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

https://arctichealth.org/en/permalink/ahliterature164689
Source
Scand J Prim Health Care. 2007 Mar;25(1):27-32
Publication Type
Article
Date
Mar-2007
Author
Pekka Mäntyselkä
Pirjo Halonen
Arto Vehviläinen
Jorma Takala
Esko Kumpusalo
Author Affiliation
Department of Public Health and Clinical Nutrition, Unit of Family Practice, University of Kuopio, Kuopio, Finland. pekka.mantyselka@uku.fi
Source
Scand J Prim Health Care. 2007 Mar;25(1):27-32
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Chronic Disease - therapy
Community Health Centers - standards - statistics & numerical data
Continuity of Patient Care
Family Practice - standards - statistics & numerical data
Finland
Health Services Accessibility
Humans
Middle Aged
Occupational Health Services - standards - statistics & numerical data
Patient satisfaction
Primary Health Care - standards - statistics & numerical data
Private Sector
Public Sector
Questionnaires
Abstract
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.
Finland.
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.
Notes
Cites: Fam Pract. 2000 Jun;17(3):236-4210846142
Cites: Br J Gen Pract. 2000 Nov;50(460):882-711141874
Cites: Scand J Prim Health Care. 2001 Jun;19(2):131-4411482415
Cites: Br J Gen Pract. 2002 Jun;52(479):459-6212051209
Cites: Health Serv Res. 2002 Oct;37(5):1403-1712479503
Cites: Scand J Prim Health Care. 2006 Sep;24(3):140-416923622
Cites: Scand J Prim Health Care. 1992 Dec;10(4):290-41480869
Cites: J Fam Pract. 2004 Dec;53(12):974-8015581440
Cites: CMAJ. 2006 Jan 17;174(2):177-8316415462
Cites: Scand J Prim Health Care. 2006 Mar;24(1):1-216464807
Cites: Ann Fam Med. 2003 Sep-Oct;1(3):149-5515043376
PubMed ID
17354156 View in PubMed
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Choosing a medical specialty--study of Finnish doctors graduating in 1977-2006.

https://arctichealth.org/en/permalink/ahliterature132817
Source
Med Teach. 2011;33(8):e440-5
Publication Type
Article
Date
2011
Author
Teppo Heikkilä
Harri Hyppölä
Esko Kumpusalo
Hannu Halila
Jukka Vänskä
Santero Kujala
Irma Virjo
Kari Mattila
Author Affiliation
Unit of General Practice, Kuopio University Hospital, Asemakatu 44 A 4, 70110 Kuopio, Finland. teppo.heikkila@fimnet.fi
Source
Med Teach. 2011;33(8):e440-5
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Attitude of Health Personnel
Career Choice
Chi-Square Distribution
Data Collection - methods
Education, Medical, Graduate - methods
Female
Finland
Humans
Male
Medicine
Middle Aged
Questionnaires
Abstract
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.
PubMed ID
21774641 View in PubMed
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Depressive symptomatology is associated with decreased interleukin-1 beta and increased interleukin-1 receptor antagonist levels in males.

https://arctichealth.org/en/permalink/ahliterature151688
Source
Psychiatry Res. 2009 May 15;167(1-2):73-9
Publication Type
Article
Date
May-15-2009
Author
Yrjö Ovaskainen
Hannu Koponen
Jari Jokelainen
Sirkka Keinänen-Kiukaanniemi
Esko Kumpusalo
Mauno Vanhala
Author Affiliation
Department of Psychiatry, South-Savo Hospital District, Moisio Hospital, FIN-50520 Mikkeli, Finland.
Source
Psychiatry Res. 2009 May 15;167(1-2):73-9
Date
May-15-2009
Language
English
Publication Type
Article
Keywords
Depressive Disorder - blood - diagnosis - immunology
Female
Finland
Humans
Interleukin 1 Receptor Antagonist Protein - blood - immunology
Interleukin-1 - blood
Interleukin-1beta - blood - immunology
Male
Middle Aged
Personality Inventory
Severity of Illness Index
Sex Factors
Abstract
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.
PubMed ID
19346005 View in PubMed
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Facilitating as a guidelines implementation tool to target resources for high risk patients - the Helsinki Prevention Programme (HPP).

https://arctichealth.org/en/permalink/ahliterature159303
Source
J Interprof Care. 2008 Jan;22(1):31-44
Publication Type
Article
Date
Jan-2008
Author
Raija Sipilä
Eeva Ketola
Tiina Tala
Esko Kumpusalo
Author Affiliation
City of Helsinki Health Centre, Helsinki, Finland. raija.sipila@rohto.fi
Source
J Interprof Care. 2008 Jan;22(1):31-44
Date
Jan-2008
Language
English
Publication Type
Article
Keywords
Cardiovascular Diseases - prevention & control - therapy
Finland
Guideline Adherence
Humans
Patient care team
Physician-Patient Relations
Practice Guidelines as Topic
Preventive Health Services - methods - standards
Primary Health Care - methods - standards
Abstract
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.
PubMed ID
18202984 View in PubMed
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Factors associated with physicians' choice of working sector: a national longitudinal survey in Finland.

https://arctichealth.org/en/permalink/ahliterature168150
Source
Appl Health Econ Health Policy. 2006;5(2):125-36
Publication Type
Article
Date
2006
Author
Terhi Kankaanranta
Jari Vainiomäki
Ville Autio
Hannu Halila
Harri Hyppölä
Mauri Isokoski
Santero Kujala
Esko Kumpusalo
Kari Mattila
Irma Virjo
Jukka Vänskä
Pekka Rissanen
Author Affiliation
Tampere School of Public Health, University of Tampere, Tampere, Finland. kankaanranta@uta.fi
Source
Appl Health Econ Health Policy. 2006;5(2):125-36
Date
2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude of Health Personnel
Career Choice
Decision Making
Entrepreneurship
Female
Finland
Health Care Surveys
Humans
Likelihood Functions
Longitudinal Studies
Male
Middle Aged
Physicians - psychology - supply & distribution
Private Sector - economics - manpower
Public Sector - economics - manpower
Abstract
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.
PubMed ID
16872253 View in PubMed
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Factors related to poor control of blood pressure with antihypertensive drug therapy.

https://arctichealth.org/en/permalink/ahliterature185813
Source
Blood Press. 2003;12(1):49-55
Publication Type
Article
Date
2003
Author
Erkki Jokisalo
Hannes Enlund
Pirjo Halonen
Jorma Takala
Esko Kumpusalo
Author Affiliation
Department of Social Pharmacy, University of Kuopio, Finland. jokisalo@hytti.uku.fi
Source
Blood Press. 2003;12(1):49-55
Date
2003
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Antihypertensive Agents - administration & dosage - therapeutic use
Blood Pressure - drug effects
Cross-Sectional Studies
Data Collection
Female
Finland
Humans
Hypertension - drug therapy - psychology
Logistic Models
Male
Middle Aged
Odds Ratio
Patient Compliance - psychology - statistics & numerical data
Professional-Patient Relations
Risk factors
Sex Factors
Time Factors
Abstract
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.
Notes
Comment In: Blood Press. 2003;12(1):5-612699128
PubMed ID
12699136 View in PubMed
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Far from easy and accurate - detection of metabolic syndrome by general practitioners.

https://arctichealth.org/en/permalink/ahliterature147067
Source
BMC Fam Pract. 2009;10:76
Publication Type
Article
Date
2009
Author
Eeva-Eerika Helminen
Pekka Mäntyselkä
Irma Nykänen
Esko Kumpusalo
Author Affiliation
Kuopio Health Centre, Kuopio, Finland. eeva-eerika.helminen@fimnet.fi
Source
BMC Fam Pract. 2009;10:76
Date
2009
Language
English
Publication Type
Article
Keywords
Aged
Attitude of Health Personnel
Attitude to Health
Clinical Competence
Comorbidity
Coronary Disease - diagnosis - epidemiology - psychology
Female
Finland - epidemiology
Health status
Humans
Male
Metabolic Syndrome X - diagnosis - epidemiology
Middle Aged
Physician-Patient Relations
Physicians, Family - psychology - standards - statistics & numerical data
Questionnaires
Risk factors
Sensitivity and specificity
Abstract
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.
Notes
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PubMed ID
19948040 View in PubMed
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Gender differences relating to metabolic syndrome and proinflammation in Finnish subjects with elevated blood pressure.

https://arctichealth.org/en/permalink/ahliterature148924
Source
Mediators Inflamm. 2009;2009:959281
Publication Type
Article
Date
2009
Author
Tiina Ahonen
Juha Saltevo
Markku Laakso
Hannu Kautiainen
Esko Kumpusalo
Mauno Vanhala
Author Affiliation
Palokka Health Center, 40270 Jyväskylä, Finland. tiina.ahonen@fimnet.fi
Source
Mediators Inflamm. 2009;2009:959281
Date
2009
Language
English
Publication Type
Article
Keywords
Adult
Biological Markers - metabolism
Blood Pressure - physiology
C-Reactive Protein - metabolism
Female
Finland
Humans
Inflammation - metabolism - physiopathology
Insulin - blood
Interleukin 1 Receptor Antagonist Protein - metabolism
Interleukin-1beta - immunology
Male
Metabolic Syndrome X - metabolism - physiopathology
Middle Aged
Odds Ratio
Sex Factors
Abstract
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.
Notes
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PubMed ID
19707530 View in PubMed
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Health views and metabolic syndrome in a Finnish rural community: a cross-sectional population study.

https://arctichealth.org/en/permalink/ahliterature128583
Source
Can J Rural Med. 2012;17(1):10-6
Publication Type
Article
Date
2012
Author
Juhani Miettola
Irma Nykanen
Esko Kumpusalo
Author Affiliation
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. juhani.miettola@uef.fi
Source
Can J Rural Med. 2012;17(1):10-6
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Blood Glucose - analysis
Cholesterol - blood
Cross-Sectional Studies
Female
Finland - epidemiology
Health Knowledge, Attitudes, Practice
Humans
Life Style
Logistic Models
Male
Metabolic Syndrome X - diagnosis - epidemiology
Middle Aged
Motor Activity
Odds Ratio
Physical Examination
Prevalence
Primary Health Care - organization & administration
Questionnaires
Risk Reduction Behavior
Rural Population
Abstract
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.
PubMed ID
22188621 View in PubMed
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Improvement in undergraduate medical education: a 10-year follow-up in Finland.

https://arctichealth.org/en/permalink/ahliterature71623
Source
Med Teach. 2002 Jan;24(1):52-6
Publication Type
Article
Date
Jan-2002
Author
Harri Hyppölä
Esko Kumpusalo
Irma Virjo
Kari Mattila
Liisa Neittaanmäki
Hannu Halila
Santero Kujala
Riitta Luhtala
Mauri Isokoski
Author Affiliation
Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland. harri.hyppola@fimnet.fi
Source
Med Teach. 2002 Jan;24(1):52-6
Date
Jan-2002
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Education, Medical, Undergraduate - standards
Female
Finland
Follow-Up Studies
Hospital Administration - education
Humans
Male
Medical Staff, Hospital - psychology
Physicians - psychology
Primary Health Care
Program Evaluation
Questionnaires
Abstract
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.
PubMed ID
12098458 View in PubMed
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16 records – page 1 of 2.