The Finnish National Programme for Chronic Bronchitis and Chronic Obstructive Pulmonary Disease (COPD) 1998-2007 was set up to reduce the prevalence of COPD, improve COPD diagnosis and care, reduce the number of moderate to severe cases of the disease, and reduce hospitalisations and treatment costs due to COPD. Over 900 events for 25,000 participating healthcare workers were arranged. The major strengths of this programme included multidisciplinary strategies and web-based guidelines in nearly all primary health care centres around the country.
Data from national registries, epidemiological studies and questionnaires were used to measure whether the goals had been reached.
The prevalence of COPD remained unchanged. Smoking decreased in males from 30% to 26% (p
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Comment In: Prim Care Respir J. 2011 Jun;20(2):109-1021603847
The aim of this study was to describe and evaluate the clinical pattern of 14 youths with presenting suicidality, to describe an integrative treatment approach, and to estimate therapy effectiveness. Fourteen patients aged 10 to 18 years from a child and adolescent outpatient clinic in Stockholm were followed in a case series. The patients were treated with active multimodal psychotherapy. This consisted of mood charting by mood-maps, psycho-education, wellbeing practice and trauma resolution. Active techniques were psychodrama and body-mind focused techniques including eye movement desensitization and reprocessing. The patients were assessed before treatment, immediately after treatment and at 22 months post treatment with the Global Assessment of Functioning Scale. The clinical pattern of the group was observed. After treatment there was a significant change towards normality in the Global Assessment of Functioning scale both immediately post-treatment and at 22 months. A clinical pattern, post trauma suicidal reaction, was observed with a combination of suicidality, insomnia, bodily symptoms and disturbed mood regulation. We conclude that in the post trauma reaction suicidality might be a presenting symptom in young people. Despite the shortcomings of a case series the results of this study suggest that a mood-map-based multimodal treatment approach with active techniques might be of value in the treatment of children and youth with suicidality.
Internet-based patient support systems are widely assumed to predict a future trend in patient education. Coherent information is still lacking on how patient education is adopted in psychiatric hospitals and how information technology is used in it. Our aim was to describe nurses' adoption of an Internet-based patient education programme and the variables explaining it. The study was based on Rogers' model of the diffusion of innovation. The Internet-based patient education sessions were carried out by nurses on nine acute psychiatric inpatient wards in two Finnish hospitals. They were evaluated with reports and analysed statistically. Out of 100 nurses, 83 adopted the programme during the study period. The nurses fell into Rogers' groups, late majority (72%), laggards (17%), early majority (7%), early adopters (3%) and innovators (1%). Three groups were formed according to their activity: laggards, late majority, adopters (including early majority, early adopters, innovators). There was a statistical difference between the nurses' programme adoption between the two hospitals (P= 0.045): more laggards (65% vs. 35%) and adopters (73% vs. 27%) in the same hospital. The findings help to provide insight into the contexts and settings when adopting information technology programmes in the area of mental health care.
Cervical cancer screening programmes have markedly reduced the incidence and mortality rates of the disease. A substantial amount of deaths from the disease could be prevented further by organised screening programmes or improving currently running programmes.
We present here a randomised evaluation trial design integrated to the Finnish cervical cancer screening programme, in order to evaluate renewal of the programme using emerging technological alternatives. The main aim of the evaluation is to assess screening effectiveness, using subsequent cancers as the outcome and screen-detected pre-cancers as surrogates. For the time being, approximately 863,000 women have been allocated to automation-assisted cytology, human papillomavirus (HPV) DNA testing, or to conventional cytology within the organised screening programme. Follow-up results on subsequent cervical cancers will become available during 2007-2015.
Large-scale randomised trials are useful to clarify effectiveness and cost-effectiveness issues of the most important technological alternatives in the screening programmes for cervical cancer.
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Cites: Br J Cancer. 2004 Aug 31;91(5):935-4115280916
Primary health care is an effective means of improving health for all while at the same time containing rising health care costs. In an effort to improve the health of one community, the Cardiovascular Health Education Program (CHEP) was implemented in a study of 44 eighth-grade adolescents. The purpose of this study was to assess the influence of the CHEP on adolescents' cardiovascular health knowledge. It was found that participants' knowledge improved significantly, whereas a control group showed no comparable improvement. This study showed that community-based health education programs for targeted populations can influence health knowledge.
Lecturer (Clinical) in Mental Health, Duke of Kent Building European Institute of Health and Medical Sciences, University of Surrey, Guildford, UK. a.green@surrey.ac.uk
This paper extends the account of a joint project of education and training of doctors and nurses in St. Petersburg, Russia funded by the Know How Fund Health Sector Small Partnership Scheme (Russia) (). It reports the findings of two evaluations of the project. The first, an external evaluation was carried on behalf of the sponsors, the KHF. The second was an 'insider' evaluation utilising a framework developed for the English National Board by Cranfield and Stoneman. The paper concludes with a discussion of issues arising from the cross-cultural evaluations.
Mood and anxiety disorders typically begin during adolescence or early adulthood. Yet services targeting this population are frequently lacking. This study implemented an outreach, access and assessment programme for youth with these concerns. The data reported constitute an evaluation of this mental healthcare delivery approach.
This evaluation included specification of both programme and implementation theories through causal and programme logic models and formative (process) evaluation. Outreach focused on access points for youth such as schools and family physicians' offices. Concerned youth were encouraged to self-refer. Participants completed a semi-structured clinical interview and symptom and function questionnaire package.
Engagement sessions were conducted and results involved 93 youth. The majority of youth self-referred, a process not possible in traditional physician-referral healthcare systems. Interestingly, almost half had received prior treatment and over half had tried a psychiatric medication. Yet participants had significant symptomatology: 81% reported moderate to severe depressive symptoms; 95% reported high levels of trait-anxiety. Functional impairment was substantial: on average, participants missed 2.6 days of school/work and functioned at reduced levels on 4.2 days in the week prior to assessment. Demographic details are presented.
This study evaluated a mental healthcare delivery system that identified individuals with significant distress and functional impairment from mood/anxiety concerns and previous unsuccessful treatment attempts, verifying that they were in need of mental health services. This approach provides a model for outreach and assessment in this population, where earlier intervention has the potential to prevent chronic mental illness and disability.
Peer support, a cornerstone in recovery programs for mental illness and addiction, has not been widely applied to service programs for survivors of suicide. In 2004-2006 Canadian Mental Health Association Suicide Services in Calgary, Alberta, introduced the Peer Support Program for adults, an adjunct to conventional individual and group intervention. This article reports on a mixed-methods evaluation of the Peer Support Program. Hogan's Grief Response Checklist and the qualitative data tracked positive outcomes for both the peer supporters and the clients. This study challenges the unspoken assumption that survivors of suicide, due to their vulnerability, require the services of highly skilled professionals and would not be in a position to offer unsupervised support to peers. Rather it supports an intervention protocol that consists of peer supporters and professionals working collaboratively to offer cost-effective, client-centered services.
