The use of videoconferencing for telepsychiatry in Finland.

Some of the first telepsychiatry experiments in Finland were carried out at the Department of Psychiatry of the University of Oulu, where videoconferencing has been used for family therapy, occupational counselling, consultation and teaching. In 1996 videoconferencing was used for a total of 249 hours, which increased to 434 hours in 1997. During 1997, 45% of the time was used for teaching, 26% for occupational counselling, consultations and therapies, 23% for training and 6% for administration (mainly testing the connections). In a survey, 37 participants rated aspects of the quality of the videoconferences on a scale from 4 (poor) to 10 (excellent). The audio quality had a mean value of 8.0 (SD 0.9), the picture quality 7.5 (SD 1.5), and the general value of the videoconference was rated 7.5 (SD 1.0). Preliminary results with telepsychiatry in Finland have been promising. Interactive videoconferencing provides an easy, fast and relatively inexpensive method of providing psychiatric services over long distances.     

Strategic questions for consumer-based health communications.

Using the consumer-oriented approach of social and commercial marketers, this article presents a process for crafting messages designed to improve people''s health behaviors. The process, termed consumer-based health communications (CHC), transforms scientific recommendations into message strategies that are relevant to the consumer. The core of CHC is consumer research conducted to understand the consumer''s reality, and thereby allowing six strategic questions to be answered. The immediate result of the CHC process is a strategy statement--a few pages that lay out who the target consumer is, what action should be taken, what to promise and how to make the promise credible, how and when to reach him or her, and what image to convey. The strategy statement then guides the execution of all communication efforts, be they public relations, mass media, direct marketing, media advocacy, or interpersonal influence. It identifies the most important "levers" for contact with the consumer. Everyone from creative specialists through management and program personnel can use the strategy statement as a touchstone to guide and judge the effectiveness of their efforts. The article provides a step by step illustration of the CHC process using the 5 A Day campaign as an example.     

Supplier-induced demand for physiotherapy in the Netherlands

Empirical studies of supplier-induced demand in health care have mostly concentrated on the analysis of physician behaviour. In this article, the focus is on the economic determinants of physiotherapist behaviour in The Netherlands. It is shown that relative prices work as strong incentives to alter the mix of services supplied, conform to the model of revenue maximization under a production constraint. However, the time-series analysis also gives some indication that this ability to influence the demand for their services to increase hourly income is not fully exploited. The latter finding is inconsistent with pure income maximization but rather points to a trade-off between loss of revenue and demand manipulation. The fact that the choice of therapy varies with the pressure on provider incomes does not cast some doubt on the appropriateness of the chosen patterns of treatment in terms of effectiveness.     

Lumbar disc syndrome in Finland.

The prevalence of lumbar disc syndrome (herniated disc or typical sciatica) and its consequences in terms of disability, handicap, and need for medical care were studied as part of the Mini-Finland Health Survey. A sample of 8000 persons representative of the Finnish population aged 30 or over was asked to come for examination, and 7217 (90%) participated. A diagnosis of lumbar disc syndrome based on medical history, symptoms, and standardised physical examination was made for 5.1% of the men and for 3.7% of the women. Half of these patients were assessed to be in need of medical care, over 80% of which was considered to be adequately met. One third of all patients with lumbar disc syndrome had been previously hospitalised for that syndrome, and one fifth of the patients had undergone lumbar surgery. At least slight disability was found in almost 60% of the patients, though severe functional limitations were rare. About 6% of the population's work disability was estimated to be attributable to lumbar disc syndrome.     

Hospital treatment of addicts arrested for intoxication in Finland.

In the present study the treatment of addicts as performed by the Finnish police was investigated. The intention was to evaluate how the treatment procedure functioned in meeting the need for medical care and safety of the addict. The series was collected from the police district of Helsinki, the Finnish capital, and comprised all addicts arrested and transported to hospital during 1969. The series totalled 859 cases, which is about 2% of all addicts arrested in Helsinki during 1969. The reasons for transportation to hospital were: external injuries (60%) and the addict's complaints of an injury or illness (17%). Of all subjects, 44 were admitted to a hospital ward and of these, 2 died later on the ward. Furthermore, 7 addicts had died at the police station, on the way to hospital, or at the out-patients' department. Thus the number of deaths totalled 9. On investigating the cases of death in detail it was found that omission of or delay in the transport to hospital may have been of decisive influence on the addict's death in 4 cases. It was estimated that, had the police not transported any of the addicts to hospital, the number of deaths would have been about 20. When the cost of hospital treatment and transport to hospital is used as an evaluation factor the effort of the activity covered by the present study is 98 500 Fmk (U.S. $ 23 200). The output is the number of lives saved, i.e. 11. The efficiency of the activity is thus the saving of one life at the cost of about 9000 Fmk (about 2 100 U.S. $). The social characteristics of the addict were not found to have had a decisive bearing on the question of transportation to hospital. Differences between the various points of activity were observed in the relative numbers of the addicts arrested and transported to hospital.     

Atopy: a predisposing factor for chronic bronchitis in Finland.

STUDY OBJECTIVE--To investigate the predictive value of atopy, smoking, and living in a farm environment in the development of chronic bronchitis. DESIGN--This was a cross sectional and longitudinal study. SETTING--Postal surveys carried out in Finland in 1975 and 1981. PARTICIPANTS--The study was part of the Finnish twin cohort study, which included adult twin pairs born in Finland before 1958. The cross sectional sample consisted of 18,351 subjects, including 1025 prevalent cases, and the follow up sample comprised 17,134 subjects, 553 of whom were incident cases of chronic bronchitis. MAIN RESULTS--According to the cross sectional data, chronic bronchitis was associated with atopy (relative risk 1.41) and smoking (2.43). In the follow up data, chronic bronchitis was related to atopy (1.28), smoking (2.31), and farming (1.45). CONCLUSIONS--The results confirm the earlier finding in the Finnish farming population that, in addition to smoking, atopy predisposes the development of chronic bronchitis. A farm environment was also found to be a predisposing factor. The results give further support to the "Dutch hypothesis" on the etiology of chronic bronchitis, according to which atopy is a predisposing factor.     

Occupational exposure to carcinogens in Finland.

Finland has kept a registry on the manufacture and use of carcinogenic agents involving occupational exposure since 1979. Employers must report annually to the labor safety authorities the employees who have been exposed to carcinogens and provide information on carcinogenic agents produced, used, or formed. Out of 131 substances or groups of agents listed as carcinogenic, occupational exposure to 78 of them was reported in 1987. About half of the agents reported were used or produced in industry and half were handled on a laboratory scale. About 15,000 employees from 1,700 work departments were reported to the registry; 17% of them were women. The number of workers reported in 1987 accounted for 0.6% of the total work force. It has been estimated that at least 60,000 workers are exposed annually to carcinogens in Finland. The three most prevalent exposures--hexavalent chromium compounds, nickel and its inorganic compounds, and asbestos--accounted for over 60% of all exposed workers; only five carcinogenic chemicals were produced in Finland in 1987.     

Quality of contraceptive services in Finland.

OBJECTIVE: To investigate whether the quality of contraceptive services in Finland varies by the type of care provider. DESIGN: A cross sectional questionnaire survey. PARTICIPANTS: A random sample of 3000 Finnish women aged 18-44 years (response rate 74%) in 1994. RESULTS: Almost all women (94%) had used contraception at some time and 75% were current users. Although self care was common (29% had obtained their latest method outside the health services), 83% had sometimes used the health services for contraception. For their last visit, 55% of women had chosen a health centre (a publicly administered and funded health service), and 33% a private unit. In the health centre, the care provider was usually a general practitioner or a public health nurse, whereas in private care the providers were gynaecologists. Women who used private care were more likely to be from higher social classes and urban areas. After adjustment for a women's background, the two groups were similar for most indicators of the quality of care, but access to care and woman's experiences of treatment were better with private care. CONCLUSIONS: In terms of availability and choices the current system of contraceptive services in Finland is adequate. It is not always an integral part of municipal primary health care, and many women prefer private care for gynaecological services; this may case problems of comprehensiveness and equality of care.     

Social group and mortality in Finland.

Morality rates for various social groups within the population of Finland were compared, using 179 919 death certificates for the period 1969-72. Morality was generally lowest in the highest social groups and highest among unskilled workers. Male mortality from coronary heart disease was also high among lower salaried employees. In the less developed area of northern Finland, female mortality from coronary heart disease and vascular lesions of the central nervous system was highest among the agricultural population. Cancer of the breast, cancer of the intestine, and suicides among women were apparently concentrated in the higher classes. Life table analysis showed that the social group differences in life expectancy at birth could be as great as 7.2 years. It is considered indispensable for a national health policy to improve on the recording of occupational data and to give regularly the occupation of the deceased when publishing mortality rates.     

Screening for asbestos-induced diseases in Finland

Screening for asbestos-induced diseases in Finland was carried out in 1990–1992 as a part of the Asbestos Program of the Finnish Institute of Occupational Health. The aim of the present study was to find the workers who had developed an asbestos-induced disease in certain occupations. Examination of active or retired workers included a personal interview on work history and asbestos exposure, and a chest X-ray. The target group for the screening comprised workers under 70 years of age who had worked at least for 10 years in construction, 1 year in a shipyard or in the manufacture of asbestos products. A preliminary questionnaire was sent to 54,409 workers, 18,943 of whom finally participated in the screening examination. The mean age of the workers was 53 years; 95% were employed in construction, 2% in shipyards, and 3% in the asbestos industry. The criteria for a positive screening result were (1) a radiographic finding clearly indicating lung fibrosis (at least ILO category 1/1), (2) a radiographic finding indicating mild lung fibrosis (ILO category I/O) with unilateral or bilateral pleural plaques, (3) marked abnormalities of the visceral pleura (marked adhesions with or without pleural thickening), or (4) bilateral pleural plaques. The positive cases totalled 4,133 (22%) and were sent for further investigation. In addition to the screening, information on the presence of asbestos in the work environment, prevention of asbestos exposure, as well as on the health effects of asbestos exposure and smoking were given to the participating workers. The screening acted as a preliminary survey to prompt further national follow-up of asbestos-induced diseases among the workers who have been exposed to asbestos. This article presents the material, methods, and overall results of the screening. © 1996 Wiley-Liss, Inc.     

Puumala virus infections in Finland: increased occupational risk for farmers.

Puumala hantavirus, transmitted by bank voles (Clethrionomys glareolus), causes a mild-type hemorrhagic fever with renal syndrome. The disease is common in Finland and is considered an occupational hazard for farmers, but the actual risk has not been assessed by analytical studies. Data on 5,132 serologically confirmed Puumala virus infections during 1989-1994 were analyzed, and cases among farmers and the population living in similar conditions were compared. The farmers contracted the disease earlier and more often than did the comparison group. In the province of Mikkeli with the highest incidence (70/100,000), the risk ratio was 5.1 (95% confidence interval (CI) 3.0-8.4) for 20- to 29-year-old farmers; in the older age groups, the risk was still increased but the risk ratios were lower. The peak incidence in the comparison group was 10 years later (age group 30-39 years). For the whole country, the result was similar although less marked. The average risk ratio adjusted by age, sex, and geographic variation was 1.7 (95% CI 1.5-1.8) for the whole country and 1.9 (95% CI 1.5-2.3) for the Mikkeli province, where 80% of Puumala virus infections among young farmers could be estimated to be attributable to occupation.