Twenty years of telemedicine in chronic disease management – an evidence synthesis

A literature review was conducted to obtain a high-level view of the value of telemedicine in the management of five common chronic diseases (asthma, COPD, diabetes, heart failure, hypertension). A total of 141 randomised controlled trials (RCTs) was identified, in which 148 telemedicine interventions of various kinds had been tested in a total of 37,695 patients. The value of each intervention was categorised in terms of the outcomes specified by the investigators in that trial, i.e. no attempt was made to extract a common outcome from all studies, as would be required for a conventional meta-analysis. Summarizing the value of these interventions shows, first, that most studies have reported positive effects (n = 108), and almost none have reported negative effects (n = 2). This suggests publication bias. Second, there were no significant differences between the chronic diseases, i.e. telemedicine seems equally effective (or ineffective) in the diseases studied. Third, most studies have been relatively short-term (median duration 6 months). It seems unlikely that in a chronic disease, any intervention can have much effect unless applied for a long period. Finally, there have been very few studies of cost-effectiveness. Thus the evidence base for the value of telemedicine in managing chronic diseases is on the whole weak and contradictory

Meat Consumption Patterns and Intentions for Change Among Finnish Consumers

During the past few decades, meat has increasingly become a subject of controversies relating to health and safety, environment, and animal welfare. Even though these changes in perceptions of meat are not yet visible in aggregate consumption figures, they can be observed in individual consumption patterns and as intentions to change the consumption. In this study, we examine changes in meat consumption among the Finnish consumers taking into account both stated changes in the past and intended changes in the future. Based on these changes, we identify consumer segments and investigate in which ways these segments differ from each other socio-demographically and with respect to current meat consumption and the stated reasons for the change. The latent class analysis based on representative Internet survey data revealed nine consumer clusters that formed three cluster blocks. The results showed that a large number of people, over 40%, had stabile consumption patterns. A cluster block of 14% of consumers had already shifted their consumer patterns to contain more vegetables and less meat. One third of the consumers were identified to be in the middle of the change with a general tendency to decrease the use of meat and increase the use of vegetables. Although, environmental effects of meat and animal welfare issues were important reasons for change in some clusters, healthiness was the most salient stated reason for change in consumption habits.Food Consumption/Nutrition/Food Safety, Livestock Production/Industries,

Low schoolwork engagement and schoolwork difficulties predict smoking in adolescence?

Low academic achievement has been associated with smoking but factors behind this association are poorly known. Such factors could include schoolwork disengagement and schoolwork difficulties. To assess the extent to which they contribute to the explanation of how health inequalities emerge, we study in a longitudinal design whether these have an independent effect on smoking or whether their effect is mediated through academic achievement. Longitudinal data were collected in the Helsinki metropolitan area, Finland in 2011 and 2014. Participants were seventh-graders (12 13 years, N=9497). In the follow-up, 6534 students reported their smoking status in the ninth grade (15 16 years). Smoking, schoolwork behavioural engagement, i.e. participation in academic activities, and disengagement, schoolwork difficulties and cognitive competence were self-reported by adolescents. Academic achievement was obtained from the Finnish national application register on upper secondary education. A mediation analysis was executed with bootstrapped confidence intervals. Higher schoolwork behavioural engagement and cognitive competence in the seventh grade predicted that adolescents were more likely not to smoke in the ninth grade (all P <0.001) while higher schoolwork disengagement and schoolwork difficulties predicted adolescents smoking (all P <0.001). The effects were mediated through academic achievement. Students behavioural disengagement with schoolwork and schoolwork difficulties are risks for smoking initiation. Their effect is mediated through poor school achievement. As smoking often continues in adulthood and poor school performance typically leads to lower education, schoolwork disengagement and difficulties in adolescence constitute potential pathways to inequalities in health.Peer reviewe

Strategies and barriers to achieving the goal of Finland’s tobacco endgame

ObjectivesFinland boldly legislated the end of tobacco use in its 2010 Tobacco Act, and subsequently expanded the goal in 2016 to eradicate other nicotine-containing products. This study explored stakeholders' perceptions about the strengths, barriers, solutions and rationale for Finland's comprehensive but conventional strategy to achieve its nicotine-free goal.DesignStudy participants were selected based on expertise in policy or practice of tobacco control (n=32). Semi-structured interviews, conducted in 2017 and 2018, covered topics ranging from consensus among stakeholders to Finland's ranking on the 2016 Tobacco Control Scale. The framework method was chosen for analysing interview transcripts.ResultsA perceived strength of Tobacco-Free Finland 2030 was the consensus and cooperation among members of the tobacco control community. The objective of becoming a nicotine- versus smoke-free society had almost unanimous support, challenged by a small minority who argued for greater discussion of harm reduction approaches. The need for maintaining legitimacy and historical successes in tobacco control were reasons for using a conventional strategy. Barriers to achieving the endgame goal included insufficient funding and over-reliance on non-governmental organisations, political/legal constraints, impact of institutional practices on tobacco disparities, ambivalence about the role of mass media and lack of prioritising smoking cessation.ConclusionsStakeholders' broad confidence in reaching the goal of Finland's tobacco endgame suggests that future policy initiatives will reflect the current, conventional strategy. If the Finnish government chooses to continue this approach, then it should designate separate funds for Tobacco-Free Finland 2030 and implement structural changes that will facilitate tobacco control initiatives

Gingival cell growth with antiresorptive treatment combined with corticosteroids or antiestrogen

Objectives: Antiresorptive treatment has been shown to impair mucosal cell proliferation, migration, and viability. However, in the clinic, antiresorptives are often used in combination with other drugs. We studied the effect of antiresorptives combined with a corticosteroid or antiestrogen on oral mucosal keratinocytes and fibroblasts. Material and methods: Human gingival keratinocyte and fibroblast cell lines were exposed to bisphosphonates (BPs) and denosumab in different concentrations and durations together with an antiestrogen or corticosteroid. Changes in cell viability, proliferation and migration after exposures were measured. Data were evaluated with hierarchical linear mixed model for repeated measurements. Results: Bisphosphonate exposure suppressed keratinocyte and fibroblast cell viability, proliferation, and migration in a time-dependent manner. Combining a corticosteroid or antiestrogen with BPs further increased this negative effect. Denosumab alone had a mild positive effect on keratinocyte and fibroblast growth. When denosumab was combined with a corticosteroid or antiestrogen, cell growth was suppressed. Conclusions: Our results show that coexisting medications may increase the negative impact of BPs or denosumab on oral mucosal cells.Peer reviewe

Developments in Labour Law from a Comparative Perspective

The “Labour Law Education Society”, established in 2012, is one of the academic networks which were brought to life to study labour law from a comparative perspective. This monograph is a result of research made by LLES Members. In its contents latest issues of labour law are being presented. Hence, the essence of the presented studies would be interesting for those who analyze labour law from a comparative perspective. A dynamic development of labour law, connected with its social, political and economic conditions is a reason to study it from many different views. This monograph attempts to accomplish this objective

Morphologic and functional correlates of synaptic pathology in the cathepsin D knockout mouse model of congenital neuronal ceroid lipofuscinosis

Mutations in the cathepsin D (CTSD) gene cause an aggressive neurodegenerative disease (congenital neuronal ceroid lipofuscinosis) that leads to early death. Recent evidence suggests that presynaptic abnormalities play a major role in the pathogenesis of CTSD deficiencies. To identify the early events that lead to synaptic alterations, we investigated synaptic ultrastructure and function in pre-symptomatic CTSD knock-out (Ctsd(−/−)) mice. Electron microscopy revealed that there were significantly greater numbers of readily releasable synaptic vesicles present in Ctsd(−/−) mice than in wild-type control mice as early as postnatal day 16. The size of this synaptic vesicle pool continued to increase with disease progression in the hippocampus and thalamus of the Ctsd(−/−) mice. Electrophysiology revealed a markedly decreased frequency of miniature excitatory postsynaptic currents (EPSCs) with no effect on pair-pulse modulation of the evoked EPSPs in the hippocampus of Ctsd(−/−) mice. The reduced miniature EPSC frequency was observed before the appearance of epilepsy or any morphological sign of synaptic degeneration. Taken together, the data indicate that CTSD is required for normal synaptic function, and that a failure in synaptic trafficking or recycling may be an early and important pathological mechanism in Ctsd(−/−) mice; these presynaptic abnormalities may initiate synaptic degeneration in advance of subsequent neuronal loss

Effect of Toluene on PEMFC Performance

Liquid organic hydrogen carriers (LOHCs) are promising means for hydrogen transportation. They are compatible with existing liquid fuel transport infrastructure and enable for efficient and safe hydrogen storage and transfer over long distances. Toluene and dibenzyltoluene are considered the two most promising LOHCs. Toluene is probably a contaminant found in hydrogen released from these LOHC liquids. The impact of hydrocarbon contaminants on automotive type fuel cells has been analyzed to a limited extent, and a few species only have specific limits (CO, CO2, HCOOH, HCHO, CH4). Currently, hydrocarbons are limited to a total of 2 ppm (methane basis) in the automotive hydrogen fuel standard, ISO 14687:2019. This may lead to strict impurity levels for species from LOHC, and therefore higher costs of hydrogen purification and quality assurance. This work presents contamination studies with toluene. The measurements were conducted using a PEMFC short stack with anode recirculation and with high fuel utilization (98%). The results show no effect or only a small contamination effect with up to 20 ppm toluene, and clear contamination with 50 ppm toluene. This supports the need for more studies so that a separate limit can be defined for toluene in future versions of the ISO 14687.</p

Forests between the economic and other values

Peer reviewe