Browsing by Subject "INTERVENTIONS"

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  • Gagnon, Joseph Calvin; Swank, Jacqueline M. (2021)
    A national study of clinical directors examined professional development (PD) focused on mental health provided to professionals in juvenile justice facilities for adjudicated youth. A total of 85 clinical directors responded to a mail survey (45% return rate). The survey questions related to (a) topics of staff training and the basis for choosing topics, (b) which professionals participated in each PD topic, (c) training format and frequency of PD, (d) recommended attributes of PD, (e) methods of evaluating PD, and (f) adequacy of PD and how can it be improved. For each topic, PD was typically provided once per year and face to face, rather than online. PD participation rates were commonly in the 30% and 40% ranges for professionals other than clinical directors and counselors, with teachers, correctional officers, administrators, and teaching assistants receiving PD the least. Rarely did PD include recommended attributes of PD, and it was commonly viewed as ineffective. Implications for research and practice related to PD and its relationship to youth reentry from juvenile justice facilities are discussed.
  • Tornivuori, Anna; Tuominen, Outi; Salantera, Sanna; Kosola, Silja (2020)
    Aims To define digital health services that have been studied among chronically ill adolescents and to describe e-health coaching elements that may have an impact on transition outcomes. Design Systematic review without meta-analysis. Data sources MEDLINE (Ovid), Pub Med, Scopus and CINAHL on 28 May 2018. Review methods Peer-reviewed articles published between January 2008-May 2018 were reviewed following the Cochrane Handbook for Systematic Reviews of Interventions and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Results Twelve randomized controlled trials were included. The interventions varied significantly in duration and content. E-coaching that included human and social support showed positive impact on transition outcomes. Digital health services incorporated into usual care provide efficient and accessible care. Conclusion E-coaching elements enable tailoring and personalization and present a tool for supporting and motivating chronically ill adolescents during transition of care. Future research should evaluate the effectiveness of e-coaching elements. Impact Digital services are considered a means for increasing adolescents' motivation for self-care and for increasing their accessibility to health care. The coaching elements in digital services consist of a theoretical basis, human support, interactive means and social support. Included interventions varied in terms of duration, dose, content and design. Our results may serve the development of digital health services for adolescents in transition. E-coaching can be used to engage and motivate chronically ill adolescents to improve health behaviour and self-management during transition of care.
  • Treanor, Charlene J; Kouvonen, Anne; Lallukka, Tea; Donnelly, Michael (2021)
    Background: Mental ill-health presents a major public health problem. A potential part solution that is receiving increasing attention is computer-delivered psychological therapy, particularly during the COVID-19 pandemic as health care systems moved to remote service delivery. However, computerized cognitive behavioral therapy (cCBT) requires active engagement by service users, and low adherence may minimize treatment effectiveness. Therefore, it is important to investigate the acceptability of cCBT to understand implementation issues and maximize potential benefits. Objective: This study aimed to produce a critical appraisal of published reviews about the acceptability of cCBT for adults. Methods: An umbrella review informed by the Joanna Briggs Institute (JBI) methodology identified systematic reviews about the acceptability of cCBT for common adult mental disorders. Acceptability was operationalized in terms of uptake of, dropping out from, or completion of cCBT treatment; factors that facilitated or impeded adherence; and reports about user, carer, and health care professional experience and satisfaction with cCBT. Databases were searched using search terms informed by relevant published research. Review selection and quality appraisal were guided by the JBI methodology and the AMSTAR tool and undertaken independently by 2 reviewers. Results: The systematic searches of databases identified 234 titles, and 9 reviews (covering 151 unique studies) met the criteria. Most studies were comprised of service users with depression, anxiety, or specifically, panic disorder or phobia. Operationalization of acceptability varied across reviews, thereby making it difficult to synthesize results. There was a similar number of guided and unguided cCBT programs; 34% of guided and 36% of unguided users dropped out; and guidance included email, telephone, face-to-face, and discussion forum support. Guided cCBT was completed in full by 8%-74% of the participants, while 94% completed one module and 67%-84% completed some modules. Unguided cCBT was completed in full by 16%-66% of participants, while 95% completed one module and 54%-93% completed some modules. Guided cCBT appeared to be associated with adherence (sustained via telephone). A preference for face-to-face CBT compared to cCBT (particularly for users who reported feeling isolated), internet or computerized delivery problems, negative perceptions about cCBT, low motivation, too busy or not having enough time, and personal circumstances were stated as reasons for dropping out. Yet, some users favored the anonymous nature of cCBT, and the capacity to undertake cCBT in one's own time was deemed beneficial but also led to avoidance of cCBT. There was inconclusive evidence for an association between sociodemographic variables, mental health status, and cCBT adherence or dropping out. Users tended to be satisfied with cCBT, reported improvements in mental health, and recommended cCBT. Overall, the results indicated that service users' preferences were important considerations regarding the use of cCBT. Conclusions: The review indicated that "one size did not fit all" regarding the acceptability of cCBT and that individual tailoring of cCBT is required in order to increase population reach, uptake, and adherence and therefore, deliver treatment benefits and improve mental health.
  • Sturesson, L.; Lindstrom, V.; Castren, M.; Niemi-Murola, L.; Falk, A. -C. (2016)
    Background: Pain is one of the most common symptoms in the Emergency Department (ED) and is the cause of more than half of the visits to the ED. Several attempts to improve pain management have been done by using, for example, standards/guidelines and education. To our knowledge no one has investigated if and how different actions over a longitudinal period affect the frequency of pain documentation in the ED. Therefore the aim of this study was to describe the frequency of documented pain assessments in the ED. Method: A cross-sectional study during 2006-2012 was conducted. The care of patients with wrist/arm fractures or soft tissue injuries on upper extremities was evaluated. Result: Despite various actions our result shows that mandatory pain assessment in the patient's computerized medical record was the only successful intervention to improve the frequencies of documentation of pain assessment during care in the ED. During the study period, no documentation of reassessment of pain was found despite the fact that all patients received pain medication. Conclusion: To succeed in increasing the frequency of documented pain assessment, mandatory pain rating is a successful action. However, the re-evaluation of documented pain assessment was nonexisting. (C) 2016 Elsevier Ltd. All rights reserved.
  • Mattila-Holappa, Pauliina; Kausto, Johanna; Aalto, Ville; Kaila-Kangas, Leena; Kivimäki, Mika; Oksanen, Tuula; Ervasti, Jenni (2021)
    PurposeAlternative duty work is a procedure that enables an employee with a short-term disability to perform modified duties as an alternative to sickness absence. We examined whether the implementation of an alternative duty policy was associated with reduced sickness absence in the Finnish public sector.MethodsTwo city administrations (A and D) that implemented an alternative duty work policy to their employees (n=5341 and n=7538) served as our intervention cities, and two city administrations (B and C) that did not implement the policy represented the reference cities (n=6976 and n=6720). The outcomes were the number of annual days, all episodes, and short-term (
  • Kiiski, A.; Airaksinen, M.; Mäntylä, A.; Desselle, S.; Kumpusalo-Vauhkonen, A.; Järvensivu, T.; Pohjanoksa-Mäntylä, M. (2019)
    Background Collaborative medication review (CMR) practices for older adults are evolving in many countries. Development has been under way in Finland for over a decade, but no inventory of evolved practices has been conducted. The aim of this study was to identify and describe CMR practices in Finland after 10 years of developement. Methods An inventory of CMR practices was conducted using a snowballing approach and an open call in the Finnish Medicines Agency's website in 2015. Data were quantitatively analysed using descriptive statistics and qualitatively by inductive thematic content analysis. Clyne et al's medication review typology was applied for evaluating comprehensiveness of the practices. Results In total, 43 practices were identified, of which 22 (51%) were designed for older adults in primary care. The majority (n = 30, 70%) of the practices were clinical CMRs, with 18 (42%) of them being in routine use. A checklist with criteria was used in 19 (44%) of the practices to identify patients with polypharmacy (n = 6), falls (n = 5), and renal dysfunction (n = 5) as the most common criteria for CMR. Patients were involved in 32 (74%) of the practices, mostly as a source of information via interview (n = 27, 63%). A medication care plan was discussed with the patient in 17 practices (40%), and it was established systematically as usual care to all or selected patient groups in 11 (26%) of the practices. All or selected patients' medication lists were reconciled in 15 practices (35%). Nearly half of the practices (n = 19, 44%) lacked explicit methods for following up effects of medication changes. When reported, the effects were followed up as a routine control (n = 9, 21%) or in a follow-up appointment (n = 6, 14%). Conclusions Different MRs in varying settings were available and in routine use, the majority being comprehensive CMRs designed for primary outpatient care and for older adults. Even though practices might benefit from national standardization, flexibility in their customization according to context, medical and patient needs, and available resources is important.
  • Niemi, Riitta; Vilar, Maria J; Dohoo, I.R.; Hovinen, Mari; Simojoki, Heli; Rajala-Schultz, Päivi Johanna (2020)
    Antibiotic dry cow therapy (DCT) is an important part of most mastitis control programs. Updating DCT recommendations is an ongoing topic due to the global problem of antimicrobial resistance. Finland, along with other Nordic countries, has implemented selective DCT for decades. Our study analyzed Dairy Herd Improvement (DHI) information from 241 Finnish farmers who participated in a survey about their drying-off practices. The aim was to evaluate herd-level associations between milk somatic cell count (SCC), milk production, and various antimicrobial DCT approaches both cross-sectionally in 2016 and longitudinally in 2012 - 2016. The three DCT approaches in the study were selective, blanket, and no DCT use. An additional aim was to evaluate whether dynamic changes occurred in herd-average SCC and annual milk production over five years, and whether these potential changes differed between different DCT approaches. The method for the longitudinal analyses was growth modeling with random coefficient models. Differences in SCC and milk production between farms with different DCT approaches were minor. Regardless of the farm's DCT approach, annual milk production increased over the years, while average SCC was reasonably constant. The variability in SCC and milk production across all DCT groups was low between years, and most of the variability was between farms. Compared to other milking systems, farms with automatic milking system (AMS) had higher SCC, and in 2016 higher milk production. The results of this study suggest that it is possible to maintain low herd-average SCC and good milk production when using selective DCT and following the guidelines for prudent antimicrobial use. Average SCC and milk production varied across the herds, suggesting that advice on DCT practices should be herd-specific. The methodology of growth modeling using random coefficient models was applicable in analyzing longitudinal data, in which the time frame was relatively short and the number of herds was limited.
  • Aulbach, Matthias Burkard; Knittle, Keegan; van Beurden, Samantha Barbara; Haukkala, Ari; Lawrence, Natalia S. (2021)
    Food Go/No-Go training aims to alter implicit food biases by creating associations between perceiving unhealthy foods and withholding a dominant response. Asking participants to repeatedly inhibit an impulse to approach unhealthy foods can decrease unhealthy food intake in laboratory settings. Less is known about how people engage with app-based Go/No-Go training in real-world settings and how this might relate to dietary outcomes. This pragmatic observational study investigated associations between the number of completed app-based food Go/No-Go training trials and changes in food intake (Food Frequency Questionnaire; FFQ) for different healthy and unhealthy food categories from baseline to one-month follow-up. In total, 1234 participants (m(BMI) = 29 kg/ m2, m(age) = 43years, 69% female) downloaded the FoodT app and completed food-Go/No-Go training at their own discretion (mean number of completed sessions = 10.7, sd = 10.3, range: 1-122). In pre-registered analyses, random-intercept linear models predicting intake of different foods, and controlled for baseline consumption, BMI, age, sex, smoking, metabolic syndrome, and dieting status, revealed small, significant associations between the number of completed training trials and reductions in unhealthy food intake (b = -0.0005, CI95 = [-0.0007;0.0003]) and increases in healthy food intake (b = 0.0003, CI95 = [0.0000; 0.0006]). These relationships varied by food category, and exploratory analyses suggest that more temporally spaced training was associated with greater changes in dietary intake. Taken together, these results imply a positive association between the amount of training completed and beneficial changes in food intake. However, the results of this pragmatic study should be interpreted cautiously, as self-selection biases, motivation and other engagement-related factors that could underlie these associations were not accounted for. Experimental research is needed to rule out these possible confounds and establish causal dose-response relationships between patterns of engagement with food Go/No-Go training and changes in dietary intake.
  • Kosola, Silja; Culnane, Evelyn; Loftus, Hayley; Tornivuori, Anna; Kallio, Mira; Telfer, Michelle; Miettinen, Päivi J.; Kolho, Kaija-Leena; Aalto, Kristiina; Raivio, Taneli; Sawyer, Susan (2021)
    Introduction More than 10% of adolescents live with a chronic disease or disability that requires regular medical follow-up as they mature into adulthood. During the first 2 years after adolescents with chronic conditions are transferred to adult hospitals, non-adherence rates approach 70% and emergency visits and hospitalisation rates significantly increase. The purpose of the Bridge study is to prospectively examine associations of transition readiness and care experiences with transition success: young patients' health, health-related quality of life (HRQoL) and adherence to medical appointments as well as costs of care. In addition, we will track patients' growing independence and educational and employment pathways during the transition process. Methods and analysis Bridge is an international, prospective, observational cohort study. Study participants are adolescents with a chronic health condition or disability and their parents/guardians who attended the New Children's Hospital in Helsinki, Finland, or the Royal Children's Hospital (RCH) in Melbourne, Australia. Baseline assessment took place approximately 6 months prior to the transfer of care and follow-up data will be collected 1 year and 2 years after the transfer of care. Data will be collected from patients' hospital records and from questionnaires completed by the patient and their parent/guardian at each time point. The primary outcomes of this study are adherence to medical appointments, clinical health status and HRQoL and costs of care. Secondary outcome measures are educational and employment outcomes. Ethics and dissemination The Ethics Committee for Women's and Children's Health and Psychiatry at the Helsinki University Hospital (HUS/1547/2017) and the RCH Human Research Ethics Committee (38035) have approved the Bridge study protocol. Results will be published in international peer-reviewed journals and summaries will be provided to the funders of the study as well as patients and their parents/guardians.
  • Bousquet, J.; Bewick, M.; Cano, A.; Eklund, P.; Fico, G.; Goswami, N.; Guldemond, N. A.; Henderson, D.; Hinkema, M. J.; Liotta, G.; Mair, A.; Molloy, W.; Monaco, A.; Monsonis-Paya, I.; Nizinska, A.; Papadopoulos, H.; Pavlickova, A.; Pecorelli, S.; Prados-Torres, A.; Roller-Wirnsberger, R. E.; Somekh, D.; Vera-Munoz, C.; Visser, F.; Farrell, J.; Malva, J.; Ranberg, K. Andersen; Camuzat, T.; Carriazo, A. M.; Crooks, G.; Gutter, Z.; Iaccarino, G.; Manuel De Keenoy, E.; Moda, G.; Rodriguez-Manas, L.; Vontetsianos, T.; Abreu, C.; Alonso, J.; Alonso-Bouzon, C.; Ankri, J.; Arredondo, M. T.; Avolio, F.; Bedbrook, A.; Bialoszewski, A. Z.; Blain, H.; Bourret, R.; Cabrera-Umpierrez, M. F.; Catala, A.; O'Caoimh, R.; Cesari, M.; Chavannes, N. H.; Correia-Da-Sousa, J.; Dedeu, T.; Ferrando, M.; Ferri, M.; Fokkens, W. J.; Garcia-Lizana, F.; Guerin, O.; Hellings, P. W.; Haahtela, T.; Illario, M.; Inzerilli, M. C.; Carlsen, K. C. Lodrup; Kardas, P.; Keil, T.; Maggio, M.; Mendez-Zorrilla, A.; Menditto, E.; Mercier, J.; Michel, J. P.; Murray, R.; Nogues, M.; O'Byrne-Maguire, I.; Pappa, D.; Parent, A. S.; Pastorino, M.; Robalo-Cordeiro, C.; Samolinski, B.; Siciliano, P.; Teixeira, A. M.; Tsartara, S. I.; Valiulis, A.; Vandenplas, O.; Vasankari, T.; Vellas, B.; Vollenbroek-Hutten, M.; Wickman, M.; Yorgancioglu, A.; Zuberbier, T.; Barbagallo, M.; Canonica, G. W.; Klimek, L.; Maggi, S.; Aberer, W.; Akdis, C.; Adcock, I. M.; Agache, I.; Albera, C.; Alonso-Trujillo, F.; Angel Guarcia, M.; Annesi-Maesano, I.; Apostolo, J.; Arshad, S. H.; Attalin, V.; Avignon, A.; Bachert, C.; Baroni, I.; Bel, E.; Benson, M.; Bescos, C.; Blasi, F.; Barbara, C.; Bergmann, K. C.; Bernard, P. L.; Bonini, S.; Bousquet, P. J.; Branchini, B.; Brightling, C. E.; Bruguiere, V.; Bunu, C.; Bush, A.; Caimmi, D. P.; Calderon, M. A.; Canovas, G.; Cardona, V.; Carlsen, K. H.; Cesario, A.; Chkhartishvili, E.; Chiron, R.; Chivato, T.; Chung, K. F.; D'Angelantonio, M.; De Carlo, G.; Cholley, D.; Chorin, F.; Combe, B.; Compas, B.; Costa, D. J.; Costa, E.; Coste, O.; Coupet, A. -L.; Crepaldi, G.; Custovic, A.; Dahl, R.; Dahlen, S. E.; Demoly, P.; Devillier, P.; Didier, A.; Dinh-Xuan, A. T.; Djukanovic, R.; Dokic, D.; Du Toit, G.; Dubakiene, R.; Dupeyron, A.; Emuzyte, R.; Fiocchi, A.; Wagner, A.; Fletcher, M.; Fonseca, J.; Fougere, B.; Gamkrelidze, A.; Garces, G.; Garcia-Aymeric, J.; Garcia-Zapirain, B.; Gemicioglu, B.; Gouder, C.; Hellquist-Dahl, B.; Hermosilla-Gimeno, I.; Heve, D.; Holland, C.; Humbert, M.; Hyland, M.; Johnston, S. L.; Just, J.; Jutel, M.; Kaidashev, I. P.; Khaitov, M.; Kalayci, O.; Kalyoncu, A. F.; Keijser, W.; Kerstjens, H.; Knezovic, J.; Kowalski, M.; Koppelman, G. H.; Kotska, T.; Kovac, M.; Kull, I.; Kuna, P.; Kvedariene, V.; Lepore, V.; Macnee, W.; Maggio, M.; Magnan, A.; Majer, I.; Manning, P.; Marcucci, M.; Marti, T.; Masoli, M.; Melen, E.; Miculinic, N.; Mihaltan, F.; Milenkovic, B.; Millot-Keurinck, J.; Mlinaric, H.; Momas, I.; Montefort, S.; Morais-Almeida, M.; Moreno-Casbas, T.; Moesges, R.; Mullol, J.; Nadif, R.; Nalin, M.; Navarro-Pardo, E.; Nekam, K.; Ninot, G.; Paccard, D.; Pais, S.; Palummeri, E.; Panzner, P.; Papadopoulos, N. K.; Papanikolaou, C.; Passalacqua, G.; Pastor, E.; Perrot, M.; Plavec, D.; Popov, T. A.; Postma, D. S.; Price, D.; Raffort, N.; Reuzeau, J. C.; Robine, J. M.; Rodenas, F.; Robusto, F.; Roche, N.; Romano, A.; Romano, V.; Rosado-Pinto, J.; Roubille, F.; Ruiz, F.; Ryan, D.; Salcedo, T.; Schmid-Grendelmeier, P.; Schulz, H.; Schunemann, H. J.; Serrano, E.; Sheikh, A.; Shields, M.; Siafakas, N.; Scichilone, N.; Siciliano, P.; Skrindo, I.; Smit, H. A.; Sourdet, S.; Sousa-Costa, E.; Spranger, O.; Sooronbaev, T.; Sruk, V.; Sterk, P. J.; Todo-Bom, A.; Touchon, J.; Tramontano, D.; Triggiani, M.; Tsartara, S. I.; Valero, A. L.; Valovirta, E.; Van Ganse, E.; Van Hage, M.; Van den Berge, M.; Vandenplas, O.; Ventura, M. T.; Vergara, I.; Vezzani, G.; Vidal, D.; Viegi, G.; Wagemann, M.; Whalley, B.; Wickman, M.; Wilson, N.; Yiallouros, P. K.; Zagar, M.; Zaidi, A.; Zidarn, M.; Hoogerwerf, E. J.; Usero, J.; Zuffada, R.; Senn, A.; De Oliveira-Alves, B. (2017)
    The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups' new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).
  • 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.
  • Kallio, Sonja E.; Kiiski, Annika; Airaksinen, Marja S. A.; Mäntylä, Antti T.; Kumpusalo-Vauhkonen, Anne E. J.; Järvensivu, Timo P.; Pohjanoksa-Mantyla, Marika K. (2018)
    ObjectivesTo identify medication review interventions for older adults that involve community pharmacists and evidence of outcomes of these interventions. DesignSystematic review. MeasurementsCinahl, MEDLINE (Ovid), Scopus, International Pharmaceutical Abstracts, and Cochrane Library were searched for articles published between January 2000 and February 2016. Articles involving community pharmacists in medication reviews for outpatients aged 65 and older were included. Evidence of economic, clinical, and humanistic outcomes of interventions was summarized. ResultsSixteen articles were found that described 12 medication review interventions, of which 6 were compliance and concordance reviews, 4 were clinical medication reviews, and 2 were prescription reviews according to a previously developed typology. Community pharmacists' contributions to reviewing medications varied from sending the dispensing history to other healthcare providers to comprehensive involvement in medication management. The most commonly assessed outcomes of the interventions were medication changes leading to reduction in actual or potential drug-related problems (n=12) and improved adherence (n=5). ConclusionRegardless of community pharmacists' contributions to interventions, medication review interventions seem to reduce drug-related problems and increase medication adherence. More well-designed, rigorous studies with more sensitive and specific outcomes measures need to be conducted to assess the effect of community pharmacists' contributions to reviewing medications and improving the health of older adults.
  • Lohela, Terhi J.; Nesbitt, Robin C.; Pekkanen, Juha; Gabrysch, Sabine (2019)
    Facility delivery should reduce early neonatal mortality. We used the Slope Index of Inequality and logistic regression to quantify absolute and relative socioeconomic inequalities in early neonatal mortality (0 to 6 days) and facility delivery among 679,818 live births from 72 countries with Demographic and Health Surveys. The inequalities in early neonatal mortality were compared with inequalities in postneonatal infant mortality (28 days to 1 year), which is not related to childbirth. Newborns of the richest mothers had a small survival advantage over the poorest in unadjusted analyses (-2.9 deaths/1,000; OR 0.86) and the most educated had a small survival advantage over the least educated (-3.9 deaths/1,000; OR 0.77), while inequalities in postneonatal infant mortality were more than double that in absolute terms. The proportion of births in health facilities was an absolute 43% higher among the richest and 37% higher among the most educated compared to the poorest and least educated mothers. A higher proportion of facility delivery in the sampling cluster (e.g. village) was only associated with a small decrease in early neonatal mortality. In conclusion, while socioeconomically advantaged mothers had much higher use of a health facility at birth, this did not appear to convey a comparable survival advantage.
  • Puumalainen, Emmi; Airaksinen, Marja; Jalava, Sanni E.; Chen, Timothy F.; Dimitrow, Maarit (2020)
    Purpose This study aims to systematically review studies describing screening tools that assess the risk for drug-related problems (DRPs) in older adults (>= 60 years). The focus of the review is to compare DRP risks listed in different tools and describe their development methods and validation. Methods The systematic search was conducted using evidence-based medicine, Medline Ovid, Scopus, and Web of Science databases from January 1, 1985, to April 7, 2016. Publications describing general DRP risk assessment tools for older adults written in English were included. Disease, therapy, and drug-specific tools were excluded. Outcome measures included an assessment tool's content, development methods, and validation assessment. Results The search produced 15 publications describing 11 DRP risk assessment tools. Three major categories of risks for DRPs included (1) patient or caregiver related risks; (2) pharmacotherapy-related risks; and (3) medication use process-related risks. Of all the risks included in the tools only 8 criteria appeared in at least 4 of the tools, problems remembering to take the medication being the most common (n=7). Validation assessments varied and content validation was the most commonly conducted (n = 9). Reliability assessment was conducted for 6 tools, most commonly by calculating internal consistency (n = 3) and inter-rater reliability (n = 2). Conclusions The considerable variety between the contents of the tools indicates that there is no consensus on the risk factors for DRPs that should be screened in older adults taking multiple medicines. Further research is needed to improve the accuracy and timeliness of the DRP risk assessment tools.
  • Helanterä, Ilkka; Snyder, Jon; asberg, Anders; Cruzado, Josep Maria; Bell, Samira; Legendre, Christophe; Tedesco-Silva, Helio; Barcelos, Giovanna Tedesco; Geissbuehler, Yvonne; Prieto, Luis; Christian, Jennifer B.; Scalfaro, Erik; Dreyer, Nancy A. (2022)
    While great progress has been made in transplantation medicine, long-term graft failure and serious side effects still pose a challenge in kidney transplantation. Effective and safe long-term treatments are needed. Therefore, evidence of the lasting benefit-risk of novel therapies is required. Demonstrating superiority of novel therapies is unlikely via conventional randomized controlled trials, as long-term follow-up in large sample sizes pose statistical and operational challenges. Furthermore, endpoints generally accepted in short-term clinical trials need to be translated to real-world (RW) care settings, enabling robust assessments of novel treatments. Hence, there is an evidence gap that calls for innovative clinical trial designs, with RW evidence (RWE) providing an opportunity to facilitate longitudinal transplant research with timely translation to clinical practice. Nonetheless, the current RWE landscape shows considerable heterogeneity, with few registries capturing detailed data to support the establishment of new endpoints. The main recommendations by leading scientists in the field are increased collaboration between registries for data harmonization and leveraging the development of technology innovations for data sharing under high privacy standards. This will aid the development of clinically meaningful endpoints and data models, enabling future long-term research and ultimately establish optimal long-term outcomes for transplant patients.
  • Lias, Noora; Lindholm, Tanja; Pohjanoksa-Mantyla, Marika; Westerholm, Aleksi; Airaksinen, Marja (2021)
    Background New competence requirements have emerged for pharmacists as a result of changing societal needs towards more patient-centred practices. Today, medication review competence can be considered as basic pharmaceutical competence. Medication review specific competence criteria and tools for self-assessing the competence are essential in building competences and a shared understanding of medication reviews as a collaborative practice. The aim of this study was to develop and pilot a self-assessment tool for medication review competence among practicing pharmacists in Finland. Methods The development of the self-assessment tool was based on the national medication review competence criteria for pharmacists established in Finland in 2017 and piloting the tool among practicing pharmacists in a national online survey in October 2018. The pharmacists self-assessed their medication review competence with a five-point Likert scale ranging from 1 for "very poor/not at all" to 5 for "very good". Results The internal consistency of the self-assessment tool was high as the range of the competence areas' Cronbach's alpha was 0.953-0.973. The competence areas consisted of prescription review competence (20 items, Cronbach's alpha 0.953), additional statements for medication review competence (11 additional items, Cronbach's alpha 0.963) and medication review as a whole, including both the statements of prescription review and medication review competence (31 items, Cronbach's alpha 0.973). Competence items closely related to routine dispensing were most commonly self-estimated to be mastered by the practicing pharmacists who responded (n = 344), while the more clinical and patient-centred competence items had the lowest self-estimates. This indicates that the self-assessment tool works logically and differentiates pharmacists according to competence. The self-assessed medication review competence was at a very good or good level among more than half (55%) of the respondents (n = 344). Conclusion A self-assessment tool for medication review competence was developed and validated. The piloted self-assessment tool can be used for regular evaluation of practicing pharmacists' medication review competence which is becoming an increasingly important basis for their contribution to patient care and society.
  • Saarinen, Aino I. L.; Keltikangas-Järvinen, Liisa; Hintsa, Taina; Pulkki-Råback, Laura; Ravaja, Niklas; Lehtimäki, Terho; Raitakari, Olli; Hintsanen, Mirka (2020)
    Background This study investigated (i) whether compassion is associated with blood pressure or hypertension in adulthood and (ii) whether familial risk for hypertension modifies these associations. Method The participants (N = 1112-1293) came from the prospective Young Finns Study. Parental hypertension was assessed in 1983-2007; participants' blood pressure in 2001, 2007, and 2011; hypertension in 2007 and 2011 (participants were aged 30-49 years in 2007-2011); and compassion in 2001. Results High compassion predicted lower levels of diastolic and systolic blood pressure in adulthood. Additionally, high compassion was related to lower risk for hypertension in adulthood among individuals with no familial risk for hypertension (independently of age, sex, participants' and their parents' socioeconomic factors, and participants' health behaviors). Compassion was not related to hypertension in adulthood among individuals with familial risk for hypertension. Conclusion High compassion predicts lower diastolic and systolic blood pressure in adulthood. Moreover, high compassion may protect against hypertension among individuals without familial risk for hypertension. As our sample consisted of comparatively young participants, our findings provide novel implications for especially early-onset hypertension.
  • Sadeniemi, Minna; Pirkola, Sami; Pankakoski, Maiju; Joffe, Grigori; Kontio, Raija; Malin, Maili; Ala-Nikkola, Taina; Wahlbeck, Kristian (2014)
  • Pena, Sebastian; Carranza, Macarena; Cuadrado, Cristobal; Parra, Diana C.; Villalobos Dintrans, Pablo; Castillo, Cecilia; Cortinez-O'Ryan, Andrea; Espinoza, Paula; Muller, Valeska; Rivera, Cristian; Genovesi, Romina; Riesco, Juan; Kontto, Jukka; Cerda, Ricardo; Zitko, Pedro (2021)
    Objective The aim of this study was to examine the effectiveness of a school-based gamification strategy to prevent childhood obesity. Methods Schools were randomized in Santiago, Chile, between March and May 2018 to control or to receive a nutrition and physical activity intervention using a gamification strategy (i.e., the use of points, levels, and rewards) to achieve healthy challenges. The intervention was delivered for 7 months and participants were assessed at 4 and 7 months. Primary outcomes were mean difference in BMI z score and waist circumference (WC) between trial arms at 7 months. Secondary outcomes were mean difference in BMI and systolic and diastolic blood pressure between trial arms at 7 months. Results A total of 24 schools (5 controls) and 2,197 students (653 controls) were analyzed. Mean BMI z score was lower in the intervention arm compared with control (adjusted mean difference -0.133, 95% CI: -0.25 to -0.01), whereas no evidence of reduction in WC was found. Mean BMI and systolic blood pressure were lower in the intervention arm compared with control. No evidence of reduction in diastolic blood pressure was found. Conclusions The multicomponent intervention was effective in preventing obesity but not in reducing WC. Gamification is a potentially powerful tool to increase the effectiveness of school-based interventions to prevent obesity.
  • Suojanen, L-U; Ahola, A. J.; Kupila, S.; Korpela, R.; Pietiläinen, K. H. (2020)
    Obesity is an important public health concern with limited effective treatment options. Internet-based technologies offer a cost-effective means to treat obesity. However, most of the online programs have been of short duration, have focused on a limited number of treatment modalities, and have not utilized the potential of coaching as part of the intervention. In this paper, we present the design, methods and participants' baseline characteristics in a real-life internet-based weight management program. Healthy Weight Coaching (HWC) is a 12-month web-based intervention for the management of obesity. The program is based on the Acceptance and Commitment Therapy and includes themes important for weight loss, including diet, physical activity, psychological factors, and sleep. In addition to the automated, interactive program, a personal coach is allocated to each participant. The participants are nationally enrolled through referrals from primary care, occupational health, hospitals, and private health care units. Adult individuals with BMI >= 25 kg/m(2) without severe complications are included. On a weekly basis, participants submit their weight logs, training sessions, and lifestyle targets to the internet portal and are scheduled to have online discussions with their coaches 26 times over the course of a year. Questionnaires on lifestyle, diet, physical activity, psychological factors, sleep, and quality of life are completed at baseline, 3, 6, 9, and 12 months, and thereafter yearly until 5 years. Additionally, log data on the use of the service and discussions with the coach are collected. The main outcome is weight change from baseline to 12 months. Recruitment to the HWC is ongoing. Baseline data of the participants recruited between Oct 2016 and Mar 2019 (n = 1189) are provided. This research will bring insight into how internet-based technologies can be implemented in the virtual management of obesity.