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AT THE INTERSECTION OF NATURAL SCIENCES AND HUMANITIES

Jesper Ekelund, the director of psychiatry at the Hospital District of Helsinki and Uusimaa (HUS), moved into leadership roles from an established research career. In his career, he has focused on, among other things, imaging, the genetics of schizophrenia and research on information processing.


Jesper Ekelund, who began serving as the director of psychiatry at the Hospital District of Helsinki and Uusimaa (HUS) at the beginning of the year, has conducted diverse research in the field of psychiatry, including imaging, clinical trials and drug studies.

Ekelund graduated with a Licentiate of Medicine degree from the University of Helsinki, after which he focused on the genetics of schizophrenia as a doctoral researcher. His postdoctoral work took him to the United States, where he focused on brain imaging. Three years later, he returned to Finland and completed his specialist training in psychiatry. His research topics later expanded to include information processing during psychiatric disturbances.

In 2010 Ekelund was appointed to a professorship at the University of Helsinki, with an additional duty located in Vaasa. Gradually, his journey led him to leadership positions in the field.

“In 2017 I started working as director of psychiatry at the Hospital District of Southwest Finland, and then took up the same position at HUS at the beginning of this year,” Ekelund says.

Half of outpatient care in digital form at HUS

Ekelund praises the opportunities afforded by digitalisation in psychiatric care: efforts to develop the digital services of HUS’s psychiatric sector have been speedy, with half of outpatient care already provided over remote connections.

Digital care pathways have also advanced far, as has the monitoring of staff activity. Registering how patients have been treated also boosts the measurement of impact.

“Traditionally, talking therapy has been difficult to measure and define. We have created indicators, including fixed-term interventions. These indicators have helped us to better analyse our operations and their impact,” says Ekelund.

Will the pandemic leave a long-term mark on adolescents?

At HUS, the effect of the coronavirus pandemic has been apparent in the state of seriously ill patients. Ekelund says that particularly those with schizophrenia and other long-term conditions have suffered from the third sector lockdown. Many have ended up on the ward in an even poorer state due to illness combined with poor functional capacity.

A real risk of developing a mental illness is also present when a person becomes unemployed, for example, or goes bankrupt during the coronavirus period. Serious changes in people’s lives always pose a risk to mental health.

“In contrast, temporary external concerns don’t make healthy people ill. Things were slightly overdramatised, especially at the beginning of the pandemic,” Ekelund says.

Ekelund is worried about young people. Separating from your family of origin, finding your own identity and spending time with other young people are part of adolescence and young adulthood.

“The pandemic has been devastating for 15- to 20-year-olds. Spending a year or two isolated at home, and not being allowed to meet your peers as usual, is detrimental to this developmental stage,” he says.

Ekelund estimates that the coronavirus period may lead to a spike in mental disorders among young people later on.

“This is something professionals specialised in adolescent psychiatry are very worried about,” he notes.

Terminology associated with mental illness needs updating

Ekelund hopes to see psychiatric research provide answers to, for example, understanding the heterogeneity of depression. At the moment, depression as an everyday term describes both an emotional state and an actual disease. Misconceptions make it more difficult to determine the demand for psychiatric care. What is being treated when treating depressed patients?

“Can we define sub-groups for depression or anxiety, and, through that, different clinical pathways? It would be important to know who needs drug therapy, who needs psychotherapy and what is the most effective treatment for people with mild symptoms,” Ekelund says.

For a long time, the focus has been on prevention, which Ekelund believes has become an ideological mantra. He would like to see evidence of comprehensive clinical pathways, not only individual interventions.

“Scientific evidence of the cost-effectiveness of various methods as part of the overall treatment is actually insufficient. We need more research on how to use the resources available in a cost-effective way.”

“Psychiatry is at the heart of being human”

  1. Which researchers in neuroscience or psychiatry do you admire?

I want to start by mentioning Leena Palotie and Jouko Lönnqvist, my doctoral thesis supervisors. Kenneth Kendler, who examined my doctoral thesis, has significantly advanced psychiatry as a field. My opponent was Michael Owen who has a career in psychiatric genetics. During my postdoctoral period, I had the opportunity to meet one of the most pioneering researchers in the field of modern psychiatry, the Nobel laureate Eric Kandel. Through the Scandinavian College of Neuropsychopharmacology, I have also had the chance to meet Arvid Carlsson, another Nobel laureate known for his dopamine studies. He has revolutionised the entire field of psychiatry. Without him, there would be no modern psychiatry.

  • 2. Why psychiatry?

Psychiatry is overwhelmingly the most interesting specialisation: it is at the heart of what being human means – psychiatry combines hard natural sciences with humanism and care. There is enormous demand for the field, and psychiatry concerns society as a whole. Moreover, the field requires diverse expertise: in addition to being familiar with pharmacology, neuroscience and brain function, you also have to be able to encounter human beings, identify with them and understand their experiences.

3. How do you recover after work?

Exercise is my number one way of relaxing. I clear my head daily in endurance training, such as running, cycling or swimming. Another passion of mine is sailing, which is a hobby for the whole family. I also participate in competitive sailing. I find it most relaxing when I have something to do.


Article written by Elina Kirvesniemi, University of Helsinki

RESEARCHER FOCUSING ON ATTENTION

Benjamin Cowley works as an associate professor of ‘AI for learning and education’ at the Faculty of Educational Sciences at the University of Helsinki. His way of doing science is fundamentally multidisciplinary.

Benjamin Cowley is one of the researchers of the Academy of Finland-funded Mind and Matter profiling package, which brings together top-level researchers to tackle research problems and provide a radically new understanding of intelligence, consciousness and information.

Cowley’s research focuses on high-performance cognition.

“As a researcher I am a multidisciplinary PI working in computational cognitive science of high performance and learning,” he says.

Benjamin Cowley has a strong background in computer science. He did his PhD in Northern Ireland, Ulster, and focused on player modelling. The change in research field happened when he moved to Finland to work in Niklas Ravaja’s lab (Aalto University) for his postdoc, focusing on the psychophysiology of learning.

“I’ve always been interested in the human perspective. Even though methodologically I’m working with computational science, I have a human-focused interest.”

“Before I started my own group, I travelled through disciplines from psychology to cognitive science and behavioral science, looking at attention and the cognitive neuroscience of attention.”

Initial interest: Human cognition

Cowley says that his initial academic interest was in human cognition and inferential intelligence. For example, the question: “How do we see a tree?” is a metaphor for how we perceive mathematically well-founded concepts in the world around us, and then infer something about them, like how aesthetic, healthy, or ‘well-grown’ is that tree.

This conceptually philosophical question is an inspiration, but methodologically Cowley’s focus is on a more performance- and task-oriented view. How does a person perform a task and understand the requirements?

In recent years, Cowley has also been inspired by Karl Friston’s ‘Bayesian Brain’ and related theories – it gives a well-defined and integrated way to understand common concepts like ‘attention’, that are otherwise amorphous when you start to dig into them. Cowley aims to use the theory for his own research when bringing together the conceptual and empirical work.

Lab solves questions about polar opposites of attention: Flow and ADHD Cowley’s lab works primarily with empirical and experimental data. Cowley has long focused on the experience of flow when performing tasks, as a self-reported proxy for high performance cognition.

The lab has also been studying neuropsychiatric health-related topics, primarily ADHD, where the aim is to study how learning and inference might be impaired by deficits in the neural mechanisms of attention.

“We have studied ADHD in adults by recording brain imaging data in increasingly complex computer performance tests. We try to find out, for example, how relational attention differs”, he says.

Fundamentally multidisciplinary

Even though “multidisciplinary” is nowadays a buzzword that is used for having an impact, Cowley says that for him it is the fundamental way of doing things.

Multidisciplinarity is the desired path and trend, but for him, it is the only way of doing science.

“I don’t aim to be a psychologist or neuroscientist; neither do I use a structure of research that follows computer science. So, I ended up somewhere in the middle anyway,” he says.

Finland – the land of the Moomins

Cowley has settled down in Finland. But why Finland in the beginning?

“The postdoc job fit my ambitions quite well; but I also had a good impression of the country. When I was a teenager, I read Tove Jansson’s novella The Summerbook, and I found it very evocative – and I was just curious about the country,” he says.

This article is part of series where Helsinki Brain & Mind introduces researchers from a wide perspective in the neurology field.

HUS DATA SERVICE FOR NEUROSCIENCE RESEARCH PROJECTS

HUS data service is part of Helsinki University Hospital, the largest hospital district of special care in Finland, and provides real-world health care data sets for research and knowledge management purposes using Data Lake, a technique that can store big data.

HUS Data Lake holds more than 100 patient registries, each registry containing dozens of data tables and hundreds of different variables. The data consists of structured and unstructured data that is imported from the electronic patient health records from all HUS Hospitals, with more than 1 million referrals and hospital visits per year. The earliest data is from the 1980’s but more comprehensive data is available from 2010 onwards as most HUS units started to use electronic patient health records then. The data is updated daily and new integrations from new information systems are continuously built.

For neuroscience research purposes the patient cohort can be defined, for example, by diagnoses or visits to a particular ward over a specific time period. Then the data can be queried from the HUS Data Lake for those patients. Typical data queries include patients’ diagnoses, procedures, medication, laboratory tests and hospital visits and the variables can be tailored to meet the research needs. Imaging data will also be available in spring 2021. In 2021 software specialist Paula Tanni from HUS data service will provide neuroscience research data queries as a part of the Helsinki Brain & Mind team.

The data is pseudonymized and all information that could lead to individual patient identification has been removed. Different databases of the HUS Data Lake can be connected with the pseudo-ID, making it possible to gather various information about the patient cohort. Before the data set is handed over to the researcher, the pseudo-IDs are re-pseudonymized, making it impossible to combine more data than is covered by the research permit.

The HUS data service provides data according to the Finnish law of secondary use of health and social data. Transferring the data sets to researchers requires a scientific research permit recognized by HUS. HUS data service also offers analytical workspace for powerful tools for data analyzing purposes.

More information on the HUS data service can be found on the HUS website (in Finnish) and per e-mail at tietopalvelu@hus.fi.

The portal for data requests or data availability assessment can be found on the HUS website (in Finnish). If the research requires combining data with data outside of HUS, this is possible through Findata – Findata, Health and Social Data Permit Authority. Read more on the Findata-website.