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Background: There is a lack of consensus with regards to the consequences of cycling practice on urogenital and sexual problems in men. The aim of the study was to analyse the relationship between intensity of cycling practice and urinary tract symptoms, erectile dysfunction, and urinary incontinence. Methods: Observational hypothesis-generating design. Cyclists, men, between 25 and 70 years who had been cycling for more than one year were included. During the statistical analysis, a multiple linear regression model, partial correlation and Spearman’s correlation were carried out. Results: Fifty-eight men participated in the study. Results showed that there is a correlation between years of cycling and prostate symptoms (p = 0.041), and between age and erectile dysfunction (p = 0.001). The multiple linear regression model and the partial correlation analysis showed a correlation between the years of cycling and prostate symptoms (p = 0.007 and p = 0.018). Conclusions: The results have shown that there is a slight correlation between the years of cycling and the presence of lower urinary tract symptoms, independently of the man’s age. Therefore, the results display that high-intensity cycling practice might impact negatively in some men’s pelvic floor functions. Further research is needed to analyse the impact of cycling on urogenital problems in this population group.

International audience; Ensuring that schools, families and communities work in partnership to reduce the gradient in health, well-being, and resilience of children and young people is considered a priority among public health objectives. This study aimed to explore the factors having an influence on the home–school relationship in general and in the field of health. Emphasis was put on socio-economic factors. A questionnaire was administered to parents of fourth- and fifth-graders attending 37 primary schools in France. Demographic and social characteristics, and views on the home–school relationship and on health education were analysed. The majority of parents (67%) were satisfied with their relationships with their child’s school, but 22% of parents indicated the reverse. Lower socio-economic status (SES) parents were more satisfied with the home–school relationship than higher SES parents were. Parents acknowledged that health education belongs at school, but they did not see it as important a school subject as mathematics or language. They were also critical about school staff members’ health education competence (5.07 ± 2.38 on 10). Parents with lower SES had a closer relationship with their child’s school than parents with higher SES did. This suggests that schools can play a key role in the reduction of health inequities. Nevertheless, enhancing a school’s potential to become a healthy setting appears to be challenging since parentsconsidered both the status of health education and school staffs’ competence in teaching health issues low.

Aims and objectives To examine the advantages and disadvantages of external observation and self-reporting methods in investigating registered nurses’ working time use in order to improve the quality of working time use data. Background External observation and self-reporting methods are the most widely used approaches for studying nurses’ working time use in observational work sampling studies, but there is scarce information of the data collection procedures and results in the same research context and in the same study. Design A cross-sectional quantitative study with a structured data collection instrument developed for this study. The same instrument was used in both data collections. Methods Data were collected from six inpatient units at two Finnish tertiary hospitals in autumn 2013 over two consecutive weeks. All registered nurses (n = 95) from two internal medical units, two surgical units and two psychiatric units participated in this study. Results Statistically significantly divergent information was produced by the two data collection methods in the major nursing categories of value-adding care and non-value-adding work as well as in each of the seven nursing subcategories. Conclusions External observation and self-reporting gave an overall picture of how registered nurses are using their working time, and both methods were useful in examining registered nurses’ working time use when taking into account the advantages and disadvantages of these methods. The deviations between the results improved the quality of data because both methods address recognised shortcomings of the other. Relevance to clinical practice This research promotes awareness of the divergent study results by investigating registered nurses’ working time use with these two different data collection methods. In future, it would be wise to aim for more comparable data by applying external observation and self-reporting techniques simultaneously., final draft, peerReviewed

Terveysalan opettajan käsikirja (2018, 2. uudistettu laitos) tarjoaa ideoita ja ratkaisumalleja terveysalan opetuksen ja ohjauksen suunnitteluun, toteuttamiseen ja arviointiin. Kirjassa on huomioitu alan uusin kansallinen ja kansainvälinen tutkimustieto ja lainsäädännölliset muutokset sekä uudet, kehittyvät oppimisympäristöt., published version, nonPeerReviewed

Background: A systematic literature review shows there is a need to study how professionals work with multiple-birth families in different kinds of nursing contexts. Objective: The aim is to describe public-health nurses’ (n = 8) experiences of supporting multiple-birth families and to contribute to the understanding of working with such families. Methodology: The qualitative research study is guided by the phenomenological hermeneutic and van Manen’s methods have been used. The phenomenon was described through the concept of lifeworld: time, body, relations, and space. The data include participants’ interviews and written documents, as well as the researcher’s notes. Results: The phenomena of supporting multiple-birth families, as described by public-health nurses, can be expressed by “Recognizing the strain”, “Lightening the load of daily life” and “Targeting special needs”. Conclusions: The social-and health-care professionals met challenges in supporting multiple-birth families, and disclosed their need for training and education. There is a need for more understanding of the unique relevant needs and life situations of such families. Wellbeing and caring involves giving guidance and providing the parents with the special knowledge they need. Further research could concentrate on how evidence-based research guides the work of professionals in multi-professional teams., published version, peerReviewed

In phenomenological research, the reduction is a complex reflective attentiveness required for phenomenological understanding. A literature review revealed that little research has been done on health care professionals working with multiple-birth families. Van Manen’s method has been variously used in nursing science. The aim of this article is to describe the hermeneutic circle and the method of reduction, providing an empirical example of the experiences of public health nurses working with multiple-birth families. The data consisted of open interviews (n = 38) with three participant groups—parents of twins, nurses, and family care workers—written output from them and the researcher’s notes. The phenomena of the lifeworld of multiple-birth families as described by nurses can be expressed as: “recognizing the strain”, “targeting special needs”, and “lightening the load of daily life”. Reduction enables in-depth phenomenological hermeneutic research, helping to see the research stages both as parts and as a whole and the hermeneutic circle that accumulates understanding. Social and health care professionals need to listen more to parents’ voices to better understand the needs and situation of multiple-birth families. More education and training is needed to empower parents of twins. This article can stimulate discussion on phenomenology, hermeneutic research and reduction., published version, peerReviewed

Background Structural and cultural changes in the care of older people have influenced nursing practice, creating a need to identify current competency requirements for nurses working in care homes. Family members have an important role in ensuring the well-being of older people living in care homes, and family members’ can provide valuable information about competence requirements. Aim To explore the expectations of the care home residents’ family members regarding the competence of nurses in care homes for older people. Methods A qualitative descriptive design was used. Semi-structured interviews were conducted with 18 care home residents’ family members between March and September 2016. Participants were recruited with help from regional associations and member associations of The Central Association of Carers in Finland and from regional associations of The Alzheimer's Society of Finland. The snowball technique was also used. The data were analysed using inductive content analysis. Ethics Ethics committee approval was obtained from the university committee on research ethics, and written informed consent was obtained from participants. Findings The care home residents’ family members expected that nurses would be able to interact with and treat people respectfully. Reflective collaboration between the nurse and a family member was also emphasised. Family members expected nurses to provide high-quality basic care and nursing and support residents’ well-being individually and holistically. Conclusions Family members’ expectations reflect the need for ethical and interactional competence in the care home. In addition, evidence-based practice competencies are required to provide high-quality care. Nurses’ ability to provide person-centred, individual and holistic care is vital to ensure care home residents’ well-being., final draft, peerReviewed

International audience

Article, Aims and objectives To identify meaningful types of rewards and the consequences of rewards as expressed by Finnish registered nurses working in primary and private healthcare. Background Previous studies have found significant associations between nurses’ rewards and both their commitment and job satisfaction. Furthermore, appropriate rewards can have beneficial effects on factors including workforce stability and occupational satisfaction that are highly important in times of nurse shortages. Design A cross-sectional, qualitative interview study. Methods Data were collected via individual semi-structured interviews (n = 20) with registered nurses working in Finland's primary and private healthcare, and subjected to qualitative content analysis. Results Six meaningful types of rewards were identified by the registered nurses: Financial compensation and benefits, Work-Life balance, Work content, Professional development, Recognition, and Supportive leadership. Rewards encouraged respondents to perform their work correctly and reinforced occupational satisfaction, but also caused feelings of envy and stress. Conclusions It is essential to pay attention to nurses’ preferences for particular rewards and to reward management. When designing effective reward systems for registered nurses, it is not sufficient to provide financial rewards alone, as various kinds of non-financial rewards are both meaningful and necessary. Relevance to clinical practice When trying to improve registered nurses’ commitment and job satisfaction through reward management, it is important to listen to nurses’ opinions to create a reward system that integrates financial and non-financial rewards and is fair from their perspective. Healthcare organisations that offer registered nurses a holistic reward system are more likely to retain satisfied and committed nurses at a time of increasing nursing shortages., final draft, peerReviewed

Background Protecting human subjects from being exploited is one of the main ethical challenges for clinical research. However, there is also a responsibility to protect and respect the communities who are hosting the research. Recently, attention has focused on the most efficient way of carrying out clinical research, so that it benefits society by providing valuable research while simultaneously protecting and respecting the human subjects and the communities where the research is conducted. Collaboration between partners plays an important role and that is why we carried out a study to describe how collaborative partnership and social value are emerging in clinical research. Methods A supra-analysis design for qualitative descriptive secondary analysis was employed to consider a novel research question that pertained to nurse leaders’ perceptions of ethical recruitment in clinical research and the ethics-related aspects of clinical research from the perspective of administrative staff. The data consisted of two separate pre-existing datasets, comprising 451 pages from 41 interviews, and we considered the research question by using deductive-inductive content analysis with NVivo software. A deductive analysis matrix was generated on the basis of two requirements, namely collaborative partnership and social value, as presented in An Ethical Framework for Biomedical Research by Emanuel et al. Results The findings showed that collaborative partnership was a cornerstone for ethical clinical research and ways to foster inter-partner collaboration were indicated, such as supporting mutual respect and equality, shared goals and clearly defined roles and responsibilities. In addition, the social value of clinical research was an important precondition for ethical clinical research and its realisation required the research partners to demonstrate collaboration and shared responsibility during the research process. However, concerns emerged that the multidimensional meaning of clinical research for society was not fully recognised. Achieving greater social value for clinical research required greater transparency, setting research priorities, shared responsibility for the dissemination and use of the findings and stronger community awareness of the ethics-related aspects of clinical research. Conclusions Collaborative partnership and social values are essential for protecting the human subjects and communities involved in clinical research., published version, peerReviewed

Background Clinical trials (CTs) are the “gold standard” to ensure the development of new effective treatments in medicine. A study was conducted to assess knowledge of, and attitudes toward, clinical trials among patients with Parkinson’s disease (PD), along with factors that motivate them to participate. Methods A 50-item questionnaire on the views of patients with PD about CTs was developed. It included statements that the respondents assessed on a Likert scale from 1 (“strongly disagree”) to 5 (“strongly agree”). The questionnaire was mailed to a random sample (n = 2000) of members of the patient organization the Finnish Parkinson Association. In all, 708 response forms were returned, of which 681 were accepted after exclusion (a 34% response rate). Results In general, attitudes of patients with PD toward CTs were positive. Older subjects and patients with lower education levels had inadequate knowledge of general issues related to CTs. Older age, low level of education, and lower number of PD medications were significant predictors for failure to understand the nature and purpose of clinical research. Additionally, significant positive correlation was found between education level and willingness to participate in CTs. Conclusions Patients with PD have important gaps in their knowledge of methodological issues associated with CTs. The oldest subjects and those with a low level of education have the greatest information needs. Investigators should pay more attention to ensuring the comprehensibility of the information provided to potential CT participants., published version, peerReviewed

Objectives To describe and compare temporal changes in prevalence and incidence of psychotropic use (antipsychotics, antidepressants and benzodiazepines and related drugs; BZDRs) in persons with newly diagnosed Alzheimer’s disease (AD) between university hospital districts of Finland during 2005–2011. Methods The MEDALZ study includes all community-dwellers of Finland who received a clinically verified AD diagnosis in 2005–2011 (N = 70,718). Prevalent and incident use of psychotropics among those who had received AD diagnosis less than one year ago were compared in 2005–2011. Results Regional differences in psychotropic use between university hospital districts were more evident in 2005 than 2011 for prevalent use of any psychotropic, antipsychotic and BZDRs and incident use of any psychotropic and antipsychotics. Regional differences in prevalent antidepressant use and incident BZDR use remained similar during the follow-up, while differences in incident antidepressant use increased during the follow-up. The prevalence of any psychotropic use in 2005 varied between 44.7–50.7% and between 45.0–47.9% in 2011. Incidence of any psychotropic use in 2005 was between 8.6–12.1% and 6.2–8.2% in 2011. In 2005, the distribution of incident psychotropic use followed a large scale spatial variation that, however, did not correspond to university hospital districts. During the study period from 2005 to 2011 the cyclic spatial variation disappeared. No sign of adjacent hospital districts being more or less closely related to each other compared to hospital districts in general was detected. Conclusions Except for antidepressants, regional differences in psychotropic use have mainly diminished between 2005 and 2011. Our findings highlight the importance of acknowledging regional differences in a country with relatively homogeneous healthcare system and conducting future studies assessing the reasons behind these differences., published version, peerReviewed

International audience; Objective of the study is to investigate how compliance during the first year of methotrexate (MTX) treatment in rheumatoid arthritis (RA) is influenced by the patients' perception of the necessity for and concern about MTX, the patients' functional disability, and the dose of MTX. A total of 126 RA patients completed a questionnaire at start of MTX treatment and after 9 months. The MTX compliance was measured by using the Compliance Questionnaire Rheumatology (CQR). The prevalence of having a CQR score in the bottom quartile was stratified according to age, gender, the duration of RA, MTX dose, years of school education, functional disability, use of folic acid, and co-morbidity. Crude and adjusted prevalence ratios (PR) with 95% confidence intervals (CI) were calculated by using log-binomial regression. The necessity and concern scales of the Beliefs about Medication Questionnaire were dichotomised into high perception of MTX necessity and low concern about MTX treatment, and the crude and adjusted PR of having a CQR score in the bottom quartile were estimated. The prevalence of having a CQR in the bottom quartile was 23%, both at baseline and after 9 months, and this finding was not associated with the MTX dose level or the patients' functional disability. Among patients with a CQR in the bottom quartile, the prevalence of having low perceptions of MTX necessity was 37.1 versus 14.0% for patients with high perceptions of necessity [adjusted PR: 0.3 (95% CI 0.2–0.8)]. The same tendency was seen after 9 months. The prevalence of having a CQR in the bottom quartile or not was almost equally distributed among patients who had high or low concerns about treatment at baseline. After 9 months, however, the prevalence of having a CQR in the bottom quartile was 18.9% for patients who had low concerns about the MTX treatment, versus 37.7% for patients who had higher concerns about the treatment [adjusted PR: 0.5 (95% CI 0.2–1.3)]. During the first year of treatment, compliance with MTX treatment among RA patients could be explained by strong perceptions of a personal need for the treatment. Compliance did not seem to be influenced by the patients' functional impairment or the MTX dose level.

Tutkimuksen tarkoituksena on kuvata neurokirurgisen potilaan ja läheisen selviytymistä leikkauksen jälkeen. Tutkimuksen tavoitteena on tuottaa tietoa, jota voidaan käyttää neurokirurgisen potilaan perhekeskeisen hoidon kehittämiseen. Tämän tutkimuksen avulla halutaan lisätä potilasta ja läheistä koskevaa tutkimustietoa siitä, millaista heidän toimintansa on silloin, kun perheenjäsen on sairas, ja millaista potilaan ja läheisen huolehtiminen on perheenjäsenestään. Tutkimusta varten haastateltiin seitsemää potilasta ja läheistä ryhmähaastatteluina, joihin kuuluivat aikuinen neurokirurginen potilas ja hänen määrittämänsä läheisensä. Ryhmähaastattelut tehtiin teemahaastatteluina 1.3. - 30.6.2005 potilaan kotona noin 3 - 8 viikkoa leikkauksen jälkeen. Haastatteluteema sisälsi neurokirurgisen potilaan leikkauksen jälkeistä selviytymistä käsitteleviä kysymyksiä. Tutkimusaineiston analysointimenetelmänä käytettiin induktiivista sisällön analyysia. Analyysin tuloksena muodostui kaksi pääluokkaa, jotka kuvaavat tähän tutkimukseen osallistuneiden potilaiden ja läheisten leikkauksen jälkeistä selviytymistä edistäneitä ja estäneitä tekijöitä. Tässä tutkimuksessa havaittiin potilaan ja läheisen selviytymistä leikkauksen jälkeen edistäneen heidän kokemuksensa sisäisistä voimavaroistaan ja potilaan kokemus ulkoisen tuen saamisestaan. Potilaan ja läheisen odotukset leikkausta kohtaan liittyivät potilaan parantumisen odottamiseen ja päivä kerrallaan elämiseen. Potilaat luottivat omaan jaksamiseensa ja he olivat heti valmiita lähtemään hoitoon. Potilaan ja läheisen selviytymistä edisti heidän uskonsa potilaan avun saamiseen. Yhdessä ja erikseen he molemmat pohtivat etukäteen potilaalle soveltuvia hoitovaihtoehtoja. Pohdinta lisäsi heidän luottamustaan potilaan tekemien päätösten oikeellisuutta kohtaan. Leikkauksen jälkeen potilaan toipumisen havaitseminen oli kannustavaa, mistä he tunsivat hyvää oloa. Oman jaksamisen huomioiminen ja potilaan sairauteen sopeutuminen vahvisti heidän yhteistä hyvinvointiaan. Potilaat tunsivat hoitohenkilökunnan motivoinnin ratkaisevasti rohkaisseen heitä omatoimisuuteen. Potilaan ja läheisen selviytymistä leikkauksen jälkeen estivät heidän kokemuksensa voimavarojensa ehtymisestä sekä erilaiset tyytymättömyyden kokemukset. Potilaan ja läheisen voimavaroja ehdyttivät heidän epävarmuutensa potilaan psyykkisestä tasapainosta ja jaksamisesta. He kokivat epävarmuutta tulevaisuudesta, ja sosiaalinen eristäytyminen vaikeutti arjessa selviytymistä. Potilas ja läheinen tunsivat pelkoa toisen menettämisestä. Yhteisen elämän monimutkaistumista kotona lisäsivät potilaan hoitoon liittyneet ongelmat. Tyytymättömyyttä potilas ja läheinen tunsivat riittämättömistä ja epäselvistä ohjeista. Avainsanat: potilas, läheinen, selviytyminen, perhehoitotyö

Hakutermit: hoitotyön johtaminen, inhimillisten resurssien johtaminen, osastonhoitaja Tämän tutkimuksen tarkoituksena oli kuvata erikoissairaanhoidossa työskentelevien osaston-hoitajien käsityksiä inhimillisten resurssien johtamisesta työssään ja minkälaisia voimavaroja heillä kokemuksensa mukaan oli johtaa niitä. Tutkimus oli laadullinen. Tutkimusaineisto kerättiin puolistrukturoidulla teemahaastattelulla joulukuussa 2004 ja tammikuussa 2005. Tutkimus kohdennettiin yliopistosairaalan 14 osastonhoitajalle. Teemahaastattelun teemat muodostuivat inhimillisten resurssien johtamisesta. Tutkimusaineisto analysoitiin induktiivisella sisällönanalyysilla. Osastonhoitajien inhimillisten resurssien johtamisessa korostui hoitotyön päivittäisen toiminnan organisoinnin ja henkilöstöhallinnoinnin työnjohdollisten tehtävien merkitys. Osastonhoitajat halusivat edistää henkilökunnan ammatillista kasvua ja kehittymistä, mutta heillä ei ollut välineitä palkita henkilöstöä. Inhimillisten resurssien johtaminen ilmeni kannustavana ja tukea antavana johtamisena, avoimena työilmapiirinä ja työntekijöiden mahdollisuutena osallistua päätöksentekoon. Osastonhoitajan rooleista korostui oman yksikön puolesta puhujan rooli ja tulkkina toimiminen työyksikön ja muun organisaation välillä. Osastonhoitajat halusivat itse laaja-alaista lisäkoulutusta, joka sisältäisi ammatillisen osaamisen hallintaa ja työyhteisön kehittämiseen sekä omaan ammatilliseen kasvuun liittyvää koulutusta. Osastonhoitajat kokivat, että heillä on vastuuta ja valtaa omassa yksikössään vaikuttaa henkilöstövoimavarojen johtamiseen. Yksikön ulkopuolella heillä ei asemaansa perustuvaa valtaa ollut. Tutkimuksessa tuotettua tietoa voidaan hyödyntää sekä hoitotyön johtamisen suunnittelussa, toteutuksessa ja arvioinnissa että hoitotyön johtamistutkimuksen painopisteidenalueiden arvioinnissa.