eHealth challenges in rehabilitation processes - rehabilitation professionals’ experiences in the North Savo region

Aging people are forced to steadily extend their working-lives since the old-age dependency ratio will rise considerably in the near future. Meanwhile, social and healthcare resources will become increasingly scarce, although the need for healthcare and rehabilitation services is bound to increase. The aim of this study was to examine rehabilitation professionals’ experiences related to eHealth and technology in the rehabilitation process in the North Savo region. The research was carried out as a part of the European Social Fund (ESF) funded project ”Expertise and Business Network for  Rehabilitation Services in Northern Savo”. 30 rehabilitation workers were interviewed (67% women) in 2020. The participants were aged 24-60 years and their job titles were e.g. doctors, physiotherapists, practical nurses and community sector representatives. The interviews were carried out using a semi-structured format. The interviews were recorded, transcribed, and analysed using the inductive content analysis method. The technology and digitalisation experiences of the rehabilitation workers in North Savo region can be divided into five categories. Technical problems causing challenges in rehabilitation included inadequate information and patient data management, and poor or lacking data-applications, ICT-tools and systems. The cost of technology was perceived as a factor influencing rehabilitation from both an individual and organisational perspective. The emergence of COVID-19 has had a positive impact on the use of technology and digital services. Suitable technology and digital services for rehabilitation need to be developed towards a more individual, client-centric direction. To promote the adoption of technology in the field of rehabilitation and to support positive change in attitudes towards technology, more education is needed. The ever-evolving field of rehabilitation demands effective eHealth applications and processes alongside highly competent rehabilitation professionals to meet the needs of the aging population base in North Savo region. There is a need for more client-centric eHealth and rehabilitation processes, wherein the rehabilitation workers’ needs are met – physically and psychosocially. By bringing together rehabilitation and ICT expertise in North Savo region, it is possible to provide training and education to raise the level of both the rehabilitation processes and level of expertise of rehabilitation workers in the region

DEVELOPMENT AND APPLICATION OF IMPLEMENTATION TOOLS FOR REHABILITATION GUIDELINES

Objective: To describe a project to develop guideline implementation tools (GItools) for rehabilitation guidelines, and a collaboration between a guideline producer and a healthcare organization to implement guidelines into care pathways. Design: Descriptive case study. Methods: A national guideline organization in Finland launched a 3-year project in 2015 to implement rehabilitation recommendations. Usability of the GItools was evaluated and improved, based on literature, workshops and surveys. An implementation plan guided the production of the GItools. An implementation plan was developed to integrate the shoulder disorders guideline into a care pathway at Paijat-Hame district rehabilitation unit. The implementation plan was produced in 3 facilitated workshops, which included brainstorming, snowballing, prioritizing and short lectures. Results: Twenty implementation plans and 119 different GItools for 22 guidelines were developed. The GItools, in particular patient material, were perceived as useful for the facilitation of guideline implementation. Four seminars and 14 sessions of continuous medical education were arranged. A plan was developed and executed for the implementation of the shoulder disorders guideline. Conclusion: It is feasible for a guideline producer to systematically include GItools into rehabilitation guidelines. This implementation project was an example of a successful collaboration between a guideline producer and a healthcare organization.Peer reviewe

Expression of Hyaluronan Synthases (HAS1–3) and Hyaluronidases (HYAL1–2) in Serous Ovarian Carcinomas: Inverse Correlation between HYAL1 and Hyaluronan Content

<p>Abstract</p> <p>Background</p> <p>Hyaluronan, a tumor promoting extracellular matrix polysaccharide, is elevated in malignant epithelial ovarian tumors, and associates with an unfavorable prognosis. To explore possible contributors to the accumulation of hyaluronan, we examined the expression of hyaluronan synthases (<it>HAS1</it>, <it>HAS2 </it>and <it>HAS3</it>) and hyaluronidases (<it>HYAL1 </it>and <it>HYAL2</it>), correlated with hyaluronidase enzyme activity hyaluronan content and HAS1–3 immunoreactivity.</p> <p>Methods</p> <p>Normal ovaries (n = 5) and 34 serous epithelial ovarian tumors, divided into 4 groups: malignant grades 1+2 (n = 10); malignant grade 3 (n = 10); borderline (n = 4) and benign epithelial tumors (n = 10), were analyzed for mRNA by real-time RT-PCR and compared to hyaluronidase activity, hyaluronan staining, and HAS1–3 immunoreactivity in tissue sections of the same specimens.</p> <p>Results</p> <p>The levels of <it>HAS2 </it>and <it>HAS3 </it>mRNA (<it>HAS1 </it>was low or absent), were not consistently increased in the carcinomas, and were not significantly correlated with HAS protein or hyaluronan accumulation in individual samples. Instead, the median of <it>HYAL1 </it>mRNA level was 69% lower in grade 3 serous ovarian cancers compared to normal ovaries (P = 0.01). The expression of <it>HYAL1</it>, but not <it>HYAL2</it>, significantly correlated with the enzymatic activity of tissue hyaluronidases (r = 0.5; P = 0.006). An inverse correlation was noted between <it>HYAL1 </it>mRNA and the intensity of hyaluronan staining of the corresponding tissue sections (r = -0.4; P = 0.025).</p> <p>Conclusion</p> <p>The results indicate that in serous epithelial ovarian malignancies <it>HAS </it>expression is not consistently elevated but <it>HYAL1 </it>expression is significantly reduced and correlates with the accumulation of hyaluronan. (233 words)</p

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Kehityksellinen kielihäiriö (kielellinen erityisvaikeus, lapset ja nuoret) : Käypä hoito -suositus

nonPeerReviewe