Pekka Larivaara

Alexithymia, hypochondriacal beliefs, and psychological distress among frequent attenders in primary health care.

Frequent use of health services has been associated with such concepts as alexithymia, hypochondriasis, and psychological distress. The aim of this case-control study was firstly to assess whether alexithymia, hypochondriasis, and psychological distress are associated with frequent attendance and secondly to assess the gender differences of these associations in a primary health care setting. A sample of 304 frequent attenders (eight or more visits during 1 year), including all of the frequent attenders during 1994, and 304 randomly selected age- and sex-matched controls were selected. Half of the sample (every second individual selected in date-of-birth order) was invited for an interview, 113 frequent attenders and 107 controls completed a questionnaire during the interview. Alexithymia was measured with the Toronto Alexithymia Scale-20 (TAS-20), hypochondriasis was screened with the Whiteley Index (WI), and Symptom Checklist-36 (SCL-36) was used to determine psychological distress. We found a distinct gender difference in the associations of these characteristics with frequent attending. Significant associations of alexithymia, hypochondriasis, and psychological distress with frequent attending were found among men, but not among women. Alexithymia, hypochondriasis, and psychological distress should be considered when treating frequent attenders, especially males.

Evaluation of a family-oriented continuing medical education course for general practitioners

To explore the long‐term effects of a 2‐year Family Systems Medicine course. Fifteen experienced GPs participated in the training programme.

Patient–nurse–doctor interaction in general practice teleconsultations – a qualitative analysis

We analysed the interaction in doctor–nurse–patient teleconsultations in primary care. A qualitative analysis was performed of 30 primary care teleconsultations in northeastern Finland. The male doctor was the same in all consultations. One of the trained nurses appeared in 27 consultations. The analysis followed the methodological principles of the grounded theory approach. The interaction in the doctor–nurse–patient triad was complex. The doctor had to concentrate on many things at the same time and undivided attention to the patient was not always possible. The nurse assumed an active role and was a facilitator of the interaction, an advocate for the patient, a secretary for the doctor and a mediator of the doctors therapeutic influence. The patients frequently turned to the nurse for information. The role of interpersonal dynamics in telemedical encounters is important. Both the doctor and the nurse need to learn new skills to perform teleconsultations jointly.

Use of psychotropic drugs and pregnancy outcome

This study reports the use of psychotropic drugs and pregnancy outcome in a prospective survey carried out in northern Finland in 1985-1986, consisting of 7933 pregnant women and their 8030 births. Of the mothers, 120 (1.5%) used psychotropic drugs during pregnancy and of them 26 (0.3% of the total) used these drugs before and during the pregnancy. According to the logistic regression analysis, the biological and social background variables associating significantly with the use of these drugs were maternal advanced age and multiparity (> 35 years and > 4 parous), overweight (body mass index > the 90th percentile), smoking, alcohol use, belonging to social class IV, and failure to ensure contraception. The users needed hospital observation significantly more often during pregnancy (regular users, 80.8%; occasional users, 38.3; nonusers, 27.4%) and the adjustment of the background variables did not change this result. Of the pregnancy complications bleeding was significantly more common among users than nonusers (23.3 vs. 13.2%) and this difference was not explained by difference in background variables. The mean birth weight of infants of the regular users was significantly lower (255 g) when background variables were standardized by linear regression analysis. No association of increased number of birth defects was found with usage of psychotropic drugs.

Family systems medicine: A new field of medicine

Family systems medicine is a relatively new and interesting field of medicine which developed mainly from the integration of systems theory, family therapy, general practice, and modern clinical medicine. The authors describe its concepts and present a literature review documenting the issues related to the subject. Family systems medicine ideas have been applied in practice and taught to physicians principally in the United States and Canada during the past 10 years. The first 2-year continuing education course in family systems medicine for general practitioners in Finland was started at the University of Oulu in 1989. The authors have collaborated with family therapists and family physicians of the University of Rochester in the USA for improving further Finnish courses.

From biomedical teaching to biopsychosocial education: a process of change in a Finnish medical school

A group of clinicians, teachers and researchers in the University of Oulu have been worried for years about the predominantly biomedical orientation in the local Faculty of Medicine. Therefore, a project group was founded in 1992 to develop the medical degree programme towards a more comprehensive model. This article introduces the main strategies used in the process of change and describes the challenges encountered during the process. There are still many problems in the education of medical students towards a patient and family orientation and in the effort to change the whole medical culture of the university from a biomedical to a biopsychosocial approach. However, in the postgraduate education of general practitioners, we no longer prefer to teach only doctors, but education on the biopsychosocial model will also be arranged to the interdisciplinary teams working in the municipalities in the Province of Oulu in Finland.A group of clinicians, teachers and researchers in the University of Oulu have been worried for years about the predominantly biomedical orientation in the local Faculty of Medicine. Therefore, a project group was founded in 1992 to develop the medical degree programme towards a more comprehensive model. This article introduces the main strategies used in the process of change and describes the challenges encountered during the process. There are still many problems in the education of medical students towards a patient and family orientation and in the effort to change the whole medical culture of the university from a biomedical to a biopsychosocial approach. However, in the postgraduate education of general practitioners, we no longer prefer to teach only doctors, but education on the biopsychosocial model will also be arranged to the interdisciplinary teams working in the municipalities in the Province of Oulu in Finland.

Nurses learning family-oriented interprofessional collaboration

Objectives. A two-year family-oriented interprofessional education programme for professionals working in the field of primary services (e.g. health care, social welfare, school, day care) was started in the Province of Oulu, Finland in 2000. The programme aimed to provide the participants (n=76) with skills to work with families in interprofessional collaboration. The study investigated the views and working methods of all the 14 nurses who participated in the course. Study design. Qualitative study employing the content analysis method. Methods. The data were collected by using open-ended questions at the beginning and at the end of the education and analysed with the method of content analysis. Results. Initially, the nurses were aware of the significance and the premises of family-oriented interprofessional collaboration, but seldom implemented them in practice. At the end of the programme, their working methods had changed from expert-to client-and family-oriented direction. They began to appreciate interprofessional collaboration and found that client-and familyoriented working methods supported families’ own resources. Conclusions. In order to change the theoretical framework and practical working methods of the professionals a sufficiently long process of education is needed where the interprofessional collaboration is put into practice already during the education. Even though this education programme was developed and implemented for professionals working in the primary social and health care services in the Northern Finland, we believe that it is applicable to the teaching of interprofessional collaboration in different settings in different countries. (Int J Circumpolar Health 2006:65(3):206–218.)