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).
A nationwide population-based questionnaire study.
A total of 6437 (from a sample of 10,000) Finns aged 15-74 years.
Period of time (in days) to get an appointment with any physician was assessed via a single structured question. Accessibility and continuity were evaluated with a five-category Likert scale. Values 4-5 were regarded as good.
Altogether 72% had found that they could obtain an appointment with a physician within three days, while 6% had to wait more than two weeks. Older subjects and subjects with chronic diseases perceived waiting times as longer more often than younger subjects and those without chronic diseases. The proportion of subjects who perceived access to care to be good was 35% in a PPHC, 68% in OHC, and 78% in a PP. The proportion of subjects who were able to get successive appointments with the same doctor was 45% in a PPHC, 68% in OHC, and 81% in a PP. A personal doctor system was related to good continuity and access in a PPHC.
Access to and continuity of care in Finland are suboptimal for people suffering from chronic diseases. The core features of good primary healthcare are still not available within the medical care provided by public health centres.
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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.
The aim of our study was to ascertain the motives affecting physicians' choice of a medical specialty.
The study cohort comprised random sample of 7758 doctors who were registered in Finland during the years 1977-2006. Altogether 4167 questionnaires were returned, giving a response rate of 54%. An electronic questionnaire was used in data collection, supported by a traditional postal questionnaire.
Of the respondents, 76% thought the diversity of the field had affected their choices of specialty considerably or very much. For physicians under 35 years old, especially the good example set by colleagues (48%), and opportunities for career development (39%) were more important motives compared to those of older physicians.
According to this study, diversity of the work is the main motivating factor affecting physicians' choices of specialty. Especially, younger physicians follow the example set by more experienced colleagues.
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. Inventory in a large, middle-aged population-based sample collected from Central Finland. In addition, the effects of various medications and type of depressive symptomatology on the cytokine levels were scrutinized. In the whole study population, IL-1RA levels were higher in the subgroup with depressive symptomatology. In the males with depressive symptomatology, higher IL-1RA levels and lower interleukin-1 beta levels were observed as compared with the non-depressed males. The IL-1RA/IL-1 beta ratio was significantly higher in males with depressive symptomatology. The IL-1RA levels were also higher and IL-1 beta levels lower in the depressed females, but the trend was not significant. The elevated IL-1RA-levels and IL-1RA/IL-1 beta ratio suggest a role for cytokines in the pathogenesis of depression. The higher IL-1RA levels may reflect an endogenous repairing process against depression.
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. After one year, 20 health stations reported improvement in treatment practices of hypertension and the division of tasks across team members, and seven and eight health stations reported improvement in treatment of diabetes and dyslipidemia. After two years, the corresponding figures were 29, 25 and 22, respectively. Active guidance to home measurements increased from 90% to 100% and every health station identified a dedicated area for patient self-measurement. At baseline, in poor control were 17% of blood pressure measurements, and 31% of diabetic and 71% of dyslipidemic patients. At follow-up, the corresponding figures were 22%, 34% and 64%, respectively. Multiprofessional facilitation and learning proved to be effective in implementing guidelines, improving multiprofessional collaboration and sharing duties and responsibilities, as well as targeting preventative activities and resources adequately.
To analyse factors affecting physicians' choice to work in either the public or the private sector.
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.
Physicians seem to make their career choices prior to graduation, at least to some extent. Wage levels, the physician's personal characteristics and whether or not the physician knew his or her place of work before graduation were the key factors affecting the decision-making process in the years 1988, 1993, 1998 and 2003. Physicians for whom wages were important were less likely to choose the public sector. Also, physicians who regarded themselves as entrepreneurial preferred to work in the private sector. If a physician had worked in the public sector during his or her medical training before graduation, the probability of applying for a vacancy in the public sector was higher.
It is not only economic factors, such as salary, that are involved in the physician's decision to choose the working sector.
To study the associations of patient-related and perceived healthcare-related factors with the control of blood pressure.
Physicians identified all of the hypertensive patients they saw during I week in 26 health centres. Out of 2,219 patients, 80% agreed to participate, 88% of which took antihypertensive medication.
In this cross-sectional questionnaire study, based on 82 opinion statements, 14 problem indices were formed using factor analysis. Logistic regression models were used to study the associations with blood pressure control.
Eighty per cent of the men and 79% of the women had poor blood pressure control (BP > or = 140/90 mmHg). High levels of hopelessness towards hypertension (adjusted OR 2.16; 95% confidence interval (CI) 1.20-3.88) as well as medium and high levels of frustration with treatment (adjusted OR 1.50; 95% CI 1.04-2.18 and OR 1.83; 95% CI 0.98-3.44) were associated with poor control. The perceived tension with blood pressure measurement (adjusted OR 1.60; 95% CI 1.08-2.36) was similarly associated with poor control. Non-compliance in men, old age and monotherapy were also associated with poor blood pressure control.
Hopelessness, frustration with treatment, and perceived tension with blood pressure measurement are associated with poor blood pressure control.
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. This study assesses how well GPs and patients recognise MetS among patients with coronary heart disease or at least one of its risk factors.
Twenty-six health centres around Finland were randomly selected for the purpose of identifying, over a two-week period in April 2005, patients meeting the inclusion criteria of coronary heart disease or one of its risk factors. GPs and identified patients (n = 1880) were asked to complete surveys that included a question about the patient's MetS status. A trained nurse conducted health checks (n = 1180) of the identified patients, utilising criteria of MetS modified from the National Cholesterol Program. Data from the GPs' survey were compared with those from the health check to establish the extent of congruence of identification of MetS.
Almost half (49.4%) of the patients met the criteria of MetS as established by objective measures. However, in the GPs' survey responses, only 28.5% of the patients were identified as having MetS. Additionally, these groups of MetS patients were not congruent. The sensitivity of the GPs' diagnosis of MetS was 0.31 with a specificity of 0.73. Only 7.1% of the study patients stated that they were suffering from MetS.
Detection of MetS is inaccurate among GPs in Finland. Most patients were not aware of having MetS. The practical relevance of MetS in primary care should be reconsidered.
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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. The absolute gender difference in adiponectin was smaller and those in IL-1Ra and hs-CRP were greater in subjects with MetS compared to those without. After adjustment with body mass index the association between insulin and the odd's ratio (OR) for MetS remained significant in both genders, in females also the association between the OR for MetS and adiponectin. There are gender differences in subjects with elevated blood pressure and MetS with respect to inflammatory markers and the relationship between adiponectin levels and MetS.
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Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland. email@example.com
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.
The study involved adults in 8 birth cohorts between 30 and 65 years of age living in the rural community of Lapinlahti in eastern Finland. We assessed participants' demographic and lifestyle factors and health views. For assessment of health views, we applied factor analysis. For MetS classification, we used the 2005 criteria of the National Cholesterol Education Program.
The prevalence of MetS among the participants was 38%. In a backward logistic regression analysis adjusted for other variables, there was a significant association between MetS and older age (odds ratio [OR] 2.91) as well as low level of physical activity (OR 1.99). In a factor analysis, 4 principal factors of lay health views were identified, of which blame-shifting (OR 1.36, 95% confidence interval [CI] 1.21-1.49)and social alienation (OR 1.23, 95% CI 1.24-1.40) were significantly associated with MetS in an unadjusted logistic regression analysis.
It is important, particularly in primary health care, to recognize health views behind MetS and to empower communities in the prevention of MetS.
Several studies have revealed that undergraduate medical education does not adequately prepare students for their work as physicians. There have been attempts to solve this problem in curriculum reforms in medical faculties. In this article, Finnish physicians' opinions on their undergraduate medical education are analysed. In 1988, a postal questionnaire was mailed to 2632 physicians registered during 1977-86, and altogether 1745 questionnaires were returned (66.3%). A follow-up study was done in 1998, and a questionnaire was sent to 2529 physicians who graduated between 1987 and 1996; 1822 questionnaires were returned (73.1%). Half of the respondents considered undergraduate education to correspond well with the requisite diagnostic skills and hospital doctors' work in general. In older and more traditional medical faculties (Helsinki, Oulu and Turku) education in primary healthcare work was considered insufficient. Also, more than 80% of the respondents felt they received too little teaching in administrative work. They reported that both traditional and younger, community-oriented faculties (Kuopio and Tampere) had considerably improved their education, especially in primary healthcare, during the 10-year follow-up. However, there were still clear differences between the education in the respective types of faculty as evaluated by their graduates. There is still room for improvements in undergraduate medical education, the better to meet the real needs of practising physicians in different fields of health care.