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.
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
To investigate the association between blood pressure and mortality in people aged 85 and older.
Population-based prospective study with 9-year follow-up.
Department of Neuroscience and Neurology and Department of Public Health and General Practice, University of Kuopio, and Department of Clinical Neurosciences, Helsinki University Hospital.
Of all 601 people living in the city of Vantaa born before April 1, 1906, whether living at home or in institutions and alive on April 1, 1991, 521 were clinically examined and underwent blood pressure measurement.
Blood pressure was measured using a standardized method in the right arm of the subject after resting for at least 5 minutes. Information on medical history for each participant was verified from a computerized database containing all primary care health records. Death certificates were obtained from the National Register; the collection of death certificates was complete.
After adjusting for age, sex, functional status, and coexisting diseases (earlier-diagnosed myocardial infarction, congestive heart failure, dementia, cancer, stroke, or hypertension), low systolic blood pressure (BP) was associated with risk of death.
Low systolic BP may be partially related to poor general health and poor vitality, but the very old may represent a select group of individuals, and the use of BP-lowering medications needs to be evaluated in this group.
The aim of this study was to investigate the acceptability of 14 prioritization criteria from nurses', doctors', local politicians' and the general public's perspective. Respondents (nurses, n = 682, doctors, n = 837 politicians, n = 1,133 and the general public, n = 1,178) received a questionnaire with 16 imaginary patient cases, each containing 2-3 different prioritization criteria. The subjects were asked to indicate how important it was for them that the treatments in the presented patient cases be subsidized by the community. All respondents preferred treatments for poor people and children. With the exception of the doctors, the three other study groups also prioritized elderly patients. Treatment for institutionalised patients, those with self-induced disease, diseases with both poor and good prognosis, and mild disease were given low priorities. Priority setting in health care should be regarded as a continuous process because of changes in attitudes. However, the best method for surveying opinions and ethical principles concerning prioritization has not yet been discovered.
To determine the impact of diabetes on outcome after coronary artery bypass surgery.
We matched 866 diabetic patients with non-diabetic controls in regards to gender, age, left ventricular ejection fraction, body mass index, presence of unstable angina and history of myocardial infarction, and day of surgery. The 30-d mortality and morbidity were evaluated with univariate analysis and survival and freedom from cardiac death were assessed with the Kaplan-Meier method.
Follow-up time was 69+/-37 months. The 30-d mortality was 2.0% in the diabetic group and 1.0% in the non-diabetic group (p=0.15). Postoperative morbidity did not differ between groups. Cumulative 5- and 10-year survival rates were 89 and 71% in diabetics and 94 and 84% in non-diabetics (p=0.001). During follow-up, there was no difference between groups in regards to repeat revascularization.
The 30-d mortality was equally low in diabetic and non-diabetic patients with severe coronary artery disease. However, long-term survival was significantly lower in the diabetic group than in the non-diabetic group.
The goal was to determine the prevalence of medicine use and to provide population-based information on factors associated with medicine use, including prescribed and over-the-counter (OTC) medicines, in children aged under 12 years.
A cross-sectional population survey of a random sample of children aged under 12 years (n = 6000) was carried out in Finland in spring 2007, with a response rate of 67%. A questionnaire was sent to their parents. Current use of medicines prescribed by a physician and use of OTC medicines during the preceding two days were the main outcome measures.
The prevalence of current prescribed medicine use was 17%, and the 2-day prevalence of OTC medicine use 17% (vitamins excluded). The use of prescribed medicines was higher among children with illnesses diagnosed by a physician. Additionally, predictors for the use of prescribed medicines were young age among boys, health status worse than good, and the use of any prescribed medicines by a parent. The predictors for the use of OTC medicines by the child were young age and fairly good to poor health status, and the use of OTC medicines by a parent. However, children with any illnesses diagnosed by a physician were less likely to use OTC medicines.
A considerable proportion of children use prescription and OTC medicines in Finland. Young age and health-related factors, morbidity and health status, and parental medicine use predicted children's medicine use. Further studies are needed to examine the association between parents' and children's medicine use.
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.
To determine the relation between the C/T(-13910) single-nucleotide polymorphism residing 13,910 base pairs from the 5' end of the lactase gene associated with lactase persistence and the occurrence of bone fractures in elderly people.
Vantaa 85+ population-based study, including all 601 subjects born before April 1, 1906, who were living in the city of Vantaa, Finland, on April 1, 1991.
Four hundred eighty-three people aged 85 and older (106 men and 377 women).
Genotype determination was made using a polymerase chain reaction minisequencing technique.
The frequency of the genotype C/C(-13910) associated with adult-type hypolactasia (low lactase enzyme activity or primary lactose malabsorption (LM)) was significantly greater in individuals with hip fractures, with an adjusted odds ratio (OR) of 3.7 (95% confidence interval (CI)=1.8-7.8), wrist fractures with an adjusted OR of 2.5 (95% CI=1.2-5.2), and hip and wrist fractures combined with an adjusted OR of 4.1 (95% CI=2.0-8.3).
The C/C(-13910) genotype associated with primary LM could represent a genetic risk factor for bone fractures for elderly people.
To determine whether adrenal hormonal activity is altered in children born small for gestational age (SGA), and whether concentrations of adrenal hormones relate to those of serum lipids or to anthropometric measures.
We studied 55 SGA children and 55 appropriate for gestational age (AGA) children at the age of 12 years in a case-control setting. The concentrations of fasting serum cortisol, dehydroepiandrosterone sulfate (DHEAS), plasma epinephrine (E), and norepinephrine (NE) were analyzed.
The SGA children had significantly higher mean concentrations of serum DHEAS (3.53 vs 2.89 micromol/L, P =.009) and plasma E (0.33 vs 0.25 nmol/L, P =.005) than their age- and sex-matched control subjects. The mean serum cortisol and plasma NE concentrations did not differ significantly between the groups. However, the SGA children in the highest quartile for serum cortisol had significantly higher concentrations of plasma E (0.50 vs 0.28 nmol/L, P
Parents are expected to alleviate their children's pain at home after day surgery, and the methods of pain alleviation should be taught to the parents by the hospital staff. However, the lack of information related to children's pain alleviation has been pointed out in several studies.
To describe the relationship between the parent-rated sufficiency of discharge instructions and the postoperative pain behaviours of 1- to 6-year-old children at home after day surgery.
Questionnaires were handed out to mothers (n = 201) and fathers (n = 114) whose child had undergone minor day surgery in 10 Finnish central hospitals. Percentages and cross-tabulation with chi-square test were used in data analysis.
The ethical board in each hospital accepted the study. Parental participation was voluntary.
The parents considered the discharge instructions to be fairly sufficient, but criticized their content, method of providing and timing. Insufficiency of the instructions was related to children's postoperative pain behaviours at home.
The fairly low response rate of this study prevents generalization of the findings to all Finnish parents.
Both the content, the methods of providing and the timing of discharge instruction need to be developed in children's day surgery. Special attention should be paid to written instructions, which should be given to the parents prior to the day of the child's surgery. Further research is needed to explore the skills of hospital staff in advising the parents and other factors explaining children's postoperative pain at home.
Current guidelines recommend ß-blockers as the first-line preventive treatment of atrial fibrillation (AF) after cardiac surgery. Despite this, 19% of physicians report using amiodarone as first-line prophylaxis of postoperative AF. Data directly comparing the efficacy of these agents in preventing postoperative AF are lacking.
To determine whether intravenous metoprolol and amiodarone are equally effective in preventing postoperative AF after cardiac surgery.
316 consecutive patients who were hemodynamically stable and free of mechanical ventilation and AF within 24 hours after cardiac surgery.
Patients were randomly assigned to receive 48-hour infusion of metoprolol, 1 to 3 mg/h, according to heart rate, or amiodarone, 15 mg/kg of body weight daily, with a maximum daily dose of 1000 mg, starting 15 to 21 hours after cardiac surgery.
The primary end point was the occurrence of the first AF episode or completion of the 48-hour infusion.
Atrial fibrillation occurred in 38 of 159 (23.9%) patients in the metoprolol group and 39 of 157 (24.8%) patients in the amiodarone group (P = 0.85). However, the difference (-0.9 percentage point [90% CI, -8.9 to 7.0 percentage points]) does not meet the prespecified equivalence margin of 5 percentage points. The adjusted hazard ratio of the metoprolol group compared with the amiodarone group was 1.09 (95% CI, 0.67 to 1.76).
Caregivers were not blinded to treatment allocation, and the trial evaluated only stable patients who were not at particularly elevated risk for AF. The withdrawal of preoperative ß-blocker therapy may have increased the risk for AF in the amiodarone group.
The occurrence of AF was similar in the metoprolol and amiodarone groups. However, because of the wide range of the CIs, the authors cannot conclude that the 2 treatments were equally effective.
The Finnish Foundation for Cardiovascular Research and the Kuopio University EVO Foundation.