Health-related quality of life in school children: validation of instrument, child self assessment, parent-proxy assessment and school nursing documentation of health check-ups

The aims of this study were to validate an international Health-Related Quality of Life (HRQL) instrument, to describe child self and parent-proxy assessed HRQL at child age 10 to 12 and to compare child self assessments with parent-proxy assessments and school nursing documentation. The study is part of the Schools on the Move –research project. In phase one, a cross-cultural translation and validation process was performed to develop a Finnish version of Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0). The process included a two-way translation, cognitive interviews (children n=7, parents n=5) and a survey (children n=1097, parents n=999). In phase two, baseline and follow-up surveys (children n=986, parents n=710) were conducted to describe and compare the child self and parent-proxy assessed HRQL in school children between the ages 10 and 12. Phase three included two separate data, school nurse documented patient records (children n=270) and a survey (children n=986). The relation between child self assessed HRQL and school nursing documentation was evaluated. Validity and reliability of the Finnish version of PedsQL™ 4.0 was good (Child Self Report α=0.91, Parent-Proxy Report α=0.88). Children reported lower HRQL scores at the emotional (mean 76/80) than the physical (mean 85/89) health domains and significantly lower scores at the age of 10 than 12 (dMean=4, p=<0.001). Agreement between child self and parent-proxy assessment was fragile (r=0,4, p=<0.001) but increased as the child grew from age 10 to 12 years. At health check-ups, school nurses documented frequently children’s physical health, such as growth (97%) and posture (98/99%) but seldom emotional issues, such as mood (2/7%). The PedsQLTM 4.0 is a valid instrument to assess HRQL in Finnish school children although future research is recommended. Children’s emotional wellbeing needs future attention. HRQL scores increase during ages between childhood and adolescence. Concordance between child self and parent-proxy assessed HRQL is low. School nursing documentation, related to child health check-ups, is not in line with child self assessed HRQL and emotional issues need more attention.Siirretty Doriast

Finding the Voice of a Protest : Negotiating Authority among the Multiplicity of Voices in a Pro-Refugee Demonstration

The idea of organizations as polyphonic sites, where the voices of heterogeneous members are articulated to become the voice of their organization, has been widely addressed by scholars taking a discursive approach to organizations. In this study, we investigate the multivocality of organizational decision-making and meaning-making in the context of a sit-in demonstration called the Right to Live. The seven-month long demonstration was held in Helsinki, Finland, as a response to government politics during the so-called European refugee crisis. The protest collective consisted of three groups with diverging ethnolinguistic backgrounds: Afghans, Iraqis, and Finns. Using interviews, ethnographic field notes and public statements communicated by the protest, we examine the interplay between the different voices within the protest. We explore processes of building an organizational voice that were involved in the constitution of Right to Live ( as an organization: formulating demands and external statements, and communicating about the protests online. The negotiations by which the voicing processes were sustained highlight that the activists cherished the idea of multicultural polyphony, yet regarded it necessary to filter the multiplicity of voices into univocality in order to create a recognized entity and to communicate strategically and effectively. Our findings show how authority was established and negotiated in communication: in an organization in which no authority seemingly or allegedly exists, authority was revealed through the process of generating the voice of the organization and forming a textual representation of it. The more traditional forms of authority such as meritocracy become intertwined with communicative authority in the process of authoring the organization.Peer reviewe

Spatial and dietary sources of elevated mercury exposure in white-tailed eagle nestlings in an Arctic freshwater environment

Human-induced mercury (Hg) contamination is of global concern and its effects on wildlife remain of high concern, especially in environmental hotspots such as inland aquatic ecosystems. Mercury biomagnifies through the food web resulting in high exposure in apex predators, such as the white-tailed eagle (Haliaeetus albicilla), making them excellent sentinel species for environmental Hg contamination. An expanding population of white-tailed eagles is inhabiting a sparsely populated inland area in Lapland, northern Finland, mainly around two large reservoirs flooded 50 years ago. As previous preliminary work revealed elevated Hg levels in this population, we measured Hg exposure along with dietary proxies (delta C-13 and delta N-15) in body feathers collected from white-tailed eagle nestlings in this area between 2007 and 2018. Mercury concentrations were investigated in relation to territory characteristics, proximity to the reservoirs and dietary ecology as potential driving factors of Hg contamination. Mercury concentrations in the nestlings (4.97-31.02 mu g g(-1) dw) were elevated, compared to earlier reported values in nestlings from the Finnish Baltic coast, and exceeded normal background levels (40.00 mu g g(-1)). The main drivers of Hg contamination were trophic position (proxied by delta N-15), the dietary proportion of the predatory fish pike (Esox Lucius), and the vicinity to the Porttipahta reservoir. We also identified a potential evolutionary trap, as increased intake of the preferred prey, pike, increases exposure. All in all, we present results for poorly understood freshwater lake environments and show that more efforts should be dedicated to further unravel potentially complex pathways of Hg exposure to wildlife.Peer reviewe

Diet and breeding habitat preferences of White-tailed Eagles in a northern inland environment

Many apex predator populations are recolonizing old areas and dispersing to new ones, with potential consequences for their prey species and for livestock. An increasing population of the White-tailed Eagle (Haliaeetus albicilla) has settled north of the Arctic Circle in northern Finland, mainly at two big water reservoirs but also in areas with mainly terrestrial habitat. We examined nesting habitat preferences and prey use of White-tailed Eagles in this environment, where reindeer husbandry is a traditional livelihood and concerns are rising that the growing White-tailed Eagle population poses a threat to reindeer calves. Lakes, peat bogs, and marshlands were preferred habitats in the nesting territories. Fish constituted 64.3% of the identified prey items, with birds accounting for 28.5% and mammals 7.2%. The nesting territory habitat within a 10 km radius and the latitude influenced the prey composition at both the group and species level. The occurrence of reindeer calves as prey increased with latitude but was not associated with any habitat. Knowledge of the diet and territory preferences can be used to predict future dispersal and local prey use of this species. Nesting White-tailed Eagles do not seem to pose a threat to traditional reindeer herding, but further research is needed regarding non-breeding sub-adults and whether the White-tailed Eagles actually kill reindeer calves or simply exploit their carcasses

Mental health services in the school environment—Future visions using a phenomenographic approach

Aims and objectives: First, to describe the variation in stakeholders' perceptions related to the desirable mental health services in school environments. Second, to construct alternative future visions based on these perceptions. Finally, to describe stakeholders' perceptions about the actions needed to reach such an ideal state.Background: The increased need for mental health care has challenged the role of schools and school health care in the area of mental health services for those of school-age. There is a need for future visions and comprehensive statements concerning the mental health services provided in the school environment.Design: The study was undertaken in Finland, between February 2020 and February 2021. Qualitative individual interviews were conducted with 15 professional stakeholders and focus group interviews with 10 stakeholders advocating for adolescents or parents.Method: The study was conducted with the phenomenographic approach using a visioning methodology. The study is reported following the COREQ checklist.Result: Four alternative future visions were formulated based on the perceptions of the stakeholders. They emphasised different aspects: (1) non-medicalising the school environment, (2) early and extensive intervention by school nurses enabled by work distribution with mental health specialists, (3) a multiprofessional team providing help on overall health questions and (4) a focusing of the services on mental disorders. Necessary changes were identified at the micro-, mezzo- and macro-level.Conclusion: The future visions are based on opposite perceptions related to the mission and focus of school health care. One extreme emphasises overall health promotion for everyone, while the other accentuates treatment for those suffering from mental disorders. The former may lead to inadequate help for mental health problems and the latter insufficient help for other health problems.Relevance to clinical practice: This study contributes alternative future visions, promotes strategic planning and helps to clarify the future role of school nurses.</p

Spatial and dietary sources of elevated mercury exposure in white-tailed eagle nestlings in an Arctic freshwater environment

Human-induced mercury (Hg) contamination is of global concern and its effects on wildlife remain of high concern, especially in environmental hotspots such as inland aquatic ecosystems. Mercury biomagnifies through the food web resulting in high exposure in apex predators, such as the white-tailed eagle (Haliaeetus albicilla), making them excellent sentinel species for environmental Hg contamination. An expanding population of white-tailed eagles is inhabiting a sparsely populated inland area in Lapland, northern Finland, mainly around two large reservoirs flooded 50 years ago. As previous preliminary work revealed elevated Hg levels in this population, we measured Hg exposure along with dietary proxies (δ13C and δ15N) in body feathers collected from white-tailed eagle nestlings in this area between 2007 and 2018. Mercury concentrations were investigated in relation to territory characteristics, proximity to the reservoirs and dietary ecology as potential driving factors of Hg contamination. Mercury concentrations in the nestlings (4.97–31.02 μg g−1 dw) were elevated, compared to earlier reported values in nestlings from the Finnish Baltic coast, and exceeded normal background levels (≤5.00 μg g−1) while remaining below the tentative threshold of elevated risk for Hg exposure mediated health effect (>40.00 μg g−1). The main drivers of Hg contamination were trophic position (proxied by δ15N), the dietary proportion of the predatory fish pike (Esox lucius), and the vicinity to the Porttipahta reservoir. We also identified a potential evolutionary trap, as increased intake of the preferred prey, pike, increases exposure. All in all, we present results for poorly understood freshwater lake environments and show that more efforts should be dedicated to further unravel potentially complex pathways of Hg exposure to wildlife.</p

The advantages and limitations of digital games in children’s health promotion

Childhood is an important period for forming the foundation for future health and well-being, and there is need for new methods for these health promotion purposes. Digital games are promising methods that could cover the challenges current health promotion efforts are facing. Ethical acceptability is an essential aspect of health promotion methods and special attention needs to be paid when promoting the health of children. This and increased interest in digital games as health promotion methods highlight the need for discussing the limitations, in addition to reasoning the advantages of digital games in children’s health promotion, to advance ethically sustainable development and use of health games. The aim of this overview review is to summarize and discuss the advantages and limitations of digital games in children’s health promotion based on the previous literature.We conducted a systematic literature search from scientific databases, and supplemented the search with a manual search. In total 42 articles and other forms of literature were included to the content analysis. We found several advantages and limitations of digital games in children’s health promotion. The findings considered: 1) issues related to the implementation of health promotion using digital games (perspectives of the provider and the player), and 2) possible outcomes of digital games in children (perspectives of physical, psychological, cognitive, social and health behavior related outcomes).The found advantages give good reasons for the use of digital games in children’s health promotion. However, the developers, publishers and professionals should consider carefully also the limitations of digital games in children’s health promotion to support ethically sustainable development and use of health games in children. As the interest in health games and thereby the utilization of them increases, there is a need for guidelines for developers, publishers and professional who develop and recommend health games especially for children