Frequent attenders in primary health care:a cross-sectional study of frequent attenders' psychosocial and family factors, chronic diseases and reasons for encounter in a Finnish health centre

Abstract The aim of this cross-sectional controlled study was to determine frequent attenders' chronic diseases and their reasons for encounter in primary health care. Furthermore, the study aimed to determine the associations of social, psychological and family factors with frequent attendance in a Finnish health centre. Patients who made eight or more annual visits to physicians in the health centre during one year were defined as frequent attenders (FA). All the FAs during 1994 (N=304) and 304 randomly selected age- and sex-matched controls constituted the study population. The data were collected from annual statistics, medical records and postal questionnaires. Over one third of the study population was interviewed. International Classification of Primary Care (ICPC) was used to determine the reasons for encounter and Symptom Checklist - 36 (SCL-36) to assess the psychological distress. Toronto Alexithymia Scale -20 (TAS-20) was used as a measure of alexithymia and Whiteley Index (WI) to determine hypochondriacal beliefs. The results showed that 4.7% of the whole population aged 15 years or older in Oulainen were FAs. They accounted for 23.5% of all visits made within the respective age group. The mean age of the FAs was 49.8 years. Over two thirds of them were female. The FAs had lower basic education and occupational status than the controls. The FAs visited physicians in the health centre mostly for reasons related to the musculoskeletal, respiratory and digestive systems. There appeared to be more chronic diseases among the FAs than among the controls. The FAs had over three times more mental disorders than the controls. The interviewed FAs had significantly more psychological distress, somatization and hypochondriacal beliefs than the controls. The risk of frequent attendance was higher in the older family life cycle phases than in the younger family life cycle phases. Multivariate analyses showed chronic somatic disease and hypochondriacal beliefs to be risk factors for frequent attendance. Concurrence of somatization and hypochondriacal beliefs increased the risk to be a FA. As a conclusion, the results emphasize the need to consider the FAs' own bodily concerns expressed as hypochondriacal beliefs when managing them. Furthermore, the study implicates a need to integrate the biomedical, psychological and social dimensions in the care of FAs in primary health care

Cutting edge:a comparison of contemporary practices of riparian buffer retention around small streams in Canada, Finland, and Sweden

Abstract Forested riparian buffers are recommended to mitigate negative effects of forest harvesting on recipient freshwater ecosystems. Most of the current best practices of riparian buffer retention aim at larger streams. Riparian protection along small streams is thought to be lacking; however, it is not well documented. We surveyed 286 small streams flowing through recent clearcuts in three timber‐producing jurisdictions—British Columbia, Canada (BC), Finland, and Sweden. The three jurisdictions differed in riparian buffer implementation. In BC, forested buffers are not required on the smallest streams, and 45% of the sites in BC had no buffer. The average (±SE) width of voluntarily retained buffers was 15.9 m (±2.1) on each side of the stream. An operation‐free zone is mandatory around the smallest streams in BC, and 90% of the sites fulfilled these criteria. Finland and Sweden had buffers allocated to most of the surveyed streams, with average buffer width of 15.3 m (±1.4) in Finland and 4 m (±0.4) in Sweden. Most of the streams in the two Nordic countries had additional forestry‐associated impairments such as machine tracks, or soil preparation within the riparian zone. Riparian buffer width somewhat increased with stream size and slope of the riparian area, however, not in all investigated regions. We concluded that the majority of the streams surveyed in this study are insufficiently protected. We suggest that a monitoring of forestry practices and revising present forestry guidelines is needed in order to increase the protection of our smallest water courses

Drainage-induced browning causes both loss and change of benthic biodiversity in headwater streams

Abstract Concentrations of dissolved organic carbon (DOC) have increased over the past few decades, causing freshwater browning. Impacts of browning on biodiversity have been little studied, despite many of the individual stressors associated with browning being known to control freshwater communities. We explored the responses of benthic invertebrates along a wide gradient of DOC concentrations (3.6–27 mg L⁻¹) in 63 boreal streams variously impacted by peatland drainage or peat production. DOC was a prime determinant of macroinvertebrate diversity and abundance, with the strongest negative response in algal scrapers. Threshold indicator taxa analysis indicated an abrupt community change at 12–13 mg DOC L⁻¹, with only four taxa increasing, while 13 taxa decreased along the gradient. Our findings of both a gradual loss and abrupt change of biodiversity along a browning gradient provide a benchmark against which changes to stream biodiversity relative to the predicted browning trend can be gauged

Dark matters:contrasting responses of stream biofilm to browning and loss of riparian shading

Abstract Concentrations of terrestrial-derived dissolved organic carbon (DOC) in freshwater ecosystems have increased consistently, causing freshwater browning. The mechanisms behind browning are complex, but in forestry-intensive regions browning is accelerated by land drainage. Forestry actions in streamside riparian forests alter canopy shading, which together with browning is expected to exert a complex and largely unpredictable control over key ecosystem functions. We conducted a stream mesocosm experiment with three levels of browning (ambient vs. moderate vs. high, with 2.7 and 5.5-fold increase, respectively, in absorbance) crossed with two levels of riparian shading (70% light reduction vs. open canopy) to explore the individual and combined effects of browning and loss of shading on the quantity (algal biomass) and nutritional quality (polyunsaturated fatty acid and sterol content) of the periphytic biofilm. We also conducted a field survey of differently colored (4.7 to 26.2 mg DOC L−1) streams to provide a ‘reality check’ for our experimental findings. Browning reduced greatly the algal biomass, suppressed the availability of essential polyunsaturated fatty acids, especially eicosapentaenoic acid (EPA), and sterols, but increased the availability of terrestrial-derived long-chain saturated fatty acids (LSAFA). In contrast, loss of shading increased primary productivity, which resulted in elevated sterol and EPA contents of the biofilm. The field survey largely repeated the same pattern: biofilm nutritional quality decreased significantly with increasing DOC, as indicated particularly by a decrease of the ω-3:ω-6 ratio and increase in LSAFA content. Algal biomass, in contrast, was mainly controlled by dissolved inorganic nitrogen (DIN) concentration, while DOC concentration was of minor importance. The ongoing browning process is inducing a dramatic reduction in the nutritional quality of the stream biofilm. Such degradation of the major high-quality food source available for stream consumers may reduce the trophic transfer efficiency in stream ecosystems, potentially extending across the stream-forest ecotone

Cutting edge : A comparison of contemporary practices of riparian buffer retention around small streams in Canada, Finland, and Sweden

Forested riparian buffers are recommended to mitigate negative effects of forest harvesting on recipient freshwater ecosystems. Most of the current best practices of riparian buffer retention aim at larger streams. Riparian protection along small streams is thought to be lacking; however, it is not well documented. We surveyed 286 small streams flowing through recent clearcuts in three timber-producing jurisdictions—British Columbia, Canada (BC), Finland, and Sweden. The three jurisdictions differed in riparian buffer implementation. In BC, forested buffers are not required on the smallest streams, and 45% of the sites in BC had no buffer. The average (±SE) width of voluntarily retained buffers was 15.9 m (±2.1) on each side of the stream. An operation-free zone is mandatory around the smallest streams in BC, and 90% of the sites fulfilled these criteria. Finland and Sweden had buffers allocated to most of the surveyed streams, with average buffer width of 15.3 m (±1.4) in Finland and 4 m (±0.4) in Sweden. Most of the streams in the two Nordic countries had additional forestry-associated impairments such as machine tracks, or soil preparation within the riparian zone. Riparian buffer width somewhat increased with stream size and slope of the riparian area, however, not in all investigated regions. We concluded that the majority of the streams surveyed in this study are insufficiently protected. We suggest that a monitoring of forestry practices and revising present forestry guidelines is needed in order to increase the protection of our smallest water courses