Browsing by Subject "PEOPLE"

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  • Mietola, Reetta; Vehmas, Simo (2019)
    This paper discusses youth and the significance of age in the lives of persons with profound intellectual and multiple disabilities. The analysis is based on an ethnographic research project that explores what makes a good life for this group of people. The findings indicate that whilst the meaning and significance of youth and age were discussed often by care workers and family members, age had very little significance in the lives of our research participants. Youth as a phase of life gets lost in the transition from children's services to adult services: age in the lives of persons with profound intellectual disabilities means merely a move from one service system to another. For the care workers, age provides a way to evaluate and criticize the service system and whether it caters for the individual needs of persons with profound intellectual disabilities.
  • Tzoulas, Konstantinos; Galan, Juanjo; Venn, Stephen; Dennis, Matthew; Pedroli, Bas; Mishra, Himansu; Haase, Dagmar; Pauleit, Stephan; Niemelä, Jari; James, Philip (2021)
    This article provides a perspective on nature-based solutions. First, the argument is developed that nature-based solutions integrate social and ecological systems. Then, theoretical considerations relating to relational values, multifunctionality, transdisciplinarity, and polycentric governance are briefly outlined. Finally, a conceptual model of the social–ecological system of nature-based solutions is synthesised and presented. This conceptual model comprehensively defines the social and ecological external and internal systems that make up nature-based solutions, and identifies theoretical considerations that need to be addressed at different stages of their planning and implementation The model bridges the normative gaps of existing nature-based solution frameworks and could be used for consistent, comprehensive, and transferable comparisons internationally. The theoretical considerations addressed in this article inform practitioners, policymakers, and researchers about the essential components of nature-based solutions. The conceptual model can facilitate the identification of social and ecological interconnections within nature-based solutions and the range of stakeholders and disciplines involved.
  • Rapo-Pylkkö, Susanna; Haanpää, Maija; Liira, Helena (2017)
    Background: Chronic, mostly musculoskeletal pain is common among older adults. Little is known about the prognosis of chronic pain and the neuropathic pain qualities in older adults. We studied a cohort of community-dwelling older adults, clinically assessed their pain states, classified their type of pain (nociceptive, neuropathic or combined) and followed them up for a year. Methods: At baseline, a geriatrician clinically examined all study patients and classified their type of pain in collaboration with a pain specialist. Pain, quality of life and mental health were measured by questionnaires (BPI, GDS-15, BAI and SF-36) and reassessed after 1 year. Results: Despite chronic pain, all patients from the baseline cohort continued to live independently at 1 year. A total of 92 of 106 (87%) patients returned the follow-up questionnaire. Nociceptive pain on its own was present in 48 patients, whereas 44 patients also had neuropathic pain. Most patients (96%) had several pain states at baseline, and 13 patients reported a new pain state at follow-up. On average, there were no significant changes in the pain intensity, pain interference, mood or quality of life in either group between baseline and follow-up. Changes in pain were observed at the individual level, and both intensity and interference of pain at the follow-up had a negative correlation with the baseline value. Conclusions: On average, chronic pain was persistent in our patients, but they were able to live independently despite their pain. At the individual level, both relief and exacerbation of pain were observed, supporting the notion that pain is not inevitable and unremitting among older adults.
  • Rantanen, Pekka; Parkkari, Timo; Leikola, Saija; Airaksinen, Marja; Lyles, Alan (2017)
    Purpose: We examined the safety profile and usability of an integrated advanced robotic device and telecare system to promote medication adherence for elderly home-care patients. Methods: There were two phases. Phase I aimed to verify under controlled conditions in a single nursing home (n = 17 patients) that no robotic malfunctions would hinder the device's safe use. Phase II involved home-care patients from 3 sites (n = 27) who were on long-term medication. On-time dispensing and missed doses were recorded by the robotic system. Patients' and nurses' experiences were assessed with structured interviews. Findings: The 17 nursing home patients had 457 total days using the device (Phase I; mean, 26.9 per patient). On-time sachet retrieval occurred with 97.7% of the alerts, and no medication doses were missed. At baseline, Phase II home-dwelling patients reported difficulty remembering to take their medicines (23%), and 18% missed at least 2 doses per week. Most Phase II patients (78%) lived alone. The device delivered and patients retrieved medicine sachets for 99% of the alerts. All patients and 96% of nurses reported the device was easy to use. (C) 2017 The Authors. Published by Elsevier HS Journals, Inc.
  • Weichert, I.; Romero-Ortuno, R.; Tolonen, J.; Soe, T.; Lebus, C.; Choudhury, S.; Nadarajah, C. V.; Nanayakkara, P.; Orru, M.; Di Somma, S. (2018)
    What is known and objectiveDrugs with anticholinergic properties increase the risk of falls, delirium, chronic cognitive impairment, and mortality and counteract procholinergic medications used in the treatment of dementia. Medication review and optimisation to reduce anticholinergic burden in patients at risk is recommended by specialist bodies. Little is known how effective this review is in patients who present acutely and how often drugs with anticholinergic properties are used temporarily during an admission. The aim of the study was to describe the changes in the anticholinergic cognitive burden (ACB) in patients admitted to hospital with a diagnosis of delirium, chronic cognitive impairment or falls and to look at the temporary use of anticholinergic medications during hospital stay. MethodsThis is a multi-centre observational study that was conducted in seven different hospitals in the UK, Finland, The Netherlands and Italy. Results and discussion21.1% of patients had their ACB score reduced by a mean of 1.7%, 19.7% had their ACB increased by a mean of 1.6%, 22.8% of DAP naive patients were discharged on anticholinergic medications. There was no change in the ACB scores in 59.2% of patients. 54.1% of patients on procholinergics were taking anticholinergics. Out of the 98 medications on the ACB scale, only 56 were seen. Medications with a low individual burden were accounting for 64.9% of the total burden. Anticholinergic drugs were used temporarily during the admission in 21.9% of all patients. A higher number of DAPs used temporarily during admission was associated with a higher risk of ACB score increase on discharge (OR=1.82, 95% CI for OR: 1.36-2.45, P What is new and conclusionThere was no reduction in anticholinergic cognitive burden during the acute admissions. This was the same for all diagnostic subgroups. The anticholinergic load was predominantly caused by medications with a low individual burden. More than 1 in 5 patients not taking anticholinergics on admission were discharged on them and similar numbers saw temporary use of these medications during their admission. More than half of patients on cholinesterase-inhibitors were taking anticholinergics at the same time on admission, potentially directly counteracting their effects.
  • Herkman, Juha (2017)
    Populism as a concept is elusive and has been connected to very different political movements. Generally, populism's connotations are rather negative and the term is often used pejoratively in the academic field as well. However, Ernesto Laclau has approached populism by arguing that populist reason is a manifestation of political logic in which group identification formed through various signifiers such as 'the people', which are articulated as part of an 'equivalence chain' - eventually establishes political agency as a totality. This paper uses Laclau's articulation theory to analyse the public construction of contemporary populism in the Nordic countries of Sweden, Finland, Norway and Denmark. The analysis demonstrates that mainstream media frame populism rather negatively, although examples of the term's positive identification with 'the people' are available, especially in the tabloid media. Thus, the positive identification behind the forming of populist movements clashes with the media discourse that prioritizes established journalistic views, practices and sources, making populism a 'floating signifier', that is, a concept that has several meanings which are contested in various public discourses. A general pattern in the construction of populism in Northern European multi-party democracies can be discerned, thus identifying the central role of nationalist and nativist identifications in contingent populist articulations. However, the differences between the Nordic countries emphasize a context-driven approach.
  • Jyväkorpi, S. K.; Urtamo, A.; Kivimäki, M.; Strandberg, T. E. (2020)
    Key summary pointsAim To investigate how food and dietary intakes, protein daily distribution and source were associated with appendicular lean mass (ALM)/m(2) in the oldest-old community-dwelling men. Findings ALM/m(2) was associated with total protein intake, source and distribution as well as fruit and vegetable intakes. Message Not only protein intake, but also source and distribution as well as healthy overall diet characterized by abundant amounts of fruits and vegetables were important in maintaining muscle mass in the oldest-old men in our study. Purpose We explored how food and dietary intakes, protein daily distribution and source are associated with appendicular lean mass (ALM)/m(2) of the oldest-old community-dwelling men. Methods Cross-sectional analyses of Helsinki Businessmen Study (HBS, mean age 87 years) participants who came to clinic visit in 2017/2018. Nutritional status, physical performance and fasting blood samples were measured. Food and dietary intakes were retrieved from 3-day food diaries. Body composition was measured and appendicular lean mass (ALM) per m(2) was dichotomized as ALM/m(2) <7 kg/m(2) and >= 7 kg/m(2). Differences between lower and higher ALM were analyzed using t test or Mann-Whitney U test. Analysis of covariance was used to investigate independent associations with ALM/m(2). Results Random sample of 130 participants took part in the medical examinations, 126 returned food diaries, and 102 underwent DXA-scan. ALM/m(2) was associated with total protein (p = 0.033), animal protein (p = 0.043) and meat protein (p = 0.033) intakes. Protein distribution between daily meals differed at lunch; those with higher ALM/m(2) ate more protein (p = .047) at lunch. Consumption of fruits, vegetables (p = 0.022) and meat (p = 0.006) was associated with ALM/m(2). Conclusion Protein intake, source and distribution as well fruit and vegetable intakes were associated with higher ALM in oldest-old men. Study registration The study is registered with ClinicalTrials.gov identifier: NCT02526082.
  • Stubbs, Brendon; Vancampfort, Davy; Mänty, Minna; Svärd, Anna; Rahkonen, Ossi; Lahti, Jouni (2017)
    This study aimed to examine the bidirectional relationship between psychotropic medication use and changes in leisure-time physical activity (LTPA) among a population cohort study. Phase 1 data were collected by mail surveys in 2000-2002 among 40-60-year-old employees of the City of Helsinki, Finland, and phase 2 follow up survey was conducted in 2007. Based on self-report, the respondents were classified as inactive and active (.14.75 MET-hours/week) at the phases 1 and 2. Hazard ratios (HR) were calculated for subsequent (2007-10) psychotropic medication purchasing according to changes in physical activity (phases 1-2). Odds ratios (OR) for physical inactivity at phase 2 were calculated according to the amount of psychotropic medication between phases 1-2. Overall, 5361 respondents were included (mean age 50 years, 80% women). Compared with the persistently active, the persistently inactive, those decreasing and adopting LTPA had an increased risk for psychotropic medication. Only the persistently inactive remained at increased risk for psychotropic medication use, following the adjustment for prior psychotropic medication use. Compared with those having no medication, the risk for physical inactivity increased as the psychotropic medication increased. Our data suggest that physical activity has an important role in maintaining wellbeing and reducing psychotropic medication usage.
  • FINGER Study Grp; Stephen, Ruth; Liu, Yawu; Ngandu, Tiia; Antikainen, Riitta; Hulkkonen, Juha; Koikkalainen, Juha; Levälahti, Esko; Parkkola, Riitta; Pippola, Pauliina; Rinne, Juha; Strandberg, Timo; Tuomilehto, Jaakko; Vanninen, Ritva; Kivipelto, Miia; Soininen, Hilkka; Solomon, Alina (2019)
    BackgroundThe Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) was a multicenter randomized controlled trial that reported beneficial effects on cognition for a 2-year multimodal intervention (diet, exercise, cognitive training, vascular risk monitoring) versus control (general health advice). This study reports exploratory analyses of brain MRI measures.MethodsFINGER targeted 1260 older individuals from the general Finnish population. Participants were 60-77years old, at increased risk for dementia but without dementia/substantial cognitive impairment. Brain MRI scans were available for 132 participants (68 intervention, 64 control) at baseline and 112 participants (59 intervention, 53 control) at 2years. MRI measures included regional brain volumes, cortical thickness, and white matter lesion (WML) volume. Cognition was assessed at baseline and 1- and 2-year visits using a comprehensive neuropsychological test battery. We investigated the (1) differences between the intervention and control groups in change in MRI outcomes (FreeSurfer 5.3) and (2) post hoc sub-group analyses of intervention effects on cognition in participants with more versus less pronounced structural brain changes at baseline (mixed-effects regression models, Stata 12).ResultsNo significant differences between the intervention and control groups were found on the changes in MRI measures. Beneficial intervention effects on processing speed were more pronounced in individuals with higher baseline cortical thickness in Alzheimer's disease signature areas (composite measure of entorhinal, inferior and middle temporal, and fusiform regions). The randomization groupxtimexcortical thickness interaction coefficient was 0.198 (p=0.021). A similar trend was observed for higher hippocampal volume (groupxtimexhippocampus volume interaction coefficient 0.1149, p=0.085).ConclusionsThe FINGER MRI exploratory sub-study did not show significant differences between the intervention and control groups on changes in regional brain volumes, regional cortical thicknesses, or WML volume after 2years in at-risk elderly without substantial impairment. The cognitive benefits on processing speed of the FINGER intervention may be more pronounced in individuals with fewer structural brain changes on MRI at baseline. This suggests that preventive strategies may be more effective if started early, before the occurrence of more pronounced structural brain changes.Trial registrationClinicalTrials.gov, NCT01041989. Registered January 5, 2010.
  • Bombieri, G.; Naves, J.; Penteriani, Vincenzo; Selvas, N.; Fernandez-Gil, A.; Lopez-Bao, J.; Ambarli, H.; Bautista, C.; Bespalova, T.; Bobrov, Alexander; Bolshakov, Vladimir N.; Bondarchuk, S.; Camarra, J. J.; Chiriac, S.; Ciucci, P.; Dutsov, A.; Dykyy,; Fedriani, J. M.; Garcia-Rodriguez, A.; Garrote, P. J.; Gashev, S.; Groff, C.; Gutleb, B.; Haring, M.; Harkonen, S.; Huber, D.; Kaboli, M.; Kalinkin, Y.; Karamanlidis, A. A.; Karpin, Miika; Kastrikin,; Khlyap, L.; Khoetsky, P.; Kojola, Soili; Kozlow, Y.; Korolev, A.; Korytin, N.; Kozsheechkin, V.; Krofel, M.; Kurhinen, J.; Kuznetsova, Ekaterina; Larin, E.; Levykh, A.; Mamontov, Viktor N.; Mannil, P.; Melovski, D.; Mertzanis, Y.; Meydus, A.; Mohammadi, A.; Norberg, H.; Palazon, S.; Patrascu, L. M.; Pavlova, K.; Pedrini, P.; Quenette, P. Y.; Revilla, E.; Rigg, R.; Rozhkov, Y.; Russo, L. F.; Rykov, A.; Saburova, L.; Sahlen, Veronica; Saveljev, A. P.; Seryodkin, I.; Shelekhov, A.; Shishikin, A.; Shkvyria, M.; Sidorovich, Anna A.; Sopin,; Stoen, O.; Stofik, J.; Swenson, J. E.; Tirski, D.; Vasin, A.; Wabakken, P.; Yarushine, L.; Zwijacz-Kozica, T.; Delgado, M. M. (2019)
    The increasing trend of large carnivore attacks on humans not only raises human safety concerns but may also undermine large carnivore conservation efforts. Although rare, attacks by brown bears Ursus arctos are also on the rise and, although several studies have addressed this issue at local scales, information is lacking on a worldwide scale. Here, we investigated brown bear attacks (n = 664) on humans between 2000 and 2015 across most of the range inhabited by the species: North America (n = 183), Europe (n = 291), and East (n = 190). When the attacks occurred, half of the people were engaged in leisure activities and the main scenario was an encounter with a female with cubs. Attacks have increased significantly over time and were more frequent at high bear and low human population densities. There was no significant difference in the number of attacks between continents or between countries with different hunting practices. Understanding global patterns of bear attacks can help reduce dangerous encounters and, consequently, is crucial for informing wildlife managers and the public about appropriate measures to reduce this kind of conflicts in bear country.
  • Saarela, R. K. T.; Savikko, N. M.; Soini, H.; Muurinen, S.; Suominen, M. H.; Kautiainen, H.; Pitkälä, K. H. (2019)
    Objectives Poor oral health may complicate eating and deteriorate nutritional status. However, little is known about how the burden of oral symptoms (OS) is associated with the health-related quality of life (HRQoL) of vulnerable older people in institutional settings. This study explores how the burden of certain OS (chewing problems, swallowing difficulties, dry mouth) is associated with functioning, morbidity, nutritional status and eating habits. It also examines the association between the OS burden and HRQoL. Design A cross-sectional study in 2017. Setting All long-term care wards in Helsinki, Finland. Participants 2401 older residents (74% females, mean age 83.9). Measurements Nurses assessed the residents and completed questionnaires on the participants' demographics, functional status, diagnoses, OS and eating habits. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and HRQoL with a 15-dimensional instrument (15D). Results Of the residents, 25.4% had one OS and 16.6% two or three OS. OS burden was associated linearly with poorer cognitive and physical functioning and a higher number of comorbidities, edentulousness without dentures, and less frequent teeth brushing/denture cleaning. OS burden was also associated with malnutrition, lower BMI and eating less during main meals. In the multivariate analyses adjusted for various confounding factors, a higher number of OS was associated with lower HRQoL. OS burden correlated with nearly all dimensions of HRQoL. Conclusion Oral symptoms are associated with generic HRQoL. Therefore, OS should be regularly assessed and managed in daily care.
  • Ojansuu, Ilkka; Putkonen, Hanna; Tiihonen, Jari (2018)
    Purpose: To analyze the causes of mortality among patients committed to compulsory forensic psychiatric hospital treatment in Finland during 1980-2009 by categorizing the causes of mortality into somatic diseases, suicides and other unnatural deaths.Materials and methods: The causes of mortality were analyzed among 351 patients who died during the follow-up. Standardized mortality ratio (SMR) was calculated as the ratio of observed and expected number of deaths by using the subject-years methods with 95% confidence intervals, assuming a Poisson distribution. The expected number of deaths was calculated on the basis of sex-, age- and calendar-period-specific mortality rates for the Finnish population.Results: The vast majority (249/351) of deaths were due to a somatic disease with SMR of 2.6 (mean age at death 61 years). Fifty nine patients committed suicide with a SMR of 7.1 (mean age at death 40 years). Four patients were homicide victims (mean age at death 40 years) and 32 deaths were accidental (mean age at death 52 years). The combined homicides and accidental deaths resulted in a SMR of 1.7.Conclusions: The results of this study point out that the high risk for suicide should receive attention when the hospital treatment and the outpatient care is being organized for forensic psychiatric patients. In addition, the risk of accidents should be evaluated and it should be assured that the patients receive proper somatic healthcare during the forensic psychiatric treatment and that it continues also in the outpatient setting.
  • Karppinen, Helena; Pitkala, Kaisu H.; Kautiainen, Hannu; Tilvis, Reijo S.; Valvanne, Jaakko; Yoder, Kathe; Strandberg, Timo E. (2017)
    Objective: To explore changes in self-reported disabilities, health, comorbidities and psychological wellbeing (PWB) in aged cohorts over two decades. Design, setting and subjects: Cross-sectional cohort studies with postal surveys were conducted among community-dwelling people aged 75, 80, 85, 90 and 95 years in 1989 (n = 660), 1999 (n = 2598) and 2009 (n = 1637) in Helsinki, Finland. Main outcome measures: Self-reported items on disability, self-rated health (SRH), diagnoses and PWB were compared between cohorts of the same age. Standardized mortality ratios (SMRs) were calculated for each study year to explore the representativeness of the samples compared to general population of same age. Results: A significantly lower proportion of the 75-85-year-olds of the later study years reported going outdoors daily, although this group had improvements in both SRH and PWB scores. The number of comorbidities increased over time among 75-85-year-olds. The only significant change that could be verified among 90- and 95-year-olds between 1999 and 2009, was the lower proportion of participants going outdoors daily. The trend of leveling-off in disabilities was not explained by the SMRs (0.90, 0.71 and 0.60 for 1989, 1999 and 2009). Conclusions: The latest older people's cohorts showed an end to previously reported improvements in disabilities, despite having favorable trends in SRH and PWB. Primary care may be faced with increasing need of appropriate services for their senior members.
  • Ikäheimo, Ilona; Karjalainen, Merja; Tiihonen, Miia; Haanpää, Maija; Kautiainen, Hannu; Saltevo, Juha; Mäntyselkä, Pekka (2019)
    What is known and objective Polypharmacy and age are known to increase the risk for potential drug interactions. Type 2 diabetes has been associated with polypharmacy and several comorbidities. Currently, there is no information on whether the frequency of clinically relevant drug-drug interactions and the risk for drug adverse effects differ between older persons with and without diabetes. The aim of this study was to investigate the frequency of drug-drug interactions and the risk for drug adverse effects in these two groups in primary care. Methods The basic study population consisted of Finnish home-dwelling primary care patients aged >= 65 years (N = 3039). For each person with diabetes, two controls were selected with adjusted age and gender. To collect data, electronic primary care patient records, a structured health questionnaire and a structured health examination conducted by a physician were utilized. Using the SFINX-PHARAO (R) database, drug-drug interactions and the risk for drug adverse effects were evaluated in 182 persons with type 2 diabetes and 176 persons without diabetes. Results and discussion There were no significant differences in the frequency of drug-drug interactions or the risk for drug adverse effects in persons with and without diabetes. At least one clinically relevant interaction was found in 81 (44.5%) persons with diabetes and 73 (41.5%) persons without diabetes. The most common drugs causing interactions included non-steroidal anti-inflammatory drugs (NSAIDs) and warfarin. What is new and conclusion There is no difference in the frequency of drug-drug interactions or risk for drug adverse effects in older home-dwelling persons with and without diabetes. Due to common comorbidities and commonly used drugs among persons with diabetes, drug-drug interactions involving warfarin or NSAIDs in particular should be carefully monitored to avoid drug adverse effects.
  • Kallio, Eeva-Liisa; Öhman, Hanna; Kautiainen, Hannu; Hietanen, Marja; Pitkala, Kaisu (2017)
    Background: Cognitive training (CT) refers to guided cognitive exercises designed to improve specific cognitive functions, as well as enhance performance in untrained cognitive tasks. Positive effects of CT on cognitive functions in healthy elderly people and persons with mild cognitive impairment have been reported, but data regarding the effects of CT in patients with dementia is unclear. Objective: We systematically reviewed the current evidence from randomized controlled trials (RCTs) to find out if CT improves or stabilizes cognition and/or everyday functioning in patients with mild and moderate Alzheimer's disease. Results: Altogether, 31 RCTs with CT as either the primary intervention or part of a broader cognitive or multi-component intervention were found. A positive effect was reported in 24 trials, mainly on global cognition and training-specific tasks, particularly when more intensive or more specific CT programs were used. Little evidence of improved everyday functioning was found. Conclusions: Despite some positive findings, the inaccurate definitions of CT, inadequate sample sizes, unclear randomization methods, incomplete datasets at follow-up and multiple testing may have inflated the results in many trials. Future high quality RCTs with appropriate classification and specification of cognitive interventions are necessary to confirm CT as an effective treatment option in Alzheimer's disease.
  • 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.
  • Wasserman, D.; Apter, G.; Baeken, C.; Bailey, S.; Balazs, J.; Bec, C.; Bienkowski, P.; Bobes, J.; Ortiz, M. F. Bravo; Brunn, H.; Boke, O.; Camilleri, N.; Carpiniello, B.; Chihai, J.; Chkonia, E.; Courtet, P.; Cozman, D.; David, M.; Dom, G.; Esanu, A.; Falkai, P.; Flannery, W.; Gasparyan, K.; Gerlinger, G.; Gorwood, P.; Gudmundsson, O.; Hanon, C.; Heinz, A.; Dos Santos, M. J. Heitor; Hedlund, A.; Ismayilov, F.; Ismayilov, N.; Isometsä, E. T.; Izakova, L.; Kleinberg, A.; Kurimay, T.; Reitan, S. Klaebo; Lecic-Tosevski, D.; Lehmets, A.; Lindberg, N.; Lundblad, K. A.; Lynch, G.; Maddock, C.; Malt, U. F.; Martin, L.; Martynikhin, I.; Maruta, N. O.; Matthys, F.; Mazaliauskiene, R.; Mihajlovic, G.; Peles, A. Mihaljevic; Miklavic, V.; Mohr, P.; Ferrandis, M. Munarriz; Musalek, M.; Neznanov, N.; Ostorharics-Horvath, G.; Pajevic, I.; Popova, A.; Pregelj, P.; Prinsen, E.; Rados, C.; Roig, A.; Kuzman, M. Rojnic; Samochowiec, J.; Sartorius, N.; Savenko, Y.; Skugarevsky, O.; Slodecki, E.; Soghoyan, A.; Stone, D. S.; Taylor-East, R.; Terauds, E.; Tsopelas, C.; Tudose, C.; Tyano, S.; Vallon, P.; van der Gaag, R. J.; Varandas, P.; Vavrusova, L.; Voloshyn, P.; Wancata, J.; Wise, J.; Zemishlany, Z.; Oncu, F.; Vahip, S. (2020)
    Background. Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. Methods. The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. Results. We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. Conclusions. We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
  • Turunen, Merita; Hokkanen, Laura; Bäckman, Lars; Stigsdotter-Neely, Anna; Hänninen, Tuomo; Paajanen, Teemu; Soininen, Hilkka; Kivipelto, Miia; Ngandu, Tiia (2019)
    The possibilities of computer-based cognitive training (CCT) in postponing the onset of dementia are currently unclear, but promising. Our aim is to investigate older adults ' adherence to a long-term CCT program, and which participant characteristics are associated with adherence to the CCT. This study was part of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Participants were 60-77-year-old individuals with increased dementia risk, recruited from previous population-based studies. The participants included in this study (n = 631) had been randomized to receive a multi-domain lifestyle intervention, including CCT. The measure of adherence was the number of completed CCT sessions (max = 144) as continuous measure. Due to a substantial proportion of participants with 0 sessions, the zero inflated negative binomial regression analyses were used to enable assessment of both predictors of starting the training and predictors of completing a higher number of training sessions. Several cognitive, demographic, lifestyle, and health-related variables were examined as potential predictors of adherence to CCT. Altogether, 63% of the participants participated in the CCT at least once, 20% completed at least half of the training, and 12% completed all sessions. Previous experience with computers, being married or cohabiting, better memory performance, and positive expectations toward the study predicted greater odds for starting CCT. Previous computer use was the only factor associated with a greater number of training sessions completed. Our study shows that there is a large variation in adherence to a long-lasting CCT among older adults with an increased risk of dementia. The results indicate that encouraging computer use, and taking into account the level of cognitive functioning, may help boost adherence to CCT.
  • Valimaki, Maritta; Kuosmanen, Lauri; Hatonen, Heli; Koivunen, Marita; Pitkanen, Anneli; Athanasopoulou, Christina; Anttila, Minna (2017)
    Purpose: Information and communication technologies have been developed for a variety of health care applications and user groups in the field of health care. This study examined the connectivity to computers and the Internet among patients with schizophrenia spectrum disorders (SSDs). Patients and methods: A cross-sectional survey design was used to study 311 adults with SSDs from the inpatient units of two psychiatric hospitals in Finland. The data collection lasted for 20 months and was done through patients' medical records and a self-reported, structured questionnaire. Data analysis included descriptive statistics. Results: In total, 297 patients were included in this study (response rate =96%). More than half of them (n=156; 55%) had a computer and less than half of them (n=127; 44%) had the Internet at home. Of those who generally had access to computers and the Internet, more than one-fourth (n=85; 29%) used computers daily, and > 30% (n=96; 33%) never accessed the Internet. In total, approximately one-fourth of them (n=134; 25%) learned to use computers, and less than one-third of them (n=143; 31%) were known to use the Internet by themselves. Older people (aged 45-65 years) and those with less years of education (primary school) tended not to use the computers and the Internet at all (P <0.001), and younger people and those with higher education were associated with more active use. Conclusion: Patients had quite good access to use computers and the Internet, and they mainly used the Internet to seek information. Social, occupational, and psychological functioning (which were evaluated with Global Assessment of Functioning) were not associated with access to and frequency of computer and the Internet use. The results support the use of computers and the Internet as part of clinical work in mental health care.
  • Toivo, Terhi; Dimitrow, Maarit; Puustinen, Juha; Savela, Eeva; Pelkonen, Katariina; Kiuru, Valtteri; Suominen, Tuula; Kinnunen, Sirkka; Uunimäki, Mira; Kivelä, Sirkka-Liisa; Leikola, Saija; Airaksinen, Marja (2018)
    Background: The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients >= 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. Methods: Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession's existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design. Discussion: The new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50-70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients' physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure. The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources.