Relationship between physical activity and predicted home presenteeism among participants with depressive symptoms with and without clinical depression. Findings from Finnish Depression and Metabolic Syndrome in Adults (FDMSA) study

Background and objectives: Depression can pose a major threat to an individual’s ability to cope with daily activities. The aim of this study was to explore the relationship between physical activity (PA) and predicted home presenteeism (PHP) among depressive participants. The relationship between PHP and the severity of depressive symptoms was also investigated.MethodsA total of 760 participants with depressive symptoms (DS) aged ≥35 years participated in this study. The study was conducted between 2008 and 2016 in municipalities within the Central Finland Hospital District. DS were determined with the 21-item Beck Depression Inventory (BDI-21) with a cutoff score ≥10, and psychiatric diagnoses were confirmed by the Mini-International Neuropsychiatric Interview (M.I.N.I.). PA, home presenteeism and other social-clinical factors were captured by standard self-administered questionnaires.ResultsHigher PA levels were associated with lower PHP (adjusted) among depressive patients with (p < 0.001) and without clinical depression (p = 0.021). In addition, DS (adjusted BDI) correlated with PHP (r = 0.60, 95% Cl: 0.56–0.65) in such a way that the higher the BDI was, the higher the PHP was. Moreover, home presenteeism were higher among depression diagnosed participants than those without (p = 0.002).ConclusionAccording to this study, PA is associated with PHP among depressive patients in the Finnish adult population. PA seems to promote the ability to cope better with daily activities at home despite DS or a depression diagnosis. These findings outline the importance of being physically active regarding independency of daily activities, and thus, should be considered in clinical practices when treating depressive patients. (AU)

Interprofessional medication assessment among home care patients: any impact on functioning? Results from a randomised controlled trial.

BACKGROUND: Multimorbidity and polypharmacy are related to the use of potentially inappropriate medicines and negative clinical outcomes including drug-related adverse events and functional declines. Home care clients are a vulnerable patient group often exposed to these risks. The aim of this study was to examine whether an interprofessional medication assessment can influence the functioning of home care patients. METHODS: The FIMA study was a randomised controlled intervention study comparing a general practitioner-led interprofessional medication assessment conducted at the baseline of the study with usual care with a six-month follow-up. We used linear mixed models (LMM) with a random subject effect to detect differences between the usual care and intervention groups in the following outcome measures; Katz index of Activities of Daily Living (ADL), Lawton and Brody scale of Instrumental Activities of Daily Living, Timed up and go-test (TUG), Mini-Mental State Examination, Geriatric Depression Scale and the 3-level version of EQ-5D. RESULTS: Home care patients (n = 512) had major disease burdens and functional limitations. Regarding TUG times, the LMM detected a one second improvement in the FIMA group and 2.4 s worsening in the usual care group. However, the result was not statistically significant. The ADL revealed an interaction across time, treatment and sex (p = 0.026). The ADL score decreased in both groups; the decline being the steepest among women in the intervention group. CONCLUSIONS: In general, medication assessments may have limited impact on functioning of older people. Nonetheless, the FIMA intervention may prevent worsening of mobility among older home care patients. TRIAL REGISTRATION: The Interprofessional Medication Assessment for Older Patients, Clinical Trials.gov. NCT02398812 . First registration, 26 March 2015. Retrospectively registered.

The Finnish Interprofessional Medication Assessment (FIMA): baseline findings from home care setting.

PURPOSE: Medication-related problems and declined functional capacity are closely associated factors among older people. The purpose of this study is to describe the procedure of interprofessional medication assessment in home care context and the baseline characteristics of the study population. METHODS: The FIMA study was a randomized, controlled intervention study comparing general practitioner-led interprofessional medication assessment and usual care. Patients' chronic diagnoses and medication use as well as physical and cognitive functions were investigated. Performance in daily activities, use of care services and help from family and relatives, self-rated health and health-related quality of life, and adverse effects commonly related to medication were assessed. RESULTS: The home care patients (n = 512) had significant disease burden and functional limitations. The mean number of all medicines was 15 and that of regularly taken medicines 10. The majority of patients (87%) had excessive polypharmacy. The most commonly used (97%) ATC medicine class was nervous system medicines. Clinically relevant (class C or D SFINX record) drug-drug interactions were seen in 74% of the patients. The most frequent risks of adverse effects were risk of bleeding (66%), constipation (58%) and orthostatism (54%) occurring in over half of the patients. Medicines affecting renal function were used by 85% of the patients. CONCLUSIONS: There is an evident need and justification for medication assessments in home care. In most cases, home care patients fulfill the criteria for regular medication assessments.

Frequent pain in older people with and without diabetes - Finnish community based study.

BACKGROUND: The association between pain and diabetes in older people has been largely unexplored. The aim of this survey was to analyze the prevalence and characteristics of pain among Finnish men and women 65 or older with and without diabetes in primary care. METHODS: All home-dwelling persons 65 years or older with diabetes (N = 527) and age and gender matched controls (N = 890) were identified from electronic patient records. Frequent pain was regarded as any pain experienced more often than once a week, and it was divided into pain experienced several times a week but not daily and pain experienced daily or continuously. The Numeric Rating Scale (0-10) (NRS) was used to assess the intensity and interference of the pain. RESULTS: The number of subjects who returned the questionnaire was 1084 (76.5%). The prevalence of frequent pain in the preceding week was 50% among women without diabetes and 63% among women with diabetes (adjusted, p = 0.22). In men, the corresponding proportions were 42% without diabetes and 47% with diabetes (adjusted, p = 0.58). In both genders, depressive symptoms and the number of comorbidities were associated with pain experienced more often than once a week and with daily pain. Diabetes was not associated with pain intensity or pain interference in either women or men. CONCLUSIONS: Pain in older adults is associated with depressive symptoms and the number of comorbidities more than with diabetes itself.

Ageing and associations of fasting plasma glucose and 2 h plasma glucose with HbA(1C) in apparently healthy population. "FIN-D2D" study.

OBJECTIVE: In this FIN-D2D cross-sectional survey the relationship of age with HbA(1c) and fasting and 2h glucose in the oral glucose tolerance test (OGTT) was explored in apparently randomly selected healthy population. PATIENTS AND METHODS: The glycaemic parameters were measured in 1344 men and 1482 women (aged 45-74 years), and among them we excluded all subjects with known diabetes, hypertension or dyslipidaemia. The final analyses for HbA(1c) and the ratios of fasting glucose/HbA(1c) and 2h glucose/HbA(1c) included 649 men and 804 women. RESULTS: Mean age was 57 years and BMI 26.1kg/m(2) for both genders. HbA(1c) increased in both genders with age (p<0.001). For a particular fasting glucose level HbA(1c) level was higher in older age groups (p<0.001 for linearity). By contrast, a particular 2h plasma glucose value in OGTT implied significantly lower HbA(1c) in the elderly (p<0.001 for linearity). CONCLUSION: In apparently healthy population, screened with OGTT, in older individuals compared with younger ones a particular HbA(1c) value implies slightly lower fasting glucose, but relatively higher 2h glucose. These results need to be verified in different populations. The effects of age on relation between HbA(1c) and plasma glucose should be taken into account in classifying people into different dysglycaemia categories.

Increasing size of health centres may not prevent occupational isolation.

BACKGROUND: A Finnish national survey in 2002 revealed that Finnish physicians often feel that working in a primary heath care centre is isolated work. AIMS: To determine the factors related to perceived isolation in health centre work among general practitioners (GP) working in health centres. METHODS: A postal questionnaire study of physicians (N = 1829) working in primary health care centres. RESULTS: The majority of GPs (67%) agreed that 'working in a health centre is too often isolated work'. Physicians felt isolated most often when working in the largest health centres (>20 posts), whereas physicians working in health centres with 3-10 posts perceived isolation least often. Difficulty in collaboration with partners or the managerial team was associated with this feeling. CONCLUSIONS: Feelings of isolation are common among Finnish health centre physicians, but increasing the size of primary health care units may not prevent these feelings.

Occupational isolation among general practitioners in Finland.

BACKGROUND: It is proposed that isolation in general practice is one of the factors that leads to work-related stress and the low attraction of this work. In Finland, 71% of physicians who worked or had worked in a primary health care centre agreed with the statement 'working as a doctor in a health centre is too often isolated work'. AIMS: To gain a deeper understanding of this feeling and to find out which factors constitute it. METHODS: A qualitative in-depth interview study of 32 physicians working in a primary health care centre in Finland. Qualitative analysis of transcribed verbatim interviews using a constant comparison method. RESULTS: The main components of isolation were making decisions alone, lack of collaboration with other workers in the health centre and secondary care specialists, not being a part of the work community and lack of mentoring at work. CONCLUSIONS: Enabling flexible teamwork and social and professional support networks are the key issues in solving the problem of occupational isolation in general practice.

Glucose regulation and chronic pain at multiple sites.

OBJECTIVE: To analyse how glucose regulation status is associated with chronic regional pain and chronic widespread pain (CWP) in the adult population. METHODS: A structured interview and health examination study with 480 participants aged 30-65 yrs was carried out in Lapinlahti municipality in eastern Finland. The number of painful sites in the right or left upper and lower extremities, shoulders and hips, and in neck and back was summated. Those subjects with chronic pain in at least four sites were defined as having CWP. Diabetes and glucose tolerance status diagnosis were based on self-reported diagnoses, reimbursed medication and laboratory tests. Subjects with impaired fasting plasma glucose and/or elevated 2-h glucose level were combined into a group of impaired glucose regulation (IGR). RESULTS: Of the total sample, 55 subjects (11%) had diabetes. The prevalence of CWP was 13% (n = 62) in all subjects. The corresponding percentages for subjects with normal glucose regulation, IGR and diabetes were 9, 18 and 28%. In the multivariate analysis, diabetes was associated with CWP (odds ratio = 2.99; 95% CI 1.19, 7.53; P = 0.020). CONCLUSIONS: These results point to a significant association between diabetes and CWP in the adult population.

Detection of tongue cancer in primary care.

BACKGROUND: The incidence of tongue cancer is increasing, and survival has not improved since the majority of patients present at an advanced stage. Patient delay has remained the same over the years and is difficult to influence. Much less is known about the delay in diagnosis caused by physicians and dentists. AIM: To investigate the detection of tongue cancer in primary care in Northern Finland and to examine the consultation prevalence of oral symptoms in primary care in Finland. STUDY: Analysis of data from medical records of tongue cancer patients kept between 1 January 1974 and 31 December 1994 for the general health insurance scheme. SETTING: The two northernmost provinces of Finland (population of 700,000). METHOD: Data were collected on demographic and clinical variables and on the first medical visit on 75 tongue cancer patients. In addition, primary care physicians recorded all patient visits during four weeks in 25 health centres randomly selected throughout Finland in 1996. RESULTS: At the initial visit, the tongue cancer patient was correctly referred for further examinations in 49 (65%) cases. In 12 (16%) of cases the patient was not referred but was scheduled for a follow-up visit, and was neither referred nor followed-up in 14 (19%). When compared with the referred patients the median professional delay was somewhat longer for the unreferred patients but increased dramatically if no follow-up was arranged (0.6 months [range = 0.1-2.4] versus 1.2 [range = 0.3-2.2] versus 5.2 [range = 0.7-18.2], P < 0.001). Compared with the referred patients the adjusted relative hazard of death for the non-referred followed-up patients was 1.4 (95% confidence interval [CI] = 0.31-6.5) and that for the non-referred/not followed-up patients 6.3 (95% CI = 1.7-22.9). The high-risk patients included those who sought an early professional evaluation, those who made the appointment for a completely different reason and only mentioned the symptom suggestive of cancer incidentally, those that had a small ulcerative lesion, and blue-collar workers. Oral symptoms were a rare cause of visits (0.55% of all visits) in primary care in Finland. CONCLUSION: Misdiagnosis of tongue cancer at the initial professional evaluation often leads to a fatal delay if the patient is left without any follow-up.

Pain as a reason to visit the doctor: a study in Finnish primary health care.

This study aims to demonstrate the prevalence of pain as a reason for seeing a physician in primary care. We also performed an analysis of the localization, duration and frequency of pains, as well as the diagnoses of patients having pain. A total of 28 physicians at 25 health centers in Finland collected the data, comprising 5646 patient visits. Pain was identified as the reason for 2237 (40%) of the visits. The most common localizations were in the lower back, abdomen and head. One-fifth of the pain patients had experienced pain for over six months. Analysis of the diagnoses revealed half of the pains to be musculoskeletal. Patients experienced considerable limitations in various activities of life due to pain. A quarter of the pain patients of active working age received sick leave. Our results confirm that pain is a major primary health care problem, which has an enormous impact on public health.

Variability in prescribing for musculoskeletal pain in Finnish primary health care.

OBJECTIVE: To assess primary care physicians' prescribing patterns for musculoskeletal pain in different diagnostic categories. METHODS: The data were collected in 25 randomly selected health centres, in which a total of 28 physicians took part in the four-week study. Physicians recorded all the medicines they prescribed for patients visiting due to pain. Visits resulting in a diagnosis of musculoskeletal disease or injury were included in this study. RESULTS: Analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs), were prescribed for 61% of the patients. NSAIDs were prescribed for 46%, topical analgesics for 15% and opioids for 4% of the patients. In general, ibuprofen was the most frequently prescribed drug but back and neck pains were most commonly treated with naproxen. No difference between patients' genders was observed in analgesic prescriptions. Prescribing was associated with patient's age, physician's view on priority of visit, diagnosis and intensity of pain. There was a large variation in prescribing patterns between individual physicians and between different areas of the country. CONCLUSION: NSAIDs are the prevailing treatment for musculoskeletal pain in Finnish primary health care. Different drugs are favoured according to the diagnosis. The large variability in prescribing patterns cannot be explained solely by the characteristics of pain or patients.

Patients' versus general practitioners' assessments of pain intensity in primary care patients with non-cancer pain.

Pain is a major cause for visiting a primary care physician. There are, however, few studies on the assessment of pain patients at the primary care level. The aim of this cross-sectional study was to investigate the concordance between general practitioners' (GPs') and patients' assessments of pain intensity and whether this assessment is influenced by the duration or intensity of pain. Seven hundred and thirty-eight patients aged 16 to 75 years, who were visiting a GP because of pain, participated. Both the patients and the GPs rated pain intensity using the horizontal 100 mm Visual Analogue Scale (VAS). Means and correlations were calculated using non-parametric tests. The VAS scales were arbitrarily divided into five grades (one unit = 20 mm) to investigate the concordance between GPs' and patients' assessments of pain intensity. Spearman 's correlation coefficient between GPs' and patients' assessments was 0.31 for non-chronic pain (of duration less than six months) and 0.20 for chronic pain. GPs evaluated graded pain intensity at least one unit lower than patients in 37% of the visits. In one-fifth of the visits (20.5%), the GP's rating was at least two units lower than the patient's rating. The more severe the pain as assessed by patients, the greater the non-concordance between patients' and GPs' assessments. There was considerable non-concordance between GPs' and patients' assessments of pain intensity. GPs tended to estimate their patients' pain intensity as clinically significantly lower than the patients themselves, particularly in chronic and severe pain.