Marita Poskiparta

Dietary and physical activity counselling on Type 2 diabetes and impaired glucose tolerance by physicians and nurses in primary healthcare in Finland

Objective. To investigate the initiation of dietary and physical activity counselling and the arguments used when discussing physical activity and the type and consumption of dietary fats, during nurse–patient and physician–patient diabetic lifestyle counselling. Design and subjects. This study is a part of a larger follow-up research project focusing on diabetes counselling. The data include 129 videotaped counselling sessions between 17 patients and their physicians and nurses. Content analysis was carried out by identifying the verbal comments and reactions of participants concerning both physical activity and the type and consumption of dietary fats. Results. The physicians and nurses spent little time on dietary and physical activity counselling. The counselling sessions consisted mainly of short questions with minimal feedback from either party. The beginning of the sessions concentrated on blood cholesterol levels and the extent of physical activity. The health professionals failed to emphasize the roles of reduced dietary fats and increased physical activity in substituting for or supplementing diabetes care. Although the patients communicated the factors that encouraged or discouraged physical activity the subject was generally not pursued by the health professionals. Conclusion. Within primary care there is a need for methods that would facilitate the discussion of health behaviour changes. In healthcare settings, education and training are required to develop the communication skills of health professionals in all aspects of preventive medicine.

Transtheoretical model-based dietary interventions in primary care: a review of the evidence in diabetes

The objective of this study was to review the evidence concerning stage-based dietary interventions in primary care among persons with diabetes or an elevated diabetes risk. Search strategies were electronic databases and manual search. Selection criteria were randomized controlled studies with stage-based dietary intervention, conducted in primary care with at least 6 months of follow-up, and participants with either type 2 diabetes or with an elevated risk. The researchers evaluated trials for inclusion, extracted data and assessed study quality. Seven articles, based on five data sets, were included. These studies concentrated on cardiovascular diseases and being overweight, not diabetes. The quality of the studies was moderate to weak. Inadequacies in the reporting often involved unspecific information on the training of health care providers. Long-term positive outcomes (compared with controls) were found in total and monounsaturated fat intake, diastolic blood pressure, health status and well-being. The existing data are insufficient for drawing conclusions on the benefits of the transtheoretical model. More high-quality studies focusing on diabetes are needed, with greater attention to the training of providers and process evaluation. There is a need for a standardized appraisal tool for study evaluation, focusing separately on education interventions for patients and providers.

Taciturn Patients in Health Counseling at a Hospital: Passive Recipients or Active Participators?

This study explored patients’ taciturnity as observed on videotape during hospital health counseling situations with a nurse. Health counseling sessions, 38 in number, were videotaped, transcribed verbatim, and analyzed by using an adaptation of conversation analysis. The data analysis included information on 18 selected patients who spoke little and did not introduce new topics, but rather supported the discussion on the theme chosen by the nurse. When we examined nurses’ and patients’ speech word by word, we discovered four participation frames that produced taciturnity: in the hands of professionals, compliant, guilty, and polite. These could fluctuate during interaction. The findings indicate that there is a need for a more extensive description of taciturn, or silent, patients. What has been interpreted as passivity in the literature can be interpreted more constructively. This insight can be useful for developing health counseling practice in hospitals.

Relationship between Fundamental Motor Skills and Physical Activity in 4-Year-Old Preschool Children

This study evaluated the relationships between objectively measured physical activity and fundamental motor skills in 4-year-old children. Physical activity was monitored in 20 girls and 17 boys over 5 consecutive days (3 days at preschool and 2 days at home) and their fundamental motor skills measured. Multiple linear regressions controlled for sex, age, and body mass index indicated that the total skill score was significantly associated with physical activity, explaining 13%, 16%, and 16% of the variance in total, moderate-to-vigorous, and light-to-vigorous physical activity, respectively. Sliding and galloping were significantly associated with moderate-to-vigorous physical activity, and throwing and catching combination was significantly associated with total, moderate-to-vigorous, and light-to-vigorous physical activity. The findings warrant future investigations with larger samples to examine the relationship between locomotor, manipulative skills, and physical activity behaviors.

Perceived need to increase physical activity levels among adults at high risk of type 2 diabetes. A cross-sectional analysis within a community-based diabetes prevention project FIN-D2D

BackgroundIncreased physical activity is a cornerstone of type 2 diabetes prevention. The perception of a need to change is considered essential in behaviour change processes. However, the existing literature on individuals’ perceived need to change health behaviour is limited. In order to improve understanding of diabetes prevention through increased physical activity levels (PAL), we assessed factors associated with perceiving a need to increase PAL among adults at high risk of diabetes.MethodsOpportunistic screening was used within a primary-care based lifestyle intervention covering 10 149 men and women at high risk of type 2 diabetes. Data were obtained at baseline visits. The explored determinants were demographic, anthropometric/clinical, behavioural and psychosocial characteristics, along with four categories of PAL awareness. Logistic regression was used in the analysis.Results74% of men (n = 2 577) and 76% of women (n = 4 551) perceived a need to increase their PAL. The participants most likely to perceive this need were inactive, had a larger waist circumference, rated their PAL as insufficient, and were at the contemplation stage of change. Smoking, elevated blood pressure, dyslipidaemia, and a family history of diabetes were not associated with this perception. The likelihood was also greater among women with less perceived fitness and less education. Demographic factors other than education did not determine participants’ perceived need to increase PAL. PAL overestimators were less likely to perceive the need to increase their PAL than realistic inactive participants.ConclusionsSubjective rather than objective health factors appear to determine the perception of a need to increase PAL among adults at high risk of diabetes. Client perceptions need to be evaluated in health counselling in order to facilitate a change in PAL. Practical descriptions of the associations between metabolic risk factors, PAL, and diabetes are needed in order to make the risk factors concrete for at-risk individuals.

Seasonal and daily variation in physical activity among three-year-old Finnish preschool children

The purposes of this study were to assess seasonal, daily, and gender variations in childrens physical activity (PA). ActiGraph GT3X accelerometers were used to record the three-year-old childrens PA levels for five consecutive days in autumn and winter. Complete data for both seasons were obtained for 47 children. Despite a significant difference in seasonal temperatures (p < .001), differences were only found for weekdays light PA (p = .021). No difference in PA was observed between weekdays and weekend days. Only 20% of the sample had ≥120 minutes light-to-vigorous PA (LMVPA), and 46% of children had ≥60 minutes moderate-to-vigorous PA (MVPA). Boys spent more minutes in LMVPA (p = .001) and MVPA (p = .004) than girls. The current findings indicated that season and day of the week only minimally influence childrens PA levels, whereas gender continues to be a significant factor.

Perceiving Need for Lifestyle Counseling: Findings from Finnish individuals at high risk of type 2 diabetes

OBJECTIVE To investigate the proportion of individuals at high risk of type 2 diabetes who perceive the need for lifestyle counseling, factors associated with this perception, and whether the perceived need is associated with subsequent attendance in lifestyle intervention. RESEARCH DESIGN AND METHODS Baseline and intervention data were obtained from 10,149 participants in a Finnish National Diabetes Prevention Project. RESULTS In total, 36% of men and 52% of women perceived the need for counseling. Most of the risk factors did not increase the perceived need for counseling. Those agreeing to attend supervised lifestyle intervention were more likely to report a perceived need than those who agreed on a self-initiated lifestyle change or those who refused to attend lifestyle intervention. The perceived need was associated with actual attendance in the lifestyle intervention only among women. CONCLUSIONS It will be vital to find additional means to support lifestyle change.

Organisational culture: pursuing a theoretical foundation within the Finnish public oral health‐care context

At the moment, Finnish oral health care is undergoing many changes. Little attention has been paid to issues of organisational culture and communication in Finnish oral health care. Yet the question of culture is of primary importance for changes in an organisation and for planning and reconstructing the rational functioning of an organisation. The purpose of this paper is to examine Finnish public oral health care within a theoretical framework of organisational culture and to identify the various cultural traits that appear to characterise Finnish oral health care. Using a cultural point of view, we develop an orientation for understanding more profoundly and specifically the processes concerning the functioning and change of oral health care.

Directly Observed Physical Activity and Fundamental Motor Skills in Four-Year-Old Children in Day Care.

Physical activity (PA), its location, social interactions and fundamental motor skills (FMS) were investigated in four-year-old Finnish children in day care. Six skills in the stability, locomotor and manipulative domains were assessed in 53 children (24 boys, 29 girls, normal anthropometry) with the APM-Inventory manual for assessing children’s perceptual and FMS and Total Motor Scores (TMS; 0–6 points) calculated. PA intensity, location, group composition and activity type − sitting, squatting, kneeling − were directly observed with a modified version of the Observational System for Recording Physical Activity in Children – Preschool Version (OSRAC – P) during three consecutive days in 14 centres. Altogether, 13,302 PA intervals were analysed. Results: Mean TMS was 2.45 (±1.8) points. Most PA intervals were coded as sedentary. Pearson Chi-squares indicated differences in PA intensities both between indoor and outdoor locations (p < 0.001) and between solitary and non-solitary group composition (p < 0.018). Indoors, more than 70% of intervals were spent being sedentary and 5% in moderate-to-vigorous PA (MVPA). Outdoors, sedentary accounted for 45% and MVPA 19%. When solitary, 57% of intervals were sedentary and 13% MVPA. When non-solitary, 60% of intervals were sedentary and 12% MVPA. Forty-eight per cent of intervals were spent sitting, squatting or kneeling. TMS were not significantly associated with biological factors, PA or social interaction, but outdoor PA tended toward statistical significance (IRR = 1.88, p = 0.070), indicating higher TMS in those who demonstrated more outdoor PA. We concluded that PA in day care may be inadequate to support children’s FMS development.

A comparison of physical activity levels in childcare contexts among Finnish and Dutch three-year-olds

The aim of the current study was to determine Finnish and Dutch three-year-old preschool children’s physical activity (PA) levels and how levels vary across gender, location, time of day and social contexts in both countries. A modified version of the Observational System for Recording Physical Activity in Children-Preschool (OSRAC-P) was used to measure children’s PA levels and contextual variables (e.g. group composition, prompts) of children attending childcare centres in Finland and the Netherlands. In total, 90 Finnish children (46 boys and 44 girls) and 97 Dutch children (46 boys and 51 girls) were observed. Three-level linear regression analyses with cross level interactions were used to assess differences between the countries in the association between the context variables and PA. During the observations, the present sample of children was mostly sedentary in nature. Outdoor location and prompts (both positive and negative) were associated with higher levels of activity in both countries. Non-solitary playing was associated with higher activity levels in the Netherlands, but not in Finland, whereas child-initiated play was positively associated with Finnish but not Dutch children’s PA levels. Finnish children were more active in the morning compared to the afternoon, while in the Dutch children PA was unaffected by time. The present findings indicate that better understanding of the contextual factors and interactions in children’s PA behaviours across the two countries could help in planning childcare interventions to increase the PA levels of preschool children.