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Adaptive expertise is a highly sought after, but difficult to achieve, outcome of mathematics education. Many teaching methods appear to support the development of adaptive expertise only in a small proportion of students. Game-based learning environments may be useful for supporting adaptive expertise. Therefore, we carried out a quasi-experimental classroom intervention to examine the possibility of using a game-based learning environment to promote adaptive rational number knowledge, a potential indicator of adaptive expertise in the domain of rational numbers. The Number Line Elaboration and Exploration learning environment relied on the increasing elaboration of the number line analogy as a means for students to explore connections between multiple aspects of rational number knowledge. Our results show the game-based learning environment was successful in promoting adaptive rational number knowledge. These results provide directions for the development and examination of how learning environments may be able to support adaptive expertise.

Mathematics anxiety hinders students' mathematical achievement already in primary school, but research on its effects beyond whole number knowledge is limited. The main aim of the current study is to examine how state and trait mathematics anxiety relate to performance across five tasks that are relevant for the development of mathematics in primary school, including a measure of adaptive expertise with school mathematics. These include mathematical tasks with non-symbolic quantities, whole numbers, and rational numbers. The participants were 406 primary school students attending the 5th grade (N = 188) and 6th grade (N = 218). Our results showed that state anxiety varies across task type. Furthermore, students' self-evaluated state and trait mathematics anxiety had varying negative relations with performance depending on the task type. In particular, we found that mathematics anxiety may limit students' adaptive expertise with rational numbers, even after controlling for other relevant mathematical skills. Overall, our results indicate that existing accounts on the role mathematics anxiety plays in school mathematics should expand to consider differences across task type and measures of anxiety.

Serious games for learning have received increased attention in recent years. However, empirical studies on students' gaming experiences throughout the developmental process of serious games and discussions regarding game design are missing. The aims of the present study were to analyze students' gaming experiences while playing four consecutive versions of the Number Navigation Game (NNG)--a mathematical game-based learning environment focusing on flexibility and adaptivity with whole-number arithmetic; and to provide an extensive review of the NNG developmental and design process over 3 years with focus on how and why the design decisions were made, and how those choices affected students' gaming experiences. The study employed a mixed-methods design of quantitative and qualitative research. The Game Experience Questionnaire about eight core game experience dimensions was answered by different groups of students at primary schools in Finland in three different experiments after students played four versions of the NNG from 2014 to 2016. Six semi structured interviews related to students' game experiences, preferences and game features of the latest version of NNG were conducted. Overall, results indicate that improvement in game's usability and clarity in the user interface has positive impacts on students' game experiences. Furthermore, there seems to be a clear advantage in having better aesthetics and value in improving extrinsic elements that could contribute to maintain players' enthusiasm and situational interest in serious games.

A Word Problem Enrichment programme (WPE) has been found to increase student word problem solving performance when facing non-routine and application problems. However, it is unknown if the WPE has an impact on student beliefs about word problem solving and how the WPE works for students with different motivation in learning mathematics. This study investigated the impact of the WPE on student beliefs about word problem solving by using Latent Profile Analysis and Structural Equation Modelling to analyse relations among the different cognitive, motivation, and belief factors. A total of 170 fourth- and sixth-grade students from elementary schools participated. Results showed that the effects of WPE are various depending on students' initial motivation level. The impacts of the WPE on student beliefs were found only in students with a low initial motivation level, while its impacts on student problem-solving performance were found only in students with a high initial motivation level.

Simple Summary: While tumor-associated macrophages (TAMs) are known to be associated with a poor prognosis in breast cancer (BC) in general, how they influence different BC subtypes has remained poorly studied. Here, we investigated the prognostic value of M2-like TAMs (CD163+) that mediate several pro-tumoral functions, and all TAMs (CD68+) in a patient cohort of 278 non-metastatic BC cases, half of which were HER2+. Our results indicate that M2-like TAMs were associated with a poor outcome in HER2+ BC, in which a high CD163+ TAM count was independently associated with an inferior outcome regardless of hormone receptor status and the use of adjuvant trastuzumab. In summary, our results suggest that the prognostic value of M2-like TAMs is especially significant in HER2+ BC; these patients might benefit from combination treatments that include therapies targeting macrophage function. Tumor-associated macrophages (TAMs) are associated with a poor outcome in breast cancer (BC), but their prognostic value in different BC subtypes has remained somewhat unclear. Here, we investigated the prognostic value of M2-like TAMs (CD163+) and all TAMs (CD68+) in a patient cohort of 278 non-metastatic BC patients, half of whom were HER2+ (n = 139). The survival endpoints investigated were overall survival (OS), breast cancer-specific survival (BCSS) and disease-free survival (DFS). In the whole patient cohort (n = 278), a high CD163+ TAM count and a high CD68+ TAM count were associated with a worse outcome (p ≤ 0.023). In HER2+ BC, a high CD163+ TAM count was an independent factor for a poor prognosis across all the investigated survival endpoints (p < 0.001). The prognostic effect was evident in both the HER2+/hormone receptor-positive (p < 0.001) and HER2+/hormone receptor-negative (p ≤ 0.012) subgroups and regardless of the provision of adjuvant trastuzumab (p ≤ 0.002). In HER2-negative BC, the CD163+ TAM count was not significantly associated with survival. These results suggest that a high CD163+ TAM count predicts an inferior outcome, especially in HER2+ BC patients, and as adjuvant trastuzumab did not overcome the poor prognostic effect, combination treatments including therapies targeting the macrophage function could represent an effective therapeutic approach in HER2+ BC. [ABSTRACT FROM AUTHOR]

Many people have serious difficulties in understanding rational numbers, limiting their ability to interpret and make use of them in modern daily life. This also leads to later difficulties in learning more advanced mathematical content. In this study, novel tasks are used to measure 263 late primary school students' spontaneous focusing on quantitative relations, in situations that are not explicitly mathematical. Even after controlling for a number of known predictors of rational number knowledge, spontaneous focusing on quantitative relations is found to have a strong impact on students' learning of rational number conceptual knowledge. This finding opens new possibilities for developing pedagogical solutions to one of the most difficult challenges of mathematics education. The findings suggest that students' own focusing tendency and self-initiated practice may have on important role in the long-term development of complex cognitive skills.

This seven-year longitudinal study examined how children's spontaneous focusing on numerosity (SFON), subitizing based enumeration, and counting skills assessed at five or six years predict their school mathematics achievement at 12 years. The participants were 36 Finnish children without diagnosed neurological disorders. The results, based on partial least squares modeling, demonstrate that SFON and verbal counting skills before school age predict mathematical performance on a standardized test for typical school mathematics in Grade 5. After controlling for nonverbal IQ, only SFON predict school mathematics. Subitizing-based enumeration skills have an indirect effect via number sequence skills and SFON on mathematical performance at 12 years. Early mathematic skills do not predict reading skills at 12 years. Children's early numerical skills, including SFON, before school age are important contributors to substantially later success in school mathematics.

While preschool-aged children display some skills with quantitative relations, later learning of related fraction concepts is difficult for many students. We present two studies that investigate young children's tendency of Spontaneous Focusing On quantitative Relations (SFOR), which may help explain individual differences in the development of fraction knowledge. In the first study, a cross-sectional sample of 84 kindergarteners to third graders completed tasks measuring their spontaneous recognition and use of quantitative relations and then completed the tasks again with explicit guidance to focus on quantitative relations. Findings suggest that SFOR is a measure of the spontaneous focusing of attention on quantitative relations and the use of these relations in reasoning. In the second (longitudinal) study, 25 first graders completed measures of SFOR tendency and a measure of fraction knowledge three years later. SFOR tendency was found to predict fraction knowledge, suggesting that it plays a role in the development of fraction knowledge.

The aim of this 2 year longitudinal study was to explore whether children's individual differences in spontaneous focusing on numerosity (SFON) in kindergarten predict arithmetical and reading skills 2 years later in school. Moreover, we investigated whether the positive relationship between SFON and mathematical skills is explained by children's individual differences in spontaneous focusing on a non-numerical aspect. The participants were 139 Finnish-speaking children. The results show that SFON tendency in kindergarten is a significant domain-specific predictor of arithmetical skills, but not reading skills, assessed at the end of Grade 2. In addition, the relationship between SFON and number sequence skills in kindergarten is not explained by children's individual differences in their focusing on a non-numerical aspect that is, spatial locations. (Contains 3 tables.)

This 3-year longitudinal study examined how motivational tendencies, that is, task orientation and social dependence orientation, as well as cognitive-linguistic prerequisites of reading and math skills (i.e., phonological awareness, rapid naming, oral language comprehension skills, number sequence and basic arithmetic skills) measured in kindergarten (5-6 years), in preschool (6-7 years), and in grade 1, predict decoding, reading comprehension and arithmetic achievement in grade 2. Moreover, the motivational-developmental profiles of children with prospective learning difficulties were compared to the profiles of averagely achieving children. The participants were 139 Finnish-speaking children. Results from regression analyses showed that rapid naming was a unique longitudinal predictor of later decoding skills. Oral comprehension skills accounted for a unique variance in reading comprehension at every time point examined. Motivational orientations started to make unique contributions to subsequent decoding accuracy, reading comprehension and arithmetic from preschool onwards, over and above the effects of prior linguistic and math skills. High task orientation was beneficial for beginning reading, whereas high social dependence orientation was detrimental for reading comprehension and arithmetic. Students who fell behind of others both in reading comprehension and arithmetic experienced the most unfavourable development of motivation already during the first term in grade 1. Implications for instructional practices are discussed.

Background: Paramedics commonly face acute crises of patients in palliative care, but their involvement in end-of-life care is not planned systematically. Aim: To evaluate a protocol for end-of-life care at home including pre-planned integration of paramedics and end-of-life care wards. Design: Paramedic visits to patients in end-of-life care protocol were retrospectively studied. Setting/Participants: All of the patients who had registered for the protocol between 1 March 2015 and 28 February 2017 in North Karelia, Finland, were included in this study. Results: A total of 256 patients were registered for the protocol and 306 visits by paramedic were needed. A need for symptom control (38%) and transportation (29%) were the most common reasons for a visit. Paramedics visited 43% and 70% of the patients in areas with and without 24/7 palliative home care services, respectively (p < 0.001); while 58% of all the visits were done outside of office hours. Problems were resolved at home in 31% of the visits. The patient was transferred to a pre-planned end-of-life care ward and to an emergency department in 48% and 16% of the cases, respectively. More patients died in end-of-life care wards in areas without (54%) than with (33%) 24/7 home care services (p = 0.001). Conclusions: Integration of paramedics into end-of-life care at home is reasonable especially in rural areas without 24/7 palliative care services and outside of office hours. The majority of patients can be managed at home or with the help of an end-of-life care ward without an emergency visit. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the impact of glaucoma on health‐related quality of life (HRQoL) and mental health in the ageing population of Finland. Methods: Altogether 7380 and 5774 Finnish individuals aged 30 years and older with known eye disease status were studied in 2000 and 2011, respectively, in two population‐based surveys, including an 11‐year follow‐up of 4683 participants. Data on HRQoL (EQ‐5D‐3L, 15D), depression (BDI), psychological distress (GHQ‐12) and eye disease diagnoses were obtained from self‐reported assessments. Information on glaucoma was complemented with the medication, diagnosis and eye surgery data obtained from the Finnish Health Registries. Distance visual acuity was assessed using the Snellen eye chart test. In logistic regression analyses, data were corrected for age, gender and the most common comorbidities. Results: Glaucoma patients with verified diagnosis (n = 192 in 2000, n = 202 in 2011) and individuals with self‐suspected glaucoma (n = 100 in 2000, n = 41 in 2011) showed a significant decrease in their HRQoL. Glaucoma was also associated with worsened overall mental health based on BDI and GHQ‐12 results. Visual impairment associated with glaucoma is the major determinant of the reduced HRQoL and mental health. Neither glaucoma medication nor glaucoma surgery affected these parameters. The impact of glaucoma on HRQoL and mental health diminished between 2000 and 2011 in a cross‐sectional setting. The newly diagnosed glaucoma during the 11‐year follow‐up had a minimal effect on them. Conclusion: Glaucoma patients show reduced HRQoL and mental health, which is associated with vision loss regardless of the awareness or treatment of the disease. However, this effect seems to be diminishing over time, and the newly diagnosed glaucoma did not show a significant effect on either HRQoL or mental health. [ABSTRACT FROM AUTHOR]

Introduction: The educational background and size of the elderly population are undergoing significant changes in Finland during the 2020s. A similar process is likely to occur also in several European countries. For cognitive screening of early Alzheimer's disease (AD), using outdated norms and cutoff scores may negatively affect clinical accuracy. The aim of the present study was to examine the effects of education, age, and gender on the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery (CERAD-nb) in a large register-based, clinical sample of patients with mild AD and nondemented at-risk persons from the general population (controls) and to examine whether corrected cutoff scores would increase the accuracy of differentiation between the 2 groups. Methods: CERAD-nb scores were obtained from AD patients (n = 389, 58% women, mean age 74.0 years) and from controls (n = 1,980, 52% women, mean age 68.5 years). The differences in CERAD-nb performance were evaluated by univariate GLM. Differentiation between the 2 groups was evaluated using a receiver operating characteristic (ROC) curve, where a larger area under the ROC curve represents better discrimination. Youden's J was calculated for the overall performance and accuracy of each of the measures. Results: Of the demographic factors, education was the strongest predictor of CERAD-nb performance, explaining more variation than age or gender in both the AD patients and the controls. Education corrected cutoff scores had better diagnostic accuracy in discriminating between the AD patients and controls than existing uncorrected scores. The highest level of discrimination between the 2 groups overall was found for two CERAD-nb total scores. Conclusions: Education-corrected cutoff scores were superior to uncorrected scores in differentiating between controls and AD patients especially for the highest level of education and should therefore be used in clinical cognitive screening, also as the proportion of the educated elderly is increasing substantially during the 2020s. Our results also indicate that total scores of the CERAD-nb are better at discriminating AD patients from controls than any single subtest score. A digital tool for calculating the total scores and comparing education-based cutoffs would increase the efficiency and usability of the test. [ABSTRACT FROM AUTHOR]

Objectives To examine whether a regular, long-term exercise program performed by individuals with Alzheimer's disease ( AD) at home or as group-based exercise at an adult daycare center has beneficial effects on cognition; to examine secondary outcomes of a trial that has been published earlier. Design Randomized, controlled trial. Setting Community. Participants Community-dwelling dyads (N = 210) of individuals with AD and their spousal caregivers randomized into three groups. Intervention Two types of intervention comprising customized home-based exercise ( HE) and group-based exercise ( GE), each twice a week for 1 year, were compared with a control group ( CG) receiving usual community care. Measurements Cognitive function was measured using the Clock Drawing Test ( CDT), Verbal Fluency ( VF), Clinical Dementia Rating ( CDR), and Mini-Mental State Examination ( MMSE) at baseline and 3, 6, and 12 months of follow-up. Results Executive function, measured using CDT, improved in the HE group, and changes in the score were significantly better than those of the CG at 12 months (adjusted for age, sex, and CDR, P = .03). All groups deteriorated in VF and MMSE score during the intervention, and no significant differences between the groups were detected at 12-month follow-up when analyses were adjusted for age, sex, and CDR. Conclusion Regular, long-term, customized HE improved the executive function of community-dwelling older people with memory disorders, but the effects were mild and were not observed in other domains of cognition. [ABSTRACT FROM AUTHOR]

Introduction. Caregiving families of patients with dementia are often reluctant to use support services. The aim of this study was to describe their subjective critiques of these services. Material and Methods. A cross-sectional questionnaire was sent to a random sample (N = 1943) of Alzheimer's patients' spouses in Finland with an open-ended question: "What kind of problems have you faced with the services?" Their responses were analyzed with thematic content analysis. Results. Of the responders identifying themselves as caregivers (N = 1386), 728 (mean age 77.8, 65.1% females) responded. Opinions could be divided into two categories: (1) problems with the service application process (N = 296); (2) critiques of the services offered (N = 270) including either problems with community care support services or institutional care. 74 indicated that they had no need for services, and 15 praised the services they had received. Conclusions. From the caregiver's perspective, the service system is complicated, bureaucratic and works organization centredly. [ABSTRACT FROM AUTHOR]

Cyclooxygenase (COX) catalyzes formation of prostaglandins that contribute to the inflammation in atherosclerosis. Our objective was to study whether the functional C variant of the -7675G → C polymorphism in the human COX-2 gene associates with the severity of coronary atherosclerosis measured at the coronary artery level. The Helsinki sudden death study autopsy material (n = 300) comprised of Finnish men who died suddenly. The area of atherosclerotic lesions in the coronary arteries was quantitated, and coronary narrowing was measured. The occurrence of myocardial infarction (MI) was assessed. Genotyping was by restriction endonuclease analysis. Men carrying the minor C allele had larger areas of complicated lesions (P = .024) and a higher number of coronary arteries that had over 50% stenosis (P = .036) compared to men representing the common GG genotype. The COX-2 polymorphism was not associated with MI. Our data suggest that COX-2 may be involved in plaque growth. [ABSTRACT FROM AUTHOR]

Objective: to determine whether impaired glucose tolerance (IGT) is associated with an increased likelihood for ischaemic stroke. Design: prospective cohort study. Participants: a sample of 1,032 non-institutionalised people aged 70 years in the Turku Elderly Study, Turku, Finland. Measurements: the association between IGT (defined as plasma glucose level between 7.80 and 11.09 mmol/1 2 h after administration of 75 g of an oral glucose load) and diabetes mellitus (DM) (defined as the current use of insulin or an oral hypoglycaemic medication, a fasting plasma glucose level of ≥7 mmol/1 or a plasma glucose level of ≥ 11.1 mmol/1 2 h after administration of an oral glucose load) with 12-year follow-up for the development of ischaemic stroke. Results: a total of 742 (71.9%) subjects had normal glucose tolerance, 127 (12.3%) subjects had IGT and 163 (15.8%) had DM. Patients were examined in the year 1990 and followed up for stroke occurrence until death or until the end of 2002. Mean follow-up time was 9.6 years (SD ±3.3 years). In total, 119 patients (11.5%) suffered a stroke during the follow-up. In logistic regression model, previous stroke, previous TIA, DM and atrial fibrillation were risk factors for stroke occurrence. Conclusion: stroke tended to happen more often in the IGT group than in the normal group, but the difference was not statistically significant. Statistically significant risk factors for stroke in elderly people are previous TIA or stroke, DM and atrial fibrillation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although the Beers criteria have been frequently utilised to describe the use of inappropriate medications in various elderly populations, less is known about the use of such medications among patients with dementia, and nor have many studies dealt with their impact on mortality or use of healthcare services. This study examines the use of inappropriate drugs and their impact on mortality and use of health services among Finnish elderly nursing home and hospital patients. Patients with dementia were studied as a special subgroup. METHODS: A total of 425 patients consecutively admitted to seven Finnish nursing homes and two hospitals in 1999–2000 were examined. Details of all medications prescribed and administered were retrieved from medical records and coded according to the Beers 1997 criteria. Mortality data as well as days in acute hospital were obtained from central registers and all area hospitals during 2 years of follow-up. RESULTS: The entire population was old and frail (mean age 86 years, 82% females), 60% had dementia and 36.2% received at least one potentially inappropriate drug (PID). No differences existed in the proportion of users of PIDs among those 60% of patients with dementia compared with those without. The most common PID was temazepam, with 14% of all patients on high doses. Other commonly used PIDs were oxybutynin and dipyridamole. Amitriptyline was more commonly used among patients without dementia (4.7%) compared with those with dementia (0.8%). Nevertheless, in this very old and frail study population, use of inappropriate drugs did not predict mortality or use of health services. CONCLUSION: Use of PIDs is common in nursing homes and hospitals in Finland but has no impact on mortality or hospital admissions. Use of high-dose temazepam as a hypnotic accounted for most of the high use of PIDs. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of surgical treatment on health-related quality of life (QoL) and its various dimensions in four common gastrointestinal diseases, to compare it with that of the general population, and to assess the relationship between the patient's and the surgeon's satisfaction. Design: Prospective, observational study. Setting: Tertiary care centre, Finland. Patients: 131 patients, of whom 77 had cholecystectomy, 20 fundoplication, 20 incisional herniorrhaphy, 12 large bowel resection, and 2 construction of a stoma only because of unresectable colorectal cancer. Interventions: Routine operative treatment of four gastrointestinal diseases. Main outcome measures: QoL measured by a generic 15-dimensional instrument. Results: The health-related QoL improved postoperatively in the entire group. Discomfort, symptoms, and vitality were all reduced at 2 months, whereas bowel movements, eating, and usual activities had been restored at 12 months. The health related QoL was comparable with that of the general population at 12 months except for breathing and sleeping. The pattern of recovery varied among diagnostic subgroups, being most improved in patients operated on for biliary disease, those aged 60 years or younger, women and otherwise previously healthy patients. There was a close agreement between the patient's and the surgeon's opinion of outcome. Conclusions: Gastrointestinal surgery improves quality of life. Separating a generic health-related QoL measure into dimensions allows a more appropriate estimation of quality of life than a single index score. Because some dimensions were made worse soon after operation and some were restored slowly, a minimum 12-month follow-up may be needed to assess the effect of gastrointestinal surgery on health- related QoL. [ABSTRACT FROM AUTHOR]

The aim of the study was to find out whether the effect of hormonal replacement therapy (HRT) is modified by the mammographic parenchymal patterns on the risk of breast cancer. Subjects were 4163 Finnish women aged 40-47 years at entry who were invited to breast cancer screening every second year from 1982 to 1990. Mammographic parenchymal patterns (Wolfe's classification) were recorded at each screening round. The information, on use of HRT, was recorded from 1984. The follow-up ended in 1993 and up until that time 68 new breast cancers were diagnosed. A Poisson regression model was used in the analysis of the data. Use of HRT was not related to the risk of breast cancer (RR = 0.7, 95% CI 0.4-1.4), whereas mammographic parenchymal pattern was statistically significantly associated with risk of breast cancer. The age-adjusted relative risk of breast cancer among women with P2 versus N1 pattern was 2.5 (95%CI 1.3-4.8) and with DY versus N1 pattern 4.9 (95%CI 1.6-15.1). Women using HRT and with DY pattern were at substantially increased risk of breast cancer (RR = 11.6, 95%CI 2.5-53.6) compared with women not using HRT and with N1 pattern. There was an increased risk of breast cancer among women with DY mammographic parenchymal pattern who used HRT, which was consistent with a synergistic joint effect. [ABSTRACT FROM AUTHOR]

The relationship between sequential mammographic parenchymal patterns and breast cancer was estimated and the results were applied to selective screening. In a pilot screening program 4163 Finnish women aged 40-47 years at entry were invited to be screened every second year from 1982 to 1990. Mammographic parenchymal patterns (Wolfe's classification) were recorded at each screening round. The follow-up ended in 1993 and up until that time 68 new breast cancers were diagnosed. The age-adjusted relative risk of breast cancer was 2.5 (95% CI 1.5-4.0) among women with high-risk mammographic parenchymal patterns (P2,DY) at the screenings preceding cancer diagnosis compared with those with low-risk patterns (N1,P1). After further adjustment for body mass index, number of pregnancies and size of the breast, the relative risk increased to 2.8 (95% CI 1.7-4.9). The mammographic parenchymal pattern is an independent risk factor of breast cancer but not strong enough to be used as a criterion for selective screening. [ABSTRACT FROM AUTHOR]

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Abstract: Background: Human enterovirus 71 (HEV71) is a common cause of severe outbreaks of hand-foot- and mouth disease, aseptic meningitis and encephalitis in Asian populations but has not caused such epidemics in all populations. Objectives: To analyze the frequency of HEV71 in the background childhood population in Finland by screening in stool and serum samples and by measuring neutralizing antibodies against HEV71 in serum and to compare the genetic relationship of virus strains detected in asymptomatic children and those causing severe illness in Finland to the strains found in other countries. Study design: 4185 stool samples and 5686 serum samples were collected and clinical symptoms recorded from children who were observed from birth. Additional stool samples were available from four children hospitalized due to EV71 infection. Samples were screened for the presence of RNA of human enteroviruses using RT-PCR and HEV71 amplicons were identified by sequencing. Phylogenetic analyses were carried out to study genetic relationships between different virus strains. Neutralizing antibodies against HEV71 were screened from 522 children. Results: A total of 0.3% of stool samples and two serum samples from healthy children were positive for HEV71 genome. 1.6% of the children had neutralizing antibodies against HEV71. Most infections were asymptomatic or mild in contrast to the clear symptoms in the children hospitalized due to HEV71. All viruses were C strains. Conclusions: HEV71 is circulating in Finland but it is rare. No clear difference was seen between strains circulating in the Finnish background population and those found in hospitalized patients or those causing severe outbreaks worldwide. [Copyright &y& Elsevier]

Abstract: Objectives: To (1) explore clinical and demographic characteristics of users and nonusers of PPIs in 3 cohorts of institutionalized older people in Finland, and (2) compare the risk of death associated with use of PPIs in each setting. Design: Cross-sectional assessment of 3 institutionalized cohorts with 1-year follow-up of all-cause mortality. Setting and Participants: A total of 1389 residents of 69 assisted living facilities (first cohort), 1004 residents of long term care hospitals (second cohort), and 425 residents in acute geriatric wards or in nursing homes (third cohort). Measurements: Demographic, drug use, and diagnostic data were collected during structured assessments conducted by trained nurses or geriatricians. Cox proportional hazards models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between use of PPIs and mortality. Results: In the assisted living facility, the mortality was 20.2% (n = 74) and 20.4% (n = 208) among users and nonusers of PPIs, respectively (P = 0.94). PPIs were not associated with mortality in unadjusted or adjusted analyses. In the long term care hospitals, use of PPIs was associated with increased mortality (HR, 1.36; 95% CI 1.04–1.77) when adjusted for age, sex, comorbidity, use of SSRIs, and malnutrition. In the acute geriatric wards and nursing homes, use of PPIs was associated with increased mortality (HR, 1.90; 95% CI 1.23–2.94) when adjusted for age, sex, comorbidity, delirium, and use of aspirin and SSRIs. Conclusion: PPIs were not associated with mortality among residents in assisted living facilities, but were associated with increased mortality in settings where residents experienced higher levels of disability and possible susceptibility to adverse drug events. [Copyright &y& Elsevier]

High latitude peatlands act as globally important carbon (C) sinks and are in constant interaction with the atmosphere. Their C storage formed during the Holocene. In the course of time, the aggregate effect of the C fluxes on radiative forcing (RF) typically changes from warming to cooling, but the timing of this shift varies among different peatlands. Here we investigated Holocene peatland development, including vegetation history, vertical peat growth and the lateral expansion of a patterned subarctic fen in northern Finland by means of multiple sampling points. We modelled the Holocene RF by combining knowledge on past vegetation communities based on plant macrofossil stratigraphies and present in situ C flux measurements. The peatland initiated at ca. 9500 calibrated years Before Present (cal yr BP), and its lateral expansion was greatest between ca. 9000 and 7000 cal yr BP. After the early expansion, vertical peat growth proceeded very differently in different parts of the peatland, regulated by internal and external factors. The pronounced surface microtopography, with high strings and wet flarks, started to form only after ca. 1000 cal yr BP. C accumulation within the peatland recorded a high degree of spatial variability throughout its history, including the recent past. We applied two flux scenarios with different interpretation of the initial peatland development phases to estimate the RF induced by C fluxes of the fen. After ca. 4000 cal yr BP, at the latest, the peatland RF has been negative (cooling), mainly driven by C uptake and biomass production, while methane emissions had a lesser role in the total RF. Interestingly, these scenarios suggest that the greatest cooling effect took place around ca. 1000 cal yr BP, after which the surface microtopography established. The study demonstrated that despite the high spatial heterogeneity and idiosyncratic behaviour of the peatland, the RF of the studied fen followed the general development pattern of more southern peatlands. Holocene climate variations and warm phases did not seem to induce any distinctive and consistent peatland-scale patterns in C accumulation, whereas our data suggests that the changes in vegetation related to autogenic succession were reflected in the C accumulation patterns and RF more clearly. • Subarctic peatland carbon dynamics showed idiosyncratic behaviour. • Radiative forcing reconstructions suggested mid-Holocene warming impact, then cooling. • Net cooling effect was driven by C uptake and biomass production. • No consistent response to warm climate was detected. [ABSTRACT FROM AUTHOR]

Purpose: The primary aim of this study was to investigate how speech-language pathologists (SLPs) from Estonia, Finland, and Lithuania rate the significance of different features for diagnosing childhood apraxia of speech (CAS) in their languages., Method: An online survey was conducted among 197 Estonian, Finnish, and Lithuanian SLPs who have worked with children with CAS. The SLPs were asked to rate the significance of 63 features for CAS diagnosis in their respective language. Cross-linguistic patterns in diagnostic features were examined with simple correspondence analysis (SCA) and via descriptive statistics., Results: The ratings revealed six to seven diagnostic features that were considered very significant for CAS diagnosis by the majority of respondents in each country. The SCA highlighted differences between Lithuanian SLPs and Estonian and Finnish SLPs. Some possible language-specific associations were noted, such as palatalization errors for Lithuanian and Estonian and diphthong distortions for Estonian. The respondents from all countries rated highly those features that can easily be applied to most languages (e.g., groping) and gave lower ratings to features that may be influenced by the linguistic structure of different languages (e.g., word stress errors)., Conclusions: Overall, SLPs provided high ratings to CAS features that occur universally across languages, whereas features specific to languages, such as prosody-related errors, were not as highly rated. Several language-specific features were highlighted, providing direction for future research and emphasizing the importance of language-specific considerations in CAS research and diagnosis.

Background: Recent research has highlighted the deficiencies and variations in the digital competences of social services and healthcare personnel. Yet there is a shortage of data regarding how the personnel use digital devices and solutions and their attitudes towards digitalisation. Hence, a systematic investigation into digital devices and solutions in healthcare is warranted., Objectives: This study aimed to analyse the similarities and differences in digital competences and organisational support among healthcare personnel, focusing on using digital applications and services. The primary research question was to investigate what kinds of digital competence profiles are identifiable through social services and healthcare personnel self-assessments., Methods: The survey was conducted in the Wellbeing Services County of Central Finland at the end of 2023. It utilised validated self-assessment methods and garnered 643 responses from social services and healthcare professionals. Data analysis involved quantitative cluster analysis for grouping participants and qualitative content analysis for describing the clusters., Results: The study resulted in a final model of seven clusters that presented distinct digital competence profiles with relatively even sizes. These clusters represented the different aspects of digital usage among social services and healthcare professionals. They could be categorised into three overarching profiles: 1) Motivated digital experts, 2) Burdened digital users and 3) Frustrated survivors. Motivated digital experts comprised up almost half of the respondents (45.1%). Still, the findings also facilitated identifying of a small group of Frustrated survivors (7.5%) who represented burdened and stressed digital users., Conclusions: The results indicate significant variances in digital competence profiles among employees. Social services and healthcare personnel perceive the opportunities and challenges associated with digital applications and services differently. Further detailed research into the disparities between digital competence profiles is necessary, particularly regarding the types of support that benefit different profiles the most., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aim: Child mortality declined significantly in Finland in 1969-2004. We investigated whether the already low mortality rate could still decline from 2005 to 2020., Methods: This was a nationwide register-based study. The subjects were children under 16 years of age who had resided in Finland between 2005 and 2020. The study population was identified from Finland's Population Information System of the Digital and Population Data Services Agency. Causes of death were obtained from Statistics Finland. Changes in annual overall and cause-specific mortality rates were evaluated., Results: 3685 children (55% boys) under 16 years of age died in Finland in 2005-2020 from 325 causes. Overall annual child mortality declined by 50% (95% confidence interval 37 to 64%) during the study period, from 0.31/1000 in 2005 to 0.16/1000 in 2020. The mortality rate in children under one year of age declined from 3.1/1000 in 2005 to 1.8/1000 in 2020. The deaths from sudden infant death syndrome fell by 84%, congenital malformations by 62%, infectious diseases by 60%, external causes by 52%, and perinatal disorders by 41%., Conclusion: Finland's low child mortality further declined over the past two decades. Contributing factors likely include achievements in paediatric research, public health, and clinical practice., (© 2024 The Author(s). Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Despite numerous surveys conducted across the world considering assisted death, content validity evaluations of the survey questionnaires are seldom published. Likewise, there is no previous research about the content validity of the survey "Finnish physicians´ attitudes and opinions on euthanasia and physician-assisted suicide" conducted by the Finnish Medical Association. The aim of this study was to assess the content validity of the survey questionnaire. To study this, a purposive sample of physicians was recruited. Firstly, the participants were interviewed to bring up their interpretations and assessments considering the relevance, comprehensibility, and measurement scale suitability of the questions. Secondly, the participants assessed the revised study questionnaire. Altogether 16 physicians participated in the study. Although the relevance and comprehensibility of the questions were assessed to be high-level, parallel interpretations of the contents were discovered. We suggest content validity research to be essential when developing a questionnaire on assisted death. Our results could be helpful when planning future surveys about this challenging topic., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval and informed consent: This study was evaluated and approved by the Regional Ethics Committee of Human Sciences, Tampere, Finland (36/2023). The participants obtained written and oral information about the study and gave their informed consent to participate. This study was conducted according to national laws, regulations, and the Declaration of Helsinki., (© 2024. The Author(s).)

Background: Adverse events occur frequently at emergency departments (ED) because of several risk factors related to varying conditions. It is still unclear, which factors lead to patient safety incident reports. The aim of this study was to explore the root causes behind ED-associated patient safety incidents reported by personnel, and based on the findings, to suggest learning objectives for improving patient safety., Methods: The study material included incident reports (n = 340) which concerned the ED of a teaching hospital over one year. We used a mixed method combining quantitative descriptive statistics and qualitative research by inductive content analysis and deductive Ishikawa root cause analysis., Results: Most (76.5%) incidents were reported after patient transfer from the ED. Nurses reported 70% of incidents and physicians 7.4%. Of the reports, 40% were related to information flow or management. Incidents were evaluated as no harm (29.4%), mild (46%), moderate (19.7%), and severe (1.2%) harm to the patient. The main consequences for the organization were reputation loss (44.1%) and extra work (38.9%). In the qualitative analysis, nine specific problem groups were found: insufficient introduction, adherence to guidelines and protocols, insufficient human resources, deficient professional skills, medication management deficiencies, incomplete information transfer from the ED, language proficiency, unprofessional behaviour, identification error, and patient-dependent problems. Six organizational themes were identified: medical staff orientation, onboarding and competence requirements; human resources; electronic medical records and information transfer; medication documentation system; interprofessional collaboration; resources for specific patient groups such as geriatric, mental health, and patients with substance abuse disorder. Entirely human factor-related themes could not be defined because their associations with system factors were complex and multifaceted. Individual and organizational learning objectives were addressed, such as adherence to the proper use of instructions and adequate onboarding., Conclusions: System factors caused most of the patient safety incidents reported concerning ED. The introduction and training of ED -processes is elementary, as is multiprofessional collaboration. More research is needed about teamwork skills, patients with special needs and non-critical patients, and the reporting of severe incidents., (© 2024. The Author(s).)

Background: Intrapartum antibiotics are used to prevent group B streptococcus disease in newborn infants. We hypothesised that intrapartum antibiotic exposure is associated with the occurrence of childhood infectious diseases because it influences the development of the gut microbiome., Methods: The cohort for this population-based study comprised vaginally delivered children born in Northern Finland in 2007-2018. We used structured electronic medical records linked to comprehensive national registers. Primary outcome was the number of infectious disease episodes leading to an emergency room visit, outpatient hospital visit, or hospitalisation from birth until five years of age., Findings: Analyses were performed on 9733 children (48.8% girls) exposed to intrapartum antibiotics and on 35,842 unexposed children (49.9% girls). Exposure to intrapartum antibiotics was associated with increased risk of any infectious disease episode at the ages 7-28 days (adjusted incidence rate ratio [aIRR] 1.30, 95% CI 1.10-1.54) and 1-2 years (aIRR 1.10, 95% CI 1.02-1.18). The occurrence of urinary tract infections was associated with the exposure to intrapartum antibiotics whereas the occurrence of severe infections caused by pathogens susceptible to penicillin was reversely associated with the exposure to intrapartum antibiotics., Interpretation: Maternal intrapartum antibiotics were associated with the occurrence of infectious diseases in the offspring. The observed associations appeared to depend on bacterial pathogens and their antimicrobial susceptibility to penicillin., Funding: Pediatric Research Foundation, Alma och K.A. Snellman Foundation, Orion Research Foundation, Päivikki and Sakari Sohlberg Foundation, Finnish Medical Foundation, Academy of Finland, Finland., Competing Interests: Declaration of interests The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Aim: Parental adverse childhood experiences (ACE) might affect the offspring health through intergenerational inheritance. The aim of this study was to investigate how paternal ACE associate with offspring sensitisation and allergic rhinitis (AR)., Methods: The study included 590 Finnish father-child dyads from the FinnBrain Birth Cohort Study. Outcomes were offspring sensitisation against allergens and AR at age 5.5 years. Paternal ACE up to 18 years were assessed using the Trauma and Distress Scale (TADS) with the lowest quarter as the reference group., Results: Of the children, 317 (54%) were males. Sensitisation occurred in 162/533 (30%) and AR in 122/590 (21%). Paternal TADS (median 17 points; interquartile range 11-27) was inversely associated with the risk of sensitisation. Children whose fathers scored the highest quarter had the lowest risk of sensitisation (adjusted odds ratio 0.42; 95% confidence interval 0.24-0.75), followed by those in the second highest quarter (0.58; 0.34-0.99). The association between the highest quarter and reduced risk of AR was similar., Conclusion: Paternal ACE were associated with a low risk of offspring sensitisation and AR, suggesting paternal childhood stress might influence immune responses in their offspring., (© 2024 The Author(s). Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Adolescents with subclinical depression are at high risk of developing mental disorders. Early interventions are effective but expensive. Affordable and accessible mental health services are needed. This multimethod study obtained its sample from the database of the Finnish national chat room service and describes the usage of the service among young people in Finland. All chats between 1.1-31.12.2018 were extracted and analysed using quantitative and qualitative methods. The usage frequency was analysed with descriptive statistics, while the specific content of the chat topics was first categorised with content analysis and then quantified and analysed using descriptive statistics. The association between the demographic characteristics and the usage were analysed. A total of 839 young people used chat room services. The great majority of the chat users were girls, and half were 12-14 years old. The use of the chat room varied in terms of the number of words and the duration of the chat discussions. Based on the chat room topics, young people had complex life situations with psychological distress, difficulties related to their social living environment, or they were involved in risky behaviour. The gender and the age of the users influenced their chat room usage. The results of this study can be used in the development of mental health services for young people.

Objectives: Deteriorating interactive ability of people with dementia challenges formal caregivers. In Finland, Deaf people with advanced dementia may live in a nursing home designed for their care where the staff use Finnish Sign Language (FiSL). This study describes the perceptions of formal caregivers, focusing on the challenges, how they solve the challenges, and what support they need to improve interaction with Deaf residents., Methods: Semi-structured interviews with 13 formal caregivers who work with Deaf people with dementia were conducted and analyzed using qualitative content analysis. A purposive sampling was used., Results: Three key themes were challenges in interaction, strategies in supporting interaction, and support for coping. Caregivers perceived challenges in interaction caused by linguistic changes, deteriorating physical mobility and memory, and Deaf residents' behavioral challenges. Caregivers supported Deaf residents by learning to know them and using personal and linguistic strategies. Support for coping comprised supporting family members and other caregivers., Conclusions: Efficient skills in sign language (SL) and knowledge of dementia are essential in interacting with Deaf residents and to build interpersonal relationships for care., Clinical Implications: Supporting Deaf residents requires learning the way they interact which can be achieved over time.

Background: Previous studies have evaluated the accuracy of the diagnostics of electronic symptom checkers (ESCs) and triage using clinical case vignettes. National Omaolo digital services (Omaolo) in Finland consist of an ESC for various symptoms. Omaolo is a medical device with a Conformité Européenne marking (risk class: IIa), based on Duodecim Clinical Decision Support, EBMEDS., Objective: This study investigates how well triage performed by the ESC nurse triage within the chief symptom list available in Omaolo (anal region symptoms, cough, diarrhea, discharge from the eye or watery or reddish eye, headache, heartburn, knee symptom or injury, lower back pain or injury, oral health, painful or blocked ear, respiratory tract infection, sexually transmitted disease, shoulder pain or stiffness or injury, sore throat or throat symptom, and urinary tract infection). In addition, the accuracy, specificity, sensitivity, and safety of the Omaolo ESC were assessed., Methods: This is a clinical validation study in a real-life setting performed at multiple primary health care (PHC) centers across Finland. The included units were of the walk-in model of primary care, where no previous phone call or contact was required. Upon arriving at the PHC center, users (patients) answered the ESC questions and received a triage recommendation; a nurse then assessed their triage. Findings on 877 patients were analyzed by matching the ESC recommendations with triage by the triage nurse., Results: Safe assessments by the ESC accounted for 97.6% (856/877; 95% CI 95.6%-98.0%) of all assessments made. The mean of the exact match for all symptom assessments was 53.7% (471/877; 95% CI 49.2%-55.9%). The mean value of the exact match or overly conservative but suitable for all (ESC's assessment was 1 triage level higher than the nurse's triage) symptom assessments was 66.6% (584/877; 95% CI 63.4%-69.7%). When the nurse concluded that urgent treatment was needed, the ESC's exactly matched accuracy was 70.9% (244/344; 95% CI 65.8%-75.7%). Sensitivity for the Omaolo ESC was 62.6% and specificity of 69.2%. A total of 21 critical assessments were identified for further analysis: there was no indication of compromised patient safety., Conclusions: The primary objectives of this study were to evaluate the safety and to explore the accuracy, specificity, and sensitivity of the Omaolo ESC. The results indicate that the ESC is safe in a real-life setting when appraised with assessments conducted by triage nurses. Furthermore, the Omaolo ESC exhibits the potential to guide patients to appropriate triage destinations effectively, helping them to receive timely and suitable care., International Registered Report Identifier (irrid): RR2-10.2196/41423., (©Ville Liu, Minna Kaila, Tuomas Koskela. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 26.09.2024.)

Background: This study aims to describe maternal depressive symptoms (MDS) trajectories in a longitudinal study extending from pregnancy to 27 years after the birth of the firstborn child. We also explored the associations of both MDS trajectories and child internalizing and externalizing problem trajectories with maternal adjustment (adaptive functioning, emotional and behavioral problems)., Methods: The population-based study was conducted in Tampere, Finland, and the sample comprised 356 first-time mothers. MDS were screened with the Edinburgh Postnatal Depression Scale during pregnancy, first week after delivery, 2 and 6 months postnatally, and when the child was 4-5, 8-9, 16-17, and 26-27 years of age. The internalizing and externalizing problems of the children were assessed with the Child Behavior Checklist when the child was 4-5, 8-9, and 16-17 years of age. Maternal adaptive functioning and internalizing and externalizing problems were assessed with the Adult Self Report at 26-27 years after the birth of the first child. Complete follow-up data were available for 168 mothers., Results: We describe a three-group trajectory model of MDS (High Stable, Low Stable, Very Low). Elevated depressive symptom patterns were associated with less optimal maternal outcomes regarding both adaptive and problem dimensions. The child's internalizing and externalizing problem trajectories were associated with maternal internalizing and externalizing problems but not with maternal adaptive functioning., Limitations: Maternal and child measures were based on maternal reports only., Conclusions: The interconnectedness of the well-being of the mother and child should be noted in health and mental health services for adults and children., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare that are relevant to the content of this article., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background and Objectives: Large-scale genome-wide studies of chronic hydrocephalus have been lacking. We conducted a genome-wide association study (GWAS) in normal pressure hydrocephalus (NPH)., Methods: We used a case-control study design implementing FinnGen data containing 473,691 Finns with genotypes and nationwide health records. Patients with NPH were selected based on ICD-10 G91.2 diagnosis. To select patients with idiopathic NPH (iNPH) for sensitivity analysis, we excluded patients with a potentially known etiology of the condition using an algorithm on their disease history. The controls were the remaining non-hydrocephalic participants. For a replication analysis, the NPH cohort from UK Biobank (UKBB) was used., Results: We included 1,522 patients with NPH (mean age 72.2 years, 53% women) and 451,091 controls (mean age 60.5 years, 44% women). In the GWAS comparing patients with NPH with the controls, we identified 6 gene regions significantly ( p < 5.0e-8) associated with NPH that replicated in a meta-analysis with UKBB (NPH n = 173). The top loci near the following genes were rs7962263, SLCO1A2 (odds ratio [OR] 0.71, 95% CI 0.65-0.78, p = 1.0e-14); rs798495, AMZ1 / GNA12 (OR 1.29, 95% CI 1.20-1.39, p = 2.9e-12); rs10828247, MLLT10 (OR 0.77, 95% CI 0.71-0.83, p = 1.5e-11); rs561699566 and rs371919113, CDCA2 (OR 0.76, 95% CI 0.70-0.82, p = 1.5e-11); rs56023709, C16orf95 (OR 1.24, 95% CI 1.16-1.33, p = 3.0e-9); and rs62434144, PLEKHG1 (OR 1.23, 95% CI 1.14-1.32, p = 1.4e-8). In the sensitivity analysis comparing only patients with iNPH (n = 1,055) with the controls (n = 451,091), 4 top loci near the following genes remained significant: rs7962263, SLCO1A2 (OR 0.70, 95% CI 0.63-0.78, p = 2.1e-11); rs10828247, MLLT10 (OR 0.74, 95% CI 0.62-0.82, p = 4.6e-10); rs798511, AMZ1 / GNA12 (OR 1.28, 95% CI 1.17-1.39, p = 1.7e-8); and rs56023709, C16orf95 (OR 1.28, 95% CI 1.17-1.39, p = 1.7e-8)., Discussion: We identified 6 loci significantly associated with NPH in the thus far largest GWAS in chronic hydrocephalus. The genes near the top loci have previously been associated with blood-brain barrier and blood-CSF barrier function and with increased lateral brain ventricle volume. The effect sizes and allele frequencies remained similar in NPH and iNPH cohorts, indicating the identified loci are risk determinants for iNPH and likely not explained by associations with other etiologies. However, the exact role of these loci is still unknown, warranting further studies.

This study aims to examine 20-year temporal trends in all-cause mortality among psychiatric patients and investigating impacts of risk factors on the time trends based on 218,703 Finnish adults with mental disorders who were discharged from 87 psychiatric hospitals between 1 Jan 1995 and 31 Dec 2014. The age-period-cohort analysis of Poisson model with random hospital effects estimated temporal trends in death rate and associated factors at individual, healthcare system, and society levels, following the WHO multilevel intervention framework model for six major psychiatric diagnosis. The adjusted annual mortality declined by 2.2 % annually (RR: 0.978 [95 % CI 0.976-0.980]) for all individuals, and by 2.8 % after adjusting for all risk factors, with varied decreasing rate between 2.0 % and 3.6 % by diagnosis. Individual level factors accounted for the declining rate by 54.5 % for all patients, with the highest impact on patients with personality disorders, followed by patients with affective disorders and patients with schizophrenia. Identified declining trends and associated factors which are preventable and modifiable for individuals with specific psychiatric diagnosis may lead to develop targeted service and intervention strategies in bringing down mortality further for the population., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

LASTU is a tool for searching for Finnish language stimulus words for psycholinguistic studies. The tool allows the user to query a number of properties, including forms, lemmas, frequencies, and morphological features. It also includes two new measures for quantifying lemma and form ambiguity. The tool is written in Python and is available for Windows and macOS platforms. It is available at https://osf.io/j8v6b/ . Included with the tool is a database based on a massive corpus of dependency-parsed Finnish language data crawled from the Internet (over 5 billion tokens). While LASTU has been developed for researchers working on the Finnish language, the openly available implementation can also be applied to other languages., (© 2024. The Author(s).)

Aims: This study aims to describe the experiences of women with gynaecological cancer regarding family-oriented care (FOC) and how they rated their health-related quality of life (HRQoL) using a 15D instrument (15D©)., Design: A cross-sectional mixed-method study., Methods: The data were collected by electronic surveys of two Finnish cancer associations from gynaecological cancer patients (n = 53). The qualitative data were analysed using thematic analysis. The HRQoL answers were analysed statistically using IBM SPSS Statistics (Version 27)., Results: The results emphasized that FOC is not yet part of the care process. Furthermore, comprehensive encounters are lacking, and the experience of being a woman is forgotten during the care process. The results of the HRQoL analysis suggest that distress and the discomfort and symptoms of cancer patients are perceived as significant factors affecting their quality of life during different phases of treatment. Family status also has an impact on perceived quality of life, whereby those living alone gave worse ratings for the depression and vitality dimensions., Conclusion: In part, the quantitative and qualitative data supported each other, but the descriptions provided a more comprehensive view of issues that affect women in a more multidimensional way, such as sexual health issues. More research on the effectiveness of FOC is needed to develop the capacity for effective healthcare., Implications for the Profession And/or Patient Care: This study was able to identify important areas for improvement in clinical practice from the perspective of patients and their families., Reporting Method: This study was prepared and reported according to the STROBE checklist., Patient or Public Contribution: No patient or public contribution., (© 2024 The Author(s). Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Arctic regions are warming significantly faster than other parts of the globe, leading to changes in snow, ice and weather conditions, ecosystems and local cultures. These changes have brought worry and concern and triggered feelings of loss among Arctic Indigenous Peoples and local communities. Recently, research has started to address emotional and social dimensions of climate change, framed through the concept of ecological grief. In this study, we examine sociocultural impacts of climate change and expressions of ecological grief among members of reindeer herding communities in the Sámi Homeland in Finland. Results indicate that ecological grief is felt in connection to major environmental concerns in the area: changes in winter weather and extreme weather events, Atlantic salmon decline and land use changes, which all have cultural and social consequences. Our results indicate that ecological grief is strongly associated with ecological losses, but also with political decisions regarding natural resource governance., (© 2024. The Author(s).)

Background and Objectives: Maternal stroke is a rare event with an increasing incidence. Data on the long-term prognosis after a maternal stroke are limited. We aimed to examine long-term mortality, recovery, vocational status and morbidity after a maternal stroke in a population-based setting including a comparison with matched, stroke-free controls., Methods: In this register-based study with hospital chart validation, we included all women with a maternal stroke in Finland in 1987-2016 who survived the first year after the event. The recovery of the cases was assessed from the hospital charts by modified Rankin scale (mRS). Three controls matched by delivery year, age, and parity were selected for each case. All deaths until 2022 were identified from the Register for Causes of Death. Data on vocational status were obtained from Statistics Finland and morbidity from the Hospital Discharge Register and patient charts until year 2016., Results: The study included 235 women with a maternal stroke and 694 matched controls. The median follow-up time was 17.5 years (interquartile range [IQR] 9.6-25.4) for mortality and 11.8 years (IQR 3.8-19.8) for vocational status and subsequent morbidity. Mortality among cases was 5.5% and among controls, 2.4% (age-adjusted odds ratio [OR] 2.3, 95% [CI] 1.1-4.9). At the end of the follow-up, 90.3% of the cases were independent in daily activities (mRS ≤2). In 2016, fewer women with a maternal stroke were working compared with controls (65.9% vs 79.1%, OR 0.5, 95% CI 0.4-0.7) and were more often receiving a pension (18.2% vs 4.9%, OR 4.4, 95% CI 2.7-7.3). Cerebrovascular events (age-adjusted OR 8.6 95% CI 4.4-17.1), cardiac diseases (age-adjusted OR 3.3, 95% CI 1.4-7.7), and major cardiovascular events were more common among cases during the follow-up (age-adjusted OR 7.6 95% CI 3.1-18.7)., Discussion: Despite having higher overall mortality and higher cardiovascular morbidity, the majority of the maternal stroke survivors recovered well. As expected, the vocational status of cases was inferior to that of controls, but most women were working at the end of the follow-up. Our study provides important information on the prognosis and sequalae after a maternal stroke to help in patient counseling and to improve secondary prevention.

Aim: To describe the childhood experiences of patients with polio from the acute phase of the disease during post-war Finland in the 1950s and 1960s., Design: Qualitative empirical study based on self-reported history of nursing rooted in the past, a history of experiences., Methodology: Interview materials were gathered in the form of themes (45) and written interviews (4) (29 September 2018 to 30 June 2019). Data were analysed by reflexive thematic analysis to highlight hidden and latent experiences. This approach generated the study's main theme, themes and subthemes., Results: The main theme, 'shattered childhood', generated from the study results and was then divided into two themes, both of which were influenced in part by the loss of a familiar childhood, the changed environment, the breakdown of the body and the absence of control. Through their childhood memories, polio survivors described their broken childhoods using the following themes: 'betrayal by their bodies' and 'isolation'. In the narratives, the theme 'betrayal by one's own body' was generated by the following subthemes: 'suddenness of the affliction', 'paralysis' and 'being moved to the hospital'. The 'isolation' theme developed from the subthemes 'isolation from the body and surroundings' and 'emotional and social loneliness'., Conclusion: Polio survivors' experiences during the acute stage of the disease were traumatic and demonstrated children's inferior nursing position in Finland in the 1950s and 1960s., Impact: The study increases our understanding of the history of caring for children and families who were affected and disabled by polio and the importance of their experiences in society and healthcare settings., Patient or Public Contribution: The authors collaborated with the Finnish Polio Association to recruit study participants and plan the study. Patients with polio during childhood underwent interviews, and their experiences formulated the data, which were analysed and the basis of the results., Reporting Method: Consolidated criteria for reporting qualitative research (COREQ), a 32-item checklist for interviews and focus groups, have been used as a reporting and checklist tool. All authors have agreed on the final version and the use of the COREQ criteria, relationship with participants, theoretical framework, setting, data collection and data analysis and report., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

American College of Medical Genetics and Genomics (ACMG) recommends offering Tier 3 carrier screening to pregnant patients and those planning a pregnancy for conditions with a carrier frequency of ≥1/200 (96 genes for autosomal recessive [AR] conditions). Certain AR conditions referred to as Finnish disease heritage (FINDIS) have a higher prevalence in Finland than elsewhere. Data from gnomAD v2.1 were extracted to assess carrier frequencies for ACMG-recommended AR and FINDIS AR and X-linked genes in Finnish, non-Finnish European, and Ashkenazi Jewish populations. Following variants were considered: ClinVar pathogenic or likely pathogenic, loss-of-function, and Finnish founder variants. Gene carrier (GCR), cumulative carrier (CCR), and at-risk couple rates (ACR) were estimated. In Finnish population, 47 genes had a GCR of ≥0.5%. CCRs were 52.7% (Finnish), 48.9% (non-Finnish European), and 58.3% (Ashkenazi Jewish), whereas ACRs were 1.4%, 0.93%, and 2.3% respectively. Approximately 141 affected children with analyzed AR conditions are estimated to be born in Finland annually. Eighteen genes causing FINDIS conditions had a GCR of ≥0.5% in the Finnish population but were absent in the ACMG Tier 3 gene list. Two genes (RECQL4 and RMRP) had GCR of ≥0.5% either in non-Finnish Europeans or Ashkenazi Jewish populations. Results highlight the need for careful curation of carrier screening panels., (© 2024 The Authors. American Journal of Medical Genetics Part A published by Wiley Periodicals LLC.)

Aim: How maternal opioid maintenance treatment (OMT) affects children is under-researched. This population-based registry study investigated child growth and somatic health following intrauterine exposure to this treatment., Methods: Children born between 1 March 2011 and 30 May 2021 to mothers who used buprenorphine, buprenorphine-naloxone, or methadone throughout their pregnancies were followed for 2 years at the Helsinki University Hospital, Finland. Appropriate statistical tests were used to compare the treatment groups., Results: Of the 67 neonates, 52% were male, 96% were born full-term and 63% were treated for neonatal opioid withdrawal syndrome. Otherwise, the children were predominantly healthy, although relatively small: 22% were small for gestational age, the methadone group children being the smallest. Foetal exposure to maternal methadone treatment, illicit drugs, hepatitis C and smoking were associated with small for gestational age; the former two were also associated with later slower growth, especially head growth and weight gain (p < 0.001). However, 29% were overweight at 2 years., Conclusion: Using child growth as the outcome, we found that buprenorphine-naloxone and buprenorphine-monotherapy had equal effects as forms of maternal OMT. Exposure to multiple risk factors may harm foetal and subsequent growth. We recommend long-term follow-up of children exposed to maternal OMT., (© 2024 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: This nationwide study evaluated the clinical impact that an early thymectomy, during congenital heart defect (CHD) surgery, had on the health of children and adolescents., Methods: The subjects were patients aged 1-15 years who had undergone CHD surgery at the University Children's Hospital, Helsinki, where all CHD surgery in Finland is carried out, from 2006 to 2018. The parents or the cases and population-based controls, matched for sex, age and hospital district, completed electronic questionnaires. We excluded those with low birth weights or a known immunodeficiency. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated for prespecified outcomes., Results: We received responses relating to 260/450 (58%) cases and 1403/4500 (31%) controls and excluded 73 cases with persistent cardiac or respiratory complaints after surgery. The CHD group reported more recurrent hospitalisations due to infections (aOR 6.3, 95% CI 3.0-13) than the controls and more pneumonia episodes (aOR 3.5, 95% CI 2.1-5.6), asthma (aOR 2.5, 95% CI 1.5-4.1) and wheezing (aOR 2.1, 95% CI 1.5-2.9)., Conclusion: Hospitalisation due to infections, pneumonia, wheezing and asthma was more common in children after a thymectomy due to open-heart surgery than population-based controls, underlining the importance of immunological follow-ups., (© 2024 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Objective: To study whether E-learning methods are feasible in the post-graduate education of palliative medicine. Methods: A mixed-methods study. Evaluations from pilot course attendees were analyzed numerically and answers to open-ended questions about E-learning were analyzed using inductive content analysis. A national pilot E-learning-based post-graduate course in palliative medicine with 24 participating physicians in Finland. The evaluation of teaching modules and different aspects of the course was achieved from the participants through numerical statements and open-ended questions. Results: The feedback on most aspects of the course was good. For example, issues of pain and symptom control, lectures, pre-exams, and group discussions were deemed suitable for E-learning, while studying communication and existential issues through E-learning was considered more challenging. The benefits of E-learning included efficacy, better accessibility, and the possibility to go back to the teaching material. Reduced networking and face-to-face interactions were stated as challenges of E-learning. Conclusions: E-learning is feasible in the post-graduate education of palliative medicine and can be 'surprisingly rewarding'. It allows easy access to learn many important topics, while social networking may fall short. Further studies are needed to assess the increase in competence by different learning methods., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The safety and efficacy of intravenous thrombolysis (IVT) and endovascular thrombectomy for an ischemic stroke (IS) during pregnancy and puerperium are poorly studied. We evaluated the complications and outcome of recanalization therapy in maternal ISs., Methods: A nationwide cohort of maternal ISs in Finland during 1987-2016 was collected by linking national healthcare registers: Medical Birth Register, Hospital Discharge Register, and Cause-Of-Death Register. The diagnoses were verified retrospectively from patient records. IVT-treated patients were compared to controls, who were young females with non-pregnancy-related IS from the Helsinki Stroke Thrombolysis Registry., Results: Totally, 12 of 97 (12.4%) maternal ISs were treated with recanalization therapy. Compared to controls, IVT-treated maternal IS patients had more frequently early (age-adjusted odds ratio (aOR) = 7.63, 95% CI 1.49-39.04) and major (aOR = 8.59, 95% CI 2.09-35.31) neurological improvements, measured using the National Institute of Health Stroke Scale. Good functional outcomes (modified Rankin Scale 0-2) at three months were equally common in maternal ISs and controls. No other complications were observed in IVT-treated maternal ISs than 1 (9.1%) symptomatic nonfatal intracranial hemorrhage. Among maternal IS patients treated with recanalization or conventional therapy, good functional outcome at the end of the follow-up was less common in recanalization-treated patients (66.7% vs 89.4%, aOR = 0.22, 95% CI 0.052-0.90), but otherwise outcomes were similar., Conclusions: In this small nationwide cohort of maternal ISs, the complications of recanalization therapy were rare, and the outcomes were similar in IVT-treated maternal IS patients and controls. Maternal ISs should not be excluded from recanalization therapy in otherwise eligible situations., (© 2024. The Author(s).)

Background: Chronic subdural haematoma is a common surgically treated intracranial emergency. Burr-hole drainage surgery, to evacuate chronic subdural haematoma, involves three elements: creation of a burr hole for access, irrigation of the subdural space, and insertion of a subdural drain. Although the subdural drain has been established as beneficial, the therapeutic effect of subdural irrigation has not been addressed., Methods: The FINISH trial was an investigator-initiated, pragmatic, multicentre, nationwide, randomised, controlled, parallel-group, non-inferiority trial in five neurosurgical units in Finland that enrolled adults aged 18 years or older with a chronic subdural haematoma requiring burr-hole drainage. Patients were randomly assigned (1:1) by computer-generated block randomisation with block sizes of four, six, or eight, stratified by site, to burr-hole drainage either with or without subdural irrigation. All patients and staff were masked to treatment assignment apart from the neurosurgeon and operating room staff. A burr hole was drilled at the site of maximum haematoma thickness in both groups, and the subdural space was either irrigated or not irrigated before inserting a subdural drain, which remained in place for 48 h. Reoperations, functional outcome, mortality, and adverse events were recorded for 6 months after surgery. The primary outcome was the reoperation rate within 6 months. The non-inferiority margin was set at 7·5%. Key secondary outcomes that were also required to conclude non-inferiority were the proportion of participants with unfavourable functional outcomes (ie, modified Rankin Scale score of 4-6, where 0 indicates no symptoms and 6 indicates death) and mortality rate at 6 months. The primary and key secondary analyses were done in both the intention-to-treat and per-protocol populations. The trial was registered with ClinicalTrials.gov (NCT04203550) and is completed., Findings: From Jan 1, 2020, to Aug 17, 2022, we assessed 1644 patients for eligibility and 589 (36%) patients were randomly assigned to a treatment group and treated (294 assigned to drainage with irrigation and 295 assigned to drainage without irrigation; 165 [28%] women and 424 [72%] men). The 6-month follow-up period extended until Feb 14, 2023. In the intention-to-treat analysis, 54 (18·3%) of 295 participants required reoperation in the group assigned to receive no irrigation versus 37 (12·6%) of 294 in the group assigned to receive irrigation (difference of 6·0 percentage points, 95% CI 0·2-11·7; p=0·30; adjusted for study site). There were no significant between-group differences in the proportion of people with modified Rankin Scale score of 4-6 (37 [13·1%] of 283 in the no-irrigation group vs 36 [12·6%] of 285 in the irrigation group; p=0·89) or mortality rate (18 [6·1%] of 295 in the no-irrigation group vs 21 [7·1%] of 294 in the irrigation group; p=0·58). The findings of the primary intention-to-treat analysis were not materially altered in the per-protocol analysis. There were no significant between-group differences in the number of adverse events, and the most frequent severe adverse events were systemic infections (26 [8·8%] of 295 participants who did not receive irrigation vs 22 [7·5%] of 294 participants who received irrigation), intracranial haemorrhage (13 [4·4%] vs seven [2·4%]), and epileptic seizures (five [1·7%] vs nine [3·1%])., Interpretation: We could not conclude non-inferiority of burr-hole drainage without irrigation. The reoperation rate was 6·0 percentage points higher after burr-hole drainage without subdural irrigation than with subdural irrigation. Considering that there were no differences in functional outcome or mortality between the groups, the trial favours the use of subdural irrigation., Funding: State Fund for University Level Health Research (Helsinki University Hospital), Finska Läkaresällskapet, Medicinska Understödsföreningen Liv och Hälsa, and Svenska Kulturfonden., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Introduction: A better understanding of the earliest stages of Alzheimer's disease (AD) could expedite the development or administration of treatments. Large population biobanks hold the promise to identify individuals at an elevated risk of AD and related dementias based on health registry information. Here, we establish the protocol for an observational clinical recall and biomarker study called TWINGEN with the aim to identify individuals at high risk of AD by assessing cognition, health and AD-related biomarkers. Suitable candidates were identified and invited to participate in the new study among THL Biobank donors according to TWINGEN study criteria., Methods and Analysis: A multi-centre study (n=800) to obtain blood-based biomarkers, telephone-administered and web-based memory and cognitive parameters, questionnaire information on lifestyle, health and psychological factors, and accelerometer data for measures of physical activity, sedentary behaviour and sleep. A subcohort is being asked to participate in an in-person neuropsychological assessment (n=200) and wear an Oura ring (n=50). All participants in the TWINGEN study have genome-wide genotyping data and up to 48 years of follow-up data from the population-based older Finnish Twin Cohort (FTC) study of the University of Helsinki. The data collected in TWINGEN will be returned to THL Biobank from where it can later be requested for other biobank studies such as FinnGen that supported TWINGEN., Ethics and Dissemination: This recall study consists of FTC/THL Biobank/FinnGen participants whose data were acquired in accordance with the Finnish Biobank Act. The recruitment protocols followed the biobank protocols approved by Finnish Medicines Agency. The TWINGEN study plan was approved by the Ethics Committee of Hospital District of Helsinki and Uusimaa (number 16831/2022). THL Biobank approved the research plan with the permission no: THLBB2022&#95;83., Competing Interests: Competing interests: AP is the Chief Scientific Officer of the FinnGen project that is funded by 13 pharmaceutical companies. HR was a full-time employee of Biogen during study planning and manuscript drafting and has stocks at Merck & Co and Biogen. MMF has received development funding from the Regional Council of Northern Savo and Business Finland for a data-driven tool related to memory disorders and healthcare decision tools, Charles River DRS Finland Ltd. and Orion Pharma have donated equipment for nonclinical cognition testing at the University of Eastern Finland. PI-M has received funding from Orion Research Foundation and Helsinki Biomedicum Foundation outside the present work. RK declares funding paid to the institution from Academy of Finland, 27 Government research funding, Saastamoinen Foundation, Vaajasalo foundation and Jane and Aatos Erkko foundation outside the present work; consulting fees from Orion Pharma; payment or honoraria from Angelini Pharma, Jazz Pharma, Lundbeck, Eisai, Orion Pharma, OmaMedical, Takeda, UCB; participation in monitoring or advisory board from Marinus Pharma and UCB; and leadership or fiduciary role in European Academy of Neurology Epilepsy scientific panel management group, European Epilepsy Reference network Epicare Steering Group and International League Against Epilepsy Career Development Commission. RS declares stocks or stock options at Orion Pharma. S-KH declares payment or honoraria and support for attending meetings or travel from Roche, consulting fees and participation in monitoring or advisory board from Novartis. TK declares payment or honoraria from Novartis Finland and Bayer Nordic SE. The authors declare no other competing financial or non-financial Interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)