Doctor-patient interaction in Finnish primary health care as perceived by first year medical students

BACKGROUND: In Finland, public health care is the responsibility of primary health care centres, which render a wide range of community level preventive, curative and rehabilitative medical care. Since 1990's, medical studies have involved early familiarization of medical students with general practice from the beginning of the studies, as this pre-clinical familiarisation helps medical students understand patients as human beings, recognise the importance of the doctor-patient relationship and identify practicing general practitioners (GPs) as role models for their professional development. Focused on doctor-patient relationship, we analysed the reports of 2002 first year medical students in the University of Kuopio. The students observed GPs' work during their 2-day visit to primary health care centres. METHODS: We analysed systematically the texts of 127 written reports of 2002, which represents 95.5% of the 133 first year pre-clinical medical students reports. The reports of 2003 (N = 118) and 2004 (N = 130) were used as reference material. RESULTS: Majority of the students reported GPs as positive role models. Some students reported GPs' poor attitudes, which they, however, regarded as a learning opportunity. Students generally observed a great variety of responsibilities in general practice, and expressed admiration for the skills and abilities required. They appreciated the GPs' interest in patients concerns. GPs' communication styles were found to vary considerably. Students reported some factors disturbing the consultation session, such as the GP staring at the computer screen and other team members entering the room. Working with marginalized groups, the chronically and terminally ill, and dying patients was seen as an area for development in the busy Finnish primary health care centres. CONCLUSION: During the analysis, we discovered that medical students' perceptions in this study are in line with the previous findings about the importance of role model (good or bad) in making good doctors. Therefore, medical students' pre-clinical primary health care centre visits may influence their attitudes towards primary health care work and the doctor-patient relationship. We welcome more European studies on the role of early pre-clinical general practice exposure on medical students' primary care specialty choice

The Use of Complementary and Alternative Medicine in a General Population in South Korea: Results from a National Survey in 2006

The purpose of this survey was to obtain information on the prevalence, costs, and patterns of use of complementary and alternative medicine (CAM) in a general population in the Republic of Korea. In 2006, we conducted nationwide and population-weighted personal interviews with 6,021 adults ranging from 30 to 69 yr of age; the final sample consisted of 3,000 people with a 49.8% response rate. In addition to their general socio-demographics, the respondents were asked about their use of CAM during the previous 12-month period, costs, sources of information, and reasons for use. The prevalence of use overall was 74.8%, while biologically based CAM therapies were the most likely type of use (65.4%). The median annual out-of-pocket expenditures for CAM therapies was about US$203. The primary reason for using CAM was for disease prevention and health promotion (78.8%). The main source of advice about CAM therapies use was most likely to be from family and friends (66.9%). Our study suggests that CAM use has been and continues to be very popular in South Korea. Conventional western medical doctors and governments should obtain more evidence and become more interested in CAM therapies

Maantiekuljetukset Suomesta Venäjälle

Tässä opinnäytetyössä kerrotaan maantiekuljetuksista Suomesta Venäjälle. Opinnäytetyö koostuu kahdesta osasta teoriaosuudesta ja tutkimusosuudesta. Työllä ei ole toimeksiantajaa, joten se toimii opaskirjana kyseisessä tilanteessa. Teoriaosuudessa käsiteltiin lainsäädännöllisiä seikkoja maantiekuljetuksista. Siinä kerrottiin myös logistiikan perusteita ja historiaa. Työssä käsiteltiin erilaisia autotyyppejä, joilla kuljetuksia voidaan suorittaa. Teoriaosuudessa pohdittiin myös Venäjää vientikohteena. Esimerkiksi millaisia erilaisia lupia yritys saattaa tarvita viedessään tuotteita Venäjälle Työssä vertailtiin myös Suomen ja Venäjän kuljetusten eroja. Työn tutkimus tehtiin kvalitatiivisena tutkimuksena. Tutkimuksessa haastateltiin kuutta eri puolella Venäjän vientiä toimivaa henkilöä. Haastattelut jaettiin kolmeen ryhmään: myyjät, osaaminen ja viejäyritykset. Tutkimuksessa tavoitteena oli löytää erilaisia ongel-mia, joita Venäjälle kuljettamisessa voidaan kohdata. Tutkimuksesta kävi ilmi, että suurin ongelma Suomen ja Venäjän välisissä maantiekuljetuksissa on Venäjän tulli ja sen byrokratia. Jokaisessa haastattelussa tuli ilmi ainakin jonkin asteisia negatiivisia kokemuksia Venäjän byrokratiasta. Haastatteluissa saatiin myös muutamia parannusehdotuksia tilanteen parantamiseksi. Esimerkiksi sähköistä tullausta pidettäisiin tarpeellisena muutoksena Suomen ja Venäjän tullissa

Vaihtoehtoinen terveydenhuolto hyvinvointivaltion terveysmarkkinoilla

Alternative medicine has become visible, when the welfare state has reached its maturity and is getting into a crisis. It can be seen to reflect this process. This study includes seven original studies published earlier as separate articles and a summary as well as two appendices on the beliefsystems and the legal status of alternative medicine. The aim of the study was 1) to discover how alternative medicine is used and socially determined 2) to describe its cultural structure and 3) to analyse its role and functions in the welfare state especially in Finland 4) to explain alternative medicine as a representation of the health discourse in the welfare state. The methods used were two surveys with structured questionnaires, two interviews and a qualitative content analysis. The study shows that people use alternative medicine commonly and the use pattern is rather complementary than alternative. People are able to combine different official and unofficial treatments. The most frequently used treatments were herbal drugs, massage and different paramedical physical treatments. Usage of alternative medicine was determined by female sex and multidimensional ill health. Also, the study suggests that there are two different types of health cultures: modern alternative in urban areas and folk medicine in rural areas. Alternative medicine mainly operates in symbolic area, it gives explanations and meanings as well as coping methods in ill health. It includes parts of biomedical model, however, it also counteracts towards scientific medicine. In spite of great variation there are shared ideas: holism (mind body) naturalism, vitalism and purity. Alternative medicine is able to operate in natural and supernatural world. It is attempting to hold its privacy and to escape the role of social control agent in the private territory. It is satisfying the demands on the post-modern health markets. The crucial question in the future is whether alternative medicine is able to create freedom and strengthen autonomy of individuals or whether it exploits individuals by using symbolic manipulation

Unintended pregnancy and termination of studies among students in Anambra state, Nigeria: Are secondary schools playing their part?

This study evaluated efforts of secondary schools to prevent unintended pregnancy among students and their reactions to pregnant students before and after delivery. A cross-sectional survey of 46 teachers in three public and two private schools in Anambra state, Nigeria was carried out. Information was collected using self-administered questionnaire. Of all the teachers in the study, 87% reported unintended pregnancies among students in the previous 3 years. Expulsion (43%) and suspension (28%) were the most common reactions. Private schools were more likely to expel pregnant students than public schools. Following the delivery of their babies, 43% discontinued their education in the same school, whereas 37% continued their education in a different school. Counselling was given before suspension or expulsion in 4% of public schools and 15% of private schools. Majority of the schools (61%) did not have sex education as part of their schools' curriculum. Students should be re-admitted in order to ensure continuity of their academic development, prevent unemployment and mitigate poverty-induced repeat pregnancy

Becoming pregnant during secondary school: findings from concurrent mixed methods research in Anambra State, Nigeria

Objectives: Pregnancies among teenagers and problems associated with premarital births have raised concerns in many countries. It is important to explore unintended pregnancy from the viewpoints of local stakeholders such as students, schools/teachers, and community members. This study assessed reported cases of unintended pregnancy among students and perceptions of these pregnancies by members of the community.Methods: This study took place in a rural community in Anambra state, southeastern Nigeria. A cross-sectional survey of 1,234 students and 46 teachers in five secondary schools was carried out using self-administered questionnaires. In addition, focus group discussions (FGD) involving 10 parents and in-depth interview (IDI) with a student who became pregnant were conducted.Results: Reports of pregnancy were more common during second and third years of junior secondary school than other school years or level. According to teachers, ignorance was the main reason given by students who became pregnant. Students who became pregnant were reported to have performed poorly academically and lived with both parents, who were either  subsistence farmers or petty traders. In the IDI, the ex-student opined that pregnant students faced shame, marital limitations and lack of respect from community members. Participants in the FGD suggested that  teenagers should be provided with sex education in schools and in  churches; parents should communicate with teenagers about sexual matters and make adequate financial provision; and the male partners should be held more accountable for the pregnancies.Conclusion: Poor sexual knowledge and poor socioeconomic conditions play important roles in teenage pregnancy. Male participation may enhance effectiveness of prevention programmes.Key words: Teenage pregnancy, Mixed methods research, Nigeria, Focus group discussion,In-depth intervie