The use of digital tools by general practitioners in Finnish public health centres

Electronic health services (eHealth) have increased rapidly in the last few years. These services hold the potential to facilitate today’s challenging primary care. The aim of the study was to examine how digitalisation manifests in Finnish health centres in 2021. We aimed to find out which digital tools are used in health centres and how they are exploited. In addition, we were interested in general practitioners’ attitudes towards digitalisation in their everyday work. An online survey was distributed to general practitioners (GPs) working in primary health care centres throughout Finland, and 265 GPs replied. A health portal and various digital calculators were used daily. In remote communication with their patients, general practitioners preferred telephone calls over new tools (chat/video). Attitudes towards eHealth were positive, but digital tools were not yet commonly used. The implementation of digital solutions still needs more effort

The role of adolescent lifestyle habits in biological aging : A prospective twin study

Background: Adolescence is a stage of fast growth and development. Exposures during puberty can have long -term effects on health in later life. This study aims to investigate the role of adolescent lifestyle in biological aging. Methods: The study participants originated from the longitudinal FinnTwin12 study (n = 5114). Adolescent lifestyle-related factors, including body mass index (BMI), leisure -time physical activity, smoking, and alcohol use, were based on self-reports and measured at ages 12, 14, and 17 years. For a subsample, blood -based DNA methylation (DNAm) was used to assess biological aging with six epigenetic aging measures in young adulthood (21-25 years, n = 824). A latent class analysis was conducted to identify patterns of lifestyle behaviors in adolescence, and differences between the subgroups in later biological aging were studied. Genetic and environmental influences on biological aging shared with lifestyle behavior patterns were estimated using quantitative genetic modeling. Results: We identified five subgroups of participants with different adolescent lifestyle behavior patterns. When DNAm GrimAge, DunedinPoAm, and DunedinPACE estimators were used, the class with the unhealthiest lifestyle and the class of participants with high BMI were biologically older than the classes with healthier lifestyle habits. The differences in lifestyle-related factors were maintained into young adulthood. Most of the variation in biological aging shared with adolescent lifestyle was explained by common genetic factors. Conclusions: These findings suggest that an unhealthy lifestyle during pubertal years is associated with accelerated biological aging in young adulthood. Genetic pleiotropy may largely explain the observed associations.Peer reviewe

Instruments for assessing healthcare professionals' knowledge and skills of evidence-based practice : A scoping review

Objective: The aim of this scoping review was to describe the instruments used to assess the knowledge and skills of evidence-based practice (EBP) in healthcare settings. Methods: A scoping review was undertaken. Three electronic databases (CINAHL, PubMed and Cochrane) were searched in January 2022. The search phrases consisted of the following terms: healthcare professionals, EBP, competence and instrument and their synonyms, keywords and MeSH terms. The database search was run without any limitations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to support reporting. Results: Ultimately, 39 studies were included; most of them (35) were cross-sectional studies. The studies were conducted in 17 countries. A total of 17 evidence-based knowledge and skills instruments were identified. The Upton and Upton instrument was used in 19 studies. Twelve self-reported instruments were used only once. The psychometric properties of the instruments varied. The reliability was typically reported with Cronbach's alpha coefficient. The content of the EBP knowledge/skills instruments consists of five main categories: EBP, evaluation of current practice, preparation for the implementation of EBP, implementation of evidence and active participation in the development of EBP. Conclusion: Almost all instruments are self-assessment instruments. Validated knowledge tests should be further developed. The instruments emphasise the preparation for the implementation of EBP. Further research is needed to develop instruments for healthcare professionals to assess the knowledge and skills of the implementation of evidence.publishedVersionPeer reviewe

HiPS-Endothelial Cells Acquire Cardiac Endothelial Phenotype in Co-culture With hiPS-Cardiomyocytes

Cell-cell interactions are crucial for organ development and function. In the heart, endothelial cells engage in bidirectional communication with cardiomyocytes regulating cardiac development and growth. We aimed to elucidate the organotypic development of cardiac endothelial cells and cardiomyocyte and endothelial cell crosstalk using human induced pluripotent stem cells (hiPSC). Single-cell RNA sequencing was performed with hiPSC-derived cardiomyocytes (hiPS-CMs) and endothelial cells (hiPS-ECs) in mono- and co-culture. The presence of hiPS-CMs led to increased expression of transcripts related to vascular development and maturation, cardiac development, as well as cardiac endothelial cell and endocardium-specific genes in hiPS-ECs. Interestingly, co-culture induced the expression of cardiomyocyte myofibrillar genes and MYL7 and MYL4 protein expression was detected in hiPS-ECs. Major regulators of BMP- and Notch-signaling pathways were induced in both cell types in co-culture. These results reflect the findings from animal studies and extend them to human endothelial cells, demonstrating the importance of EC-CM interactions during development.Peer reviewe

Psychological flexibility mediates change in intuitive eating regulation in acceptance and commitment therapy interventions

Objective: Despite the promising results related to intuitive eating, few studies have attempted to explain the processes encouraging this adaptive eating behaviour. The focus of the present study was on exploring mechanisms of change in intuitive eating and weight in acceptance and commitment therapy (ACT) interventions. Mediation provides important information regarding the treatment processes and theoretical models related to specific treatment approaches. The study investigates whether psychological flexibility, mindfulness skills and sense of coherence mediated the interventions' effect on intuitive eating and weight. Design: Secondary analysis of a randomized control trial. Mediation analysis compared two ACT interventions - face-to-face (in a group) and mobile (individually) - with a control group using a latent difference score model. Settings: Data were collected in three Finnish towns. Subjects: The participants were overweight or obese (n 219), reporting symptoms of perceived stress. Results: The effect of the interventions on participants' (i) BMI, (ii) intuitive eating and its subscales, (iii) eating for physical rather than emotional reasons and (iv) reliance on internal hunger and satiety cues was mediated by changes in weight-related psychological flexibility in both ACT groups. Conclusions: These findings suggest that ACT interventions aiming for lifestyle changes mediate the intervention effects through the enhanced ability to continue with valued activities even when confronted with negative emotions and thoughts related to weight.Peer reviewe

Do Epigenetic Clocks Provide Explanations for Sex Differences in Life Span? A Cross-Sectional Twin Study

The sex gap in life expectancy has been narrowing in Finland over the past 4–5 decades; however, on average, women still live longer than men. Epigenetic clocks are markers for biological aging which predict life span. In this study, we examined the mediating role of lifestyle factors on the association between sex and biological aging in younger and older adults.Our sample consists of younger and older twins (21‒42 years, n = 1 477; 50‒76 years, n = 763) including 151 complete younger opposite-sex twin pairs (21‒30 years). Blood-based DNA methylation was used to compute epigenetic age acceleration by 4 epigenetic clocks as a measure of biological aging. Path modeling was used to study whether the association between sex and biological aging is mediated through lifestyle-related factors, that is, education, body mass index, smoking, alcohol use, and physical activity.In comparison to women, men were biologically older and, in general, they had unhealthier life habits. The effect of sex on biological aging was partly mediated by body mass index and, in older twins, by smoking. Sex was directly associated with biological aging and the association was stronger in older twins.Previously reported sex differences in life span are also evident in biological aging. Declining smoking prevalence among men is a plausible explanation for the narrowing of the difference in life expectancy between the sexes. Data generated by the epigenetic clocks may help in estimating the effects of lifestyle and environmental factors on aging and in predicting aging in future generations.Peer reviewe

Iloa vanhemmuuteen : vanhemmuutta tukeva teematapahtuma

Kehittämistyömme tarkoituksena oli suunnitella ja toteuttaa lapsiperheille suunnattu, vanhemmuutta vahvistava teematapahtuma kolmessa Helsinkiläisessä neuvolassa. Tavoitteena oli tuottaa kuusi neuvolaympäristöön soveltuvaa tieto- ja toimintapakettia sekä niihin liittyvä materiaali sekä järjestää vanhemmille iloinen, ideoita antava ja voimauttava hetki arjen keskelle ja arkea tukemaan. Pyrimme tuottamaan sisällöllisesti innostavan ja voimauttavan kokonaisuuden, joka olisi vanhempia osallistava. Kokeilimme teematapahtumaa terveyden edistämisen työmenetelmänä vastaamaan neuvolatyön haasteisiin vanhemmuuden tukemisen alueella. Lähtökohtana tälle kehittämistyölle oli sekä käytännön neuvolatyöstä että tutkimuksista esiin noussut tarve tukea perheitä entistä enemmän vanhemmuuteen, kasvatustyöhön, voimavaroihin ja arjessa selviytymiseen liittyen. Kehittämistyömme tuotoksena oli kolme vanhemmuutta vahvistavaa teematapahtumaa sekä tapahtuman toteutukseen tarvittava materiaali. Teematapahtumat koostuivat seuraavista osa-alueista: Vauvan kehollisuus- vauvahieronta ja vauvatus, Liikkeelle vauvan kanssa, Vauvavuoden kulku, Kontakti lapseen - sadutus ja lapsihieronta, Mitä tehdä lapsen kanssa kotona ja kodin ulkopuolella sekä Tahtoikäisen kanssa selviytyminen. Teematapahtuman nimeksi muotoutui Iloa vanhemmuteen. Iloa vanhemmuuteen -tapahtumissa oli yhteensä 78 osallistujaa ja palaute oli positiivista. Osallistujat olivat pääosin vauvojen ja varhaisleikki-ikäisten lasten äitejä, mutta paikalla oli myös joitakin isiä ja terveysaseman henkilökuntaa. Osallistujat kiersivät, keskustelivat ja keräsivät tietoa tarjolla olleista aiheista. Terveydenhoitajaopiskelijoiden ja osallistujien välinen keskustelu oli rakentavaa ja tietoa välittävää, vaikkakin keskustelu jäi enimmäkseen pinnalliseksi, mahdollisesti tapahtuman messumaisen luonteen vuoksi. Tällaisen projektiluonteisen kehittämistyön tekeminen oli mielenkiintoinen, kehittävä ja opettava kokemus. Tapahtuman toteuttaminen kolmessa eri toimipisteessä mahdollisti kolmen varsin erilaisen kokemuksen saannin. Jatkoa ajatelleen olisi tärkeää löytää motivoituneet yhteistyöneuvolat sekä sopiva paikka tapahtuman järjestämiselle, jotta se tavoittaisi mahdollisimman suuren osan kohderyhmästään eli neuvolan asiakkaista.The purpose of this final project was to plan and organise an event that was directed at families with children under school age and conducted in three maternity and child health centres in Helsinki. The aim of this project was to produce informative material that can be used when holding similar events in the future, and to arrange an event with a focus on strengthening parenthood and parental resources. Our aim was also to get into interaction with the maternity and child health centres and their customers. The starting point for this project was that both practice and research show that parents of today need even more support than before regarding parenthood, parenting, parental resources, and everyday life with small children. As an output, we organized three events with a turnout of seventy-eight parents most of which were mothers of small babies. The material consisted of topics concerning parenthood and parenting. The parents gathered up information by talking with the students and by collecting the provided material. Organizing an event such as this one was an interesting and informative experience. Because the event was organized three times in three different locations we were left with three diverse learning experiences that can be of use for future reference. When planning an event similar to this one attention should be paid to finding motivated maternity and child health centres for partners in co-operation and a more suitable location for the event to reach as many parents as possible

Leisure-Time and Occupational Physical Activity Associates Differently with Epigenetic Aging

PurposeGreater leisure-time physical activity (LTPA) associates with healthier lives, but knowledge regarding occupational physical activity (OPA) is more inconsistent. DNA methylation (DNAm) patterns capture age-related changes in different tissues. We aimed to assess how LTPA and OPA are associated with three DNAm-based epigenetic age estimates, namely, DNAm age, PhenoAge, and GrimAge.MethodsThe participants were young adult (21-25 yr, n = 285) and older (55-74 yr, n = 235) twin pairs, including 16 pairs with documented long-term LTPA discordance. Genome-wide DNAm from blood samples was used to compute DNAm age, PhenoAge, and GrimAge Age acceleration (Acc), which describes the difference between chronological and epigenetic ages. Physical activity was assessed with sport, leisure-time, and work indices based on the Baecke Questionnaire. Genetic and environmental variance components of epigenetic age Acc were estimated by quantitative genetic modeling.ResultsEpigenetic age Acc was highly heritable in young adult and older twin pairs (~60%). Sport index was associated with slower and OPA with faster DNAm GrimAge Acc after adjusting the model for sex. Genetic factors and nonshared environmental factors in common with sport index explained 1.5%-2.7% and 1.9%-3.5%, respectively, of the variation in GrimAge Acc. The corresponding proportions considering OPA were 0.4%-1.8% and 0.7%-1.8%, respectively. However, these proportions were minor (ConclusionsLTPA associates with slower and OPA with faster epigenetic aging. However, adjusting the models for smoking status, which may reflect the accumulation of unhealthy lifestyle habits, attenuated the associations.</p

Change in brain amyloid load and cognition in patients with amnestic mild cognitive impairment: a 3-year follow-up study

Background Our aim was to investigate the discriminative value of F-18-Flutemetamol PET in longitudinal assessment of amyloid beta accumulation in amnestic mild cognitive impairment (aMCI) patients, in relation to longitudinal cognitive changes. Methods We investigated the change in F-18-Flutemetamol uptake and cognitive impairment in aMCI patients over time up to 3 years which enabled us to investigate possible association between changes in brain amyloid load and cognition over time. Thirty-four patients with aMCI (mean age 73.4 years, SD 6.6) were examined with F-18-Flutemetamol PET scan, brain MRI and cognitive tests at baseline and after 3-year follow-up or earlier if the patient had converted to Alzheimer ' s disease (AD). F-18-Flutemetamol data were analyzed both with automated region-of-interest analysis and voxel-based statistical parametric mapping. Results F-18-flutemetamol uptake increased during the follow-up, and the increase was significantly higher in patients who were amyloid positive at baseline as compared to the amyloid-negative ones. At follow-up, there was a significant association between F-18-Flutemetamol uptake and MMSE, logical memory I (immediate recall), logical memory II (delayed recall) and verbal fluency. An association was seen between the increase in F-18-Flutemetamol uptake and decline in MMSE and logical memory I scores. Conclusions In the early phase of aMCI, presence of amyloid pathology at baseline strongly predicted amyloid accumulation during follow-up, which was further paralleled by cognitive declines. Inversely, some of our patients remained amyloid negative also at the end of the study without significant change in F-18-Flutemetamol uptake or cognition. Future studies with longer follow-up are needed to distinguish whether the underlying pathophysiology of aMCI in such patients is other than AD.</p

Subjective stress, objective heart rate variability-based stress, and recovery on workdays among overweight and psychologically distressed individuals : a cross-sectional study

Background: The present study aimed to investigate how subjective self-reported stress is associated with objective heart rate variability (HRV)-based stress and recovery on workdays. Another aim was to investigate how physical activity (PA), body composition, and age are associated with subjective stress, objective stress, and recovery. Methods: Working-age participants (n = 221; 185 women, 36 men) in this cross-sectional study were overweight (body mass index, 25.3-40.1 kg/m(2)) and psychologically distressed (>= 3/12 points on the General Health Questionnaire). Objective stress and recovery were based on HRV recordings over 1-3 workdays. Subjective stress was assessed by the Perceived Stress Scale. PA level was determined by questionnaire, and body fat percentage was assessed by bioelectrical impedance analysis. Results: Subjective stress was directly associated with objective stress (P = 0.047) and inversely with objective recovery (P = 0.046). These associations persisted after adjustments for sex, age, PA, and body fat percentage. Higher PA was associated with lower subjective stress (P = 0.037). Older age was associated with higher objective stress (P <0.001). After further adjustment for alcohol consumption and regular medication, older age was associated with lower subjective stress (P = 0.043). Conclusions: The present results suggest that subjective self-reported stress is associated with objective physiological stress, but they are also apparently affected by different factors. However, some of the found associations among these overweight and psychologically distressed participants with low inter-individual variation in PA are rather weak and the clinical value of the present findings should be studied further among participants with greater heterogeneity of stress, PA and body composition. However, these findings suggest that objective stress assessment provides an additional aspect to stress evaluation. Furthermore, the results provide valuable information for developing stress assessment methods.Peer reviewe