South Ostrobothnia, Finland
South Ostrobothnia, Finland

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Mantyselka P.,University of Eastern Finland | Mantyselka P.,Kuopio University Hospital | Korniloff K.,University of Jyväskylä | Korniloff K.,Central Finland Health Care District | And 14 more authors.
Diabetes Care | Year: 2011

OBJECTIVE - To study the association between impaired glucose regulation (IGR), screen-detected type 2 diabetes, and previously known diabetes and depressive symptoms. RESEARCH DESIGN AND METHODS - Altogether, 2,712 participants from three hospital districts in Finland attended a health examination. Cutoff scores ≥10 and ≥16 in the 21-item Beck Depression Inventory (BDI-21) were used for depressive symptoms. The participants were defined as having known diabetes if they reported diabetes. An oral glucose tolerance test was used to detect normal glucose regulation (NGR), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and screen-detected diabetes. The participants were defined as having IGR if they had IFG or IGT. RESULTS - Prevalence of depressive symptoms, defined as a BDI-21 cutoff score ≥10, was 14.4% for those with NGR, 13.7% for those with IGR, 14.8% for those with screen-detected diabetes, and 26.4% for those with previously known diabetes. The corresponding prevalences for a cutoff score ≥16 were 3.4, 3.4, 4.2, and 7.5%, respectively. Compared with NGR and adjusted for demographic, lifestyle, and biological factors, the odds ratios for IGR, screen-detected diabetes, and previously known diabetes were 0.91 (95% CI 0.69-1.20), 0.70 (0.45-1.08), and 1.35 (0.84-2.15), respectively, for a cutoff score ≥10. For a cutoff score ≥16, the corresponding odds ratios were 1.05 (0.62-1.76), 0.87 (0.40-1.90), and 1.56 (0.69-3.50), respectively. CONCLUSIONS - Participants with diagnosed diabetes had a higher prevalence of depressive symptoms than participants with NGR, IGR, and previously unknown diabetes. When potential confounding factors were included in the analysis, previously known diabetes was not significantly associated with depressive symptoms. © 2011 by the American Diabetes Association.


Saltevo J.,Central Finland Central Hospital | Niskanen L.,Central Finland Central Hospital | Niskanen L.,University of Eastern Finland | Kautiainen H.,Unit of Family Practice of Central Finland Central Hospital | And 10 more authors.
European Journal of Endocrinology | Year: 2011

Background: The aim of this cross-sectional study was to examine the association between serum calcium and the components of metabolic syndrome (MetS). Methods: As a part of the national prevention program of diabetes in Finland (FIN-D2D), a randomly selected study population of 4500 middle-aged men and women were recruited from three central hospital district areas. Anthropometric measurements were performed by a trained nurse. An oral glucose tolerance test was performed and serum calcium and lipids were measured. We assessed current medications, physical activity, smoking, alcohol consumption, calcium intake, and vitamin D intake. The MetS was defined according to the criteria of the updated National Education Program. The study population consisted of 2896 individuals: 1396 men (62% of invited individuals) and 1500 women (66.7% of invited individuals). Results: The mean age was 60.3±8.3 Years in men and 59.8±8.5 years in women. The prevalence of MetS was 50.7% in women and 55.8% in men. The prevalence of MetS and its components, except high-density lipoprotein (HDL)-cholesterol, increased linearly with increasing serum calcium (P<0.001), even after adjustment for age, physical activity, alcohol, vitamin D intake, calcium intake, and smoking. The threshold value for serum calcium for MetS was 2.50 mmol/l in this population. The association of MetS with total serum calcium was similar even after exclusion of patients treated with hypertensive drugs. The drug treatments for hypertension, dyslipidemia, and diabetes increased in a similar pattern. Conclusions: Serum calcium level is associated with MetS and its components, except HDL-cholesterol. © 2011 European Society of Endocrinology.


Saaristo T.,Pirkanmaa Hospital District | Moilanen L.,Kuopio University Hospital | Korpi-HYOVALTI E.,South Ostrobothnia Hospital District | Vanhala M.,Central Finland Hospital District | And 10 more authors.
Diabetes Care | Year: 2010

OBJECTIVE - To investigate 1-year outcomes of a national diabetes prevention program in Finland. RESEARCH DESIGN AND METHODS - Altogether 10,149 individuals at high risk for diabetes were identified with the Finnish Diabetes Risk Score (FINDRISC; scoring ≥15 points), by a history of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), cardiovascular disease, or gestational diabetes mellitus in 400 primary health care centers. One-year follow-up data were available for 2,798 participants who were nondiabetic at baseline (919 men and 1,879 women, aged 56.0 ± 9.9 and 54.0 ± 10.7 years [mean ± SD] with BMI 30.9 ± 4.6 and 31.6 ± 5.4 kg/m2). RESULTS - The incidence of diabetes was 2.0 and 1.2% in men and women with normal glucose tolerance at baseline, 13.5 and 7.4% in those with IFG, and 16.1 and 11.3% in those with IGT, respectively. Altogether 17.5% of the subjects lost ≥5% weight with no sex difference. The relative risk of diabetes was 0.31 (95% CI 0.16-0.59) in the group who lost ≥5% weight, 0.72 (0.46-1.13) in the group who lost 2.5-4.9% weight, and 1.10 (0.77-1.58) in the group who gained ≥2.5% compared with the group who maintained weight. CONCLUSIONS - The FIN-D2D was the first national effort to implement the prevention of diabetes in a primary health care setting. Methods for recruiting high-risk subjects were simple and easy to use. Moderate weight loss in this very high-risk group was especially effective in reducing risk of diabetes among those participating in the program. © 2010 by the American Diabetes Association.


Levola J.,A clinic Foundation | Levola J.,Finnish National Institute for Health and Welfare | Aalto M.,Finnish National Institute for Health and Welfare | Aalto M.,South Ostrobothnia Hospital District | And 5 more authors.
Nordic Journal of Psychiatry | Year: 2014

Background: Health-related quality of life (HRQOL) is considered a valid measure of treatment effectiveness in addictions. However, alcohol research has lagged behind other biomedical fields in using HRQOL outcomes as primary or secondary endpoints. Previous work has suggested that psychiatric co-morbidity may mediate the relationship between alcohol dependence and HRQOL. Aim: The goal was to summarize the literature on HRQOL and its domains in the context of alcohol dependence. A specific focus was on the impact of depression and other psychopathology on these areas of life. Materials and methods: A database search of MEDLINE and PsychINFO was performed within the scope of PARADISE (Psychosocial fActors Relevant to brAin DISorders in Europe); a European Commission funded coordination action. Using pre-defined eligibility criteria, 42 studies were identified. A systematic approach to data collection was employed. Results and conclusions: Alcohol dependence was shown to affect overall HRQOL and its domains, including general health, physical and mental health, general and social functioning, activities of daily living, pain and sleep. The evidence demonstrating that alcohol dependence is a primary cause of impairments in overall HRQOL, general health, mental and physical health and social functioning was fairly strong. Treatment interventions helped improve HRQOL and its aforementioned domains. The reduction or cessation of alcohol use facilitated these improvements; however, it was not reported to be predictive of improvement in all instances where improvement was reported. Depression was associated with further decreases in HRQOL. Personality disorders contributed to the severity of social functioning impairment. © 2014 Informa Healthcare.


Aromaa E.,Finnish National Institute for Health and Welfare | Tolvanen A.,University of Jyväskylä | Tuulari J.,South Ostrobothnia Hospital District | Wahlbeck K.,Finnish National Institute for Health and Welfare
Nordic Journal of Psychiatry | Year: 2011

Background: For planning effective and well-targeted initiatives to reduce stigma, we need to identify which factors are associated with stigmatizing of people with mental disorders. Aims: This study examined how well a combination of variables predicts stigmatizing attitudes and discrimination in a general population. Methods: A survey questionnaire was sent to 10,000 persons aged 15-80 years residing in western Finland. Attitudes were measured using a scale consisting of negative stereotypes about people with depression and stereotypical beliefs connected with mental problems, while discrimination was measured by a social distance scale. Predictors included demographic variables, mental health resources, personal experience of depression or psychological distress, knowing someone who suffers from mental health problems, and negative stereotypical beliefs. Results: Although 86% of the population thought that depression is a real medical condition, the majority of respondents believed that people with depression are responsible for their illness. Social discrimination was significantly associated with respondents' age, gender, native language, sense of mastery, depression, stereotypical beliefs and familiarity with mental problems. Conclusions: The results suggest that the need to address stigma is higher among men, older people and those without familiarity with mental problems. When planning interventions to shape stereotypes, the need for change is highest among those with a low sense of life control and poor social networks. Direct interactions with persons who have mental problems may change the stereotypical beliefs and discriminative behaviour of those who do not have familiarity with mental problems. © 2011 Informa Healthcare.


Seppanen K.K.,Co operation Area for Health Care Services in Jyvaskyla | Seppanen K.K.,University of Tampere | Aalto M.,South Ostrobothnia Hospital District | Aalto M.,Finnish National Institute for Health and Welfare | Seppa K.,University of Tampere
Alcoholism: Clinical and Experimental Research | Year: 2012

Background: There have been several research and practical projects to promote alcohol brief interventions (BIs) in healthcare settings, but no reports of nationwide outcome have so far been published. In Finland, these activities started in the early 1990s, and in the past years, the focus has been mainly on primary and occupational health care. The aim of the present study was to ascertain whether the extensive and long-lasting implementation efforts have led to the institutionalization of this activity among primary healthcare physicians and to the identification of factors that may be associated with it. Methods: The data were gathered by a questionnaire sent to all Finnish primary healthcare physicians in 2002 and 2007. In both years, the questionnaire contained questions on demographics, professional background and the physicians' own BI activity (regular, occasional, or none). In 2007, a question eliciting information about the change in BI activity during the past 5 years was added. The response rate was 67.1% (95% CI 65.4 to 68.8) (2,001/2,980) in 2002 and 50.9% (95% CI 49.2 to 52.6) (1,610/3,163) in 2007. Results: The number of physicians offering BI had increased during the study years from 59.2 to 78.5%. Regular activity was reported in 2002 by 9.3% of physicians and in 2007 by 17.2% and occasional activity correspondingly by 49.9 and 61.3%. Of the physicians who offered BI in 2007, 52.4% reported increased activity and 42.6% similar activity to that reported 5 years earlier. Having a specialist's license in general practice or occupational health care or long experience as a primary healthcare physician predicted high activity. Conclusions: The BI activity of Finnish primary healthcare physicians is reasonably high and rising. Training and motivating those with low BI activity remains future challenge. © 2012 by the Research Society on Alcoholism.


Aromaa E.,Finnish National Institute for Health and Welfare | Tolvanen A.,University of Jyväskylä | Tuulari J.,South Ostrobothnia Hospital District | Wahlbeck K.,Finnish National Institute for Health and Welfare
BMC Psychiatry | Year: 2011

Background: A minority of people suffering from depression seek professional help for themselves. Stigmatizing attitudes are assumed to be one of the major barriers to help seeking but there is only limited evidence of this in large general population data sets. The aim of this study was to analyze the associations between mental health attitude statements and depression and their links to actual use of mental health services among those with depression.Methods: We used a large cross-sectional data set from a Finnish population survey (N = 5160). Attitudes were measured by scales which measured the belief that people with depression are responsible for their illness and their recovery and attitudes towards antidepressants. Desire for social distance was measured by a scale and depression with the Composite International Diagnostic Interview Short Form (CIDI-SF) instrument. Use of mental health services was measured by self-report.Results: On the social discrimination scale, people with depression showed more social tolerance towards people with mental problems. They also carried more positive views about antidepressants. Among those with depression, users of mental health services, as compared to non-users, carried less desire for social distance to people with mental health problems and more positive views about the effects of antidepressants. More severe depression predicted more active use of services.Conclusions: Although stronger discriminative intentions can reduce the use of mental health services, this does not necessarily prevent professional service use if depression is serious and views about antidepressant medication are realistic. © 2011 Aromaa et al; licensee BioMed Central Ltd.


PubMed | Pirkanmaa Hospital District, Finnish National Institute for Health and Welfare, University of Eastern Finland, University of Oulu and 2 more.
Type: Journal Article | Journal: Diabetic medicine : a journal of the British Diabetic Association | Year: 2016

To examine changes in glucose metabolism (fasting and 2-h glucose) during follow-up in people with impaired fasting glucose in comparison with changes in people with isolated impaired glucose tolerance, people with impaired fasting glucose and impaired glucose tolerance combined and people with screening-detected Type 2 diabetes at baseline, among those who participated in a diabetes prevention programme conducted in Finland.A total of 10 149 people at high risk of Type 2 diabetes took part in baseline examination. Of 5351 individuals with follow-up 9 months, 1727 had impaired glucose metabolism at baseline and completed at least one lifestyle intervention visit. Most of them (94.6%) were overweight/ obese.Fasting glucose decreased during follow-up among overweight/obese people in the combined impaired fasting glucose and impaired glucose tolerance group (P = 0.044), as did 2-h glucose in people in the isolated impaired glucose tolerance group (P = 0.0014) after adjustment for age, sex, medication and weight at baseline, follow-up time and changes in weight, physical activity and diet. When comparing changes in glucose metabolism among people with different degrees of glucose metabolism impairment, fasting glucose concentration was found to have increased in those with isolated impaired glucose tolerance (0.12 mmol/l, 95% Cl 0.05 to 0.19) and it decreased to a greater extent in those with screening-detected Type 2 diabetes (-0.54 mmol/l, 95% Cl -0.69 to -0.39) compared with those with impaired fasting glucose (-0.21 mmol/l, 95% Cl -0.27 to -0.15). Furthermore, 2-h glucose concentration decreased in the isolated impaired glucose tolerance group (-0.82 mmol/l, 95% Cl -1.04 to -0.60), in the combined impaired fasting glucose and impaired glucose tolerance group (-0.82 mmol/l, 95% Cl -1.07 to -0.58) and in the screening-detected Type 2 diabetes group (-1.52, 95% Cl -1.96 to -1.08) compared with those in the impaired fasting glucose group (0.26 mmol/l, 95% Cl 0.10 to 0.43). Results were statistically significant even after adjustment for covariates (P < 0.001 in all models).Changes in glucose metabolism differ in people with impaired fasting glucose from those in people with isolated impaired glucose tolerance, people with impaired fasting glucose and impaired glucose tolerance combined and people with screening-detected Type 2 diabetes.


PubMed | University of Tampere and South Ostrobothnia Hospital District
Type: | Journal: Evaluation and program planning | Year: 2015

This implementation study was part of the Ostrobothnia Depression Study, in Finland, which covered implementation of motivational interviewing (MI) and behavioral activation (BA) within regional public psychiatric secondary care. It aimed to evaluate the mid-term progress of implementation and related factors. Altogether, 80 therapists had been educated through the implementation program by the point of the mid-term evaluation. Eligible information for evaluation was gathered using two questionnaires (q1, q2) with a one-year interval. A total of 45 of the 80 therapists completed q1, 30 completed q2, and 24 completed both questionnaires. Professional education was the only background factor associated with adopting the interventions (q1: p=0.059, q2: p=0.023), with higher education indicating greater activity. On the basis of trends such as changes in overall usefulness score from q1 to q2, the most involved therapists were slightly more likely to adopt MI/BA. Our experience so far suggests that encouraging staff to begin using new interventions during education is very important. The Consolidated Framework for Implementation Research was found to be a useful tool for constructing the evaluation.


Nuotio M.,South Ostrobothnia Hospital District
European Geriatric Medicine | Year: 2011

Urinary incontinence is a common geriatric syndrome with considerable impacts on the quality of life of older individuals and their families and costs in the health and social care services. It is one of the major predictors of admission to long-term institutional care. In Finland, the National Framework for High Quality Services for Older People aims to reduce the proportion of older people living in the long-term institutional care and this poses a great challenge for health care professionals to improve the assessment and care of older patients with continence problems. There is a need from other specialists such as the gynaecologists and urologists to have consultative support from geriatricians in the management of their older patients with comorbidities, multiple medications and disabilities. Primary care physicians need education on the multifactorial nature of urinary incontinence and the potential harmful effects of a big anticholinergic load on the older patient. Nurses need to adopt more rehabilitative practices in the care of patients suffering from incontinence in all care settings and physiotherapists and urotherapists need to be more involved in the care of urinary incontinence among frail older patients. There is a clear call for a systematic assessment and care model and pathway based on international guidelines for an older patient with continence problems and related symptoms in the health care. Given the syndromic nature of the condition, the geriatricians should take the lead in this process of development. There could be an opportunity for cross-European collaboration. © 2011 Elsevier Masson SAS and European Union Geriatric Medicine Society.

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