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Lindfors O.,Finnish National Institute for Health and Welfare | Knekt P.,Finnish National Institute for Health and Welfare | Virtala E.,Finnish National Institute for Health and Welfare | Haaramo P.,Biomedicum Helsinki
Psychopathology | Year: 2013

Background/Aims: Clinical assessment of object relations is essential when evaluating treatability by different types of psychotherapy. The Quality of Object Relations Scale (QORS) is an established interview measure used for assessing object relations, but the validity of the QORS in relation to its theoretical constituents has not been examined. Our aim was to study the concurrent validity of the QORS. Methods: Trained interviewers assessed 263 outpatients seeking psychotherapy due to mood or anxiety disorder, with the QORS and with selected proxy criterion measures representing constituents of object-relational maturity. Results: Discontinuity in relationships and the use of devaluation in relationships were the main determinants of low Quality of Object Relations (low-QOR). Patients with discontinuity in relationships had a four-fold and patients with devaluation in relationships a three-fold risk of belonging to the low-QOR group (p = 0.001) in comparison to those without these relational characteristics. Also poor self-confidence and major separations in childhood predicted the low- versus high-QOR category. Conclusion: The results indicate adequate concurrent validity of the QORS and support its credibility in assessing personality pathology, beyond axis II diagnosis, by trained clinicians. Copyright © 2012 S. Karger AG, Basel. Source


Maljanen T.,Social Insurance Institution | Paltta P.,Social Insurance Institution | Harkanen T.,Finnish National Institute for Health and Welfare | Virtala E.,Finnish National Institute for Health and Welfare | And 4 more authors.
Journal of Mental Health Policy and Economics | Year: 2012

Background: Mood and anxiety disorders are characterized by a high and increasing prevalence, they cause a lot of costs and human suffering and there are many treatment options with differing costs. The benefits of identifying the treatments with the most favourable cost-effectiveness ratios can be substantial. However, the number of randomized trials where psychological treatments are compared with each other and where economic aspects, too, are taken into account is still relatively small. Aim: To compare the cost-effectiveness of two short-term psychotherapies in the treatment of depressive and anxiety disorders during a one-year follow-up. Methods: In the Helsinki Psychotherapy Study, 198 patients, who were 20-45 years of age and met DSM-IV criteria for anxiety or mood disorder, were randomized to short-term psychodynamic psychotherapy (SPP) or solution-focused therapy (SFT). Psychiatric symptoms were assessed at baseline and 4 times during the one-year follow-up from the start of therapy using the Beck Depression Inventory and the Symptom Check List Anxiety Scale, and 2 times using the Hamilton Depression Rating Scales and Hamilton Anxiety Rating Scales. Both direct costs (therapy sessions, outpatient visits, medication, inpatient care) and indirect costs (production losses due to work absenteeism, value of neglected household work, lost leisure time and unpaid help received) due to mental disorders were measured. Mean total costs were compared and incremental costeffectiveness ratios analyzed. Results: According to all 4 psychiatric outcome measures, symptoms of depression and anxiety were reduced statistically significantly in both therapy groups during the one-year follow-up. The relative changes were about the same size according to all four outcome measures. In both groups the reductions took place mainly in the first half of the follow-up. The reductions were somewhat greater with SPP, but the differences between the two groups were small and not statistically significant at any measurement point. The mean total direct costs were 1791 euros in the SPP group, being 346 euros (16%) lower than those of the SFT group, but this difference was not statistically significant either. Also the incremental costeffectiveness ratio points calculated by 500 bootstrap iterations favoured SPP. The total indirect costs in the SPP group were, in contrast to direct costs, higher than those in the SFT group, but, again, the difference was not statistically significant. Limitations: The generalization of our results may be weakened by the fact that the patients included in our study were relatively young, and the follow-up period was restricted to one year. Implications: This study suggests that there are no notable differences in cost-effectiveness between SPP and SFT. If one were obliged to choose between these two therapies our results would support the choice of SPP. However, more research with extensive data about both costs and effectiveness, compiled over a period longer than one year, are needed before any firm conclusions can be drawn about the cost-effectiveness of the two therapies compared in this study. Copyright g 2012 ICMPE. Source


Williams K.H.,University of Sydney | Sullivan D.R.,Royal Prince Alfred Hospital | Sullivan D.R.,University of Sydney | Veillard A.S.,University of Sydney | And 10 more authors.
Diabetic Medicine | Year: 2016

Aims: To determine whether alanine aminotransferase or gamma-glutamyltransferase levels, as markers of liver health and non-alcoholic fatty liver disease, might predict cardiovascular events in people with Type 2 diabetes. Methods: Data from the Fenofibrate Intervention and Event Lowering in Diabetes study were analysed to examine the relationship between liver enzymes and incident cardiovascular events (non-fatal myocardial infarction, stroke, coronary and other cardiovascular death, coronary or carotid revascularization) over 5 years. Results: Alanine aminotransferase measure had a linear inverse relationship with the first cardiovascular event occurring in participants during the study period. After adjustment, for every 1 sd higher baseline alanine aminotransferase measure (13.2 U/l), the risk of a cardiovascular event was 7% lower (95% CI 4-13; P = 0.02). Participants with alanine aminotransferase levels below and above the reference range 8-41 U/l for women and 9-59 U/l for men, had hazard ratios for a cardiovascular event of 1.86 (95% CI 1.12-3.09) and 0.65 (95% CI 0.49-0.87), respectively (P = 0.001). No relationship was found for gamma-glutamyltransferase. Conclusions: The data may indicate that in people with Type 2 diabetes, which is associated with higher alanine aminotransferase levels because of prevalent non-alcoholic fatty liver disease, a low alanine aminotransferase level is a marker of hepatic or systemic frailty rather than health. © 2016 Diabetes UK. Source


Keikkala E.,University of Helsinki | Hytinantti T.,University of Helsinki | WathEn K.-A.,University of Helsinki | Andersson S.,Biomedicum Helsinki | And 2 more authors.
Acta Obstetricia et Gynecologica Scandinavica | Year: 2012

Objective. To characterize the physiological distribution of angiopoietins (Ang)-1 and Ang-2 and soluble endothelial cell-spesific tyrosine kinase receptor-2 (Tie-2) at term and following delivery. Design. A prospective, descriptive study. Setting. Helsinki University Central Hospital. Population. Twenty healthy term pregnant women undergoing elective cesarean delivery and their newborns. Methods. The concentrations were analysed by enzyme-linked immunosorbent assay in maternal antepartum and the first postpartum day sera, umbilical serum, amniotic fluid and maternal and newborn urine. Main outcome measures. Concentrations of Ang-1, Ang-1 and Tie-2. Results. Concentrations of maternal serum Ang-1 and Ang-2 decreased after delivery {[median (range)]: Ang-1, from 33 (25-51) to 30 (18-49) ng/mL, p= 0.017; and Ang-2, from 5.4 (1.8-18) to 1.4 (0.7-4.6) ng/mL, p < 0.0001}, whereas Tie-2 concentrations remained stable [23 (13-41) vs. 25 (14-29) ng/mL, p= 0.107]. Compared with maternal antepartum serum, umbilical serum concentrations of Ang-1 [46 (28-59) ng/mL, p < 0.0001] and Tie-2 [45 (21-71) ng/mL, p < 0.0001] were higher and those of Ang-2 similar [5.4 (1.8-18) vs. 4.2 (2.9-6.0) ng/mL; p= 0.067]. Low concentrations of Ang-1 [1.2 (0.1-2.2) ng/mL], Ang-2 [1.1 (0.3-4.1) ng/mL] and Tie-2 [0.4 (0.08-0.9) ng/mL] were observed in amniotic fluid, but they were undetectable in newborn urine and in most of the maternal urine samples. Conclusions. Maternal Ang-1 and Ang-2 concentrations decreased following delivery. Umbilical concentrations of Ang-1 and Tie-2 were higher than the maternal concentrations. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2012 Nordic Federation of Societies of Obstetrics and Gynecology. Source


Knekt P.,Finnish National Institute for Health and Welfare | Knekt P.,Social Insurance Institution | Lindfors O.,Finnish National Institute for Health and Welfare | Renlund C.,Biomedicum Helsinki | And 3 more authors.
Journal of Affective Disorders | Year: 2011

Background: The need for treatment is, despite of its obvious usefulness, a scarcely used measure of effectiveness in psychotherapy trials. This study considers changes in the need for auxiliary psychiatric treatment after starting short- and long-term psychotherapy and psychoanalysis. Methods: Altogether 326 psychiatric outpatients with mood or anxiety disorder were randomly assigned to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP), or long-term psychodynamic psychotherapy (LPP) while 41 self-selected patients were allocated to psychoanalysis (PA). The patients were followed for 5 years from start of treatment. Outcome measures were use of auxiliary psychotherapy, psychotropic medication, and hospitalization for mental reasons. Results: About 60% of the patients used auxiliary treatment during the follow-up. It was most common in the short-term therapy groups and its incidence was highest during the first year after the start of therapy. The average numbers of all therapy sessions among patients starting the therapy were 60, 70, 240, and 670 in SFT, SPP, LPP, and PA, respectively, whereas the corresponding average numbers of study therapy sessions alone were 10, 19, 232, and 646. Over 50% of the patients receiving short-term therapy received on average 4-6 times more therapy sessions than initially assigned. Limitations: Post-randomization withdrawal was uneven. Conclusions: Auxiliary treatment is usual among patients receiving short- and long-term therapies, and apparently becomes common shortly after the start of treatment. Auxiliary treatment can be used as an outcome measure indicating the need for treatment, should be monitored clinically and considered when interpreting the results of effectiveness studies. © 2011 Elsevier B.V. All rights reserved. Source

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