Pertti Kekki

Performance of two measures of general health-related quality of life, the EQ-5D and the RAND-36 among critically ill patients

Objective To compare two health-related quality of life measures, the preference-based EQ-5D with five questions and the profile-based RAND-36 with 36 questions, in previous critically ill patients.Design Prospective observational study.Setting A ten-bed medical-surgical intensive care unit (ICU) in a tertiary care university hospital.Patients Of the 2,709 critically ill patients, treated during the years 1995–2000, the 1,099 patients of the 1,443 still alive who returned both mailed measures were included in the study.Interventions None.Measurements and main results The EQ-5D and the RAND-36 correlated well (P <.001). Ceiling effect was more obvious with the EQ-5D; the values of the RAND-36 varied usually from 0 to 100 in all the three levels of the corresponding EQ-5D question, and the weakest statistically significant differences were between the EQ levels 2 and 3. In particular, the RAND-36 proved to differentiate better the levels of mobility, self-care, and poor outcome.Conclusions The EQ-5D and the RAND-36 correlated well, but when more precisely stated information is needed, especially regarding mobility, self-care, or low quality of life levels of previous critically ill patients, the profile-based RAND-36 may discriminate better.

A multilevel analysis examining the association between school-based smoking policies, prevention programs and youth smoking behavior: evaluating a provincial tobacco control strategy

This paper examined how smoking policies and programs are associated with smoking behavior among Grade 10 students (n = 4709) between 1999 and 2001. Data from the Tobacco Module from the School Health Action Planning and Evaluation System were examined using multilevel logistic regression analyses. We identified that (i) attending a school with smoking prevention programs only was associated with a substantial risk of occasional smoking among students with two or more close smoking friends and (ii) attending a school with both smoking prevention programs and policies was associated with substantial risk of occasional smoking among students who did not believe there were clear smoking rules present. Students attending schools where year of enrollment in high school starts in Grade 9 were more likely to be regular and occasional smokers. Each 1% increase in Grade 12 smoking rates increased the odds that a Grade 10 student was an occasional smoker. It appears that grade of enrollment, senior student smoking behavior, close friends smoking behavior and clear rules about smoking at school can impact school-based tobacco control programming. These preliminary study findings suggest the need for further research targeting occasional smoking behavior and the transition stage into high school.

The cervical spine in juvenile chronic arthritis

BACKGROUND CONTEXT In patients with juvenile chronic arthritis (JCA) the cervical spine is often affected, leading to pain and functional limitations. PURPOSE To describe the frequency of the radiographic abnormalities in the cervical spine of a large series of patients with JCA, examined after skeletal maturity. STUDY DESIGN Consecutive patients with JCA, who had cervical spine radiographs available taken at adult age (>18 years) were included in the study from one outpatient clinic and one rheumatology ward in the Rheumatism Foundation Hospital, Heinola, Finland. PATIENT SAMPLE The series consisted of 159 patients fulfilling the diagnostic criteria of the European League Against Rheumatism for JCA. OUTCOME MEASURES Evaluation of cervical spine radiographs for inflammatory changes. METHODS Inflammatory changes in the cervical spine radiographs were measured as well as the size of the fourth cervical vertebra. Patient records were studied. The statistical analysis was calculated by Students t-test or Mann-Whitney U test. RESULTS In 98 cases (62%) some inflammatory changes were detected in the cervical spine. Apophyseal joint ankylosis was noted in 65 patients (41%), anterior atlantoaxial subluxation in 27 (17 %) and atlantoaxial impaction in 39 (25 %). The fourth cervical vertebra was abnormally small in 41 patients (26%). CONCLUSIONS Radiographically, the most frequent inflammatory change in the cervical spine of patients with JCA was apophyseal joint ankylosis at multiple levels. Atlantoaxial impaction and anterior atlantoaxial subluxation were typical of the upper cervical spine. Clinically, these changes tend to limit neck movements. A small C4 vertebral body was seen in patients with early disease onset and short body stature.

Culturally diverse nursing students in Finland: some experiences.

Abstract Around the world, student populations are internationalizing and diversifying. The purpose of this study was to research culturally and linguistically diverse nursing students’ experiences in Finland. The data were collected from 27 students in four polytechnics through focus group interviews. The findings highlight the importance of concreteness in theoretical instruction. In clinical settings, language barriers and negative attitudes towards students and their cultural background lead to social and professional isolation. The findings suggest that development of culturally sensitive pedagogy requires further investigation with strong research designs. Intensified language instruction for those who need it is essential. Strategies that increase cultural competence and promote appreciation of cultural diversity in health care settings should be developed.

Promoting clinical research in general practice.

CONTEXT Research is a critical component to the continued growth and development of the quality of primary care. The common rules and values concerning research apply to general practice in the same way as to other specialties. Research should be an integral part. OBJECTIVES To identify and discuss the elements and requirements needed in the promotion of research in general practice. DISCUSSION At the university level, undergraduate education is a start, but a university department of general practice must have responsibilities in postgraduate education. Academic departments of general practice must be adequately resourced to be able to conduct credible research and to organize training in research and research methods. They should provide advisory services and guidance to support the activities of motivated GP researchers in the field and also help them to get into contact with other research-minded clinicians. If GPs want to develop their knowledge and skills in research, they must be willing to pay for them in terms of time and effort, which are away from something else. In return, the service organizations and governments benefiting from these increased skills must be willing to create a system which recognizes the value of the activities and aspirations of these general practitioners by creating new career structures and bonus mechanisms. These incentives and value systems must be accepted by the profession. CONCLUSIONS High quality applied clinical research can successfully be done in primary care. It needs a supportive climate, motivated researchers and adequate funding.

Unnecessary Visits to Health Centres as Perceived by the Staff

The aim of this study was to assess the present situation concerning unnecessary visits to health centres as perceived by the primary health care staff. Associations of this perception with the internal work motivators were analysed. Data consisted of the personnel of four health centres located in various parts of Finland. A pretested questionnaire was employed with a response rate of 87%. The number of responders was 644, comprising 24 administrative staff, 146 general practitioners, 383 nursing staff, and 91 office staff. An estimate of the number of unnecessary visits (%) was obtained using a scale from 0 to 50%. Estimates less than 20% were regarded in the analyses as acceptable by the authors. The methods of analysis included cross tabulations and logistic regression. The theoretical framework for this research was a modification of the work motivation model by Hackman and Oldham. 41% of responders felt that at least 20% of patient visits could be characterized as unnecessary (49% of doctors, 37% of nursing staff). The health centres also differed from each other. The longer the doctors had worked in their present health centre, the less they regarded the visits as unnecessary. Among those doctors who had worked in the health centre less than four years, 63% indicated that 20% or more of all visits to doctors were unnecessary. There was no similar trend with nurses. With the doctors, the most important risk factors among the internal motivators for perceiving the proportions of unnecessary visits high were the lack of work significance and lack of task identity whereas with the nursing staff the important risk factors appeared to be the perceived lack of skill variety of the work and lack of task identity. The study suggests the need for specific postgraduate training for doctors who intend to work permanently in primary health care.

Health status, symptoms and health counselling among middle-aged men: comparison of men at low and high risk.

AIM To assess the levels of health indicators, health behaviour and health counselling among men at low and high risk for adverse health outcomes. METHODS A total of 273 middle-aged men, 145 at low and 128 at high risk for adverse health outcomes, were studied. Two- and three-way tables with chi-squared tests were performed to identify differences between the groups. A step-wise logistic regression model was used to analyse symptoms and complaints associated with the likelihood of perceived health. RESULTS One-half of the low-risk men were overweight, of whom 8% were obese. Forty per cent of the low-risk men smoked cigarettes and one-fifth used alcohol excessively. Headache, chest and back pain, stress, and insomnia occurred frequently (range: 20-38%) and were highly correlated with depression. Joint pain (p = 0.012) in the low-risk men and sciatica (p = 0.047) in the high-risk men were the only statistically significant differences related to normal weight vs. overweight status. There was a greater than sixfold odds of average/poor health among low-risk men who were depressed than in those who were not depressed men. Only a small percentage of the low-risk men had received counselling from professionals for different health issues, including weight control and smoking cessation; the corresponding percentages were somewhat higher when given by family members. CONCLUSIONS A real need for better counselling was found among middle-aged men identified with obesity and risky behaviours. Public health nurses and other health workers should be aware of the differences between men at low and high risk. Men had different health experiences and lifestyles in these groups. More research is needed to determine the most efficient counselling strategies among men.

Health Centre Efficiency: First Results of an Organizational Analysis of Four Finnish Health Centres

First results are given on the opinions and perceptions of the health centre personnel (including administrative staff, doctors, nursing and office personnel) concerning their work at four health centres, which represent different types of organization with respect to urbanrural axis, geographical location, and size of base population. Data were collected using a pretested questionnaire. The number of completed forms was 710, of which 702 were included in the final analysis. The response rate was 95%. The results indicated that doctors and administrative staff considered their work mentally more stressful than the other groups. According to the doctors, important adverse factors in their work were 1) the forced pace of work and 2) the perceived haste and tight schedule. The findings also suggest that, at least in those health centres studied, communication between various professional groups was insufficient. Likewise, the transfer of information between the various functional units was problematic. These findings may indicate difficulties in the planning, organization, and coordination of the work. Therefore the attention should be focused especially on the management of health centre organizations.

Health behaviour and health beliefs among Finnish middle-aged men

Background This study was part of a major project studying the metabolic syndrome in Finnish men. The final sample composed of 273 (39%) men who voluntarily completed the Health Behaviour Questionnaire. Aims To identify key determinants of health behaviour and health beliefs in middle-aged men, and to analyse how they are associated with underlying health covariates. Methods A stepwise logistic regression model was used to estimate the adjusted odds of the outcome by socio-demographic, health-behaviour, health-belief and clinical factors. Findings Five models were developed: (1) use of medications, (2) alcohol consumption, (3) self-rated health status, (4) burnout, and (5) motivation to change unhealthy behaviours. Existing illness or injury and occupation had the strongest associations with medication use, in which industrial workers were more likely to use medications than office personnel. A positive association was found between alcohol counselling by family members and less use of alcohol. Lack of illness or injury, good dental health, and normal waist circumference had the strongest associations with perceived good health. Depression and insomnia were the most significant predictors for burnout. Men who exercised 4–7 times a week, or who used alcohol infrequently or not at all, were over two times more likely to be motivated than inactive men. Conclusions Many relevant predictors that were significantly associated with the selected key determinants of health behaviour and health beliefs of middle-aged men were found in this study. The promotion of regular physical activity and healthy lifestyles among middle-aged men is currently one of the most important priorities of preventive work in primary health care. More gender-specific studies are needed to obtain a deeper understanding regarding men’s health issues.

Has brief counselling an impact on the risk factors for cardiovascular disease in 40-year-old men. A three-year follow-up study

The metabolic syndrome presents a serious challenge to health professionals. The aim of the present study is to analyze the impact of a brief counselling on cardiovascular risk factors among 40-year-old men. Forty-six males living in north-eastern Helsinki voluntarily completed the follow-up study between 2001 and 2004, and were assessed for clinical risk factors. The mean differences were determined by a paired t-test, and the interaction between groups and time by the F-test with repeated measures ANOVA. After baseline assessment and in 2002, males received a 45 minute nurse-delivered counselling session with self-administered protocol. Cardiovascular risk factors improved significantly (p<0.05) from baseline within months. However, the final measurements obtained after three years showed that almost all risk factors, except the low and high density lipoprotein, tended to revert back to baseline. The profiles were similar in all predictor groups. Brief counselling had an impact on risk factors measured in 2002, but only a partial effect on them in 2004. Conclusive results lead to the idea thatmore collaboration is needed between private health care agencies and official primary health care for ensuring the continuity of improved health habits among middle-aged males.