Anne M. Koponen

Moral Reasoning and Values in Medical School: A longitudinal study in Finland

Changes in moral reasoning, value priorities and self-descriptions were examined in 43 medical students over the first two years of study. At both times, moral reasoning was assessed using a written Kohlberg Moral Judgment Interview, values by the Rokeach Value Survey and self-image by the Ha¨yrynen Inventory. Moral reasoning scores declined significantly while no significant changes were found in any other measures. Schwartzs value model was used to analyse the relationship of moral stages and values. In accordance with previous studies, universalism values correlated positively and self-enhancement values nega tively with moral stage. The instrumental value hierarchy of the students converged by the third year toward the typical medical student value hierarchy. The results are discussed in terms of the disillusionment hypothesis and alternative interpretations of the Kohlberg stages.

Social Functioning and Psychological Well‐Being of 347 Young Adults with Epilepsy Only—Population‐Based, Controlled Study from Finland

Summary:  Purpose: To explore social functioning and psychological well‐being in a population‐based cohort of epilepsy patients compared to matched controls.

Organizational Justice in Primary-Care Health Centers and Glycemic Control in Patients With Type 2 Diabetes

Background:Organizational justice has been put forward as a measure of leadership quality that is associated with better health among employees. Objectives:We extended that idea to test whether perceived organizational justice among health care providers might be positively associated with glycemic control among their diabetic patients. Setting:Eighteen primary-care health centers (HCs) in Finland. Participants:Type 2 diabetes patients (n=8954) and HC staff (n=422). Measurements:Mean of 1 year’s measurements of glycated hemoglobin [≥7.0 (the least optimal); 6.5–6.9; 6.0–6.4; and 4.5–5.9 (the most optimal)], health-center psychosocial work characteristics (staff-reported procedural justice and relational justice, effort-reward imbalance, and work-unit team climate), and individual-level and work-unit-level covariates. Results:Perceptions of higher levels of procedural justice among staff were associated with more optimal glycated hemoglobin levels among patients (cumulative odds ratio per 1-U increase in justice=1.54, 95% confidence interval, 1.08–2.18) after adjustment for patient-level and unit-level covariates. Relational justice, effort-reward imbalance, and work-unit team climate were not associated with glycemic control. Conclusion:The quality of leadership at HCs, as indicated by staff perceptions of procedural justice, may play a role in achieving good glycemic control among type 2 diabetes patients.

Determinants of physical activity among patients with type 2 diabetes: the role of perceived autonomy support, autonomous motivation and self-care competence.

Abstract Based on self-determination theory (SDT), this study investigated, whether the three central SDT variables (perceived autonomy support, autonomous motivation and self-care competence), were associated with engagement in physical activity (PA) among patients with type 2 diabetes when the effect of a wide variety of other important life-context factors (perceived health, medication, duration of diabetes, mental health, stress and social support) was controlled for. Patients from five municipalities in Finland with registry-based entitlement to a special reimbursement for medicines used in the treatment of type 2 diabetes (n = 2866, mean age 63 years, 56% men) participated in this mail survey in 2011. Of all measured explanatory factors, autonomous motivation was most strongly associated with engagement in PA. Autonomous motivation mediated the effect of perceived autonomy support on patients’ PA. Thus, perceived autonomy support (from one’s physician) was associated with the patient’s PA through autonomous motivation. This result is in line with SDT. Interventions for improved diabetes care should concentrate on supporting patients’ autonomous motivation for PA. Internalizing the importance of good self-care seems to give sufficient energy to maintain a physically active lifestyle.

Health-care climate, perceived self-care competence, and glycemic control among patients with type 2 diabetes in primary care

This study showed, in line with self-determination theory, that glycemic control among patients with type 2 diabetes (n = 2866) was strongly associated with perceived self-care competence, which in turn was associated with autonomous motivation and autonomy-supportive health-care climate. These associations remained after adjusting for the effect of important life-context factors. Autonomous motivation partially mediated the effect of health-care climate on perceived competence, which fully mediated the effect of autonomous motivation on glycemic control. The results of the study emphasize health-care personnel’s important role in supporting patients’ autonomous motivation and perceived self-care competence.

Job strain and supervisor support in primary care health centres and glycaemic control among patients with type 2 diabetes: a cross-sectional study

Objectives This study investigates associations between healthcare personnels perceived job strain, supervisor support and the outcome of care in terms of glycaemic control among patients with type 2 diabetes. Design A cross-sectional study from 2006. Setting 18 primary care health centres (HCs) from five municipalities in Finland. Participants Aggregated survey data on perceived job strain and supervisor support from healthcare personnel (doctors, n=122, mean age 45.5 years, nurses, n=300, mean age 47.1 years) were combined with registered data (Electronic Medical Records) from 8975 patients (51% men, mean age 67 years) with type 2 diabetes. Outcome measure Poor glycaemic control (glycated haemoglobin (HbA1c) ≥7%). Results The mean HbA1c level among patients with type 2 diabetes was 7.1 (SD 1.2, range 4.5–19.1), and 43% had poor glycaemic control (HbA1c ≥7%). Multilevel logistic regression analyses, adjusted for patients age and sex, and HC and HC service area-level characteristics, showed that patients’ HbA1c-levels were less optimal in high-strain HCs than in low-strain HCs (OR 1.44, 95% CI 1.12 to 1.86). Supervisor support in HCs was not associated with the outcome of care. Conclusions The level of job strain among healthcare personnel may play a role in achieving good glycaemic control among patients with type 2 diabetes.

Socio-emotional development of children with foetal alcohol spectrum disorders in long-term foster family care: a qualitative study

The study investigated the socio-emotional development of children with FASD (n = 34) in long-term foster family care based on foster parents’ descriptions of the child. Children taken into care at birth (n = 7) were compared with children, who had lived the first years of life with their biological parents (n = 27). Children in the second group had faced more traumatic experiences, had more placements and were placed at older age into long-term foster family care. They were reported to have more socio-emotional problems and to be more difficult to foster. In both groups, children had somatic and neuropsychological disabilities caused by prenatal alcohol exposure but in the second group neuropsychological problems, especially concentration and hyperactivity problems, seemed to be more severe. Children who had lived with their biological parents were also reported to have multiple and serious behavioural and attachment problems, and developmental delays at the beginning and during the placement. These problems proved difficult to overcome, even though family care improved the socio-emotional development of all children in the study. In some cases, meetings with biological parents after the placement caused fear and insecurity for the children and increased their behavioural problems. Conclusion: Traumatic experiences in the first years of life during the rapid development of the central nervous system form a major risk for the later development of children with FASD.

Psychosocial work environment and emotional exhaustion--Does a service provision model play a role?

OBJECTIVES To investigate whether outsourcing of primary health care (PHC) services has affected the psychosocial work environment and emotional exhaustion. METHODS Panel mail study 2000-2002 in Finland, 369 PHC employees. Comparison between Southern municipality (SM) after outsourcing PHC services to a not-for-profit organization and three municipalities with municipal service providers. RESULTS Despite the positive development of the psychosocial work environment in SM, emotional exhaustion had increased there like in the comparison municipalities. However, in 2002 emotional exhaustion was at a lower level in SM than in one of the comparison municipalities. This difference could not be attributed to the production model itself but rather to baseline levels and changes in work demands and work resources. CONCLUSIONS Outsourcing of PHC services may improve employee health and thus effectiveness of health care if a new service provider emphasizes employee health more than a previous one and is more flexible to improve the quality of the psychosocial work environment. However, change itself may be stressful, and frequent changes of service providers should be avoided.

Job involvement of primary healthcare employees: Does a service provision model play a role?

Aim: To investigate whether the development of job involvement of primary healthcare (PHC) employees in Southern Municipality (SM), where PHC services were outsourced to an independent non-profit organisation, differed from that in the three comparison municipalities (M1, M2, M3) with municipal service providers. Also, the associations of job involvement with factors describing the psychosocial work environment were investigated. Methods: A panel mail survey 2000—02 in Finland (n=369, response rates 73% and 60%). The data were analysed by descriptive statistics and multivariate linear regression analysis. Results: Despite the favourable development in the psychosocial work environment, job involvement decreased most in SM, which faced the biggest organisational changes. Job involvement decreased also in M3, where the psychosocial work environment deteriorated most. Job involvement in 2002 was best predicted by high baseline level of interactional justice and work control, positive change in interactional justice, and higher age. Also other factors, such as organisational stability, seemed to play a role; after controlling for the effect of the psychosocial work characteristics, job involvement was higher in M3 than in SM. Conclusion: Outsourcing of PHC services may decrease job involvement at least during the first years. A particular service provision model is better than the others only if it is superior in providing a favourable and stable psychosocial work environment.

Quality of primary health care and autonomous motivation for effective diabetes self-management among patients with type 2 diabetes:

This study showed, in line with self-determination theory, that of the six central quality dimensions of primary health care (access to care, continuity of care, diabetes counseling, autonomy support from one’s physician, trust, patient-centered care), autonomy support from one’s physician was most strongly associated with autonomous motivation (self-regulation) for effective diabetes self-management among patients with type 2 diabetes (n = 2866). However, overall support for diabetes care received from friends, family members, other patients with diabetes, and health care professionals may even play a greater role.