The acceptance of telemedicine technology among medical doctors in Finland

Historically, healthcare has been seen as a slow adopter of new technology. Telemedicine services and its related technologies currently face significant changes and rapid expansion, partly due to the Covid-19 pandemic. It is generally accepted that the success of any new technology relies to a great extent on users’ satisfaction and satisfied medical doctors are therefore one of the key objectives of telemedicine service success. This quantitative study aims to determine which factors predict the adoption of telemedicine technology among medical doctors in Finland. It applies the telemedicine service acceptance model (TSA) which is based on the technology acceptance model (TAM) and has been previously validated in South Korea. In addition, this study evaluates the effects of Covid-19 pandemic on the medical doctors’ attitude towards telemedicine services. To test the hypotheses of the TSA model, an online survey was distributed to medical doctors in Finland. Non-probabilistic “snowballing” sampling technique was used and resulted in 185 responses. Structural equation modeling was applied to evaluate the causal relationships within the model. The results confirm the original TAM constructs: perceived ease of use & perceived usefulness are strong predictors of medical doctors’ behavioral intention to adopt telemedicine technology, and perceived ease of use is a predictor of perceived usefulness. Of the new predictive constructs in the TSA model, self-efficacy and accessibility of medical records were predictors of perceived ease of use, whereas accessibility of patients was a predictor of perceived usefulness. Perceived incentives were not found to be important concerning the intention to use telemedicine technology. Also, having had experience with telemedicine either before or during the Covid-19 pandemic and if the attitude towards telemedicine services had improved during the Covid-19 pandemic, they both predicted a higher behavioral intention to use telemedicine services in the future. This study contributes to the theoretical knowledge of technology acceptance by identifying important factors increasing the medical doctors’ acceptance of telemedicine technology. The results also indicate that the adoption of telemedicine services is likely to further accelerate due to the Covid-19 pandemic.Historiallisesti terveydenhuoltoalaa on pidetty hitaana uuden teknologian omaksujana. Etälääketieteen palvelut ja siihen liittyvä teknologia kokevat tällä hetkellä paljon muutoksia ja nopeaa kasvua, osittain Covid-19-pandemiasta johtuen. On yleisesti tunnustettu, että minkä tahansa uuden teknologian menestys riippuu paljolti käyttäjien tyytyväisyydestä ja tyytyväiset lääkärit ovatkin etälääketieteen palveluiden onnistumisen kannalta avainasemassa. Tässä kvantitatiivisessa tutkimuksessa määritetään, mitkä tekijät ennakoivat etälääketieteen teknologian omaksumista lääkäreiden keskuudessa Suomessa. Tutkimuksessa käytetään etälääketieteen palveluiden omaksumismallia (TSA; telemedicine service acceptance), joka perustuu teknologian omaksumismalliin (TAM; technology acceptance model) ja on aikaisemmin validoitu Etelä-Koreassa. Lisäki tässä tutkimuksessa tarkastellaa Covid-19-pandemian vaikutuksia lääkäreiden asenteisiin etälääketieteen palveluita kohtaan. Etälääketieteen palveuiden omaksumismallin hypoteesien testaamista varten verkkopohjaista kyselyä jaettiin lääkäreille Suomessa. Ei todennäköisyysotantaan perustuvaa ”lumipallotekniikkaa” käytettiin vastausten keräämisessä, jonka seurauksena kyselyyn kertyi 185 vastausta. Rakenneyhtälömallia käytettiin tarkasteltaessa syy-yhetyksiä. Tulokset vahvistavat alkuperäisen teknologian omaksumismallin käsitteitä: koettu käyttöhelppous & koettu hyödyllisyys ennakoivat vahvasti lääkäreiden käyttöaikeita omaksua etälääketieteen teknologiaa sekä koettu käyttöhelppous ennakoi koettua hyödyllisyyttä. Etälääketieteen palveluiden omaksumismallin uusista ennakoivista käsitteistä minäpystyvyys ja pääsy potilasasiakirjoihin ennakoivat koettua käyttöhelppoutta, kun taas potilaiden saavutettavuus ennakoi koettua hyödyllisyyttä. Koettujen kannusteiden ei todeta olevan tärkeä tekijä ennakoimassa etälääketieteen teknologian käyttöä. Lisäksi aikaisempi kokemus etälääketieteestä joko ennen Covid-19-pandemiaa tai sen aikana sekä jos asenne etälääketiedettä kohtaan Covid-19-pandemian aikana oli parantunut ennakoivat molemmat korkeampaa etälääketieteen teknologian käyttöaikeita tulevaisuudessa. Tämä tutkimus edesauttaa teknologian käyttöönoton teoreettista ymmärryspohjaa tunnistamalla niitä tärkeitä tekijöitä, jotka lisäävät etälääketieteen teknologian omaksumista lääkäreiden keskuudessa. Tulokset osoittavat myös, että etälääketieteen palveluiden omaksuminen todennäköisesti kiihtyy entisestään Covid-19-pandemian johdosta

Quantitative determination of estrone by liquid chromatography-tandem mass spectrometry in subcutaneous adipose tissue from the breast in postmenopausal women

Estrone is the most abundant estrogen after the menopause. We developed a liquid chromatography-tandem mass spectrometric method (LC-MS/MS) for determination of estrone in adipose tissue. Subcutaneous adipose tissue from the breast was collected during elective surgery in postmenopausal women undergoing mastectomy for treatment of breast cancer (n = 13) or reduction mammoplasty (controls, n = 11). Homogenized adipose tissue was extracted with organic solvents and the estrone fraction was purified by LH-20 column chromatography from the excess of lipids. The concentration of estrone was analyzed by LC-MS/MS. The method was accurate with an intra-assay variation of 8% and an interassay variation of 10%. The median concentration of estrone in subcutaneous adipose tissue from the breast did not differ between breast cancer and control women, 920 pmol/kg and 890 pmol/kg, respectively. In breast cancer patients but not in the controls, breast adipose tissue estrone levels correlated positively with the serum estrone concentration. In conclusion, the new method provides a reliable means to measure estrone concentrations in adipose tissue in postmenopausal women. (C) 2015 Elsevier Ltd. All rights reserved.Peer reviewe

Estrogen biosynthesis in breast adipose tissue during menstrual cycle in women with and without breast cancer

Circulating estrogens fluctuate during the menstrual cycle but it is not known whether this fluctuation is related to local hormone levels in adipose tissue. We analyzed estrogen concentrations and gene expression of estrogen-regulating enzymes in breast subcutaneous adipose tissue in premenopausal women with (n = 11) and without (n = 17) estrogen receptor-positive breast cancer. Estrone (E-1) was the predominant estrogen in premenopausal breast adipose tissue, and E-1 and mRNA expression of CYP19A1 in adipose tissue correlated positively with BMI. Adipose tissue estradiol (E-2) concentrations fluctuated during the menstrual cycle, similarly to the serum concentrations. In women with breast cancer median adipose tissue E-1 (1519 vs. 3244, p <.05) and E-2 (404 vs. 889 pmol/kg, p <.05) levels were lower in the follicular than in the luteal phase whereas in control women no significant differences were observed. In the follicular phase, mRNA expressions of HSD17B1 (median 0.06; interquartile range 0.05-0.07 vs. 0.17; 0.03-0.2, p = .010) and CYP19A1 (0.08; 0.07-0.14 vs. 0.22; 0.09-0.54, p = .025) were lower in women with breast cancer than in controls. In conclusion, the changes in adipose tissue E-1 and E-2 concentrations and the estrogen-regulating CYP19A1 and HSD17B1 during the menstrual cycle may be related to dysfunctional local estrogen metabolism in women with breast cancer.Peer reviewe

Adipose tissue estrogen production and metabolism in premenopausal women

Objective: Although the ovaries produce the majority of estrogens in women before menopause, estrogen is also synthesized in peripheral tissues such as adipose tissue (AT). The typical female AT distribution, concentrated in subcutaneous and femoro-gluteal regions, is estrogen-mediated, but the significance of estrogen synthesis in AT of premenopausal women is poorly understood. Design and Methods: Serum and subcutaneous and visceral AT homogenates from 28 premenopausal women undergoing non-malignant surgery were analyzed for estrone, estradiol, and serum estrone sulfate (E1S) concentrations with liquid chromatography-tandem mass spectrometry. Isotopic precursors were used to measure enzyme activities of estrone-producing steroid sulfatase and estradiol-producing 17?-hydroxysteroid dehydrogenases (17?-HSD). Messenger RNA (mRNA) expression levels of genes for estrogen-metabolizing enzymes were analyzed using real-time reverse transcription quantitative polymerase chain reaction. Results: While estradiol was the predominant circulating active estrogen, estrone dominated in AT, with a higher concentration in visceral than subcutaneous AT (median, 2657 vs 1459 pmol/kg; P = 0.002). Both AT depots converted circulating E1S to estrone, and estrone to estradiol. Median levels of estrone were five to ten times higher in subcutaneous and visceral AT than in serum (P <0.001) and the estradiol level in visceral AT was 1.3 times higher than in serum (P <0.005). The local estrone concentration in visceral AT correlated positively with mRNA expression of estrone-producing enzyme aromatase (r = 0.65, P = 0.003). Waist circumference correlated positively with increased estradiol production in subcutaneous AT (r = 0.60, P = 0.039). Conclusions: Premenopausal AT demonstrated high estrogenic enzyme activity and considerable local estrogen concentrations. This may be a factor promoting female-typical AT distribution in premenopausal women.Peer reviewe

Increased body fat mass and androgen metabolism - A twin study in healthy young women

Objective: Obesity may alter serum steroid concentrations and metabolism. We investigated this in healthy young women with increased body fat and their leaner co-twin sisters. Design: Age and genetic background both strongly influence serum steroid levels and body composition. This is a cross-sectional study of 13 female monozygotic twin pairs (age, 23-36 years), ten of which were discordant for body mass index (median difference in body weight between the co-twins, 19 kg). Methods: We determined body composition by dual energy X-ray absorptiometry and magnetic resonance imaging, serum androgens by liquid chromatography-tandem mass spectrometry, and mRNA expression of genes in subcutaneous adipose tissue and adipocytes. Results: The heavier women had lower serum dehydroepiandrosterone (DHEA), dihydrotestosterone (DHT), and sex hormone-binding globulin (SHBG) (P <0.05 for all) compared to their leaner co-twins with no differences in serum testosterone or androstenedione levels. Serum DHEA correlated inversely with %body fat (r = -0.905, P = 0.002), and DHT positively with SHBG (r = 0.842, P = 0.002). In adipose tissue or adipocytes, expressions of STS (steroid sulfatase) and androgen-related genes were significantly higher in the heavier compared to the leaner co-twin, and within pairs, correlated positively with adiposity but were not related to serum androgen levels. None of the serum androgen or SHBG levels correlated with indices of insulin resistance. Conclusions: Serum DHEA levels were best predicted by %body fat, and serum DHT by SHBG. These or other serum androgen concentrations did not reflect differences in androgen-related genes in adipose tissue. General or intra-abdominal adiposity were not associated with increased androgenicity in young women.Peer reviewe

Metabolism of sex steroids is influenced by acquired adiposity-A study of young adult male monozygotic twin pairs

Obesity and ageing are associated with lower serum testosterone levels in men. How fat distribution or adipose tissue metabolism, independent of genetic factors and age, are related to sex steroid metabolism is less clear. We studied the associations between adiposity and serum sex hormone concentrations, and mRNA expression of genes regulating sex hormone metabolism in adipose tissue in young adult male monozygotic (MZ) twin pairs. The subjects [n = 18 pairs; mean age, 32 years; individual body mass indexes (BMIs) 22-36 kg/m(2)] included 9 male MZ twin pairs discordant for BMI [infra-pair difference (Delta) in BMI >= 3 kg/m(2)]. Sex steroid concentrations were determined by liquid chromatography-tandem mass spectrometry, body composition by dual-energy X-ray absorptiometry and magnetic resonance imaging, and mRNA expressions from subcutaneous adipose tissue by Affymetrix. In BMI-discordant pairs (mean Delta BMI = 5.9 kg/m2), serum dihydrotestosterone (DHT) was lower [mean 1.9 (SD 0.7) vs. 2.4 (1.0) nmol/l, P = 0.040] and mRNA expressions of DHT-inactivating AKR1C2 (P = 0.021) and cortisol-producing HSD11B1 (P = 0.008) higher in the heavier compared to the leaner co-twins. Serum free 17 beta-estradiol (E2) was higher [2.3 (0.5) vs. 1.9 (0.5) pmol/l, P = 0.028], and in all twin pairs, serum E2 and estrone concentrations were higher in the heavier than in the leaner co-twins [107 (28) vs. 90 (22) pmol/l, P = 0.006; and 123 (43) vs. 105 (27) pmol/l, P = 0.025]. Within all twin pairs, i.e. independent of genetic effects and age, 1) the amount of subcutaneous fat inversely correlated with serum total and free testosterone, DHT, and sex hormone-binding globulin (SHBG) concentrations (P <0.01 for all), 2) infra-abdominal fat with total testosterone and SHBG (P <0.05), and 3) liver fat with SHBG (P = 0.006). Also, 4) general and intra-abdominal adiposity correlated positively with mRNA expressions of AKR1C2, HSD11B1, and aromatase in adipose tissue (P <0.05). In conclusion, acquired adiposity was associated with decreased serum DHT and increased estrogen concentrations, independent of genetic factors and age. The reduction of DHT could be linked to its increased degradation (by AKR1C2 and HSD11B1) and increased estrogen levels to increased adiposity-related expression of aromatase in adipose tissue.Peer reviewe