Download - High risk strategy
High risk High risk strategystrategy
Eeva Korpi-HyövältiEeva Korpi-Hyövälti
04.06.200704.06.2007
Type 2 diabetes – Type 2 diabetes – Prevention strategiesPrevention strategies
A population strategy – prevention of A population strategy – prevention of obecityobecity
A high risk strategyA high risk strategy persons with high risk of DM are persons with high risk of DM are
encouraged to take part in systematic encouraged to take part in systematic screening, education and monitoring screening, education and monitoring activitiesactivities
An early detection and treatment An early detection and treatment strategystrategy lifestyle interventions, systematic lifestyle interventions, systematic
treatmenttreatment
07.08.1908 Austria,miniature statuette of paleolitic Stone Age
Venus von Willendorf Venus von Willendorf 25000 b. Chr25000 b. Chr
Kouluterv.hoit. Paula Etula Diabeteshoitaja Kirsti Mäkinen
Overweight of the Children Overweight of the Children at Junior Grade of Alajärvi at Junior Grade of Alajärvi
Basic School Basic School
0
10
20
30
40
50
%
A ala-asteB ala-asteC ala-aste D ala-aste
A ala-asteB ala-asteC ala-asteD ala-aste
Kouluterv.hoit. Paula Etula Diabeteshoitaja Kirsti Mäkinen
Overweight at the Basic Overweight at the Basic School School
(7-15 years) in Alajärvi (7-15 years) in Alajärvi 20052005
0 %
5 %
10 %
15 %
20 %
25 %
Yhteensä Years
13- 15
Years
7- 12
Yhteensä
Years 13- 15
Years 7- 12
Total
Total
THE WEIGHT AND HEIGHT OF CONSCRIPTS IN MILITARY SERVICE
HEIGHT
WEIGHT
CONDITION OF CONSCRPTS IN MILITARY SERVICE
MEAN WEIGHT MUSCLE STRENGHT
COOPER TEST
South Ostrobothnia
Type 2 diabetes 2002
Prevalence of Type 2 diabetes in hospital districts 2002
Population study 2004Population study 2004(45-74 years)(45-74 years)
33 %42 %Abnormal glucose regulation
11 %16 %DM after the study
4,3 %7,4 %DM before the study
76 %69 %Central obesity Waist(>94/80cm)
67 %62 %Participation rates
Women 45-74Men 45-74Random selected
Duodecim 2004;120:2173-9
Life expectancyLife expectancy 2002 men 74,9 years2002 men 74,9 years 2002 2002
women81,5yearswomen81,5years 2030 men 79,2 years2030 men 79,2 years 2030 2030
women84,5yearswomen84,5years How to intensify the How to intensify the
care?care? Mortality rates in Mortality rates in
cardiovascular cardiovascular complications?complications?
FIN
Type 2 diabetes – Type 2 diabetes – Prevention strategiesPrevention strategies
A Population Strategy – prevention of A Population Strategy – prevention of obecityobecity
A High-Risk StrategyA High-Risk Strategy persons with high risk of DM are persons with high risk of DM are
encouraged to take part in systematic encouraged to take part in systematic screening, education and monitoring screening, education and monitoring activitiesactivities
An early detection and treatment An early detection and treatment strategystrategy lifestyle interventions, systematic lifestyle interventions, systematic
treatmenttreatment
Improvement of health care Improvement of health care processes in primary and processes in primary and occupational health care occupational health care
Screening method of persons with Screening method of persons with high riskhigh risk
Organize a lifestyle interventionOrganize a lifestyle intervention co-operation with the municipal field of co-operation with the municipal field of
physical activities and with other groups physical activities and with other groups concerned concerned
co-operation with groups concerning co-operation with groups concerning nutritional education – lack of nutritional education – lack of nutritionists nutritionists
co-operation with the local service co-operation with the local service networksnetworks
Project funding in every Project funding in every hospital districthospital district
Hospital district 100 000 €Hospital district 100 000 € Ministry of Social Affairs and Ministry of Social Affairs and
Health 100 000 €, common Health 100 000 €, common costs of the project 20 000 €costs of the project 20 000 €
180 000 €/ year in every hospital 180 000 €/ year in every hospital districtdistrict
That means salary of a nurse for That means salary of a nurse for 2-8 months/ year/a health care 2-8 months/ year/a health care centrecentre
The staff of the project in The staff of the project in South Ostrobothnia South Ostrobothnia
Nutritionist 12 - 11 months (2003-2007)Nutritionist 12 - 11 months (2003-2007) Health care nurse 12 - 4 months (2003-Health care nurse 12 - 4 months (2003-
2004)2004) Nurse - secretary 11- 12 months (2003-Nurse - secretary 11- 12 months (2003-
2007)2007) Diabetes-nurse 8 – 2 months ( 2003-2007)Diabetes-nurse 8 – 2 months ( 2003-2007) Physician 2 months (2003-2007)Physician 2 months (2003-2007) Physiotherapist 12 months (2006 – 2007)Physiotherapist 12 months (2006 – 2007) Regional coordinator - Finnish Diabetes Regional coordinator - Finnish Diabetes
Assosiation (RAY-fundingAssosiation (RAY-funding))
SENUKO – EDUCATION FAIR 2007
Goals during years 2003 Goals during years 2003 - 2007- 2007
Improvement of health care Improvement of health care processes in primary health careprocesses in primary health care
Municipal exercise calendarsMunicipal exercise calendars Co-operators in the field of nutritionCo-operators in the field of nutrition Step-by-Step lifestyle educationStep-by-Step lifestyle education VLCD- educationVLCD- education Regional Health Fair 2005, Farmers Regional Health Fair 2005, Farmers
Fair2006Fair2006 Regional education and training Regional education and training
Education and trainingEducation and training Step-by-step weigth control nurses(42 + 20)Step-by-step weigth control nurses(42 + 20) VLCD – education, doctor + nurse (40)VLCD – education, doctor + nurse (40) 2 days education for psychologists including 2 days education for psychologists including
psychological support of the health care psychological support of the health care teamteam
Seminars for collecting regional ideasSeminars for collecting regional ideas Doctors lectures in the hospital districtDoctors lectures in the hospital district Lectures in Seinäjoki PolytechnicLectures in Seinäjoki Polytechnic
The care and education in diabetesThe care and education in diabetes Intervention education and data collectionIntervention education and data collection
Screening of high risk Screening of high risk patientspatients
Women with a history of gestation Women with a history of gestation diabetes – diabetes – maternal- and child health maternal- and child health centrescentres
Patients who have PAD, CVD, AMI or Patients who have PAD, CVD, AMI or who have to undergo a coronary who have to undergo a coronary interventionintervention OGTT is performed in central hospital OGTT is performed in central hospital
Previously diagnosed IGT = Impaired Previously diagnosed IGT = Impaired glucose tolerance or IFG = Impaired glucose tolerance or IFG = Impaired fasting glucosefasting glucose
Findrisk score > 15Findrisk score > 15
High risk patients High risk patients treatment pathstreatment paths
Nurse intervention 1: FINDRISK, Nurse intervention 1: FINDRISK, personal risk score and personal goalspersonal risk score and personal goals
Nurse intervention 2: all the risk factorsNurse intervention 2: all the risk factors OGTT, lipids, hypertension, smoking habits, OGTT, lipids, hypertension, smoking habits,
lack of physical activity, nutrition habits, lack of physical activity, nutrition habits, status of mental healthstatus of mental health
lifestyle intervention in groups or personally, lifestyle intervention in groups or personally, step- by- step educationstep- by- step education
Doctor / nurse intervention - once in a Doctor / nurse intervention - once in a yearyear risk factors and personal goals, interventionsrisk factors and personal goals, interventions
8.2.2005
FINDRISK-nurse-doctor
GESTATION DM-one year after delivery in child health centres
AMI, PAD, CVDOGTT IN CENTRAL
HOSPITAL
IFG (6.1-6.9) or IGT (7.8-11.0)
> 15D2D-etl
OGTT + LIPIDS
DIABETES- in health care centre
Nurse in occupational health care
Diabetes
Doctor
IFGIGT
NORM.
DM-Nurse in health
care centre
DOCTORS interventionin occupational care
INTERVENTION once in a year
DM-nurse
INTERVENTION-personally or in groups-nurse occ, DM-nurse
PHYS.ACT.PRESCRIPTION
PRIVATE OCCUPATIONAL HEALTH CARE
PREVENTION OF DMTREATMENT PATHS
Hovinmäki2005
9
Treatment pathsTreatment paths In every municipal health care centresIn every municipal health care centres Treatment paths has been done Treatment paths has been done
together with the occupational health together with the occupational health care staffcare staff
More advising is still neededMore advising is still needed The price: 50 000 €The price: 50 000 €
Salary of the nurse 2 weeks – 2months Salary of the nurse 2 weeks – 2months Local expert knowledge is neededLocal expert knowledge is needed
Education of diabetes Education of diabetes treatment and weight treatment and weight control groups 2006 control groups 2006 PlacePlace First First
HandHand
InformatiInformationon
EducatioEducation n
of of treatmentreatmentt
weighweight t
controcontroll
VLCDVLCD
health health carecare
centrecentre
1010 11 1717 44
mun. mun. occ.occ.
health health carecare
22 77 88 00
priv. priv. occ.occ.
health health carecare
00 22 3+2 3+2 cont.cont.
00
Groups Groups Tot. 57Tot. 57
1212 1010 30+30+
1 ite1 ite44
Results of weight control Results of weight control groupsgroups
2004 - 20062004 - 2006 Meetings x 10 -19(10/04 – 8/05 occ. Meetings x 10 -19(10/04 – 8/05 occ.
health c)health c) Size of groups 10 – 27(interrupted 1-7)Size of groups 10 – 27(interrupted 1-7) Age 47 years ( 26 – 67years)Age 47 years ( 26 – 67years) BMI in the beginning 37 (28 – 60)BMI in the beginning 37 (28 – 60) Weight change – 4,6 kg (1,3 – 7,8 kg)Weight change – 4,6 kg (1,3 – 7,8 kg) Waist circumference – 7 cm(2,5 – 11,9 Waist circumference – 7 cm(2,5 – 11,9
cm)cm) BP change - 5,7/- 4,4 mmHgBP change - 5,7/- 4,4 mmHg
Doctors orders in group counselling
Physical activity Physical activity prescriptionprescription
Liihota-project and Kuortane Sport Liihota-project and Kuortane Sport InstituteInstitute
Physical activity prescription-projectPhysical activity prescription-project 264 doctors educated264 doctors educated 500 nurses educated500 nurses educated
Soininhoikka – The Slim of Soini Soininhoikka – The Slim of Soini – project – project physical activity prescription in physical activity prescription in
groupsgroups
Municipal exercise Municipal exercise calendarscalendars
in 2 municipalities in 2 municipalities in 2003in 2003
in every in every municipalities on municipalities on the internetthe internet
D2D-, Liihota-, D2D-, Liihota-, phys.act.prescriptiophys.act.prescription-, Verka-projectsn-, Verka-projects
For the For the professional use professional use and for inhabitantsand for inhabitants
www.TEP.fi, www.TEP.fi, updated 2x/yearupdated 2x/year
Low level exercise groups in the week 19. WWW.TEP.FI
Ti 09.05.2006 oTerveysasemaSoiniTerveysaseman ulkoliikuntaryhmä
Ti 09.05.2006 oliikuntatoimiSeinäjokiMielenterveyskuntoutujien liikuntaryhmä
Ti 09.05.2006 oEläkeliittoYlistaroEläkeliitto
Ti 09.05.2006 oliikuntatoimiSeinäjokiLiikkuva luokka
Ti 09.05.2006 oKKIYlistaroKKI- kunta, ikäihmiset
Ti 09.05.2006 oliikuntatoimiYlistaroTuolijumppaa naisille ja miehille
Ti 09.05.2006 oSeinäjoen Voimistelijat rySeinäjokiLady-Jumppa
Ma 08.05.2006 oAlahärmän terveyskeskus
AlahärmäKuntovoimistelu varttuneille
Ma 08.05.2006 oAlahärmän terveyskeskusAlahärmäNiskaryhmä
Ma 08.05.2006 oliikuntatoimiSeinäjokiTULES-kuntosaliryhmä
Kokoontuminen Rasitustaso Järjestäjä Kunta Toiminta
o (matalan kynnyksen ryhmät)x (helppo, vasta-alkajille sopiva, ei vaikeusasteita)xx (kuntotasoltaan vaativampi)xxx (rasittavuudeltaan vaativin)-- (kaikille sopiva)
Activities Municipality Organizer Exercise level Time
0 low level groups and x easy groups
together
TEP-municipal exercise TEP-municipal exercise calendarscalendars
Filled in 26 municipalities, used in 50%-70%Filled in 26 municipalities, used in 50%-70% more practising is neededmore practising is needed
The number of different organizers: 160The number of different organizers: 160 municipal physical training activities, health care municipal physical training activities, health care
centres, private associations, pension federations, centres, private associations, pension federations, gymnasts etcgymnasts etc
Low level exercise groups + easy groups: Low level exercise groups + easy groups: hundredshundreds chair gym, neck group, lady gym, mental physical chair gym, neck group, lady gym, mental physical
activity group, the lowest level: exercise or not, etcactivity group, the lowest level: exercise or not, etc in seven municipalities no low level groupsin seven municipalities no low level groups
Nutritional educationNutritional education Co-operators in the field of nutritionCo-operators in the field of nutrition ””Positive lifestyle intervention” 632 Positive lifestyle intervention” 632
participitantsparticipitants Kauhajoki Polytechnic – nutritionKauhajoki Polytechnic – nutrition Pilot schools: Lintuviita, Aapiskuja, Pikku-Alvari Pilot schools: Lintuviita, Aapiskuja, Pikku-Alvari
”Healthy kids” ja ”Healthy snacks after school””Healthy kids” ja ”Healthy snacks after school” Domestic science teachersDomestic science teachers
Senior Grade of the Basic School Senior Grade of the Basic School ”Kitchen ”Kitchen Novice”- education materialNovice”- education material
Large scale catering, Meeting catering Large scale catering, Meeting catering ”Coffee ”Coffee and catering” and ”Heavenly delicious and and catering” and ”Heavenly delicious and healthy” healthy”
ITE-selfhelp-peer groupsITE-selfhelp-peer groups Local Associations, Hearth AssociationLocal Associations, Hearth Association
Recipes for Healthy snacksRecipes for Healthy snacks after school after school
Healthy Kids - Education Material for Junior Grade of the Basic School
and Day Care
Kitchen Novice - Education Material for Domestic Science Teaching
Kaffit&
Trahteerit
KOKOUSTARJOILURESEPTITEtelä-Pohjanmaan sairaanhoitopiiriDehkon 2D-hanke ja Ravintokeskus
Coffee &
Catering
RECIPES FOR MEETINGS
FIN-D2D, Hospital District of South Ostrobothnia
Heavenly delicious and Heavenly delicious and healthyhealthy
for large-scale cateringfor large-scale catering
Health Fair in South Health Fair in South Ostrobothnia 09.04.2005Ostrobothnia 09.04.2005
A great success: 7000 guestsA great success: 7000 guests fair guests from young to oldfair guests from young to old looking for true knowledge of healthlooking for true knowledge of health
A careful planningA careful planning The municipal regions in key position The municipal regions in key position No-nonsense – everything controlled No-nonsense – everything controlled
by our nutritionistby our nutritionist The support of pharmaceutical The support of pharmaceutical
industryindustry
SOUTH 0STROBOTHNIA HOSPITAL DISTRICT THE HUNTING OF MISSING WAIST 8/2006
Co-operation Co-operation partnershipspartnerships
Kuortane Sport Institute Kuortane Sport Institute Several Projects, e.g. Syke-projectSeveral Projects, e.g. Syke-project
” ” Fit for Life” for adultsFit for Life” for adults Heart Association of South Heart Association of South
Ostrobothnia: ”Health is a Super Ostrobothnia: ”Health is a Super Thing” – for Senior Grade at the Basic Thing” – for Senior Grade at the Basic SchoolSchool
Diabetes - and Heart Associations, Diabetes - and Heart Associations, ITE-peer groups, Ruukki-Steal ITE-peer groups, Ruukki-Steal CompanyCompany
FAT-PONDSFAT-PONDS
LAKE SLIM-HOIKKA
The SLIM of SOINI - PROJECTSOINI
The Slim of SoiniMiss Finland 2007
DM-luokitus 30.3.2007LEHTIMÄKI
SOINI
ÄHTÄRI YHT
KAIKKI
Pieni riski sairastua tyypin 2 diabetekseen (<7) 92 108 375 575 690
Jkv kohonnut riski sairastua tyypin 2 diabetekseen (7-11) 79 203 354 636 710
Koht. kohonnut riski sairastua tyypin 2 diabetekseen (12-14) 42 107 150 299 335
Suuri riski sairastua tyypin 2 diabetekseen (15-20) 20 63 93 176 197
Hyvin suuri riski sairastua tyypin 2 diabetekseen (>20) 1 4 10 15 17
Kohonnut paastoglukoosi (IFG, fP-Gluc 6,1-6,9) 52 62 127 241 245
Heikentynyt glukoosinsieto (IGT, 2h Gluc 7,8-11,0) 22 57 107 186 189
Ruokavaliohoitoinen tyypin 2 diabetes (E11) 29 109 112 250 258
Tablettihoitoinen tyypin 2 diabetes (E11) 48 76 180 304 312
Insuliinihoitoinen tyypin 2 diabetes (E11) 33 46 100 179 179
Tyypin 1 diabetes (E10) 4 15 3 22 24
Muu diabetestyyppi (E12-14) 1 1 1
Kaikki yhteensä 423 850 1611 2884 3157
THE REGISTER OF DIABETESin Lehtimäki, Soini and Ähtäri
246
119
67
Soini: Inhabitants 2579, screened inhabitants for DM 850,DM-patients 246 = 10 %IFG + IGT patients 119 + high risk patients 67 = 186
The second round in The second round in municipalities – the first municipalities – the first
one 2003one 2003 A letter to all municipal managers, who A letter to all municipal managers, who
invite the municipal management, elected invite the municipal management, elected officials and local associations to a meetingofficials and local associations to a meeting
The matters considered at the meetingThe matters considered at the meeting Overweight as a risk factor of loosing health(EK-Overweight as a risk factor of loosing health(EK-
H)H) Promotion of health in our municipality (mun. Promotion of health in our municipality (mun.
man)man) Promotion of health in health care and social Promotion of health in health care and social
affairsaffairs D2D in our municipalityD2D in our municipality DiscussionDiscussion
Challenges in the futureChallenges in the future
Prevention of obesity of children and Prevention of obesity of children and young people young people
Unemployed people – low level of Unemployed people – low level of education education
A connection between depression A connection between depression and diabetes, 30 – 40 %and diabetes, 30 – 40 % Ostrobothnia – project: mental Ostrobothnia – project: mental
health and intoxicantshealth and intoxicants