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Spring cultivars of barley (Hordeum vulgare L.), oat (Avena sativa L.), and wheat (Triticum aestivum L.) are the most important crops in Finnish agricultural systems. The increasing need to reduce pollution from N fertilizer is concomitantly strengthening the importance of improving the understanding of nitrogen use efficiency (NUE) of these crops. The aim of this work was to study the differences in NUE, defined as the crop's ability to produce yield with one available N unit, among spring cereal cultivars, and to determine the achievements of plant breeding in NUE under northern European growing conditions. Field experiments were conducted in Finland during 2003 and 2004. Samples from matured plants of 17 to 18 cultivars of each of the three cereal species released between 1909 and 2002 were studied. There were no clear differences in NUE among modern spring cultivars. However, there were cultivar differences within species and significant NUE improvements on wheat and particularly for oat across time. There was no clear trend of NUE and year of release of cultivars in two-row spring barley, probably because breeding for malting barley involves consistent selection for low-protein cultivars. The study revealed that most breeding effects on NUE were associated with changes in nitrogen uptake efficiency (UPE)., SPRING BARLEY, OAT, AND WHEAT are important crops in the Nordic region (Denmark, Finland, Norway, and Sweden). Finland has larger areas sown to oat (424 000 ha) and barley (550 [...]

At high northern latitudes, growing seasons are short with long days. In these conditions, tillering is an unwanted trait in barley (Hordeum vulgare L.), because the grains on tillers develop later than those on the main stem and are often harvested before they are fully mature, leading to reductions in overall quality. Hence, the uniculm growth habit has been considered an interesting option for boreal barley production. The aim of the present study was to determine the differences in the yield formation of conventional tillering and uniculm barley, using two pairs of near-isogenic lines and two controls. Uniculm and conventional tillering barley were grown in three experiments conducted at Suitia Experimental Farm, University Helsinki, Finland during 1999–2001. Samples were collected frequently to monitor the biomass and leaf area accumulation. Water-soluble carbohydrate content was analysed at anthesis and at maturity in different plant parts. At maturity, the numbers of spikes/plant and grains/spike were calculated and grain yield weighed. The grain yield of the uniculm barleys was stable over these growing seasons, but it was only half that of the conventional barley cultivars due to the absence of spike-bearing tillers, lower spike grain number and spike weight. In addition, the ability to transport photosynthesized carbohydrates to grains may have been reduced. Thus, it seems that uniculm barleys do not provide further improvement in barley yield. [ABSTRACT FROM PUBLISHER]

Increased harvest index (HI) has been one of the principal factors contributing to genetic yield improvements in spring barley (Hordeum vulgare L.), oat (Avena sativa L.) and wheat (Triticum aestivum L.) cultivars. Although high HI demonstrates high-yielding ability when cultivars are compared, it can also indicate challenges to yield formation when comparisons are made across differing growing conditions. The present study was designed to investigate variation in HI among modern cereal cultivars relative to that brought about by a northern environment, to assess whether HI still explains the majority of the differences in grain yield when only modern cereal cultivars are compared, and to monitor key traits contributing to HI. Stability of HI was also investigated with reference to the role of tillers. Twelve experiments (3 years, two locations, two nitrogen fertilizer regimes) were carried out in southern Finland to evaluate 12 two-row spring barley, 10 six-row barley, 10 oat and 11 wheat cultivars. In addition to HI, days to heading and maturity, length of grain filling period, grain yield, test weight and 13 traits characterizing plant stand structure were measured and analysed with principal component analysis (PCA) to detect traits associated with HI and those contributing to stability of HI. Although only modern cereals were studied, differences among cultivars were significant both in mean HI and stability of HI, and HI was associated with short plant stature in all modern cereal species. Also, single grain weight was associated with HI in all species. Differences between, but not within, species in HI were partly attributable to differences in tiller performance. Grain yield was associated closely with HI except in two-row barley. It may be possible to further increase HI of wheat, as it still was relatively low. High HI did, however, not indicate the degree of success in yield determination when environments are compared. [ABSTRACT FROM PUBLISHER]

Background: Aged residents in nursing homes are at particularly high risk of fractures. Vitamin D and calcium have a preventative role. Objective: To describe the use of vitamin D and calcium supplementations, and their association with nutritional factors among nursing home residents. Methods: Our study is a cross-sectional assessment of long-term residents in all nursing homes in Helsinki during February 2003. We collected residents' background information, nutritional status (Mini Nutritional Assessment, MNA), and data on daily nursing routines in institutions, including nutritional care. Vitamin D and calcium supplementations were inquired after in the questionnaire and retrieved from residents' medication lists. Results: 2 114 (87%) of all 2424 eligible residents had available data on the use of vitamin D and calcium supplementation. Their mean age was 83 years, and 80.7% were female. Of all participants, 32.9% received vitamin D supplementation and 27.7% calcium supplementation. Altogether 20.0% received both. However, only 21.3% received vitamin D in the therapeutic dose of 10mg (400 IU) or more, and 3.6% in the recommended dose of 20µg (800 IU) or more. in logistic regression analysis, residents who received vitamin D supplementation also had better nutritional status (MNA), ate snacks between meals, did not have constipation and their weight was checked more frequently. Conclusions: Regardless of the known benefit and recommendation of vitamin D supplementation for the elderly residing mostly indoors, the proportion of nursing home residents receiving vitamin D and calcium was surprisingly low. Our study shows how slowly evidence and recommendations are implemented in practice. [ABSTRACT FROM AUTHOR]

This study was designed to gain information on the quality of nursing care based on the comments in nursing records. The specific aims of the study were to find out if the patients' (i) individual needs are assessed, the goals for nursing care are set, and the nursing interventions are determined; (ii) if the patients' needs are met and (iii) if goal achievement is regularly evaluated by including comments in nursing documents. In addition, the study aimed to describe the up-to-dateness of nursing care plans as well as the frequency of making daily notes. The data were collected on 36 wards of four residential homes. A 30% sample of the nursing documents on each ward was collected (n=332) using the Senior Monitor instrument. The documents studied were mainly nursing care plans and daily note sheets. Seventy-three per cent of the nursing home residents had an up-to-date nursing care plan at the time of data collection. The main results demonstrated that a written statement on the patient's mental ability was lacking in every fourth document although 75% of the patients suffer from at least moderate dementia in Finnish long-term care institutions. Development activities should also be targeted to the documentation of clear and concrete means by which patients' independent functioning is supported. In addition, evaluation was the area that warranted attention and development activities since only every fourth record included information on changes in the patients' functional capability. Although a lot of in-service training has been focused on improving the documentation practices, there is still a need for development. The means by which knowledge is transferred to guide the practice should be carefully considered. Also forms should be developed to meet the special requirements for recording nursing care in long-term care settings. [ABSTRACT FROM AUTHOR]

Objectives: To explore how oral problems, chewing problems, dry mouth, and swallowing difficulties cluster and whether their burden is associated with nutritional status, eating habits, gastrointestinal symptoms, psychological well-being, and mortality among institutionalized residents., Design: Cross-sectional study with 1-year mortality., Setting and Participants: 3123 residents living in assisted facilities and nursing homes in Helsinki, Finland., Measures: Trained nurses assessed residents in all nursing homes and assisted living facilities in Helsinki in 2011. A personal interview, the Mini Nutritional Assessment (MNA), oral symptoms, questions about eating habits, and psychological well-being were used to assess each resident. We divided the subjects first according to the number of oral symptoms into 4 groups: no oral symptoms (G0), 1 oral symptom (G1), 2 oral symptoms (G2), and all 3 symptoms (G3); and second according to the symptoms: dry mouth, chewing problems, and swallowing difficulties. The diagnoses and medications were retrieved from medical records, and mortality data were obtained from central registers., Results: In all, 26% of the subjects had 1 oral problem (G1), 11% had 2 oral problems (G2), and 4% had all 3 oral problems (G3), whereas 60% (n = 1870) had no oral symptoms. Thus, the oral symptoms moderately overlapped. The burden of oral symptoms was linearly associated with malnutrition, higher numbers of comorbidities, dependency in physical functioning, gastrointestinal symptoms, and eating less and more often alone. The higher the burden of oral symptoms, the lower the self-rated health and psychological well-being. Mortality increased along with the higher oral symptoms burden. Among residents having 1 or more symptoms, 26% had chewing problems, 18% swallowing difficulties, and 15% dry mouth., Conclusions/implications: The burden of oral health problems was associated in a stepwise fashion with poor health and psychological well-being, malnutrition, and mortality. Clinicians should routinely assess older institutionalized residents' oral health status to improve residents' well-being., (Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: While nutritional problems have been recognized as common in institutional settings for several decades, less is known about how nutritional care and nutrition has changed in these settings over time., Objectives: To describe and compare the nutritional problems and nutritional care of residents in all nursing homes (NH) in 2003 and 2011 and residents in all assisted living facilities (ALF) in 2007 and 2011, in Helsinki, Finland., Methods: We combined four cross-sectional datasets of (1) residents from all NHs in 2003 (N=1987), (2) residents from all ALFs in 2007 (N=1377), (3) residents from all NHs in 2011 (N=1576) and (4) residents from all ALFs in 2011 (N=1585). All participants at each time point were assessed using identical methods, including the Mini Nutritional Assessment (MNA)., Results: The mean age of both samples from 2011 was higher and a larger proportion suffered from dementia, compared to earlier collected samples. A larger proportion of the residents in 2011 were assessed either malnourished or at-risk for malnutrition, according to the MNA, than in 2003 (NH: 93.5% vs. 88.9%, p<0.001) and in 2007 (ALF: 82.1% vs. 78.1%, p=0.007). The use of nutritional, vitamin D and calcium supplements, and snacks between meals was significantly more common in the 2011 residents, compared to the respective earlier samples., Conclusions: In 2011, institutionalized residents were more disabled and more prone to malnourishment than in 2003 or 2007. Institutions do seem to be more aware of good nutritional care for vulnerable older people, although there is still room for improvement., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: This study aims to assess potentially severe class D drug-drug interactions (DDDIs) in residents 65 years or older in assisted living facilities with the use of a Swedish and Finnish drug-drug interaction database (SFINX)., Design: A cross-sectional study of residents in assisted living facilities in Helsinki, Finland., Setting: A total of 1327 residents were assessed in this study. Drugs were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and DDDIs were coded according to the SFINX., Main Outcome Measures: Prevalence of DDDIs, associated factors and 3-year mortality among residents., Results: Of the participants (mean age was 82.7 years, 78.3% were females), 5.9% (N = 78) are at risk for DDDIs, with a total of 86 interactions. Participants with DDDIs had been prescribed a higher number of drugs (10.8 (SD 3.8) vs. 7.9 (SD 3.7), p < 0.001). A larger proportion of residents with DDDIs suffered from rheumatoid arthritis or osteoarthritis than those not exposed to DDDIs (24.7% vs. 15.4%, p = 0.030). The most frequent DDDIs were related to the concomitant use of potassium with amiloride (N = 12) or spironolactone (N = 12). Carbamazepine (N = 13) and methotrexate (N = 9) treatments were also frequently linked to DDDIs. During the follow-up, no differences in mortality emerged between the participants exposed to DDDIs and the participants not exposed to DDDIs., Conclusions: Of the residents in assisted living, 5.9% were exposed to DDDIs associated with the use of a higher number of drugs. Physicians should be trained to find safer alternatives to drugs associated with DDDIs. KEY POINTS   Potentially severe, class D drug-drug interactions (DDDIs) have been defined in the SFINX database as clinically relevant drug interactions that should be avoided.  • Of the residents in assisted living, 5.9% were exposed to DDDIs that were associated with the use of a higher number of drugs.  • The most frequent DDDIs were related to the concomitant use of potassium with amiloride or spironolactone. Carbamazepine and methotrexate were also linked to DDDIs.  • No difference in mortality was observed between residents exposed to DDDIs and residents not exposed to DDDIs.

Objective: We examined the relationships between dentition, nutritional status and dietary intakes of energy, protein and micronutrients among older people in assisted living facilities in Helsinki., Background: Poor dentition is associated with malnutrition. Less is known about how dentition is associated with detailed nutrient intakes in institutionalised older people., Materials and Methods: This cross-sectional study assessed 343 participants (mean age 83 years). Dentition was assessed by trained ward nurses and divided into edentulous participants without dentures (group 1), edentulous participants with removable dentures (group 2) and those with any natural teeth (group 3). Nutritional status was assessed by Mini Nutritional Assessment (MNA). The energy, protein and nutrient intakes were calculated from detailed 1-day food diaries and compared with the recommendations of the Finnish National Nutrition Council as a measure of dietary adequacy. Assessment included also participants' cognitive and functional status., Results: Of the participants, 8.2, 39.1 and 52.8% were in groups 1, 2 and 3, respectively. Altogether 22% were malnourished according to MNA. Group 1 had the poorest nutritional status. A large proportion of participants consumed less than the recommended amounts of energy, protein or micronutrients. Half of the participants consumed <60 g/day of protein. The intake of protein was significantly lower in group 1 than in other two groups., Conclusion: Malnutrition and inadequate protein intake were very common and associated with dentition among older people with multiple disabilities in assisted living facilities. Assessment of dental status should be part of good nutritional care in long-term care., (© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.)

The aim of this study was to determine the associations of older assisted living residents' tooth brushing habits with health and nutritional status. We assessed the tooth brushing habits, nutritional status, oral health, use of dental services, and morbidity of 1,447 assisted living residents in the Helsinki metropolitan area of Finland. Of the residents, 17% did not clean or had not cleaned their teeth and/or dentures daily. Those not cleaning their teeth and/or dentures daily were more often male, less educated and had a mean length of stay in assisted living longer than those who cleaned their teeth and/or dentures daily. They were more often malnourished and dependent in ADLs. In addition they more often had poorer oral health and used fewer dental services. Poor tooth brushing habits indicate poor oral and subjective health. More attention should focus on the oral hygiene of frail older assisted living residents., (©2012 Special Care Dentistry Association and Wiley Periodicals, Inc.)

Objectives: To examine the nutritional status and energy, protein, and micronutrient intake of aged residents living in service houses and to compare how they meet official recommendations., Design: Cross-sectional study., Participants: Service house residents (n = 375) in the metropolitan region of Helsinki, Finland., Measurements: The nutritional status of residents was assessed with the Mini Nutritional Assessment. Residents' energy, protein, and nutrient intake were calculated from 1-day food diaries and compared with the nutrition recommendations., Results: The mean age of participants was 83 years; 82% were females. According to the Mini Nutritional Assessment, 65% were at risk for malnutrition and 21% were malnourished. Energy, protein, and nutrient intake varied greatly among residents. Inadequate energy, protein, and micronutrient intake was common among the oldest residents. Of the whole group, 46% received less than 1570 kcal/d of energy and 47% received less than 60 g/d of protein. Their intake of fiber, vitamin E, vitamin D, and folic acid was especially low. The percentages of residents receiving less than the recommended intake of these nutrients were 98%, 98%, 38%, and 86%, respectively., Conclusions: Taking into account the large number of aged residents suffering from malnutrition or being at risk for malnutrition, low energy, protein, and micronutrient intake was very common. Assessment-based nutritional care should be a significant part in supporting frail older people in service houses., (Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)

Background: Drugs with anticholinergic properties have harmful effects among frail older people and they may antagonize the effects of cholinesterase inhibitors (ChEIs). However, their association with psychological well-being has not been studied., Objective: To determine (1) the prevalence of the use of anticholinergic drugs, ChEIs, or their combination among older adults in residential care facilities and their association with psychological well-being, and (2) the association of anticholinergic drugs with an individual's psychological well-being., Methods: In 2007, all older adults (N = 1475) living in residential care facilities in the cities of Helsinki and Espoo, Finland, were assessed in a cross-sectional study. A trained nurse retrieved data on demographic factors, regularly administered medications, and diagnoses from medical charts. Psychological well-being was assessed using 6 questions concerning life satisfaction, zest for life, plans for the future, feeling needed, and feeling depressed or lonely, and a psychological well-being score was created (range 0-1)., Results: Residents taking anticholinergic drugs (n = 613) were significantly younger, used more drugs, and were more often on ChEIs compared with nonusers (n = 862). There was no significant difference in Charlson comorbidity index, stage of cognition, or dependence on activities of daily living between the users or nonusers of anticholinergic drugs. The anticholinergic drug users had significantly lower psychological well-being scores compared with the nonusers. Of the participants, 10.7% used ChEIs and anticholinergic drugs concomitantly. In logistic regression analysis where age, sex, comorbidities, and use of ChEIs were used as covariates, lower psychological well-being was associated with the use of anticholinergic drugs (OR 1.40; 95% CI 1.00 to 1.94; p = 0.048)., Conclusions: Concomitant use of anticholinergic drugs and ChEIs is common among older adults. The use of anticholinergic drugs is associated with poor psychological well-being.

Objective: The aim of this study is to investigate the use of proton-pump inhibitors (PPI) and their associated risks among frail elderly nursing home residents., Design: A cross-sectional study., Setting: General practice., Subjects: An assessment of residents (n = 1987, mean age 83.7 years) in all nursing homes in Helsinki was carried out in February 2003. Data included demographic characteristics, symptoms such as diarrhea, vomiting and constipation, use of various drugs, and medical diagnoses., Outcome: Coded data analysis with NCSS statistical program. Multivariate logistic regression analysis served to determine which variables were independently associated with diarrhea; variables which were statistically significant or near p < 0.05 in univariate analyses were included., Results: Altogether 433 residents were on PPIs. The factors associated with regular PPI use in univariate analyses included poor functional status, higher number of comorbidities, higher number of medications and lactose intolerance. The users had suffered from a prior ventricular or duodenal ulcer, cancer and coronary heart disease more often than the non-users. In accordance with our hypothesis, the users of PPIs more often had diarrhea (19.7%) than the non-users (12.9%) (p < 0.001), and they had a prior hip fracture (28.5%) more often than the non-users (19.4%) (p < 0.001). In logistic regression analysis the use of PPIs had an independent association with diarrhea (OR 1.60 (95% CI 1.20 to 2.15)., Conclusion: Physicians should avoid unnecessary long-term use of PPIs, particularly among frail elderly long-term care patients.

Background and Objective: Constipation and, as a consequence, the use of laxatives are common among frail older people. The causes of and factors associated with laxative use, however, have undergone surprisingly little study. The objectives of our study were to (i) assess the prevalence of regularly administered laxatives, (ii) identify factors associated with regular use of laxatives, and (iii) determine which drug classes or medications are associated with regular laxative use in an older nursing home population in Helsinki., Methods: This study was a cross-sectional assessment of all long-term nursing home residents aged >/=65 years in Helsinki, Finland. In February 2003, the health status of these residents was assessed and data on their demographic characteristics, health and medication use were collected from medical charts., Results: Of all nursing home residents in Helsinki, 82% (n = 1987, mean age 83.7 years) participated in the study. Of all residents, 55.3% received laxatives regularly. Factors associated with regular laxative use in univariate analysis included age >80 years, stroke, Parkinson's disease, inability to move independently, poor Mini Nutritional Assessment (MNA) score (<17), fluid intake less than five glasses per day, and chewing problems. Drugs associated with laxative use included opioids, antacids, diuretics, tricyclic antidepressants, lipid-lowering drugs other than HMG-CoA reductase inhibitors (statins), histamine H(2) receptor antagonists, nonselective NSAIDs, anticholinergic drugs for urine incontinence, and calcium channel antagonists other than verapamil and nifedipine. In logistic regression analysis, age >80 years (odds ratio [OR] 1.29; 95% CI 1.03, 1.60), inability to move independently (OR 1.80; 95% CI 1.42, 2.28), poor MNA score (<17) [OR 1.51; 95% CI 1.19, 1.93], chewing problems (OR 1.27; CI 95% 1.00, 1.61), Parkinson's disease (OR 1.63; 95% CI 1.01, 2.64), and concomitant use of a high number (>7) of drugs other than laxatives and constipation-inducing drugs found in univariate analysis (OR 1.06; 95% CI 1.03, 1.09) were associated with use of laxatives. Having snacks between meals (OR 0.74; 95% CI 0.60, 0.90) was associated with lower risk of laxative use., Conclusions: Regular laxative use in older nursing home residents in Helsinki is very common. Offering snacks between meals and regular evaluation of medication use may influence laxative use.

Objectives: To determine the oral status of elderly residents in nursing homes (NH) and long term care wards (LT) and to describe associations between oral status and nutritional status among institutionalized elderly residents., Design: Descriptive, cross-sectional study., Setting: All elderly residents in all NH and LT in Helsinki, the capital of Finland., Participants: The study included 2036 out of 2424 (84 %) eligible subjects in NH, 1052 out of 1444 (73%) eligible subjects in LT, and all wards in NH (N = 92) and LT (N = 53)., Measurements: A structured questionnaire, oral examination, and Mini Nutritional Assessment (MNA) were completed by ward nurses for all participating residents. The structured questionnaire included information on oral status and oral health problems, demographic characteristics, functional status, diseases and medication. One questionnaire for each ward was used to evaluate the daily ward routines related to nutritional care and meal management., Results: 11 % of the NH residents and 3 % of LH patients were well nourished. Of NH residents 60 % were at risk of malnutrition and 29 % were malnourished. The respective figures for LT patients were 40 % and 57 %. Nutritional status was significantly associated with oral status and with the number of oral health problems. Those with mixed dentition or complete dentures tended to have better nutritional status than those totally edentulous without prosthesis. Malnutrition increased consistently with the increasing number of oral health problems (including chewing problems, swallowing difficulties, pain in mouth and xerostomia)., Conclusion: In the population of institutionalized frail elderly, malnutrition was related to both poor oral status and oral health problems.