Addressing sustainable health promotion in theory and practice:Nordic contexts - Nordic perspectives

Godkänd;2020;Nivå 0;2020-09-11 (alebob)</p

The effectiveness of the HIPPA intervention in the sociocultural environment of ECEC physical activity

Studies have shown that, on average, children’s physical activity (PA) levels in early childhood education and care (ECEC) environments are low, thus opening up the possibility of interventions. We examined the effect of the teacher-implemented one-year long ‘home-and-childcare-based intervention to promote physical activity’ (HIPPA) study on children’s PA in ECEC settings in Finland. Participating four-year-old children (N = 128) were cluster-randomised into two groups, intervention (seven childcare centres) and control (seven childcare centres), in autumn 2011. The children were observed directly during their ECEC times. Multilevel linear analysis was used to test the PA differences between the intervention conditions. Post-intervention results showed that the HIPPA intervention increased the children’s PA. To enhance the real-life effectiveness of the present multicomponent intervention, we examined methods based on the intervention’s success and found areas of development for future studies. Overall, promoting active play by ECEC personnel offers an effective way to enhance children’s PA. Furthermore, to ensure the sustainability of the intervention effects, specific changes in practice have been identified that should be transferred into the policies intended for ECEC settings

Daily physical activity in Finnish adolescents with long term illnesses or disabilities: psychosocial associations with participation in sports club

Background: Physical activity (PA) in adolescence with long term illnesses or disabilities (LTID) is a public health concern. One way of increasing PA is through participation in sports clubs. Since sports clubs are organised and regular, there are expected to be differences in motivation for physical activity between adolescents that are members and non-members. The purpose of this study is to assess the impact of psychosocial factors on sports club membership and daily PA. Methods: Finnish adolescents with self-reported LTID (n=1006) took part in the WHO collaborative Health Behaviour in School-aged Children (HBSC) study in 2002 and 2010. Daily self-reported moderate to vigorous PA (MVPA) was the outcome variable. Psychosocial variables included intention for future PA, self-perceptions, and educational aspirations. Age and sports club membership was included in binary logistic regression analyses Analyses were done separately for boys and girls.&nbsp; Results: Adolescents with LTID who were sports club members were two times more likely to be active daily than non-members. However, for girls, there was no significant difference between members and non-members. Moreover, definite intention for future PA, higher self-perceptions, and educational aspirations to other education or training than general upper secondary school were significant predictors. Conclusions: Adolescents with LTID need encouragement to be active daily. One possible way to achieve this is through sports club participation. Implementing adaptive motivating techniques in sports clubs is especially important for girls in clubs. More research is needed on the associations of daily MVPA with different educational aspirations &nbsp;for adolescents with LTID

Young People in the Social World of Physical Activities: Meanings and Barriers

Physical inactivity has become one of the leading risk factors for non-communicable diseases (NCDs) and death worldwide. From the future perspective it is alarming that in the group of young people few meet the recommendations. In this respect, physical activity promotion in general and physical education have challenges and new approaches are needed. In this study, the theoretical framework is based on the physical activity relationship (PAR) approach and the barriers were grouped according to the ecological model. The aim of the study was firstly to present both the meanings and barriers of physical activity in a comprehensive Finnish population of 11-15 year old (n = 2728) and secondly to examine how the number of important meanings and mentioned barriers associate with each other with physical activity levels. Data were collected using a questionnaire. To examine how the meanings and barriers associate with each other and with the PA level, chi-squared test (χ2), Pearson correlation and General linear model (ANCOVA) were used. Logistic regression was applied to estimate effect sizes by odds ratios and 95% confidence intervals. According to the results, the associations between physical activity with the meanings and barriers were reverse and linear. The more important the meanings were found to be, the more likely the study participants were physically active, whereas the more barriers participants reported, the less active they were. The approach which utilizes meanings and barriers has a lot of untapped potential for the promotion of physical activity and physical education. With the right actions, some barriers could be removed or dampened, and by opening up and deepening meanings, PAR could be strengthened.</p

Sports Clubs Can Contribute to the Physical Activity of Children and Adolescents in More Diverse and Sustainable Activities

An increasing number of children are taking part in supervised club activities, starting at a younger age. They also start focusing on one sport at a younger age, and the dropping out of club activities starts already at the age of 11. These changes are challenging the current club activities. There has been a large increase in participation in club activities. In the 1990s, just over 30% of children and young people in Finland practiced sports in a club, while today, the participation rate has risen to 60%. The age at which children start participating in club activities has decreased by an average of one year per decade. Those born before the 1950s typically started participating in clubs at the age of 12, compared with an average age of six today. This change means that children specialise in one sport and then drop out of club activities too early. As a result, the hobby does not continue as far into adolescence as it should. This increases the likelihood of inactivity in adolescence and further on in adulthood. The clubs do not need to fix the insufficient physical activity of the population alone, but they have the potential to develop their own activities in promoting physical activity and physical education, as well as their cooperation with other actors. This policy brief is the third and last in its series from the Healthy Lifestyles to Boost Sustainable Growth (STYLE) project, combining interdisciplinary knowledge on trends in transport and physical activity. Interpreting them through infrastructure and service designs and changing lifestyles, we generate insight on novel business opportunities and intervention models that induce physical activity. This provides innovative pathways towards current national policy targets and promotion of the societal vision. The project is funded by the Strategic Research Council at the Academy of Finland. Read more: www.styletutkimus.fi/e

Declining Fitness Levels are a Challenge to Well-Being in Finland – effective actions to increase physical activity and reverse the downward spiral of fitness

The physical functional capacity of Finns has been declining for decades: • The number of young men entering military service with poor physical fitness has increased eightfold • The number of men with poor muscle fitness has increased manifold • The average weight of new recruits has increased by 8 kg • The results of the MOVE! measurements of schoolchildren show the same alarming trend also in schoolchildren. As a result of the prolonged negative trend described above, the physical fitness of Finns of working age will continue to deteriorate significantly also in the coming decades. By 2040, according to a very conservative forecast, only very few people aged 50 or over in Finland will be in good physical fitness. This vicious cycle will lead to an increasing incidence of non-communicable diseases (such as type 2 diabetes, depression, cardiovascular diseases, musculoskeletal diseases, etc.). Being ill leads to increased sickness absences, earlier disability, and lower labour productivity. Unless this negative trend can be reversed, we will not be able to extend working life, the economic backbone of the state, municipalities, and cities will be broken, and the base of the national defence (the reserve army) will not hold up. The steady decline in fitness and increase in obesity will cause problems across all sectors of government. No amount of economic growth will be enough if the downward spiral of the physical functional capacity and fitness of working-age Finns is not reversed. We need multiple, simultaneous, effective measures across all sectors, at the national as well as the local level. These simultaneous, multi-sectoral actions require strong leadership and coordination between different sectors. Therefore, at the national level, the Prime Minister's Office and, at the local level, the municipal or city management group, are capable actors to lead these simultaneous measures that are needed across sectors of government. Effective measures are needed for those in the working life today who are struggling with their physical functional capacity, as well as to ensure the functional capacity of the workforce in the future. This policy brief is the second in its series from the Healthy Lifestyles to Boost Sustainable Growth (STYLE) project, combining interdisciplinary knowledge on trends in transport and physical activity. Interpreting them through infrastructure and service designs and changing lifestyles, we generate insight on novel business opportunities and intervention models that induce physical activity. This provides innovative pathways towards current national policy targets and promotion of the societal vision. The project is funded by the Strategic Research Council at the Academy of Finland. Read more: www.styletutkimus.fi/e

Medical priority dispatch codes-comparison with National Early Warning Score

Background: In Finland, calls for emergency medical services are prioritized by educated non-medical personnel into four categories-from A (highest risk) to D (lowest risk)-following a criteria-based national dispatch protocol. Discrepancies in triage may result in risk overestimation, leading to inappropriate use of emergency medical services units and to risk underestimation that can negatively impact patient outcome. To evaluate dispatch protocol accuracy, we assessed association between priority assigned at dispatch and the patient's condition assessed by emergency medical services on the scene using an early warning risk assessment tool. Methods: Using medical charts, clinical variables were prospectively recorded and evaluated for all emergency medical services missions in two hospital districts in Northern Finland during 1.1.2014-30.6.2014. Risk assessment was then re-categorized as low, medium, or high by calculating the National Early Warning Score (NEWS) based on the patients' clinical variables measured at the scene. Results: A total of 12,729 emergency medical services missions were evaluated, of which 616 (4.8%) were prioritized as A, 3193 (25.1%) as B, 5637 (44.3%) as C, and 3283 (25.8%) as D. Overall, 67.5% of the dispatch missions were correctly estimated according to NEWS. Of the highest dispatch priority missions A and B, 76.9 and 78.3%, respectively, were overestimated. Of the low urgency missions (C and D), 10.7% were underestimated; 32.0% of the patients who were assigned NEWS indicating high risk had initially been classified as low urgency C or D priorities at the dispatch. Discussion and conclusion: The present results show that the current Finnish medical dispatch protocol is suboptimal and needs to be further developed. A substantial proportion of EMS missions assessed as highest priority were categorized as lower risk according to the NEWS determined at the scene, indicating over-triage with the protocol. On the other hand, only a quarter of the high risk NEWS patients were classified as the highest priority at dispatch, indicating considerable under-triage with the protocol.Peer reviewe

One-year healthcare costs of patients with spontaneous intracerebral hemorrhage treated in the intensive care unit

Background: Spontaneous intracerebral hemorrhage (ICH) entails significant mortality and morbidity. Severely ill ICH patients are treated in intensive care units (ICUs), but data on 1-year healthcare costs and patient care cost-effectiveness are lacking. Methods: Retrospective multi-center study of 959 adult patients treated for spontaneous ICH from 2003 to 2013. The primary outcomes were 12-month mortality or permanent disability, defined as being granted a permanent disability allowance or pension by the Social Insurance Institution by 2016. Total healthcare costs were hospital, rehabilitation, and social security costs within 12 months. A multivariable linear regression of log transformed cost data, adjusting for case mix, was used to assess independent factors associated with costs. Results: Twelve-month mortality was 45% and 51% of the survivors were disabled at the end of follow-up. The mean 12-month total cost was euro49,754, of which rehabilitation, tertiary hospital and social security costs accounted for 45%, 39%, and 16%, respectively. The highest effective cost per independent survivor (ECPIS) was noted among patients aged >70 years with brainstem ICHs, low Glasgow Coma Scale (GCS) scores, larger hematoma volumes, intraventricular hemorrhages, and ICH scores of 3. In multivariable analysis, age, GCS score, and severity of illness were associated independently with 1-year healthcare costs. Conclusions: Costs associated with ICHs vary between patient groups, and the ECPIS appears highest among patients older than 70 years and those with brainstem ICHs and higher ICH scores. One-third of financial resources were used for patients with favorable outcomes. Further detailed cost-analysis studies for patients with an ICH are required.Peer reviewe