Finnish Primary Health Care Research Articles

Long- and short-term frequent attenders' perceptions of patient-centredness in Finnish primary healthcare: A cross-sectional survey and the equivalence of the factor structure of the 36-item patient-centred primary care instrument.

The study aimed to compare long- and short-term frequent attenders' (FAs) perceptions of patient-centredness and to assess the equivalence of the factor structure of patient-centred primary care (PCPC) instrument for long- and short-term FAs. A cross-sectional survey of long-term (n = 234) and short-term (n = 261) FAs within the primary healthcare of one city in Finland. The data collected in January-July 2020 via 'the 36-item PCPC instrument' were analysed using Pearson's chi-squared test, Mann-Whitney U-test, Cronbach's alpha, and multigroup confirmatory factor analysis (MGCFA). Long-term FAs had worse perceptions of patient-centredness than short-term FAs across all subscales: patients' preferences, physical comfort, coordination of care, continuity and transition, emotional support, access to care, information and education, and family and friends. The MGCFA indicated a good fit for the predicted eight-factor model. Long-term FAs' care needs are currently not being met, indicating the need for considering how the way healthcare services are arranged and care is provided affects prolonged and high care needs. Various dimensions of patient-centredness need to be addressed when developing not only FAs' care but also wider service paths. A distinction should be made between long- and short-term frequent attendance when identifying and addressing FAs' service needs.

Attitudes of primary healthcare chief physicians towards research in Finland – a national study

Objective To illustrate the views of chief physicians in Finnish primary healthcare health centres (HCs) on the existing research capacity of their centres, their attitudes to practice-based research network activity, and research topics of interest to them. Design A cross-sectional survey study. Setting Finnish HCs. Subjects Chief physicians in Finnish HCs. Main outcome measures We used a questionnaire that included five-point Likert scales and multiple choice and open-ended questions to identify the chief physician’s profile, the HC content, the attitudes of chief physicians towards engagement in research, research topics of interest to them, and factors that may influence their motivation. Descriptive methods were used for the analysis of the quantitative data, while the qualitative data were processed using inductive thematic analysis. Results There was a relatively good representation of all hospital districts. One-third of HCs had at least one person doing research, and 61% of chief physicians would support research in their setting. Their stimulus for research was primarily testing new therapies, protocols, and care processes, as well as effectiveness and healthcare improvement. The expected benefits that motivate engagement in Practice-based research networks (PBRNs) are evidence-based practice and raised professional capacity and profile of the HC. Conclusions Chief physicians regard research as an elementary part of the development of primary care practices and health policy. Their motivation to engage in PBRN activity is determined by the relevance of the research to their interests and the management of competing priorities and resource limitations.

Patient activation for self-management among adult patients with multimorbidity in primary healthcare settings.

Background and AimsMultimorbidity is a major public health and healthcare challenge around the world, including in Finland. As multimorbidity necessitates self‐management in everyday life, the effects of patient activation – a patient's knowledge, skills, and confidence in managing own health – on the capacity for self‐management warrant study, especially in primary healthcare settings. This study aimed to assess patient activation among multimorbid primary healthcare patients, identify factors associated with patient activation, and determine whether patients with low and high activation differ in terms of health and self‐management behavior, related perceptions, and health‐related quality of life (HRQoL).MethodsA cross‐sectional survey was conducted among multimorbid patients who attended Finnish primary healthcare consultations (November 2019 to May 2020). The main outcome, patient activation, was assessed using the patient activation measure, PAM‐13®. Responses from 122 patients were analyzed using descriptive statistics, t‐tests, analysis of variance, linear modeling, the χ 2 test, and binary regression analysis.ResultsThe mean score of patient activation was 56.12 (SD 12.82) on a scale 0–100 where ≤55.1 indicate low activation. The lower activation scores were significantly associated with old age, obesity, loneliness, and lower perceived health, functional ability, and vitality. Patients with low activation (47%) had significantly poorer physical activity, diets, adherence to care, and HRQoL, and significantly worse perceptions related to self‐management including motivation and energy, sense of normality, and support from physicians, nurses, and close people.ConclusionPatient activation among multimorbid outpatients was rather low. Findings indicate that patients' perceptions of their health and psychosocial factors may be important for activation and that patients with low and high activation differ with respect to several health variables. Determining patient activation in multimorbid patients may facilitate adaptation of care to better meet patient capabilities and needs in clinical settings. Knowledge of a patient's activation level may also be useful when developing interventions and care strategies for this patient group.

Development of office-hours use of primary health centers in the early years of the 21st century: a 13-year longitudinal follow-up study

ABSTRACT This study, conducted in a Finnish city, examined whether a long-lasting observed trend in Finnish primary health care, namely, a decreasing rate of office-hour visits to general practitioners (GPs), would lead to reduced services for specific gender, diagnosis or age groups. This was an observational retrospective follow-up study. The annual number of visits to office-hour primary care GPs in different gender, diagnosis and age groups was recorded during a 13-year follow-up period. The effect of the decreasing visit rate on the annual mortality rate in different age and gender groups was also studied. The total number of monthly visits to office-hour GPs decreased slowly over the whole study period. This decrease was stronger in women and older people. The proportion of recorded infectious diseases (Groups A and J and especially diagnoses related to infections of respiratory airways) decreased. Proportions of recorded chronic diseases increased (Group I, cardiovascular diseases, diabetes and osteoarthrosis) during the follow-up. The annual rate of visits to office-hour GP/per GP decreased. There was a decrease in the mortality in two of the age groups (20–64, 65+ years) and no change in the youngest population (0–19 years). The decrease in the office-hours GP activity does not seem to increase mortality either.

Prevention of leg cramps by using compression stockings or magnesium supplements in the 50\u201384 age group: study protocol for a randomised controlled trial

BackgroundLeg cramps are painful sensations of tightening in the muscles of the legs that commonly appear during the night and are often associated with secondary insomnia. They are common especially in older age. There is no evidence that any method of prevention of nocturnal leg cramps is both safe and effective. There are no previous trials concerning cramp prevention by using compression stockings. The objective of this study is to assess in a prospective randomised controlled trial whether leg cramps can be prevented by the daily use of knee-length compression stockings or magnesium supplements.MethodsThe study will be set in Finland, and 50–84-year-old volunteers will be recruited through Google Ads, the Finnish health library website and Finnish primary health care centres. The participants must have a minimum of two episodes of leg cramps per week for the past 4 weeks to be included in the study. The participants (n = 225) will be allocated to three equal groups: the compression stocking arm, the magnesium supplement arm and the placebo arm. The participants will go through 4 weeks of follow-up without intervention and then another 4 weeks of follow-up with the assigned intervention. The material for the study will be collected through electronic questionnaires.DiscussionThis protocol describes a study that compares compression stockings, magnesium supplements and placebo for the prevention of leg cramps. The results of this study can significantly improve knowledge on the methods of preventing leg cramps.Trial registrationClinicalTrials.gov NCT04694417. Registered on Jan 4, 2021.

Design of a prospective follow-up study on early parenthood and smoking behaviour during pregnancy in Finnish primary healthcare.

Aims: The primary aim of the study is to explore different factors affecting parents’ smoking behaviour, and especially how smoking may be connected with individual differences in the psychological process of becoming a parent. In the current paper, we present the study design together with basic information on the study population. Methods: The Central Satakunta Maternity and Child Health Clinic (KESALATU) Study is an ongoing prospective follow-up study in primary healthcare of the Satakunta region of southwest Finland. Families were recruited during their first maternity clinic visit between 1 September 2016 and 31 December 2019, and participation will continue until the child is 1.5 years of age. The study combines different sources and types of data: e.g. routine data obtained from primary healthcare clinic records, specific parental self-report data and data from a new exhaled carbon monoxide meter indicating maternal smoking. The data are collected using frequently repeated assessments both during pregnancy and postnatally. The methods cover the following areas of interest: family background factors (including smoking and alcohol use), self-reported parental–foetal/infant attachment and mentalization, self-reported stress, depression and quality of life. Results: 589 pregnant women and their partners were asked to participate in the study during the collection time period. The final study population consisted of 248 (42.1%) pregnant women and 160 (27.1%) partners. Conclusions: The new methods and study design have the potential to increase our understanding about the link between early parenting psychology, prenatal psychosocial risk factors and parental health behaviour.

How GPs can Recognize Persistent Frequent Attenders at Finnish Primary Health Care Using Electronic Patient Records.

Introduction:The proportion of patients who are frequent attenders (FAs) varies from few percent to almost 30% of all patients. A small group of patients continued to visit GPs year after year. In previous studies, it has been reported that over 15% of all 1-year FAs were persistent frequent attenders (pFAs).Objectives:This study aimed to identify typical features of pFAs from the textual content in their medical entries, which could help GPs to recognize pFAs easily and facilitated treatment.Methods: A retrospective register study was done, using 10 years of electronic patient records. The data were collected from Finnish primary health care centers and used to analyze chronic symptoms and diagnoses of pFAs and to calculate the inverse document frequency weight (IDF) of words used in the patient records. IDF was used to determine which words, if any, are typical for pFAs. The study group consisted of the 5-year pFAs and control group of 1-year FAs. The main background variables were age, gender, occupation, smoking habits, use of alcohol, and BMI.Results:Out of 4392 frequent attenders, 6.6% were pFAs for 3 years and 1.1% were pFAs for 5 years. Of the pFAs, 65% were female and 35% were male. The study group had significantly more depressive episodes (P = .004), heart failure (P = .019), asthma (P = .032), COPD (P = .036), epilepsy (P = .035), and lumbago (P = .046) compared to the control group. GPs described their 5-year pFAs by words related to lung and breathing issues, but there was no statistical difference to the 1-year FAs’ descriptions.Conclusion:A typical pFA seems to be a woman, aged about 55 years with depressive episodes, asthma or COPD, and lower back pain. Physicians describe pFAs with ordinary words in patient records. It was not possible to differentiate pFAs from 1-year FAs in this way.

Patients’ conceptions of undergoing physiotherapy for persistent low back pain delivered in Finnish primary healthcare by physiotherapists who had participated in brief training in cognitive functional therapy

Purpose To explore the conceptions of patients with persistent low back pain (LBP) of undergoing physiotherapy delivered in Finnish primary healthcare by physiotherapists who had participated in brief training in Cognitive Functional Therapy (CFT). Methods As part of a feasibility implementation study exploring CFT in management of LBP in the Finnish primary healthcare system, we interviewed nine patients from four geographical areas in Finland after receiving care. We used a phenomenographic approach to explore the variation in their conceptions. Results The analysis revealed four descriptive categories: “hung out to dry,” “stuck,” “making sense and taking control,” and “holistic approach to care and living,” that varied based on six themes. Conclusions Although the participants accepted this approach to care well, there was significant variation in patients’ conceptions. Restricted access to care within the healthcare system and a lack of social support led some of them to feel they had been left alone to suffer with their pain. On the other hand, based on the results of this study, positive experiences of physiotherapy and good collaboration with the physiotherapist, wider social support outside of physiotherapy, a better understanding of the multidimensional nature of pain and the acquisition of self-management skills were reported as positive aspects of undergoing physiotherapy that may be related to positive treatment outcomes. Implications for rehabilitation The participants of this study saw undergoing physiotherapy delivered within biopsychosocial framework as different from their previous physiotherapy experiences and for some the process ended with feeling empty-handed and for others it could be a turning point in their lives. This study encourages the health care providers to create flexible care pathways and ongoing support for more vulnerable individuals so that they don’t feel abandoned by the system. Professionals could also pay attention to building strong therapeutic alliance, help patients understand pain in biopsychosocial framework, take into consideration social support networks of the patients, and support patients toward effective self-management strategies.

The dental healthcare professionals' competence in mentoring students in the clinical practice.

The aim of this study was to evaluate dentists', dental hygienists' and dental assistants' competence in mentoring students and to identify distinct mentor profiles. The study employed a cross-sectional design. Data were collected using the Mentors' Competence Instrument (MCI), which includes 45 items structured under seven mentoring competence sub-dimensions. The data were collected during autumn 2017 from dentists, dental hygienists and dental assistants working in the Finnish primary healthcare (n=1097) using a paper survey, whilst dentists (n=26) who have completed mentoring education in one university completed an electronic questionnaire. Cases with more than 5% missing data (n=164) were listwise deleted, whilst the remaining data (n=933) underwent analysis. K-mean clustering was used to identify significantly different mentor profiles, whilst comparisons of mentoring competence between the identified profiles were performed with Kruskal-Wallis and Mann-Whitney tests. Three distinct mentor profiles (A, B and C) that differed in the level of mentoring competence were identified. The participants in profile A encompassed mostly dental assistants, profile B included mostly dental assistants and dentists, and profile C mainly comprised dentists and dental assistants. Profiles A, B and C differed significantly in terms of education, job title, role of mentor and participation in mentoring education. The largest difference in competence was observed between participants of profiles A and C. Each profile differed significantly from the other two across all seven competence areas. Most of the participants had not previously received any mentoring education. There is room for improvement in the competence of dentistry student mentors, especially regarding knowledge of effective mentoring practices, goal-oriented mentoring, mentor characteristics and motivation for mentoring. Every mentor that works with oral healthcare students should receive mentoring training.

The validity and reliability of the patient enablement instrument (PEI) after GP appointments in Finnish health care centres

BackgroundThe aim of this study was to assess the validity and reliability of the Patient Enablement Instrument (PEI) in Finnish health care centre patients. A pilot study was conducted to assess the content validity of the PEI. A questionnaire study in three health care centres in Western Finland was performed in order to assess acceptability, construct validity, internal consistency, and measurement error of the instrument. A telephone interview 2 weeks after the appointment was performed to evaluate reproducibility.ResultsThe pilot study with 17 participants indicated good content validity of the PEI. In the questionnaire study, altogether 483 with a completed PEI score were included in the analyses. Factor analysis and item-scale correlations suggested high structural validity. The internal consistency of the instrument was high (Cronbach’s α = 0.93). The PEI score diminished strongly over the two-week period.ConclusionsThe PEI has good content validity and acceptability, good construct validity, high internal consistency but low reproducibility. Thus, the PEI seems to be an applicable tool to measure patient enablement in Finnish primary health care.

The prevalence of chronic kidney disease and screening of renal function in type 2 diabetic patients in Finnish primary healthcare

AimsTo estimate the prevalence of chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) in Finnish primary healthcare, and to evaluate the screening for CKD and the proportions of patients receiving antihyperglycemic and cardiovascular preventive medication. Material and methodsT2D patients treated at the Rovaniemi Health Center, Finland during the years 2015–2019. Data included patient characteristics, blood pressure, HbA1c, lipid levels, kidney function and albuminuria, and medications prescribed. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.72 m2 and/or albuminuria. ResultsThe study population comprised of 5112 T2D patients with a mean (SD) age of 66.7 (13.0) years. Of these, 60.2% were screened for CKD with both eGFR and albuminuria, and 30.1% of these patients had CKD. The prevalence of moderately increased and severely increased albuminuria was 19.6% and 3.2%, respectively. A total of 57.0% of the study population received angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB). ConclusionsScreening for CKD with both recommended measures (eGFR and albuminuria) was insufficiently performed among this T2D population. Additionally, just over half of the study population had been prescribed ACE inhibitors or ARB. These results suggest an incongruity between the gold standard of diabetes care and real-world clinical practice.

Trajectory modelling of ambulatory care sensitive conditions in Finland in 1996\u20132013: assessing the development of equity in primary health care through clustering of geographic areas \u2013 an observational retrospective study

BackgroundDue to stagnating resources and an increase in staff workload, the quality of Finnish primary health care (PHC) is claimed to have deteriorated slowly. With a decentralised PHC organisation and lack of national stewardship, it is likely that municipalities have adopted different coping strategies, predisposing them to geographic disparities. To assess whether these disparities emerge, we analysed health centre area trajectories in hospitalisations due to ambulatory care sensitive conditions (ACSCs).MethodsACSCs, a proxy for PHC quality, comprises conditions in which hospitalisation could be avoided by timely care. We obtained ACSCs of the total Finnish population aged ≥20 for the years 1996–2013 from the Finnish Hospital Discharge Register, and divided them into subgroups of acute, chronic and vaccine-preventable causes, and calculated annual age-standardised ACSC rates by gender in health centre areas. Using these rates, we conducted trajectory analyses for identifying health centre area clusters using group-based trajectory modelling. Further, we applied area-level factors to describe the distribution of health centre areas on these trajectories.ResultsThree trajectories – and thus separate clusters of health centre areas – emerged with different levels and trends of ACSC rates. During the study period, chronic ACSC rates decreased (40–63%) within each of the clusters, acute ACSC rates remained stable and vaccine-preventable ACSC rates increased (1–41%). While disparities in rate differences in chronic ACSC rates between trajectories narrowed, in the two other ACSC subgroups they increased. Disparities in standardised rate ratios increased in vaccine-preventable and acute ACSC rates between northern cluster and the two other clusters. Compared to the south-western cluster, 13–16% of health centre areas, in rural northern cluster, had 47–92% higher ACSC rates – but also the highest level of morbidity, most limitations on activities of daily living and highest PHC inpatient ward usage as well as the lowest education levels and private health and dental care usage.ConclusionsWe identified three differing trajectories of time trends for ACSC rates, suggesting that the quality of care, particularly in northern Finland health centre areas, may have lagged behind the general improvements. This calls for further investments to strengthen rural area PHC.

Patients’ perceptions of participation: Pilot validation study of the FI-PPRQ questionnaire in Finnish primary healthcare settings

Patient participation is is a highly valued goal within healthcare. The aim of this study was to assess the validity of a Finnish version of the Participation in Rehabilitation Questionnaire (FI-PPRQ) developed to measure patients’ perceptions of the importance and their experience of participation in care. The original PPRQ was translated from Swedish into Finnish, then subjected to psychometric pilot testing using data acquired in a cross-sectional survey with a sample of adult patients in eight primary healthcare units (n = 88). The importance and experience ratings were evaluated separately, by calculating distributions of item and scale scores, Cronbach’s alpha coefficients, and correlations between items and scales. In addition, experience ratings were subjected to exploratory factor and multi-trait scaling analyses. The results of this study support the validity and reliability of the instrument for use in clinical settings to provide information about patient participation. However, further studies are needed with more varied settings.

Continuity of nursing care in Finnish primary health care settings: A 15-year follow-up

Objective: Continuity is an essential part of high-quality nursing care. This study is the first systematic follow-up of Finnish primary health care patients assessing continuity of health centre nursing staff. The aim was to ascertain how longitudinal interpersonal continuity of care is related to patients’ characteristics, their consultation experiences, and how continuity had changed over the 15-year study period.Methods: A questionnaire survey was conducted among patients attending the health centres in the Tampere University Hospital catchment area from 1998 to 2013. A total of 157,549 patients responded out of 363,464 in almost 60 health centres. We analysed the opinions of patients (n = 47,470) who had visited a nurse during the survey weeks. Opinions on the continuity of care were assessed with the question: “When visiting the health centre, do you usually see the same nurse”, the alternatives being “yes” or “no”. A binary logistic regression model was used.Results: Almost two thirds of the respondents had met the same nurse when visiting their health care centre. Longitudinal interpersonal continuity of care decreased by 15 percentage (67%-52%) during the study years. Continuity was connected to patient-related items such as a visit in the preceding 12 months (OR 1.32, 95% CI 1.17-1.49) and non-urgency of the visit (OR 1.44, 95% CI 1.27-1.63). The most prominent factor contributing to the sense of continuity of care was how attentively nurses had listened to their patients’ problems and shown an interest in them and a willingness to answer their questions (OR 1.31, 95% CI 1.120-1.43).Conclusions: In the past 15 years patient-reported longitudinal interpersonal continuity of nursing care has declined. However continuity of care proved to enhance the experienced quality of primary health care. Continuity was best realized in nursing care when nurses had listened to their patients’ problems, showed interest toward them and a willingness to answer their questions.

Patient Enablement After a Single Appointment With a GP: Analysis of Finnish QUALICOPC Data.

Background: Patient enablement is described as patient’s ability to understand and cope with illness after a consultation. The purpose of this study was to analyze factors associated with enablement in Finnish primary health care. An additional aim was to evaluate whether a single question could be used to measure enablement. Methods: A questionnaire survey was addressed to Finnish general practitioners (GPs) within the Quality and Costs of Primary Care in Europe (QUALICOPC) study framework. A trained fieldworker contacted nine patients for every participating GP. Two to 9 patients per GP (median 9 patients) completed the questionnaire. Patient enablement was measured by a single question based on the Patient Enablement Instrument questionnaire. Multivariate and multilevel analyses were performed to find variables that have an independent association with patient enablement. Results: A total of 1196 patients completed the QUALICOPC questionnaire. A total of 898 patients (75.1%) agreed that they felt better able to cope with their health problem or illness after an appointment with a GP, reflecting patient enablement. In the theme group analyses, 11 factors were found to have a statistically significant (P < .05) association with enablement. In the final multivariable model, positive perceptions of doctor-patient communication and patient satisfaction were positively associated with enablement. Conclusions: The results, using a single question to measure enablement, are comparable to previous findings on factors associated with enablement. Further research is needed and these results should be regarded as preliminary.

PHP253 - Icpc-2 Episode-Based Health-Related Quality Of Life And Three Months Effectiveness In Three Finnish Primary Health Care Settings

PHP253 - Icpc-2 Episode-Based Health-Related Quality Of Life And Three Months Effectiveness In Three Finnish Primary Health Care Settings

PM224 Improving the Quality of Type 2 Diabetes Care and Secondary Prevention of Coronary Heart Disease in Finnish Primary Health Care: Use of Medical and Geospatial Data, and the Breakthrough Collaborative Method

PM224 Improving the Quality of Type 2 Diabetes Care and Secondary Prevention of Coronary Heart Disease in Finnish Primary Health Care: Use of Medical and Geospatial Data, and the Breakthrough Collaborative Method

Applying the theory of information worlds within a health care practise in Finland

Purpose– The purpose of this paper is to increase understanding about value creation to families in childhood obesity care in multiprofessional collaboration in an integrated care pathway (ICP).Design/methodology/approach– The qualitative case study involves the ICPs of two Finnish University Hospital districts. The empirical data, collected between 2009 and 2012, consists of semi-structured interviews of 30 health professionals in primary and special health care, of three children and their mothers, a family questionnaire (n=13) complemented with care path instructions and memos of an ICP work group.Findings– The findings indicate that organisational culture confirms boundaries which hinder transfer of information and sharing of knowledge between organisations and professional groups. The concepts of Chatman’s theory of everyday life information seeking complemented with the concepts of Burnett’s and Jaeger’s theory of information worlds are applicable to describe aspects of organisational culture on patient value creation in the ICP for obese children.Research limitations/implications– The data of the patients and families were limited. Interviews were completed with a questionnaire which has its limitations in qualitative research. In future studies, e.g., families’ focus-group interviews could bring new insights.Practical implications– The practise of information transfer between Finnish primary and special health care need changes. Modern information technology, e.g., videoconference could be used to increase family involvement in the value creation and the environment should be more supportive for healthy lifestyle.Originality/value– The study is one of the first which empirically applies Chatman’s and Burnett’s and Jaeger’s theories in a work-related setting.

Prevention of type 2 diabetes - where is the evidence?

Diabetes is an “old disease”. The first description of diabetes written on papyrus about 3500 years ago is found in the Ebers papyrus, which was discovered in Egypt in 1873 by the German archeologist Georg Ebers. Humans, like most mammals, may develop diabetes, if sufficient environmental exposure to physical inactivity, unhealthy diet and obesity are present. Genetic effects are important for the individual risk of type 2 diabetes (T2D) but twin studies have shown that the genetic effects combined explain less than 50% of the risk of T2D (1). Today we know almost 100 susceptibility genes associated with T2D but the relative importance of each of these genes is low (2), and together they explain only a small part of the disease risk. Thus, genetic screening cannot be used for the prediction of T2D for individuals. On the other hand, healthy lifestyle can also prevent T2D in people who are genetically at high risk, e.g. those with positive family history (3). Thus, the importance of lifestyle factors for the development and prevention of T2D is overwhelming. The strongest evidence in medicine is considered to come from randomized controlled trials (RCTs). They are also important in providing the link to causal inference that in most observational studies cannot be derived. At the same time, observational studies are necessary for the identification of factors associated with an increased or decreased risk of a disease, and for generation of hypotheses on potential means for prevention based on modifiable risk factors. Observational studies have by now identified a large number of factors that are associated with the development of T2D or with the protection against it. Most of them are related to physical activity, diet and obesity. It has also been shown unequivocally that exposures (poor nutrition, infections, smoking, etc.) during fetal life and early infancy resulting in insufficient development (often shown as low birth weight) also predict T2D later in life (4). Traditionally, T2D has been considered to be a disease of the elderly. However, with increasing obesity and sedentary lifestyle in children, there are increasing numbers of cases of T2D already occurring at a young age in many populations (5). In the past two decades several innovative RCTs have repeatedly shown that interventions on modifiable risk factors can reduce the incidence of diabetes in high-risk groups. The evidence has been summarized in several systematic reviews and meta-analyses (6,7). There is compelling scientific evidence from RCTs that T2D can be prevented or its onset delayed. The key for prevention is a multimodal package of lifestyle changes that is a sum outcome of dietary and physical activity behaviours. The power of lifestyle was dramatically illustrated by the Finnish Diabetes Prevention Study (DPS) that explicitly showed that when the study participants with impaired glucose tolerance reached all five modest lifestyle intervention targets, none of them progressed to T2D (8). Importantly, lifestyle intervention lasting for 3–6 years has been shown to have a carry-over effect on T2D incidence that lasts for several years; up to 15 in the Finnish Diabetes Prevention Study (9) and 20 years in the China Da Qing Diabetes Prevention Study (10). The observed sustained risk reduction seems to be a result of sustained lifestyle changes, but the legacy effect of improved glycaemia during the early intervention may also have contributed to the long-term effect. The follow-up data from the Chinese study indicate moreover that vascular risks are also reduced by lifestyle management. Several prognostic questionnaires exist for detecting people at risk of T2D (11). One of the screening tools with an adequately high sensitivity and specificity is the Finnish Diabetes Risk Score (FINDRISC) developed in Finland (12). The FINDRISC has been successfully implemented in the Finnish primary health care system and used also in many other countries. The FINDRISC was also tested in the Omani population and as a result a slightly modified Omani Diabetes Risk Score was developed (13) which may be a suitable screening tool for the Arab populations in the Middle East. Lifestyle interventions aiming at translating evidence from efficacy RCTs on T2D prevention into “real world” intervention programmes have also been carried out in various populations. Such data were recently combined in a meta-analysis considering the relationship between intervention effectiveness and adherence to guidelines (14). The primary meta-analysis included 22 studies with outcome data for weight loss at 12 months. The pooled result of the direct pairwise meta-analysis shows that lifestyle

Relational continuity of care in integrated maternity and child health clinics improve parents' service experiences.

In the Finnish primary health care, relational continuity of care is implemented in integrated maternity and child health clinics where the same nurse takes care of the family from the pregnancy until the child reaches school age. The aim of this study was to clarify the association between this relational continuity of care and the availability, utilisation and selected features of the maternity and child health clinic services, as evaluated by the parents. A comparative, cross-sectional service evaluation survey was used. Eighteen months after their baby's delivery, mothers (N = 987) and fathers (N = 835) from Southwest Finland evaluated specific maternity and child health clinic services. Comparisons were made between the parents who had relational continuity of care in the integrated maternity and child health clinics and those who did not. Home visits were more frequently provided when relational continuity of care in integrated maternity and child health clinics existed. Parents who had this relational continuity of care, evaluated several features of the service, especially provided support, more positively than parents who did not. Relational continuity of care in integrated maternity and child health clinics seems to increase parents' satisfaction with the services and might increase the provision of home visits.