Vaikuttavan elintapaohjausintervention suunnittelu – helpommin sanottu kuin tehty?

Vaikuttavan elintapaohjauksen kehittäminen on haaste sekä tieteelle että käytännön ohjaustyölle. Vaikka elintapaohjaukseen perustuvia interventiotutkimuksia on olemassa, niiden perusteella on vaikea tehdä yhteenvetoa siitä, miten myönteiset vaikutukset saatiin aikaiseksi. Tässä artikkelissa vaikuttavan elintapaohjauksen suunnittelua pohditaan sekä teoriaan että näyttöön perustuvan ohjauksen näkökulmasta. Lisäksi artikkelissa esitellään Michien ym. (2009) uusi lähestymistapa, jolla voidaan helpottaa vaikuttavan elintapaohjausintervention suunnittelua: Ensimmäisessä askeleessa tunnistetaan käyttäytymisen osatekijät eli vaikuttamisen kohde. Toisessa askeleessa tunnistetaan tekniikoita, joilla käyttäytymiseen on mahdollista vaikuttaa. Kolmannessa eli viimeisessä vaiheessa pyritään tunnistamaan nimenomaan ne tekniikat, joilla voidaan vaikuttaa kohteena oleviin osatekijöihin. Erilaisten tekniikoiden listaaminen ja määrittely helpottaisi elintapaohjausinterventioiden vaikuttavuustulosten vertailua ja vaikuttavien tekniikoiden löytymistä

Sustainable antibullying program implementation: School profiles and predictors

We examined the sustainability of the KiVa antibullying program in Finland from its nationwide roll‐out in 2009 to 2016. Using latent class analyses, we identified four different patterns of implementation. The persistent schools (43%) maintained a high likelihood of participation throughout the study period. The awakened (14%) had a decreasing trend during the first years, but then increased the likelihood of program participation. The tail‐offs (20%) decreased in the likelihood of participating after the third year, and the drop‐offs (23%) already after the first year. The findings suggest that many schools need support during the initial years to launch and maintain the implementation of evidence‐based programs; yet a large proportion of schools manage to sustain the program implementation for several years. The logistic regression analyses showed that large schools persisted more likely than small schools. Lower initial level of victimization was also related to the sustainability of the program. Finally, persistent program participation was predicted by several school‐level actions during the initial years of implementing the program. These results imply that the sustainability of evidence‐based programs could be enhanced by supporting and guiding schools when setting up the program during the initial implementation.</p

Transtheoretical model-based dietary interventions in primary care: a review of the evidence in diabetes

The objective of this study was to review the evidence concerning stage-based dietary interventions in primary care among persons with diabetes or an elevated diabetes risk. Search strategies were electronic databases and manual search. Selection criteria were randomized controlled studies with stage-based dietary intervention, conducted in primary care with at least 6 months of follow-up, and participants with either type 2 diabetes or with an elevated risk. The researchers evaluated trials for inclusion, extracted data and assessed study quality. Seven articles, based on five data sets, were included. These studies concentrated on cardiovascular diseases and being overweight, not diabetes. The quality of the studies was moderate to weak. Inadequacies in the reporting often involved unspecific information on the training of health care providers. Long-term positive outcomes (compared with controls) were found in total and monounsaturated fat intake, diastolic blood pressure, health status and well-being. The existing data are insufficient for drawing conclusions on the benefits of the transtheoretical model. More high-quality studies focusing on diabetes are needed, with greater attention to the training of providers and process evaluation. There is a need for a standardized appraisal tool for study evaluation, focusing separately on education interventions for patients and providers

Simplified routines in prescribing physical activity can increase the amount of prescriptions by doctors, more than economic incentives only: an observational intervention study

<p>Abstract</p> <p>Background</p> <p>Physical inactivity is one well-known risk factor related to disease. Physical activity on prescription (PAP) has been shown in some studies to be a successful intervention for increasing physical activity among patients with a sedentary lifestyle. The method involves motivational counselling that can be time-consuming for the prescribing doctor and might be a reason why physical activity on prescription is not used more frequently. This study might show a way to make the method of prescribing physical activity more user-friendly. The purpose is to determine whether a change in procedures increases the use of physical activity on prescription, and thus the aim of this study is to describe the methodology used.</p> <p>Results</p> <p>The observational intervention study included an intervention group consisting of one Primary Health Care (PHC) clinic and a control group consisting of six PHC clinics serving 149,400 inhabitants in the County of Blekinge, Sweden.</p> <p>An economic incentive was introduced in both groups when prescribing physical activity on prescription. In the intervention group, a change was made to the process of prescribing physical activity, together with information and guidance to the personnel working at the clinics. Physical therapists were used in the process of carrying out the prescription, conducting the motivational interview and counselling the patient. This methodology was used to minimise the workload of the physician. The chi-2 test was used for studying differences between the two groups. PAP prescribed by doctors increased eightfold in the intervention group compared to the control group. The greatest increase of PAP was seen among physicians in the intervention group as compared to all other professionals in the control group. The economic incentive gave a significant but smaller increase of PAP by doctors.</p> <p>Conclusion</p> <p>By simplifying and developing PAP, this study has shown a concrete way to increase the implementation of physical activity on prescription in general practice, as opposed to what can be gained by an economic bonus system alone. This study indicates that a bonus system may not be enough to implement an evidence-based method.</p

Особенности развития малого предпринимательства в Украине

В этой работе рассмотрена эволюция предпринимательства Украины на всех этапах ее общественной жизни, в том числе в период экономического кризиса в годы становления независимости. Отражены основные параметры отнесения предприятий к субъектам малого предпринимательства и их роль в развитии экономики государств.У цій роботі розглянута еволюція підприємництва України на всіх етапах її суспільного життя, зокрема в період економічної кризи в роки становлення незалежності. Відображені основні параметри віднесення підприємств до суб'єктів малого підприємництва і їх роль в розвитку економіки держав

Zdravstveno obrazovanje i informiranje koje provode službe medicine rada u Finskoj

This article discusses health education and communication in Occupational Health Services (OHS) based on a questionnaire study conducted in Finnish OHS in 2005. The study focused on educational activities carried out by OH professionals and directed at individual employees, work communities and groups, and representatives of client organisations. The questionnaire was sent to 1132 OH professionals - physicians, nurses, physiotherapists and psychologists - working in 130 OHS units, and representing different OHS providers in Finland. 635 respondents (162 physicians, 342 nurses, 96 physiotherapists, 35 psychologists) returned the questionnaire. The overall response rate was 58 %. There were statistically significant differences in educational activities by different professional groups; differences were also related to the length of working experience in OHS. For all OH professionals, individual employees were the primary clients of health education and communication. Education was less often directed at work communities and representatives of client organisations. However, many issues related to health and well-being at work are not within the reach of individual employees. The impact of health education would be more evident if it also reached those organisational stakeholders with discretion in decision-making. Furthermore, OH personnel should pay attention to the social aspect of learning and work more with groups and work communities.U ovome se članku raspravlja o zdravstvenom obrazovanju i informiranju koje provode službe medicine rada, a na temelju istraživanja provedenog među tim službama 2005. U središtu su ispitivanja bile obrazovne aktivnosti medicinara rada usmjerene na radnike kao pojedince, radne zajednice i skupine te predstavnike korisničkih organizacija. Upitnik su dobila 1132 medicinara rada, uključujući liječnike, medicinske sestre, fizioterapeute i psihologe zaposlene u 130 jedinica koje pružaju usluge medicine rada u Finskoj. Ispunjene je upitnike vratilo 635 sudionika (162 liječnika, 342 sestre, 96 fizioterapeuta te 35 psihologa). Ukupni odgovor iznosio je 58 %. Zamijećene su statistički značajne razlike u obrazovnim aktivnostima između pojedinih zanimanja, a one su bile povezane i sa stažem u medicini rada. Svim medicinarima rada pojedinačni radnici primarni su korisnici zdravstvenoga obrazovanja i informiranja. Obrazovanje se rjeđe usmjeravalo na radne zajednice i predstavnike korisničkih organizacija. Međutim, mnoga otvorena pitanja vezana uz zdravlje i dobrobit na radu nisu u nadležnosti pojedinačnih zaposlenika. Utjecaj zdravstvenoga obrazovanja bio bi stoga svrhovitiji kada bi ono obuhvatilo i one strukture koje donose odluke. Osim toga, osoblje medicine rada treba obratiti pozornost na socijalni aspekt učenja te treba više raditi sa skupinama i radnim zajednicama

Precursors of Reading Skill From Infancy to First Grade in Finnish: Continuity and Change in a Highly Inflected Language

Contains fulltext : 55339.pdf (publisher's version ) (Closed access)The course of language acquisition from infancy to public primary school was followed in a sample of 56 Finnish children to examine precursors to reading at first grade. Structural equation modeling of continuity suggested effects from growth in early vocabulary to mastery of inflectional forms at preschool age. The early language directly influenced early phonological awareness (PA) and only indirectly influenced later development in PA and word reading. The course of development in PA progressed from detecting larger multiphonemic units toward recognizing and producing phonemes in words, which, in turn, were positively associated with differences in producing new words by deleting and blending phonemes at kindergarten age. Including word reading before school entry levelled out the influence of the concurrent phonemic awareness factor on reading at first grade. Hence, in a highly inflected language with a transparent orthography, the pathway to reading consisted of skills learned in succession, the last phase being characterized by simultaneous development involving phonemic awareness and emerging reading skill. The finding led to the conclusion that, in addition to universal routes, language- and culture-specific routes to literacy must be acknowledged when searching for the precursors to reading at school age.15 p