Anja Rantanen

The burden of inflammatory bowel disease on health care utilization and quality of life

Abstract Objective. The aim of this study was to explore the utilization of health services by Finnish adults with inflammatory bowel disease (IBD) and to assess the associated demographic and health-related quality of life (HRQoL) factors. Material and methods. 556 Finnish IBD patients eligible for reimbursement for IBD medication according to the Social Insurance Institution in Finland answered our postal cross-sectional survey. The study questionnaire included questions about demographic characteristics of the patients, health care resource use, and HRQoL. The number of doctor visits was compared with those of irritable bowel syndrome patients. Results. During the previous year, more than three quarters of the respondents reported disturbing IBD symptoms. The majority (64%) had seen a doctor due to their IBD, women more often than men (p < 0.001). The use of health services did not differ between diagnostic (Crohns disease or ulcerative colitis) or age groups, marital status, education, or time elapsed since diagnosis. Women were absent from work more frequently than men (p = 0.01). The amount of physician visits, work absenteeism, and a higher amount of undergone procedures were related to impaired HRQoL (p < 0.001 on all accounts). Conclusions. Despite comprehensive public health services and specialized care for IBD patients in Finland, a majority expressed disturbing IBD symptoms. Since the amount of physician visits, work absenteeism and a higher amount of procedures were related to a diminished HRQoL, the patients who are most often met by professional caregivers are often those whose HRQoL needs to be more adequately addressed.

Motives of cancer patients for using the internet to seek social support

The purpose of the study was to describe why Finnish cancer patients choose the internet as a source of social support. The data were collected in May 2010, using an online questionnaire with open-ended questions, through four discussion forums on the websites of the non-profit Cancer Society of Finland. Seventy-four adult patients with cancer participated. The data were analysed using inductive content analysis. The mean age of the participants was 53 years and they were predominantly women. The most common cancer was breast cancer and more than three quarters of the participants had suffered from cancer for less than 5 years. The initial stimuli to use the internet as a source of social support were the ease of communication and access to information as well as the need for emotional and informational support. The actual motives that drove the use of the internet as a source of social support were the requirements for information and peer support, internet technology, a lack of support outside the internet and the negative experiences caused by the illness. The fact that there is an enormous need for information as well as for emotional support and that cancer treatment in Finland is concentrated in major hospitals, to which cancer patients may travel a considerable distance, suggests that nurses should learn to make more frequent virtual contact with their patients.

Patients' and significant others' health-related quality of life one month after coronary artery bypass grafting predicts later health-related quality of life

OBJECTIVE To describe and compare the health-related quality of life (HRQoL) of patients (N = 367) and significant others (N = 367) and to identify factors associated with HRQoL after coronary artery bypass grafting (CABG). METHODS HRQoL was measured by the 15D in 3 stages: 1, 6, and 12 months after CABG. The focus in this study is on HRQoL at the second (6 months) and third (12 months) stages of the recovery process. Stepwise linear regression analysis was used to identify the associations of independent variables with HRQoL. RESULTS Patients had a lower HRQoL than significant others in both stages after CABG. The HRQoL of patients and significant others was explained by their HRQoL 1 month after the operation. Other significant explanatory factors among patients were cardiac symptoms on physical exertion and other additional diseases. Among significant others, chronic diseases were associated with HRQoL. CONCLUSION The HRQoL of patients and significant others differed from each other at both 6 and 12 months after CABG. Previous HRQoL affects later HRQoL in both patients and significant others.

The quality of life and social support in significant others of patients with breast cancer--a longitudinal study.

The purpose of this study was to evaluate prospectively the quality of life (QOL) and received social support from the network and nurses in significant others of breast cancer patients and identify factors predicting negative changes in their QOL within 6 months. The quasi-random longitudinal study conducted for the breast cancer patients and their significant others. Patients were quasi-randomised to supportive intervention group (via telephone at baseline and face-to-face at follow-up) and control group. This paper reports results of significant others (N = 165). The QOL data were collected using the Quality of Life Index - Cancer Version (QLI-CV). Support from network in aid increased the risk of negative changes in health and functioning. Retired significant others had a greater risk of more negative changes in their global and in socio-economic QOL than other. Relatives had a smaller risk to negative changes both in their global and in their family QOL than spouses/partners/boyfriends of patients with breast cancer. QOL of the significant others should be supported more intensively and enhanced by the use of individually tailored methods on the basis of significant others and their family needs.

Perceived family health in persons with prostate cancer and their family members

AIMS AND OBJECTIVES To describe perceived family health in persons with prostate cancer and their family members. An additional purpose was to describe the associations between the background variables of persons with prostate cancer and their family members and perceived family health. BACKGROUND Prostate cancer in one family member affects the health of the whole family. It is important to study perceived family health in families of persons with prostate cancer and associated factors. DESIGN A cross-sectional study. METHOD Data were collected using the Family Functioning, Health and Social Support (FAFHES) scale, modified for use in this study. Questionnaires were distributed to 100 persons with prostate cancer treated with surgery or radiation therapy and 100 family members at one Finnish university hospital in April-October 2009. Responses were received from 76 persons and 71 family members, a response rate of 74%. RESULTS Persons with prostate cancer and family members rated family health good despite prostate cancer. Family members reported higher levels of illness-related ill-being than persons with prostate cancer. Family health was associated with the persons age, basic education, employment status, number of family members visits to the hospitalised patient, first symptom of prostate cancer and previous hospitalisations were associated with. Family health was associated with the family members basic and vocational education. CONCLUSIONS The results show that nursing care should pay attention to family members of persons with prostate cancer and that support to them should be a natural part of a good care of persons with prostate cancer. RELEVANCE TO CLINICAL PRACTICE The quality of prostate cancer care should be improved to provide more individualised and family-focussed services.

Women’s Perceptions of Caesarean Birth A Roy International Study

The purpose of this Roy adaptation model-based multi-site international mixed method study was to examine the relations of type of caesarean birth (unplanned/planned), number of caesarean births (primary/repeat), and preparation for caesarean birth to women’s perceptions of and responses to caesarean birth. The sample included 488 women from the United States (n = 253), Finland (n = 213), and Australia (n = 22). Path analysis revealed direct effects for type of and preparation for caesarean birth on responses to caesarean birth, and an indirect effect for preparation on responses to caesarean birth through perception of birth the experience.

Online social support received by patients with cancer.

Patient education in the public healthcare system does not necessarily meet the needs of patients with cancer. Because of this, they may turn to the Internet, or they are guided to electronic sources of social support. The purposes of this study were to describe what kind of social support patients with cancer receive from the Internet and its meaning for them. The data were collected using an online survey that consisted of open-ended questions based on a theory of online social support. The data were analyzed using an inductive content analysis. Online social support consisted of three categories: disease-related information from reliable sources, supportive interaction enhancing positive emotions, and practical tips for daily life with cancer. Three major categories related to the meaning of online social support were identified: peers helping make life easier, empowerment, and inadequate support. The findings can be utilized in tailoring educational interventions for patients with cancer. In the future, the long-lasting effects of online social support need to be examined.

Enhancing nurses' participation in implementing evidence-based practice.

The article gives an overview of a multidimensional project to enhance nurses’ participation in implementing evidence-based practice (EBP) in one university hospital in Finland. The project provided an opportunity for many nurses to be an active part of the EBP process. Moreover, it provided an interesting opportunity to increase all nurses’ awareness of EBP.

The Effects of the Primary Nursing Care Model: A Systematic Review

Background: Nursing care models provide the infrastructure for organizing and delivering care to patients and families. Over the decades, different models have waxed and waned. Since the 1980s, the primary nursing model has gained increasing prominence. However, there is no systematic research evidence on the effects of this model for patients, their family members, nursing staff or the care organization. This subject has much current relevance because of the requirement to develop evidence-based nursing care. Objective: To describe the effects of the primary nursing model for patients, their family members, nursing staff and the care organization. Design: A systematic literature review. The studies selected for review (n=9) were appraised for quality using the Quality Assessment Tool for Quantitative Studies, as developed by the Effective Public Health Practice Project. Data sources: The research data were collected from four databases from January 1990 to March 2013. Results: Research on the effects of the primary nursing model has largely been restricted to the effects for patients and nursing staff. No data are available on how it affects the patient’s family members or the care organization. The preliminary evidence suggests that the primary nursing model may have beneficial effects for patients in the context of maternity care. There is less evidence of the primary nursing model’s positive effects for nursing staff. However, it is possible that the model contributes to an increased sense of job control and autonomy. Conclusion: The existing body of research has methodological shortcomings, and more RCT studies are needed to establish the effects of the primary nursing model, for instance on the organization’s costs, nurses’ job satisfaction and staff retention. Further research is also needed into the effects of the primary nursing model on numerically measurable outcomes, such as medication errors during hospital care and the length of treatment periods.

Self-rated health, symptoms and health behaviour of upper secondary vocational students by field of study

This article examines the self-rated health, symptoms and health behaviour of upper secondary vocational students in Finland. The data consist of the responses of first- and second-year vocational students (n = 34 554) to the 2013 School Health Promotion Survey. The data were analysed statistically and processed separately for girls and boys. Associations between self-rated health, symptoms and health behaviour and fields of study were examined by cross-tabulation. Statistical significance was measured using the chi-squared test. Self-rated health, symptoms and health behaviour were found to have a statistically significant association with field of study (p < 0.001). Vocational students in different fields had different experiences of health, different symptoms and different health behaviours. The results complement existing evidence about disparities in well-being among young people in the context of education.