Medicines information sources and services for consumers : A special focus on the Internet and people with depression

The range of consumer health and medicines information sources has diversified along with the increased use of the Internet. This has led to a drive to develop medicines information services and to better incorporate the Internet and e-mail into routine practice in health care and in community pharmacies. To support the development of such services more information is needed about the use of online information by consumers, particularly of those who may be the most likely to use and to benefit from the new sources and modes of medicines communication. This study explored the role and utilization of the Internet-based medicines information and information services in the context of a wider network of information sources accessible to the public in Finland. The overall aim was to gather information to develop better and more accessible sources of information for consumers and services to better meet the needs of consumers. Special focus was on the needs and information behavior among people with depression and using antidepressant medicines. This study applied both qualitative and quantitative methods. Consumer medicines information needs and sources were identified by analyzing the utilization of the University Pharmacy operated national drug information call center (Study I) and surveying Finnish adults (n=2348) use of the different medicines information sources (Study II). The utilization of the Internet as a source of antidepressant information among people with depression was explored by focus group discussions among people with depression and with current or past use of the antidepressant(s) (n=29, Studies III & IV). Pharmacy response to the needs of consumers in term of providing e-mail counseling was assessed by conducting a virtual pseudo customer study among the Finnish community pharmacies (n=161, Study V). Physicians and pharmacists were the primary sources of medicines information. People with mental disorders were more frequent users of telephone- and Internet-based medicines information sources and patient information leaflets than people without mental disorders. These sources were used to complement rather than replace information provided face-to-face by health professionals. People with depression used the Internet to seek facts about antidepressants, to share experiences with peers, and for the curiosity. They described that the access to online drug information was empowering. Some people reported lacking the skills necessary to assess the quality of online information. E-mail medication counseling services provided by community pharmacies were rare and varied in quality. Study results suggest that rather than discouraging the use of the Internet, health professionals should direct patients to use accurate and reliable sources of online medicines information. Health care providers, including community pharmacies should also seek to develop new ways of communicating information about medicines with consumers. This study determined that people with depression and using antidepressants need services enabling interactive communication not only with health care professionals, but also with peers. Further research should be focused on developing medicines information service facilitating communication among different patient and consumer groups.

Nitrous oxide emissions from selected natural and managed northern ecosystems

Microbial activity in soils is the main source of nitrous oxide (N2O) to the atmosphere. Nitrous oxide is a strong greenhouse gas in the troposphere and participates in ozone destructive reactions in the stratosphere. The constant increase in the atmospheric concentration, as well as uncertainties in the known sources and sinks of N2O underline the need to better understand the processes and pathways of N2O in terrestrial ecosystems. This study aimed at quantifying N2O emissions from soils in northern Europe and at investigating the processes and pathways of N2O from agricultural and forest ecosystems. Emissions were measured in forest ecosystems, agricultural soils and a landfill, using the soil gradient, chamber and eddy covariance methods. Processes responsible for N2O production, and the pathways of N2O from the soil to the atmosphere, were studied in the laboratory and in the field. These ecosystems were chosen for their potential importance to the national and global budget of N2O. Laboratory experiments with boreal agricultural soils revealed that N2O production increases drastically with soil moisture content, and that the contribution of the nitrification and denitrification processes to N2O emissions depends on soil type. Laboratory study with beech (Fagus sylvatica) seedlings demonstrated that trees can serve as conduits for N2O from the soil to the atmosphere. If this mechanism is important in forest ecosystems, the current emission estimates from forest soils may underestimate the total N2O emissions from forest ecosystems. Further field and laboratory studies are needed to evaluate the importance of this mechanism in forest ecosystems. The emissions of N2O from northern forest ecosystems and a municipal landfill were highly variable in time and space. The emissions of N2O from boreal upland forest soil were among the smallest reported in the world. Despite the low emission rates, the soil gradient method revealed a clear seasonal variation in N2O production. The organic topsoil was responsible for most of the N2O production and consumption in this forest soil. Emissions from the municipal landfill were one to two orders of magnitude higher than those from agricultural soils, which are the most important source of N2O to the atmosphere. Due to their small areal coverage, landfills only contribute minimally to national N2O emissions in Finland. The eddy covariance technique was demonstrated to be useful for measuring ecosystem-scale emissions of N2O in forest and landfill ecosystems. Overall, more measurements and integration between different measurement techniques are needed to capture the large variability in N2O emissions from natural and managed northern ecosystems.

Pajala–Kolarin ja Soklin kaivoshankkeisiin liittyvien rautatie- ja tieinvestointien ja Kemin satamainvestointien aluetaloudelliset vaikutukset

Lappiin suunnitteilla olevat Pajala–Kolarin rauta- ja Soklin fosforikaivos ovat megaluokan hankkeita. Kaivosten rakentaminen ei voi kuitenkaan toteutua jos niiden tarvitsemia rautatie-, satama- ja tieinvestointeja ei voida toteuttaa. Tutkimuksen tavoitteena oli arvioida näiden väyläinvestointien aluetaloudellisia vaikutuksia. Tutkimus on jatkoa Ruraliassa juuri valmistuneelle yhdeksää Pohjois- ja Itä-Suomen kaivoshanketta koskevalle tutkimukselle, jossa keskitytään itse kaivosinvestointien vaikutuksiin. Tutkimuksen on rahoittanut Liikenne- ja viestintäministeriö yhdessä Työ- ja elinkeinoministeriön kanssa. Työvälineenä oli Ruraliassa kehitetty RegFinDyn-aluemalli. Simuloinnit suoritettiin vuosille 2008–2030 ja raportoitiin Lapin seutukuntien tasolla. Tulosten mukaan kaikki, mutta erityisesti mittavat rautatieinvestoinnit olisivat merkittäviä seutukuntien taloudelliselle kasvulle. Äkäsjoki–Ajos radan rakentaminen auttaisi Tunturi-Lapin, Torniolaakson ja Kemi–Tornion seutukuntia taantuman yli. Taloudellinen kasvu voisi lisääntyä läntisen Lapin seutukunnissa yhteensä 0,6–2,2% vuoteen 2011 ja yhteensä 1,3–4,3% vuoteen 2016 mennessä. Tämä olisi keskimäärin 0,1–0,5% vuodessa. Soklin kaivoksen tapauksessa Kemijärvi–Kelloselkä–Sokli rautatien vaikutukset Itä- ja Pohjois-Lapin seutukuntiin olisivat merkittäviä. Investointien edetessä Itä-Lapin seutukunnan taloudellinen kasvu voisi vahvistua kumulatiivisesti tarkasteltuna 8,3% vuoteen 2013 mennessä. Vuosikeskiarvona tämä olisi 2,8%. Radan vaikutus Pohjois-Lapin taloudelliseen kasvuun olisi pienempi, vuoteen 2014 mennessä yhteensä 3% eli keskimäärin 0,8% vuodessa. Väyläinvestointien työllisyysvaikutukset olisivat myönteisiä. Pajala–Kolarin kaivoksen rautatieinvestoinnit toisivat läntiseen Lappiin uusia työpaikkoja vuoteen 2015 mennessä yhteensä 418. Tästä Tunturi-Lapin osuus olisi 147, Torniolaakson 114 ja Kemi–Tornion seutukunnan 157. Vastaavat vuosikeskiarvot olisivat 52, 18, 14 ja 20. Soklin kaivoksen rautatieinvestoinnit toisivat jonkun verran enemmän uusia työpaikkoja Pajala–Kolariin verrattuna koska investoinnit olisivat suuremmat. Radan rakentaminen voisi tuoda Itä-Lappiin yhteensä 506 uutta työpaikkaa vuoden 2013 loppuun mennessä. Pohjois-Lapin työllisyys voisi lisääntyä 153 uudella työpaikalla. Yhteensä voisi siten syntyä 660 uutta työpaikkaa. Vastaavat vuosikeskiarvot olisivat 169, 51, 220 uutta työpaikkaa. Kun kaivoksia tarkastellaan yhdessä, työllisyysvaikutukset olisivat suurimmat vuonna 2015, jonka loppuun mennessä väyläinvestoinnit voisivat luoda yhteensä 1288 uutta työpaikkaa. Vastaava vuosikeskiarvo olisi 161. Taloudellisen kasvun ohella työllisyystulokset korostavat analysoitujen väyläinvestointien myönteistä aluetaloudellista merkitystä. Ruralia-instituutin arvioinnin perusteella molempien kaivosten rautatie-, satama- ja tieinvestoinnit olisivat toteuttamiskelpoisia aluetaloudellisin perustein. Ne lisäisivät tuotantoa, työllisyyttä, tuloja, kulutusta ja verotuloja useissa Lapin seutukunnissa.

Oral health and menopause

Hormone therapy (HT) is widely used to relieve climacteric symptoms in order to increase the well-being of the women. The benefits as well as side-effects of HT are well documented. The principal menopausal oral symptoms are dry mouth (DM) and sensation of painful mouth (PM) due to various causes. Profile studies have indicated that HT users are more health-conscious than non-users. The hypothesis of the present study was that there are differences in oral health between woman using HT and those not using HT. A questionnaire study of 3173 women of menopausal age (50-58 years old) was done to investigate the prevalence of self-assessed sensations of PM and DM. Of those women participating in the questionnaire study, a random sample of 400 (200 using, 200 not using HT) was examined clinically in a 2-year follow-up study. Oral status was recorded according to WHO methods using DMFT and CPITN indices. The saliva flows were measured, salivary total protein, albumin and immunoglobulin concentrations and selected periodontal micro-organisms were analysed, and panoramic tomography of the jaws was taken. The patients filled in a structured questionnaire on their systemic health, medication and health habits. According to our questionnaire study there was no significant difference in the occurrence of self- assessed PM or DM between the HT users and non-users. According to logistic regression analyses, climacteric complaints significantly correlated with the occurrence of PM (p=0.000) and DM (p=0.000) irrespective of the use of HT, indicating that PM and DM are associated with climacteric symptoms in general. There was no difference between the groups in DMFT index values at follow up. The number of filled teeth (FT) showed a significant (p<0.05) increase in the HT group at follow-up. Periodontitis was diagnosed in 79% of HT users at baseline and in 71% at the follow-up. The values for non-HT users were 80% vs. 76%, respectively (Ns.). The mean numbers of ≥ 6 mm deep periodontal pockets were 0.9 ± 1.7 at baseline vs. 1.1 ± 2.1 two years later in the HT group, and 1.0 ± 1.7 vs. 1.2 ± 1.9, respectively, in the non-HT group. In a large Finnish national health survey, the prevalence of peridontitis of women of this age group was lower, but the prevalence of severe periodontitis seemed to be higher than in our study. Salivary albumin, IgG and IgM concentrations decreased in the HT group during the 2-year follow up (p<0.05), possibly indicating an improvement in epithelial integrity. No difference was found in any other salivary parameters or in the prevalence of the periodontal bacteria between or within the groups. In conclusion, the present findings showed that 50 to 58 year old women living in Helsinki have fairly good oral and dental health. The occurrence of PM and DM seemed to be associated with climacteric symptoms in general, and the use of HT did not affect the oral symptoms studied.

Traditionally Protected Forests´ Role within Transforming Natural Resource Management Regimes in Taita Hills, Kenya

In Taita Hills, south-eastern Kenya, remnants of indigenous mountain rainforests play a crucial role as water towers and socio-cultural sites. They are pressurized due to poverty, shortage of cultivable land and the fading of traditional knowledge. This study examines the traditional ecological knowledge of Taitas and the ways it may be applied within transforming natural resource management regimes. I have analyzed some justifications for and hindrances to ethnodevelopment and participatory forest management in light of recently renewed Kenyan forest policies. Mixed methods were applied by combining an ethnographic approach with participatory GIS. I learned about traditionally protected forests and their ecological and cultural status through a seek out the expert method and with remote sensing data and tools. My informants were: 107 household interviewees, 257 focus group participants, 73 key informants and 87 common informants in participatory mapping. Religious leaders and state officials shared their knowledge for this study. I have gained a better understanding of the traditionally protected forests and sites through examining their ecological characteristics and relation to social dynamics, by evaluating their strengths and hindrances as sites for conservation of cultural and biological diversity. My results show that, these sites are important components of a complex socio-ecological system, which has symbolical status and sacred and mystical elements within it, that contributes to the connectivity of remnant forests in the agroforestry dominated landscape. Altogether, 255 plant species and 220 uses were recognized by the tradition experts, whereas 161 species with 108 beneficial uses were listed by farmers. Out of the traditionally protected forests studied 47 % were on private land and 23% on community land, leaving 9% within state forest reserves. A paradigm shift in conservation is needed; the conservation area approach is not functional for private lands or areas trusted upon communities. The role of traditionally protected forests in community-based forest management is, however, paradoxal, since communal approaches suggests equal participation of people, whereas management of these sites has traditionally been the duty of solely accredited experts in the village. As modernization has gathered pace such experts have become fewer. Sacredness clearly contributes but, it does not equal conservation. Various social, political and economic arrangements further affect the integrity of traditionally protected forests and sites, control of witchcraft being one of them. My results suggest that the Taita have a rich traditional ecological knowledge base, which should be more determinately integrated into the natural resource management planning processes.