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High risk strategy

High risk strategy. Eeva Korpi-Hyövälti 04.06.2007. Type 2 diabetes – Prevention strategies. A population strategy – prevention of obecity A high risk strategy persons with high risk of DM are encouraged to take part in systematic screening, education and monitoring activities

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High risk strategy

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  1. High risk strategy Eeva Korpi-Hyövälti 04.06.2007

  2. Type 2 diabetes – Prevention strategies • A population strategy – prevention of obecity • A high risk strategy • persons with high risk of DM are encouraged to take part in systematic screening, education and monitoring activities • An early detection and treatment strategy • lifestyle interventions, systematic treatment

  3. Venus von Willendorf 25000 b. Chr 07.08.1908 Austria,miniature statuette of paleolitic Stone Age

  4. Overweight of the Children at Junior Grade of Alajärvi Basic School Kouluterv.hoit. Paula Etula Diabeteshoitaja Kirsti Mäkinen

  5. Overweight at the Basic School (7-15 years) in Alajärvi 2005 Total Total Kouluterv.hoit. Paula Etula Diabeteshoitaja Kirsti Mäkinen

  6. THE WEIGHT AND HEIGHT OF CONSCRIPTS IN MILITARY SERVICE HEIGHT WEIGHT

  7. CONDITION OF CONSCRPTS IN MILITARY SERVICE MEAN WEIGHT MUSCLE STRENGHT COOPER TEST

  8. Type 2 diabetes 2002 South Ostrobothnia Prevalence of Type 2 diabetes in hospital districts 2002

  9. Random selected Men 45-74 Women 45-74 Participation rates 62 % 67 % Central obesity Waist(>94/80cm) 69 % 76 % DM before the study 7,4 % 4,3 % DM after the study 16 % 11 % Abnormal glucose regulation 42 % 33 % Population study 2004(45-74 years)

  10. 2002 men 74,9 years 2002 women81,5years 2030 men 79,2 years 2030 women84,5years How to intensify the care? Mortality rates in cardiovascular complications? Life expectancy FIN Duodecim 2004;120:2173-9

  11. Type 2 diabetes – Prevention strategies • A Population Strategy – prevention of obecity • A High-Risk Strategy • persons with high risk of DM are encouraged to take part in systematic screening, education and monitoring activities • An early detection and treatment strategy • lifestyle interventions, systematic treatment

  12. Improvement of health care processes in primary and occupational health care • Screening method of persons with high risk • Organize a lifestyle intervention • co-operation with the municipal field of physical activities and with other groups concerned • co-operation with groups concerning nutritional education – lack of nutritionists • co-operation with the local service networks

  13. Project funding in every hospital district • Hospital district 100 000 € • Ministry of Social Affairs and Health 100 000 €, common costs of the project 20 000 € • 180 000 €/ year in every hospital district • That means salary of a nurse for 2-8 months/ year/a health care centre

  14. The staff of the project in South Ostrobothnia • Nutritionist 12 - 11 months (2003-2007) • Health care nurse 12 - 4 months (2003-2004) • Nurse - secretary 11- 12 months (2003-2007) • Diabetes-nurse 8 – 2 months ( 2003-2007) • Physician 2 months (2003-2007) • Physiotherapist 12 months (2006 – 2007) • Regional coordinator - Finnish Diabetes Assosiation (RAY-funding)

  15. SENUKO – EDUCATION FAIR 2007

  16. Goals during years 2003 - 2007 • Improvement of health care processes in primary health care • Municipal exercise calendars • Co-operators in the field of nutrition • Step-by-Step lifestyle education • VLCD- education • Regional Health Fair 2005, Farmers Fair2006 • Regional education and training

  17. Education and training • Step-by-step weigth control nurses(42 + 20) • VLCD – education, doctor + nurse (40) • 2 days education for psychologists including psychological support of the health care team • Seminars for collecting regional ideas • Doctors lectures in the hospital district • Lectures in Seinäjoki Polytechnic • The care and education in diabetes • Intervention education and data collection

  18. Screening of high risk patients • Women with a history of gestation diabetes – maternal- and child health centres • Patients who have PAD, CVD, AMI or who have to undergo a coronary intervention • OGTT is performed in central hospital • Previously diagnosed IGT = Impaired glucose tolerance or IFG = Impaired fasting glucose • Findrisk score > 15

  19. High risk patients treatment paths • Nurse intervention 1: FINDRISK, personal risk score and personal goals • Nurse intervention 2: all the risk factors • OGTT, lipids, hypertension, smoking habits, lack of physical activity, nutrition habits, status of mental health • lifestyle intervention in groups or personally, step- by- step education • Doctor / nurse intervention - once in a year • risk factors and personal goals, interventions

  20. PRIVATE OCCUPATIONAL HEALTH CARE PREVENTION OF DM TREATMENT PATHS DIABETES - in health care centre FINDRISK -nurse -doctor Doctor > 15 D2D-etl Diabetes GESTATION DM -one year after delivery in child health centres OGTT + LIPIDS Nurse in occupational health care IFG IGT NORM. DM-Nurse in health care centre INTERVENTION -personally or in groups -nurse occ, DM-nurse PHYS.ACT. PRESCRIPTION AMI, PAD, CVD OGTT IN CENTRAL HOSPITAL DOCTORS intervention in occupational care IFG (6.1-6.9) or IGT (7.8-11.0) INTERVENTION once in a year DM-nurse Hovinmäki 2005 8.2.2005 9

  21. Treatment paths • In every municipal health care centres • Treatment paths has been done together with the occupational health care staff • More advising is still needed • The price: 50 000 € • Salary of the nurse 2 weeks – 2months • Local expert knowledge is needed

  22. Education of diabetes treatment and weight control groups 2006

  23. Results of weight control groups2004 - 2006 • Meetings x 10 -19(10/04 – 8/05 occ. health c) • Size of groups 10 – 27(interrupted 1-7) • Age 47 years ( 26 – 67years) • BMI in the beginning 37 (28 – 60) • Weight change – 4,6 kg (1,3 – 7,8 kg) • Waist circumference – 7 cm(2,5 – 11,9 cm) • BP change - 5,7/- 4,4 mmHg

  24. Doctors orders in group counselling

  25. Physical activity prescription • Liihota-project and Kuortane Sport Institute • Physical activity prescription-project • 264 doctors educated • 500 nurses educated • Soininhoikka – The Slim of Soini – project • physical activity prescription in groups

  26. in 2 municipalities in 2003 in every municipalities on the internet D2D-, Liihota-, phys.act.prescription-, Verka-projects For the professional use and for inhabitants www.TEP.fi, updated 2x/year Municipal exercise calendars

  27.  Toiminta  Kunta  Järjestäjä  Rasitustaso  Kokoontuminen TULES-kuntosaliryhmä Seinäjoki liikuntatoimi o Ma 08.05.2006    Niskaryhmä Alahärmä Alahärmän terveyskeskus o Ma 08.05.2006         Kuntovoimistelu varttuneille Alahärmä Alahärmän terveyskeskus o Ma 08.05.2006     Lady-Jumppa Seinäjoki Seinäjoen Voimistelijat ry o Ti 09.05.2006         Tuolijumppaa naisille ja miehille Ylistaro liikuntatoimi o Ti 09.05.2006    KKI- kunta, ikäihmiset Ylistaro KKI o Ti 09.05.2006         Liikkuva luokka Seinäjoki liikuntatoimi o Ti 09.05.2006    Eläkeliitto Ylistaro Eläkeliitto o Ti 09.05.2006         Mielenterveyskuntoutujien liikuntaryhmä Seinäjoki liikuntatoimi o Ti 09.05.2006        Terveysaseman ulkoliikuntaryhmä Soini Terveysasema o Ti 09.05.2006         Low level exercise groups in the week 19. WWW.TEP.FI Activities Municipality Organizer Exercise level Time 0 low level groups and x easy groups o (matalan kynnyksen ryhmät)x (helppo, vasta-alkajille sopiva, ei vaikeusasteita)xx (kuntotasoltaan vaativampi)xxx (rasittavuudeltaan vaativin)-- (kaikille sopiva) together

  28. TEP-municipal exercise calendars • Filled in 26 municipalities, used in 50%-70% • more practising is needed • The number of different organizers: 160 • municipal physical training activities, health care centres, private associations, pension federations, gymnasts etc • Low level exercise groups + easy groups: hundreds • chair gym, neck group, lady gym, mental physical activity group, the lowest level: exercise or not, etc • in seven municipalities no low level groups

  29. Nutritional education • Co-operators in the field of nutrition • ”Positive lifestyle intervention” 632 participitants • Kauhajoki Polytechnic – nutrition • Pilot schools: Lintuviita, Aapiskuja, Pikku-Alvari ”Healthy kids” ja ”Healthy snacks after school” • Domestic science teachers • Senior Grade of the Basic School ”Kitchen Novice”- education material • Large scale catering, Meeting catering ”Coffee and catering” and ”Heavenly delicious and healthy” • ITE-selfhelp-peer groups • Local Associations, Hearth Association

  30. Recipes for Healthy snacks after school

  31. Healthy Kids - Education Material for Junior Grade of the Basic School and Day Care

  32. Kitchen Novice - Education Material for Domestic Science Teaching

  33. Kaffit & Trahteerit Coffee & Catering RECIPES FOR MEETINGS KOKOUSTARJOILURESEPTIT Etelä-Pohjanmaan sairaanhoitopiiri FIN-D2D, Hospital District of South Ostrobothnia Dehkon 2D-hanke ja Ravintokeskus

  34. Heavenly delicious and healthyfor large-scale catering

  35. Health Fair in South Ostrobothnia 09.04.2005 • A great success: 7000 guests • fair guests from young to old • looking for true knowledge of health • A careful planning • The municipal regions in key position • No-nonsense – everything controlled by our nutritionist • The support of pharmaceutical industry

  36. SOUTH 0STROBOTHNIA HOSPITAL DISTRICT THE HUNTING OF MISSING WAIST 8/2006

  37. Co-operation partnerships • Kuortane Sport Institute • Several Projects, e.g. Syke-project • ” Fit for Life” for adults • Heart Association of South Ostrobothnia: ”Health is a Super Thing” – for Senior Grade at the Basic School • Diabetes - and Heart Associations, ITE-peer groups, Ruukki-Steal Company

  38. SOINI The SLIM of SOINI - PROJECT LAKE SLIM-HOIKKA FAT-PONDS FAT-PONDS

  39. The Slim of Soini Miss Finland 2007

  40. THE REGISTER OF DIABETES in Lehtimäki, Soini and Ähtäri 67 119 246 Soini: Inhabitants 2579, screened inhabitants for DM 850, DM-patients 246 = 10 % IFG + IGT patients 119 + high risk patients 67 = 186

  41. The second round in municipalities – the first one 2003 • A letter to all municipal managers, who invite the municipal management, elected officials and local associations to a meeting • The matters considered at the meeting • Overweight as a risk factor of loosing health(EK-H) • Promotion of health in our municipality (mun. man) • Promotion of health in health care and social affairs • D2D in our municipality • Discussion

  42. Challenges in the future • Prevention of obesity of children and young people • Unemployed people – low level of education • A connection between depression and diabetes, 30 – 40 % • Ostrobothnia – project: mental health and intoxicants

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