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Kaija Seppä

Publications and source records attributed to Kaija Seppä.

At least 19 recordsLinked to original sources
PubMed2006

Primary health care physicians' definitions on when to advise a patient about weekly and binge drinking.

OBJECTIVE: Little is known about the level of alcohol consumption at which physicians think that they should advise their patients to reduce drinking. This is especially true concerning the amounts consumed per one drinking occasion. The aim of the present study was to examine these issues and also characteristics of physicians possibly associated with their different opinions. METHOD: Cross-sectional self-administered questionnaire survey to all 3193 primary health care physicians in Finland. Response rate was 61.0%. RESULTS: The physicians reported that on average 14.8 drinks (one drink=12 g of absolute alcohol)/week for males and 10.6 drinks/week for females to be the threshold that would cause them to advise their patients. Corresponding figures for one drinking occasion were 6.6 and 4.9 drinks/week. In linear regression analyses physicians' AUDIT scores, use of brief intervention, experience as a physician and age explained the variance of all or some reported thresholds, but all the variables explained only about 10% of the phenomena. CONCLUSIONS: Compared to the official Finnish recommendations regarding the definition of heavy drinking, the physicians reported similar levels of drinking per occasion for deciding to advise their patients, but rather low levels concerning weekly drinking. This may lead to extra workload for physicians and thus hamper implementation of brief intervention. Physicians' characteristics seem to be a decidedly minor issue in implementing drinking limits in health care.

Adult↗
PubMed2006

Effectiveness of strategies to implement brief alcohol intervention in primary healthcare. A systematic review.

OBJECTIVE: To review systematically the available literature on implementation of brief alcohol interventions in primary healthcare in order to determine the effectiveness of the implementation efforts by the health are providers. KEY QUESTION: To what extent have the efforts to implement brief alcohol interventions in primary healthcare environments been successful? METHOD: Literature search from Medline, Cinahl, PsychLIT, Cochrane. SETTING: Primary healthcare. MATERIAL: A total of 11 studies encompassing 921 GPs, 266 nurses, 88 medical students, and 44 "non-physicians" from Europe, the USA, and Australia. MAIN OUTCOME MEASURES: Material utilization, screening, and brief intervention rates. ANSWER: Intervention effectiveness (material utilization, screening, and brief intervention rates) generally increased with the intensity of the intervention effort, i.e. the amount of training and/or support provided. Nevertheless, the overall effectiveness was rather modest. However, the studies examined were too heterogeneous, not scientifically rigorous enough, and applied too brief follow-up times to provide conclusive answers.

Alcohol Drinking↗
PubMed2006

Effectiveness of structured questionnaires for screening heavy drinking in middle-aged women.

BACKGROUND: There is a need for an effective and feasible alcohol screening instrument. The aim of the study was to evaluate how the abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) questionnaire perform in comparison with the original AUDIT and what the optimal cutoffs are when screening for heavy drinking among women. METHODS: All the 40-year-old women in the city of Tampere, Finland, are invited yearly for a health screening. From 1 year, data from 894 women (response rate 68.2%) invited for a health screening were utilized in the study. The original 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, AUDIT-3, AUDIT-QF, and CAGE were evaluated against the Timeline Followback. Consumption of at least 140 g of absolute ethanol per week on average during the past month was considered heavy drinking. RESULTS: In the Timeline Followback, the mean+/-SD weekly reported alcohol consumption was 45+/-67 g (range 0-936 g) of absolute ethanol. Of the women, 6.2% (55/894) were heavy drinkers. The optimal combination of sensitivity and specificity was reached for the AUDIT with cutoff > or =6, for the AUDIT-C with cutoff > or =5, for the Five Shot with cutoff > or =2.0, for the AUDIT-PC with cutoff > or =4, and for the AUDIT-QF with cutoff > or =4. When choosing the optimal cutoffs, the AUDIT-C, the Five Shot, the AUDIT-PC, and the AUDIT-QF performed as well as the 10-item AUDIT. With these cutoffs, sensitivities were 0.84 to 0.93 and specificities were 0.83 to 0.90. The AUDIT-3 and the CAGE did not perform as well as the other questionnaires. CONCLUSIONS: The 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, and AUDIT-QF seem to be equally effective tools in screening for heavy drinking among middle-aged women. However, their applicability is achieved only if the cutoffs are tailored according to gender.

Alcoholism↗
PubMed2006

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Journal Article↗
PubMed2005

Do primary care physicians' own AUDIT scores predict their use of brief alcohol intervention? A cross-sectional survey.

BACKGROUND: To define whether the Alcohol Use Disorders Identification Test (AUDIT) scores of primary care physicians themselves predict their willingness to use brief alcohol intervention. METHODS: Cross-sectional self-administered questionnaire survey to all 3193 physicians providing primary health care in Finland. The response rate was 1909 (59.8%). Odds ratios from multinomial regression analysis were calculated for self-reported frequency (never, occasionally or regularly) of conducting brief interventions by physicians with AUDIT scores of 0-1, 2, 3, 4, 5-7 or >or=8. RESULTS: The prevalence of heavy drinkers based on AUDIT score (>or=8) was 14.5% among all physicians, 7.0% among females and 27.0% among males. Of the respondents 9.4% reported doing brief intervention regularly and 50.0% occasionally. AUDIT scores did not significantly predict either regular or occasional use of brief intervention. Instead, some other independent predictors for more frequent use of brief intervention were found. These included having a specialist licence in general practice or occupational health care and the location of the practice, but not gender or age. CONCLUSIONS: The present results indicate that in general heavy drinking among primary care physicians do not explain the low frequency with which brief intervention is used in primary health care.

Adult↗
PubMed2005

Old people, alcohol use and mortality. A ten-year prospective study.

BACKGROUND AND AIMS: Several studies suggest an association between lower mortality and moderate drinking, particularly wine-drinking, compared with abstainers, in middle-aged populations. The aim of this study was to examine the association of drinking frequencies and beverage types with all-cause mortality among old people. METHODS: A prospective population study with a 10-year follow-up of mortality was carried out in the city of Tampere, Finland, population approximately 180,000. The sample consisted of 365 men and 402 women aged 60-99 years. All-cause mortality was used as the main outcome measure. RESULTS: Death occurred in 182 men and 158 women. Mortality was lowest among frequent and occasional drinkers, second lowest among abstainers, and highest among ex-drinkers. In a Cox proportional hazard model, drinking showed an independent protective effect on mortality. After adjustment for age, sex, educational level, marital status, chronic diseases, functional ability and smoking, the relative risk (RR) of mortality for frequent drinkers was 0.6 (95% CI 0.4-0.8), for occasional drinkers 0.7 (95% CI 0.5-1.0) and for ex-drinkers 1.1 (95% CI 0.8-1.7), compared with abstainers. Adjusted for other mortality risk factors, the mortality of those who drank wine was lower than that of abstainers. CONCLUSIONS: Findings suggest that drinking, and perhaps wine-drinking in particular, is associated with lower mortality even in old age. Future studies are needed to identify the possible role of background characteristics of different drinking pattern groups.

Aged↗
PubMed2005

Cutting down substance abuse--present state and visions among surgeons and nurses.

BACKGROUND: Although substance abuse is variably common among surgical patients, detection of the problem and brief interventions are seldom undertaken. The aim of the present study was to assess surgeons' and nurses' activity in screening substance abuse among their patients and obstacles concerning intervention of patients with substance abuse. METHODS: Surgeons and nurses of The Department of Surgery, Tampere University Hospital were asked to predict if the surgical patients treated during a 24-h period (n=211) had a substance abuse disorder. This was compared to the patients' self-reports based on the Alcohol Use Disorders Identification Test (AUDIT) and questions about use of other substances. The surgeons and the nurses were also asked to complete a questionnaire related to interventions of patients with substance abuse; perceived knowledge, skills, attitudes and obstacles. RESULTS: Of the surgical patients, 47 (22%) proved to be substance abusers. Out of them, 23% were detected by surgeons and nurses. Of the surgeons (n=44) 83% and of the nurses (n=332) 84% perceived responsibility for intervention but claimed many obstacles. Nurses reported the lack of knowledge as the main obstacle. Of the nurses 18% reported enough knowledge to conduct the whole brief intervention compared to 34% of surgeons (p=0.021). The main obstacle reported by surgeons was the lack of time. CONCLUSIONS: Surgeons and nurses detect only minority of the substance abusing surgical patients. Lack of knowledge and time prevent intervening in patients' substance abuse. These results may be utilized when developing a program to better involve surgeons and nurses in detection and intervention of surgical patients' substance abuse.

Adult↗
PubMed2005

Implementation of brief alcohol intervention in primary health care: do nurses' and general practitioners' attitudes, skills and knowledge change?

Brief alcohol intervention reduces heavy drinking, but its implementation has been challenging. The purpose was to evaluate self-reported changes in attitudes, skills and knowledge regarding brief intervention among nurses and general practitioners (GPs) during an implementation project. A questionnaire survey was used before and after the implementation to all nurses and GPs working at the time in the seven primary health-care centres of the city of Tampere, Finland. Several positive changes indicate an increased amount of knowledge regarding brief intervention among the professionals during the implementation. This was found especially among the nurses. The success in increasing the knowledge can also be seen in a decrease of training needs. Instead, attitudes and skills among the professionals did not seem to develop positively. Increasing motivational skills especially seems to be the future challenge.

Adult↗
PubMed2004

Usefulness, length and content of alcohol-related discussions in primary health care: the exit poll survey.

AIMS: To evaluate patients' opinions of the usefulness of alcohol-related discussions with general practitioners (GPs), the time used for the discussion and its main content. METHODS: Exit poll survey to 2000 consecutive patients right after GP consultations. RESULTS: The response rate was 60.2% (1203/2000). Of the patients 11.6% (139/1203) reported that they were asked and/or advised about alcohol during the consultation. The time used for discussion about alcohol was mostly <4 min; longer for heavy than for non-heavy drinkers. Main topics of the discussion dealt with quantities consumed and harm caused by alcohol. The majority of the patients (81%) reported that discussions concerning alcohol were useful. In that respect heavy drinkers did not differ from non-heavy drinkers. CONCLUSIONS: Discussions about alcohol in primary health care were rare and short, but patients' opinions about their usefulness were mainly positive.

Adult↗
PubMed2004

A brief intervention for risky drinking--analysis of videotaped consultations in primary health care.

In order to study activity in conducting brief alcohol intervention, a total of 83 consecutive consultations by eight general practitioners were videotaped. The categorization included the nature of the patient's health problems and whether alcohol consumption was elicited. The discussions were compared to previously given instructions. Alcohol consumption was elicited in 9/34 of the consultations where enquiry was indicated by the instructions, and rarely in any other situations. The activity among the individual physicians varied, but none of them elicited systematically in all situations with indication. No information was given to any of these patients concerning the relation between their symptoms and alcohol consumption. In conclusion, enquiring and advising on alcohol were seldom performed. More training is needed, especially on how to inform individual patients of the health risks of alcohol.

Alcohol Drinking↗
PubMed2003

Primary health care professionals' activity in intervening in patients' alcohol drinking during a 3-year brief intervention implementation project.

AIM: The study examined the change of primary health care professionals' activity in asking patients about alcohol and giving advice to heavy drinkers during a 3-year brief intervention implementation project. METHOD: A patient questionnaire survey after consultation blind to the primary health care professionals before and after the implementation project. Brief intervention implementation was based on action research. Subjects were 1,000 consecutive 16-65-year-old patients consulting general practitioners at two primary health care centres at baseline and follow-up, of whom 655 and 768, respectively, participated. RESULTS: No statistically significant differences were found regarding asking or advising about alcohol between baseline and 3-year follow-up. Of all patients, 19.1% (125/655) at baseline versus 19.7% (151/768) at follow-up were last asked about alcohol during the consultation in question or during past year (P=0.784). Likewise, of heavy drinkers, 30.9% (30/97) versus 33.9 (38/112) were asked (P=0.644). Of heavy drinkers, 13.4 (13/97) versus 14.9% (17/114) were advised about alcohol during the consultation in question (P=0.754). CONCLUSION: The activity to do brief intervention remained stable. This may be due to the short follow-up time, the way brief intervention was implemented in the present study or the saturation in the activity reached already before the present study.

Adult↗
PubMed2003

The role of general practitioners' working style and brief alcohol intervention activity.

AIMS: To examine correlates of general practitioners' (GP) activity delivery of brief alcohol interventions to patients with particular reference to their 'working style'. DESIGN: A postal questionnaire survey. SETTING AND PARTICIPANTS: All 75 GPs in the Community Primary Health Care Centre of the City of Tampere, Finland. MEASUREMENTS: Measures of working style classifying GPs into 'problem solving' versus 'technological', self-reported brief advice activity and other demographic details. FINDINGS AND CONCLUSIONS: Of the respondents (response rate 85%) 45% (29/64) reported carrying out brief alcohol interventions. Male GPs provided brief interventions more often than female GPs (71% versus 36%, P = 0.017). The respondents had mainly positive attitudes to brief interventions for excessive drinkers. The working style typology did not show any relationship with brief intervention activity.

Adult↗
PubMed2003

Transient loss of consciousness as reason for admission to primary health care emergency room.

OBJECTIVE: To study the occurrence and main causes of transient loss of consciousness in primary health care. DESIGN: A 4-month prospective survey. SETTING: Primary health care emergency room of the City of Tampere, Finland. SUBJECTS: Consecutive patients, aged over 15 years, admitted to the emergency room. MAIN OUTCOME MEASURES: The overall prevalence of loss of consciousness divided into three subgroups: seizure, syncope and uncertain, and their distribution by gender and age. The prevalence of epilepsy, coronary heart disease and alcohol abuse among these diagnostic subgroups. RESULTS: Of all emergency room visits, 1.2% were for loss of consciousness. Of these, 53% were diagnosed as seizures, 33% as syncope attacks and 14% as uncertain. In the seizure group, 75% of patients were men and 67% had a history of alcohol abuse. In the syncope group, 44% of patients had coronary heart disease and 68% were women. CONCLUSION: Loss of consciousness is a fairly frequent problem for the primary health care emergency room. A history of alcohol abuse is commonly associated with seizures.

Adolescent↗
PubMed2003

Obstacles to carrying out brief intervention for heavy drinkers in primary health care: a focus group study.

The objective of this study was to identify possible obstacles to carrying out competent early identification and brief intervention (EIBI) of heavy drinkers in primary health care. Qualitative focus group discussion method study applying the deductive framework approach. Six focus groups involving 18 general practitioners and 19 nurses were recruited from primary health care of the City of Tampere, Finland. Possible obstacles are: (1) confusion regarding the content of early-phase heavy drinking, (2) lack of self-efficacy among primary health care professionals, (3) sense of lacking time needed for carrying out brief intervention, (4) not having simple guidelines for brief intervention, (5) sense of difficulty in identifying of early-phase heavy drinkers, and (6) uncertainty about the justification for initiating discussion on alcohol issues with patients. The main actions to be taken to promote brief intervention are to educate professionals about the content of early-phase heavy drinking and to produce directing, but not excessively demanding guidelines for carrying out EIBI. Probably successful personal experiences carrying out EIBI can improve professionals' self-efficacy and give to them final justification for discussion alcohol issues with their patients.

Alcoholism↗
PubMed2003

Transient loss of consciousness with and without injuries: where to treat these patients?

OBJECTIVES: Transient loss of consciousness (LOC) is a fairly common phenomenon and frequently carries a risk of injury. The aim was to study the occurrence of injuries and causes of emergency referrals versus later specialist consultation in association with LOC in the primary healthcare setting. METHODS: A four-month survey was carried out in the Primary Healthcare Emergency Department of the City of Tampere, Finland (198,000 inhabitants). The subjects comprised consecutive patients aged at least 15 years, attending a primary healthcare emergency department because of LOC. The type of LOC was determined (seizure, syncope and uncertain) and the type and site of all injuries associated with LOC were registered. All referrals to hospital or specialist consultation because of LOC were also registered and the predictors of admission were analysed by logistic regression modelling. RESULTS: Injury was associated with 43 (20%) out of 220 visits because of LOC; in 12/72 (17%) cases with syncope, in 24/118 (20%) with seizures and in 7/30 (23%) with an uncertain cause of LOC. Most of the injuries were minor. Emergency referral was required in 45/220 (20%) cases of LOC. Coronary heart disease and injury were the main predictors of emergency referral to hospital. CONCLUSIONS: Injuries are as frequent in patients with syncope as in those suffering seizures. Most patients with LOC in primary healthcare emergency departments do not seem to require emergency admission to hospital.

Adult↗