A quality assessment of inflammatory bowel disease nursing care in Finland: a nationwide cross-sectional descriptive study.

OBJECTIVES OF THE ARTICLE: Inflammatory bowel disease (IBD) nursing has been identified as a crucial component in the IBD service delivery. This article aims to provide a comprehensive overview of the state of IBD nursing care in Finland, and to identify areas that would benefit from further research. MATERIALS AND METHODS: Tertiary IBD outpatient clinics nationwide were invited to participate in a cross-sectional descriptive study conducted using an electronic survey. The quality of IBD nursing services was assessed using the Nursing Care Quality in IBD (NCQ-IBD) evaluation tool. RESULTS: Of the 34 identified clinics, 27 participated (79.4%) in the study. The NCQ-IBD tool classifies the clinics in four categories, where A indicates the highest level of quality, and D the lowest. In this study, 26 clinics (96.3%) were classified at level C, and one clinic (3.7%) at level D. Nursing responsibilities in IBD management and informing the patients were at a high level of quality, whereas nursing research in IBD was at a low level. An IBD database (i.e. clinical IBD registry) was in use only in 10 clinics. Although training in the clinical aspects of IBD was readily available, there was a lack of training plans for IBD, and clinics seldom held an annual review of the IBD nursing activities and outcomes. There were very few clinics using structured indices and questionnaires, and only 16 clinics (59.3%) applied a written IBD protocol. CONCLUSION: In the Finnish IBD nursing service, as measured with the NCQ-IBD tool, several areas for future improvement were identified.

Strabismus is more than a misalignment; a cross-sectional pilot study of HRQOL in Finnish strabismic adults referred to a university hospital.

PURPOSE: To evaluate associations between the health-related quality of life (HRQOL) and demographic, self-reported strabismus-related and orthoptic status variables in Finnish strabismic adults. METHODS: Participants (n = 137) of this study were adult patients who previously participated in the pilot study to translate and validate Adult Strabismus Questionnaire (AS-20) into Finnish. For this study, the participants' orthoptic status were collected among the previously obtained self-reported demographic and strabismus-related data. The refined AS-20 structure of 18 items and four subscales of self-perception, interaction, reading function and general function was used. Low scores on AS-20 indicate low HRQOL. The associations were evaluated with cross-tabulation and nonparametric methods of Mann-Whitney U and Kruskal-Wallis tests. Statistical significance was set at p < 0.05. RESULTS: Interaction subscale scores were the highest of all subscale scores among the participants. Age had an association with HRQOL in self-perception and the youngest participants had the lowest scores. Importantly, participants who did not experience diplopia suffered from lower self-perception and interaction but reported higher scores on reading function and general function subscales compared to the participants who experienced diplopia. Exotropia with or without vertical strabismus were most common types among the participants. The education background was not associated with HRQOL. CONCLUSION: Impacts of strabismus are similar in Finnish strabismic adults compared to international studies. Healthcare professionals and decision-makers should always consider the psychosocial impact of strabismus on patients without diplopia when making decisions on strabismus treatment and care processes.

Health-Related Quality of Life in Adult Patients with Strabismus-Translation and Psychometric Testing of the Adult Strabismus Questionnaire (AS-20) into Finnish.

(1) Strabismus has an impact on individuals' health-related quality of life. The impact should be assessed with valid patient-reported outcome measures such as the Adult Strabismus Questionnaire (AS-20). The AS-20 was further refined using a Rasch analysis for the American population. The aims of the study were to translate and culturally adapt the AS-20 into Finnish and to evaluate the psychometric properties of the Finnish AS-20. (2) The guidelines of the Professional Society for Health Economics and Outcomes Research steered the process and four items were added from the original data as Finnish additions. The construct and convergent validity and internal consistency were evaluated via psychometric testing for three potential Finnish AS-20 structures. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was applied. (3) The participants (n = 137) reported that the translation was clear and understandable. All structures showed high reliability and internal consistency as measured using Cronbach alpha values. The convergent validity assessed using Spearman's correlation coefficients between the structures and one item of Satisfaction with Life Scale indicated very low to moderate positive correlations. The construct validity evaluated using a confirmatory factor analysis revealed the refined AS-20 structure to be satisfactory. (4) The refined AS-20 can be used in clinical practice and research, but further validation is recommended.

Associations Between Children's Depressive Symptoms, Life Events, and Family Factors Among School-Aged Children.

BACKGROUND: About 20-30% of children worldwide report depressive symptoms. This study examined associations between children's depressive symptoms, life events, and family factors. METHODS: Nationally representative data (n = 95,725) were drawn from the 2017 School Health Promotion Study in Finland. The respondents were 4th and 5th grade pupils (aged 10-12) in primary schools and their parents/guardians (n = 33,726). Data were analyzed for child-parent dyads (n = 32,181). Associations were studied using cross tabulation and logistic regression models. RESULTS: Children's reports of poor self-rated health, problems with family interactions, and the accumulation of life events were statistically significantly associated with depressive symptoms, also when controlling for sociodemographic factors. Financial situation and parent's depressed mood, both reported by parents, were associated with children's depressive symptoms when both were included in the regression model. However, this association disappeared when other predictors were added to the model. CONCLUSION: The results make apparent the complex associations between children's depressive symptoms and family factors. Further research is needed on the discrepancies between parent and child experiences.

The marital relationship and health-related quality of life of prostate cancer patients and their spouses: A prospective, longitudinal study.

AIMS: This study aims to measure any changes in the marital relationship during the first year after a diagnosis of prostate cancer, identify the demographic characteristics that influenced such changes, and measure changes related to health-related quality of life (HRQoL). BACKGROUND: Knowledge is limited on the impact of a diagnosis of prostate cancer on the marital relationship and HRQoL of patients and their spouses. DESIGN: A 1-year longitudinal study. METHODS: Data were collected from five Finnish hospitals between October 2013 and January 2017. Of the 350 recruited couples (N = 700), 179 patients and 166 spouses completed the Marital Questionnaire and the RAND 36-Item Health Survey 1 year after diagnosis. RESULTS: No major changes were found in the marital relationship during the follow-up period. The spouses reported statistically significant changes in their marital relationships, but the patients did not. Furthermore, changes in the marital relationship were not associated with the patients' HRQoL. Among spouses, emotional well-being was associated with changes in the marital relationship. CONCLUSION: The marital relationship was relevant in terms of the spouses' HRQoL during the first year after a diagnosis of prostate cancer. Nurses and other healthcare providers should assess counselling and support provided to spouses individually.

Effects of intervention on lifestyle changes among coronary artery disease patients: A 6-month follow-up study.

AIM: The main aim of the study was to investigate the effects of a nurse-led lifestyle-related risk factor modification intervention on multiple lifestyle behaviours among coronary artery disease patients over six months. DESIGN: A pre-test post-test control group design was conducted in a single clinical centre in Nepal. METHODS: A total of 224 eligible patients were randomly assigned to either the usual care group or the intervention group at baseline. The lifestyle intervention consisted of a brief counselling session supplemented with informational leaflets. Standard questionnaires were used to collect self-reported data from patients on multiple lifestyle behaviours: diet, physical activity, adherence to medication, stress, body mass index, smoking and alcohol consumption. General linear model repeated measure analysis was used to estimate the effect of intervention. RESULTS: A statistically significant effect of study group-by-time interaction for diet, adherence to medication, physical activity, and perceived stress was found at 6-month follow-up. Overall, greater improvement in lifestyle habits was found in the intervention group compared with the control group at 6-month follow-up.

Early identification of depressive symptoms in school-aged children: Psychometric properties and validation of a new short version of Short Mood & Feelings Questionnaire.

BACKGROUND: Depressive mood is a common problem among children in Western countries. Professionals in school and other health services have an important role in identifying children at increased risk for depression. The Short Mood and Feelings Questionnaire (SMFQ) is a widely used screening tool, but its 13 items still make it quite time-consuming to complete. There is an urgent need for a quick and easy-to-complete self-report depressive mood scale for use in school health examinations. AIM: This paper aims to describe and validate a revised version of SMFQ: FsMFQ-6 is intended as a short screening tool for the early identification of depressive symptoms in children. METHODS: Nationally representative data (n = 95,725) were drawn from the 2017 School Health Promotion Study. The respondents were fourth- and fifth-grade pupils (aged 10-12) in Finnish primary schools. The data were analysed separately by gender. The construct validity of the scale was studied by principal component analysis and confirmatory factor analysis (CFA), convergent validity by both receiver operating characteristic (ROC) analysis and Spearman's correlation coefficient. Reliability was tested by Cronbach's alpha coefficient. RESULTS: Principal component analysis yielded a one-component model: the Finnish Short Mood and Feelings Questionnaire 6 (FsMFQ-6). CFA confirmed the validity of FsMFQ-6. Compared with mood at home (AUC = 0.80) and mood at school (AUC = 0.85), overall sensitivity and specificity were optimal at cut-off point 0. Cronbach's alpha coefficient was 0.73, indicating good internal consistency. The results for girls and boys were almost identical. CONCLUSION: The results confirmed the validity and reliability of FsMFQ-6. FsMFQ-6 recognises depressive mood in children and is suitable for screening depressive symptoms in fourth- and fifth-grade pupils in Finland. However, it is important to pay close attention to children who choose the 'Sometimes' response option more than once, for that can be a sign of depressive symptoms.

Parenting Fears and Concerns during Pregnancy: A Qualitative Survey.

Previous research on the fears and anxieties of expectant mothers has focused mostly on their fears about giving birth rather than parenting. This study aims to describe mothers' fears and concerns about parenthood during pregnancy and to examine the similarities and differences in the perspectives of primiparous and multiparous mothers. The qualitative research for this study was conducted in three postpartum units in Finland and focused on the responses to an open-ended question about parenting fears and concerns that was part of a questionnaire given to 250 mothers after they had given birth. The responses from the 128 mothers who answered this question were subject to inductive content analysis. Fears and concerns on parenthood included worries about coping with the future and everyday life with their new baby, the psychological burden of parenthood, their maternal resources and self-efficacy, meeting their baby's needs, their baby's health, concerns about their relationship with their partner and financial issues. Primiparous and multiparous mothers shared many of the same concerns, but some differences emerged. The findings contribute an interesting perspective to the social debate about declining birth rates and their psychosocial causes. Further studies are needed to examine the fears and concerns of younger adults, and even teens, about parenthood.

Associations between Perceived Child-Parent Relationships and School Engagement among 9-11 Aged Children.

School engagement has been shown to protect students from dropping out of education, depression and school burnout. The aim of this Finnish study was to explore the association between child-parent relationships and how much 99,686 children aged 9-11 years liked school. The data were based on the 2019 School Health Promotion Study, conducted by the Finnish Institute for Health and Welfare. This asked children whether they liked school or not and about their child-parent relationships. Univariate and multivariate analyses were used to examine the data separately for boys and girls and the results are presented as odds ratios (OR) and 95% confidence intervals (CI). According to the results, girls showed more school engagement than boys (81.9% versus 74.0%), and it was more common in children who felt that their parents communicated with them in a supportive way. This association was slightly stronger for girls than boys (OR 2.46 95% CI 2.33-2.59 versus OR 2.10 95% CI 2.02-2.20). It is important that child-parent relationships and communication are considered during school health examinations, so that children who have lower support at home can be identified.

Self-Reported School Difficulties and the Use of the School Nurse Services by Adolescent Students.

Adolescents are increasingly finding school difficult and physical, mental and social problems increase the risk of exclusion. School health services help to identify problems and prevent them from escalating and the school nurse should be consulted when children are struggling academically. This study explored associations between school difficulties and the use of school health nurse services by 73,680 comprehensive school students with median age of 15.3. The study was based on nationally representative data from the 2017 Finnish School Health Promotion study and analyzed by gender. Difficulties in schooling were common and ranged from 9.9-32.7%. Girls reported difficulties more frequently than boys. Having self-reported difficulties was associated with greater use of school health nurse services, with girls seeking help more often than boys with similar issues and more boys saying they had no need for services. In addition, more self-reported difficulties with schooling were associated with unmet need for school health nurse services. School difficulties were associated with greater use of the school health nurse service use when the data were controlled for background factors. This study highlights shortcomings in access to school health nurse services by children with self-reported school difficulties and that girls were more likely report problems and seek help.

Effects of a lifestyle-related risk factor modification intervention on lifestyle changes among patients with coronary artery disease in Nepal.

OBJECTIVE: To investigate the effect of a lifestyle-related risk factor modification intervention on coronary artery disease (CAD) patients' lifestyle changes. METHOD: A randomized controlled study was conducted in Nepal. A total of 224 CAD patients (112 in each study group) were included at baseline, and 196 patients (98 in each group) completed the one-month follow-up. Patients in the intervention group (IG) received nurse-led intervention in addition to the usual care. Face-to face and telephone interview was conducted using standard questionnaires to collect data on lifestyle-related risk factors; smoking, alcohol consumption, diet, body mass index, stress, adherence to medical therapy, and physical activity. General linear model repeated measure analysis was used to analyse the effects of the intervention. RESULTS: Based on self-reported data we found significant improvement in lifestyle-related risk factor habits in the IG compared with the usual care group with respect to diet (p < 0.001), physical activity (p < 0.001), medication adherence (p < 0.001) and stress (p < 0.001) at one-month follow-up. CONCLUSION: Lifestyle-related risk factor modification intervention can positively influence health risk habits, even when it is less intensive but supplemented with information leaflets. PRACTICAL IMPLICATIONS: Nurse-led one-time intervention may successfully deliver counselling to improve healthy lifestyle among underserved CAD patients.

School Achievement and Oral Health Behaviour Among Adolescents in Finland: A National Survey.

PURPOSE: We examined oral health behaviour and its association with school achievement among Finnish adolescents. MATERIALS AND METHODS: This study is part of the Finnish national School Health Promotion study (SHP). The study population comprised a representative sample of Finnish 15-year-olds (N = 45,877). A questionnaire inquired about the respondents' school achievements and health habits (toothbrushing, smoking), background factors (age, gender, school type, family structure), and their parents' background factors (education, smoking). Chi-square tests and logistic regression models were used in the statistical analyses. RESULTS: Better school achievements were associated with better oral health behaviour: 73.1% of students with the highest mean grades (9-10) brushed their teeth twice daily, compared to 33.8% of those with the lowest mean grade (6.9 or less). The lowest mean grade was associated with brushing less than twice daily, especially among boys (odds ratios (OR) = 4.1; 95% CI 3.6-4.7) when compared to those with the highest mean grade, but also among girls (OR = 2.3; 95% CI 2.1-2.7). Smoking among boys was associated with poor oral hygiene (OR = 1.3; 95% CI 1.2-1.4). CONCLUSION: School success is strongly associated with oral health behaviour among adolescents. Preventive treatment should be targeted especially at boys with poor school achievement and smoking behaviour.

Lifestyle-related risk factors among patients with coronary artery disease in Nepal.

BACKGROUND: Coronary artery disease (CAD) is the leading cause of death and morbidity globally. South Asia, including Nepal, has higher risks for CAD due to relatively higher exposures to risk factors. This study evaluated the prevalence of lifestyle-related risk factors and the associations of risk factors with socio-demographic variables among CAD patients. METHODS: A cross-sectional study was conducted among CAD patients (n = 224) admitted to a national heart centre in Nepal. Data on dietary habits, smoking, alcohol consumption, stress, physical activity, overweight or obesity and adherence to medication were collected using standard questionnaires. The numbers of risk factors were categorised into three groups (1-2 = low, 3 = medium, 4-7 = high). Data analysis was performed by cross-tabulation and multinomial logistic regression. Prevalence odds ratios (POR) and their 95% confidence intervals (CIs) were used as the measure of the associations. RESULTS: The prevalence of risk factors among patients varied from 23% to 97%, with stress being the most prevalent, and current alcohol consumption the least. The majority of study patients had multiple lifestyle-related risk factors. Male patients (POR for medium vs. low 2.83; 95% CI 1.3, 6.18) and patients with high incomes (POR for high vs. low 2.53; 95% CI 1.10, 5.83) had higher odds of being in the medium- and high-risk group, respectively. CONCLUSIONS: Lifestyle-related risk factors were highly prevalent among CAD patients. Various socio-demographic variables were associated with the risk groups. Intervention studies on lifestyle risk factor modifications among this target group are recommended.

Self-rated health, symptoms and health behaviour of upper secondary vocational students by field of study.

This article examines the self-rated health, symptoms and health behaviour of upper secondary vocational students in Finland. The data consist of the responses of first- and second-year vocational students (n = 34 554) to the 2013 School Health Promotion Survey. The data were analysed statistically and processed separately for girls and boys. Associations between self-rated health, symptoms and health behaviour and fields of study were examined by cross-tabulation. Statistical significance was measured using the chi-squared test. Self-rated health, symptoms and health behaviour were found to have a statistically significant association with field of study (p < 0.001). Vocational students in different fields had different experiences of health, different symptoms and different health behaviours. The results complement existing evidence about disparities in well-being among young people in the context of education.

Health-related quality of life in patients with prostate cancer and their spouses: Results from a longitudinal study.

PURPOSE: The purpose of this study was to explore changes in HRQoL (health-related quality of life) and identify the associated factors in patients with prostate cancer and their spouses during the year following their diagnosis of prostate cancer. METHODS: The longitudinal study design consisted of 179 patients and 166 spouses, using discretionary sampling, at five Finnish central hospitals. Participants completed a self-reported RAND-36-Item Health Survey at three time-points: time of diagnosis and 6 and 12 months later. Changes in HRQoL were analysed using descriptive statistics and non-parametric tests. Linear mixed-effects models were used to identify the factors associated with the changes in HRQoL in the patients and their spouses. RESULTS: On average, the HRQoL of patients with prostate cancer changed in physical functioning (p = 0.015), emotional well-being (p = 0.029) and general health (p = 0.038) were statistically significant over the 12-month study period. In spouses, statistically significant changes in HRQoL were not observed. Interaction between the age of participants and changes in HRQoL were statistically significant. CONCLUSIONS: Findings in this study suggest that interventions aimed at improving the HRQoL of patients should support a few different dimensions of HRQoL for the patients themselves than for their spouses. Nurses should pay more attention to elderly couples.

Marital relationship and health-related quality of life of patients with prostate cancer and their spouses: A longitudinal clinical study.

AIMS AND OBJECTIVES: To examine changes in the marital relationship 6 months after the diagnosis and the effects of these changes on the health-related quality of life of the patients with prostate cancer and their spouses. BACKGROUND: There is limited knowledge on the impact of a diagnosis of prostate cancer on the marital relationship and health-related quality of life of patients and their spouses. DESIGN: Survey with longitudinal descriptive and comparative elements. METHODS: Of 350 recruited couples (N = 700), 186 couples (n = 372) completed the Marital Questionnaire and RAND 36-Item Health Survey at the two measurement points: time of diagnosis and 6 months later. Changes in the marital relationship were analysed statistically using descriptive statistics and nonparametric tests. The influence of changes in the marital relationship on health-related quality of life was evaluated using linear regression analyses. RESULTS: The patients and their spouses reported lower marital satisfaction 6 months after the diagnosis than at the time of diagnosis. The summary score for marital satisfaction of the spouses significantly decreased during the follow-up period. In contrast, decreasing changes in the marital relationship of the patients were not statistically significant. Furthermore, the marital relationship of the patients and their spouses was not statistically significantly associated with changes in the health-related quality of life of the patients and their spouses within 6 months. CONCLUSIONS: The results of this study add to current knowledge of the marital relationship of patients with prostate cancer and their spouses. The spouses reported that their marital relationship had suffered, whereas the patients reported that the marital relationship remained unchanged. RELEVANCE TO CLINICAL PRACTICE: These findings may be useful when counselling of patients with prostate cancer and their spouses.

The health-related quality of life of patients with prostate cancer and their spouses before treatment compared with the general population.

AIMS: To describe the health-related quality of life (HRQOL) of patients with prostate cancer and their spouses in comparison with the Finnish general population, using the RAND 36-Item Health Survey. An additional purpose was to describe the associations between the background variables of the participants and their HRQOL. BACKGROUND: The HRQOL of patients with prostate cancer and especially their spouses at the time of diagnosis is not well known. DESIGN: A cross-sectional study. METHODS: Responses were received from 232 patients and 229 spouses at 5 central hospitals in Finland between October 2013 and January 2016. RESULTS: Compared to the Finnish general population mean, the HRQOL of the patients and their spouses was, on average, better for all dimensions. Patients' age, the presence of disease, and the treatment method were associated with the dimensions of HRQOL. The dimensions of HRQOL were also associated with spouses' age, basic and vocational education, and the presence of disease. CONCLUSION: The patients and their spouses experienced their HRQOL as very similar; however, on average, it is better than the general population mean. However, the evidence suggests that support from the nurses should focus on emotional well-being, the dimension that received the lowest scores in both groups.

Family factors and health behaviour of thin adolescent boys and girls.

AIM: The aim of this study was to examine prevalence of extreme thinness and thinness in adolescent boys and girls and to study associations between family factors, health behaviour and thinness in boys and girls. BACKGROUND: Extreme thinness carries high health risks. The family and health behavioural factors related to adolescent thinness have not been studied previously using a nationally representative data. DESIGN: This is a cross-sectional quantitative study. METHODS: The nationally representative data were obtained from the Finnish School Health Promotion study conducted in 2013. The sample of this study included 12-17 year old adolescents (n = 71,973) who were categorised as extremely thin, thin and normal weight using international age and gender body mass index (BMI) cut-off points for children and adolescents. Associations with family factors and health behaviour were examined separately for boys and girls using cross-tabulations, Chi-square test and multinomial logistic regression. RESULTS: Thinness and extreme thinness were more common in girls than in boys. Health behaviour, such as smoking and exercise, were associated with thinness and extreme thinness in both genders. Regarding family factors; low maternal education, family meal and parental knowledge of adolescents' friends and whereabouts were associated with thinness and, or extreme thinness in both boys and girls. However, there were gender differences in the associations. CONCLUSIONS: It is important for healthcare professionals working with adolescents to be aware of prevalence in thinness and aware of health behaviour and family factors that are associated with thinness and extreme thinness in adolescence.

Two models of nursing practice: a comparative study of motivational characteristics, work satisfaction and stress.

AIM: To examine the differences in work-related motivational and stress factors between two nursing allocation models (the primary nursing model and the individual patient allocation model). BACKGROUND: A number of nursing allocation models are applied in hospital settings, but little is known about the potential associations between various models and work-related psychosocial profiles in nurses. METHOD: A cross-sectional study using an electronic questionnaire. The data were collected from nurses (n = 643) working in 22 wards. In total, 317 questionnaires were returned (response rate 49.3%). RESULTS: There were no significant differences in motivational characteristics between the different models. The nurses working according to the individual patient allocation model were more satisfied with their supervisors. The work itself and turnover caused more stress to the nurses working in the primary nursing model, whereas patient-related stress was higher in the individual patient allocation model. CONCLUSION: No consistent evidence to support the use of either of these models over the other was found. Both these models have positive and negative features and more comparative research is required on various nursing practice models from different points of view. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing directors and ward managers should be aware of the positive and negative features of the various nursing models.

Enhancing nurses' participation in implementing evidence-based practice.

The article gives an overview of a multidimensional project to enhance nurses' participation in implementing evidence-based practice (EBP) in one university hospital in Finland. The project provided an opportunity for many nurses to be an active part of the EBP process. Moreover, it provided an interesting opportunity to increase all nurses' awareness of EBP.