Southwest Finland Research Articles

Effectiveness of Supporting lifestyle change in pregnant mothers with obesity through the wearable internet-of-things (SLIM) -intervention on self-efficacy in weight management in pregnant women: a quasi-experimental trial

BackgroundHalf of women with overweight gain excessive weight during pregnancy. Perceived self-efficacy plays a significant role in adherence to healthy behaviours, especially in turning points of life, such as a pregnancy. ObjectivesTo assess the effectiveness of the Supporting lifestyle change in pregnant mothers with obesity through the wearable internet-of-things (SLIM)-intervention in terms of improving self-efficacy in eating and physical activity and preventing excessive weight gain of pregnant women with overweight. The second aim was to evaluate the fidelity of the intervention implementation. MethodsPregnant women with overweight (N=54) attending maternity clinics in Southwest Finland between 2021 and 2023, were recruited using convenience sampling. The SLIM-intervention included: health technology, motivational interviewing, feedback, and goal setting. The intervention was implemented in prenatal visits in maternity clinics continuing to 12 weeks postpartum. The change in self-efficacy was measured with Weight Efficacy Life-Style Questionnaire (score 0–180) and Self-Efficacy for Physical Activity Scale (score 5–25) with repeated measures in three timepoints. Data on weight were collected from patient records. ResultsThe levels of self-efficacy were high throughout the study period and there were no significant changes in self-efficacy in eating (p=0.650) or physical activity (p=0.936). Most of the women (N=9/10), whose gestational weight gain was within recommendations or less, managed to lose weight during the postpartum period (p<0.001). ConclusionsAlthough the intervention was not effective in improving self-efficacy, the importance of recommended gestational weight gain on better postpartum weight management was highlighted. A long follow-up time was valuable for examination of changes over time and understanding trends, patterns, and outcomes of the study. RegistrationThe trial was registered at the Clinicaltrials.gov register platform (ID NCT04826861) on March 17th, 2021.

Long-term outcomes of extracapsular tonsillectomy in the treatment of obstructive sleep apnoea in adults

Background Tonsillectomy is an effective treatment option for obstructive sleep apnoea in selected adult patients, but there has been a lack of long-term follow-up data. Objectives To analyse the long-term outcomes of extracapsular tonsillectomy in the treatment of obstructive sleep apnoea in adults, with the longest follow-up periods to date. Materials and methods We recruited adults who had undergone extracapsular tonsillectomy because of obstructive sleep apnoea between 2004 and 2018 in the Hospital District of Southwest Finland. A new home sleep study, questionnaires, and a structured phone interview were conducted on these patients 4–17 years after surgical treatment. The primary outcome was the change in the apnoea-hypopnoea index. Results The mean apnoea-hypopnoea index was reduced from 27.1 preoperatively to 14.1 after the long-term follow-up (mean 12 years), and the mean Epworth Sleepiness Scale score decreased from 9.2 to 4.6. The long-term surgical success rate was 38.5%. Four out of five patients would choose the surgery again according to the phone interview. Conclusions and significance This study supports the notion that extracapsular tonsillectomy alone can be considered as a surgical treatment option for selected adults with obstructive sleep apnoea and tonsillar hypertrophy. For most of the patients, the obstructive sleep apnoea is alleviated.

New evidence of late Neolithic and early Metal Period agriculture in Turku, southwest Finland

New evidence of late Neolithic and early Metal Period agriculture in Turku, southwest Finland

Bridging the gap: Exploring urban resilience and sustainability in Finnish regional development

AbstractThis study investigates the dynamics of urban resilience (UR) and sustainability (US) in Finnish regional planning cultures, focusing on the Helsinki‐Uusimaa and Southwest Finland regions. It highlights the intertwined nature of UR and US, emphasizing the need for clearer distinctions to enhance planning effectiveness. Through comparative case studies, this research explores the role of institutional planning culture in shaping procedural resilience amidst complex socio‐environmental changes. It reveals resource constraints as critical challenges, influencing decision‐making and collaboration across governance levels. Additionally, it underscores the importance of long‐term commitment and integrated regional visions for fostering sustainable development beyond electoral cycles. The paper advocates for an integrated approach to regional development, emphasizing the significance of addressing power dynamics and economic resilience alongside environmental considerations. Overall, it calls for a nuanced understanding of resilience‐sustainability interlinkages to craft more effective and adaptive planning strategies.

Conserving apollo butterflies: habitat characteristics and conservation implications in Southwest Finland

The conservation of insects, particularly endangered species such as the Apollo butterfly, is a pressing global concern. Understanding the habitat requirements and factors influencing species occupancy is crucial for designing effective conservation strategies. We focused on investigating the habitat characteristics expected to affect the occupancy of the nationally endangered Apollo butterfly in Southwest Finland. We conducted field surveys and GIS analysis to assess the impact of larval host plant and adult nectar resources, habitat encroachment, elevation, connectivity, and spatial variation on Apollo larval occupancy in rocky outcrop habitats. We found that rocky outcrops with abundant host plants and those less isolated from nectar patches play a significant role in supporting Apollo reproduction, whereas encroachment, specifically increased tree volume, negatively affected occupancy. We additionally observed spatial variation in occupancy across different blocks within the study area. Our findings emphasise the importance of resource availability for Apollo butterflies and highlight the dynamic nature of their habitat requirements. Maintaining a network of intact rocky outcrops with suitable resources is essential for the long-term persistence of the Apollo butterfly population in the region.Implications for insect conservation: Our research underscores the critical need to protect and restore habitats for the Apollo butterfly, particularly by addressing threats such as habitat encroachment and construction projects that pose risks to their breeding sites.

Incidence, surgical eligibility and outcome of spontaneous intracerebral haemorrhage in Southwest Finland – A retrospective study

IntroductionSpontaneous intracerebral haemorrhage (sICH) is a major cause of morbidity and mortality. Large-scale trials have shown neutral outcomes for surgical interventions. The recent trial suggested functional benefits from surgical intervention. Surgical treatment for sICH is likely increasing. Research questionTo determine the incidence of sICH in Southwest Finland, standardized to the European population, and to identify the proportion of large sICH patients eligible for surgery based on previously published trial criteria. We also examined factors associated with outcomes, including the effects of anticoagulant and antithrombotic medications. Material and methodsA retrospective clinical study identified 596 ICH cases treated at Turku University Hospital (2018–2019), of which 286 were supratentorial sICHs. Variables were analysed using a t-test, chi-squared or Fisher's exact test. A multivariate logistic modelling was performed to evaluate outcome differences. ResultsThe sICH incidence was 29.9/100,000 persons per year, with the highest European population age and sex standardized rates in individuals over 80 years old (110/100,000 males, 142/100,000 females). The incidence of sICH patients meeting surgical criteria was 2.7/100,000 persons per year. Out of 286 patients, 26 were eligible for surgery and had unfavourable outcomes (p = 0.0049). Multivariate analysis indicated a significant decrease in favourable outcomes with warfarin (p = 0.016, OR 0.42) and direct-acting anticoagulants (DOACs) (p = 0.034, OR 0.38), while antithrombotic medications showed no significant effect. Discussion and conclusionWe identified comparable incidence of sICH as European average. A small proportion of sICH cases were identified to be candidates for surgical intervention. Anticoagulants were associated with increased risk of unfavourable outcomes.

Outcomes After Multimodality Treatment of Pancreatic Cancer in an Unselected Single-Center Cohort.

Pancreatic ductal adenocarcinoma (PDAC) remains a lethal and rarely resectable malignancy. Here we explore the outcomes of surgery, as compared to definitive radiotherapy (dRT) or systemic therapy only in PDAC. Pancreatic surgery and radiotherapy in Southwest Finland have been centralized to Turku University Hospital. Previously validated population-based electronic health records database was searched for all unselected PDAC patients from the years 2009-2019. Main outcome was median overall survival (mOS). Demographics, pathology, surgery, and oncological treatment data were collected. We identified 1006 patients with PDAC, 49% male, median age 71 years and 77% presenting with metastatic disease. In total, 405 patients were treated; 92 resected, 26 dRT without resection and 287 systemic therapy only. mOS was 34.6 months for resected, 26.7 months for dRT, and 7.5 months for systemic therapy patients. Among the 88 patients with locally advanced inoperable PDAC, dRT was independently associated with longer mOS (26.7 months) as compared to systemic therapy only (mOS 10.6 months). Among the 287 patients treated with systemic therapy only, combination chemotherapy was independently associated with longer mOS (11.6 months) as compared to gemcitabine-monotherapy (6.8 months). In patients progressing to second-line systemic treatment after gemcitabine failure, mOS was the same (5.0 months) with single or combination regimens. Surgery remains the only curative approach for PDAC. In locally advanced PDAC, dRT was associated with longer survival as compared to systemic therapy only. Concerning first-line systemic therapy, our results support the use of combination chemotherapy over single-agent therapy.

Treatment and clinical outcomes of patients with acute myeloid leukemia in Finland 2010-2020: A retrospective analysis of electronic health records.

Our retrospective study (2010-2020) examined treatment patterns, outcomes, and healthcare resource utilization in Finnish acute myeloid leukemia (AML) patients. Data covered 153 patients diagnosed at Hospital District of Southwest Finland (HDSF) and 107 from other districts who underwent allogeneic stem cell transplantation (aSCT) at HDSF. Of the 153 patients, 56.2% received intensive chemotherapy (IC), while 43.8% deemed ineligible for IC received low-intensity therapies or best supportive care (BSC). Median overall survival for IC patients was 31.2 months, compared to 5.3 months for those under azacytidine and 1.2 months on BSC. Majority (57.5%) of patients over 60 with intermediate/high European leukemia network risk had poor outcomes with IC and couldn't proceed to aSCT. These patients carried the highest costs and hospital resource use per patient month. Most common reasons for transplant ineligibility after IC were refractory disease and infection. Our data provides a comprehensive view on AML treatment landscape from a period when the latest treatment advancements were not yet accessible. The data describes patient groups with poor prognosis and increased healthcare burden, emphasizing the need to improve treatment practices and identify better ways to get more patients to transplant, in a rapidly evolving treatment landscape.

Regional variations in incidence and treatment trends of Achilles tendon ruptures in Finland: a nationwide study.

The aim of our study was to assess the regional variations in Achilles tendon rupture incidence and treatment methods in Finland during the period 1997-2019. The Finnish National Hospital Discharge Register (NHDR) and the Finnish Register of Primary Health Care Visits (PHCR) were searched to identify all adult patients diagnosed with Achilles tendon rupture during our study period. The population-based annual incidence and incidences of surgically and non-surgically treated Achilles tendon ruptures were calculated for each hospital district. Achilles tendon rupture incidence increased from 17.3 per 105person-years in 1997 to 32.3 per 105in 2019. The mean incidence of Achilles tendon ruptures ranged from 26.4 per 105(North Savo) to 37.2 per 105(Central Ostrobothnia). The incidence of Achilles tendon ruptures increased in all areas. The proportion of non-surgical treatment of Achilles tendon ruptures ranged in 1997 from 7% (Vaasa) to 67% (Åland) and in 2019 from 73% (Southwest Finland) to 100% (East Savo, Kainuu, Länsi-Pohja, Åland). During the study period, a shift towards non-surgical treatment was evident in all hospital districts. Regional variations in Achilles tendon rupture incidence exist in Finland; however, the incidence increased in all areas during the follow-up period. More Achilles tendon rupture patients are currently being treated non-surgically throughout the country.

The experiences of patients not conveyed after evaluation by emergency medical services in Southwest Finland – A qualitative survey study

BackgroundThe amount of non-critical Emergency Medical Services missions has been increasing. After examination and treatment, paramedics can decide, based on guidelines, not to convey the patient to a healthcare facility. This study aimed to investigate patients’ experiences in non-conveyance situations in Southwest Finland. Our research questions were: 1) Which patient concerns were not addressed? 2) What key actions improved patient comfort? and 3) What possible enhancements could make the patient experience more positive? MethodsThis was a qualitative survey study. In March 2023, all the patients who met the inclusion criteria (N = 1017) received a survey via mail. The data from three open-ended questions were analyzed using inductive content analysis. ResultsThe response rate was 22.2 % (n = 226). The unaddressed patient concerns were related to inadequate immediate care and guidance and non-clinical factors causing concern. Key actions for improved patient comfort were related to immediate treatment and guidance, as well as non-clinical factors that impact the patient experience. More thorough treatment processes and more attentive encounters would have enhanced the patient experience. ConclusionsPredominantly, patients reported having received excellent services. Utilizing paramedics’ soft skills and keeping the patient as the central focus is key to improving the non-conveyance process and experience.

Myocardial Blood Flow in Newly Diagnosed Breast Cancer Patients at Rest and During Exercise

Heart depends critically on continuous supply of blood, but it is unknown whether cancer, without any treatments, affects myocardial blood flow (MBF) at rest or during exercise. This study therefore aimed at measuring MBF in cancer patients and control subjects and it was hypothesized that MBF is affected by cancer. The study included recently-diagnosed breast cancer patients (n=18) who had not started their oncologic treatments and age-matched female control participants (n=32). Controls were women referred to cardiac diagnostic testing but who were by this testing judged to be free of obstructive coronary artery disease. MBF was quantified with [15O]H2O positron emission tomography (PET) at rest in both groups and additionally during 10-min supine bicycling exercise in the breast cancer patients. Furthermore, cardiac morphological changes were analyzed with a breast cancer mice-model four weeks after the inoculation of 13TC mammary tumor cells. Respective mice without tumors served as controls. Resting heart rate (HR) and rate pressure product (RPP) correlated positively with resting MBF, but were similar in both groups resulting also in similar resting MBF in cancer patients and controls. MBF increased significantly from rest during exercise in breast cancer patients (p&lt;0.0001) and exercising MBF correlated positively with the histologic grade of cancer (r=0.54, p=0.021). However, cancer grade did not associate with exercise intensity measures such as HR, RPP or HR percentage from age-predicted maximal HR. In the mouse model, the breast cancer did not affect heart weight, cardiomyocyte size, myocardial capillary density, or capillary-to-myocyte size ratio. In conclusion, resting MBF in humans or myocardial capillarity in mice appear not to be affected by breast cancer. However, the more severe is the histologic grade of cancer, the higher is the MBF during exercise in patients with breast cancer, independently of the intensity of the exercise suggesting dysregulation of myocardial blood supply with cancer. This novel finding requires further investigations. This study was financially supported by Academy of Finland and Hospital District of South-West Finland. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Patient experience of non-conveyance in the EMS of Southwest Finland: a descriptive survey study

BackgroundEmergency Medical Services are dispatched more frequently than before. However, many non-urgent patients do not need ambulance transportation to a healthcare facility after evaluation and treatment on scene. This study explored the experiences of non-conveyed patients. Our research questions were: (1) How have non-conveyed patients experienced the service received from EMS? (2) Does a patient’s age, gender, or time of the emergency call impact the patient’s experience?MethodsThis descriptive survey study examined non-conveyed Emergency Medical Services patients in the Wellbeing Services County of Southwest Finland. The study period was from March 1, 2023, to March 31, 2023. The study population was 1017. They received a questionnaire that was sent by mail. The questionnaire was formed based on questions previously used in four different questionnaires. We received 247 answers (24.3% response rate). Percentages, medians with interquartile ranges, and non-parametric tests were used in the descriptive analyses.ResultsNon-conveyed patients were very satisfied with the paramedics’ expertise and behavior, their ability to meet their individual needs, the sense of safety provided by the paramedics, and the instructions given to the patients. Time to receive help (19% rated 3 or less on a scale from 1 to 5), how paramedics introduced themselves (16.5%), and satisfaction with non-conveyance decisions (14.6%) were more frequently rated lower than other areas. Further, pain management stood out in the less favorable evaluations. Still, patients’ experiences of the service were positive. The age group, gender, or time of the emergency call were not associated with patient experience.ConclusionsPatients were very satisfied with the paramedics’ interpersonal skills. A more focused approach to pain management and developing EMS to ensure faster patient outreach and clearer explanations of non-conveyance decisions could further enhance the patient experience.

Gamified Intervention for Health Promotion of Families in Child Health Clinics — A Cluster Randomised Trial

Objectives This study aimed to evaluate the effectiveness of the digital and gamified WellWe intervention on parental self-efficacy for healthy behaviours and mindfulness in parenting at the comprehensive health checks of 4-year-old children. Methods Two-arm cluster, randomised, controlled trial with a 4-month follow-up.The data were collected from parents of 4-year-old children. Cluster randomisation was done at the municipality level. Fifteen child health clinics within 4 municipalities located in Southwest Finland were randomly allocated to either an intervention (WellWe intervention) or a control group (usual care). The outcome measures included the Parental Self-Efficacy for Healthy Behaviours (PDAP) and Mindfulness in Parenting (MIPQ) questionnaires. Data were collected at baseline, after the intervention and at the 4-month follow-up. Results Initially a total of 110 parents (50 in the intervention and 60 in the control group) participated in the study. At the end of the study, there were 33 parents involved, with 12 in the intervention group and 21 in the control group. Parental self-efficacy and mindfulness in parenting showed no statistically significant difference between the groups or within the groups at the different time points. Conclusions The results of the study showed no difference between the intervention and the usual care. The commitment of the subjects was lower than expected. The intervention could be improved by placing a greater focus on engaging and motivating both families and public health nurses (PHNs). Therefore, when refining the intervention further, it's important to involve the target group more actively in the design of both content and delivery.

The impact of prognostic factors and comorbidities on survival in older adults with stage I − III cutaneous melanoma in Southwest Finland: A register study

IntroductionDespite being diagnosed with thicker and more often ulcerated melanomas, cancer-specific survival (CSS) is not necessarily inferior in older adults with melanoma compared to younger patients. Materials and MethodsOur aim was to evaluate the impact of baseline melanoma-specific prognostic factors and comorbidities on recurrence-free survival (RFS), CSS, and overall survival (OS) in patients aged 70–79 (n = 474) and ≥ 80 years (n = 286) with resected stage I − III cutaneous melanoma in Southwest Finland between January 1, 2000 and December 31, 2020. Patients were restaged according to the 8th edition of TNM classification, and comorbidities were assessed using the Charlson Comorbidity Index (CCI). ResultsPatients aged ≥80 years had thicker and more commonly ulcerated melanomas: 43.0%, 40.9%, and 16.1% of patients aged ≥80 and 56.5%, 25.3%, and 18.1% of patients aged 70–79 years were diagnosed with stage I, II, and III melanoma, respectively. Multiple comorbidities (CCI ≥2) were more common and sentinel lymph node biopsy less frequently performed in patients aged ≥80 years. RFS and CSS were similar in patients aged 70–79 years and ≥ 80 years: median RFS 13.8 years vs not reached, with the hazard ratio of melanoma recurrence or death from melanoma 1.25 (95% confidence interval [CI]: 0.91–1.71); median CSS was not reached, with the hazard ratio of death from melanoma 1.12 (95%CI: 0.81–1.75). The proportion of patients who were alive with melanoma recurrence or had died from melanoma was similar in both age groups. In multivariable analysis, higher pathological stage was the only independent risk factor for short RFS regardless of age group, sex, CCI, and tumor ulceration. Higher stage and male sex were associated with short CSS. Age ≥ 80 years, stage III disease, and CCI ≥ 2 were associated with short OS and female sex with long OS in multivariable analysis. DiscussionPathological stage was the most influential factor determining RFS and CSS in older adults with resected stage I − III melanoma. Concerning OS, age ≥ 80 years, stage III disease, and multiple comorbidities had a significant negative impact.

Reasons for Treatment Discontinuation and Their Effect on Outcomes of Immunotherapy in Southwest Finland: A Retrospective, Real-World Cohort Study.

Immune checkpoint inhibitors (ICI) have improved survival in several cancer types. Still, most patients develop disease progression during or after treatment. We evaluated the reasons for treatment discontinuation and their effect on treatment outcomes in adult patients with advanced cancer with ICI in the first or later treatment lines in Southwest Finland between 1 January 2015 and 31 December 2021. Baseline characteristics and treatment outcomes were retrospectively obtained from the electronic medical records. There were 317 patients with 15 different cancer types, most commonly non-small cell lung cancer, melanoma, and kidney cancer, treated with ICI outside clinical trials. During follow-up, 94% of the patients had discontinued treatment. A total of 62% was due to disease progression, 17% due to immune-related adverse events (irAEs), 12% after achieving disease control or radiological response, and 9% due to poor performance status. The median progression-free survival (mPFS) was 5.4 months and the median overall survival (mOS) was 20.3 months in the whole cohort. Longer mPFS and mOS were observed in patients who discontinued ICI due to irAEs (24.3 and 49.2 months) and after disease control (49.7 months and not reached). In total, 46% of the patients who discontinued ICI after irAEs or disease control remained alive and progression-free during follow-up.

PET imaging of unruptured intracranial aneurysm inflammation (PET-IA) study: a feasibility study protocol

IntroductionPositron emission tomography (PET) imaging can be used to evaluate arterial wall inflammation in extracranial vascular diseases. However, the application of PET imaging in unruptured intracranial aneurysms (UIA) remains unexplored....

Ramp traps versus pitfall traps for collecting epigeal arthropods: a case study in a coniferous forest in Southwest Finland

ABSTRACT Pitfall traps are commonly used to sample epigeal arthropods, but they are not ideal in areas where soil disturbance is restricted or not possible. Ramp traps are a less well known alternative that does not require excavation. To compare the performance of the two trap types in capturing epigeal arthropods, both ramp (n = 12) and pitfall traps (n = 12) were set up in four paired transects in Korkiakallio forest (Turku, Finland), in summer 2022. The project team identified adult spiders to the species level, and other arthropods to the family level. Ramp traps captured significantly more individuals of ants (Hymenoptera: Formicidae), beetles (Coleoptera), true bugs (Hemiptera), and spiders of the species Minyriolus pusillus (Wider, 1834) (Araneae: Linyphiidae), while pitfall traps captured more myriapods (Myriapoda). Our findings provide additional evidence that ramp traps are not only a viable alternative to pitfall traps in challenging environments, but also complement (and should ideally be used alongside) pitfall traps.

Long-term decline of whitefish (Coregonus lavaretus) population in the boreal lake Pyhäjärvi, southwest Finland, relative to simultaneous abiotic and biotic changes

In recent decades many lake fish populations have faced complex pressures particularly due to climate warming and eutrophication. In Lake Pyhäjärvi, southwest Finland, profound changes have occurred in the commercial winter fisheries targeting the coregonids vendace, Coregonus albula, and whitefish, Coregonus lavaretus. The responses of vendace have been examined earlier, and here the detailed analyses are extended to the whitefish. In the 1970s and 1980s, the coregonid fishery was sustainable, but in 1991–1998, intense exploitation led to recruitment overfishing of vendace. Despite temporarily improved growth and recruitment of whitefish during vendace decline, whitefish population biomass declined throughout the study period, while perch (Perca fluviatilis), roach (Rutilus rutilus) and ruffe (Gymnocephalus cernuus) increased and vendace and smelt (Osmerus eperlanus) maintained their abundance. As many other northern lakes, Pyhäjärvi seems to be changing from coregonid to perch dominance due to climate warming and eutrophication. Whitefish decline was associated with decreases in fecundity, winter survival of embryos, and larval density. The spawning stock was kept small by intensive fishery. The decline of the relative fecundity was likely due to food competition with vendace and especially the perch and roach populations that increased with eutrophication and more frequent hot summers. The winter survival of whitefish embryos decreased when the introduced signal crayfish (Pacifastacus leniusculus) increased. Despite decreasing fishing effort in the 2000s the larval numbers continued to decline. In the prevailing circumstances in Pyhäjärvi, whitefish will with high probability remain as a minor and still declining species of the fish assemblage.

Developing millennial tree-ring chronology for Turku (Åbo) and comparing palaeoclimaticsignals inferred from archaeological, subfossil and living Pinus sylvestris datain Southwest Finland

Archaeological and living tree data were used to construct tree-ring chronologies over the medieval (AD 1183–1430) and recent (AD 1812–2020) periods in Turku, which is historically an important population centre in Southwest Finland and the country. Comparisons between the two tree-ring assemblages, and between the previously built chronologies from the Åland (historical timber) and Tavastia (lacustrine subfossils and living trees) sites, provided ways of understanding the growth patterns and their linkages to climatic, environmental, and edaphic factors. Tree growth in and around Turku was affected by warm-season precipitation and winter temperature. Similar relationships were previously evident also in the Åland tree rings, whereas the data from a wetter Tavastia site did not exhibit similar precipitation signal. The site conditions influence also the correlations which are higher between Turku and Åland than between Turku and Tavastia chronologies. Construction of long continuous chronology is impaired by human-related activities, the Great Fire of Turku in 1827 and logging, which have diminished the availability of dead and living-tree materials, respectively. These conditions lead to hardships of filling the gap between the medieval and recent periods and updating the archaeological datasets with compatible living-tree data, which are both demonstrated by our results.

Adolescents with neuropsychiatric symptoms in the turmoil of the service system: The NEPSOS interdisciplinary study of social work, adolescent psychiatry, special education, and expert organisations

Existing social, health and education services do not respond to the needs of adolescents with neuropsychiatric symptoms. These services are usually fragmented and their professionals’ expertise is insufficient. In this interprofessional context, the integration of specialisations, multidisciplinary expertise and knowledge is a challenge. In the NEPSOS study, we explore the services aimed at and service needs of adolescents with neuropsychiatric symptoms and their families. The NEPSOS study is collaboratively designed and carried out by experts from the University of Turku and the University of Eastern Finland, including researchers of adolescent psychiatry, social work and special education, as well as expert organisations such as the Southwest Finland Centre of Excellence on Social Welfare and the Nationwide Association of Different Learners. These organisations provide their expertise for the implementation and integration of the research results into the service system and the development of recommendations. &#x0D; In this study, the appropriateness of services and service paths are examined from the perspectives of adolescents and families, professionals and interprofessional collaboration. The study has four different lines. Line 1 examines the relationships between a) the socio-economic status of the parent and the situation of the adolescent and b) neuropsychiatric symptoms and child protection support measures. Line 2 examines the experiences and views of adolescents and their parents concerning the functionality of the service system and the functional forms of psychosocial support. Line 3 studies the professionals’ perspectives on the functionality of the service system and interprofessional collaboration in the context of adolescent service paths. Line 4 focuses on communication and interaction activities, including the implementation of the research results.&#x0D; The NEPSOS study will provide knowledge and deepen the understanding of the following topics:&#x0D; •How interprofessional cooperation is implemented in the service paths for adolescents with neuropsychiatric symptoms from the perspective of professionals from the fields of social work, adolescent psychiatry and education.&#x0D; •How existing service networks meet the needs of adolescents and their families, and what kind of psychosocial support is provided to them by the professionals of social work, adolescent psychiatry, and special education. &#x0D; •How psychosocial services and interprofessional collaboration are performed to improve the timeliness, targeting and integration of services for adolescents with neuropsychiatric symptoms and their families.&#x0D; Furthermore, the impact of this study’s findings will be manifested as practical recommendations and training materials for professionals. The NEPSOS study forms part of an interdisciplinary research consortium whose ongoing and future studies specifically aim at strengthening the integration of social care, health care and education for the health and wellbeing of children and families. Our experiences regarding interdisciplinary collaboration and the future results of the study can be applied internationally both in higher education and the integration of child social, health and education services.&#x0D; Keywords: neuropsychiatric symptoms, adolescents, interdisciplinary collaboration, social work, adolescent psychiatry, special education.