Healthcare Professionals' Breastfeeding Attitudes and Hospital Practices During Delivery and in Neonatal Intensive Care Units: Pre and Post Implementing the Baby-Friendly Hospital Initiative

Background: The Baby-Friendly Hospital Initiative represents a global effort to support breastfeeding. Commitment to this program has been associated with the longer duration and exclusivity of breastfeeding and improvements in hospital practices. Further, healthcare professionals' breastfeeding attitudes have been associated with the ability to provide professional support for breastfeeding.Research aims: To determine healthcare professionals' breastfeeding attitudes and hospital practices before and after the implementation of the Baby-Friendly Hospital Initiative.Methods: Using a quasi-experimental pretest-posttest study design, healthcare professionals (N = 131) from the single hospital labor and delivery, maternity care, and neonatal intensive care were recruited before and after the Baby-Friendly Hospital Initiative intervention during 2017 and 2019. Breastfeeding attitudes with the validated Breastfeeding Attitude Questionnaire, breastfeeding-related hospital practices, and background characteristics were collected.Results: The healthcare professionals' breastfeeding attitude scores increased significantly after the implementation of the Baby-Friendly Hospital Initiative, difference = 0.16, (95% CI [0.13, 0.19]) and became breastfeeding favorable among all professional groups in each study unit. Positive changes in breastfeeding-supportive hospital practices were achieved. The infants had significantly more frequent immediate and uninterrupted skin-to-skin contact with their mothers. The rate of early breastfeeding, as well as the number of exclusively breastfed infants, increased.Conclusions: After the Baby-Friendly Hospital Initiative and Baby-Friendly Hospital Initiative for neonatal wards (Neo-BFHI) interventions were concluded, we found significant improvements in the breastfeeding attitudes of healthcare professionals and in breastfeeding-related care practices.This RCT was registered (0307-0041) with ClinicalTrials.gov on 03/03/2017.</p

Estimating intraseasonal intrinsic water-use efficiency from high-resolution tree-ring delta C-13 data in boreal Scots pine forests

Intrinsic water-use efficiency (iWUE), a key index for carbon and water balance, has been widely estimated from tree-ring delta C-13 at annual resolution, but rarely at high-resolution intraseasonal scale. We estimated high-resolution iWUE from laser-ablation delta C-13 analysis of tree-rings (iWUE(iso)) and compared it with iWUE derived from gas exchange (iWUE(gas)) and eddy covariance (iWUE(EC)) data for two Pinus sylvestris forests from 2002 to 2019. By carefully timing iWUE(iso) via modeled tree-ring growth, iWUE(iso) aligned well with iWUE(gas) and iWUE(EC) at intraseasonal scale. However, year-to-year patterns of iWUE(gas), iWUE(iso), and iWUE(EC) were different, possibly due to distinct environmental drivers on iWUE across leaf, tree, and ecosystem scales. We quantified the modification of iWUE(iso) by postphotosynthetic delta C-13 enrichment from leaf sucrose to tree rings and by nonexplicit inclusion of mesophyll and photorespiration terms in photosynthetic discrimination model, which resulted in overestimation of iWUE(iso) by up to 11% and 14%, respectively. We thus extended the application of tree-ring delta C-13 for iWUE estimates to high-resolution intraseasonal scale. The comparison of iWUE(gas), iWUE(iso), and iWUE(EC) provides important insights into physiological acclimation of trees across leaf, tree, and ecosystem scales under climate change and improves the upscaling of ecological models.Peer reviewe

Modelling sun-induced fluorescence and photosynthesis with a land surface model at local and regional scales in northern Europe

Recent satellite observations of sun-induced chlorophyll fluorescence (SIF) are thought to provide a large-scale proxy for gross primary production (GPP), thus providing a new way to assess the performance of land surface models (LSMs). In this study, we assessed how well SIF is able to predict GPP in the Fenno-Scandinavian region and what potential limitations for its application exist. We implemented a SIF model into the JSBACH LSM and used active leaf-level chlorophyll fluorescence measurements (Chl F) to evaluate the performance of the SIF module at a coniferous forest at Hyytiala, Finland. We also compared simulated GPP and SIF at four Finnish micrometeorological flux measurement sites to observed GPP as well as to satellite-observed SIF. Finally, we conducted a regional model simulation for the Fenno-Scandinavian region with JSBACH and compared the results to SIF retrievals from the GOME-2 (Global Ozone Monitoring Experiment-2) space-borne spectrometer and to observation-based regional GPP estimates. Both observations and simulations revealed that SIF can be used to estimate GPP at both site and regional scales. At regional scale the model was able to simulate observed SIF averaged over 5 years with r(2) of 0.86. The GOME-2-based SIF was a better proxy for GPP than the remotely sensed fA-PAR (fraction of absorbed photosynthetic active radiation by vegetation). The observed SIF captured the seasonality of the photosynthesis at site scale and showed feasibility for use in improving of model seasonality at site and regional scale.Peer reviewe

Digital photography for assessing the link between vegetation phenology and CO2 exchange in two contrasting northern ecosystems

Digital repeat photography has become a widely used tool for assessing the annual course of vegetation phenology of different ecosystems. By using the green chromatic coordinate (GCC) as a greenness measure, we examined the feasibility of digital repeat photography for assessing the vegetation phenology in two contrasting high-latitude ecosystems. Ecosystem-atmosphere CO2 fluxes and various meteorological variables were continuously measured at both sites. While the seasonal changes in GCC were more obvious for the ecosystem that is dominated by annual plants (open wetland), clear seasonal patterns were also observed for the evergreen ecosystem (coniferous forest). Daily and seasonal time periods with sufficient solar radiation were determined based on images of a grey reference plate. The variability in cloudiness had only a minor effect on GCC, and GCC did not depend on the sun angle and direction either. The daily GCC of wetland correlated well with the daily photosynthetic capacity estimated from the CO2 flux measurements. At the forest site, the correlation was high in 2015 but there were discernible deviations during the course of the summer of 2014. The year-to-year differences were most likely generated by meteorological conditions, with higher temperatures coinciding with higher GCCs. In addition to depicting the seasonal course of ecosystem functioning, GCC was shown to respond to environmental changes on a timescale of days. Overall, monitoring of phenological variations with digital images provides a powerful tool for linking gross primary production and phenology.Peer reviewe

Tree organ growth and carbon allocation dynamics impact the magnitude and δ13C signal of stem and soil CO2 fluxes

Incomplete knowledge of carbon (C) allocation dynamics in trees hinders accurate modeling and future predictions of tree growth. We studied C allocation dynamics in a mature Pinus sylvestris L. dominated forest with a novel analytical approach, allowing the first comparison of: (i) magnitude and delta C-13 of shoot, stem and soil CO2 fluxes (A(shoot), R-stem and R-soil), (ii) concentration and delta C-13 of compound-specific and/or bulk non-structural carbohydrates (NSCs) in phloem and roots and (iii) growth of stem and fine roots. Results showed a significant effect of phloem NSC concentrations on tracheid growth, and both variables significantly impacted R-stem. Also, concentrations of root NSCs, especially starch, had a significant effect on fine root growth, although no effect of root NSC concentrations or root growth was detected on R-soil. Time series analysis between delta C-13 of A(shoot) and delta C-13 of R-stem or delta C-13 of R-soil revealed strengthened C allocation to stem or roots under high C demands. Furthermore, we detected a significant correlation between delta C-13 of R-stem and delta C-13 of phloem sucrose and glucose, but not for starch or water-soluble carbohydrates. Our results indicate the need to include C allocation dynamics into tree growth models. We recommend using compound-specific concentration and delta C-13 analysis to reveal C allocation processes that may not be detected by the conventional approach that utilizes bulk organic matter.Peer reviewe

Evaluating Biosphere Model Estimates of the Start of the Vegetation Active Season in Boreal Forests by Satellite Observations

The objective of this study was to assess the performance of the simulated start of the photosynthetically active season by a large-scale biosphere model in boreal forests in Finland with remote sensing observations. The start of season for two forest types, evergreen needle-and deciduous broad-leaf, was obtained for the period 2003-2011 from regional JSBACH (Jena Scheme for Biosphere-Atmosphere Hamburg) runs, driven with climate variables from a regional climate model. The satellite-derived start of season was determined from daily Moderate Resolution Imaging Spectrometer (MODIS) time series of Fractional Snow Cover and the Normalized Difference Water Index by applying methods that were targeted to the two forest types. The accuracy of the satellite-derived start of season in deciduous forest was assessed with bud break observations of birch and a root mean square error of seven days was obtained. The evaluation of JSBACH modelled start of season dates with satellite observations revealed high spatial correspondence. The bias was less than five days for both forest types but showed regional differences that need further consideration. The agreement with satellite observations was slightly better for the evergreen than for the deciduous forest. Nonetheless, comparison with gross primary production (GPP) determined from CO2 flux measurements at two eddy covariance sites in evergreen forest revealed that the JSBACH-simulated GPP was higher in early spring and led to too-early simulated start of season dates. Photosynthetic activity recovers differently in evergreen and deciduous forests. While for the deciduous forest calibration of phenology alone could improve the performance of JSBACH, for the evergreen forest, changes such as seasonality of temperature response, would need to be introduced to the photosynthetic capacity to improve the temporal development of gross primary production.Peer reviewe

Carbon sink and CarbonSink+ : from observations to global potential

Carbon balance of forests is defined by three main processes; photosynthesis, autotrophic respiration, and heterotrophic respiration. Climate impact of forests include also non-carbon effects like albedo, biogenic aerosols, effect on clouds, evaporation and surface roughness. A well-thought measurement setup as well as standardised procedures are essential for a meaningful and robust monitoring and the comparability of the observations at the same site and in inter-site comparisons. Depending on the mitigation project objectives and scale different combination of methodologies could be used including forest carbon inventories, chamber measurements, tower-based eddy covariance flux measurements, large-scale atmospheric greenhouse gas measurements, aircraft and satellite remote sensing. In addition to GHGs, forests have other important climate effects. They change surface albedo (warming effect), are source of volatile organic compounds (VOC), have effect on aerosol particle formation and growth, increases amount of cloud condensation nuclei (CCN), and has effect on cloud formation as well as on the precipitation. Moreover, any modification of the carbon cycle by removing or increasing CO2-binding vegetation has impact on the complex climate - carbon cycle feedback. We define these additional cooling effects as CarbonSink+. Accounting all these effects, this CarbonSink+ may increase the climate cooling impact of forests compared with pure carbon sink effect. Land use based mitigation plays an important role in current Nationally Determined Contributions of Paris Agreement. Scientific findings indicate that through different actions land sector could provide up to 1/3 of the needed total mitigation through year 2030. However, permanence of ecosystem based carbon storages is still a challenge and trade-offs between different land use form exist and should be properly acknowledged in the mitigation projects. We define in this report a cost effective, i.e. as simple as possible but good enough, measurement setup to verify both ordinary carbon sink and CarbonSink+ -effect. The methodology is planned for commercial applications, rather than for scientific purposes. The estimated prices of the instrumentation are based on present-day situation. In the conclusions of the report, we also describe first level principles and challenges which could help to formulate protocols for larger framework needed for the global commercial carbon marketNon peer reviewe

Preface to the special issue on Monitoring and Modelling of Carbon-Balance-, Water- and Snow-Related Phenomena at Northern Latitudes

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Nuorten kokemuksia kouluterveydenhoitajan toteuttamasta seksuaalikasvatuksesta

Tutkielman tarkoituksena oli kuvata nuorten kokemuksia ja kehittämisehdotuksia kouluterveydenhoitajan antamasta seksuaalikasvatuksesta. Lisäksi tutkimuksessa selvitettiin, mikä on nuoren lähiympäristön osuus seksuaalikasvatuksessa. Tutkimusaineiston muodostivat neljäkymmentä (N=40) vapaaehtoista toisen asteen oppilaitoksessa opiskelevaa 18 vuotta täyttänyttä nuorta. Ensimmäisenä aineistonkeruumenetelmänä käytettiin esseekirjoitelmaa, jonka kirjoittivat kaikki neljäkymmentä nuorta annetun ohjeistuksen pohjalta. Toisessa vaiheessa viisi (N=5) nuorista osallistui syventävään ryhmähaastatteluun. Aineisto analysoitiin laadullisella, induktiivisella sisällön analyysilla. Nuoret arvostivat kouluterveydenhoitajaa seksuaalikasvatuksen toteuttajana ja tiedonantajana. He painottivat, että terveydenhoitajan tulee hallita tiedollisesti seksuaalikasvatukseen liittyvät asiat. Nuoret pitivät tärkeänä, että terveydenhoitaja ottaa aktiivisesti esille seksuaalisuuteen liittyviä asioita terveystarkastusten yhteydessä, sillä nuoret itse eivät uskalla toimia aina aloitteentekijänä. Terveydenhoitajan avoimuus ja luotettavuus edistivät merkittävästi seksuaalikasvatuksen onnistumista. Haittaavina ominaisuuksina pidettiin terveydenhoitajan estyneisyyttä ja alentuvaa suhtautumista nuoriin. Kouluterveydenhoitajan palvelujen saatavuudessa ilmeni suuria eroja. Nuoren lähiympäristön merkittävimpiä seksuaalikasvattajia olivat perhe, ystävät, koulu, media ja seurakunta. Osa nuorista sai avointa seksuaalikasvatusta perheeltään, mutta enemmistön kokemukset kodin antamasta seksuaalikasvatuksesta olivat vähäiset. Osa heistä koki vanhemmilta saatavan ohjauksen vaivaannuttavaksi. Ystävien ja rippileirillä toisten nuorten kanssa keskustelua kuvattiin vastavuoroiseksi pohdiskeluksi. Nuoret saivat runsaasti seksuaalisuuteen liittyvää tietoa myös joukkotiedotusvälineistä. Median riskeiksi nuoret nimesivät internetin haittaavan ja vaurioittavankin materiaalin; myös mahdollinen päivittämätön ja vanhentunut tieto koettiin internetin haitaksi. Nuoret toivovat, että terveydenhoitajan toteuttamaa seksuaaliopetusta voisi kehittää toiminnallisempaan suuntaan. Nuoret tulisi ottaa mukaan opetuksen sisältöjen suunnitteluun, ja sen tulisi olla konkreettista sekä itsenäiseen tiedonhakuun kannustavaa. Ryhmämuotoista seksuaalikasvatusta annettaessa on kiinnitettävä huomiota turvallisen ja luottamuksellisen ilmapiirin luomiseen. Opetusta tulisi antaa toistuvasti ja jokaisella vuosiluokalla. Nuoret toivovat, että kouluterveydenhoitajan antamista palveluista tiedotettaisiin enemmän, sillä osa nuorista ei tiedä, että juuri kouluterveydenhoitajan kanssa voi puhua seksuaalisuuteen liittyvistä asioita. Nuoret odottavat terveydenhoitajalta tietoa myös muista seksuaalitietoutta ja ­ terveyttä edistävistä palveluista. Asiasanat: nuori, kouluterveydenhoitaja, seksuaalikasvatus The purpose of this study was to describe adolescents` experiences and development propositions of a school nurse giving sexual education. In addition, the role of the adolescents` close environment in giving sexual education, was studied. The data consisted of 40 volunteer young people at least 18 years of age studying in the upper secondary level. The first data collecting method was essay writing, which was made by all forty adolescents as directed. On the second stage five of the adolescents were interviewed in a group. The data were analyzed using inductive content analysis. The adolescents appreciated school nurses giving sexual education. They made clear, that school nurses have to know the information belonging to the sexual education. The adolescents considered that school nurses have to talk about sexual things in an active way, because many young persons are afraid to talk about it at first. School nurses, who had positive characteristics like openness and reliability, gave good sexual education. The negative characteristics in school nurses were discomfiture and bad attitude towards the young. There were big differences between schools offering the services of a school nurse. The most important sexual educators in the adolescents` life were family, friends, school, media and congregation. One part of adolescents got open sexual education from their families, but the majority got very little sexual education from home. Part of the young thought that the guidance coming from their parents was bothering. The conversations between friends and at the confirmation camp with other adolescents were described as a mutual contemplation. Adolescents got much information also from the media. They mentioned some risks using the internet: there can be found harmful or even damaging sexual material. Some pages can also be un-updated and outdated. . The adolescents hope that the sexual education could be more functional in the future. They should be asked what they want and need to know. The atmosphere in the classes when giving sexual education should be safe and confidential. Also the education should be given every year. Adolescents hope that they should be better informed about the services of school nurses and also about other sexual health services. Keywords: adolescents, school nurse, sexual educatio