative insights into web-based patient-professional communication over patient portals. Most commonly, the positive experiences seem to be related to the patients and patient outcomes, such as having better patient engagement. Health care professionals also have negative experiences, for example, web-based patient-professional communication sometimes has deficiencies and has a negative impact on their workload. These negative experiences may be explained by the poor functionality of the patient portals and insufficient training and resources. To reduce health care professionals' negative experiences of web-based patient-professional communication, their experiences should be taken into account by policy makers, health care organizations, and information technology enterprises when developing patient portals. In addition, more training regarding web-based patient-professional communication and patient portals should be provided to health care professionals.
  • Seilo, Noora; Paldanius, Susanna; Autio, Reija; Kunttu, Kristina; Kaila, Minna (2022)
    Background: General health checks are an established component of preventive health care in many countries. Declining participation rates have raised concerns in health care providers. Understanding the reasons for attendance and non-attendance is necessary to improve the preventive health care system. The aim of this study was to examine health- and study-related factors associated with university entrants' health check attendance. Methods: Since 2009, an electronic health questionnaire (eHQ) has been conducted yearly to all Finnish university entrants by the Finnish Student Health Service (FSHS) to screen students for a general health check. The questionnaire comprises 26 questions about health, health habits and studying. The study population consisted of the 3346 entrants from the 2011-2012 academic year who were referred to a health check based on their eHQ responses. The eHQ data were linked with health check attendance information. Multivariable logistic regression was used to study the associations between the questionnaire responses and non-attendance of the health check. Results: Male sex (OR 1.6, 95% CI % 1.4-1.9) and low engagement with studies (OR 1.5, 95% CI 1.2-2.0) were the variables most strongly associated with non-attendance. Having low state of mind was negatively associated with health check non-attendance thus enhanced the health-check attendance (OR 0.6, 95% CI 0.5-0.8). Conclusions: The results suggest that providing health checks in student health care may serve as a way of reaching students with health concerns. However, motivating males and smokers to attend general health checks continue to be a challenge also in a university student population. That low engagement with studies associates with health check non-attendance points to need to improve collaboration between universities and student health care.
  • Csonka, Peter; Tapiainen, Terhi; Mäkelä, Mika J.; Lehtimäki, Lauri (2021)
    Aim Our aim was to survey treatment practices used for preschool children with wheezing in emergency rooms (ER) focussing on inhalation device choice and handling, face mask use, salbutamol dosing and written instructions. We sought to assess whether current protocols are in line with published evidence and guidelines. Methods This is a cross-sectional survey done in paediatric ER units located in Finnish municipalities with more than 10 000 inhabitants. Results Of the 100 units contacted, 50% responded. More than 50% of the units used nebulisers. Only 13% of the units administered salbutamol in single puffs. More than 30% of the units lacked criteria on face mask use. Poor co-operation had no effect on the dose of salbutamol in 62% of the units. Ensuring tight mask-to-face seal was included in the training in 20% of the units. A written action plan was provided to the caregivers in 28% of the units. Conclusion ER treatment guidelines for preschool children with wheezing are poorly endorsed. Research is needed to identify approaches to guideline implementation that are specific for primary care. Clinical research should focus on strengthening recommendations that are currently not embraced. ER treatment protocols need to be updated and adherence to guidelines should be re-evaluated.
  • Halmesmäki, Esa; Pasternack, Iris; Roine, Risto Paavo Antero (2016)
    Background: This study examines, as a part of the European Union funded Adopting Hospital Based Health Technology Assessment (AdHopHTA) project, the results and barriers of collaboration between Finnish hospitals and the national health technology assessment (HTA) agency, Finohta. A joint collaborative HTA program has existed since 2006 between the Finnish hospitals and the national agency. Methods: A case study method was used. Information about the collaboration between Finnish hospitals and Finohta was retrieved from interviews and publications, and categorised per theme. Hypotheses and indicators of successful collaboration were determined beforehand and reflected on the observations from the interviews and literature. Results: Overall, 48 collaborative HTA reports have been performed during 7 years of collaboration. However, there were no clear indications that the use of HTA information or the transparency of decision-making regarding new technologies would have increased in hospitals. The managerial commitment to incorporate HTAs into the decision-making processes in hospitals was still low. The quality of the collaborative HTA reports was considered good, but their applicability in the hospital setting limited. There were differing expectations about the timing and relevance of the content. Signs of role conflict and mistrust were observed. Conclusions: Despite collaborative efforts to produce HTAs for hospitals, the impact of HTA information on hospital decision-making appears to remain low. The difficulties identified in this case study, such as lack of managerial commitment in hospitals, can hopefully be better addressed in the future with the guidance and tools having been developed in the AdHopHTA project. Collaboration between hospitals and national HTA agencies remains important for the efficient sharing of skills and resources.
  • Annala, Salla; Ruggiero, Salvatore; Kangas, Hanna Liisa; Honkapuro, Samuli; Ohrling, Tiina (2022)
    The transition toward more renewable-based energy systems increases the need for new flexible resources, such as demand response (DR). Previous literature has found various barriers for DR utilization, but much of this research has focused on the initiation of DR operations or barriers in national markets and not on factors that hinder market upscaling and firm internationalization. We address this gap by analyzing interviews with 22 DR companies active in Finland, one of the early mover countries for automated DR. While most of previous research has focused on electricity DR, our interviewees also include district heating DR companies. By using the Technological Innovation System (TIS) framework, we study how the advanced regulatory and market framework and the technology rollout in Finland have affected the DR service development and the internationalization of Finnish companies. Based on our results, the DR market formation in Finland has largely relied on the Finnish transmission system operator's early decision to allow independent aggregation and the early large-scale rollout of smart meters. The advanced home market has enabled firms to develop new solutions and prove their concept. Yet, the highly structured nature of energy markets complicates the access to both advanced and less advanced foreign markets.
  • D'amato, Dalia; Korhonen, Jouni (2021)
    The green economy, circular economy and bioeconomy are popular narratives in macro-level sustainability discussions in policy, scientific research and business. These three narratives offer three different recipes to address economic, social and ecological goals, thus promoting different pathways for sustainability transformations. We employ the well-known Framework for Strategic Sustainable Development (The Natural Step Framework) to comparatively identify the relative and integrated contribution of the three narratives for global net sustainability. We conclude that none of the three narratives, individually, offer a comprehensive ‘package’ of solutions. However, when considered jointly as collaborative narratives, they point towards a society and economy based on renewable/reproductive and biodiversity-based/benign processes, delivering material and immaterial benefits that fulfil the economic and social requirements of all people now and in the future. While the complementary understanding of the circular economy, bioeconomy and green economy provides important guidelines for sustainability transformations post-Covid-19, there is a need for more holistic, systems-wide and integrative research work on potentially competing or supplementary sustainability narratives. This type of work of clarification and synthesis is relevant to a wide range of scholars and professionals, since the conceptual understanding of sustainability narratives informs practical implementation through strategies, actions and monitoring tools, in public and private decision-making.
  • Vihemäki, Heini; Toppinen, Anne; Toivonen, Ritva (2020)
    Intermediaries can potentially help reduce institutional lock-ins that slow down sustainability transitions by influencing policy processes, because of their connectedness and often high level of legitimacy. In this paper, we analysed intermediaries seeking to accelerate the diffusion of wooden multi-storey construction (WMC) in Finland, their roles and engagement in policy processes. Increasing the use of wood in construction has high policy support nationally, backed up with climate and forest policies. Yet, market diffusion has been slow. The data consist of qualitative interviews of intermediaries and other actors, participatory observation and a review of secondary materials. The results reveal a complex set of intermediaries, including systemic, niche and regime-based ones. The intermediaries are characterised by multiple goals, partly overlapping roles and means of policy influencing. The low degree of coordination among the intermediaries and the differences in their agenda for transition are critical challenges which limit the effectiveness of their actions.
  • Tavakoli, Shirin; Puranen, Jooseppi; Bahrpeyma, Sina; Lautala, Veera E.; Karumo, Suvi; Lajunen, Tatu; del Amo, Eva M.; Ruponen, Marika; Urtti, Arto (2022)
    Choroidal neovascularization (CNV) is a prevalent vision-threatening vascular disorder in aging population. CNV is associated with several diseases in the posterior segment of the eye such as age-related macular degeneration (AMD). In this study we developed sunitinib-loaded liposomes to block the neovascularization signalling pathway through inhibition of tyrosine kinase of vascular endothelial growth factor receptors (VEGFRs). Liposomal sunitinib formulations were prepared by thin film hydration method and studied for their encapsulation efficiency (EE), loading capacity (LC) and drug release profile in buffer andvitreous. Our finding showed that the liposomes (mean size 104 nm) could effectively entrap sunitinib (EE approximate to 95%) at relatively high loading capacity (LC approximate to 5%) and release sunitinib over at least 3 days. Intravitreal sunitinib-loaded liposomes revealed inhibitory effect on established neovascularization in laser-induced CNV mouse model while the intravitreal injection of sunitinib solubilized with cyclodextrin was inefficient in management of neovascularization. Accordingly, liposomal sunitinib is a promising drug delivery system that should be further studied to inhibit the CNV related to AMD.
  • Aaltonen, Sari; Waller, Katja; Vähä-Ypyä, Henri; Rinne, Juha; Sievänen, Harri; Silventoinen, Karri; Kaprio, Jaakko; Kujala, Urho M. (2020)
    Motives for physical activity may vary considerably by age, sex, and the level of physical activity. We aimed to examine motives for physical activity in older men and women with different physical activity levels as well as whether genetic and/or environmental factors explain those motives. Finnish twins (mean age 72.9 years, 262 full twin pairs) self-reported their motives for physical activity. Time spent on moderate-to-vigorous physical activity was monitored using a hip-worn accelerometer. Comparisons between the different physical activity groups of older twins (n = 764-791/motive dimension) were analyzed using the Wald test, and effect sizes were calculated as Cohen's d. Quantitative genetic modeling was used to estimate genetic and environmental contributions. For both sexes, the most frequently reported motives for physical activity were physical fitness, health maintenance, and psychological well-being. Conforming to others' expectations was more important for men than for women (P <.001, Cohen's d = 0.38), while appearance (P = .001 Cohen's d = -0.24) and psychological well-being (P = .02, Cohen's d = -0.17) were highlighted by women. Most of the motive dimensions differed significantly between the physically active and inactive individuals. It was estimated that 5%-42% of the variation in motives was contributed by genetic factors and 58%-95% by environmental factors. The result that environmental factors contribute in a great deal to motives indicates that interventions to motivate physically inactive older individuals to be physically active can be successful. However, personalized interventions are needed because sex and the level of physical activity were found to be associated with older individuals' motives for physical activity.