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MASK-air® , a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK-air® is a Good Practice of DG Santé on digitally-enabled, patient-centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co-operation and Development). MASK-air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK-air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as-needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom-medication score (ARIA-EAACI-CSMS) has been validated for clinical practice and trials. The implications of the novel MASK-air® results should lead to change management in rhinitis and asthma. info:eu-repo/semantics/publishedVersion

The aim of this essay is to address the challenges and problems in communicating with horses and interpreting their communication in everyday handling and training situations. We seek ways to learn more about equine communication and agency in the prevention of cruelty against animals and in enhancing animal welfare. We ask how it would be possible to learn to read the subtle signs of equine communication and agency in a sensible, sensitive, and ethical way to increase the health and wellbeing of horses that humans interact with. We have placed this theoretical examination in a multidisciplinary framework that consists of humananimal studies, feminist posthumanities, cultural and literary studies, and equine social science, as well as applied insights from, for example, discussions on power, ethics, and politics. Our emphasis is on the need for situated knowledges, among scientific and tacit knowledges, in order to ‘become with’ a horse in a relationship based on mutual communication and trust. These different types of knowledges are central to an ‘animal politics’ that is organised politically on behalf of animals and motivated by an ethics of care and responsibility, echoing recent requests for a relational ethics in interactions with animals in multispecies societies and more-than-human worlds.

The paper studies two fundamentally different forms in which the concept of care makes its comeback in twentieth-century thought. We make use of a distinction made by Peter Sloterdijk, who argues that the ancient and medieval ‘ascetic’ ideal of self-enhancement through practice has re-emerged in the nineteenth and twentieth centuries, particularly in the form of a rehabilitation of the Hellenistic notion of self-care (epimeleia heautou) in Michel Foucault’s late ethics. Sloterdijk contrasts this return of self-care with Martin Heidegger’s concept of being-in-the-world as ‘total care’ (Sorge), an utterly ‘secularized’ understanding of the human being as irreducibly world-embedded that rejects the classical ascetic ideal of world-secession. We examine further the historical roots and emergence of these contrasting contemporary reappropriations of care in the Western tradition of thought and show them to be rooted in two different ontologies and ethics of the self as either world-secluded or world-immersed, autonomous or constitutively relational. The historical point of divergence of these two approaches to care, we argue, can be found in the Christian transformation of Hellenistic ethics. peerReviewed

Digital technologies shape our embodied lives and affect our knowledge of the self and the world. The introductory chapter of the book presents the state of the art in the research on digitalisation of health and social care work, with a focus on care for older people. In ageing societies, understanding what it takes to introduce and use digital technologies can pave the way to a successful, sustainable, and equally accessible system of social care and healthcare provision for older people. The chapter discusses some of the limitations in the present discussion and how the book at hand aims to address these gaps. The chapter proposes that living in an increasingly digitalised world requires digital agency, that is the individual’s ability to control and adapt to their surroundings, and to critically address technological determinism in the everyday life. The chapter ends with an overview of the book’s subsequent chapters that demonstrate different aspects to service users’ and care workers’ digital agency based on recent studies of digital technologies in care for older people. peerReviewed

Objectives The aim of this preplanned secondary analysis of a 12-month randomised controlled trial was to investigate the effects of a multicomponent exercise programme combined with daily whey protein, calcium and vitamin D supplementation on cognition in men with prostate cancer treated with androgen deprivation therapy (ADT). Design 12-month, two-arm, randomised controlled trial. Setting University clinical exercise centre. Participants 70 ADT-treated men were randomised to exercise-training plus supplementation (Ex+ Suppl, n=34) or usual care (control, n=36). Intervention Men allocated to Ex + Suppl undertook thrice weekly resistance training with weight-bearing exercise training plus daily whey protein (25 g), calcium (1200 mg) and vitamin D (2000 IU) supplementation. Primary and secondary outcome measures Cognition was assessed at baseline, 6 and 12 months via a computerised battery (CogState), Trail-making test, Rey auditory-verbal learning test and Digit span. Data were analysed with linear mixed models and an intention-to-treat and prespecified per-protocol approach (exercise-training: ≥66%, nutritional supplement: ≥80%). Results Sixty (86%) men completed the trial (Ex + Suppl, n=31; control, n=29). Five (7.1%) men were classified as having mild cognitive impairment at baseline. Median (IQR) adherence to the exercise and supplement was 56% (37%–82%) and 91% (66%–97%), respectively. Ex + Suppl had no effect on cognition at any time. Conclusions A 12-month multicomponent exercise training and supplementation intervention had no significant effect on cognition in men treated with ADT for prostate cancer compared with usual care. Exercise training adherence below recommended guidelines does not support cognitive health in men treated with ADT for prostate cancer. Trial registration number Australian and New Zealand Clinical Trial Registry (ACTRN12614000317695, registered 25/03/2014) and acknowledged under the Therapeutic Goods Administration Clinical Trial Notification Scheme (CT-2015-CTN-03372-1 v1). peerReviewed

This article analyses local care policies through the lens of the feminist ethics of care. The focus is on the normative understandings regarding care that emerge in local care strategy documents and how these understandings relate with the concept of ‘responsibility’. In this article, strategies published by the municipality of Jyväskylä, Finland, between the years 2008 and 2016, are analysed using Trace analysis. The research questions are: How is the division of responsibility regarding care among different actors constructed in the strategies? How do the roles assigned to these different actors accord with the principles of ethics of care? The findings show that the documents emphasise individual responsibility in managing risks related to old age, as the norms of local societal institutions are largely detached from the principles of ethics of care. The analysis also reveals the absence of gender and human frailty from the care strategy documents. Rethinking the strategies through the lens of the ethic of care would mean reconceptualising responsibility as relational.

Kakeksia on sairauden aiheuttama tila, jossa paino sekä luurankolihaksen ja rasvakudoksen määrä vähenevät ja toimintakyky heikkenee, eikä näitä oireita voida täysin kumota ravitsemuksen tuella. Kakeksiaa esiintyy erityisesti syöpäsairauksien yhteydessä. Se heikentää elämänlaatua, lisää kuolleisuutta ja hankaloittaa perustaudin hoitovasteen saavuttamista. Kakeksian patofysiologia tunnetaan vain osittain. Tärkeimpiä mekanismeja ovat yleistynyt tulehdusvaste, luurankolihaksen surkastuminen, rasvakudoksen aineenvaihdunnan muutokset ja hormonaalisen toiminnan häiriintyminen. Yksittäisiin tekijöihin vaikuttavat lääkitykset eivät tilan monitekijäisen patofysiologian vuoksi tehoa riittävästi, eikä toimivaa hoitoa ole vielä löydetty. Kakeksian diagnosointi ja riskipotilaiden tunnistaminen on tärkeää, jotta potilaille voidaan ajoissa aloittaa mahdolliset kokonaisvaltaiset hoidot ja näin lieventää heidän kokemiaan oireita sekä parantaa heidän elämänlaatuaan. peerReviewed

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Gynekologisista syövistä munasarjasyöpä on yleisin kuolemaan johtava syöpä (1,3,7,9). Sairaus on yleisin vaihdevuodet jo ohittaneilla naisilla, oireina vatsassa esiintyvä kipu ja turvotus. Monesti syöpä on diagnoosivaiheessa jo edennyt ja sen hoitona käytetään leikkausta ja platinapohjaista sytostaattihoitoa. Usein tauti kuitenkin uusiutuu ja tällöin johtaa kuolemaan. (6) Tässä tutkimuksessa tutkitaan TAYS:issa hoidettuja munasarja-, munanjohdin- ja peritoneaalikarsinoomapotilaita, jotka ovat menehtyneet vuosina 2007–2008 ja 2017–2019. Kymmenen vuoden aikana TAYS:issa on kehitetty gynekologisten syöpäpotilaiden palliatiivista hoitoa, jotta syöpäpotilaat saisivat mahdollisimman hyvää terminaalivaiheen hoitoa. Tarkoituksena on selvittää kuinka palliatiivinen hoito ja hoitolinjaukset ovat muuttuneet TAYS:issa kyseisenä aikana. Selvitimme kuinka laajasti palliatiivisia hoitopäätöksiä ja DNR-päätöksiä oli uudemmassa ja vanhemmassa kohortissa tehty. Kohorttien välillä oli tapahtunut huomattava muutos hoitopäätösten määrässä ja kirjaustavassa kymmenessä vuodessa. Palliatiivisten hoitopäätösten teko on selkeästi lisääntynyt kymmenessä vuodessa 18,8 %:sta 68,2 %:iin. Samassa ajassa DNR-päätösten teko on kasvanut 37,5 %:sta 86,4 %:iin. Myös aika viimeisestä sytostaattihoidosta kuolemaan oli kasvanut 41,1 päivästä 67,3 päivään.

This chapter uses the theoretical framework of sense of belonging to explore how eldercare workers from Finnish service housing units for older people describe the use of digital devices and applications in their work and the work practices that relate to their sense of belonging. The study is based on interview data (n = 25) that was collected in 2018 for a study on digitalisation of eldercare. The chapter asks: what does a sense of belonging mean for care workers’ agency in a digital era? The analysis concentrates especially on the practices of belonging and how they are enacted in a digitalised work environment. The chapter proposes that in the digital era, a sense of belonging is particularly fluid and dynamic, and that it is constructed in the daily practices of work. peerReviewed

Tausta: Epilepsiaa sairastaa maailmanlaajuisesti yli 50 miljoonaa ihmistä, ja heistä 20-30%:lla kyseessä on vaikeahoitoinen epilepsia, eivätkä kohtaukset ole hallinnassa kahdella oikein käytetyllä epilepsialääkkeellä. Vagushermostimulaatio (VNS) on verrattain uusi hoitovaihtoehto näille potilaille, ja tulokset hoidon tehosta ovat lupaavia. Neuromodulaatiohoitoja tutkitaan laajasti, eivätkä toimintamekanismit tai tarkempi ymmärrys laitteiden toiminnasta ole selviä. Tavoitteet: Väitöskirjassa selvitetään VNS-hoidon toimintaa ja tehokkuutta erityisesti automaattiseen stimulaatioon (rVNS, responsiivinen VNS) liittyen. Lisäksi tavoitteena on selvittää laitteen virrankulutusta suhteessa käytettyihin asetuksiin ja automaattisen stimulaation käyttöönottoon, sekä saada tietoa automaattisten stimulaatioiden käyttäytymisestä epilepsiapotilailla. Materiaalit ja menetelmät: Yhteensä 42 vaikeahoitoista epilepsiaa sairastavaa potilasta sisällytettiin neljään tutkimukseen. Seuranta-aika vaihteli laajasti, kolmestatoista päivästä yli yhteentoista vuoteen. Kliiniset ja stimulaatioihin liittyvät tiedot analysoitiin SPSS-, Excel- ja Matlab -ohjelmistoilla. Käytimme ei-parametrisia tilastollisia testejä ja havainnollistimme tuloksia kuvaajilla. Tulokset: Ensimmäisessä tutkimuksessa havaitsimme samankaltaisuuksia vasteissa VNS- ja ANT-DBS (talamuksen anteriorisen tumakkeen syväaivostimulaatio) -hoitoihin 90%:lla vaikeahoitoista epilepsiaa sairastavilla potilaista (progressiivinen paranema, osittainen vaste, ei vastetta). Toisessa tutkimuksessamme havaitsimme automaattisen stimulaation tuovan lisävastetta VNS-hoitoon 36.4 %:lla potilaista, jolloin normaalistimulaation asetuksia pystyttiin muuttamaan, mikä johti virrankulutuksen merkittävään vähenemiseen. Kolmannessa tutkimuksessa varmensimme, että asetuksia, erityisesti OFF-aikaa ja autostimulaation kynnystä, muuttamalla voidaan vaikuttaa stimulaatioiden määrään ja laitteen virrankulutukseen, sekä havaitsimme eroavaisuuksia automaattisen stimulaation toiminnassa ohimolohkoepilepsiaa ja muita epilepsioita sairastavien potilaiden välillä. Neljännessä tutkimuksessa havaitsimme, että suurimmalla osalla potilaista automaattisten stimulaatioiden vuorokausittainen vaihtelu muistuttaa kortisolintuotannon vuorokausittaista rytmiä. Lisäksi tuloksemme tukevat hypoteesia VNS-vasteen kehittyvästä luonteesta ajan kuluessa. Johtopäätökset: Vagushermostimulaatio on lupaava hoitovaihtoehto vaikeahoitoista epilepsiaa sairastaville potilaille. Automaattisen stimulaation käyttöönotto johtaa parempaan kohtausten hallintaan mahdollisesti vähäisemmällä virrankulutuksella. VNS- ja ANT-DBS -hoitojen vasteissa on samankaltaisuuksia. Automaattisen stimulaation toiminnassa on vuorokautinen vaihtelu. OFF-ajan lyhentäminen ja autostimulaation kynnyksen laskeminen johtaa suurempaan stimulaatioiden määrään. Background: More than 50 million people worldwide suffer from epilepsy, and approximately 30% of them are considered as drug-resistant (refractory), as the seizures are not in control with two adequately used antiepileptic drug schedules. Vagus nerve stimulation (VNS) is a promising treatment option for these patients. Neuromodulation therapies in the treatment of epilepsy are under substantial research, and the mechanisms of actions and details of function are still not fully understood. Aims: The purpose of this study is to elucidate the functions of VNS therapy including the efficacy and the details concerning the automatic stimulation (responsive VNS, rVNS) properties. Other goals are to assess the power usage aspects of the treatment with different settings and after initiating automatic stimulation mode, and to gain a better understanding of the behavior of responsive stimulations in epilepsy patients. Materials and Methods: Altogether 42 patients with refractory epilepsy were included in four studies. Follow-up time was highly variant, from 13 days to more than 11 years. The clinical and stimulation-related data were analyzed with SPSS, Excel, and Matlab softwares. We used nonparametric statistical tests and elucidated the results with illustrations. Results: In the first study we found that in 90% of the patients the response to ANT-DBS (deep brain stimulation of the anterior nucleus of the thalamus) therapy was similar to VNS therapy (progressively better, partial response, no response) in patients with refractory epilepsy. In the second study, we found the initiation of automatic stimulation mode leading to better seizure control in 36.4 % of the patients. Therefore we were able to alter other stimulation settings, which led to significantly reduced battery usage. In the third study, we confirmed the altered stimulator settings affecting the number of stimulations and total charge delivered in the patient, especially when altering the OFF-time and the autostimulation threshold, and a possible difference between the function of rVNS in the temporal lobe and other epilepsy patients. In the fourth study, we found circadian patterns in automatic stimulations in most of the patients resembling the pattern of cortisol secretion. Our results support the finding that response to VNS therapy improves over time. Conclusions: Vagus nerve stimulation is a promising treatment option for patients with refractory epilepsy. The automatic stimulation mode of VNS offers better seizure control with possibly lesser power usage than the older models. The responses to VNS and ANT-DBS therapies show similarities. There is circadian rhythmicity in the autostimulation activations in rVNS therapy. Shortening the OFF- time and lowering the threshold rate leads to a larger number of stimulations delivered.

International audience; In this overview (introductory article to a special issue including 14 papers), we consider all main types of natural and artificial inland freshwater habitas (fwh). For each type, we identify the main biodiversity patterns and ecological features, human impacts on the system and environmental issues, and discuss ways to use this information to improve stewardship. Examples of selected key biodiversity/ecological features (habitat type): narrow endemics, sensitive (groundwater and GDEs); crenobionts, LIHRes (springs); unidirectional flow, nutrient spiraling (streams); naturally turbid, floodplains, large-bodied species (large rivers); depth-variation in benthic communities (lakes); endemism and diversity (ancient lakes); threatened, sensitive species (oxbow lakes, SWE); diverse, reduced littoral (reservoirs); cold-adapted species (Boreal and Arctic fwh); endemism, depauperate (Antarctic fwh); flood pulse, intermittent wetlands, biggest river basins (tropical fwh); variable hydrologic regime—periods of drying, flash floods (arid-climate fwh). Selected impacts: eutrophication and other pollution, hydrologic modifications, overexploitation, habitat destruction, invasive species, salinization. Climate change is a threat multiplier, and it is important to quantify resistance, resilience, and recovery to assess the strategic role of the different types of freshwater ecosystems and their value for biodiversity conservation. Effective conservation solutions are dependent on an understanding of connectivity between different freshwater ecosystems (including related terrestrial, coastal and marine systems).

Metsälaitumet tarjoavat eläimille monia hyötyjä, kuten suojan talvella ja varjoa kesällä. Lisäksi ne tarjoavat rapsutuspuita karvan kunnon ylläpitoon. Kotieläinten käyttäytyminen voidaan jakaa seuraaviin ryhmiin: liikkuminen, syöminen, lisääntyminen, sosiaalinen käytös, lepo ja jälkikasvun hoitaminen. Pääsy puiden luo voi jollain tavoin hyödyttää kaikkia näitä käytöksiä. Suuri osa eläinten päivittäisestä käytöksestä liittyy tasapainotilan, eli homeostasian, ylläpitoon: eläin esimerkiksi etsii ja syö ruokaa ollessaan nälkäinen. Samalla tavoin ollessaan kuumissaan tai kylmissään se etsii varjoa tai suojaa, ja puut, pensaat ja suojaistutukset voivat tarjota sille suojaa tehokkaasti. Karvan kunto on tärkeä eläimen hyvinvoinnin kannalta, ja eläimet käyttävät puiden runkoja ja oksia mielellään rapsutuspuina. Eläinten vastasyntynyt jälkikasvu joko piiloutuu (esim. vasikat) tai seuraa laumaa (esim. karitsat), mutta kaikkien lajien emot etsivät suojaa synnyttäessään. - AFINET Factsheet exploring the benefits of silvopasture to domestic animals. The benefits of silvopasture to domestic animals include access to shelter in the winter and shade in the summer, as well as providing scratching posts to maintain coat condition. The behaviour of domestic animals can be grouped into the categories of locomotion, maternal, nutritional, reproductive, social and resting behaviours and access to trees can be of some benefit to them all.

Polven ja olan alueen vammat ovat tyypillisiä työtapaturmavammoja ja aiheuttavat merkittävän osan työtapaturmavammojen hoitokustannuksista. Tutkimusaineistona käytettiin suomalaisen vakuutusyhtiön keräämää rekisteriaineistoa korvattujen työtapaturmavammojenhoidosta yksityisissä lääkärikeskuksissa vuosilta 2010-2015. Yhteensä 555 (miehiä: 57 %, ikä: 40,9±11,8 vuotta) ICD-10-tautiluokituksen pääluokkaan S83 kuuluvaa polven ja 377 (miehiä: 56 %, ikä: 42,4±12,1 vuotta) pääluokkaan S43 tai S46 kuuluvaa olan alueen vammaa tarkasteltiin tehtyjen hoitotoimenpiteiden, hoitokustannusten, hoidon keston sekä sairauslomien pituuksien suhteen. Lisäksi leikattujen ja/tai kuntoutettujen potilaiden osalta tarkasteltiin suomalaisten hoitosuositusten toteutumista ensisijaisen hoitomuodon sekä leikkausajankohdan suhteen. Polven ja olan alueen vammoista kaksi kolmasosaa aiheutui työpaikkatapaturmissa henkilön kaatuessa, pudotessa tai fyysisesti kuormittuessa ja loput työmatkatapaturmissa jalankulkijan tai pyöräilijän kaatuessa, liukastuessa tai kompastuessa. Suurin osa vammoista oli lieviä: 84 % potilaista hoidettiin tavanomaisilla lääkärinvastaanottokäynneillä ja 54 %:lla potilaista sairausloma oli korkeintaan viikon. Vain 16 % potilaista hoidettiin kuntouttamalla ja/tai leikkauksella, mutta nämä hoidot aiheuttivat 61 % kaikista hoitokustannuksista ja puolilla (51 %) näistä potilaista sairausloma kesti yli 3 kuukautta. Toteutuneessa hoidossa fysioterapeuttista kuntoutusta annettiin ennen leikkaushoitoa neljäsosalle polven ja kolmasosalle olan alueen vammoista. Hoitosuositusten mukaiset leikkausajankohdat toteutuivat aineistossa, kun leikkausajankohdan suositus oli yli 2 kuukautta vammautumisesta. Esimerkiksi 80 % kiertäjäkalvosinvammoista leikattiin hoitosuositusten mukaisesti noin 4 kuukauden kuluessa vammautumisesta, mutta nivelkierukkavammoista vain 5 % leikattiin hoitosuositusten mukaisesti 1-2 viikon kuluessa vammautumisesta. Työtapaturmista aiheutuu vain vähän vakavia polven ja olan alueen vammoja, mutta niiden hoitoon keskittyminen on tärkeää, koska ne aiheuttavat sekä suuria kustannuksia että pitkiä sairauslomia. Ylimääräisten hoitokustannusten ja sairauslomapäivien ehkäisy työtapaturmavammoissa vaatii toisaalta lääketieteellisesti oikeita ja varhaisia diagnooseja sekä optimaalisia hoitokäytäntöjä, mutta myös joustavia ja tapauskohtaisia toimia vakuutusyhtiöltä., Knee and shoulder injuries are typical for occupational accidents causing significant treatment expenses. This study employed an insurance company’s register considering treatments given for occupational accident injuries in private clinics in years 2010-2015. Treatments, treatment expenses, durations of treatments and sick-leaves were analyzed for 555 (men: 57 %, age: 40.9±11.8 yrs) knee injury diagnoses with ICD-10 code of class S83 and 377 (men: 56 %, age: 42.4±12.1 yrs) shoulder injury diagnoses with ICD-10 code of class S43 or S46. In surgical and rehabilitative treatments, the method of treatment and time-to-surgery were studied. Of the injuries, 66 % resulted from workplace and 33 % from commuting accidents. The injuries were mostly minor: 84 % needed only doctor appointments as treatment, and 54 % caused at maximum one-week sick-leave. Only 16 % of the injuries required rehabilitation and/or surgical treatment but they caused 61 % of all treatment expenses and 51 % caused over three-month sick-leave. In only 25 % and 33 % of knee and shoulder injuries, respectively, rehabilitation was given before surgical treatment. The times-to-surgeries followed the Finnish guidelines as the recommendation was more than two months. The time-to-surgery in 80 % of the rotator cuff injuries was at maximum four months but only in 5 % of the meniscus injuries was 1-2 weeks as recommended. Occupational accidents cause only a few serious knee and shoulder injuries but they cause high treatment expenses and long sick-leaves. To avoid extra expenses and days lost, right and early medical diagnosis and optimal treatments together with flexible and case-by-case discretion and practices from the insurance companies are needed.

The cost of cancer and outcomes of cancer care have been discussed a lot since cancer represents 3-6% of total healthcare costs and cost estimations have indicated growing costs. There are studies considering the cost of all cancers, but studies focusing on the cost of disease and outcomes in most common cancer sites are limited. The objective of this study was to analyze the development of the costs and outcomes in Finland between 2009 and 2014 per cancer site.The National cost, episode and outcomes data were obtained from the National register databases based on International Statistical Classification of Diseases (ICD)-10 diagnosis codes. Cost data included both the direct and indirect costs. Two hospitals were used to validate the costs of care. The outcome measures included relative survival rate, mortality, sick leave days per patient and number of new disability pensions.The outcomes of cancer care in most common cancer sites have improved in Finland between 2009-2014. The real costs per new cancer patient decreased in seven out of ten most common cancer sites. The significance of different cost components differ significantly between the different cancer sites. The share of medication costs of the total cost of all cancers increased, but decreased for the five most common cancer sites.The changes in the cost components indicate that the length of stay has shortened in special care and treatment methods have developed towards outpatient care. This partially explains the decrease of costs. Also, at the same time outcomes improved, which indicates that decrease in costs did not come at the expense of treatment quality. As the survival rates increase, the relevance of mortality measures decreases and the relevance of other, patient-relevant outcome measures increases. In the future, the outcomes and costs of health care systems should be assessed routinely for the most common patient groups.

The objective of the study was to examine the effects of a group-based behavioural, cognitive and skills training intervention (Maltti) provided in schools for elementary school pupils with attention and executive function (EF) deficits. The treatment effects were identified by comparing an intervention group (n = 46) with a waitlist control group (n = 26). Specific effects of the intervention on behavioural deficits in attention and EF in a classroom setting as well as on academic skills were examined. Our analysis indicated that significant intervention effects could be found in the behavioural manifestation of attentional and executive skills in the classroom setting among children (n = 30) who were evaluated as having moderate symptoms in the pre-intervention assessment. Positive effects of the intervention were also observed in arithmetic and reading skills. The severity level of pre-intervention attention and EF deficits did not moderate the results observed in the academic skills tests. The results of this study suggest that a combination of behavioural, cognitive and skills training methods applied in a school context can be effective in reducing attention and EF problems and enhancing the academic performance of children with attention and EF deficits. peerReviewed

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Esittelyssä tarkastellaan miksi agrometsätys on erilainen ja miten sillä on vaikutusta peltoalaan, luonnonvarojen käyttöön, biologiseen monimuotoisuuteen ja tuottavuuteen. Se käsittelee myös metsälaitumien ja metsäkenttien mahdollisuuksia. - The presentation looks at why agroforestry is different, and what is the impact on arable land, resource use, biodiversity and productivity. It also addresses the possibilities of forest pastures and forest fields.

Esitys selittää, miten Bluebell-tiloja hoidetaan. - The presentation explains how the Bluebell Farms are managed.

Background Antihypertensive medicines are effective in reducing adverse cardiovascular events. Our aim was to compare hypertension awareness, treatment, and control, and how they have changed over time, in high-income countries. Methods We used data from people aged 40–79 years who participated in 123 national health examination surveys from 1976 to 2017 in 12 high-income countries: Australia, Canada, Finland, Germany, Ireland, Italy, Japan, New Zealand, South Korea, Spain, the UK, and the USA. We calculated the proportion of participants with hypertension, which was defined as systolic blood pressure of 140 mm Hg or more, or diastolic blood pressure of 90 mm Hg or more, or being on pharmacological treatment for hypertension, who were aware of their condition, who were treated, and whose hypertension was controlled (ie, lower than 140/90 mm Hg). Findings Data from 526 336 participants were used in these analyses. In their most recent surveys, Canada, South Korea, Australia, and the UK had the lowest prevalence of hypertension, and Finland the highest. In the 1980s and early 1990s, treatment rates were at most 40% and control rates were less than 25% in most countries and age and sex groups. Over the time period assessed, hypertension awareness and treatment increased and control rate improved in all 12 countries, with South Korea and Germany experiencing the largest improvements. Most of the observed increase occurred in the 1990s and early-mid 2000s, having plateaued since in most countries. In their most recent surveys, Canada, Germany, South Korea, and the USA had the highest rates of awareness, treatment, and control, whereas Finland, Ireland, Japan, and Spain had the lowest. Even in the best performing countries, treatment coverage was at most 80% and control rates were less than 70%. Interpretation Hypertension awareness, treatment, and control have improved substantially in high-income countries since the 1980s and 1990s. However, control rates have plateaued in the past decade, at levels lower than those in high-quality hypertension programmes. There is substantial variation across countries in the rates of hypertension awareness, treatment, and control. peerReviewed

Summary Springs are unique ecosystems, but in many cases they are severely threatened and there is an urgent need for better spring management and conservation. To this end, we studied water quality and quantity in springs in Oulanka National Park, north-east Finland. Multivariate statistical methods were employed to relate spring water quality and quantity to hydrogeology and land use of the spring capture zone. This revealed that most springs studied were affected by locally atypical dolostone–limestone bedrock, resulting in high calcium, pH, and alkalinity values. Using Ward’s hierarchical clustering, the springs were grouped into four clusters based on their water chemistry. One cluster consisted of springs affected by past small-scale agriculture, whereas other clusters were affected by the variable bedrock, e.g., springs only 1 km from the dolostone–limestone bedrock area were beyond its calcium-rich impact zone. According to a random forest model, the best predictors of spring water chemistry were spring altitude and the stable hydrogen isotope ratio of the water (δ2H). Thus stable water isotopes could be widely applicable for boreal spring management. They may also provide a rough estimate of groundwater flow route (i.e., whether it is mainly local or regional), which largely determines the chemical characteristics of spring water. Our approach could be applied in other boreal regions and at larger spatial scales for improved classification of springs and for better targeted spring management.

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