Nina Santavirta

Neuropeptides of the autonomic nervous system in Sjögren’s syndrome

OBJECTIVE To assess the activity level of the autonomic nervous system in Sjögren’s syndrome (SS) and to correlate this with stress. METHODS Patients with SS (n=12) and healthy controls (n=10) were analysed for the content of vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) in their stimulated saliva by radioimmunoassays and for stress by the use of a modified Jenkins Activity Survey (JAS). RESULTS The data are expressed as median (interquartile range). Salivary VIP output (pg/min) and NPY output (pg/min) were high in SS compared with healthy controls (30.0 (15.6, 36.6) versus 12.3 (9.2, 24.0), p=0.045, 4.8 (0.6, 24.1) versus 0.7 (0.0, 2.4), p=0.038, respectively). Patients experienced only a little, but not significantly, more stress than the healthy controls (stress index −2.8 (−7.7, 6.9) versus −5.2 (−12.9, 2.7), p>0.05). Stress in general was associated with high salivary VIP concentrations (r=0.41, p=0.05). CONCLUSIONS These findings show that adequately processed saliva (containing aprotinin and EDTA as neuropeptidase inhibitors) contains measurable amounts of marker peptides of the autonomic nervous system. Secondly, VIP concentration but not output may be affected by stress, which may act by decreasing watery salivary flow. In patients with SS, VIP and NPY outputs are increased. This may indicate increased leakage into saliva or efforts to compensate for the diminished salivary flow, or both.

Teaching of patients undergoing total hip replacement surgery

We studied the effect of patient teaching in 60 patients who underwent primary total hip replacement surgery. All the patients received an illustrated patient guide. In addition to the general patient teaching given by doctors, nurses and physiotherapists, a randomly chosen group of 27 patients received a session of intensified patient teaching. At the follow-up, 2-3 months postoperatively, 61% of patients thought that they had received the main part of their information from the physiotherapists, 9% from their doctors and 4% from the nursing staff. The importance of a well-illustrated guide was pointed out. The knowledge of potential complications, such as infection, remained poor; 37% could not name one single relevant complication. At the follow-up, the younger or better educated patients did not score any better. The experimental group who had received intensified teaching differed only slightly from the controls, but they knew significantly better when to inform their doctor of potential complications. Also, the experimental group showed greater interest in obtaining more information about their replaced hip. Patients in the experimental group showed significantly better adherence to the instructions for the postoperative rehabilitation programme.

Musculoskeletal pain and functional ability in haemophilia A and B. Physiotherapy and rehabilitation in haemophilia patients

Abstract. The present study was carried out to evaluate the progress of physical musculoskeletal ability and pain in Finnish haemophilia A and B patients during a given period of time and to find out the role of rehabilitation and physiotherapy in this process. In the physiotherapy/rehabilitation group, pain index by visual analogue scale (VAS) improved through time by 26%/4.6%. The nontreatment group showed slight aggravation. Regression analysis revealed that age, pain intensity, and functional disability in 1994 were the only significant explanatory factors influencing musculoskeletal functional ability at the end of the study. The current study was not planned as an intervention study and yet the results show some evidence, although not strongly, of the positive effect of physiotherapy and inpatient rehabilitation courses in reducing pain and functional disability for haemophilia patients. One of the important contributions of physiotherapy and rehabilitation is their educational role.

Coping Strategies, Pain, and Disability in Patients With Hemophilia and Related Disorders.

OBJECTIVE To analyze the use of various coping strategies in homogeneous groups of patients with hemophilia and von Willebrands disease and to investigate the relationship between the state of the disease, the use of coping strategies, and management of the disease. METHODS The coping strategies measured by the Coping Strategies Questionnaire were analyzed in 3 homogeneous groups of 224 patients. Psychosocial well-being (PWB) measured by the Rand 36-item Health Survey 1.0 was used as an indicator of management of the disease. The pain factor consisted of the following variables: pain intensity, use of analgesics, Functional Disability Index, and physical activity level. RESULTS The groups of patients differed significantly only in the use of the catastrophizing strategy (CAT). In all pain groups, distraction was the most commonly used coping strategy. A significant interaction effect of pain factor and age on PWB (P = 0.04) was found. The mediating function of the CAT strategy was confirmed by the series of regression analyses. CONCLUSION The coping strategy profile in hemophilia was found to be similar to those in other chronic pain states. The use of the strategies does not depend on the severity of the disease. We confirmed the role of age and the use of the CAT strategy as, respectively, moderator and mediator in the pattern of relationships between the clinical state of the disease and psychosocial well-being.

Construct Validity and Reliability of the Finnish Version of the Demand-Control Questionnaire in Two Samples of 1028 Teachers and 630 Nurses

The job demand-control (JDC) model has dominated research into occupational stress for the last 20 years. Two concepts lie at the core of the demand-control model: job demands and job control. Control is also referred to as decision latitude and the concept has two facets: decision authority and skill discretion. The purpose of the current study was to conduct an empirically correct specification of the key concepts of the JDC model. The Scandinavian version of an instrument assessing the key concepts of the model was used and the objective of the study was to test the validity and reliability of the Finnish version of the job content questionnaire (JCQ) among teachers and nurses. Altogether 1028 teachers and 630 nurses participated. Exploratory factor and confirmatory analyses were employed to assess the factorial structure of the Finnish version of the JCQ and to evaluate which factorial model fitted the data best. Analyses indicated a factor solution with two factors: job demands and decision authority. The confirmatory factor analyses supported the results from the exploratory factor analyses. The model which fitted the data best was the model with two oblique factors with the items measuring skill discretion removed. Based on the results of exploratory and confirmatory factor analyses it seems reasonable to measure job demands and control in this sample with two factors: demand and decision authority.

Long term mental health outcomes of Finnish children evacuated to Swedish families during the second world war and their non-evacuated siblings: cohort study

Objectives To compare the risks of admission to hospital for any type of psychiatric disorder and for four specific psychiatric disorders among adults who as children were evacuated to Swedish foster families during the second world war and their non-evacuated siblings, and to evaluate whether these risks differ between the sexes. Design Cohort study. Setting National child evacuation scheme in Finland during the second world war. Participants Children born in Finland between 1933 and 1944 who were later included in a 10% sample of the 1950 Finnish census ascertained in 1997 (n=45 463; women: n=22 021; men: n=23 442). Evacuees in the sample were identified from war time government records. Main outcome measure Adults admitted to hospital for psychiatric disorders recorded between 1971 and 2011 in the Finnish hospital discharge register. Methods We used Cox proportional hazards models to estimate the association between evacuation to temporary foster care in Sweden during the second world war and admission to hospital for a psychiatric disorder between ages 38 and 78 years. Fixed effects methods were employed to control for all unobserved social and genetic characteristics shared among siblings. Results Among men and women combined, the risk of admission to hospital for a psychiatric disorder did not differ between Finnish adults evacuated to Swedish foster families and their non-evacuated siblings (hazard ratio 0.89, 95% confidence interval 0.64 to 1.26). Evidence suggested a lower risk of admission for any mental disorder (0.67, 0.44 to 1.03) among evacuated men, whereas for women there was no association between evacuation and the overall risk of admission for a psychiatric disorder (1.21, 0.80 to 1.83). When admissions for individual psychiatric disorders were analyzed, evacuated girls were significantly more likely than their non-evacuated sisters to be admitted to hospital for a mood disorder as an adult (2.19, 1.10 to 4.33). Conclusions The Finnish evacuation policy was not associated with an increased overall risk of admission to hospital for a psychiatric disorder in adulthood among former evacuees. In fact, evacuation was associated with a marginally reduced risk of admission for any psychiatric disorder among men. Among women who had been evacuated, however, the risk of being admitted to hospital for a mood disorder was increased.

CHILD PROTECTION AND ADULT DEPRESSION: EVALUATING THE LONG-TERM CONSEQUENCES OF EVACUATING CHILDREN TO FOSTER CARE DURING WORLD WAR II

This paper combined data collected from war time government records with survey data including background characteristics, such as factors that affected eligibility, to examine the adult depression outcomes of individuals who were evacuated from Finland to temporary foster care in Sweden during World War II. Using war time government records and survey data for a random sample of 723 exposed individuals and 1321 matched unexposed individuals, the authors conducted least squares adjusted means comparison to examine the association between evacuation and adult depression (Beck Depression Inventory). The random sample was representative for the whole population of evacuees who returned to their biological families after World War II. The authors found no statistically significant difference in depressive symptoms during late adulthood between the two groups; for example, the exposed group had a 0.41 percentage points lower average Beck Depression Inventory score than the unexposed group (p = 0.907). This study provides no support for family disruption during early childhood because of the onset of sudden shocks elevating depressive symptoms during late adulthood.

Parents and children as agents of disease management in JIA

*Department of Rheumatology, Rheumatism Foundation Hospital, Heinola †Department of Pediatric Rheumatology, Hospital for Children and Adolescents, Helsinki University Central Hospital ‡Department of Pediatric Rheumatology, Hospital for Children and Adolescents §Department of Education, Helsinki University ¶Department of Medicine/invärtes medicin, Helsinki University Central Hospital **ORTON Orthopaedic Hospital of the Invalid Foundation, Helsinki, and ††COXA, the Joint Replacement Hospital, Tampere, Finlandcch_981 578..585

Developing an instrument to evaluate suffering related to care.

The ultimate purpose of caring is to alleviate suffering. Interest in the question of suffering has increased in a marked way in the fields of nursing and caring science during the last decade. The aim of the pilot-study was to test the validity and reliability of a newly construed instrument to assess suffering related to care in a sample of 130 nurses. The ultimate aim is to develop a scale which could be used for the continuous evaluation of quality of care. A study comprised of a group of nurses including head nurses, nursing supervisors, and Registered Nurses (n = 130) employed at a central university hospital in Finland. The nurses answered a questionnaire which consisted of a newly construed instrument, such instrument could be used for discovering suffering related to care and thus contribute to good quality of care. The development of the instrument was based on the theoretical perspective of suffering related to care. Principal component analysis was used to test the validity and the internal consistency to test the reliability of the instrument. The analysis provided a four-factor solution, which demonstrated a reasonable level of consistency and reliability. Conclusion indicated that the instrument consisted of four dimensions which reflect and are in correspondence with the theoretical framework. The next step is to cross-validate and refine the instrument by carrying out a confirmatory factor analysis. The development of a robust instrument will contribute towards new thinking in the field of nursing care.

Association of the World War II Finnish Evacuation of Children With Psychiatric Hospitalization in the Next Generation

Importance Although there is evidence that adverse childhood experiences are associated with worse mental health in adulthood, scarce evidence is available regarding an emerging concern that the next generation might also be affected. Objective To compare the risk of psychiatric hospitalization in cousins whose parents were vs were not exposed to the Finnish evacuation policy that involved a mean 2-year stay with a Swedish foster family. Design, Setting, and Participants This multigenerational, population-based cohort study of Finnish individuals and their siblings born between January 1, 1933, and December 31, 1944, analyzed the association of evacuee status as a child during World War II in the first generation with the risk of psychiatric hospitalization among offspring in the second generation. Evacuee status during World War II was determined using the Finnish National Archive’s registry of participants in the Finnish evacuation. Data on evacuee status were linked to the psychiatric diagnoses in the Finnish Hospital Discharge Register from January 1, 1971, through December 31, 2012, for offspring (n = 93 391) born between January 1, 1950, and December 31, 2010. Sex-specific Cox proportional hazards regression models were used to estimate hazard ratios for risk of psychiatric hospitalization during the follow-up period. Because offspring of evacuees and their nonevacuated siblings are cousins, the Cox proportional hazards regression models included fixed effects to adjust for confounding factors in families. Data analysis was performed from June 15, 2016, to August 26, 2017. Exposures Parental participation in the evacuation during World War II (coded 1 for parents who were evacuated and placed in foster care and 0 for those not evacuated). Main Outcomes and Measures Offspring’s initial admission to the hospital for a psychiatric disorder, obtained from the Finnish Hospital Discharge Register from January 1, 1971, through December 31, 2012. Results Of the 93 391 study persons, 45 955 (49.2%) were women and 47 436 (50.8) were men; mean (SD) age in 2012 among survivors was 45.4 (6.58) years. Female offspring of mothers evacuated to Sweden during childhood had an elevated risk of psychiatric hospitalization (hazard ratio for any type of psychiatric disorder: 2.04 [95% CI, 1.04-4.01]; hazard ratio for mood disorder: 4.68 [95% CI, 1.92-11.42]). There was no excess risk of being hospitalized for a psychiatric disorder among women whose fathers were exposed to the Finnish evacuation policy during World War II or among men whose mothers or fathers were exposed. Conclusions and Relevance In a prior follow-up study of the Finnish evacuees, girls evacuated to Swedish foster families during World War II were more likely to be hospitalized for a psychiatric disorder—in particular, a mood disorder—in adulthood than their nonevacuated sisters. The present study found that the offspring of these individuals were also at risk for mental health problems that required hospitalization and suggests that early-life adversities, including war-related exposures, may be associated with mental health disorders that persist across generations.