Browsing by Subject "general practice"

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  • Miettola, Juhani; Viljanen, Anna Maria (2014)
    Objective. To find a salutogenic approach for prevention of metabolic syndrome in primary care practice. Design. An explanatory sequential mixed-methods procedure was used to fi nd salutogenic approaches for lifestyle change by assessing individual need, potential, and personal motivation. Data from a population health survey and interviews that focused on a sense of coherence were analysed. Subjects. Altogether 480 Finnish subjects participated in a population health survey, and 43 of them were interviewed. The 43 interviewees' data were included in the fi nal analysis. Main outcome measures. With the health survey participants' liability for MetS was assessed, and the objective need for lifestyle intervention was determined. Through the focused interviews potential and personal motivation for lifestyle modifi cation were explored. Finally the data of the 43 interviewed subjects were merged. Results. Four possible lifestyle intervention approaches were identifi ed for specifi c intervention. First, subjects with a strong sense of coherence only need encouragement to maintain a healthy lifestyle; second, professional support was found important for subjects with gaps in health awareness to improve health understanding; third, strengthening of social support for lifestyle change is necessary for subjects with various practical constraints in their everyday life; and fourth, strengthening of stress adaptation is important for subjects with redundant concerns about their health. Conclusions. Salutogenic client-centred lifestyle modifi cation approaches should be part of primary care practice. Further, a cross-disciplinary approach is needed in primary care research and practice to combat the exploding lifestyle illnesses.
  • Rapo-Pylkkö, Susanna; Haanpää, Maija; Liira, Helena (2016)
    Objective: To present the occurrence, characteristics, etiology, interference, and medication of chronic pain among the elderly living independently at home. Design/setting: A total of 460 subjects in three cohorts aged 75, 80 and 85 years respectively received visits by communal home-care department nurses for a cross-sectional survey. Of them, 175 had chronic (duration 3 months) pain with an average intensity of 4/10 and/or moderate interference in daily life. Main outcome measures: Clinical assessment was performed for consenting subjects to define the location, intensity, etiology, type, interference and medications of chronic pain. Results: According to home visits, elderly people with chronic pain rated their health and mobility worse and felt sadder, lonelier and more tired than those without chronic pain. A geriatrician made clinical assessments for 106 patients with chronic pain in 2009-2013. Of them, 66 had three, 35 had two and 5 had one pain condition. The worst pain was musculoskeletal in 88 (83%) of patients. Pain was pure nociceptive in 61 (58%), pure neuropathic in 9 (8%), combined nociceptive and neuropathic pain in 34 (32%), and idiopathic in 2 (2%) patients. On a numerical rating scale from 0 to 10, the mean and maximal intensity of the worst pain was 5.7 and 7.7, respectively, while the mean pain interference was 5.9. Mean pain intensity and maximal pain intensity decreased by age. Duration of pain was longer than 5 years in 51 (48%) patients. Regular pain medication was used by 82 (77%) patients, most commonly paracetamol or NSAIDs. Although pain limited the lives of the elderly with chronic pain, they were as satisfied with their lives as those without chronic pain. Conclusions: Elderly people in our study often suffered from chronic pain, mostly musculoskeletal pain, and the origin of pain was neuropathic in up to 40% of these cases. However, elderly people with chronic pain rarely used the medications specifically for neuropathic pain. Based on increased loneliness, sadness and tiredness, as well as decreased subjective health and mobility, the quality of life was decreased among those with chronic pain compared with those without pain.
  • Kauppila, Timo; Laine, Merja K.; Honkasalo, Mikko; Raina, Marko; Eriksson, Johan G. (2016)
    Objective: To characterize dropouts from type-2 diabetes (T2D) care in communal primary health care. Design: An observational study. Setting: In a Finnish city, patients with T2D who had not contacted the public primary health care system during the past 12 months were identified with a computer based search and contacted by a trained diabetes nurse. Subjects: Dropouts from T2D treatment. Main outcome measures: Demographic factors, laboratory parameters, examinations, medications, and comorbidities. Results: Of the patients with T2D, 10% (n=356) were dropouts and 60% of them were men. Median HbA(1c) was 6.5 (QR for 25% and 75%: 6.0, 7.7) %, (45 [42,61] mmol/mol). Of the dropouts, 14% had HbA(1c)9.0% (75mmol/mol), and these patients were younger than the other dropouts (mean age 54.4 [SD 10.8] years vs. 60.6 [9.4] years, p Conclusions: Ten percent of T2D patients were dropouts of whom those with a poor glycaemic control were younger than the other dropouts. BP and LDL cholesterol concentrations were non-optimal among the majority of the dropouts. Metformin was prescribed less frequently to the dropouts than is usual for T2D patients. The comorbidities were equally common among the dropouts as among the other T2D patients.
  • Liira, Helena; Koskela, Tuomas; Thulesius, Hans; Pitkala, Kaisu (2016)
    Objective: Research and PhDs are relatively rare in family medicine and primary care. To promote research, regular one-year research courses for primary care professionals with a focus on clinical epidemiology were started. This study explores the academic outcomes of the first four cohorts of research courses and surveys the participants' perspectives on the research course. Design: An electronic survey was sent to the research course participants. All peer-reviewed scientific papers published by these students were retrieved by literature searches in PubMed. Setting: Primary care in Finland. Subjects: A total of 46 research course participants who had finished the research courses between 2007 and 2012. Results: Of the 46 participants 29 were physicians, eight nurses, three dentists, four physiotherapists, and two nutritionists. By the end of 2014, 28 of the 46 participants (61%) had published 79 papers indexed in PubMed and seven students (15%) had completed a PhD. The participants stated that the course taught them critical thinking, and provided basic research knowledge, inspiration, and fruitful networks for research. Conclusion: A one-year, multi-professional, clinical epidemiology based research course appeared to be successful in encouraging primary care research as measured by research publications and networking. Activating teaching methods, encouraging focus on own research planning, and support from peers and tutors helped the participants to embark on research projects that resulted in PhDs for 15% of the participants.
  • Liira, Helena; Engberg, Elina; Leppavuori, Jenni; From, Svetlana; Kautiainen, Hannu; Liira, Juha; Remes-Lyly, Taina; Tikkanen, Heikki; Pitkala, Kaisu (2014)
  • Teramura-Gronblad, Mariko; Raivio, Minna; Savikko, Niina; Muurinen, Seija; Soini, Helena; Suominen, Merja; Pitkala, Kaisu (2016)
    Objective: This study aims to assess potentially severe class D drug-drug interactions (DDDIs) in residents 65 years or older in assisted living facilities with the use of a Swedish and Finnish drug-drug interaction database (SFINX). Design: A cross-sectional study of residents in assisted living facilities in Helsinki, Finland. Setting: A total of 1327 residents were assessed in this study. Drugs were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and DDDIs were coded according to the SFINX. Main outcome measures: Prevalence of DDDIs, associated factors and 3-year mortality among residents. Results: Of the participants (mean age was 82.7 years, 78.3% were females), 5.9% (N=78) are at risk for DDDIs, with a total of 86 interactions. Participants with DDDIs had been prescribed a higher number of drugs (10.8 (SD 3.8) vs. 7.9 (SD 3.7), p Conclusions: Of the residents in assisted living, 5.9% were exposed to DDDIs associated with the use of a higher number of drugs. Physicians should be trained to find safer alternatives to drugs associated with DDDIs.
  • Laukkanen, L Erika; Vehkalahti, Miira M; Kotiranta, Anja (2021)
    Objective:This study evaluated the radiographic outcome of root canal treatments (RCTs) performed by general dental practitioners (GDPs) with focus on tooth type and quality of root filling. Materials and methods:The target population included all patients receiving root filling by GDPs in City of Helsinki in 2010-2011. Equal numbers of each tooth type (anteriors, premolars, molars) by jaw were included, resulting in 426 teeth. Pre- and post-operative periapical radiographs were assessed to evaluate periapical status and quality of root filling. Statistical evaluation utilized Chi-squared tests, Cohen's kappa and logistic regression modelling. Results:The overall success rate of RCT was 67.4%, being 76.8%, 69.7% and 55.6% (p <.001) for anteriors, premolars and molars, respectively. The quality of root fillings varied by tooth type (p <.001); optimal fillings were least frequent (43%) in molars. In multifactorial analysis, RCTs were more likely to succeed in non-molars (OR = 1.8), in teeth with optimal root fillings (OR = 3.6) and in teeth without apical periodontitis (OR = 3.2). Conclusion:The quality of root fillings and radiographic outcome of RCTs varied considerably according to tooth type; success was least likely in molars. Improvement is needed in quality of RCTs by GDPs.
  • Kuneinen, Susanna M.; Eriksson, Johan G.; Kautiainen, Hannu; Ekblad, Mikael O.; Korhonen, Päivi E. (2021)
    Objective There is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. This study aimed to evaluate the effectiveness of a primary care CVD prevention program on mortality during a 13-year follow-up. Design A risk factor survey was sent, followed by a nurse-led lifestyle counselling to respondents with at least one CVD risk factor, and a general practitioner's (GP) appointment for high-risk persons. Screening and interventions were performed during 2005-2006. Setting A public health care centre in the town of Harjavalta, Finland. Subjects All home-dwelling 45-70-year old inhabitants without manifested CVD or diabetes. Main outcome measures All-cause and CVD mortality. Results Altogether 74% (2121/2856) inhabitants responded to the invitation. The intervention was received by 1465 individuals (52% of the invited population): 398 risk persons had an appointment with a nurse, followed by an appointment with a GP for 1067 high-risk persons. During the follow-up, 370 persons died. Mortality among the non-respondents was twofold compared to the participants'. In subjects who received the intervention, the age- and gender-adjusted hazard ratio for all-cause mortality was 0.44 (95% CI: 0.36 to 0.54) compared to the subjects who did not receive the intervention. Conclusions Reducing mortality is possible in a primary care setting by raising health awareness in the community with screening, by targeted lifestyle counselling and evidence-based preventive medication for persons at high risk for CVD. Subjects not willing to participate in health surveys have the worst prognosis.