Animal Welfare Attitudes: Effects of Gender and Diet in University Samples from 22 Countries.

Animal Welfare Attitudes (AWA) are defined as human attitudes towards the welfare of animals in different dimensions and settings. Demographic factors, such as age and gender are associated with AWA. The aim of this study was to assess gender differences among university students in a large convenience sample from twenty-two nations in AWA. A total of 7914 people participated in the study (5155 women, 2711 men, 48 diverse). Participants completed a questionnaire that collected demographic data, typical diet and responses to the Composite Respect for Animals Scale Short version (CRAS-S). In addition, we used a measure of gender empowerment from the Human Development Report. The largest variance in AWA was explained by diet, followed by country and gender. In terms of diet, 6385 participants reported to be omnivores, 296 as pescatarian, 637 ate a vegetarian diet and 434 were vegans (n = 162 without answer). Diet was related with CRAS-S scores; people with a vegan diet scored higher in AWA than omnivores. Women scored significantly higher on AWA than men. Furthermore, gender differences in AWA increased as gender inequality decreased.

School burnout and sleep in Finnish secondary school students.

INTRODUCTION: Studies have shown that poor sleep is related to burnout, but research to date has not yet explored sleep-related factors in relation to school burnout. METHODS: A total of 555 students, aged 15 to 20 years, participated in this study. The participants reported their diurnal patterns, sleep quality, tiredness, and school burnout in printed questionnaires. Using logistic regression analysis, the study examined how sleep-related factors explained school burnout. RESULTS: School burnout was related to daytime sleepiness, tiredness and poor sleep quality. Neither time in bed, social jet lag nor diurnal preferences could explain school burnout. CONCLUSION: The results contribute to the growing evidence showing the importance of sleep for well-being.

Development of voluntary private health insurance in Nordic countries - An exploratory study on country-specific contextual factors.

The Nordic countries are healthcare systems with tax-based financing and ambitions for universal access to comprehensive services. This implies that distribution of healthcare resources should be based on individual needs, not on the ability to pay. Despite this ideological orientation, significant expansion in voluntary private health insurance (VPHI) contracts has occurred in recent decades. The development and role of VPHIs are different across the Nordic countries. Complementary VPHI plays a significant role in Denmark and in Finland. Supplementary VPHI is prominent in Norway and Sweden. The aim of this paper is to explore drivers behind the developments of the VPHI markets in the Nordic countries. We analyze the developments in terms of the following aspects: the performance of the statutory system (real or perceived), lack of coverage in certain areas of healthcare, governmental interventions or inability to reform the system, policy trends and the general socio-cultural environment, and policy responses to voting behavior or lobbying by certain interest groups. It seems that the early developments in VPHI markets have been an answer to the gaps in the national health systems created by institutional contexts, political decisions, and cultural interpretations on the functioning of the system. However, once the market is created it introduces new dynamics that have less to do with gaps and inflexibilities and more with cultural factors.

A Qualitative Study of Barriers to Care for People With Co-Occurring Disorders.

The present qualitative study used face-to-face and telephone interviews with service providers in the Tampere area in Finland to describe the provider viewpoint on barriers to care for people with co-occurring disorders. The core barrier concerns the definition and understanding of the problems: client and professional perspectives often differ, and both can be out of step with what the care system actually proposes. Professionals need to take into account contexts with potentially multiple barriers to care. Providers in each local area should examine possible barriers and find solutions together, integrating the client perspective at each step in the process.

Circadian preferences and sleep in 15- to 20-year old Finnish students.

PURPOSE: Despite progress in research concerning adolescent and young adult sleep and circadian preferences, several aspects have remained unexamined. This study explored gender and diurnal rhythms in relation to several sleep-related factors: sleep duration, bedtime, wake-up time, tiredness, sleepiness, and optimal subjective sleep duration. METHODS: Circadian preferences and sleep were investigated in 555 (Females N=247) Finnish students aged 15-20. The self-report measures included a shortened version of the Horne-Östberg Morningness-Eveningness Scale, the Epworth Sleepiness Scale as well as items probing feelings of tiredness, optimal subjective sleep durations, and bedtime and wake-up time on the most recent day and a typical weekend. Data were collected from Tuesday to Thursday during an ordinary school week. RESULTS AND CONCLUSION: The most frequent chronotype was the intermediate type (54%), and compared to previous studies, the prevalence of evening-oriented individuals was high (37%), whereas only 9% of the participants were classified as morning oriented. No gender-specific or chronotype-specific differences in sleep durations were observed, but girls/women and evening-orientated individuals reported suffering more from sleepiness, compared to boys/men and more morning-typed participants, respectively. About 20% of the total sample indicated that their subjective need for sleep was not satisfied during the weekdays nor the weekend, indicating chronic sleep deprivation. Among girls/women and evening-oriented individuals, the subjective sleep need was greater for weekday nights.

Perceived and observed quality of long-term care for residents - Does functional ability account?

BACKGROUND: Measuring quality in long-term residential care involves challenges concerning both the measurement method and the impaired functional ability of many older people. Ensuring quality in care is even more important for people with functional impairments, as this is a vulnerable group who may be unable to report poor quality of care for themselves. AIMS AND OBJECTIVES: The aim of this study was to analyse how perceived and observed assessments of the quality of care varied according to the residents' functional ability. DESIGN: The data (n = 278) used in the analyses included residents', family members' and staff assessments of perceived and observed quality of care combined with the Resident Assessment Instrument (RAI) scales measuring the same residents' functional abilities (physical, psychological, cognitive and social). Observations were included in the data if all four assessment types (by residents, family members, staff and the RAI) were available. The dimensions of quality of care emerging from the factor analysis were used. METHODS: Linear regression was used to explore the association between resident's functional abilities and assessed quality of care. RESULTS: Higher level of depression symptoms and higher level of dependency in activities of daily living (ADL) were significantly associated with lower level of perceived and observed quality of care. By contrast, the level of residents' cognitive functioning was not significantly associated with any quality dimensions. The social aspect was the only dimension of functional ability on which better functional ability indicated better quality of care, although differences between respondent groups were also observed. CONCLUSIONS: These analyses emphasize the importance of taking residents' functional ability into account when collecting information on and interpreting the results of perceived and observed quality of care reported separately by residents, family members and staff. IMPLICATIONS FOR PRACTICE: The information obtained can inform care professionals of how dimensions of residents' functional impairments are associated with perceived and observed quality of care and the quality of older people's care can thereby be improved.

The reactions to macro-economic crises in Nordic health system policies: Denmark, Finland and Sweden, 1980-2013.

Denmark, Finland and Sweden have experienced two major recessions during the last 25 years. The adjustments to the earlier crisis in the late 1980s (Denmark) and early 1990s (Finland and Sweden) resembled the policies in many other European countries during the present crisis. The analysis of relationship of deep economic crises and growth period between them to the health system policies and institutions in the three countries from the 1980s to 2013 is based on a categorisation of reactions to external shocks as path conforming or path breaking. The results of the empirical long-term trends show that the reactions to deep recessions have been mainly temporary adjustments and acceleration of changes already prepared before economic crisis. The economic crisis in the three countries has not been 'good enough' to enable paradigmatic changes in the Nordic public, decentralised and equity-oriented health systems. Changes such as the slow privatisation in care funding and production and the adoption of new management practices indicate an ongoing paradigmatic change related to longer-term societal, ideological and political developments rather than directly to economic crises or growth.

Purchaser-provider splits in health care-the case of Finland.

The purchaser-provider split (PPS) is a service delivery model in which third-party payers are kept organizationally separate from service providers. The operations of the providers are managed by contracts. One of the main aims of PPS is to create competition between providers. Competition and other incentive structures built into the contractual relationship are believed to lead to improvements in service delivery, such as improved cost containment, greater efficiency, organizational flexibility, better quality and improved responsiveness of services to patient needs. PPS was launched in Finland in the early 1990s but was not widely implemented until the early 2000s. Compared to other countries with PPS the development and implementation of PPS in Finland has been unusual. Firstly, purchasing is implemented at the level of municipalities, which means that the size of the Finnish purchasers is extremely small. Elsewhere purchasing is mostly implemented at the regional or national levels. Secondly, PPS is also applied to primary health care and A&E services while in other countries the services mainly include specialized health care and residential care for the elderly. Thirdly, PPS in health and social services is not regulated by any specific legislation, regulative mechanisms or guidelines. Instead it is regulated within the same framework as public procurement in general.

Talking about the institutional complexity of the integrated rehabilitation system-the importance of coordination.

Rehabilitation in Finland is a good example of functions divided among several welfare sectors, such as health services and social services. The rehabilitation system in Finland is a complex one and there have been many efforts to create a coordinated entity. The purpose of this study is to open up a complex welfare system at the upper policy level and to understand the meaning of coordination at the level of service delivery. We shed light in particular on the national rehabilitation policy in Finland and how the policy has tried to overcome the negative effects of institutional complexity. In this study we used qualitative content analysis and frame analysis. As a result we identified four different welfare state frames with distinct features of policy problems, policy alternatives and institutional failure. The rehabilitation policy in Finland seems to be divided into different components which may cause problems at the level of service delivery and thus in the integration of services. Bringing these components together could at policy level enable a shared view of the rights of different population groups, effective management of integration at the level of service delivery and also an opportunity for change throughout the rehabilitation system.

A qualitative study on clinical research in Finland: fragmented governance and volume in the 2000s.

OBJECTIVES: Although concerns over clinical research have been expressed, the governance of clinical research has been little studied. The aim was to describe research policy, volume, funding and concerns over clinical research in Finland. DESIGN: A qualitative study and the data were collected from various sources, including documents, statistics and semistructured expert interviews. SETTING: Finland. RESULTS: We found no national policy for clinical research. Many actors were responsible for facilitating, directing, regulating and funding clinical research, but no actor had the main responsibility. Health professionals were the main drivers for clinical research. The role of the health ministry was small. The ministry distributed state money for clinical research in health services (EVO-money), but did not use it to direct research. Municipalities responsible for health services or national health insurance had little interest in clinical research. The Academy of Finland had had initiatives to promote clinical research, but they had not materialised in funding. Clinical research was common and internationally competitive, but its volume had declined relatively in the 2000s. Industry was an important private funder, mainly supporting drug trials made for licensing purposes. Drug trials without an outside sponsor (academic projects) declined between 2002 and 2010. The funding and its targeting and amount were no one's responsibility. Concerns over clinical research were similar as in other countries, but it had appeared late. CONCLUSIONS: Our results suggest fragmented governance and funding in clinical research. The unsystematic research environment has not prevented clinical research from flourishing, but the public health relevance of the research carried out and its sustainability are unclear.

Identifying cancer patients with greater need for information about sexual issues.

PURPOSE: The aim of the research was to identify cancer patients who may have a greater need about sexuality-related information. The study explored the association between sexuality-related information need and socio-demographic factors, cancer type, types of cancer treatment, experienced adverse effects on sexuality, and changes experienced in relationships. METHODS AND SAMPLE: This study used a survey design. Questionnaires were distributed and completed by 505 patients, with a diversity of cancer diagnoses, treated at a university hospital in Finland in 2009 and 2010. Information needs were rated using the international and well validated Information Needs Questionnaire (INQ). Sosiodemographic factors, cancer type, treatments, experienced adverse effects on sexuality and changed experienced in relationships were measured by using another questionnaire. KEY RESULTS: Those patients with experiences of functional problems or other adverse effects on sexuality due to cancer or treatment found sexuality related information more important than those with no experiences of adverse effects on sexuality. Patients with experiences of weakened relationships due to cancer had greater information needs than those with experiences of strengthened relationships or no changes in relationships due to cancer. CONCLUSIONS: Cancer patients should be asked whether cancer or treatment has caused problems in their sexuality and possible relationships. Patients who experience problems in their sexuality or relationships should be provided an opportunity to discuss the issues. The whole oncology team have a role to play in patient sexuality guidance. The items on the INQ could be used as a reference tool for exploring patients' information needs.

Framing the decision to contract out elderly care and primary health care services - perspectives of local level politicians and civil servants in Finland.

BACKGROUND: In the literature there are only few empirical studies that analyse the decision makers' reasoning to contract out health care and social services to private sector. However, the decisions on the delivery patterns of health care and social services are considered to be of great importance as they have a potential to influence citizens' access to services and even affect their health. This study contributes to filling this cap by exploring the frames used by Finnish local authorities as they talk about contracting out of primary health care and elderly care services. Contracting with the private sector has gained increasing popularity, in Finland, during the past decade, as a practise of organising health care and social services. METHODS: Interview data drawn from six municipalities through thematic group interviews were used. The data were analysed applying frame analysis in order to reveal the underlying reasoning for the decisions. RESULTS: Five argumentation frames were found: Rational reasoning; Pragmatic realism; Promoting diversity among providers; Good for the municipality; Good for the local people. The interviewees saw contracting with the private sector mostly as a means to improve the performance of public providers, to improve service quality and efficiency and to boost the local economy. The decisions to contract out were mainly argued through the good for the municipal administration, political and ideological commitments, available resources and existing institutions. CONCLUSIONS: This study suggests that the policy makers use a number of grounds to justify their decisions on contracting out. Most of the arguments were related to the benefits of the municipality rather than on what is best for the local people. The citizens were offered the role of active consumers who are willing to purchase services also out-of-pocket. This development has a potential to endanger the affordability of the services and lead to undermining some of the traditional principles of the Nordic welfare state.

Mental health in complex health promotion policy programmes: the contribution of programme evaluations.

BACKGROUND: In order to develop policymaking, evaluation is required. The research project studied national health promotion policies concentrating on mental health promotion policy. In this paper the focus is on the position of evaluation. AIM: To explore the position of evaluation in the development of the national public health strategies of England and Finland and particularly with regard to mental health promotion policies. The evaluation phase of the policymaking process is also scrutinised through multiple streams of policy change. METHODS: Meta-evaluative approach applying a conceptual framework of policy analysis. RESULTS: Evaluations of national health strategies were executed in both countries. These evaluations entailed multiple tasks; not only to monitor the progress of the targets but to learn for the future in a wider perspective. Aims of mental health policy are not easily turned into quantitative targets and therefore outcome evaluation was not felt to be satisfactory as it lacks focus on process as well as null, perverse, and unintended consequences. CONCLUSIONS: While the position of evaluation is almost always more complicated than is assumed in so-called rational policymaking theory, mental health appears to be even more challenging in this respect. Possibilities for alternative evaluation strategies should be studied further.

Coordination of a complex welfare system case: rehabilitation entity in Finland.

The main purpose of this article is to analyse the institutional and political structures of the Finnish rehabilitation entity and the governmental efforts to improve the governance of the rehabilitation policy. Rehabilitation in Finland is a complex welfare system which has undergone several coordination attempts during the last two decades. The centrality of the coordination of this welfare system is obvious. Based on the content analysis of three Government's rehabilitation reports from 1994 to 2002 and their background papers, this article provides two main findings. First, the rehabilitation entity seems to be based on different funding strategies, different governing and different coordination models between the rehabilitation subsystems. Second, the governance discourse in the reports seems to be unchanging with a predominantly hierarchical mode. The article concludes with a discussion on the challenges to coordinate this kind of a complex welfare system as an entity and also how to overcome those challenges.

An analysis of ophthalmology services in Finland - has the time come for a Public-Private Partnership?

BACKGROUND: We studied the prerequisites for Public-Private Partnership (PPP) in the context of the Finnish health care system and more specifically in the field of ophthalmology. PPP can be defined as a more or less permanent cooperation between public and private actors, through which the joint products or services are developed and in which the risks, costs and profits are shared.The Finnish eye care services system is heterogeneous with several different providers and can be regarded as sub-optimal in terms of overall resource use. What is more, the public sector is suffering from a shortage of ophthalmologists, which further decreases its possibilities to meet the present needs. As ophthalmology has traditionally been a medical specialty with a substantial private sector involvement in service provision, PPP could be a feasible policy to be used in the field. We thus ask the following research question: Is there, and to what extent, an open window of opportunity for PPP? METHODS: In addition to the previously published literature, the research data consisted of 17 thematic interviews with public and private experts in the field of ophthalmology. The analysis was conducted in two stages. First, a literature-based content analysis was used to explore the prerequisites for PPP. Second, Kingdon's (1995) multiple streams theory was used to study the opening of the window of opportunity for PPP. RESULTS: Public and private parties reported similar problems in the current situation but defined them differently. Also, there is no consensus on policy alternatives. Public opinion seems to be somewhat uncertain as to the attitudes towards private service providers. The analysis thus showed that although there are prerequisites for PPP, the time has not yet come for a Public-Private Partnership. CONCLUSION: Should the window open fully, the emergence of policy entrepreneurs and an opportunity for a win-win situation between public and private organizations are required.

Knowledge sources affecting decision-making among social and health care managers.

PURPOSE: The purpose of this paper is to investigate how managers in social and health care evaluate the knowledge sources affecting their decision-making, and how the evaluations were associated with the managers' professional background, activity sector, gender, age and management experience. DESIGN/METHODOLOGY/APPROACH: The study data are gathered from a questionnaire survey to the middle-line doctor, nurse and social managers (n = 404) within the responsibility area of a Finnish university hospital. Assessed the proportions of individual knowledge sources in the complete data set and their associations with the subjects' background data. In addition, grouping of individual knowledge sources variables are made using factor analysis. FINDINGS: The findings indicate that social and health care managers attempt to utilize diverse knowledge sources. Overall, professional experience and education, organization budget, and action plans of one's own unit are estimated as knowledge sources with the greatest impact. Manager's professional background and activity sector are associated with the kind of knowledge affecting their decision-making. Some differences are noted between genders, but differences with respect to age or management experience are non-significant. RESEARCH LIMITATIONS/IMPLICATIONS: Social and health care organizations represent expert organizations where decision-making is steered by professions and management tasks. ORIGINALITY/VALUE: This paper suggests that the future decision-makers will be required to identify versatile knowledge areas across cultural barriers, and to be capable of making comprehensive decisions affecting the entire organization.

Window of opportunity for intersectoral health policy in Sweden--open, half-open or half-shut?

'Health in All Policies' (HiAP) is defined as a 'horizontal, complementary policy-related strategy with a high potential for contributing to population health'. To ensure that health impacts are highlighted across sectors, the support of actors in different sectors, not just the health sector, is needed. Public health, here defined as a universally important but a low prioritized politics area, needs to involve high politics areas to fulfil the HiAP strategy. This study aimed to analyse the agenda setting, formulation, initiation and implementation of the intersectoral public health policy and one tool of HiAP, health impact assessment (HIA), at the national and local level (exemplified by Stockholm County) in Sweden. A literature search was carried out of scientific and grey literature on intersectoral health policy and HIA in Sweden. The study was a policy analysis, using a content analysis method, and the theoretical framework of Kingdon where the results were examined through problem identification (why a window of opportunity opens for an intersectoral health policy and HIA), the factors and impact of politics (support for the formulation and implementation of policy) and policy (how best to solve the problem). The results showed that actors perceived the problems (the rationale) differently depending on their agenda and interest. Politicians and experts had a high impact on the formulation of the policy, agreeing on the policy goals. However, there was little focus on implementation plans implying that the political actors were not in agreement, and the experts sometimes showing conflicting evidence-based opinions on how to best ensure the policy. Without this in place, it is difficult to involve high politics areas, and vice versa, without the involvement of high politics, it is difficult to achieve the policy. However, this is a long-term process, where small steps need to be taken, leaving the policy window half-shut.

Opening communication with cancer patients about sexuality-related issues.

This study describes 215 healthcare professionals' experiences of discussing sexuality-related issues with cancer patients at a university hospital in Finland. The results indicate that staff on the cancer ward regard discussions about sexuality as a part of their job. However, discussions on these issues are uncommon: 98% of the respondents said that they talked about these issues with less than 50% of their patients, and only 35% started these discussions on their own initiative. The most important reason for not raising the issue is lack of training. More intensive education on how to open discussions on sensitive areas such as sexuality is needed.