Disease-related distress among insulin-treated diabetic patients: Associations with health status, psychosocial factors and self-care practices

Background: Diabetes is a chronic illness that affects manydomains of life. This cross-sectional study examined disease-relateddistress and its associations with health and psychosocial factorsamong insulin-treated diabetic persons. Method: The sample (n=423)was drawn from the Social Insurance Institution's drug registry.Health indicators were duration of diabetes, complications,and glycaemlc control. Psychosocial measures included generaland diabetes-specific social support, diabetes locus of control(DLC), self-efficacy, diabetes health beliefs and self-carepractices and subjective health. Results: Most respondents reportedmoderate diabetes-related distress. In multi-variate analysis,severe diabetes distress was related to lower net benefits ofregimen (ß = –0.29, and p<0.001), poorerperceived health (ß = –0.25, and p<0.001),higher perceived threat of complications (ß = 0.19,and p<0.001), less adequate social support (ß =–0.16, and p<0.01), stronger beliefs in chance (ß= 0.15, and p<0.01) and internal DLC (ß = 0.11,and p<0.05) and more frequent exercising (ß = 0.10,and p<0.05). Conclusions: The results suggest that emotionaladjustment to diabetes is predominantly determined by diabetes-relatedcognitions and subjective health and to a lesser degree by objectivediabetes indlcators, which underlines the Importance of assistingthe patient with adjustment with the disease in health carecentres.     

Physical fitness in children with haemophilia and the effect of overweight

Summary.  Although children with haemophilia are advised to participate in physical activities, their physical fitness has not been studied in a large group. In addition, children with haemophilia may be at increased risk for becoming overweight as a result of inactivity because of joint bleedings or because of overprotection. This study aimed to assess physical fitness (aerobic capacity), joint status, muscle strength, quality of life (QoL), self-reported motor competence and also prevalence of overweight and its association with physical parameters. Weight and height were measured. Skin folds were measured unilaterally at biceps, triceps, subscapular and supra-iliac sites. Aerobic capacity was determined on a cycle ergometer or with a 6-min walk test (6MWT). Muscle strength and active range of motion of elbows, knees and ankle joints were measured. Self-reported motor competence was measured with the 'Competentie BelevingsSchaal voor Kinderen'. Joint pain was scored on a Visual Analogue Scale. The Haemo-QoL Index was used to measure QoL. In 158 Dutch boys with haemophilia, with a mean age of 12.7 years (SD 2.9), normal aerobic capacity and muscle strength were found. Joint pain was reported by 16% of the participants. The prevalence of overweight (16%) was slightly increased when compared with healthy Dutch boys (13.5%). Being overweight had a negative association with the 6MWT and QoL. Dutch children with haemophilia have normal aerobic exercise capacity and muscle strength. The majority also has normal joint mobility. Prevalence of overweight is slightly increased.     

Leadership styles of Finnish nurse managers and factors influencing it

Aim  The purpose of the present study was to explore nurse managers' perceptions of their leadership styles and factors influencing it.
Background  It is a challenge for nurse managers to retain nurses in hospitals and to ensure a high quality of care in nursing practice. Leadership style is an important part of leadership. Knowledge concerning nurse managers' resonant and non-resonant leadership styles provides nurse managers with tools to reflect on their own leadership style.
Method  Open-ended, tape-recorded interviews were conducted with 13 nurse managers from five Finnish hospitals and two long-term care facilities. The data were analysed using qualitative content analysis.
Results  Five categories of leadership style were discerned: visionary, coaching, affiliate, democratic, commanding. Factors that influence leadership style were identified: earlier superiors, values, information, cooperation, employees and education.
Conclusions  The results of this study show that Finnish nurse managers use both resonant and non-resonant leadership styles.
Implications for nursing management  The findings of this study show that nurse managers use a variety of leadership styles. The study demonstrates the importance of knowledge about leadership styles and factors influencing it among nurse managers providing future leadership and management education.     

Use of fluorides by Finnish adolescents

According to the recommendations of the National Board of Health in Finland fluoride tablets should be used daily from the age of 6 months to 15 yr in fluoride deficient areas. Topical fluorides are recommended in addition to systemic fluorides. The aim of this study was to analyze the use of fluoride tablets and topical fluorides by Finnish adolescents. Teenagers (n= 4705) representing Finnish youth aged 12, 14, 16 and 18 yr were sent mail questionnaires in February 1981. The response rate was 88%. The proportion of daily fluoride tablet users was 12% among 12-yr-old girls, 3% among 14-yr-old girls and among boys 10% and 4%, respectively. Fluoride rinses at home were used daily by only 1%. During the most recent school term, 34% had several times, and 8% once, participated in classroom fluoride rinsing. In the same period 14% had used fluoride gel several times, and 10% once. Thus despite dental health education, fluoride tablets and rinses are used very rarely at home by Finnish teenagers. The recommendations of the National Board of Health are far removed from the behavior of adolescents. Use of fluoride tablets and topical fluorides do not seem to be a practical alternative to drinking-water fluoridation, because of the low level of compliance.     

Bullying at school—an indicator of adolescents at risk for mental disorders

A number of 14–16 year old Finnish adolescents taking part in the School Health Promotion Study (n=8787 in 1995, n=17643 in 1997) were surveyed about bullying and victimization in relation to psychosomatic symptoms, depression, anxiety, eating disorders and substance use. A total of 9 per cent of girls and 17 per cent of boys were involved in bullying on a weekly basis. Anxiety, depression and psychosomatic symptoms were most frequent among bully-victims and equally common among bullies and victims. Frequent excessive drinking and use of any other substance were most common among bullies and thereafter among bully-victims. Among girls, eating disorders were associated with involvement in bullying in any role, among boys with being bully-victims. Bullying should be seen as an indicator of risk of various mental disorders in adolescence.     

Causes of stillbirth: a clinicopathological study of 243 patients

Summary. The clinical and autopsy findings in all stillbirths during the years 1974—1979 at the Helsinki University Central Hospital were analysed. There were 243 stillborn infants of whom 200 died before labour. According to the autopsy findings asphyxia accounted for 38% and major malformations for 17% of the deaths, but because of fetal maceration no diagnosis could be made at autopsy in 43%. The cause of death suggested by the clinical findings was placental failure in 57%, cord complication in 12% and major malformations in 17%. The cause of death remained unsolved in 9%. The importance of routine ultrasound and a- fetoprotein screening for the detection of unrecognized risk patients is emphasized.     

Scanning electron microscopic study of surface of human oral mucosa

The surface ultrastructure of the healthy oral mucosa of humans was studied using SEM as follows: dorsum of the tongue (10 specimens), buccal mucosa (5), floor of the mouth (3), hard palate (5), and gingiva (10). One part of each formalin-fixed sample was processed routinely using the system of critical point drying for scanning electron microscopy. The other part of the specimen was embedded in paraffin blocks and stained with hematoxylin-eosin for light microscopy. With SEM at low magnification, the surface structure of the oral mucosa at different areas of the oral cavity was smooth with some desquamating cells. Only the tongue mucosa with its papillae formed a specialized mucosa. The hairs of the filiform papillae were covered by microorganisms, whereas on the oral mucosa there usually was little or no colonization by microorganisms. At high magnification, the surface structure of the superficial epithelial cells was pitted or microplicated. On keratinized epithelium the surface structure was pitted, whereas on non-keratinized epithelium it was microplicated. On cell boundaries some variation could also be seen; in keratinized epithelium these boundaries were overlapping and in non-keratinized epithelium they were tight.     

Subgingival microflora, dental and periodontal conditions in patients with hereditary fructose intolerance

Abstract – Hereditary fructose intolerance (HFI) is a rare autosomally recessive disease which leads to severe hypoglycemia. The fructose-free diet of these patients apparently influences dental health. Half of the patients are free of caries, but there are no reports on their periodontal condition nor on the composition of their subgingival microflora. Therefore 18 patients with HFI were examined for the following parameters: radiographic bone loss, caries rate, gingival bleeding, occurrence of calculus, pocket depths, salivary flow rate, buffer capacity and pH from paraffin wax-stimulated saliva. Salivary S. mutans and lactobacilli were also enumerated. Specific antibody titers from whole saliva and serum to Actinobacillus actinomycetemcomitans Y4, Bacteroides gingivalis , and Capnocytophaga ochracea were determined with ELISA. Finally the subgingival plaque was analyzed by culture. Altogether 196 anaerobic or microaerophilic isolates representing 29 different species were obtained from the HFI patients and 164 isolates of 26 species from the controls. The frequency of Actinomyces odontolyticus, Veillonella parvula , and Wolinella recta in the HFI patients was significantly high. The DMF-indices were lower in the study group than in the controls and so was the occurrence of S. mutans and lactobacilli in the saliva. Of the periodontal parameters examined, the only difference found was an increased incidence of gingival bleeding and calculus formation in the HFI patients. The results suggest that in the HFI patients the common gingival bleeding is associated with the more frequent occurrence of Actinomyces odontolyticus, Veillonella parvula , and Wolinella recta .     

Oral contraception and smoking: Time trends for a risk behaviour in Finland

The main health risks of modern oral contraceptives (OCs) areassociated with simultaneous smoking. According to current medicalguidelines in Finland, OCs should not be prescribed for smokersaged over 30 years. We report how smoking and OC use were relatedfrom 1975 to 1993. The data were collected from 3 national postalsurveys: a biannual survey of 16 and 18 year old girls since1981 (sample sizes of 462–1,667 and response rates of83–91%), an annual survey of 20–39 year old womensince 1978 (size of 5 year age groups of 205–375 and responserates of 68–91%) and a survey of 20–39 year oldtwins in 1975 and 1981 (size of 5 year age groups of 758–3,366and response rates of 85–90%). Early initiation of OCsbecame more frequent. Half of the 16 year old and one-thirdof 18 year old OC users were smokers in the most recent survey.Adult women aged under 30 years more than doubled their OC useduring the 1980s. Although smoking showed a declining trend,the proportion of women having combined use of OCs and tobaccoincreased (up to 9–13% in the most recent surveys). Womenaged over 30 years increased their OC use in the late 1980s(10–18% in the most recent surveys). The combined useof OCs and tobacco has become more frequent both among adolescentand adult women. The lifetime duration of combined use willprobably increase without more active intervention on smokingin the family planning clinics, even among young women.     

Examination of Infant Brain Maturation Using Ultra Low Field MRI

ABSTRACT. The brains of 42 newborn infants were examined with MRI at 0.02 T field, and regional variations of T1 relaxation time were measured from the images. There were three groups: 1. full term infants (9), 2. preterm infants (10) and 3. SGA (= small for gestational age) infants (20). Relaxation times showed a correlation to myelination of the brain. The brain of SGA infants showed a large variation in their T1 values.