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.

The association of adiponectin and low-grade inflammation with the course of metabolic syndrome.

Background And Aims: Metabolic syndrome (MetS) is associated with low-grade inflammation. The connections of adiponectin and inflammatory cytokines with the course of MetS are not well-known. The aim of this study was to investigate the relation of adiponectin and low-grade inflammation with the development or resolution of MetS.

Occupational isolation among general practitioners in Finland.

Background: It is proposed that isolation in general practice is one of the factors that leads to work-related stress and the low attraction of this work. In Finland, 71% of physicians who worked or had worked in a primary health care centre agreed with the statement 'working as a doctor in a health centre is too often isolated work'.

Aims: To gain a deeper understanding of this feeling and to find out which factors constitute it.

Increasing size of health centres may not prevent occupational isolation.

Background: A Finnish national survey in 2002 revealed that Finnish physicians often feel that working in a primary heath care centre is isolated work.

Aims: To determine the factors related to perceived isolation in health centre work among general practitioners (GP) working in health centres.

Methods: A postal questionnaire study of physicians (N = 1829) working in primary health care centres.

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.

Depressive symptoms predispose females to metabolic syndrome: a 7-year follow-up study.

Objective: To evaluate the risk for developing metabolic syndrome when having depressive symptoms.

Method: The prevalence of depressive symptoms and metabolic syndrome at baseline, and after a 7-year follow-up as measured with Beck depression inventory (BDI), and using the modified National Cholesterol Education Program--Adult Treatment Panel III criteria for metabolic syndrome (MetS) were studied in a middle-aged population-based sample (n = 1294).

Results: The logistic regression analysis showed a 2.

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.

Glucose regulation and chronic pain at multiple sites.

Objective: To analyse how glucose regulation status is associated with chronic regional pain and chronic widespread pain (CWP) in the adult population.

Methods: A structured interview and health examination study with 480 participants aged 30-65 yrs was carried out in Lapinlahti municipality in eastern Finland. The number of painful sites in the right or left upper and lower extremities, shoulders and hips, and in neck and back was summated.

Gender differences in C-reactive protein, interleukin-1 receptor antagonist and adiponectin levels in the metabolic syndrome: a population-based study.

Aims: We explored gender differences in the association of high-sensitivity C-reactive protein (hs-CRP), interleukin-1 receptor antagonist (IL-1Ra) and adiponectin with the metabolic syndrome (MetS) defined by the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) criteria.

Methods: A population-based study of 923 middle-aged subjects in Pieksämäki, East Finland.

Results: The prevalence of the MetS according to the IDF and NCEP definitions was 38% and 34% in men (N = 405) and 34% and 27% in women (N = 497), respectively.

Levels of adiponectin, C-reactive protein and interleukin-1 receptor antagonist are associated with insulin sensitivity: a population-based study.

Background: We evaluated the relationship of insulin sensitivity (assessed with the quantitative insulin sensitivity check index, QUICKI) to adiponectin and pro-inflammatory markers, levels of high-sensitivity C-reactive protein (hs-CRP) and interleukin-1 receptor antagonist (IL-1 Ra).

Methods: Cross-sectional study. Study population (N=923, i.

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.