Reproductive and maternity health care services in Finland: perceptions and experiences of Somali-born immigrant women

Objective. To explore immigrant Somali women's experiences of reproductive and maternity health care services (RMHCS) and their perceptions about the service providers.

Design. Five focus group discussions were conducted from April 1999 to June 2000 using a purposeful sampling strategy in order to reach multiparous female Somali-born Immigrants with experiences from the maternity health care in Finland.

Participants. A total of 70 married Somali women aged 18–50 and mother of 2–10 children were studied. Among them, 18 came from Kenya, 32 from Mogadishu and 20 from Hargeysa.

Settings. Of the participants, 45 were living in the city of Vantaa, 22 in the city of Helsinki and 13 in the city of Turku.

Results. Participants were satisfied with the RMHCS they received in Finland. Despite their satisfaction, the health care providers' social attitudes towards them were perceived as unfriendly, and communication as poor.

Conclusions. The women's experiences revealed that they have access to good quality RMHCS in Finland. While their experiences are significant, their perceptions are important for physicians, nurses and midwives in order to achieve culturally competent care.     

Effect of Different Obesity Phenotypes on Incidence of Chronic Kidney Disease in Tehranian Adults

Background: The aim of this community-based study is to ascertain the effect of different obesity phenotypes on the incidence of chronic kidney disease in Iranian adults.

Study Design: A prospective cohort study, the Tehran Lipid Glucose Study (TLGS).

Setting and Participants: Adults aged ≥ 20 years with a mean age of 40.38 years (54.8% female) who were free from chronic kidney disease (CKD) at baseline (phase 1) and were followed up at 3 time stages (phases 2, 3, and 4) for a mean duration of 9.4 years to assess the risk for CKD.

Predictor: Obesity phenotypes.

Outcome: Incidence of chronic kidney disease.

Measurements: Glomerular filtration rate (GFR) was estimated from the simplified equation developed using data from the Modification of Diet in Renal Disease (MDRD) Study.

Results: CKD events occurred in 1162 participants. The prevalence of the 2 known obesity phenotypes (metabolically obese normal weight [MONW] and metabolically healthy but obese [MHO]) in the overall population was 3.5% and 8.8%, respectively. According to Kaplan-Meier curves, rates of freedom from CKD in the MHO and MONW obesity phenotypes were 75.3% and 60.6%, respectively (p < 0.0001). Age- and sex-adjusted (model 1) hazard ratios for participants with MHO or MONW obesity phenotype were 1.14 (95% confidence interval [CI], 0.91–1.43) and 1.43 (95% CI, 1.09–1.88), respectively. After further adjustment for confounder variables (model 2), multivariate-adjusted hazard ratios for CKD for participants with MHO or MONW obesity phenotypes were 1.23 (95% CI, 0.93–1.62) and 1.43 (95% CI, 1.08–1.90), respectively.

Conclusion: Adults with the MONW obesity phenotype compared to those with MHO obesity phenotype have a higher risk for incidence of CKD. The results indicate that having a normal weight is not the only factor to protect against incidence of CKD.     

Occupational exposure and respiratory health problems among nutmeg production workers in Grenada,the Caribbean

Background: The nutmeg industry is a major contributor to the Grenadian economy. However, workers in the industry face many environmental and occupational health risks.

Objectives: The goal of this study was to investigate respiratory health problems and possible related occupational exposures among nutmeg production workers.

Methods: A questionnaire, spirometry and allergen skin-prick test was given to 92 nutmeg workers. Samples for measurement of airborne dust, mold, and phosphine were also collected from work environments.

Results: Approximately half of the workers with lower respiratory symptoms such as dry cough (49.4%) and shortness of breath (42.9%) reported that their symptoms were work related. Spirometry results showed that 18.8% of workers had obstruction. Area geometric mean (GM) inhalable dust concentrations, GM personal concentrations, and total mold spores during work activities were found to be high.

Conclusions: High prevalence of respiratory symptoms among workers in this facility was consistent with measured levels of dust and mold, and was widespread over all work areas.     

Short-term Exposure to a Mediterranean Environment Influences Attitudes and Dietary Profile in U.S. College Students: The MEDiterranean Diet in AMEricans (A-MED-AME) Pilot Study

Objective: The aim of this study was to investigate whether short-term exposure to a Mediterranean diet during a structured abroad experience could influence dietary habits and attitudes.

Design: This study used a cross-sectional design.

Setting: The study was conducted on the Florence University of the Arts (FUA) campus, Italy.

Subjects: Fifty-four (47 females, 7 males; mean age 21.1 ± 1.9 years) college students from 12 different states, mainly located in the central United States, were enrolled in this study.

Measures of Outcome: Outcome measures included adherence score to Mediterranean diet and self-reported perceptions of diet and food availability. A demographic survey was used to collect data regarding personal characteristics, anthropometrics, duration of stay, and residency status.

Analysis: Chi-square test, independent T-test, and Mann-Whitney test were used to perform analyses.

Results: At 3 weeks' follow-up, 94% of the population reported that availability of foods affected their food choices. Interestingly, students reported that they consumed less meat with respect to their usual dietary habits in the United States (p < 0.0001) and they reported significantly increased the consumption of olive oil, cereals, fruit, and alcohol (p < 0.05). The adherence score to a Mediterranean diet significantly increased by about 1 point, going from 9.9 ± 2.4 to 10.9 ± 2.0 (p < 0.05).

Conclusions: After a 3-week stay in Italy, an increase in the adherence score to a Mediterranean diet was observed. Future research should explore the relationship between length of time spent in a foreign country and dietary adherence in a cultural context.     

Impact of occupational,physical, and speech and language therapy in preschoolers with hyperactive/inattentive symptoms: A naturalistic 2-year follow-up study

Objective: Impact of speech and language therapy (ST) and occupational/physical therapy (OT/PT) on language and motor skills was examined in hyperactive/inattentive children.

Methods: Preschoolers were divided into those receiving and not receiving ST or OT/PT.

Results: Children receiving ST showed no gains in language functioning relative to those not receiving ST. OT/PT yielded similar results for motor functions. Hours of a service did not predict improvement. However, children who received ST showed improvement in social skills.

Discussion: The apparent lack of benefit suggests the need for further investigation into efficacy of these treatments in hyperactive/inattentive preschool children.     

Book Reviews

Marketing for health services

Rod Sheaff. Open University Press, Milton Keynes. ISBN 0-335-15427-1 (pbk) £11.99.

Quasi-Markets and Contracts: A market and Heirarchies Perspective on NHS Reform

Will Bartlett. SAUS Publications, University of Bristol, 1991. ISBN 1-873575-05-X.     

Clinical,nerve conduction and nerve biopsy study in vitamin B12 deficiency neurological syndrome with a short-term follow-up

Objective

The frequency and type of neuropathy in vitamin B12 deficiency neurological syndrome (VBDNS) is controversial. This study reports the frequency and type of nerve dysfunction in VBDNS using nerve conduction and sural nerve biopsy and its response to treatment.

Method

Sixty-six patients with VBDNS diagnosed on the basis of low serum vitamin B12 level and/or megaloblastic bone marrow were subjected to clinical evaluation, hemoglobin, mean corpuscular volume, thyroid function test, HIV serology, and vasculitic profile. Peroneal motor and sural sensory nerve conduction studies were done. Sural nerve biopsy was done in six patients. The patients were treated with cyanocobalamin injection and followed up clinically and with nerve conduction study at 3 and 6 months.

Results

The median age of the patients was 46 (12–80) years and 11 patients were females. The duration of symptoms was 1–96 (median 7) months. Clinical features of neuropathy were present in 46 (69.7%) patients and nerve conduction was abnormal in 36 (54.5%) patients. On nerve conduction study, 8 (22.2%) patients had axonal, 4 (11.1%) had demyelinating, and 24 (66.7%) had mixed features. Nerve biopsy revealed acute axonal degeneration in early stage and chronic axonopathy with demyelination in the late stages of disease. The nerve conduction parameters improved at 6 months along with clinical recovery.

Conclusion

Nearly 70% patients with VBDNS had evidence of neuropathy which is mainly axonal with some demyelinating features.     

Preventive behaviour at work – A concept analysis

Background: Preventive behaviour is a significant intervention target in order to promote health at work, but has never been discussed in an occupational perspective.

Aim: To clarify the concept of preventive behaviour at work.

Methods: The Walker and Avant (2011) method was used to conduct the study.

Results: The attributes of the concept are: (1) compliance with safety rules and procedures, (2) proactivity, participation, engagement and initiatives related to prevention, (3) maintenance of physical environment, (4) concern for social environment and (5) reflexivity and analytical skills of work situations. The analysis also identified the antecedents and the consequences of the concept that are all related to either the person, the environment or the occupation.

Conclusion: Preventive behaviour occurs when a worker shows an active involvement to comply with safety rules and procedures of his trade, takes initiatives to improve prevention, preserves his physical environment, communicates with his peers and analyses work situations before committing to it.

Significance: Occupational therapists have a central role in primary prevention of work injuries and have the expertise to help develop each of the five attributes of the concept of preventive behaviour.     

Evaluation of Barley's Beta-glucan Food Fortification through Investigation of Intestinal Permeability in Healthy Adults

Objective: Intestinal permeability is an index of the adequate function of the intestinal barrier and its modification is associated with intestinal diseases. The aim of the study is to investigate the hypothesis that barley's beta-glucan can inhibit the alteration of intestinal permeability and maintain intestinal integrity after a period of consumption of a carbohydrate snack (cake) rich in sugars.

Methods and Design: Volunteers participated in a placebo-controlled intervention study for 1 month. In this double-blind methodology, they were randomly assigned to (1) the intervention group (daily consumption of one portion of cake fortified with barley's beta-glucan) or (2) the placebo group (daily consumption of the same cake without the enrichment). Intestinal permeability was assessed using the lactulose/mannitol test.

Setting: Athens, Greece.

Subjects: Twenty-three healthy volunteers (age > 40 years).

Results: Intestinal permeability did not differ between the 2 groups, both at the beginning and at the end of the intervention. In addition, the intestinal permeability was not significantly modified at the end of the intervention in each group.

Conclusions: The results of the lactulose/mannitol test for the intervention and placebo groups were comparable. For healthy adults, the daily consumption of a simple cake (placebo) and the consumption of the cake fortified with barley's beta-glucan resulted in similar impact for intestinal permeability; thus, beta-glucans did not exert a protective role in intestinal permeability of healthy adults.     

The non-clinical contents of GP training need more attention. Results from the Finnish Physician Study

Background: The competencies required of a GP are complex and ever-expanding. GP training should adequately cover all the content areas.

Objectives: The aim was to assess GPs’ and GP trainees’ satisfaction with their specialist training and with the contents of training. Trends in assessments over a ten-year period were investigated.

Methods: Data from Finnish national surveys of physicians conducted in 1998, 2003 and 2008 were analysed with 606, 457 and 324 GPs and GP trainees respectively being sampled in the present study. Respondents were asked how satisfied they were with their own specialist training in general, and how much instruction they had received in 12 specific areas during their specialist training.

Results: Satisfaction with GP training slowly increased during the study years. In 2008, 59% of respondents were satisfied with their training, compared to 46% in 1998. The best covered content area was clinical work. Major shortcomings were reported in many of the content areas analysed, e.g. management and leadership.

Conclusion: Although the trend in satisfaction with GP training in Finland is for the better, there are shortcomings, especially in many of the non-clinical content areas of training. More attention needs to be paid to these areas in the future.     

Rodent control in urban communities in Johannesburg,South Africa: from research to action

Introduction:

Rodents are troublesome urban pests, with potentially serious health implications. Preventive efforts require greater understanding of social contexts in which they are prevalent. This study aimed to determine rodent prevalence and identify factors associated with rodent infestations in urban residential settings.

Methods:

The Health, Environment and Development study is a longitudinal panel study conducted in five settlements across Johannesburg. Data on socio-economic status, domestic behaviour and housing quality are collected annually. Logistic regression revealed risk factors for rodent prevalence at household level.

Results:

Rodents are a major household problem in all study areas (prevalence 54%). Factors associated with increased prevalence of rats included lower income, living in informal areas, overcrowding, cracks in dwelling walls and internal damp.

Conclusion:

Socio-economic status, housing quality, domestic behaviour and environmental health services are associated with exposure to rodents in urban Johannesburg communities. This information served as a platform to launch rodent awareness campaigns at study sites.     

Strategies to manage activities in everyday life after a pain rehabilitation program

Background: Owing to the complexity of the pain experience, it is important to understand how persons with chronic pain manage their condition, in order to provide an indication of how occupational therapists can enable participation in meaningful everyday activities during pain rehabilitation.

Aim: The aim of this study was to explore how persons with chronic pain reason about their use and choice of strategies to manage activities of everyday life.

Materials and methods: A qualitative approach was used to capture experiences of strategies employed to manage activities while living with chronic pain. Eight persons agreed to participate.

Results: An overall theme, ‘adjusting to life with chronic pain’, encompasses the underlying meaning and the relations between the categories: finding new ways to perform activities, reaching for a reasonable balance of activities and using activities to achieve other purposes.

Conclusion and significance: Persons with chronic pain use various strategies as means to enable performance in activities of everyday life despite living with pain, which supports the conception that occupational therapists should focus on activities and strategies rather than the pain condition during pain rehabilitation.     

Dietary fat and antioxidant vitamin intake in patients of neurodegenerative disease in a rural region of Jalisco,Mexico

Objective

To evaluate and compare the intake of lipids and (A, E, and C) vitamins in patients with and without possible neurodegenerative diseases.

Methods

Twenty adults with possible Alzheimer's disease or Parkinson's disease and 41 control subjects (50–89 years old) from a rural region were studied. Dietary intake was evaluated with the analysis of macronutrients and micronutrients conducted by a food frequency questionnaire and 24 hours dietary record. Analyses were adjusted for age, sex, body mass index, and energy intake. Through interrogation and use of medical record form of health secretary we obtained information about the sociodemographic characteristics. Multivariate analysis of variance to allow for covariated adjustment was used.

Results

Patients had a lower energy intake, vitamin C (P = 0.016), fruits (P < 0.001), vegetables (P = 0.037), and oils and fat (P = 0.002), than the controls. Interestingly, the C vitamin intake in patients was still higher than the recommended. Patients had a higher consumption of cereals (P = 0.017), high-animal fat diet (P = 0.024), and whole milk (P < 0.001); 2.4% of the controls smoke and 5% are alcohol consumers. Eighty-five percent of patients and 78% of the controls do not have physical activity. Family history of subjects in this study indicated chronic diseases.

Conclusion

The subjects included in this study had a high intake of C vitamin, this is due to the consumption of fruits and vegetables. However, patients with possible Alzheimer's or Parkinson's disease had a lower intake of fruits and vegetables, which could be due to type of food to which they have access.     

Functions of Coenzyme Q10 Supplementation on Liver Enzymes,Markers of Systemic Inflammation,and Adipokines in Patients Affected by Nonalcoholic Fatty Liver Disease: A Double-Blind,Placebo-Controlled,Randomized Clinical Trial

Background: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disorder related to inflammation. Coenzyme Q10 (CoQ10) is a natural compound that has recently been considered as an anti-inflammatory factor. In the current study we aimed to evaluate the effects of CoQ10 supplementation on liver enzymes, inflammation status, and adipokines in patients with NAFLD.

Methods: Forty-one subjects with NAFLD participated in the current randomized, double-blind, placebo-controlled trial. The participants were randomly divided into 2 groups: one group received CoQ10 capsules (100 mg once a day) and the other received placebo for 12 weeks. Blood samples of each patient were taken before and after the 12-week intervention period for measurement of liver aminotransferases, inflammatory biomarkers, and adipokines (adiponectin and leptin).

Results: Taking 100 mg CoQ10 supplement daily resulted in a significant decrease in liver aminotransferases (aspartate aminotransferase [AST] and gamma-glutamyl transpeptidase [GGT]), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor α, and the grades of NAFLD in the CoQ10 group in comparison to the control group (p < 0.05). In addition, patients who received CoQ10 supplement had higher serum levels of adiponectin (p = 0.016) and considerable changes in serum leptin (p = 0.053). However, no significant changes occurred in serum levels of interleukin-6 in both groups.

Conclusion: The present study suggested that CoQ10 supplement at a dosage of 100 mg could be effective for improving the systemic inflammation and biochemical variables in NAFLD.     

Family history tools for primary care are not ready yet to be implemented. A systematic review

Background: Taking the family history helps the doctor in estimating the probability of disease in individual patients. However, significant barriers to obtaining adequate family history information remain. Tools overcoming these barriers might support family physicians in this task.

Objective: To review systematically the characteristics of existing family history tools and discuss their potential use in primary care.

Methods: Studies were identified through searches of PubMed, Embase and Cinahl from 1 January 2002 until May 2012. All authors independently screened studies and included original research papers on family history tools of which assessment had been performed or was planned. We reviewed diseases for which family history information was collected, study setting, tool design, type of family history collection, presence of risk-assessment and recommendations for management, and assessment (categorized as either validity or benefit).

Results: Eighteen family history tools were identified: six generic, two on cardiovascular disease and ten on cancer. The six generic tools were partly tested in primary care (3x), are mainly computerized (4x), rarely include management recommendations for the physician (1x) and were partly validated against a reference standard (genetic counsellor) (3x, plus one planned). Of the five specific tools studied in primary care, none was validated. No family history tool allows electronic transfer of family history information to electronic medical record systems. Use of a family history tool improved identification of patients at risk for disease.

Conclusion: Several promising family history tools for primary care have been developed but large-scale implementation cannot be advised yet, based on available validation studies.     

Occupational problems and barriers reported by individuals with obesity

Background: Even if occupational therapists meet many people with obesity in the course of their work, a majority of them do not seem to view weight management as within their area of professional practice.

Aim: To explore the occupational problems and barriers among persons with severe obesity from an occupational therapy perspective.

Materials and methods: The study used the Canadian Model of Occupation and Engagement (CMOP-E) and Canadian Occupational Performance Measure (COPM) to identify and analyze prioritized occupational performance problems and barriers perceived by 63 individuals with obesity.

Results: The occupational problems individuals with obesity most frequently prioritized comprised playing with (grand)children, purchasing clothes, implementing regular meals and going to the swimming pool, while the barriers they most frequently described were dyspnea, musculoskeletal disorders, narrow chairs and seats, fear of glances and comments from others, and social anxiety.

Conclusion: Persons with obesity struggle with a large variety of occupational performance problems, which occur in the dynamic relationship between these individuals, their environment and their occupation. Occupational therapists have the skills to take more active role in helping persons with obesity to perform valued occupations and establish healthier everyday routines.     

Self-rating of daily time management in children: psychometric properties of the Time-S

Background: Impaired ability to manage time has been shown in several diagnoses common in childhood. Impaired ability involves activities and participation domain (daily time management, DTM) and body function and structure domain (time-processing ability, TPA). DTM needs to be evaluated from an individual’s own perspective. To date, there has been a lack of self-rating instruments for children that focus on DTM.

Aim: The aim of this study is to describe psychometric properties of Time-S when used in children aged 10–17 years with a diagnosis of ADHD, Autism, CP or mild ID. Further, to test whether TPA correlates with self-rated DTM.

Material and methods: Eighty-three children aged 10–17 years participated in the study. Rasch analysis was used to assess psychometric properties. Correlation analysis was performed between Time-S and a measure of TPA.

Results: The 21 items of the Time-S questionnaire fit into a unitary construct measuring self-perceived daily management of an individual’s time. A non-significant, small correlation was found between TPA and DTM.

Conclusion and significance: The results indicate good psychometric properties for the questionnaire. The questionnaire is potentially useful in intervention planning and evaluation.     

Comparison of nutritional status indicators according to feeding methods in patients with acute stroke

Background

Feeding methods for patients with acute stroke differ based on their ability to swallow; therefore, it is necessary to determine whether these methods deliver enough nourishment to these patients. Although nutrition could affect recovery from acute stroke, it is often overlooked. Indicators of nutritional status are important for the nutritional assessment of patients.

Purpose

The purpose of this study was to compare changes in nutritional indicators with various feeding methods in patients with acute stroke.

Methods

Data on 261 patients with acute stroke who were admitted to a stroke unit in 2010 and met the inclusion criteria of the study were retrospectively analyzed. For comparative analysis, we investigated the participants' National Institutes of Health Stroke Scale score, feeding methods using the Modified Gugging Swallowing Screen, and indicators of nutritional status, such as body mass index, pre-albumin level, albumin level, total lymphocyte count, and total protein level. All nutritional indicators were compared at the time of admission to the stroke unit and at 7 days after admission.

Results

At the time of admission, indicators of nutritional status were within normal ranges in all feeding groups (tube, dysphagia, and general diet). At 7 days after admission, pre-albumin (P = 0.003), albumin (P = 0.001), and total protein (P = 0.000) values in the tube feeding group were below the normal range, and the pre-albumin value and total lymphocyte count were below the normal range in the dysphagia diet group (P = 0.027). The values for all nutritional indicators were within normal limits in the general diet group.

Conclusions

Indicators of nutritional status change according to the swallowing ability of patients with acute stroke. At 7 days after admission to the stroke unit, patients with severe dysphagia had higher levels of indicators of malnutrition. Health care providers should consider whether the feeding method of each patient with stroke provides suitable nourishment. Additionally, it is important to know why these indicators vary based on swallowing abilities and what these patients require for adequate nutrition.     

Extending viability of Lactobacillus plantarum and Lactobacillus johnsonii by microencapsulation in alginate microgels

Aim: To investigate whether microencapsulation of Lactobacillus in alginate microbeads will lead to increased longevity during refrigerated storage or simulated digestion.

Materials and methods: Microscopy was used to confirm that Lactobacillus plantarum ATCC BAA-793 and Lactobacillus johnsonii ATCC 33200 were immobilised within the microbeads and laser scattering analysis was used to determine the mean diameter of the microbeads. The number of viable cells were enumerated throughout refrigerated storage and simulated digestion experiments.

Results: Microencapsulation was shown to have differing effects on viability depending on the species, but led to extended viability during refrigerated storage and simulated digestion in L. johnsonii and L. plantarum respectively.

Conclusion: Fermented functional foods contain microbes beneficial to human health. However, extended shelf storage and the harsh environment of the GI tract significantly reduces the number of viable microbes reaching the consumer. Microencapsulation allows beneficial microbes to reach the gut of the consumer in higher numbers, and thus confer greater health benefits.