Towards digital counselling in primary care management of symptomatic knee osteoarthritis: a qualitative descriptive study in Finnish primary care

Digital counselling may improve patients’ health outcomes, when eHealth solutions are accessible and tailored to the patients’ needs, which is especially important for people with chronic and long-term conditions such as knee osteoarthritis. This study aims to identify patients’ eHealth needs to improve the quality of digital counselling in a primary care management of symptomatic knee osteoarthritis. A qualitative study was used to collect patients’ eHealth needs through semi-structured interviews in a single outpatient clinic in Finland between August 2020 and November 2020. The data was analyzed using both deductive and inductive content analysis approaches. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative research checklist to improve the transparency of the study. Analysis of the data revealed five main categories to be considered when implementing digital counselling in patients with symptomatic knee osteoarthritis: background factors (functional impairments, health literacy, digital literacy, cost-related access barriers), resources (digital methods and materials), sufficiency (knee osteoarthritis-related knowledge and skills), implementation (simplicity, trust, patient-centeredness), and benefits (self-care capabilities, confidence). According to our findings, both health and digital literacy seems to be important contributors to the adoption of digital counselling in a primary care management of symptomatic knee osteoarthritis. New eHealth solutions should not replace the first visit in the outpatient clinic. Instead, the use of eHealth solutions should be based on the first visit, during which a trusting relationship between patients and healthcare providers is established. In future, the level of health and digital literacy in patients with symptomatic knee osteoarthritis should be taken account

Baroreflex sensitivity following acute upper-body exercise in the cold among stable coronary artery disease patients

Background: A cold environment and exercise separately affect the autonomic nervous system (ANS), baroreflex sensitivity (BRS), and blood pressure variability (BPV) but their combined effects on post-exercise recovery are not known. Our cross-over trial examined these responses following upper-body static and dynamic exercise performed in a cold and neutral environment in patients with coronary artery disease (CAD). Methods: 20 patients with stable coronary artery disease performed both graded static (10%–30% of maximal voluntary contraction) and dynamic (light, moderate and high perceived intensity) upper-body exercise at −15°C and +22°C for 30 min. Electrocardiogram and continuous blood pressure were measured to compute post-exercise (10 and 30 min after exercise) spectral powers of heart rate (HR), blood pressure variability and BRS at low (0.04–0.15 Hz) and high (0.15–0.4 Hz) frequencies. Results: Static upper-body exercise performed in a cold environment increased post-exercise high frequency (HF) spectral power of heart rate (HF RR) (p Conclusion: Static upper-body exercise in the cold increased post-exercise BRS and overall vagal activity but without reduced systolic blood pressure. Dynamic upper-body exercise in the cold reduced post-exercise vagal BRS but did not affect the other parameters. The influence of cold exposure on post-exercise autonomic and cardiovascular responses following static upper-body exercise require further studies. This information helps understanding why persons with cardiovascular diseases are vulnerable to low environmental temperature. ClinicalTrials.gov: NCT02855905 (04/08/2016)

Yliopisto-opiskelijoiden motivaatioprofiilit koronapandemian aikana ja toiveet opetuksen toteuttamisesta jatkossa

Tämän tutkimuksen ensimmäisenä tehtävänä oli tarkastella, minkälaisia motivaatioprofiileja – odotusten, arvostusten ja kustannusten painotuksia – voidaan tunnistaa yliopisto-opiskelijoilla koronapandemian aikana. Tutkimuksen toisena tehtävänä oli tutkia, miten opintojen vaihe on yhteydessä motivaatioon, eli miten eri aikoihin opintonsa aloittaneet (esimerkiksi ennen koronapandemiaa aloittaneet vs. pandemian aikana aloittaneet) opiskelijat jakautuvat motivaatioryhmiin. Kolmantena tehtävänä oli tarkastella, minkälaisia toiveita eri tavoin motivoituneilla opiskelijoilla on opetuksen toteuttamisesta jatkossa (lähi-, hybridi- vai etäopetus). Tutkimuksen aineisto kerättiin sähköisellä kyselylomakkeella keväällä 2021. Tutkimukseen osallistui 1718 eri alojen yliopisto-opiskelijaa. Henkilösuuntautuneen tutkimusotteen mukaisesti opiskelijat ryhmiteltiin eri motivaatioprofiileihin TwoStep-ryhmittelyanalyysillä. Tunnistimme viisi erilaista motivaatioprofiilia: heikosti motivoituneet kuormittuneet (30 %), kohtalaisen motivoituneet (25 %), kuormittuneet hyötyorientoituneet (16 %), hyötyorientoituneet (16 %) ja myönteisen kunnianhimoiset (13 %). Ristiintaulukoinnin mukaan alkuvaiheen opiskelijoita oli kielteisimmässä, heikosti motivoituneiden kuormittuneiden, ryhmässä odotettua vähemmän. Eri tavoin motivoituneet opiskelijat erosivat siinä, minkälaisia toiveita heillä oli opetuksen toteuttamisesta pandemian jälkeen. Heikosti motivoituneet kuormittuneet kaipasivat takaisin lähiopetukseen, kun taas myönteisen kunnianhimoiset toivoivat voivansa jatkaa opintojaan etänä tulevaisuudessakin. Vaikuttaa siis siltä, että toisille opiskelijoille etäopetuksella voi olla kielteisempiä seurauksia kuin toisille.Non peer reviewe

Migration, Mobility and Human Rights at the Eastern Border of the European Union - Space of Freedom and Security

This edited collection of migration papers would like to emphasise the acute need for migration related study and research in Romania. At this time, migration and mobility are studied as minor subjects in Economics, Sociology, Political Sciences and European Studies only (mostly at post-graduate level). We consider that Romanian universities need more ‘migration studies’, while research should cover migration as a whole, migration and mobility being analysed from different points of view – social, economical, legal etc. Romania is part of the European Migration Space not only as a source of labourers for the European labour market, but also as source of quality research for the European scientific arena. Even a country located at the eastern border of the European Union, we consider Romania as part of the European area of freedom, security and justice, and therefore interested in solving correctly all challenges incurred by the complex phenomena of migration and workers’ mobility at the European level. The waves of illegal immigrants arriving continuously on the Spanish, Italian and Maltese shores, and the workers’ flows from the new Member States from Central and Eastern Europe following the 2004 accession, forced the EU officials and the whole Europe to open the debate on the economical and mostly social consequences of labour mobility. This study volume is our contribution to this important scientific debate. Starting with the spring of 2005, the Jean Monnet European Centre of Excellence and the School of High Comparative European Studies (SISEC), both within the West University of Timisoara, have proposed a series of events in order to raise the awareness of the Romanian scientific environment on this very sensitive issues: migration and mobility in the widen European Space. An annual international event to celebrate 9 May - The Europe Day was already a tradition for SISEC (an academic formula launched back in 1995 in order to prepare national experts in European affairs, offering academic post-graduate degrees in High European Studies). With the financial support from the Jean Monnet Programme (DG Education and Culture, European Commission), a first migration panel was organised in the framework of the international colloquium ‘Romania and the European Union in 2007’ held in Timisoara between 6 and 7 of May 2005 (panel Migration, Asylum and Human Rights at the Eastern Border of the European Union). Having in mind the positive welcoming of the migration related subjects during the 2005 colloquium, a second event was organised on 5 May 2006 in the framework of the European Year of Workers’ Mobility: the international colloquium Migration and Mobility: Assets and Challenges for the Enlargement of the European Union. In the same period, the Jean Monnet European Centre of Excellence, SISEC and The British Council in Bucharest have jointly edited two special issues of The Romanian Journal of European Studies, no.4/2005 and 5-6/2006, both dedicated to migration and mobility. Preliminary versions of many of the chapters of this volume were presented at the above mentioned international events. The papers were chosen according to their scientific quality, after an anonymously peer-review selection. The authors debate both theoretical issues and practical results of their research. They are renowned experts at international level, members of the academia, PhD students or experienced practitioners involved in the management of the migration flows at the governmental level. This volume was financed by the Jean Monnet Programme of the Directorate General Education and Culture, European Commission, throughout the Jean Monnet European Centre of Excellence (C03/0110) within the West University of Timisoara, Romania, and is dedicated to the European Year of Workers’ Mobility 2006. Timisoara, December 200

Effects of age, amyloid, sex, and APOE ε4 on the CSF proteome in normal cognition

Introduction: It is important to understand which biological processes change with aging, and how such changes are associated with increased Alzheimer's disease (AD) risk. We studied how cerebrospinal fluid (CSF) proteomics changed with age and tested if associations depended on amyloid status, sex, and apolipoprotein E Ɛ4 genotype. Methods: We included 277 cognitively intact individuals aged 46 to 89 years from Alzheimer's Disease Neuroimaging Initiative, European Medical Information Framework for Alzheimer's Disease Multimodal Biomarker Discovery, and Metabolic Syndrome in Men. In total, 1149 proteins were measured with liquid chromatography mass spectrometry with multiple reaction monitoring/Rules-Based Medicine, tandem mass tag mass spectrometry, and SOMAscan. We tested associations between age and protein levels in linear models and tested enrichment for Reactome pathways. Results: Levels of 252 proteins increased with age independently of amyloid status. These proteins were associated with immune and signaling processes. Levels of 21 proteins decreased with older age exclusively in amyloid abnormal participants and these were enriched for extracellular matrix organization. Discussion: We found amyloid-independent and -dependent CSF proteome changes with older age, perhaps representing physiological aging and early AD pathology

Decreased Aerobic Exercise Capacity After Long-Term Remission From Cushing Syndrome: Exploration of Mechanisms.

BACKGROUND: Although major improvements are achieved after cure of Cushing syndrome (CS), fatigue and decreased quality of life persist. This is the first study to measure aerobic exercise capacity in patients in remission of CS for more than 4 years in comparison with matched controls, and to investigate whether the reduction in exercise capacity is related to alterations in muscle tissue. METHODS: Seventeen patients were included. A control individual, matched for sex, estrogen status, age, body mass index, smoking, ethnicity, and physical activity level was recruited for each patient. Maximal aerobic capacity (VO2peak) was assessed during incremental bicycle exercise to exhaustion. In 8 individually matched patients and controls, a percutaneous muscle biopsy was obtained and measures were made of cross-sectional areas, capillarization, and oxphos complex IV (COXIV) protein content as an indicator of mitochondrial content. Furthermore, protein content of endothelial nitric oxide synthase (eNOS) and eNOS phosphorylated on serine1177 and of the NAD(P)H-oxidase subunits NOX2, p47phox, and p67phox were measured in the microvascular endothelial layer. FINDINGS: Patients showed a lower mean VO2peak (SD) (28.0 [7.0] vs 34.8 [7.9] ml O2/kg bw/min, P < .01), maximal workload (SD) (176 [49] vs 212 [67] watt, P = .01), and oxygen pulse (SD) (12.0 [3.7] vs 14.8 [4.2] ml/beat, P < .01) at VO2peak. No differences were seen in muscle fiber type-specific cross-sectional area, capillarization measures, mitochondrial content, and protein content of eNOS, eNOS-P-ser1177, NOX2, p47phox, and p67phox. INTERPRETATION: Because differences in muscle fiber and microvascular outcome measures are not statistically significant, we hypothesize that cardiac dysfunction, seen in active CS, persists during remission and limits blood supply to muscles

Assessment of β-amyloid deposits in human brain: a study of the BrainNet Europe Consortium

β-Amyloid (Aβ) related pathology shows a range of lesions which differ both qualitatively and quantitatively. Pathologists, to date, mainly focused on the assessment of both of these aspects but attempts to correlate the findings with clinical phenotypes are not convincing. It has been recently proposed in the same way as ι and α synuclein related lesions, also Aβ related pathology may follow a temporal evolution, i.e. distinct phases, characterized by a step-wise involvement of different brain-regions. Twenty-six independent observers reached an 81% absolute agreement while assessing the phase of Aβ, i.e. phase 1 = deposition of Aβ exclusively in neocortex, phase 2 = additionally in allocortex, phase 3 = additionally in diencephalon, phase 4 = additionally in brainstem, and phase 5 = additionally in cerebellum. These high agreement rates were reached when at least six brain regions were evaluated. Likewise, a high agreement (93%) was reached while assessing the absence/presence of cerebral amyloid angiopathy (CAA) and the type of CAA (74%) while examining the six brain regions. Of note, most of observers failed to detect capillary CAA when it was only mild and focal and thus instead of type 1, type 2 CAA was diagnosed. In conclusion, a reliable assessment of Aβ phase and presence/absence of CAA was achieved by a total of 26 observers who examined a standardized set of blocks taken from only six anatomical regions, applying commercially available reagents and by assessing them as instructed. Thus, one may consider rating of Aβ-phases as a diagnostic tool while analyzing subjects with suspected Alzheimer’s disease (AD). Because most of these blocks are currently routinely sampled by the majority of laboratories, assessment of the Aβ phase in AD is feasible even in large scale retrospective studies

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele