Awareness of hypertension and depressive symptoms: a cross-sectional study in a primary care population.

OBJECTIVE: To investigate the association of hypertension awareness and depressive symptoms, and to analyse factors predisposing aware hypertensives to depressive symptoms. DESIGN: Cross-sectional study in a primary care population. SETTING: Cardiovascular risk factor survey in two semi-rural towns in Finland. SUBJECTS: Two thousand six hundred seventy-six middle-aged risk persons without an established cardiovascular or renal disease or type 2 diabetes. MAIN OUTCOME MEASURES: Depressive symptoms, previous and new diagnosis of hypertension. RESULTS: Hypertension was diagnosed in 47.9% of the subjects, of whom 34.5% (442/1 282) had previously undetected hypertension. Depressive symptoms were reported by 14% of the subjects previously aware of their hypertension, and by 9% of both unaware hypertensives and normotensive subjects. In the logistic regression analysis, both the normotensive (OR 0.62, 95% CI 0.45-0.86) (p = 0.0038) and the unaware hypertensive subjects (OR 0.54, 95% CI 0.35-0.84) (p = 0.0067) had lower risk for depressive symptoms than the previously diagnosed hypertensives. Among these aware hypertensives, female gender (OR 3.61, 95% CI 2.06-6.32), harmful alcohol use (OR 2.55, 95% CI 1.40-4.64) and obesity (OR 2.50, 95% CI 1.01-6.21) predicted depressive symptoms. Non-smoking (OR 0.57, 95% Cl 0.33-0.99) and moderate leisure-time physical activity compared to low (OR 0.53, 95% CI 0.33-0.84) seemed to buffer against depressive symptoms. CONCLUSION: Depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension. Many modifiable, lifestyle associated factors may contribute to the association of hypertension and depressive symptoms. Key Points Hypertension and depressive symptoms are known to form a toxic combination contributing even to all-cause mortality. Comorbidities or the labelling effect of the diagnosis of hypertension can confound their association. Our study shows that depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension. Many modifiable, lifestyle-associated factors may contribute to the association of hypertension and depressive symptoms. When treating hypertensive patients, consideration of depressive symptoms is important in order to promote favorable lifestyle and control of hypertension.

Ideal cardiovascular health and psychosocial risk factors among Finnish female municipal workers.

AIMS: Ideal cardiovascular health has been defined by the American Heart Association as the absence of disease and the presence of seven key health factors and behaviours. However, little is known about the mental aspects associated with ideal cardiovascular health metrics. The objective of this study was to assess the relationships between psychosocial risk factors and ideal cardiovascular health metrics among Finnish women at municipal work units. METHOD: A cross-sectional study was conducted in Finland among 732 female employees (mean±SD age 48±10 years) from ten work units in 2014. Ideal cardiovascular health metrics were evaluated with a physical examination, laboratory tests, medical history and self-administrated questionnaires. Psychosocial risk factors (social isolation, stress, depressive symptoms, anxiety, hostility and type D personality) were assessed with core questions as suggested by the European Society of Cardiology. RESULTS: The prevalence of having 5-7 ideal cardiovascular health metrics was 183 (25.0%), of whom 54.1% had at least one psychosocial risk factor. Anxiety (31.3%), work stress (30.7%) and type D personality (26.1%) were the most prevalent of the psychosocial risk factors. The prevalence of depressive symptoms ( p<0.001) and type D personality ( p=0.049) decreased linearly according to the sum of ideal cardiovascular health metrics after adjustment for age and years of education. CONCLUSIONS: Even women with good cardiovascular health are affected by psychosocial risk factors at municipal work units. Although the association is possibly bidirectional, screening and treating depression and dealing with type D personality might be crucial in improving cardiovascular health among women.

Weight change and health related quality of life: population-based longitudinal study of the effects of health related quality of life on the success of weight management.

Our aim was to investigate how health related quality of life (HRQoL) influence on the success of weight management and how to utilize this information. Population-based longitudinal study. A community sample of apparently healthy middle-aged individuals living in Western Finland were invited to clinical survey in order to assess total cardiovascular risk among people who had at least one cardiovascular risk factor but no previous diagnoses of any long-lasting disease. A total of 2,752 individuals, aged 45-70 years, enrolled. The individuals completed HRQoL questionnaire before laboratory tests were completed and overweight people were instructed to lose weight at least 5 %. A physician examined 1950 high risk people during the years 2005-2007. Three years later a trained nurse invited them for a control examination, 1,287 high risk subjects participated, 1,049 had completely filled the questionnaires and 906 of them were overweight or obese at baseline. We assessed the success in weight management in this group of participants. The subjects (53 % women with mean age of 59 ± 7 years) had mean body mass index of 39.6 ± 4.6 kg/m². During the 3 years follow-up period 18 % of them had lost weight ≥5, 70 % had stabilized their weight and 12 % had gained weight ≥5 %. Subjects who had gained weight had worse results in every item of HRQoL both mental and physical at baseline. The results of the HRQoL questionnaire suggested that obesity and deteriorating quality of life interrelate.

[Update on current care guidelines: schizophrenia]. / Skitsofrenia.

Early recognition and treatment of persons at risk of psychosis is emphasized in the updated Current Care Schizophrenia guideline. Antipsychotic medication is effective in the treatment. To avoid side-effects, the lowest possible effective dosage is recommended. Psychosocial interventions, such as cognitive-behavioral therapy, psychoeducation and social skills training, as well as cognitive rehabilitation should be integrated with other treatments according to patient's individual needs. Supported employment is a feasible option to some patients. Care of people with schizophrenia is primarily offered in an outpatient setting.

How does a shortage of physicians impact on the job satisfaction of health centre staff?

OBJECTIVE: The aim was to determine how a shortage of physicians at Finnish health centres has affected the job satisfaction of the entire staff. METHODS: A questionnaire was posted to 2848 employees working with patients at health centres in the Finnish provinces of Satakunta and Varsinais-Suomi. The information concerning the shortage of physicians at health centres was taken from research undertaken by the Finnish Medical Association in October 2003. The health centres were divided into four groups according to the severity of the shortage. RESULTS: The questionnaire was returned by 1447 employees. The staff at health centres with the most severe shortage of physicians were less satisfied with the management of the organization. Employees at health centres with a minor shortage of physicians were more satisfied with the quality of services in their operational unit. The shortage of physicians had no impact on staff satisfaction regarding the operation of their work unit, the strain of dealing with issues within their work environment, feelings of stress, the strain of working under pressure that they experienced, or interest in finding a new job. CONCLUSION: The majority of healthcare employees are satisfied and motivated in their work. The shortage of physicians has only a slightly negative impact on their satisfaction.

Professionalism Mini-Evaluation Exercise in Finland: A preliminary investigation introducing the Finnish version of the P-MEX instrument.

INTRODUCTION: Teaching medical professionalism is increasingly acknowledged as an important aspect of medical education. The Professionalism Mini-Evaluation Exercise (P-MEX) is an assessment tool for evaluating medical professionalism, but no studies using it as a self-assessment instrument have been reported. This paper reports on a preliminary investigation of the Finnish version of the P-MEX instrument as an assessment and self-assessment measure. METHODS: The sample in the present cross-sectional study comprised all 23 medical students and recent graduates (15 females and 8 males) participating in a summer school of psychiatry program in 2014. The two-month program combines clinical work with multifaceted teaching and intensive tutoring. At the end of the program, the participants' medical professionalism was assessed by the tutors and other members of the work community as well as the students themselves using the Finnish version of the P-MEX instrument. The P-MEX scores were compared, using the Friedman test. RESULTS: The mean values and SD for the P-MEX assessments were as follows: tutor assessment 3.26±0.21, work community assessment 3.32±0.26 and self-assessment 3.01±0.07. No significant gender differences were observed. The tutor and work community assessments were significantly correlated (r=0.573, p=0.040), but the self-assessment scores did not correlate with either of the other assessments. Overall, the students evaluated their skills significantly poorer in comparison to the other assessments. CONCLUSION: Although the small sample size limits the generalization of these preliminary results, the Finnish version of the P-MEX instrument appears to be a feasible measure of medical professionalism. The instrument can also be used as a self-assessment instrument, but subjective evaluations should be complemented with external assessments or feedback in order to take individual and cultural aspects into account.

Impaired glucose metabolism and health related quality of life.

AIMS: We aimed at investigating whether different categories of glucose tolerance have any effect on a person's HRQoL. METHODS: Population-based cross-sectional study conducted as a community sample of apparently healthy middle-aged individuals living in Western Finland. The subjects of the study, 1383 individuals, aged 45-70 years, had at least one cardiovascular risk factor but no previous diagnoses of either diabetes or cardiovascular disease. They completed health related quality of life (HRQoL) questionnaire before the oral glucose tolerance test (OGTT) was performed to diagnose the gategories of glucose tolerance. RESULTS: Persons with newly diagnosed type 2 diabetes (NDM) had lower scores for physical functioning, general health and emotional role than subjects with normal glucose tolerance. CONCLUSION: The results of the HRQoL questionnaire demonstrated that NDM is negatively associated with HRQoL, but prediabetes - IFG or IGT - does not.