Culturally diverse nursing students in Finland: some experiences.

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.

Teachers' experiences of English-language-taught degree programs within health care sector of Finnish polytechnics.

The purpose of this study was to research teachers' experiences of the English-Language-Taught Degree Programs in the health care sector of Finnish polytechnics. More specifically, the focus was on teachers' experiences of teaching methods and clinical practice. The data were collected from eighteen teachers in six polytechnics through focus group interviews. Content analysis was used to analyse the data. The results suggested that despite the positive interaction between students and teachers, choosing appropriate teaching methods provided a challenge for teachers, due to cultural diversity of students as well as to the use of a foreign language in tuition. Due to students' language-related difficulties, clinical practice was found to be the biggest challenge in the educational process. Staffs' attitudes were perceived to be significant for students' clinical experience. Further research using stronger designs is needed.

Health, utilisation of health services, 'core' information, and reasons for non-participation: a triangulation study amongst non-respondents.

AIM: To explore health, use of health services, 'core' information and reasons for non-participation amongst males. BACKGROUND: Gender may provide an explanation for non-participation in the healthcare system. A growing body of research suggests that males are less likely than females to seek help from health professionals for their problems. The current research had its beginnings with the low response rate in a prior voluntary survey and health examination for Finnish males born in 1961. DESIGN: Data triangulation among 28 non-respondent middle-aged males in Helsinki was used. METHODS: The methods involved structured and in-depth interviews and health measurements to explore the views of these males concerning their health-related behaviours and use of health services. RESULTS: Non-respondent males seldom used healthcare services. Despite clinical risk factors (e.g. obesity and blood pressure) and various symptoms, males perceived their health status as good. Work was widely experienced as excessively demanding, causing insomnia and other stress symptoms. Males expressed sensitive messages when a session was ending and when the participant was close to the door and leaving the room. This 'core' information included major causes of concern, anxiety, fears and loneliness. CONCLUSIONS: This triangulation study showed that by using an in-depth interview as one research strategy, more sensitive 'feminist' expressions in health and ill-health were got by men. The results emphasise a male's self-perception of his masculinity that may have relevance to the health experience of the male population. RELEVANCE TO CLINICAL PRACTICE: Nurses and physicians need to pay special attention to the requirements of gender-specific healthcare to be most effective in the delivery of healthcare to males.

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.

The Finnish national asthma programme: communication in asthma care--quality assessment of asthma referral letters.

AIMS AND OBJECTIVES: The Finnish National Asthma Programme, which was launched in year 1994, considered the management of asthma as a community problem. The role of the primary health care in the management of asthma was emphasized. Optimal asthma management includes good communication between health care professionals. Referral letters are an accepted tool for evaluation of the communication process. The aim of this study was to assess the quality of asthma-related referral letters. METHODS: All non-acute referral letters (n=3176) to three pulmonary departments were screened in 2001 and all those related to asthma were included (n=1289). The 14 previously derived asthma-specific criteria were applied: occupation, smoking, known allergies, current medication, other diseases, onset of symptoms, wheezing, dyspnoea, specified dyspnoea, cough, specified cough, use of asthma medication, peak-flow follow-up or spirometry with bronchodilatation test as an attachment. The study group was prepared to accept the maximum of 30% of the referral letters to be of poor quality. RESULTS: Twenty-one per cent of the referral letters were graded good, 34% satisfactory and 45% poor. Information on wheezing, smoking habits and current medication was mentioned in 44%, 42% and 41% of asthma letters respectively. CONCLUSIONS: The Finnish National Asthma Programme calls for optimizing communication between doctors. The proportion of poor letters was 50% higher than the preset standard and clearly indicates a need for improvement. We found several issues, which need to be better communicated (smoking, lung function tests, wheezing, medication) when referring a patient with suspected asthma.

The relationship between school-based smoking policies and prevention programs on smoking behavior among grade 12 students in Prince Edward Island: a multilevel analysis.

PURPOSE: To examine how school-based smoking policies and prevention programs are associated with occasional and regular smoking among a cohort of grade 12 students in Prince Edward Island, Canada, between 1999 and 2001. METHODS: Data from the Tobacco Module of the School Health Action, Planning and Evaluation System (SHAPES) collected from 3,965 grade 12 students in 10 high schools were examined using multi-level regression analysis. RESULTS: Attending a school with smoking prevention programming was associated with a decreased risk of being an occasional smoker (OR 0.42, 95% CI: 0.18, 0.97). School-based policies banning smoking on school property were associated with a small increased risk of occasional smoking (OR 1.06, 95% CI: 0.67, 1.68) among some students. The combination of both policies and programs was not associated with either occasional or regular smoking. CONCLUSION: This preliminary evidence suggests that tailored school-based prevention programming may be effective at reducing smoking uptake; however, school smoking policies and the combination of programs and policies were relatively ineffective. These findings suggest that a new approach to school-based tobacco use prevention may be required.

Self-rated health and risk factors for metabolic syndrome among middle-aged men.

OBJECTIVES: To examine lifestyle and clinical risk factors for metabolic syndrome (MBO) and compare their significance between levels of self-rated health among middle-aged men. DESIGN: A cross-sectional baseline study. SAMPLE: 273 men, aged 40, living in Helsinki, Finland. METHODS: Postal questionnaires and health examinations by public health nurses were used in data collection. Statistical differences between groups of self-rated health and risk factors were analyzed by chi-square tests. RESULTS: Of all the respondents, 55% rated their health as good and 45% as average. Two thirds were overweight or obese, and 35% had waist-hip ratio more than 100 cm. Approximately 43% had diastolic blood pressure greater than 90 mmHg. Over half of the men smoked daily, and 28% used alcohol excessively. CONCLUSIONS: The men in this sample were found to be at high risk of developing MBO. The results underscore the importance of understanding the contradiction that exists between subjective and objective health ratings. Public health nurses are in a key position to educate men on how to use simple measurements to objectively assess their risk factors and, thus, potentially reduce their risk of developing diabetes, heart attack, or stroke.

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.

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.

Quality of life six years after intensive care.

OBJECTIVE: To assess the degree of change in long-term quality of life (QOL) in critically ill patients 1 and 6 years after discharge from the intensive care unit (ICU). DESIGN: Prospective observational study. SETTING: A ten-bed medical-surgical ICU in a tertiary care hospital. PATIENTS: Of the 591 consecutive patients admitted in 1995 the study comprised those 169 who responded to both QOL questionnaires, sent in 1996 and 2001. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A generic scale assessing health-related QOL, the RAND 36, sent by mail. Six years after discharge 9% of the patients considered their present health status as excellent, 37% as good, 45% as satisfactory and 9% as poor. The absolute values of the different QOL domains revealed worse physical functioning ( p<0.001), pain ( p=0.008) and general health ( p=0.012), but less emotional role limitation ( p=0.006) as compared with the 1996 values. Compared with the age- and gender-matched general population (controls), a marked improvement was detected in physical and emotional role limitations, and in vitality. However, 6 years after ICU discharge pain was worse, and physical functioning and general health were still reduced as compared with controls. CONCLUSIONS: When evaluating the long-term outcome of ICU patients, the timing of QOL assessment is essential; especially the emotional domains seem to improve slowly. Further studies focusing on the effect of time on various QOL domains and the predictive factors for a long-term QOL are therefore warranted.

Re-hospitalizations after myocardial infarction on Prince Edward Island: analysis of the reasons.

In the province of Prince Edward Island (PEI), which has a small homogeneous population of approximately 140,000 people, cardiovascular disease is the leading cause of death accounting for 37% of the total deaths. Next to Newfoundland, this province ranks second highest in Canada for its incidence of cardiovascular disease. This high incidence of cardiovascular disease in this population has been attributed to smoking, physical inactivity, hypertension and obesity. In examining provincial comparisons across Canada, PEI has the highest proportion of physically inactive adults at 68%. PEI has the second highest proportion of adults, 15 years and older, who are daily or occasional smokers at 65% and who have high blood pressure at 12%. PEI has the third highest proportion of adults who are overweight. At the Queen Elizabeth Hospital in Charlottetown, PEI, where the researcher has conducted her study, during the period of January 1997 and December 1997, 192 patients were admitted with the diagnosis of acute myocardial infarction (AMI). The average length of stay in hospital for these patients was 10.3 days. This is high compared to the national average of 6.6 days in hospital. During a one year period, 111 of these 192 patients were re-admitted to hospital with a related cardiovascular diagnosis. This equates to a 57.8% readmission rate for post MI patients. These re-hospitalizations are both costly to health care and disruptive to the quality of life of the individual and his or her family. There is evidence that a portion, approximately 50% of these re-hospitalizations, are due mainly to psychosocial factors and not to unavoidable clinical reasons. A cross-sectional design representing this one year period was used in a chart audit with an analysis done to determine factors associated with re-hospitalization of post MI patients. This article will offer insight regarding the results of this analysis as well as future recommendations for patients being discharged home follow an AMI. The significance of the research lies in its collection of data focusing on behaviors and attitudes around cardiovascular risk factor modification which will enable effective planning and evaluation of health promotion programs, policies, and legislation.

Development of family medicine education in Moldova with Carelift International.

BACKGROUND: As in other former Soviet republics, Moldova's health system has been dependent upon multispecialty and hospital care. The government has undertaken a planning process to develop a primary care-based system utilizing family physicians. Carelift International and Moldova State Medical and Pharmaceutical University joined together to design an educational program to help create a family medicine specialty in the country. METHODS: Introductory concepts were incorporated into a workshop co-sponsored by the World Health Organization, Carelift International, UNICEF and Moldova Ministry of Health. Faculty teams participated in Carelift's 8-week US program, comprising a range of topics in family medicine: educational development at all levels, public health applications, health care organization, insurance, financing, and technology. Training also included 1 week in Finland, a fellowship in Lithuania, an in-country workshop on rural health, and a supplemental 5-week US immersion program. OUTCOMES: A Department of Family Medicine was established, and a residency program instituted. It has already been strengthened with a 2-week introduction to the specialty, and rotations in family practice centers. Continued improvements and updates are planned. Urban and rural model family practice centers serve concurrent purposes of teaching, demonstrating and health care. Carelift shipped equipment for the principal center and a department library, and is equipping a teaching family practice center near the university. The Society of Family Physicians of Moldova was founded. The introduction of family medicine as a discipline into the health system of Moldova could be a valuable model for other former Soviet republics.

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 Student's 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.