Associations of excessive internet use, sleep duration and physical activity with school absences: a cross-sectional, population-based study of adolescents in years 8 and 9.

BACKGROUND: Internet use has increased and sleep and physical activity (PA) have decreased in recent years among adolescents. Besides sleep and PA, another determinant of future health for adolescents is education. Our aim was to evaluate the associations of excessive internet use (EIU), short sleep duration and low PA with both unexcused absences and medical absences during lower secondary school. METHODS: The School Health Promotion study is a national survey of adolescents conducted biennially in Finland. We used data collected in 2019, when EIU was assessed for the first time. Cumulative odds ratio analysis was conducted with unexcused absences and medical absences as outcome variables. Besides EIU, sleep duration and PA, the associations of maternal education and parental relations were assessed. RESULTS: The mean age of the 86 270 participants was 15.3 years. Girls scored higher than boys on EIU. In all, 34.7% of participants slept less than 8 hours per night during the school week, and 34.3% reported low PA (ie, less than 3 days per week with minimum 1 hour of PA per day). EIU, short sleep and low PA were associated with both unexcused absences and medical absences from school. Longer sleep during weekends showed no association with absences, but good parental relations had the strongest protective association with both unexcused and medical absences. CONCLUSIONS: EIU, short sleep duration and low PA were associated with both unexcused and medical absences from school. This has important implications for both the promotion of general health and the support offered to students with alarming school absences.

Association between game metrics in a simulation game and nursing students' surgical nursing knowledge - a quasi-experimental study.

BACKGROUND: Simulation games are effective for acquiring surgical nursing knowledge during education by offering possibilities to learn theoretical knowledge through practical patient scenarios, thus preparing students for demanding surgical nursing care. Game metrics stored in the game system enable assessment of students' behaviour while gameplaying. Combining game metrics with the assessment of a student's surgical nursing knowledge allows versatile information to be obtained about the student's learning outcomes. However, studies on game metrics stored in systems and their relationship with learning outcomes are scarce. METHODS: The aim here was to evaluate the association between game metrics in a simulation game and nursing students' surgical nursing knowledge. Nursing students from three universities of applied sciences in Finland participated in a one-week simulation gameplaying intervention that included five surgical nursing scenarios. Students' surgical nursing knowledge was investigated with a quasi-experimental, one-group, pre- and post-test design using a surgical nursing knowledge test. In total, 280 students filled in the knowledge tests. In addition, cross-sectional game data were collected at a single time point between pre- and post-tests. The data were analysed with descriptive statistics and multivariate analysis methods. RESULTS: Students' surgical nursing knowledge improved with the intervention. The total number of playthroughs was 3562. The mean maximum score was 126.2 (maximum score range 76-195). The mean playing time of all playthroughs by all players was 4.3 minutes (SD = 81.61). A statistically significant association was found between mean score and knowledge test total score (p < 0.0072), but no significant association emerged between mean playing time and knowledge test total score. CONCLUSION: The results indicated that the higher the mean score the better the students' surgical nursing knowledge in the knowledge test. This study did not show that the time spent playing had an impact on students' post-playing knowledge. Our findings support the idea that game metrics can be used in performance evaluation and the results can be used to improve nursing students' readiness for challenging preoperative and postoperative clinical situations.

Development and psychometric testing of an instrument to measure applicants' desire to work in nursing.

Nursing applicants' desire to work in nursing has been identified as an important aspect to consider in nursing student selection, but relevant instruments are missing.To describe the development and psychometric testing of the Desire to Work in Nursing instrument.A mixed-methods design.The development phase included the collection and analysis of two types of data. First, three focus group interviews were organised with volunteer nursing applicants (n = 18) after the entrance exams of three universities of applied sciences (UAS) (in 2016). The interviews were analysed inductively. Second, scoping review data from four electronic databases were collected. Thirteen full-text articles (published between 2008 and 2019) were included in the review and analysed deductively based on the results of the focus group interviews. The items for the instrument were generated by synthesising the results of the focus group interviews and the scoping review. The testing phase included 841 nursing applicants who participated in the entrance exams of four UAS on 31 October 2018. The psychometric properties were analysed by examining internal consistency reliability and construct validity by principal component analysis (PCA).The desire to work in nursing was classified into four categories: nature of the work, career opportunities, suitability for nursing and previous experiences. The internal consistency reliability of the four subscales was satisfactory. The PCA found only one factor with an eigenvalue over one, explaining 76% of the total variance.The instrument can be considered reliable and valid. Although theoretically the instrument contains four categories, a one-factor solution should be considered in the future.Evaluation of applicants' desire to work in nursing may provide a strategy to retain students. Individuals choose the nursing profession for variety of reasons. However, there is very little understanding of why nursing applicants desire to work in nursing. With the current challenges in the adequate staffing in the nursing workforce, it is important to understand any aspects that may be associated with student recruitment and retention. In this study, it was identified that nursing applicants desire to work in nursing because of the nature of the work, career opportunities, being suitable for nursing and of previous experiences. Instrument to measure this desire was developed and tested. The tests revealed that the instrument can be used reliably in this context. It is suggested that the developed instrument could be used as a pre-screening or self-assessment tool before applying to nursing education to provide further insights to applicants about their reasons for applying and an opportunity to reflect on their decision.

Nursing Students' Scenario Performance: Game Metrics in a Simulation Game.

AIM: The purpose of this study was to examine nursing students' scenario performance in a simulation game by utilizing game metrics. BACKGROUND: A significant advantage of simulation games is that they can store large amounts of data. Although game metrics enable the objective evaluation and analysis of performance, their use in the evaluation of students' performance is limited. METHOD: Nursing students ( N = 376) played a simulation game at home for 1 week. The resulting data consisted of game metrics stored in the game: number of playthroughs, mean scores, and mean playing times. RESULTS: The total number of playthroughs was 1,923. Statistically significant differences were found between different scenarios regarding the mean score ( p < .0001). Mean playing time was significantly associated with the mean score ( p < .05). CONCLUSION: Game metrics demonstrate nursing students' scenario performance in clinical reasoning skills in different scenarios in a simulation game.

Action research on promoting hand hygiene practices in an intensive care unit.

AIM: Evaluate the intensive care acquired infections incidence and the change over time in infection practices in one intensive care unit. DESIGN: We used an action research approach with cyclical activities. METHODS: Our study included two cycles with hand hygiene observation based on the WHO's five-moments observation tool, observing hand hygiene practices, analysing the observations, and giving feedback on observations, intensive care acquired infection rates, and alcohol-based hand rub consumption. The Revised Standards for Quality Improvement Reporting Excellence is the basis for this research report describing research aimed at improving patient safety and quality of care. RESULTS: During the study, annual alcohol-based hand rub consumption increased by 6.7 litres per 1000 patient days and observed hand hygiene compliance improved. In the first cycle of the study, there was a decrease in critical care acquired infection rates, but the improvement was not sustainable.

Effects of a lifestyle counselling intervention on adherence to lifestyle changes 7 years after stroke - A quasi-experimental study.

BACKGROUND: Adherence to medication and healthy lifestyle is crucial for preventing secondary strokes and other vascular events. However, there is not enough evidence on the long-term effects of hospital-initiated lifestyle counselling. AIM: To determine the effects of The Risk Factor Targeted Lifestyle Counselling Intervention, which is implemented during acute hospitalisation, on adherence to lifestyle changes 7 years after stroke or TIA. METHODS: Quasi-experimental design with 7-year follow-up period. Baseline data (n = 150) were gathered from a neurology unit in Finland between 2010 and 2011. Patients received either the studied intervention (n = 75) or the prevailing form of counselling at the time (n = 75). Data concerning lifestyle and clinical values were measured at the baseline time point, while adherence to lifestyle changes was assessed 7 years later (2017-2018). Analysis of covariance and multivariate ordinal logistic regression were used to describe the mean differences between the intervention and control groups. RESULTS: Several between-group differences were detected, namely, members of the intervention group reported consuming less alcohol and having lost more weight during hospitalisation relative to the control group. No between-group differences in the prevalence of smokers were found, but the intervention group reported a greater number of daily cigarettes than the control group. Adherence to medication, importance of adherence to a healthy lifestyle, support from family and friends, and support from nurses were all significantly higher in the intervention group than in the control group. CONCLUSIONS: The results suggest that the lifestyle counselling intervention was effective in decreasing alcohol use and weight, as well as increasing factors that are known to support adherence to a healthy lifestyle. RELEVANCE TO CLINICAL PRACTICE: The results indicate that the adherence process already begins during acute phase counselling. To ensure long-lasting lifestyle changes, counselling should be started at the hospital, after which it can be provided by friends and family members.

The Effects of Computer-Based Simulation Game and Virtual Reality Simulation in Nursing Students' Self-evaluated Clinical Reasoning Skills.

Research has shown that nursing students can learn clinical reasoning skills by engaging in simulation games. However, there has been no research regarding the effects of simulation games on clinical reasoning skills when nursing students also engage in virtual reality simulations. Furthermore, by engaging in simulation games, neither game metrics nor their impact on students' self-evaluated clinical reasoning skills has been studied. The purpose of this study was to evaluate the effects of these two kinds of simulation games using a one-group pretest-posttest design. Forty nursing students self-evaluated their clinical reasoning skills in three phases using the Clinical Reasoning Skills scale. Furthermore, the game metrics of the simulation games were analyzed, and the results clearly showed that students' self-evaluated clinical reasoning skills were systematically improved. There was a systematic association between better playing scores and better self-evaluated clinical reasoning skills in playing both kinds of simulation games. Moreover, students engaged more time in the virtual reality simulation than the computer-based simulation game. Overall, the results suggest that the use of a combination of both kinds of simulation games is an effective way for nursing students to learn clinical reasoning skills.

Nursing applicants' reasoning skills and factors related to them: A cross-sectional study.

BACKGROUND: The assessment of reasoning skills is recommended in undergraduate nursing student selection. Reasoning skills are crucial for sound decision-making, improving patient safety and are necessary from the very beginning of studies. Nursing applicants' reasoning skills based on the reasoning process have not been previously measured. OBJECTIVES: To assess undergraduate nursing applicants' reasoning skills and factors related to them. DESIGN: A cross-sectional study. SETTING AND PARTICIPANTS: Undergraduate nursing applicants (n = 1056, response rate 55.4%), who consented to the study and performed a joint electronic entrance examination to six Finnish Universities of Applied Sciences in spring 2019, participated in the study. METHODS: The Reasoning Skills (ReSki) test, based on the steps of the reasoning process, was used, comprising three question sections (collecting information, processing information, and identifying the problem and establishing goals). Background variables were collected through a questionnaire and the Positive System Usability Scale (P-SUS). The data were analysed with descriptive statistics, Pearson correlation coefficients and analysis of covariance with Tukey's test in post-hoc multiple group comparisons. RESULTS: Applicants' total reasoning skills mean scores were above the centre of the range of possible scores (2.72/4.5, SD = 0.80). The applicants scored higher in collecting and processing information than in identifying the problem and establishing goals. Standard deviations demonstrated variance between the applicants' ability. Age, gender, and previous education were statistically significantly related to applicants' reasoning skills. Previous work experience was statistically significantly related to success only in the step of identifying the problem and establishing goals. CONCLUSIONS: Nursing applicants' reasoning skills vary in the student selection phase. Applicants are less able to identify the problem and establish goals than to collect and process information. Vocational education does not necessarily develop adequate reasoning skills and thus prepare students for higher education studies. The results have implications for educational institutions and further research.

Development and psychometric testing of Reasoning Skills test for nursing student selection: An item response theory approach.

AIMS: To develop and psychometrically test the Reasoning Skills (ReSki) test assessing undergraduate nursing applicants' reasoning skills for student selection purposes. DESIGN: A methodological cross-sectional design was applied for the psychometric testing. METHODS: The ReSki test was developed as part of a wider electronic entrance examination. The ReSki test included a case followed by three question sections assessing nursing applicants' reasoning skills according to the reasoning process. Item response theory was used for psychometric testing to assess item discrimination, difficulty and pseudoguessing parameters. The ReSki test was taken by 1056 nursing applicants in six Finnish Universities of Applied Sciences (28 May 2019). RESULTS: In the development process, the expert evaluations indicated acceptable content validity. In the psychometric testing, the test reliability was supported by item variance, the theoretical structure was supported by the correlation coefficients and the applicant mean performance supported an acceptable overall test difficulty. The item response theory indicated variance between the items' difficulty and discrimination ranges. However, most of the wrong items failed at being functional distractors. CONCLUSION: The ReSki test is a new and valid objective assessment of undergraduate nursing applicants' reasoning skills. The item response theory provided item-level information that can be used for further development of the test, especially related to the revisions needed for the distractor items to achieve the desired level of difficulty. IMPACT: What problem did the study address? The assessment of nursing applicants' reasoning skills is suggested, but there is a lack of admission tools. What were the main findings? The results provided support for the reliability and validity of the ReSki test. Item response theory indicated the need for further item-level improvement. Where and on whom will the research have an impact? The results may benefit higher education institutions and researchers when developing a test and/or student selection processes.

A randomized clinical trial of a new perioperative practice model on anxiety and health-related quality of life in arthroplasty patients.

AIMS: To explore the effectiveness of a new perioperative practice model on anxiety and health-related quality of life in patients undergoing total hip arthroplasty and total knee arthroplasty under spinal anaesthesia. DESIGN: A randomized clinical trial. METHODS: Control group participants (N = 222) received standard perioperative care, meaning they were cared for by various nurses during their perioperative process without postoperative visits. Intervention group participants (N = 231) were assigned one named anaesthesia nurse during their entire perioperative process who visited them postoperatively. Both groups responded to two self-reported questionnaires: the generic 15D health-related quality of life instrument and the State-Trait Anxiety Inventory (STAI) measuring anxiety two to three weeks pre-operatively and three months postoperatively. RESULTS: There were no statistically significant differences between the groups at baseline or at follow-up in health-related quality of life or anxiety.

The effect of a new perioperative practice model on length of hospital stay and on the surgical care process in patients undergoing hip and knee arthroplasty under spinal anesthesia: a randomized clinical trial.

BACKGROUND: The shortened length of hospital stays (LOS) requires efficient and patient-participatory perioperative nursing approaches to enable early and safe discharge from hospitals for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The primary aim of this study was to explore the effect comparative to standard perioperative care of a new perioperative practice model (NPPM) on the LOS and the time points of the surgical care process in patients undergoing THA and TKA under spinal anesthesia. The secondary aim was to find out if any subgroups with different response could be found. METHODS: Patients scheduled for elective, primary THA and TKA were assessed for eligibility. A two-group parallel randomized clinical trial was conducted with an intervention group (n = 230) and control group (n = 220), totaling 450 patients. The patients in the intervention group were each designated with one named anesthesia nurse, who took care of the patient during the entire perioperative process and visited the patient postoperatively. The patients in the control group received standard perioperative care from different nurses during their perioperative processes and without postoperative visits. The surgical care process time points for each study patient were gathered from the operating room management software and hospital information system until hospital discharge. RESULTS: We did not find any statistically significant differences between the intervention and control groups regarding to LOS. Only slight differences in the time points of the surgical care process could be detected. The subgroup examination revealed that higher age, type of arthroplasty and ASA score 3-4 all separately caused prolonged LOS. CONCLUSION: We did not find the new perioperative practice model to shorten either length of hospital stays or the surgical care process in patients undergoing THA and TKA. Further studies at the subgroup level (gender, old age, and ASA score 3 and 4) are needed to recognize the patients who might benefit most from the NPPM. TRIAL REGISTRATION: This study was registered in NIH Clinical.Trials.gov under registration number NCT02906033, retrospectively registered September 19, 2016.

Identifying nurse managers' essential information needs in daily unit operation in perioperative settings.

Aim: To identify nurse managers' essential information needs in daily unit operation in perioperative settings. Design: Qualitative and quantitative descriptive design. Methods: The study consisted of (I) generation of an item pool of potential information needs, (II) assessment of the item pool by an expert panel and (III) confirming the essential information needs of nurse managers in daily unit operation with a survey (N = 288). Content validity index values were calculated for the assessments by expert panel and in the survey. Internal consistency of the final item pool was explored with Cronbach's alpha. The data were collected from 2011-2015. Results: During the study process, the number of essential information needs decreased from 92-41. The final item pool consisted of 12 subthemes, and they were categorized into four main themes: patient's care process, surgical procedure, human resources and tangible resources. The findings can be used to create a knowledge map for information system purposes.

Emotional intelligence of nursing applicants and factors related to it: A cross-sectional study.

BACKGROUND: Emotions influence patient care decisions and professional relationships. Emotional intelligence has been proven to predict nursing students' success in clinical practice and academic performance. Scarce amount of studies have assessed the emotional intelligence in the nursing student selection context. OBJECTIVES: To assess the emotional intelligence of applicants to undergraduate (bachelor level) nursing education and the factors related to it. DESIGN: Cross-sectional quantitative study. SETTINGS: The data collection took place in four Universities of Applied Sciences in October 2016. PARTICIPANTS: Participants were nursing applicants (N = 529) who took part in the entrance exams of the four Universities. Overall, 430 applicants (response rate 81%, 75 males) gave permission to access their results for the study's purposes. METHODS: The Rankein Scale measure of emotional intelligence was used. All of the nursing applicants undertook the same electronic entrance exam in supervised computer classrooms. Statistical analysis included the use of two independent samples tests to compare differences in emotional intelligence scores and ANCOVA models to investigate whether background variables explained the observed differences. RESULTS: In this study, nursing applicants' level of emotional intelligence was found to be average (on a scale of below average, average, above average). However, total scores ranged between 102 and 160 (of 160). Approximately 4% of the applicants scored below the minimum score (<130) and therefore failed the emotional intelligence test. A statistically significant difference was found between the pass and fail groups in terms of the total score. Significant differences were also found in the three subscores and in the total score of admitted and not admitted applicants. CONCLUSIONS: Nursing applicants enter their studies with differing EI skills. This finding may have a major impact on how nursing students experience emotions during their studies. More research is needed to establish the use of EI in student selection context.

Climacteric-related symptoms in menopause transition and beyond: a prospective 19-year follow-up study on previously hysterectomized women.

OBJECTIVE: Only a few extended follow-up studies have investigated the natural progress of climacteric-related symptoms. The results have been conflicting. Thus, our aim was to evaluate, through a 19-year longitudinal study, whether these symptoms decrease or disappear as time elapses after menopause. METHODS: Our study was a prospective follow-up survey of 65 hysterectomized peri or postmenopausal women. The women were interviewed at the baseline, and at 6 and 19 years thereafter. Changes in various climacteric-related symptoms were evaluated by repeated-measures analysis of variance with time as the independent variable. The analyses were adjusted for baseline age, body mass index, employment, and use of hormone therapy. Climacteric-related symptoms were evaluated with the Women's Health Questionnaire, of which we included seven symptom domains (vasomotor, sleep, depressive, anxiety/fears, cognitive, sexual, and somatic). RESULTS: Vasomotor symptoms decreased remarkably during the follow-up period. In addition, a statistically significant decrease was found in sleep problems and cognitive difficulties. However, the decrease was minor, and thus probably clinically insignificant. CONCLUSIONS: The only symptom with notable decrease was vasomotor symptoms. The etiology of other symptoms, commonly connected to menopause transition, is probably multifactorial and not substantially dependent on the climacteric.

A study of the relationship between the quality of lifestyle counselling and later adherence to the lifestyle changes based on patients with stroke and TIA.

OBJECTIVE: To identify associations between lifestyle counselling quality and adherence to lifestyle changes during the 12-month period after discharge. SETTING: Neurology unit. SUBJECTS: Stroke and transient ischaemic attack (TIA) patients ( n = 98). DESIGN: Longitudinal explorative study that utilized data initially collected for quasi-experimental study. MAIN MEASURES: The exploratory measures of Counselling Quality were collected at the hospital on the day of discharge between January 2010 and October 2011, and the outcome measures of Adherence to Lifestyle Change and clinical values were collected 3, 6 and 12 months after discharge. RESULTS: There were significant associations between the exploratory and outcome measures over time. Three of the counselling quality parameters, counselling interaction, advantages and resources, were found to be significantly associated with adherence to lifestyle change. In particular, counselling interactiveness was positively associated with physical activity at 3 ( B = 0.31, SD = 0.10, P = 0.004) and 12 ( B = 0.29, SD = 0.13, P = 0.030) months, as was advantages of following the advice at 3 ( B = 0.33, SD = 0.11, P = 0.006) and 12 ( B = 0.34, SD = 0.14, P = 0.021) months. Counselling resources were associated with lower body mass index throughout the entire follow-up period, that is, at 3 ( B = -0.06, SD = 0.02, P = 0.006), 6 ( B = -0.05, SD = 0.02, P = 0.040) and 12 months ( B = -0.05, SD = 0.02, P = 0.022). Furthermore, all aspects of counselling quality were positively related to support from nurses. CONCLUSION: Adherence to lifestyle change is more likely to be attained if lifestyle counselling is interactive, the advantages of following the given advice are perceived as beneficial and the counsellor has sufficient resources.

Lifestyle Counseling Intervention Effects on Counseling Quality in Patients With Stroke and Transient Ischemic Attack.

BACKGROUND: Studies have shown that counseling about risk factor-related lifestyle habits can produce significantly beneficial changes in the lifestyle habits of patients with stroke. However, it is not sufficient only to provide a patient with appropriate information, but the quality of lifestyle counseling is also essential. The aim of the study was to investigate the effects of a lifestyle counseling intervention on lifestyle counseling quality in patients with stroke and transient ischemic attack. METHODS: Posttest control group design was used. Patients with stroke and transient ischemic attack (n = 98), divided into intervention and control groups, completed the Counseling Quality Questionnaire after receiving lifestyle counseling at the hospital (January 2010 to October 2011). Data were analyzed with an analysis of variance. RESULTS: The patients rated lifestyle counseling quality quite high in terms of all sum variables except patient centeredness. Counseling quality except for counseling resources was estimated to be significantly better by the intervention group. CONCLUSIONS: Lifestyle counseling quality at the hospital can be enhanced by a counseling intervention. More attention to factors that promote patient centeredness of counseling is required because patient centeredness has repeatedly been recognized as the weakest aspect of counseling by both patients with stroke and other patient groups.

Sleep During Menopausal Transition: A 6-Year Follow-Up.

Study Objectives: Menopausal transition is associated with increased dissatisfaction with sleep, but the effects on sleep architecture are conflicting. This prospective 6-year follow-up study was designed to evaluate the changes in sleep stages and sleep continuity that occur in women during menopausal transition. Methods: Sixty women (mean age 46.0 years, SD 0.9) participated. All women were premenopausal at baseline, and at the 6-year follow-up, women were in different stages of menopausal transition. Polysomnography was used to study sleep architecture at baseline and follow-up. The effects of aging and menopause (assessed as change in serum follicle-stimulating hormone [S-FSH]) on sleep architecture were evaluated using linear regression models. Results: After controlling for body mass index, vasomotor, and depressive symptoms, aging of 6 years resulted in shorter total sleep time (B -37.4, 95% confidence interval [CI] -71.5 to (-3.3)), lower sleep efficiency (B -6.5, 95%CI -12.7 to (-0.2)), as well as in increased transitions from slow-wave sleep (SWS) to wakefulness (B 1.0, 95%CI 0.1 to 1.9), wake after sleep onset (B 37.7, 95%CI 12.5 to 63.0), awakenings per hour (B 1.8, 95%CI 0.8 to 2.8), and arousal index (B 2.3, 95%CI 0.1 to 4.4). Higher S-FSH concentration in menopausal transition was associated with increased SWS (B 0.09, 95%CI 0.01 to 0.16) after controlling for confounding factors. Conclusions: A significant deterioration in sleep continuity occurs when women age from 46 to 52 years, but change from premenopausal to menopausal state restores some SWS.

Psychometric properties of the Finnish version of the Women's Health Questionnaire.

OBJECTIVE: The Women's Health Questionnaire (WHQ) is a validated and commonly used instrument for measuring climacteric-related symptoms. A revised version was previously developed. However, validation in a Finnish population is lacking. As it is important to use qualified instruments, we performed a validation study of the WHQ in a Finnish population. METHODS: In all, 3,421 women, aged 41 to 54 years, formed the study population. In the original 36-item WHQ, the items were rated on a 1 to 4 scale and on a binary scale (0-1). The scaling of the revised 23-item WHQ was 0 to 100. We evaluated the psychometric properties (internal consistency, correlations between the symptom domains, factor structure, and sampling adequacy) in all three versions. RESULTS: For the 1 to 4 scale and on the revised version of the WHQ, the internal consistency was acceptable (the Cronbach's α coefficients >0.70) for most of the domains. On the binary scale, the majority of the coefficient values were below the acceptable level. The original symptom domains, especially those on the revised version, were recognizable from the factors in the exploratory factor analysis, but there were some limitations. The Kaiser-Meyer-Olkin values were high. CONCLUSIONS: The WHQ is a valid instrument for measuring climacteric-related symptoms in Finnish middle-aged women. The psychometric properties of the revised 23-item WHQ were as good or even better than those of the original 36-item WHQ. Thus, we encourage use of the revised version.

The effects of Risk Factor-Targeted Lifestyle Counselling Intervention on working-age stroke patients' adherence to lifestyle change.

INTRODUCTION: Since a history of stroke or transient ischaemic attack is a major risk factor for a recurrent event, lifestyle counselling during the hospital phase is an essential component of treatment and may increase the probability of lifestyle change. AIMS AND OBJECTIVES: To study the effect of risk factor-targeted lifestyle counselling intervention on working-age stroke patients' adherence to lifestyle changes. DESIGN: A quasi-experimental, nonequivalent control group pretest-post-test design. METHODS: Stroke patients in an acute neurological unit were divided into a control group (n = 75) receiving standard counselling and an experimental group (n = 75) receiving risk factor-targeted counselling. Lifestyle data and clinical outcomes were collected at hospital between January 2010 and October 2011, while data on adherence to lifestyle changes 3, 6, and 12 months after discharge. RESULTS: The baseline lifestyle habits did not differ significantly other than in alcohol behaviour. Both groups increased their intake, but the intervention group to a lesser degree. However, the experimental group significantly lost their weight for the first 3 and 6 months; at 3 months reduction in cigarette consumption and at 6 months significant increases in smoking cessation were also achieved. All improved some of their lifestyle habits. Intervention was associated with support from nurses as well as from family and friends. Adherence scores were higher in the experimental group. CONCLUSION: Some short-term advantages in lifestyle habits due to the intervention were noted. Participants in both groups improved some of their lifestyle habits.

Predictors of sleep disturbance in menopausal transition.

OBJECTIVE: This follow-up study aimed to evaluate risk factors for menopausal sleep disturbances already identifiable before menopause. METHODS: At baseline, all 81 women were premenopausal. At year-five follow-up, 27 of the women were premenopausal, 40 postmenopausal, and 14 postmenopausal and using hormone therapy. We used the Basic Nordic Sleep Questionnaire to study sleep; additional questionnaires evaluated risk factors for sleep impairment. RESULTS: Sleep quality differed only marginally between the groups. The following baseline variables were associated with impaired sleep quality at follow-up: depressive symptoms increased the risk of nocturnal awakenings (OR 1.16 (95%CI 1.02-1.32), p=0.025), morning tiredness (OR 1.22 (95%CI 1.06-1.40), p=0.007), daytime tiredness (OR 1.24 (95%CI 1.06-1.44), p=0.007) and propensity to fall asleep during work or leisure time (OR 1.18 (95%CI 1.01-1.37), p=0.036). Personal crises increased the risk of longer sleep latency (OR 5.46 (95%CI 1.13-26.32), p=0.035) and of propensity to fall asleep when not active (OR 5.41 (95%CI 1.42-20.83), p=0.014). Use of medications affecting the CNS increased the risk of worse general sleep quality (OR 11.44 (95% CI 1.07-121.79), p=0.044). Perceived impaired general health (OR 2.87 (95%CI 1.04-7.94), p=0.043) and frequent night sweats (OR 10.50 (95%CI 2.25-49.01), p=0.003) increased the risk of difficulty falling asleep. CONCLUSIONS: Various premenopausal health-related factors seem to predict poor sleep in menopausal transition. Menopause itself appears to have only minor effects. Thus, it is essential to identify high-risk women to allow timely interventions that may prevent the development of sleep disturbances at menopause.