The effects of integrated home care and discharge practice on functional ability and health-related quality of life: a cluster-randomised trial among home care patients

<b>Objectives</b>: The aim was to evaluate the effects of integrated home care and discharge practice on the functional ability (FA) and health-related quality of life (HRQoL) of home care patients. <br> <b>Methods</b>: A cluster randomised trial (CRT) with Finnish municipalities (n=22) as the units of randomisation. At baseline the sample included 669 patients aged 65 years or over. Data consisted of interviews (at discharge, and at 3-week and 6-month follow-up), medical records and care registers. The intervention was a generic prototype of care/case management-practice (IHCaD-practice) that was tailored to municipalities needs. The aim of the intervention was to standardize practices and make written agreements between hospitals and home care administrations, and also within home care and to name a care/case manager pair for each home care patient. The main outcomes were HRQoL—as measured by a combination of the Nottingham Health Profile (NHP) and the EQ-5D instrument for measuring health status—and also Activities of Daily Living (ADL). All analyses were based on intention-to-treat. <br> <b>Results</b>: At baseline over half of the patient population perceived their FA and HRQoL as poor. At the 6-month follow-up there were no improvements in FA or in EQ-5D scores, and no differences between groups. In energy, sleep, and pain the NHP improved significantly in both groups at the 3-week and at 6-month follow-up with no differences between groups. In the 3-week follow-up, physical mobility was higher in the trial group. <br> <b>Conclusions</b>: Although the effects of the new practice did not improve the patients' FA and HRQoL, except for physical mobility at the 3-week follow-up, the workers thought that the intervention worked in practice. The intervention standardised practices and helped to integrate services. The intervention was focused on staff activities and through the changed activities also had an effect on patients. It takes many years to achieve permanent changes in every worker's individual practice and it is also likely that changes in working practices would be visible before effects on patients. The use of other outcome measures, such as the use of services, may be clearer in showing a positive impact of the intervention rather than FA or HRQoL

Discriminating the viscoelastic properties of cellulose textile fibers for recycling

The viscoelastic properties of cellulose fibers play an important role in chemical recycling of textiles. Here we discriminated the intrinsic viscosity of cotton roll towels and bed linens using near-infrared imaging spectroscopy and supervised pattern recognition. The classification results showed training and test set accuracies of 84–97% and indicated that the relevant spectral features were related to water, cellulose, and cellulose crystallinity. We hypothesized that the decreasing intrinsic viscosity of cotton was associated with changes in cellulose crystallinity and water adsorption, which was supported by additional X-ray and sorption measurements. These results are important as they indicate the potential to non-invasively estimate the degree of polymerization and the suitability of different cotton materials for chemical recycling. We propose that changes in the degree of polymerization and cellulose crystallinity could be used as an indicator of the chemical quality of cellulose fibers, which would have wider impacts for textile recycling.</p

Denitrifying microbial communities along a boreal stream with varying land-use

Streams have an important role in regulating nitrogen (N) transportation from terrestrial ecosystems to downstream waters. Here, we examined how catchment land-use affects potential denitrification rates and the function and composition of denitrifier communities in boreal stream sediments, using stable isotope incubations and qPCR and 454-pyrosequencing targeted on nirS, nirK and nosZ genes. Although land-use influenced the water chemistry as higher nitrite+nitrate (NOx)-concentration at the agriculture-affected sampling point, sediment organic matter content was found to be the key factor in regulating potential denitrification rates. However, the abundance as well as the diversity and community composition of denitrifying microbes, and genetic N2O production potential (the ratio between nirS+nirK and nosZ gene abundances) were connected to both NOx- and sediment quality. Overall, our results suggest that catchment land-use-driven changes in N and carbon availability affect the denitrification rates, and possibly N-2:N2O production ratio, in boreal streams, through altering denitrifier abundance and community composition.Peer reviewe

Separation of fiber bundles from willow bark using sodium bicarbonate and their novel use in yarns for superior UV protection and antibacterial performance

The development of a mild and green method for separating natural fiber bundles from willow bark is an essential step in exploring and preserving their natural functions. The isolation of well-oriented fiber bundles from the bark of a fast-growing willow hybrid solely using sodium bicarbonate under mild conditions was successfully demonstrated. Additionally, Lyocell fibers were mixed with an equal amount of the willow bark fiber bundles and proved their ability to convert into spun yarns, which provided excellent protection for ultraviolet radiation (UPF > 140). Moreover, these yarns demonstrated strong antibacterial activity (A > 8) against the Gram-positive pathogen Staphylococcus aureus, resulting in complete eradication of viable bacteria after 24 -h incubation with the material. A laundering treatment had no effect on the UV protection or the antibacterial performance. Utilizing these inherent properties from natural fibers for technical textile applications is very promising.Peer reviewe

Nuorten itsetuhoisuuden syyt, ilmeneminen ja avun saannin odotukset vanhempien näkökulmasta

Nuorten itsetuhoisuus on moniulotteinen ilmiö, ja se koskettaa vähintään joka kymmenettä nuorta. Vanhemmille oman nuoren itsetuhoisuus aiheuttaa monenlaisia negatiivisia seurauksia, ja itsetuhoisten nuorten lailla myös vanhemmat tarvitsevat apua. Tämän tutkimuksen tarkoituksena oli kuvata nuorten itsetuhoisuuden syitä, ilmenemistä sekä avun saannin odotuksia itsetuhoisten nuorten vanhempien näkökulmasta. Aineisto kerättiin äideiltä ja isiltä (n = 23) kirjoitelmina (n = 9), e-lomakevastauksina (n = 16) sekä haastatteluina (n = 4). Aineisto koostui osin samojen henkilöiden useista vastauksista. Aineisto analysoitiin induktiivisella sisällönanalyysilla. Vanhempien mukaan nuorten itsetuhoisuuden syyt liittyivät nuoreen, perheeseen ja ympäristöön sekä yhteiskuntaan. Vanhemmat kuvasivat monenlaisia syitä itsetuhoisuuteen, kuten nuoren kokemaa kaltoinkohtelua ja kiusaamista, vanhempien terveysongelmia sekä nuoreen kohdistuvia menestymisen paineita. Vanhempien mukaan itsetuhoisuus ilmeni itsetuhoisina tekoina, kuolemaan liittyvänä itsetuhoisuutena sekä nuoren huolestuttavana oireiluna. Kaiken kaikkiaan itsetuhoisuudella oli monia ilmenemismuotoja, mutta useimmiten siihen liittyi päihteiden vahingollista käyttämistä sekä itsensä viiltelemistä. Vanhempien avun saannin odotukset kohdentuivat avun tarvitsijoihin, apuun sekä avun tarjoajiin. Vanhemmat odottivat apua itselleen, itsetuhoiselle nuorelleen sekä perheelle ja läheisille. Apua halutaan enemmän kuin sitä saadaan, mikä asettaa ammattilaiset yhteiskunnan joka sektorilla suuren haasteen eteen

CH4 oxidation in a boreal lake during the development of hypolimnetic hypoxia

Freshwater ecosystems represent a significant natural source of methane (CH4). CH4 produced through anaerobic decomposition of organic matter (OM) in lake sediment and water column can be either oxidized to carbon dioxide (CO2) by methanotrophic microbes or emitted to the atmosphere. While the role of CH4 oxidation as a CH4 sink is widely accepted, neither the magnitude nor the drivers behind CH4 oxidation are well constrained. In this study, we aimed to gain more specific insight into CH4 oxidation in the water column of a seasonally stratified, typical boreal lake, particularly under hypoxic conditions. We used (CH4)-C-13 incubations to determine the active CH4 oxidation sites and the potential CH4 oxidation rates in the water column, and we measured environmental variables that could explain CH4 oxidation in the water column. During hypolimnetic hypoxia, 91% of available CH4 was oxidized in the active CH4 oxidation zone, where the potential CH4 oxidation rates gradually increased from the oxycline to the hypolimnion. Our results showed that in warm springs, which become more frequent, early thermal stratification with cold well-oxygenated hypolimnion delays the period of hypolimnetic hypoxia and limits CH4 production. Thus, the delayed development of hypolimnetic hypoxia may partially counteract the expected increase in the lacustrine CH4 emissions caused by the increasing organic carbon load from forested catchments.Peer reviewe

Health-related quality of life in patients waiting for major joint replacement. A comparison between patients and population controls

BACKGROUND: Several quality-of-life studies in patients awaiting major joint replacement have focused on the outcomes of surgery. Interest in examining patients on the elective waiting list has increased since the beginning of 2000. We assessed health-related quality of life (HRQoL) in patients waiting for total hip (THR) or knee (TKR) replacement in three Finnish hospitals, and compared patients' HRQoL with that of population controls. METHODS: A total of 133 patients awaiting major joint replacement due to osteoarthritis (OA) of the hip or knee joint were prospectively followed from the time the patient was placed on the waiting list to hospital admission. A sample of controls matched by age, gender, housing and home municipality was drawn from the computerised population register. HRQoL was measured by the generic 15D instrument. Differences between patients and the population controls were tested by the independent samples t-test and between the measurement points by the paired samples t-test. A linear regression model was used to explain the variance in the 15D score at admission. RESULTS: At baseline, 15D scores were significantly different between patients and the population controls. Compared with the population controls, patients were worse off on the dimensions of moving (P < 0.001), sleeping (P < 0.001), sexual activity (P < 0.001), vitality (P < 0.001), usual activities (P < 0.001) and discomfort and symptoms (P < 0.001). Further, psychological factors – depression (P < 0.001) and distress (P = 0.004) – were worse among patients than population controls. The patients showed statistically significantly improved average scores at admission on the dimensions of moving (P = 0.026), sleeping (P = 0.004) and discomfort and symptoms (P = 0.041), but not in the overall 15D score compared with the baseline. In patients, 15D score at baseline (P < 0.001) and body mass index (BMI) (P = 0.020) had an independent effect on patients' 15D score at hospital admission. CONCLUSION: Although patients' HRQoL did not deteriorate while waiting, a consistently worse HRQoL was observed in patients waiting for major joint replacement compared with population controls