Content

Preface

Non-Metal Ceramic Restorations, and the Review of Technological PossibilitiesInese Bunga, Aldis Vidžis, Aleksandrs Praščuks, Rīgas 1. medicīnas koledža, Latvia

Ergonomic Hazards at Occupational Therapists WorkplaceLija Gadzhialijeva, Olga Novikova, Margarita Kirichenko, Riga Stradins University, LatviaMentor: Liene Saukuma, lecturer, Riga Stradins University, Latvia

Assessment of Learning Environment to a Person with Functional Disability Liga Gosteva, Elva Pule, Diana Cuncule, Riga Stradins University, LatviaMentor: Liene Saukuma

Evaluation of “Diabetes“ Module of Russian Version of PedsQL 4.0 Life Quality Questionnaire in Children and Adolescents with Diabetes Mellitus Kolbasina E., Vorobyeva V., Azova E., Nizhny Novgorod State Medical Academy, Russia

Prevention of Pressure Ulcers. An Intervention StudyMattila, L-R., Rekola L., Eriksson E., Wikberg E., Hietanen H.Metropolia University of Applied Sciences, City of Helsinki Health Centre, Finland

Evaluation of Readiness of Nurses for Conduction of Therapeutic Education of Patients with Diabetes MellitusNoskova V., Pozdeejeva T., Petrov, A. Department of organization of health care and nursing management of FHNE, Department of endocrinology and internal medicine of FOA, Nizhny Novgorod State Medical Academy, Russia

Development of Models of Nursing Staff Workplaces as a Way for Staff Selection Pozdeeva T., Petrov A., Department of organization of health care and nursing management of FHNE, department of endocrinology and internal medicine of FOA, Nizhniy Novgorod State Medical Academy, Russia

The role of the private nurse practitioner in Kenya and the education needed to maintain the quality of that role in meeting the health care needs of the rural population in KenyaEileen Richardson, Bournemouth, United Kingdom

Life Quality and Metabolic Control in Children and Adolescents With Diabetes Mellitus Type 1.Vorobyeva V., Kolbasina E., Azova E., Petrov A., Nizhny Novgorod State Medical Academy, Russia

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Preface

Dear Colleagues, I have a great pleasure to introduce our Tallinn Health Care College (College) and our development plans to you. Health care has always been and is still one of the priorities in all European coun-tries and we are proud to be members of Tallinn Health Care College, offering education in the field.Since the year 1800 there have been operating several health care schools and medical courses in Tallinn, where midwives, nurses and doctor’s assistants have been trained mainly for army purposes. Continual training for health care specialities started in 1940, when the School of Nurses was opened. After consolidation with Assistant Physicians School, Tallinn Medical Secondary School was established.In 1945 the school was renamed to Tallinn Republican Medical Secondary School. The school offered study programs in five fields of study: assistant of physician, midwifery, assistant pharmacist, dental technicians and nursing.In 1996 the training of nurses at the level of higher education started. All the curricula were corrected and approved by the Ministry of Education and Research as professional higher education curricula.

From �006/�007 the College has a structural unit in Kohtla-Järve.From January �009 the College’s name is Tallinn Health Care College.

Tallinn Health Care College offers education on following higher educational curri-cula: nurse, midwife, dental technician, optometrist, pharmacist, occupational therapist and health promotion specialist. We have about 1�00 students in our College.On the level of vocational education we offer education to practical nurses and have planned to develop this area in the near future more actively.

Our College offers also different courses for adult learners and last study year about 1500 workers have actively used this possibility.

To be ready to offer best education to our students, College is active in European programmes, taking active part of Lifelong Learning Programme/Erasmus and Leonardo activities, developing activities in NORD Plus and working in international networks as: EAIE - European Association for International Education, ENOTHE – Erasmus Thematic Network of Occupational Therapists in Higher Education, EURASHE – European Association of Institutions in Higher Education, IUHPE –

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International Union for Health Promotion and Education, COHEHRE – Consortium of Institutes of Higher Education in Health and Rehabilitation, EBHA – Evidence Based Health Care Teachers & Developers and EAIL – European Association for Health Information and Libraries.

In order to present our research and project work, to discuss with our partners best practice and development, we organise our College International Week every year in May.

This year, after sending thesis book materials to print, we have received some very good materials from our partners. Not to loose the possibility to introduce them, we discussed with our Development and International Committee the idea to pre-pare a small information for the next years and found that the College is ready to have also a journal of Development and International Relations of Tallinn Health Care College

To have a common understanding of materials, how and in which form they must be presented, you will find the information below.

Plans for the future

Content Time to present

materials�009 �010 �011 �01� �01�

Thesis Book of the Inter-national Week of Tallinn Health Care College

Thesis – In English

Open access

Final date 1.0�

+ + + + +

Journal of Tallinn Health Care College Development and International Relations

Articles to discuss the research, deve-lopment or learning/studying in the field in English

Final date 15.0�

+ + + + +

Tallinna Tervishoiu Kõrgkooli toimetised

In Estonian for teaching staff of Tallinn Health Care College to present their research article (will be in Estonian and a short summery in English)

Final date15.09

+ +

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Thesis of the International Week

At the beginning of December there will be information available at Tallinn Heath Care College homepage (http://www.ttk.ee) about the cover headline of the International Week the preliminary program and the information how you can pre-sent your thesis. You can find information Tervishoiu Kõrgkool/Tallinn Health Care College: http://www.ttk.ee on the first page under the News as text: Rahvusvahe-line nädal/International Week and you will find the description there, the final date of submission of thesis and a link where you can submit your thesis.

Thesis will be reviewed by the International and Development Committee of Tallinn Health Care College. Thesis that do not correspond with the rules or have mistakes are not accepted into the thesis book.

Development and International Relations of Tallinn Health Care College

Two articles will be subscribed by the Development and International Relations Committee of College about the actual development or research problem (5 pages) and some short presentations about the foreign activities (each one page). The article in Development and International Relations Magazine must contain: head-line, author(s) first name, last name, degree, work place, e-mail address; introduc-tion, discussion about the problem, conclusions; references: authors last name, first name’s first letter, year of print; headline; journal or book title, pages, maxi-mum 15 authors.

Tallinna Tervishoiu Kõrgkooli Toimetised

To present an article the rules are the same as for the journal article.

We hope that this information will help us to prepare better for the International Week and also helps our partners not to forget to send us their materials.

On behalf of Tallinn Health Care College I wish you a successful conference, active work and good atmosphere, enjoyable cultural activities and a lot of success to find new ideas and to make plans for common activities in the future.

Sincerely,Tiina JuhansooVice Rector of Development and International Relations

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Non-Metal Ceramic Restorations, and the Review of Technological Possibilies

Inese Bunga, Aldis Vidžis, Aleksandrs PraščuksRīgas 1. medicīnas koledža, Latvia

SummaryThe metalceramic restorations, which are used in dentistry and dental technology, are characterized by highly durable materials, corresponding dental prostheses resistance and retention, however the esthetic achievements may be imperfect. The metal casting visually changes the color, tone, intensity, depth and light ray breaking angles of porcelain layers. Nowadays there are widely used non-metal ceramis constructions, which completely prevent the above stated problems (IPS Empress system, CEREC CAD/CAM, Cercon). This review is devoted to the description and comparative evaluation of these technologies.

IntroductionNon-metal constructions are made out of durable ceramics (without metal casting). This kind of dental prostheses corresponds to esthetic requirements. Non-metal ceramic constructions are used to make crowns, bridges, veneers, inlays, onlays, root inlays, and implant supported dental prostheses. This type of dental prosthe-ses, non-metal, is highly esthetic, despite this factor- they are fragile.

Materials and methodsThe present research is a literature review and analysis of non-metal ceramic dental prostheses restorations in Latvia. The folowing methods were evaluated and analysed; IPS Empress system, CEREC CAD/CAM Cercon, CEREC, Ceramic reconstruction, and Inceram Alumina.

Results and discussionEmpress is a non-metal ceramic system, which is achieved as a result of compress-ing porcelain. This system generates durable material, as well as contributes to the fit percision. Ceramic materials that are compressed are symilar to natural tooth tissues, which have a good light and color conductivity. Non-metal ceramic restora-tions do not cause alergic reactions, they are not toxic, they cannot corode, as well as they are inert to bacteria adhesion. In the dental technician laboratories in Latvia the non-metal ceramic constructions are made with Empress�, and Cerec-ceramis CAD/CAM computerized technology ( it uses scanning principles, this way creat-ing a three dimensional picture). This method is highly precise and qualitative. The manual method Inceram Alumina is also used in practice. The dental prostheses manufactured with the use of these methods, correspond with the �1st century demands.

Conclusion 1. Non-metal ceramic dental prostheses are produced without a metal casting, so the esthetics, as well as the adaptation mechanism to this type of dental prostheses are improved.

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�. Non-metal ceramic dental prostheses casting is made of porcelain, thus the mechanical durability decreases.�. Porcelain is an inert material, it practicaly does not affect the restored area, and is absolutely harmless to one’s health.4. IPS Empress system, CEREC CAD/CAM, Cercon, CEREC, Ceramic reconstruc-tion, Inceram Alumina all meet the demand of the newest technologies.

Ergonomic Hazards at Occupational Therapists Workplace Lija Gadzhialijeva, Olga Novikova, Margarita Kirichenko, Riga Stradins University, LatviaMentor: Liene Saukuma, lecturer, Riga Stradins University, Latvia

In Latvian Professional Standard of Occupational Therapist (OT), it is mentioned about ergonomic hazards which may affect OT at their workplace. These factors include physical (intensity), psychological (stress), biological (viruses, bacteria) and chemical agents. The aim of the project was to evaluate ergonomic hazards at OT’s workplace and suggest recommendations for changes in work environ-ment according to principles of ergonomics. Participant for this study was OT who works in Children Rehabilitation Centre located in Riga, Latvia. The following was used: a semi-structured interview, photography, observation of OT’s workplace, as well as PLIBEL, a method for identifying ergonomic hazards (K. Kemmlet, 1986) for acquiring data. The physical and the psychological factors are two main types of ergonomic hazards which may affect OT. The most affected by the physical ergo-nomic hazards were neck, shoulders and back due to not always having a neutral work position. For instance, positioning of the child with high spasticity requires higher physical activity. The psychological factors included high stress risk due to work with clients with mental retardation or autism spectrum disorders which require high level of concentration for OT.

Assessment of Learning Environment to a Person with Functional Disability

Liga Gosteva, Elva Pule, Diana Cuncule, Riga Stradins University, Faculty of Rehabilitation, Academic School of Occupational Therapy, 3 rd year studentsMentor: Liene Saukuma, Riga Stradins University, lecturer

Background: There are approximately 70000 people with disability in able-bodied age in Latvia. Only 16 % of them are working hired job. Yearly approximately �8 % of registered unemployed people start work. The low level of education and their skills are only some of the reasons, why 84 % of people with disability are hard to find a job. People with disability have problems to get qualitative education (also higher, professional) due to the environmental barriers – most of educational institutions aren’t adjusted to persons with functional disability.

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Aim of the study: To assess ergonomic risks and evaluate accessibility of learning environment for a person with functional disability who is acquiring a profession at institution of professional education.

Methods of the study: The information was collected by observation; photo-graphy; semi-structured interview; collaboration with profession teacher and occupational therapist, who is working in the institution of professional education. We used the assessment tools: The Housing Enabler (Iwarsson & Slaug, �001); PLIBEL (Kemmlert, K. Kilborn, 1986, Sweden); Example of questionnaire for deter-mination of ergonomic risks (designed by Ergonomic centre of Michigan University and NIOSH); Work Behaviour Inventory (G. Bryson, G. Tamasine, M. D. Bell, K. Edward, 1997) and Role Checklist (Oakley, Kielhofner, & Barris, 1985).

Results of the study: We determined several physical environment barriers in work place as well as outside of building, which can essentially affect persons learning process, for example, inappropriate stairs, holes in a walking surface, un-regulated table at work place. Also we found that a person does not know about ergonomic principles, wherewith does not follow them. The recommendations for institution of professional education to eliminate barriers of physical environment were created. The person was introduced with ergonomic principles in relation with demands of profession he is acquiring.

Evaluation of “Diabetes“ Module of Russian Version of PedsQL 4.0 Life Quality Questionnaire in Children and Adolescents with Diabetes Mellitus

Kolbasina E., Vorobyeva V., Azova E., Nizhniy Novgorod State Medical Academy, Russia

Any chronic somatic disease independently on biological nature and affected organs and systems puts a patient in special conditions of life. The aim of study was to evaluate problems associated with diabetes in diabetic children and ado-lescents.Materials and methods. We have evaluated children having diabetes mellitus type 1 (N = 1�1, average age 11.69±0.�8, average duration of illness 4.17±0.�� years) together with their parents with use of Russian version of PedsQL 4.0 life quality questionnaire “Diabetes” module (Varni et al., �001).

Results and discussion. There was found statistically significant difference in evaluation of disease and related problems between children and parents (p=0.00�)/ Parents are more frequently indicating presence of decompensation symptoms compared to children (p=0.0�) which is the evidence of higher compen-satory potential in children. Children are not feeling embarrassed because of their

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disease and do not experience problems with treatment (self-control, insulin treat-ment) compared to their parents (p < 0.01). Both children and parents demonstrate anxiety related to diabetes (effectiveness of treatment, long-term consequences of the disease) as well as problems in communication (both with medical person-nel and other people). In this domains difference of scores was not statistically significant (p > 0.05). There was not found any statistically significant difference dependent on gender, duration of illness, metabolic control and variant of insulin treatment (p > 0.05).

Conclusion. Elicited problems in communication between patients and medical staff require search of effective actions toward producing relations of partnerships which can enable positive achievements in treatment of illness.

Prevention of Pressure Ulcers. An Intervention Study

Mattila, L-R., Rekola L., Eriksson E., Wikberg E., Hietanen H.Metropolia University of Applied Sciences, City of Helsinki Health Centre, Finland

Evaluation of Readiness of Nurses for Conduction of Therapeutic Education of Patients with Diabetes Mellitus

Noskova V., Pozdeejeva T., Petrov, A. Department of organization of health care and nursing management of FHNE, department of endocrinology and internal medicine of FOA, Nizhny Novgorod State Medical Academy, Russia

The aim of current study was to determine readiness of nurses to conduct inde-pendent therapeutic education of patients with diabetes mellitus. The evaluation has been performed among student of higher nursing education faculty (FHNE) of NNSMA who have finished training in a training module “Organization of thera-peutic education in nursing”. Information was obtained with use of specially deve-loped questionnaire which included assessment of knowledge in medical and age-specific psychology, pedagogic, diabetes and therapeutic education.

Obtained results demonstrated that up to 85% of students who finished train-ing can provide therapeutic education to diabetes patients; the main limitation was insufficient level of psychological and pedagogical skills and knowledge about the disease; majority of students assessed therapeutic education as one principal fields of nursing staff responsibilities. Effective implementation of therapeutic education approach in nursing requires special training which can allow nursing staff not only conduct education, but also work on higher level as organizers and managers of therapeutic education in health care.

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Development of Models of Nursing Staff Workplaces as a Way for Staff Selection

Pozdeejeva T., Petrov A., Department of organization of health care and nursing management of FHNE, department of endocrinology and internal medicine of FOA, Nizhniy Novgorod State Medical Academy, Russia.

The key factor of effective functioning of health care and its reform is the quality of professional staff. The aim of this study was to use method of expert evaluation in modelling of positions of nursing staff on different levels such as floor nurse, head nurse of the division or hospital. We have evaluated this method to determine its usefulness in staff selection system. Heads of nursing staff have been involved as experts. Evaluated factors were professional training, working experience and personal characteristics of a nurse.

As a result of the programme have been obtained models of workplaces – desirable characteristics of potential worker for different positions which allowed effective selection of candidates. Requirements from experts indicate that in-creased effectiveness of selection is possible with combination of step-by-step evaluation which should include assessment of training history with consecutive evaluation of professional and personal qualities, objective testing of knowledge and mastering of professional practical skills.

The role of the private nurse practitioner in Kenya and the education needed to maintain the quality of that role in meeting the health care needs of the rural population in Kenya

Eileen Richardson MA (Ed) BA RN, Retired Senior lecturerBournemouth, UK

“More than 85% of Kenya’s nurses are trained at certificate level and do not have the registered nurses Diploma leaving them inadequately qualified to treat major diseases such as HIV, TB and Malaria” (www.UK.amref.org). These are very often the care providers for the majority of the people living in remote rural areas where there is no access to other health care facilities. Using photographic evidence this presentation will describe the work of some of the Private Nurse Practitioners who are stationed in the Nyeri District of Kenya. The facilities in which they run their clinics vary enormously from those which are brick built to those which are much less secure and lack basic facilities such as electricity and running water. These nurses also identify a number of learning needs amongst which are the manage-ment of addictions and domestic violence as well as the commoner disorders mentioned above

A visit to the area confirmed that this group is made up of 90% Enrolled Nurses. The Nursing Council of Kenya has ruled that these nurses should be upgraded to Registered Nurse level. To facilitate this Council has set up a public-private partner-

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ship with the African Medical Research Foundation, Accenture, the Ministry of Health, the Kenyan Medical Training Colleges and several private colleges to deve-lop an e-learning programme. Learning centres have been set up around the country and AMREF have promised to provide a computer for every 5 nurses who will enrol on the programme. The Nyeri private Nurses are seeking to access this but the cost of the programme and the availability of a centre are still difficult for them to meet. The presentation will describe their search for and discovery of a solution to this problem.

Life Quality and Metabolic Control in Children and Adolescents With Diabetes Mellitus Type 1.

Vorobyeva V., Kolbasina E., Azova E., Petrov A., Nizhny Novgorod State Medical Academy, Russia

Diabetes mellitus represents a severe somatic pathology which manifestations affect different life aspects. The aim of this study was to evaluate the influence of diabetes mellitus type 1 on different domains of life quality in diabetic children and adolescents.Materials and methods. Evaluation was performed among children (average age 11.69±0.�8 years) having diabetes mellitus type 1 (average duration of ill-ness 4.17±0.��) and their parents with russian version of PedsQL 4.0 life quality questionnaire (Varni et al., �001) General Core Scale.Results. There was found no statistically significant differences in life quality evaluation between children and their parents (p > 0.05). Life quality in diabetic children and adolescents does not depend on the degree of metabolic control (r = 0.1 p > 0.05). Children and adolescents with diabetes who were receiving insulin analogues had sufficiently high level of physical and social functioning (p = 0.0�).Conclusion. Use of insulin analogues in treatment of diabetes mellitus in children and adolescents improves indicators of life quality if requirements for treatment of this disease are adhered to.

COHEHRE Conference`09 Tallinn, Estonia “Health of Migrants and Displaces Persons. Implications for Education” pre-conference “Putting Culture in the Curriculum” team with leader Eileen Richardson from Bournemouth, United Kingdom in Tallinn Health Care College on April �1, �009.