Cardiovascular risk management in patients with coronary heart disease in primary care: variation across countries and practices. An observational study based on quality indicators.

Background: Primary care has an important role in cardiovascular risk management (CVRM) and a minimum size of scale of primary care practices may be needed for efficient delivery of CVRM . We examined CVRM in patients with coronary heart disease (CHD) in primary care and explored the impact of practice size.

Methods: In an observational study in 8 countries we sampled CHD patients in primary care practices and collected data from electronic patient records.

Sex differences in the association of adiponectin and low-grade inflammation with changes in the body mass index from youth to middle age.

Background: There are sex differences in low-grade inflammation markers in obesity-related disorders. Little is known, however, about a possible sex-specific association of relative weight change from youth to adulthood with actual low-grade inflammation.

Objective: The aim of this study was to identify possible sex differences in adiponectin, interleukin-1β (IL-1β), interleukin-1Ra (IL-1Ra), and high-sensitivity C-reactive protein (hs-CRP) levels with respect to the relative change in body mass index (BMI) from youth to middle age.

Health views and metabolic syndrome in a Finnish rural community: a cross-sectional population study.

Introduction: Metabolic syndrome (MetS) can be prevented through the promotion of healthy lifestyles. In rural areas, MetS is associated with unhealthy lifestyles and socioeconomic and demographic changes. However, there is scarce evidence on how health views contribute to the unhealthy lifestyles that result in MetS.

Choosing a medical specialty--study of Finnish doctors graduating in 1977-2006.

Background: Choosing a medical specialty is an important element predefining a physician's career and life. Although there has been some research in this area of interest, there has not been much research where the profession has been researched as a whole, or where trend data over different generations has been presented.

Aim: The aim of our study was to ascertain the motives affecting physicians' choice of a medical specialty.

Far from easy and accurate - detection of metabolic syndrome by general practitioners.

Background: Metabolic syndrome (MetS) is a major public health challenge. General practitioners (GPs) could play a key role in its recognition. However, it often remains undiagnosed in primary care.

Gender differences relating to metabolic syndrome and proinflammation in Finnish subjects with elevated blood pressure.

Fasting insulin, adiponectin, high-sensitivity C-reactive protein (hs-CRP), and interleukin-1 receptor antagonist (IL-1Ra) were determined in 278 men and 273 women with blood pressure > or = 130 and/or > or = 85 mmHg and/or with antihypertensive medication. Metabolic syndrome (MetS) with the National Cholesterol Education Program (NCEP) criteria was observed in 35% of men and 34% of women. Men with MetS had lower hs-CRP and IL-1Ra than women.

Depressive symptomatology is associated with decreased interleukin-1 beta and increased interleukin-1 receptor antagonist levels in males.

Previous studies with selected patient populations have suggested that cytokines, the immune system messengers, may play a role in the aetiology of depression. However, the data concerning the increase or decrease of the plasma cytokine levels in depression is controversial and the effects of the medications and type of depression are largely unknown. We studied the connections between plasma interleukin-1 beta (IL-1 beta) and interleukin 1 receptor antagonist (IL-1RA) levels, and depressive symptomatology measured with the Beck Depression.

Persistent pain at multiple sites--connection to glucose derangement.

The aim of this study was to analyse the prevalence of prediabetes and diabetes among subjects with daily chronic widespread pain (DCWP). In the multivariate analysis, DCWP was significantly associated with prediabetes and diabetes. Persistent chronic pain at multiple sites may be an additional symptom of prediabetes and diabetes.

Proinflammation and hypertension: a population-based study.

There is evidence that proinflammation may be linked to the development of hypertension (HT). We examined the association of both the interleukin-1 beta (IL-1beta) and the interleukin 1-receptor antagonist (IL-1ra) with future blood pressure (BP) and HT occurrence (BP >or= 140/90 mmHg, or antihypertensive drug) in a population-based prospective study. Our study consisted of 396 (147 men and 249 women) middle-aged, baseline apparently healthy, normotensive subjects participating in a 6.

Gender difference among smoking, adiponectin, and high-sensitivity C-reactive protein.

Background: Subclinical inflammation is a novel risk factor of cardiovascular diseases and type 2 diabetes. An inverse association between plasma adiponectin and insulin resistance has been previously shown. Elevated levels of high-sensitivity C-reactive protein (hs-CRP) predict future cardiovascular events.

Metabolic syndrome is associated with impaired health-related quality of life: Lapinlahti 2005 study.

Purpose: Association of Metabolic Syndrome (MetS) with Health-Related Quality of Life (HRQoL) is poorly documented. Our objective was to examine this association in an adult general population.

Methods: In our cross-sectional community-based health survey in a semirural Finnish community, we invited all the adults (n = 760) of eight birth cohorts between 30 and 65 years, of which 480 (63%) participated.

Metabolic syndrome is associated with self-perceived depression.

Objective: To study the association between metabolic syndrome (MetS) and self-perceived depression.

Design: A cross-sectional community-based study.

Setting: Semi-rural community of Lapinlahti in eastern Finland in 2005.

Use of quality improvement methods in Finnish health centres in 1998 and 2003.

Objective: To evaluate how widely quality improvement methods are used in Finnish primary health centres and how the use has changed over five years.

Design: Two national cross-sectional postal enquiries.

Setting And Subjects: The questionnaire in 1998 was sent to every other physician graduated during the years 1977-1986, and the questionnaire in 2003 to every other physician graduated during the years 1982-1991.

Association of C-reactive protein, interleukin-1 receptor antagonist and adiponectin with the metabolic syndrome.

This Finnish population-based study, mean age 46 years, evaluates the association of high-sensitivity C-reactive protein (hs-CRP), interleukin-1 receptor antagonist (IL-1Ra), and adiponectin with the NCEP and IDF definitions of metabolic syndrome (MetS). Adiponectin levels were higher, hs-CRP and IL-1Ra levels lower in subjects without MetS compared to subjects with MetS. If MetS was present according to both IDF and NCEP criteria, BMI, waist, triglycerides, hs-CRP, and IL-1Ra were significantly higher compared to subjects who had MetS according to either only IDF or only NCEP criteria.

Metabolic syndrome predisposes to depressive symptoms: a population-based 7-year follow-up study.

Objective: Previous cross-sectional studies have suggested that patients with depression have a high risk for metabolic syndrome. As there is a paucity of data concerning the temporal relationship of depression and metabolic syndrome, we decided to evaluate the risk for developing depressive symptoms in patients with metabolic syndrome in a population-based follow-up study.

Method: The prevalence of depressive symptoms and metabolic syndrome at baseline in 1998 and at 7-year follow-up in 2004/2005 was studied in a large, middle-aged, population-based sample collected from Central Finland.

Facilitating as a guidelines implementation tool to target resources for high risk patients - the Helsinki Prevention Programme (HPP).

Interprofessional care may provide some answers to the challenge of scarce healthcare resources, through the utilization of the expertise of various professionals to improve evidence-based care. This was a two-year programme in primary care, where doctor and nurse pairs acted as intrinsic facilitators creating and implementing local guidelines and encouraging multiprofessional teamwork. The effect of implementation was studied by auditing professional opinion change, blood pressure, serum lipid and HbA1C levels.

Chronic pain, impaired glucose tolerance and diabetes: a community-based study.

The aim of this study was to analyse how plasma glucose level and diabetes mellitus (DM) are associated with chronic pain in the adult population. A structured interview and health examination study with 480 participants aged 30-65 years was carried out in Lapinlahti municipality in Eastern Finland. Chronic pain (duration of at least 3 months) was graded according to frequency: being present less often than daily, or every day or continuously (daily chronic pain, DCP).

Access to and continuity of primary medical care of different providers as perceived by the Finnish population.

Objective: To study people's views on the accessibility and continuity of primary medical care provided by different providers: a public primary healthcare centre (PPHC), occupational healthcare (OHC), and a private practice (PP).

Design: A nationwide population-based questionnaire study.

Setting: Finland.

The role of job satisfaction, job dissatisfaction and demographic factors on physicians' intentions to switch work sector from public to private.

This study is based on a unique data set for the years 1988-2003 and uses structural equation models to examine the impact of job satisfaction and job dissatisfaction on physicians' intention to switch from public- to private-sector work. In Finland, physicians who work primarily in a public-hospital or health-centre setting can also run a private practice. Therefore, we also analysed the impact of having a private practice on a physician's intention to change sector.

Factors associated with physicians' choice of working sector: a national longitudinal survey in Finland.

Objective: To analyse factors affecting physicians' choice to work in either the public or the private sector.

Method: We undertook a longitudinal data analysis in the years 1988, 1993, 1998 and 2003 (n = 12 909) using a multilevel modelling technique. Factors related to economic factors, physician identity, appreciation as well as demographic factors were hypothesised to influence sector choice.

Doctor-managers as decision makers in hospitals and health centres.

Purpose: This paper describes factors influencing doctor-managers' decision making in specialised health care, health centres and at different levels of management.

Design/methodology/approach: Data were collected as part of a survey on physicians graduating in 1977-1991 as drawn from the register of the Finnish Medical Association. The study sample was formed by selecting all physicians born on odd days (n=4144) from the baseline group (n=8232).

Frequent analgesic use at population level: prevalence and patterns of use.

Statistics and prescription database studies show that analgesics are widely utilized, but do not tell anything about either the factors behind analgesic use or how over-the-counter (OTC) analgesics are being used. We aimed to study the prevalence of frequent use of prescribed and OTC analgesics. We also investigated the background factors related to frequent analgesic use and assessed rationality of analgesic usage patterns.

How do people ease their pain? A population-based study.

Unlabelled: We investigated how a general population treat their pain and determined factors affecting use of different pain management strategies. From the respondents of a cross-sectional postal survey we selected those who had experienced pain during the past 7 days (n = 3641) and analyzed how they had tried to manage their pain during the past 6 months. The most common pain management strategies were use of over-the-counter medicines (53% of 3641 respondents), physical exercise (52%), prescription medicines (35%), and visiting a physician (33%).

Managerial skills of principal physicians assessed by their colleagues. A lesson from Finland.

The purpose of this paper was to discover the views of doctors regarding the managerial skills of their principal physicians and the views of doctors of their postgraduate specialist training in management. This was done by sending out a questionnaire to every second physician registered in 1977-1986 in Finland. They were asked to evaluate their principal physician's managerial skills using a visual analogue scale.

Chronic pain and poor self-rated health.

Context: Chronic pain is common in Western societies. Self-rated health is an important indicator of morbidity and mortality, but little is known about the relation between chronic pain and self-rated health in the general population.

Objective: To analyze the association between chronic pain and self-rated health.