The feasibility of alcohol screening and interventions in emergency care: a comparison of primary and specialised health care settings

Background: Implementation of alcohol screening and brief intervention in emergency departments is inadequate and the evidence base more mixed than in primary health care (PHC). This comparison study investigates the feasibility of alcohol screening and interventions by nurses in emergency departments, seven based in PHC and two in specialised health care clinics. The aim is to analyse barriers to implementation in these two contexts.

Methods: A questionnaire was used among emergency nurses in the Kymenlaakso hospital district in Finland. The response rate was 71% (N?=?112; PHC clinics n?=?42; specialised clinics n?=?38). The statistical differences in responses were analysed using the χ² test. Open-ended questions were analysed qualitatively.

Results: The nurses in specialised clinics treated patients with alcohol-attributable conditions/traumas more often than the nurses in PHC did (p?p?p?Conclusions: The results indicate an intervention paradox in the emergency care setting: compared to nurses in PHC clinics, nurses in specialised health care clinics work more often with intoxicated patients but they are less willing to implement alcohol screening and interventions. The findings highlight the need for institutional-level support in addition to capacity building among nurses.     

Comparison of self-rated health in older people of St. Petersburg,Russia, and Tampere,Finland: how sensitive is SRH to cross-cultural factors?

The aim of this study was to examine if there are differences in self-rated health (SRH) between older people in St. Petersburg, Russia, and Tampere, Finland. Two SRH measures were examined: a global measure without any frame of reference, and an age-comparative SRH with an explicitly elicited reference of age peers. The Tampere data, consisting of 737 60–89-year-old respondents, came from the Tampere Longitudinal Study on Ageing (TamELSA) in 1989. The St. Petersburg data, consisting of 1,168 people aged 60–89 years, came from the Planning of Medical and Social Services within Elder Care in St. Petersburg project (IPSE) in 2000. In both cities the data were collected by same structured questionnaire. Self-rated health, both global and comparative, was better in Tampere than in St. Petersburg when symptoms, chronic diseases and functional ability were adjusted for. Also, the association of chronic diseases with global SRH was different in St. Petersburg and Tampere. In addition to the real differences in the prevalence and seriousness of health problems, the differences in SRH may be caused by different ways of evaluating health. Our conclusion is that self-rated health is sensitive to cultural and social factors. Direct comparisons between different countries should be made with caution, and the differences in language use must be taken into account when interpreting the results.     

Cardiac troponin T release after prolonged strenuous exercise

Over the past 2 decades, there has been a large interest in cardiac troponin T (cTnT) elevations, which are often seen following endurance sport events. There have been many reports on this topic, although sometimes with different approaches. We reviewed the available literature on cTnT elevations after prolonged strenuous exercise and discovered profound differences in the percentage of subjects reported to have elevated cTnT concentrations. This could partly be attributed to differences in immunoassay characteristics, such as cross-reactivity with skeletal troponin T, and the use of different cut-off values used in the different studies. The elevations were transient, with levels decreasing to pre-event concentrations within 24-48 hours. This might be explained by the relatively short half-life of cTnT, or water imbalance during and after the event. The release mechanism of cTnT, as well as the long-term positive or negative effects, remains unclear. Future research should therefore be aimed at clarifying the release mechanism of cTnT. Furthermore, the benefits and the possible long-term negative aspects of prolonged exercise should be evaluated.