Prevalent migraine as a predictor of incident hypertension.

BACKGROUND: Migraine has been associated with several diseases. This population-based prospective Finnish postal survey Health and Social Support Study explored whether self-reported migraine predicted incident hypertension independently in a working-age population by utilizing two data sources: the baseline survey from the year 1998 in combination with the follow-up survey data from the years 2003 and 2012 with linkage to the national Social Insurance Institution registry data of the special reimbursement medication for hypertension from 1999 to 2013. The survey follow-up reached until the second follow-up in the year 2012. The register follow-up also included the year 2013. METHODS: The present population-based prospective cohort study, utilizing two different data sources, included 8593 respondents (22.7% response rate) who participated in 1998, 2003, and 2012 but who did not report hypertension at the baseline in 1998, and whose responses could be linked with the Social Insurance Institution registry data from the beginning of 1999 to the end of 2013. The multivariable logistic regression analysis was based on the combined two data sets. RESULTS: A significant association of self-reported migraine and incident hypertension (odds ratio 1.37; 95% confidence interval 1.20-1.57) prevailed in the multiple logistic regression analysis adjusted for central socio-demographic and health behaviour variables. CONCLUSION: Extra attention should be paid to prevention and control of hypertension in working-age migraine patients.

Effect of administrative information on visit rate of frequent attenders in primary health care: ten-year follow-up study.

BACKGROUND: Frequent attenders (FAs) use a disproportionately large share of the resources of general practitioners (GPs) working in primary healthcare centres. The aim of this study was to estimate the proportion of FAs among all patients in the primary health care centres of a medium-sized city in Finland, and to examine whether providing GPs with administrative information about their frequent attenders (names and numbers of visits per year) can reduce the number of FAs and the frequency of their visits. METHODS: Statistic data on all GP visits (n = 1.8 million) to 11 public healthcare centres in one city were collected from the electronic patient records covering the period from 2001 to 2010. A FA-patient was defined as a person who made10 or more visits to GPs during one year. The baseline situation in 2001 was compared with the situation in 2006 after administrative information had been provided three times to all GPs working in the healthcare centres. Poisson's regression analysis was used, and FA numbers and consultation rates in the years 2002-2005 were compared with the year 2006; figures for 2006 were also compared with those for the follow-up period 2007-2010. RESULTS: During the years 2001-2006, the proportion of visits of FA-patients fell overall from 9.1 to 8.5%, a decline of 0.6% (p < 0.0001). This reduction was equivalent to an annual work load of two GPs in the study center. The proportion of visits of FA patients increased again in the follow-up period (2007-2010), when administrative information was no longer provided. CONCLUSION: When GPs are provided with information on the number and names of their FA-patients, the annual rate of FA visits to GPs drops significantly. The method is simple and repeatable. However, without a control group of GPs who have not received such information, it is impossible to assess if the intervention was the only circumstance affecting the reduction in FA consultation rates.

Migraine predicts hypertension--a cohort study of the Finnish working-age population.

BACKGROUND: Migraine has been suggested to be associated with hypertension. The aim of the present 5-year prospective cohort study was to examine whether self-reported migraine in 1998 predicted hypertension in 2003 in a Finnish working-age population. METHODS: This cohort study consisted of 13 454 randomly selected initially non-hypertensive working-age participants of the prospective postal survey of the Health and Social Support. A total of 13 426 responses of the initial participants were linked with the register data of the Social Insurance Institution on the special reimbursement medication for hypertension. The outcome variable, hypertension, was determined according to the survey data and the register data of the Social Insurance Institution. The statistical analysis was carried out using logistic regression. RESULTS: In a multivariate model adjusted for gender, age, occupational training, living alone, metabolic equivalent of task, body mass index and alcohol consumption, self-reported migraine predicted hypertension (odds ratio 1.39; 95% confidence interval 1.19-1.64) for the self-reported and (odds ratio 1.42; 95% confidence interval 1.13-1.77) for the register data of the Social Insurance Institution. CONCLUSION: The findings may indicate a focus on hypertension screening for the working-age population with migraine.

Factors associated with perceived health among 12-year-old school children. Relevance of physical exercise and sense of coherence.

BACKGROUND: Poor perceived health during childhood may affect an individual's well-being throughout life. In adult studies, sense of coherence (SOC) has been shown to be associated with perceived health. AIMS: The aim of this study was to determine which factors with an emphasis on SOC and physical exercise were associated with perceived health among 12-year-old children. METHODS: A total of 1,231 12-year-old school children (83%) completed a questionnaire. Most of the 37 questions had multiple-choice types of response. The questions were largely based on those used in the Health Behaviour in School-aged Children (HBSC) study coordinated by the WHO. SOC was determined using the 13-item scale developed by Antonovsky. Factors used in calculating performance at school were marks (given by the teachers, range 4-10, 10 being the best) in mathematics, native language, and first foreign language. Statistical analysis involved the use of logistic regression models and the so-called generalized estimation technique because of the multi-level study design. RESULTS: In a multivariate model adjusted for reported psychosomatic symptoms, insufficient physical exercise was clearly (OR 4.6) associated with poor perceived health. Other variables with significant associations (OR 1.4-1.7) were a mark below 9 in mathematics, belonging to the weakest SOC tertile, reporting of problems of perceived support from teachers, and reporting of various problems involving the class climate. CONCLUSIONS: Among the studied variables physical exercise was the most strongly associated with perceived health, even when several social and psychological risk factors were included in the analysis. SOC and variables of social support were also of importance.

Restrictions on import of drugs for personal use within the European single market.

BACKGROUND: The European Union (EU) has harmonized legislation on pharmaceutical products to implement the single market in this field. European consumers are offered with high quality and safe products that have been brought onto the market through harmonized procedures. The aim of the study was to find out if there still were legislative restrictions to purchasing prescription only medicines (POMs) for personal use from another EU member state. METHODS: The medicines authorities in the EU were inquired about the possibilities of a citizen to obtain POMs for personal use from another EU country. The method used was a questionnaire covering both the delivery of foreign prescriptions and import of prescription-only medicines. The questionnaire was mailed, e-mailed or faxed to the national medicines authorities. RESULTS: An answer was obtained from 11 of the 15 member states. The results showed that the delivery of foreign prescriptions was regulated only in the Nordic countries. All the countries reported prohibitions on delivering prescriptions for drugs that act on the central nervous system and prescriptions that were suspicious. The personal import of drugs was restricted as to the amounts and reimbursement policy. CONCLUSIONS: The import of drugs for personal use is not yet comparable to other consumables in the EU. The prevailing restrictions contravene the community legislation and this problem has not yet been solved. It is probable that problems will arise in the near future when information technology is likely to be used increasingly in the delivery of drugs.