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  • Mikkola, Ilona; Hagnäs, Maria; Hartsenko, Jelena; Kaila, Minna; Winell, Klas (2020)
    Aims To investigate whether the use of a personalized care plan is associated with clinical outcomes of type 2 diabetes (T2D) treatment in real-world. Methods Quality of treatment was assessed using data from a yearly sample of patients with T2D visiting primary care health centres in 2012–2016. Patients were divided into three groups: 1) patient has a copy of their personalized care plan, 2) care plan exists in the patient record only or 3) patient has no care plan. Data on smoking, laboratory tests, systolic blood pressure (sBP) and statin use were collected. We compared the outcomes between the three groups in terms of proportions of patients achieving the clinical targets recommended by international guidelines. Results Evaluable data were available for 10,403 patients. Of these, 1,711 (16%) had a copy of their personalized care plan, and 3,623 (35%) had no care plan. Those who had a copy of their care plan were significantly more likely than those without to achieve the sBP target (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.29–1.51, p
  • Lemetti, Terhi; Voutilainen, Paivi; Stolt, Minna; Eloranta, Sini; Suhonen, Riitta (2017)
    Introduction: Health care systems for older people are becoming more complex and care for older people, in the transition between hospital and primary healthcare requires more systematic collaboration between nurses. This study describes nurses' perceptions of their collaboration when working between hospital and primary healthcare within the older people care chain. Theory and methods: Using a qualitative approach, informed by grounded theory, six focus groups were conducted with a purposive sample of registered nurses (n = 28) from hospitals (n = 14) and primary -healthcare (n = 14) during 2013. The data were analyzed using dimensional analysis. Findings: Four dimensions of collaboration were identified: 1) Context and Situation, 2) Conditions, 3) Processes and Interactions and 4) The Consequences of nurse-to-nurse collaboration within the older people care chain. These four dimensions were then conceptualized into a model of nurse-to-nurse collaboration. Discussion and conclusion: Improved collaboration is useful for the safe, timely and controlled transfer of older people between hospital and primary healthcare organizations and also in healthcare education. The findings in this study of nurse-to-nurse collaboration provides direction and opportunities to improve collaboration and subsequently, the continuity and integration in older people care in the transition between organizations.
  • Di Masso, Andres; Williams, Daniel R.; Raymond, Christopher M.; Buchecker, Matthias; Degenhardt, Barbara; Devine-Wright, Patrick; Hertzog, Alice; Lewicka, Maria; Manzo, Lynne; Shahrad, Azadeh; Stedman, Richard; Verbrugge, Laura; von Wirth, Timo (2019)
    This paper develops a theoretical argument for how place attachments are forged and become dynamically linked to increasingly common mobility practices. First, we argue that mobilities, rather than negating the importance of place, shift our understanding of place and the habitual ways we relate to and bond with places as distinct from a conception of place attachment premised on fixity and stability. Second, we document how the body of research on place attachment has both reinforced and contested 'sedentaristic' assumptions criticized within the so-called 'mobilities turn' in the social sciences. Third, we present a conceptual framework, built around different modes of interrelation between fixity and flow, as a way to re-theorize, link and balance the various studies of place attachment that have grappled with mobility. Finally, we sketch out the main research implications of this framework for advancing our understanding of place attachment in a mobile world.
  • Kokkonen, Kristiina; Tasmuth, Tiina; Lehto, Juho T.; Kautiainen, Hannu; Elme, Anneli; Jaaskelainen, Anna-Stina; Saarto, Tiina (2019)
    Background/Aim: To observe changes in symptoms and health-related quality of life (HRQoL) over 7 years among cancer patients at different stages of the disease. Patients and Methods: This prospective cross-sectional study at the Helsinki University Hospital Cancer Center, was carried out in 2006 and repeated in 2013. All participants filled in the EORTC-QLQ-C30 questionnaire. Results: Altogether, 581 patients responded (49% in 2006 and 54% in 2013). The disease was local in 51% and advanced in 49% of patients. The HRQoL was significantly lower, except for emotional and cognitive functions, and the symptom burden more severe in advanced cancer. The most prevalent symptoms were fatigue (93% and 85%; moderate/severe 22% and 9%), pain (65% and 47%; moderate/severe 16% and 5%), and insomnia (64% and 60%; moderate/severe 20 and 21%), respectively. No changes in HRQoL or symptoms were found at 7 years. Conclusion: There is a need for early integrated palliative care to improve HRQoL during cancer treatments.
  • Salmi, Saara; Kumpulainen, Kristiina (2019)
    Despite vast research on school transitions, less attention has been paid to understanding children's own sense-making of their transition from preschool to first grade. Drawing on sociocultural and dialogic approaches, this study addresses this gap by investigating children's experiencing (perezhivanie) of their school transitioning nested in the interaction between their motives and perceived demands. The data are derived from an ethnographic research project with 19 first-graders aged six to seven years old attending a Finnish primary school. The children were invited to draw their transition experiences and narrate their drawings to their peers and the researchers. The visual narrations were videotaped, transcribed, and analysed. The findings highlight the children's dialogic sense-making processes of their educational transitioning. The study reveals that the children's motives were related to opportunities to engage in physical activities, play, make relationships, and make sense of their changing positions and identities in relation to transitioning to primary school. The results also illuminate how the children actively created subversive spaces for pushing the demands of school rules and routines to fulfil their subjective motives. Altogether, the study demonstrates the potential of visual narrative methods in contributing to a nuanced understanding of children's sense-making of their school transitioning, including the dialogic processes of what it entails to become a 'primary school child'.
  • Pirhonen, Jari Pentti Tapio; Melkas, Helinä; Laitinen, Arto; Pekkarinen, Satu (2020)
    There is an urge to introduce high technology and robotics in care settings. Assisted living (AL) is the fastest growing form of older adults’ long-term care. Resident autonomy has become the watchword for good care. This article sheds light on the potential effects of care robotics on the sense of autonomy of older people in AL. Three aspects of the residents’ sense of autonomy are of particular interest: (a) interaction-based sense of autonomy, (b) coping-based sense of autonomy, and (c) potential-based sense of autonomy. Ethnographical data on resident autonomy in an AL facility and existing literature on care robots are utilized in studying what kind of assurances different types of robots would provide to maintain the sense of autonomy in AL. Robots could strengthen the different types of sense of autonomy in multiple ways. Different types of robots could widen the residents’ space of daily movements, sustain their capacities, and help them maintain and even create future expectations. Robots may strengthen the sense of autonomy of older persons in AL; however, they may simultaneously pose a threat. Multi-professional discussions are needed on whether robots are welcomed in care, and if they are, how, for whom, and in what areas.
  • Leino, Akseli; Korkalainen, Henri; Kalevo, Laura; Nikkonen, Sami; Kainulainen, Samu; Ryan, Alexander; Duce, Brett; Sipila, Kirsi; Ahlberg, Jari; Sahlman, Johanna; Miettinen, Tomi; Westeren-Punnonen, Susanna; Mervaala, Esa; Toyras, Juha; Myllymaa, Sami; Leppanen, Timo; Myllymaa, Katja (2022)
    We have previously developed an ambulatory electrode set (AES) for the measurement of electroencephalography (EEG), electrooculography (EOG), and electromyography (EMG). The AES has been proven to be suitable for manual sleep staging and self-application in in-home polysomnography (PSG). To further facilitate the diagnostics of various sleep disorders, this study aimed to utilize a deep learning-based automated sleep staging approach for EEG signals acquired with the AES. The present neural network architecture comprises a combination of convolutional and recurrent neural networks previously shown to achieve excellent sleep scoring accuracy with a single standard EEG channel (F4-M1). In this study, the model was re-trained and tested with 135 EEG signals recorded with AES. The recordings were conducted for subjects suspected of sleep apnea or sleep bruxism. The performance of the deep learning model was evaluated with 10-fold cross-validation using manual scoring of the AES signals as a reference. The accuracy of the neural network sleep staging was 79.7% (kappa = 0.729) for five sleep stages (W, N1, N2, N3, and R), 84.1% (kappa = 0.773) for four sleep stages (W, light sleep, deep sleep, R), and 89.1% (kappa = 0.801) for three sleep stages (W, NREM, R). The utilized neural network was able to accurately determine sleep stages based on EEG channels measured with the AES. The accuracy is comparable to the inter-scorer agreement of standard EEG scorings between international sleep centers. The automatic AES-based sleep staging could potentially improve the availability of PSG studies by facilitating the arrangement of self-administrated in-home PSGs.
  • Beinert, Cecilie; Sørlie, Anne Catherine; Åbacka, Gun; Palojoki, Päivi; Nordgård Vik, Frøydis (2022)
    Objective: The Norwegian National Action Plan for a Healthier Diet calls for discussion of new ways to communicate health information. An already established and important arena in which to do so is school, in the Food and Health (FH) subject in particular. The aim of this study was to investigate how Norwegian students experience the FH subject, and how they believe it impacts on their everyday lives. Design: Qualitative study using focus group discussions Setting: Three public schools in Norway Methods: Focus group discussions were audio-recorded, transcribed verbatim and thematically analysed. Results: The students reported the relevance of the school subject FH to their everyday life. However, how much FH was experienced as having impacted on their everyday lives with respect to cooking at home, food choice and food hygiene varied. Conclusions: More research is needed to explore how FH can have a stronger impact on students' actual food choices and cooking practices. This is important in order to tackle contemporary dietary challenges among children and adolescents. Rather than discussing new channels of health education, we suggest that the FH subject area should be strengthened in schools by increasing teachers' competence and focusing more strongly on how best to influence students' food choices.
  • Rintala, Aki; Päivärinne, Ville; Hakala, Sanna; Paltamaa, Jaana; Heinonen, Ari; Karvanen, Juha; Sjögren, Tuulikki (2019)
    Objective: To study the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning in stroke. Data Sources: A systematic literature search was conducted in 6 databases from January 2000 to May 2018. Study Selection: Inclusion criteria applied the patient, intervention, comparison, outcome, study design framework as follows: (P) stroke; (I) technology-based distance physical rehabilitation interventions; (C) any comparison without the use of technology; (0) physical functioning; (S) randomized controlled trials (RCTs). The search identified in total 693 studies, and the screening of 162 full-text studies revealed 13 eligible studies. Data Extraction: The studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and assessed for methodological quality and quality of evidence. Meta-analysis was performed if applicable. Data Synthesis: A total of 13 studies were included, and online video monitoring was the most used technology. Seven outcomes of physical functioning were identified-activities of daily living (ADL), upper extremity functioning, lower extremity functioning, balance, walking, physical activity, and participation. A meta-analysis of 6 RCTs indicated that technology-based distance physical rehabilitation had a similar effect on ADL (standard mean difference 0.06; 95% confidence interval: -0.22 to 0.35, P=.67) compared to the combination of traditional treatments (usual care, similar and other treatment). Similar results were obtained for other outcomes, except inconsistent findings were noted for walking. Methodological quality of the studies and quality of evidence were considered low. Conclusions: The findings suggest that the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning might be similar compared to traditional treatments in stroke. Further research should be performed to confirm the effectiveness of technology-based distance physical rehabilitation interventions for improving physical functioning of persons with stroke. (C) 2018 by the American Congress of Rehabilitation Medicine
  • Rabiei, Sepideh; Mohebbi, Simin Z.; Yazdani, Reza; Virtanen, Jorma I. (2014)
  • Rautalin, Ilari M.; Sebök, Martina; Germans, Menno R.; Korja, Miikka; Dannecker, Noemi; Zindel-Geisseler, Olivia; Brugger, Peter; Regli, Luca; Stienen, Martin N. (2020)
    Background Although most aneurysmal subarachnoid hemorrhage (aSAH) patients suffer from neuropsychological disabilities, outcome estimation is commonly based only on functional disability scales such as the modified Rankin Scale (mRS). Moreover, early neuropsychological screening tools are not used routinely. Objective To study whether two simple neuropsychological screening tools identify neuropsychological deficits (NPDs), among aSAH patients categorized with favorable outcome (mRS 0-2) at discharge. Methods We reviewed 170 consecutive aSAH patients that were registered in a prospective institutional database. We included all patients graded by the mRS at discharge, and who had additionally been evaluated by a neuropsychologist and/or occupational therapist using the Montreal Cognitive Assessment (MoCA) and/or Rapid Evaluation of Cognitive Function (ERFC). The proportion of patients with scores indicative of NPDs in each test were reported, and spearman correlation tests calculated the coefficients between the both neuropsychological test results and the mRS. Results Of the 42 patients (24.7%) that were evaluated by at least one neuropsychological test, 34 (81.0%) were rated mRS 0-2 at discharge. Among these 34 patients, NPDs were identified in 14 (53.9%) according to the MoCA and 8 (66.7%) according to the ERFC. The mRS score was not correlated with the performance in the MoCA or ERFC. Conclusion The two screening tools implemented here frequently identified NPDs among aSAH patients that were categorized with favorable outcome according to the mRS. Our results suggest that MoCA or ERFC could be used to screen early NPDs in favorable outcome patients, who in turn might benefit from early neuropsychological rehabilitation.
  • van Schaik, Ivo N.; Bril, Vera; van Geloven, Nan; Hartung, Hans-Peter; Lewis, Richard A.; Sobue, Gen; Lawo, John-Philip; Praus, Michaela; Mielke, Orell; Durn, Billie L.; Cornblath, David R.; Merkies, Ingemar S. J.; PATH Study Grp; Saarela, Mika (2018)
    Background Approximately two-thirds of patients with chronic inflammatory demyelinating polyneuropathy (CIDP) need long-term intravenous immunoglobulin. Subcutaneous immunoglobulin (SCIg) is an alternative option for immunoglobulin delivery, but has not previously been investigated in a large trial of CIDP. The PATH study compared relapse rates in patients given SCIg versus placebo. Methods Between March 12, 2012, and Sept 20, 2016, we studied patients from 69 neuromuscular centres in North America, Europe, Israel, Australia, and Japan. Adults with definite or probable CIDP who responded to intravenous immunoglobulin treatment were eligible. We randomly allocated participants to 0.2 g/kg or 0.4 g/kg of a 20% SCIg solution (IgPro20) weekly versus placebo (2% human albumin solution) for maintenance treatment for 24 weeks. We did randomisation in a 1: 1:1 ratio with an interactive voice and web response system with a block size of six, stratified by region (Japan or non-Japan). The primary outcome was the proportion of patients with a CIDP relapse or who were withdrawn for any other reason during 24 weeks of treatment. Patients, caregivers, and study personnel, including those assessing outcomes, were masked to treatment assignment. Analyses were done in the intention-to-treat and per-protocol sets. This trial is registered with ClinicalTrials. gov, number NCT01545076. Findings In this randomised, double-blind, placebo-controlled trial, we randomly allocated 172 patients: 57 (33%) to the placebo group, 57 (33%) to the low-dose group, and 58 (34%) to the high-dose group. In the intention-to-treat set, 36 (63% [95% CI 50-74]) patients on placebo, 22 (39% [27-52]) on low-dose SCIg, and 19 (33% [22-46]) on high-dose SCIg had a relapse or were withdrawn from the study for other reasons (p=0.0007). Absolute risk reductions were 25% (95% CI 6-41) for low-dose versus placebo (p=0.007), 30% (12-46) for high-dose versus placebo (p=0.001), and 6% (-11 to 23) for high-dose versus low-dose (p=0.32). Causally related adverse events occurred in 47 (27%) patients (ten [18%] in the placebo group, 17 [30%] in the low-dose group, and 20 [34%] in the high-dose group). Six (3%) patients had 11 serious adverse events: one (2%) patient in the placebo group, three (5%) in the low-dose group, and two (3%) in the high-dose group; only one (an acute allergic skin reaction in the low-dose group) was assessed to be causally related. Interpretation This study, which is to our knowledge, the largest trial of CIDP to date and the first to study two administrations of immunoglobulins and two doses, showed that both doses of SCIg IgPro20 were efficacious and well tolerated, suggesting that SCIg can be used as a maintenance treatment for CIDP.
  • Korkalo, Liisa; Nissinen, Kaija M; Skaffari, Essi; Vepsäläinen, Henna; Lehto, Reetta; Kaukonen, Riikka Elisa; Koivusilta, Leena; Sajaniemi, Nina; Roos, Eva; Erkkola, Maijaliisa (2019)
    Preschool meals may influence the formation of children's dietary habits and health. We assessed the contribution of preschool meals to the diet of Finnish children. We used food record data from the cross-sectional DAGIS survey and selected recording days which included all three meals (breakfast, lunch, afternoon snack) at preschool. We analyzed the diet of three- to four-year-olds (n = 324) and five- to six-year-olds (n = 233). Preschool meals accounted for 54% of the weekday's energy intake in both age groups, and provided >= 60% of total fiber, polyunsaturated fatty acids, and vitamins D and E. More than 60% of fish dishes but only one third of total daily fresh fruit were consumed at preschool. The mean (SD) percentages of energy from protein and fat at preschool were 17% (3%) and 30% (7%) in the younger and 17% (3%) and 31% (6%) in the older age group, respectively. The mean proportions of energy from added sugar at preschool were below 5% in both age groups. On average, salt intake exceeded recommendations and 60% of salt came from preschool food. Tackling high salt intake should be a future goal of guidance for early childhood education and care food services.
  • Kuula, Liisa; Halonen, Risto; Kajanto, Kristiina; Lipsanen, Jari; Makkonen, Tommi; Peltonen, Miina; Pesonen, Anu-Katriina (2020)
    Knowledge on efficient ways to reduce presleep arousal and, therefore, improve sleep, is scanty. We explored the effects of presleep slow breathing and music listening conditions on sleep quality and EEG power spectral density in young adults in a randomized, controlled trial with a crossover design. Participants’ (N = 20, 50% females) sleep was measured on two consecutive nights with polysomnography (40 nights), the other night serving as the control condition. The intervention condition was either a 30-minute slow breathing exercise or music listening (music by Max Richter: Sleep). The intervention and control conditions were placed in a random order. We measured heart rate variability prior to, during and after the intervention condition, and found that both interventions increased immediate heart rate variability. Music listening resulted in decreased N2 sleep, increased frontal beta1 power spectral density, and a trend towards increased N3 sleep was detected. In the slow breathing condition higher central delta power during N3 was observed. While some indices pointed to improved sleep quality in both intervention groups, neither condition had robust effects on sleep quality. These explorative findings warrant further replication in different populations.
  • Järv, Olle; Masso, Anu; Silm, Siiri; Ahas, Rein (2021)
    The extent to which ethnic segregation results from differences in socio-economic factors remains a seminal topic of debate. The growing literature demonstrating the multifaceted phenomenon of segregation urges more focus on individuals' spatial and social interactions. We applied an activity space approach and considered ethnic differences in individuals' activity spaces as an indicator of spatial segregation. We used mobile phone and survey datasets in Estonia. We show that place-based segregation indices derived from both datasets indicate similar levels of ethnic segregation. From an activity space perspective, the results show that the main socio-economic factor affecting the extensity of activity spaces is self-estimated social status rather than education and income. Results show that ethnic inequality in spatial behaviour is not straightforward, but rather that it is linked to how individuals position themselves in society. We argue that socio-economic factors need to be controlled to examine ethnic segregation from activity space perspective.
  • Looi, Valerie; Torppa, Ritva; Prvan, Tania; Vickers, Debi (2019)
    The primary aim of this current study was to compare the role, importance and value placed on music by families with normally hearing (NH) children, to those who had a child with a hearing loss (HL) who wore either hearing aids and/or cochlear implants. A secondary aim was to see whether this differed between the countries. Parents of children aged 2–6 years living in Australia, Finland, and the United Kingdom were invited to complete the Role of Music in Families Questionnaire (RMFQ). Two groups of participants were recruited from each country: (i) parents of NH children, and (ii) parents of children with a HL. The RMFQ had seven subsections covering topics such as music participation, attitudes to music, importance of music in the family, and future perspectives on music. Three hundred and twenty-two families of NH children, and 56 families of children with HL completed the questionnaire (Australia: 50 NH, 25 HL; Finland: 242 NH, 21 HL; United Kingdom: 30 NH, 10 HL). Analyses compared between NH and HL groups within each country, and between the three countries for the NH group, and the HL group, independently. Overall, there were few significant differences between the participation levels, role, or importance of music in families with NH children compared to those with a child who had a HL, regardless of whether the families lived in Australia, Finland or the United Kingdom. Children first started to respond to music at similar ages, and overall music participation frequency, and music enjoyment were relatively similar. The importance of music in the family was also similar between the NH and HL groups. In comparing between the countries, Finnish children had a tendency to have higher participation rates in musical activities, with few other differences noted. Overall, the results of this study indicate that children, regardless of hearing levels or country of residence, have similar levels of music engagement and enjoyment, and HL is not seen as a contraindication to music participation and involvement by the parents involved in this study.
  • Telles, Shirley; Kozasa, Elisa; Bernardi, Luciano; Cohen, Marc (2013)