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.
  • 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.
  • 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)
  • 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.
  • Halonen, J. I.; Solovieva, S.; Pentti, J.; Kivimaki, M.; Vahtera, J.; Viikari-Juntura, E. (2016)
    Objectives Policies have been introduced to reduce sickness absence, but their effectiveness is largely unknown. In a natural experiment, we examined effects of legislative changes on return to work and work participation. Methods The source population consisted of up to 72164 Finnish public sector employees with a permanent job contract in 2008-2011 (before) and in 2013-2014 (after). We used employees with a continuous sickness absence of at least 30 calendar-days (n=5708-6393), 60 compensated days (n=1481-1655) and 90 compensated days (n=766-932). We examined sustainable return to work (a minimum of 28 consecutive working days) with survival analysis as well as monthly work participation after a sickness absence, and annual gain in work participation after the intervention, using trajectory analyses. Results Sustainable return to work after 60days of sickness absence occurred earlier after the legislative changes (p value 0.017), although the effect reduced towards the end of the follow-up. There were no differences in return to work after a 30 or 90days of sickness absence. The largest annual gain, postintervention versus preintervention, in monthly work participation was observed among employees with 60days of sickness absence and was 230.9 person-years/10000 employees. The corresponding annual gains among those with 30days and 90days of sickness absence were 51.8 and 39.6, respectively. Conclusions Our findings suggest that the legislative changes, obligating early notification of prolonged sickness absences as well as assessment of remaining work ability and possibilities to continue working, may enhance sustainable return to work in the short term. Other measures will be needed to enhance work participation, especially in the long term.
  • Toivo, Terhi; Airaksinen, Marja; Dimitrow, Maarit; Savela, Eeva; Pelkonen, Katariina; Kiuru, Valtteri; Suominen, Tuula; Uunimäki, Mira; Kivelä, Sirkka-Liisa; Leikola, Saija; Puustinen, Juha (2019)
    Background As populations are aging, a growing number of home care clients are frail and use multiple, complex medications. Combined with the lack of coordination of care this may pose uncontrolled polypharmacy and potential patient safety risks. The aim of this study was to assess the impact of a care coordination intervention on medication risks identified in drug regimens of older home care clients over a one-year period. Methods Two-arm, parallel, cluster randomized controlled trial with baseline and follow-up assessment at 12 months. The study was conducted in Primary Care in Lohja, Finland: all 5 home care units, the public healthcare center, and a private community pharmacy. Participants: All consented home care clients aged > 65 years, using at least one prescription medicine who were assessed at baseline and at 12 months. Intervention: Practical nurses were trained to make the preliminary medication risk assessment during home visits and report findings to the coordinating pharmacist. The coordinating pharmacist prepared the cases for the triage meeting with the physician and home care nurse to decide on further actions. Each patient's physician made the final decisions on medication changes needed. Outcomes were measured as changes in medication risks: use of potentially inappropriate medications and psychotropics; anticholinergic and serotonergic load; drug-drug interactions. Results Participants (n = 129) characteristics: mean age 82.8 years, female 69.8%, mean number of prescription medicines in use 13.1. The intervention did not show an impact on the medication risks between the original intervention group and the control group in the intention to treat analysis, but the per protocol analysis indicated tendency for effectiveness, particularly in optimizing central nervous system medication use. Half (50.0%) of the participants with a potential need for medication changes, agreed on in the triage meeting, had none of the medication changes actually implemented. Conclusion The care coordination intervention used in this study indicated tendency for effectiveness when implemented as planned. Even though the outcome of the intervention was not optimal, the value of this paper is in discussing the real world experiences and challenges of implementing new practices in home care.
  • GBD 2017 DALYs & HALE Coll (2018)
    Background How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Sociodemographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7.4 years (95% uncertainty interval 74-7.8), from 65.6 years (65.3-65- 8) in 1990 to 73.0 years (72.7-73.3) in 2017. The increase in years of life varied from 5.1 years (5.0-5.3) in high SDI countries to 12.0 years (11.3-12.8) in low SDI countries. Of the additional years of life expected at birth, 26.3% (20.1-33.1) were expected to be spent in poor health in high SDI countries compared with 11.7% (8.8-15.1) in low-middle SDI countries. HALE at birth increased by 6.3 years (5.9-6.7), from 57.0 years (54.6-59.1) in 1990 to 63.3 years (60.5-65.7) in 2017. The increase varied from 3.8 years (3.4-4.1) in high SDI countries to 10.5 years (9.8-11.2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1.0 year (0.4-1.7) in Saint Vincent and the Grenadines (62.4 years [59.9-64.7] in 1990 to 63.5 years [60.9-65.8] in 2017) to 23.7 years (21.9-25.6) in Eritrea (30.7 years [28.9-32.2] in 1990 to 54.4 years [51.5-57.1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1.4 years (0.6-2.3) in Algeria to 11.9 years (10.9-12.9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75.8 years [72.4-78.7]) and males (72.6 years [69 " 8-75.0]) and the lowest estimates were in Central African Republic (47.0 years [43.7-50.2] for females and 42.8 years [40.1-45.6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41.3% (38.8-43.5) for communicable diseases and by 49"8% (47.9-51.6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40.1% (36.8-43.0), although age-standardised DALY rates decreased by 18.1% (16.0-20.2). Interpretation With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low S DI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.
  • Volanen, S-M.; Lassander, M.; Hankonen, N.; Santalahti, P.; Hintsanen, M.; Simonsen, N.; Raevuori, A.; Mullola, S.; Vahlberg, T.; But, A.; Suominen, S. (2020)
    Background Mindfulness-Based Interventions (MBIs) have shown promising effects on mental health among children and adolescents, but high-quality studies examining the topic are lacking. The present study assessed the effects of MBI on mental health in school-setting in an extensive randomised controlled trial. Methods Finnish school children and adolescents (N=3519), aged 12-15 years (6th to 8th graders), from 56 schools were randomized into a 9 week MBI group, and control groups with a relaxation program or teaching as usual. The primary outcomes were resilience, socio-emotional functioning, and depressive symptoms at baseline, at completion of the programs at 9 weeks (T9), and at follow-up at 26 weeks (T26). Results Overall, mindfulness did not show more beneficial effects on the primary outcomes compared to the controls except for resilience for which a positive intervention effect was found at T9 in all participants (β=1.18, SE 0.57, p=0.04) as compared to the relaxation group. In addition, in gender and grade related analyses, MBI lowered depressive symptoms in girls at T26 (β=-0.49, SE 0.21, p=0.02) and improved socio-emotional functioning at T9(β=-1.37, SE 0.69, p=0.049) and at T26 (β=-1.71, SE 0.73, p=0.02) among 7th graders as compared to relaxation. Limitations The inactive control group was smaller than the intervention and active control groups, reducing statistical power. Conclusions A short 9-week MBI in school-setting provides slight benefits over a relaxation program and teaching as usual. Future research should investigate whether embedding regular mindfulness-based practice in curriculums could intensify the effects.