Six decades of longitudinal health knowledge production: a systematic review on Nordic birth cohort studies

This systematic review (a) identifies birth cohort studies (BCSs) established in the Nordic countries, (b) describes their basic characteristics, and (c) explores how these characteristics have evolved over time, discussing their implications to knowledge production. To identify Nordic BCSs, cohort databases and relevant scientific articles were systematically searched and screened.The review shows that since 1959, more than 600,000 index children have participated in the 79 Nordic BCSs (22 Danish, 20 Finnish, 12 Norwegian, 24 Swedish, one Icelandic), over half of them still ongoing. The Nordic BCSs cover a wide geographical area including the Nordic Arctic. The topics of BCSs have varied over time but most have focused on examining the developmental origins of diseases. A quarter of them had a general scope, while the rest started with a specific focus, commonly atopic diseases. All BCSs collected questionnaire and/or interview data and over 60% of the BCSs announced exclusion criteria for participants, typically insufficient language proficiency.NBCSs have produced crucial scientific knowledge for over six decades, but there are underutilised opportunities including systematic interdisciplinary collaboration, inclusion of children's own views of their health and well-being, intergenerational data collection, and specific knowledge of Arctic indigenous peoples and other minorities.

Nameless strangers, similar others: the affordances of a young people's anonymous online forum for health information practices

Purpose

The study examines how the technical features and associated social practices of an anonymous, text-based online forum intended for young people make it a unique platform for acquiring and sharing health information among peers.

Design/methodology/approach

The features and content of a young people's section of a popular Finnish discussion forum were examined with a focus on health-related threads. Observational notes and thread content were analysed with a focus on the forum's affordances for health information practices.

Findings

The findings indicate that the forum's affordances including anonymity, persistence, searchability, cohesion and tolerance enabled the pooling of peer experiences, opinions and experience-based advice on health, rather than sharing factual information or embracing reciprocal discussion. As such, instead of competing for a cognitive authority position with medical authorities or offering emotional support like tight online support communities, the anonymous forum served as a platform for young people to gain information on others' experiences and opinions on sensitive, mundane and disnormative health issues and for reflecting their own lived experiences to those of others.

Originality/value

The study is original in its approach to examining the affordances of an online platform for health information practices. It helps in understanding young people's ways of using different resources to meet their diverse health information needs and the value of gaining access to experiential health information.

Predictors of response to pharmacological treatments in treatment-resistant schizophrenia - A systematic review and meta-analysis

BACKGROUND

As the burden of treatment-resistant schizophrenia (TRS) on patients and society is high it is important to identify predictors of response to medications in TRS. The aim was to analyse whether baseline patient and study characteristics predict treatment response in TRS in drug trials.

METHODS

A comprehensive search strategy completed in PubMed, Cochrane and Web of Science helped identify relevant studies. The studies had to meet the following criteria: English language clinical trial of pharmacological treatment of TRS, clear definition of TRS and response, percentage of response reported, at least one baseline characteristic presented, and total sample size of at least 15. Meta-regression techniques served to explore whether baseline characteristics predict response to medication in TRS.

RESULTS

77 articles were included in the systematic review. The overall sample included 7546 patients, of which 41% achieved response. Higher positive symptom score at baseline predicted higher response percentage. None of the other baseline patient or study characteristics achieved statistical significance at predicting response. When analysed in groups divided by antipsychotic drugs, studies of clozapine and other atypical antipsychotics produced the highest response rate.

CONCLUSIONS

This meta-analytic review identified surprisingly few baseline characteristics that predicted treatment response. However, higher positive symptoms and the use of atypical antipsychotics - particularly clozapine -was associated with the greatest likelihood of response. The difficulty involved in the prediction of medication response in TRS necessitates careful monitoring and personalised medication management. There is a need for more investigations of the predictors of treatment response in TRS.

“Let's keep this video as real as possible”: young video bloggers constructing cognitive authority through a health-related information creation process

Purpose

This study examines the information literacy practices of young video bloggers, focusing on the ways in which they construct their cognitive authority through a health-related information creation process.

Design/methodology/approach

This study draws upon socially oriented information literacy research and nexus analysis as its methodological framework. Data, including YouTube videos, theme interviews and video diaries, were collected with three Finnish video bloggers and qualitatively analysed using nexus analytical concepts to describe the central elements of social action.

Findings

The study shows that video bloggers employ several information practices during the information creation process, including planning, information-seeking, organization, editing and presentation of information. They construct their cognitive authority in relation to their anticipated audience by grounding it on different types of information: experience-based, embodied and scientific. Trustworthiness, emphasized with authenticity and genuineness, and competence, based on experience, expertise and second-hand information, were recognized as key components of credibility in this context.

Originality/value

This study increases the understanding of the complex ways in which young people create information on social media and influence their audiences. The study contributes to information literacy research by offering insights into the under-researched area of information creation. It is among the few studies to examine cognitive authority construction in the information creation process. The notion of authority as constructed through trustworthiness and competence and grounded on different types of information, can be taken into account in practice by information professionals and educators when planning information literacy instruction.

Dialogic spaces in divergent and convergent collaborative learning tasks

Purpose

The purpose of this study is to examine how dialogic spaces were co-constituted (opened, broadened and deepened) between students engaged in divergent and convergent collaborative learning tasks, orchestrated by teachers in Finnish primary and secondary schools. The concept of dialogic space refers to a dynamic, shared resource of ideas in dialogue and has come to represent an ideal form of educational interaction, in the contexts of collaborative learning, joint creative work and shared knowledge-building.

Design/methodology/approach

A socio-cultural discourse analysis of video-observed classroom dialogue, entailing the development of a new analytic typology, was undertaken to explore the co-constitution of dialogic space. The data are derived from two qualitative studies, one examining dialogue to co-create fictive video stories in primary-school classrooms (divergent task), the other investigating collaborative knowledge building in secondary-school health education (convergent task).

Findings

Dialogic spaces were opened through group settings and by the students’ selection of topics. In the divergent task, the broadening of dialogic space derived from the heterogeneous group settings, whereas in the convergent task, from the multiple and various information sources involved. As regards the deepening of dialogic space, explicit reflective talk remained scarce; instead the norms deriving from the school-context tasks and requirements guided the group dialogue.

Originality/value

This study lays the groundwork for subsequent research regarding the orchestration of dialogic space in divergent and convergent tasks by offering a typology to operationalise dialogic space for further, more systematic, comparisons and aiding the understandings of the processes implicated in intercreating and interthinking. This in turn is of significance for the development of dialogic pedagogies.

Enablers for and barriers to using My Kanta - A focus group study of older adults' perceptions of the National Electronic Health Record in Finland

To explicate how experiences with patient-accessible electronic health records correspond to the expectations of the users, we present qualitative results of older adults' experiences with the Finnish national patient-accessible health record My Kanta and similar services. 24 persons, 17 women and 7 men aged 55-73, took part in the study. We interviewed six focus groups of 3-5 participants with previous experience of My Kanta, in two cities in Finland. We used a convenience sample and video- and audio-recording as well as note taking. The interviews were transcribed verbatim. The inductive analysis was based on content analysis. We identified major uses, enablers, barriers, and outcomes of My Kanta. In addition to earlier reported barriers and enablers, the findings show that launch-time lack of useful content and features in systems still under development can cause frustration and hinder their effective use at the time and in the long run. Concerns and barriers relating to use were socio-techno-informational and tightly associated with the contents of the system. Improved security, usability and additional information and functions might increase use. Furthermore, coherent and timely information from health-care providers should be available in the e-health services.

Screening everyday health information literacy among four populations

BACKGROUND

People face varying obstacles when interacting with health information in their everyday lives.

OBJECTIVES

This study aims to examine the applicability of a multidimensional Everyday Health Information Literacy (EHIL) screening tool in detecting people with challenges in accessing, understanding, evaluating and using health information in everyday situations.

METHODS

Previously collected EHIL screening tool data from Finnish upper secondary school students (n = 217), Finnish young men (n = 1450), Finnish adults with an increased risk for metabolic syndrome (n = 559) and Namibian university students (n = 271) were reanalysed to examine the factorial structure of the tool and to compare the groups. Statistical analyses included exploratory factor analyses, calculation of mean factor scores and one-way analysis of variance.

RESULTS

A three factor structure ('awareness', 'access', 'assessment') for the screening tool was supported based on the Finnish samples. However, the Namibian data did not follow a similar structure. Significant differences in groupwise factor scores were discovered.

DISCUSSION

The findings suggest that the multidimensional EHIL screening tool can be used in pointing out areas where individuals or groups may need support.

CONCLUSION

The tool may be useful to health information and library services workers when counselling or educating the public.

Uncomfortable in my own skin – emerging, early-stage identity-related information needs of transgender people

Purpose

This study aims to increase the understanding of the early-stage identity-related information needs of transgender people.

Design/methodology/approach

This study draws on social constructivism, queer theory and information practice research. In accordance with the queer phenomenological approach which emphasises lived experiences, data was collected by interviewing 25 individuals who identified as transgender. The data was analysed with a focus on how early-stage information needs are formed into conscious information needs.

Findings

The formation of early-stage information needs were conceptualised as a chain including a trigger for information seeking, finding the right words and understanding the experience. Especially the bodily changes starting at puberty were strong causes of discomfort causing friction between the subjects' own gendered body and their gender experience, even leading to gender dysphoria. Finding words to describe the experience played an important role in the process of identity formation. In many cases this was difficult because of the lack of accurate and relevant information.

Social implications

Providing information especially of varying transgender experiences is vital for individuals trying to understand and verbalise their gender identity.

Originality/value

This study provides an understanding of the early-stage information needs described by transgender people and the process of building identities through disorientation. This study suggests that early-stage information needs are a valid concept to help understand how embodied experiences and the friction between the lived experience and the social world can lead to information seeking.

The cognitive authority of user-generated health information in an online forum for girls and young women

Purpose

The purpose of this paper is to examine the role of one particular online discussion forum as a potentially authoritative health information source for its users. The concept of cognitive authority is used as a starting point for understanding information evaluation in this context. The focus is placed on the types of information users seek for from this forum, the ways they assess the credibility of information obtained, and their views on the impact of this information.

Design/methodology/approach

The empirical data were collected with a questionnaire survey from the users of a Finnish online forum for girls and young women (n=290). The data were analyzed qualitatively with content analytic techniques and quantitatively by using descriptive analysis.

Findings

The forum was found to offer girls and young women the possibility to receive health information from peers. It was viewed as an appropriate source for experiential rather than factual health information and used to find information on sexuality, bodily functions and diets, for example. Author-related cues, argumentation and tone, veracity and verification were recognized as means to evaluate information credibility. Credibility evaluation was found to be linked with conceptions of the forum and the type of information sought. A share of the respondents recognized the information obtained to have influence on their thinking or behavior.

Originality/value

Based on the findings, it can be argued that the members of the online forum – individually or collectively – can act as cognitive authorities for other users. The findings cannot be generalized beyond this online forum, to Finnish girls or young women, or even the users of the online forum. However, they provide insights into the ways young people evaluate user-generated information in a particular online setting and domain of knowledge and as such contribute to research on cognitive authority, credibility evaluation and information literacy.

Health Literacy in Web-Based Health Information Environments: Systematic Review of Concepts, Definitions, and Operationalization for Measurement

Background

Health literacy research seems to lack a consensus on what aspects to include into literacy in the context of health and on how to operationalize these concepts for measurement purposes. In addition to health literacy, several other concepts, such as electronic health (eHealth) literacy and mental health literacy, have been developed across disciplines. This study examines how these different concepts are used when studying health-related competencies in Web contexts.

Objective

This study systematically reviews health literacy concepts and definitions and their operationalization in studies focused on Web-based health information environments.

Methods

A systematic literature search was conducted in April 2016 in 6 electronic databases with a limitation to articles in English published between January 2011 and April 2016. Altogether, 1289 unique records were identified and screened according to the predefined inclusion criteria: (1) original, peer-reviewed research articles written in English; (2) the topic of the article concerned literacy in the context of health; (3) informants of the study were lay people, not health professionals or students of the field; and (4) the focus of the study was placed on an Web-based information environment. In total, 180 full texts were screened, of which 68 were included in the review. The studies were analyzed with an emphasis on the used health literacy concepts and measures.

Results

On the basis of the included studies, several concepts are in use when studying health-related literacy in Web environments, eHealth literacy and health literacy being the most common ones. The reviewed studies represent a variety of disciplines, but mostly medical sciences. Typically, quantitative research methods are used. On the basis of the definitions for health literacy, 3 thematic categories were identified: general and skill-based, multidimensional, and domain-specific health literacy. Most studies adopted a domain-specific concept, followed by the ones that used a general and skill-based concept. Multidimensional concepts occurred least frequently. The general health literacy concepts were usually operationalized with reading comprehension measures, the domain-specific concepts with self-efficacy measures, and multidimensional concepts with several types of measures. However, inconsistencies in operationalization were identified.

Conclusions

The results show that in studies conducted in Web-based information environments, several different health literacy concepts are in use, and there is no clear consensus on the definitions for these concepts. Future studies should place emphasis on the conceptual development of health literacy in Web contexts to gain better results on operationalization for measurement. Researchers are encouraged to provide clear operational definitions for the concepts they use to ensure transparency in reporting.

Health information seeking, beliefs about abilities, and health behaviour among Finnish seniors

The paper presents a study that examines older Finnish adults’ self-perceived capability to access, evaluate, understand and use health-related information, and their perceived ability to influence their health themselves, and the relationship between these factors and their current health, health behaviour and information seeking. Questionnaires were mailed by post to 1000 Finns aged 65–79 years, and a total of 281 completed questionnaires (28%) were returned. Of these, 273 were included in the study. Cross-tabulation and chi-square tests were used for the analysis. Results showed that both a stronger belief in one’s capability to master health information and to act in a healthy manner were positively linked to better health and health behaviour as well as more active information behaviour. These beliefs can be important factors for influencing certain health behaviours and even behaviour change.

Early motor developmental milestones and schizophrenia: A systematic review and meta-analysis

The neurodevelopmental hypothesis of schizophrenia proposes that impaired brain development is a cause of the illness. Early motor developmental milestones, such as learning to walk, are predictors of later schizophrenia but studies have not been systematically reviewed. The aim of the present systematic review and meta-analysis was to explore the association between early motor developmental milestones and the risk of adult schizophrenia. In addition, we updated a systematic review on motor function and risk of schizophrenia. The PubMed, PsycINFO and Scopus databases were searched for original research articles published up to July 2015. Motor milestones were measured between ages 0 and 13years. Random effect meta-analysis calculated effect estimates (Hedges' g) for the association between individual motor milestones and schizophrenia risk. An electronic database and selected articles reference list search identified 5990 articles after removing duplicates. Sixty-nine full text articles were assessed for eligibility of which six were included in the review. Five studies provided sufficient data for meta-analyses. The following motor milestones were significantly associated with adult schizophrenia risk: walking unsupported (g=0.46; 95% CI 0.27-0.64; p<0.001), standing unsupported (g=0.28; 0.16-0.40; p<0.001) and sitting unsupported (g=0.18; 0.05-0.31; p=0.007). Results for the milestones 'holding head up' and 'grabbing object' were not statistically significant. Delayed walking, sitting and standing unsupported were associated with adult onset schizophrenia. The findings emphasise the importance of timely achievement of these motor milestones in childhood and can contribute to the identification of individuals at risk of psychosis.

Long-term antipsychotic use and brain changes in schizophrenia - a systematic review and meta-analysis

OBJECTIVE

The association between long-term antipsychotic treatment and changes in brain structure in schizophrenia is unclear. Our aim was to conduct a systematic review and a meta-analysis on long-term antipsychotic effects on brain structures in schizophrenia focusing on studies with at least 2 years of follow-up between MRI scans.

DESIGN

Studies were systematically collected using 4 databases, and we also contacted authors for unpublished data. We calculated correlations between antipsychotic dose and/or type and brain volumetric changes and used random effect meta-analysis to study correlations by brain area.

RESULTS

Thirty-one publications from 16 samples fulfilled our inclusion criteria. In meta-analysis, higher antipsychotic exposure associated statistically significantly with parietal lobe decrease (studies, n = 4; r = -.14, p = .013) and with basal ganglia increase (n = 4; r = .10, p = .044). Most of the reported correlations in the original studies were statistically nonsignificant. There were no clear differences between typical and atypical exposure and brain volume change. The studies were often small and highly heterogeneous in their methods and seldom focused on antipsychotic medication and brain changes as the main subject.

CONCLUSIONS

Antipsychotic medication may associate with brain structure changes. More long-term follow-up studies taking into account illness severity measures are needed to make definitive conclusions.

What do we know about treatment-resistant schizophrenia? – A systematic review

Introduction

Treatment-resistant schizophrenia (TRS) is a severe form of schizophrenia. From one fifth to one third of all patients with schizophrenia are resistant to treatment.

Objective

To determine the knowledge on TRS and to find out the extent and the quality of research on TRS.

Aims

To conduct a systematic review of the current literature on TRS.

Methods

Original studies and reviews on TRS were systematically collected from PubMed and Scopus databases. The following search strategy was used as a title search; (“ultra-resistant” OR “treatment-refractory” OR “treatment-resistant”) AND (schizophrenia). The search was restricted to English language articles.

Results

The literature search identified 403 studies. After abstract and title review, 324 studies were included. The included studies considered medication (n 213), electroconvulsive therapy and repetitive transcranial magnetic stimulation (15), prognosis (15), genetics (15), studies on neurobiology (15), definitions (14), psychotherapy (12), brain structures and functioning (10), cognition (7) and other miscellaneous studies (6) on TRS. Definitions of TRS varied notably and in most of the non-pharmacological studies, the samples were fairly small. Regarding treatments, clozapine, ECT, and cognitive-behavioral therapy have shown effectiveness, though the quality of research on interventions is limited. Very little is known about risk factors and predictors of outcome in TRS.

Conclusions

Our findings suggest TRS is poorly studied and understood condition contrasted to its high prevalence, clinical importance and poor prognosis. There is a lack of studies on epidemiology, for example risk factors of TRS, as well as on outcomes and longitudinal course. Most of the studies considered medication.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Everyday health information literacy among young men compared with adults with high risk for metabolic syndrome – a cross-sectional population-based study

This cross-sectional population-based study aims at identifying differences in the aspects of everyday health information literacy among young healthy men and adults with an increased risk for metabolic syndrome. Data were collected with a self-assessment-based 10-item screening tool administered at the Finnish Defence Force’s call-ups ( n=2507, response rate 59%) and at health intervention study ( n=571, response rate 98%). Adults with increased risk for metabolic syndrome seemed to value health information but had more difficulty in knowing who to believe in health issues and understanding the terminology used. The difficulties applied especially to respondents 35 years old or over. Men, and especially young men, had lower motivation than women to seek health information. Although the results are indicative, the everyday health information literacy screening tool seems to be useful in revealing areas that health communication should be focused on among different populations.

Retromer vesicles interact with RNA granules in haploid male germ cells

Spermatozoa are produced during spermatogenesis as a result of mitotic proliferation, meiosis and cellular differentiation. Postmeiotic spermatids are exceptional cells given their haploid genome and remarkable sperm-specific structural transformations to compact and reshape the nucleus and to construct the flagellum and acrosome. These processes require delicate coordination and active communication between distinct cellular compartments. In this study, we elucidated the interplay between the haploid RNA regulation and the vesicular transport system. We identified a novel interaction between VPS26A/VPS35-containing retromer vesicles and the chromatoid body (CB), which is a large ribonucleoprotein (RNP) granule unique to haploid male germ cells. VPS26A/VPS35-positive vesicles were shown to be involved in the endosomal pathway, as well as in acrosomal formation that is dependent on the Golgi complex-derived vesicular trafficking. While the exact role of the retromer vesicles in the CB function remains unclear, our results suggest a direct functional link between vesicle transport and CB-mediated RNA regulation.

Individual factors affecting preferences for feedback message tactics in the contexts of physical activity

Tailored feedback on personal physical activity behavior has been used to inform individuals and promote physical activity among different populations. This study aimed to increase the understanding of factors associated with young men's preferences for feedback message tactics in the context of physical activity and exercise. How preferences vary was analyzed in terms of the self-reported physical activity, stage of exercise behavior change, exercise self-efficacy, objectively measured physical health status, and sociodemographic characteristics of young Finnish men. Population-based survey data, including physiological measurements (n = 525), were collected at the Finnish Defence Forces' call-ups in the city of Oulu, Finland, in September 2011. The results indicate that the stage of exercise behavior change, exercise self-efficacy, physical health status, and educational level are associated with a preference for normative and ipsative comparison. Multivariate logistic regression models show that an advanced stage of exercise behavior change and education in the academic track of an upper secondary school are independent predictors of preferring ipsative and normative physical activity feedback among young men. The study provides new insights into how the stage of behavior change influences health information behavior and is in line with studies emphasizing social factors--including education--as being important in shaping health-related behavior. These factors could form the basis for tailoring information when designing health promotion.

Family history of psychosis and social, occupational and global outcome in schizophrenia: a meta-analysis

OBJECTIVE

We aimed to investigate associations between family history of psychosis and long-term occupational, social and global (i.e. combined occupational, social and clinical) outcome in schizophrenia.

METHOD

A systematic search to identify potentially relevant studies was conducted using seven electronic databases and a manual search of literature. Only observational studies with a follow-up period of at least 2 years were included.

RESULTS

The search identified 4081 unique potentially relevant articles, of which 14 met our inclusion criteria. The presence of family history of psychosis was associated with poor occupational and global outcome (n=3; r=0.17; P=0.008, n=11; r=0.13; P=0.002, respectively).

CONCLUSION

This was the first systematic review on the effects of family history of psychosis on occupational and social outcome in schizophrenia. Based on the review, the presence of family history of psychosis has a relatively small but statistically significant association with long-term occupational and global outcome in patients with schizophrenia.

Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis

BACKGROUND

Duration of untreated psychosis (DUP) is one of the few potentially modifiable predictors of outcomes of schizophrenia. Long DUP as a predictor of poor short-term outcome has been addressed in previous meta-analyses, but the long-term effects of DUP remain unclear.

AIMS

To analyse the associations between DUP and long-term outcomes of schizophrenia.

METHOD

A systematic literature search was performed using seven electronic databases and manual searches. Random effects weighted meta-analysis with correlation coefficients was used to pool the results.

RESULTS

We identified 3493 unique publications, from which 33 samples met our predefined selection criteria. Long DUP correlated statistically significantly with poor general symptomatic outcome, more severe positive and negative symptoms, lesser likelihood of remission and poor social functioning and global outcome (correlations 0.13-0.18). Long DUP was not associated with employment, quality of life or hospital treatment.

CONCLUSIONS

The small but mostly consistent correlation between long DUP and poor outcome indicates that early intervention in psychosis may have at least subtle positive effects on the long-term course of illness.

A systematic review and meta-analysis of recovery in schizophrenia

OBJECTIVE

Our primary aims were (a) to identify the proportion of individuals with schizophrenia and related psychoses who met recovery criteria based on both clinical and social domains and (b) to examine if recovery was associated with factors such as gender, economic index of sites, and selected design features of the study. We also examined if the proportions who met our definition of recovery had changed over time.

METHOD

A comprehensive search strategy was used to identify potential studies, and data were extracted for those that met inclusion criteria. The proportion who met our recovery criteria (improvements in both clinical and social domains and evidence that improvements in at least 1 of these 2 domains had persisted for at least 2 years) was extracted from each study. Meta-regression techniques were used to explore the association between the recovery proportions and the selected variables.

RESULTS

We identified 50 studies with data suitable for inclusion. The median proportion (25%-75% quantiles) who met our recovery criteria was 13.5% (8.1%-20.0%). Studies from sites in countries with poorer economic status had higher recovery proportions. However, there were no statistically significant differences when the estimates were stratified according to sex, midpoint of intake period, strictness of the diagnostic criteria, duration of follow-up, or other design features.

CONCLUSIONS

Based on the best available data, approximately, 1 in 7 individuals with schizophrenia met our criteria for recovery. Despite major changes in treatment options in recent decades, the proportion of recovered cases has not increased.