Patients with fibromyalgia in Finnish healthcare center - one-year follow up.

OBJECTIVES: The study aimed to find whether Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) predicts the severity of fibromyalgia symptoms after one year in patients with fibromyalgia. The second aim of the study was to observe how symptoms evolved during a one-year follow-up. DESIGN: Prospective cohort and observational study. Five questionnaires were sent to patients. The same questionnaires (excluding ÖMPSQ) were sent after one year. The patients were allocated into two cohorts using the results of ÖMPSQ. Other variables were analyzed and observed separately. SETTING: Primary healthcare center in the city of Nokia, Pirkanmaa, Finland. SUBJECTS: Patients with fibromyalgia were included in the study after a physician's examination and confirmation of diagnosis with the assistance of the American College of Rheumatology (ACR) 2010 criteria. MAIN OUTCOME MEASURES: Fibromyalgia impact questionnaire (FIQ) scores. RESULTS: The FIQ scores increased slightly in both ÖMPSQ-cohorts with no statistically significant differences. The patients mostly reported that the symptoms were unchanged or got worse when asked separately from other questionnaires. There was a statistically significant decrease in PHQ-9 score in depressed patients who received antidepressants and/or psychological therapy. In addition, FIQ scores also decreased in depressed patients. Patients who received alterations to the treatment plan reported positive changes in the symptoms more often. CONCLUSION: With these results, we cannot conclude that ÖMPSQ predicts the patient's severity of symptoms. On the contrary, we can conclude that antidepressants and/or psychological therapy might reduce fibromyalgia symptoms for depressed patients with fibromyalgia. Patients with fibromyalgia might benefit from clinical evaluation and modifications to the treatment plan if necessary.

The long-term prognosis is not well known, and there are limited tools to predict the development of symptoms.ÖMPSQ does not seem to be useful for predicting the development of fibromyalgia in patients who already have been diagnosed with fibromyalgia.Management of depression for patients with fibromyalgia might be effective in reducing fibromyalgia symptoms.Patients with fibromyalgia in Finnish healthcare center ­ one-year follow-up.

A named GP increases self-reported access to health care services.

BACKGROUND: Continuity of care strengthens health promotion and decreases mortality, although the mechanisms of these effects are still unclear. In recent decades, continuity of care and accessibility of health care services have both decreased in Finland. OBJECTIVES: The aim of the study was to investigate whether a named and assigned GP representing continuity of care is associated with the use of primary and hospital health care services and to create knowledge on the state of continuity of care in a changing health care system in Finland. METHODS: The data are part of the Health and Social Support (HeSSup) mail survey based on a random Finnish working age population sample of 64,797 individuals drawn in 1998 and follow-up surveys in 2003 and 2012. The response rate in 1998 was 40% (n = 25,898). Continuity of care was derived from the 2003 and 2012 data sets, other variables from the 2012 survey (n = 11,924). The principal outcome variables were primary health care and hospital service use reported by participants. The association of the explanatory variables (gender, age, education, reported chronic diseases, health status, smoking, obesity, NYHA class of any functional limitation, depressive mood and continuity of care) with the outcome variables was analysed by binomial logistic regression analysis. RESULTS: A named and assigned GP was independently and significantly associated with more frequent use of primary and hospital care in the adjusted logistic regression analysis (ORs 1.53 (95% CI 1.35-1.72) and 1.19 (95% CI 1.08-1.32), p < 0.001). CONCLUSION: A named GPs is associated with an increased use of primary care and hospital services. A named GP assures access to health care services especially to the chronically ill population. The results depict the state of continuity of care in Finland. All benefits of continuity of care are not enabled although it still assures treatment of population in the most vulnerable position.

Stroke and cardiovascular risk factors among working-aged Finnish migraineurs.

BACKGROUND: The aim of our study was to evaluate the risk for comorbid cardio- and cerebrovascular diseases in the working-aged migraine population of Finland. METHODS: A total of 1505 cases who reported diagnosed migraine and 3010 controls from a cohort of 11,596 cases in the Finnish Health and Social Support Study were included. The study material was linked with two registers. ICD diagnoses I63 for ischemic stroke (IS), I21 - I22 for acute myocardial infarction (AMI), and G43 for transient ischemic attack (TIA) among study participants were drawn from the national Finnish Care Register for Health Care at the follow-up in 2012. Reimbursed triptan prescriptions were drawn from the national Social Security Institution (SII) data. The self-reported vascular risk factors were hypertension, high cholesterol values, any diabetes, myocardial infarction, stroke, and TIA. Odds Ratios (OR) with 95% confidence (95% CI) intervals were assessed for diagnosed stroke, myocardial infarction, and TIA. RESULTS: Migraineurs were mostly female (82%) and ≥ 54 years old (62%). Triptans were reimbursed among 34.7% of migraineurs. A self-reported hypertension (21%), high serum cholesterol (38%), and any diabetes (7%) were more common among migraineurs vs controls (p < 0.05). There was no risk for AMI. The risk for TIA (OR 3.20, 95% CI 1.45-7.05) and IS (2.57, 95% CI 1.28-5.17) among migraineurs vs controls remained high after adjustment for self-reported hypertension, obesity, and smoking. The risk was higher among women in two groups ≥54 years (3.25, 95% CI 1.35-7.84 and 5.0, 95% CI 1.94-12.89, respectively). The average age for IS in migraine was 57.5 years and for TIA 58.2 years among women, and 52.8 years and 50.3 years among men, respectively. CONCLUSION: Cardiovascular risk should be screened in the aging migraine population, and hormonal and other migraine-related risk factors should be considered, especially among women. Efficacious attack treatment with triptans should be offered to migraine patients who do not show contraindications.

Frequent attenders at risk of disability pension: a longitudinal study combining routine and register data.

Aims: Frequent attendance in healthcare services is associated with ill-health and chronic illnesses. More information is needed about the phenomenon's connection with disability pensions (DPs). Methods: The study group comprised 59,676 patients divided into occasional- (1yFAs) and persistent frequent attenders (pFAs) and non-frequent attenders (non-FAs). Odds ratios for DP were analysed for these groups taking into account preceding sickness absence days. The awarded DPs were obtained from the Finnish Centre for Pensions and data on primary care visits were obtained from Pihlajalinna, a nationwide occupational healthcare provider. Results: 1yFAs and pFAs have more DPs than non-FAs. During follow-up, 14.9% of pFAs, 9.6% of 1yFAs and 1.6% of non-FAs had a DP decision of any kind. pFAs receive more partial and fixed-term decisions than the other groups and most permanent DPs are granted to 1yFAs. Musculoskeletal disorders are the most common reason for illness-based retirement in all groups but 1yFAs and pFAs have proportionally more mental disorders leading to DP. The group of non-FAs, on the other hand, has more DPs granted based on neoplasms. Both 1yFAs and pFAs have an increased risk of DP but the effect is diluted after taking into account preceding sick-leave. Conclusions: Frequent attendance of healthcare services, both occasional and persistent, is associated with increased risk of future DP. The association is linked to increased sickness absences. Frequent attenders should be identified and their rehabilitative needs evaluated. Frequency of consultation could be used in selecting candidates for early rehabilitation before sickness absences develop.

The association between bullying victimization in childhood and fibromyalgia. Data from the nationwide Finnish health and social support (HeSSup) study based on a sample of 64,797 individuals.

BACKGROUND: Fibromyalgia is a functional pain syndrome presenting with various psychological symptoms. Several studies have shown that adverse life events are associated with fibromyalgia. The aim of the current study is to explore the association between self-reported bullying victimization in childhood and self-reported fibromyalgia in adulthood. METHODS: The basic study setting is cross-sectional - with focused use of retrospective data - derived from a large on-going postal follow up survey (sample N = 64,797) initiated in Finland in 1998. Only respondents having answered the questions on fibromyalgia in both follow ups in 2003 and 2012 were included (N = 11,924). Severity of bullying was divided into three groups starting from no bullying followed by minor and severe bullying. Covariates having shown statistically significant associations with fibromyalgia in cross tabulation using Pearson's chi-squared test were included in the final multiple logistic regression analyses. RESULTS: In our study, 50.6% of the respondents reported victimization of minor and 19.6% of severe bullying in childhood. Participants reporting fibromyalgia in adulthood reported more bullying, and in females alone this association was statistically significant (p = .027). In multiple logistic regression analysis statistically significant associations between bullying victimization in childhood (reference: no bullying) and fibromyalgia were found: adjusted odds ratio (OR) for minor bullying was 1.35 (95% CI 1.09-1.67) and for severe bullying 1.58 (95% CI 1.21-2.06). However, in log-linear and logistic regression interaction models the association between bullying and fibromyalgia was not statistically significant when depression was included in the models. CONCLUSIONS: Our results suggest that peer bullying victimization might be associated with fibromyalgia. However, in logistic log linear and logistic interaction models there was no statistically significant association when depression was included. As a result, there is need for further, preferably prospective cohort studies. The findings also emphasize the importance of actions to prevent childhood bullying.

Intrahepatic cholestasis of pregnancy and associated causes of death: a cohort study with follow-up of 27-46 years.

BACKGROUND: The aim of this study was to determine whether intrahepatic cholestasis of pregnancy (ICP) is associated with causes of death during on average 35 years follow-up after the delivery. METHODS: The study population comprised 571 women with ICP in at least one pregnancy seen at Tampere University Hospital, Finland, between 1969 and 1988. ICP was verified from patient records. The previous and following subjects in the maternity ward diary were taken as controls for each ICP case. In total, there were 1333 controls. All underlying causes of death were obtained from Statistics Finland in March 2017. The deaths occurred during 1971-2015 and the causes of death were classified according to ICD-10. RESULTS: Altogether, 39 of the mothers with ICP (6.8%) and 111 of the controls (8.3%) had died by the end of 2015 (p = 0.267). There were more underlying causes of death from gastrointestinal diseases (15%) in the ICP group than in the control group (4%) (p = 0.011). The number of underlying causes of death due to diseases of the circulatory system were lower in the ICP group (13%) than in the control group (26%), although the finding was not statistically significant (p = 0.088). Moreover, neoplasms were the underlying cause of death in 46% of cases among mothers with ICP and in 41% of cases among the controls (p = 0.609). Diseases of the other organ systems were rare in both groups. CONCLUSION: Women with a history of ICP do not have an increased overall mortality. However, deaths from gastrointestinal diseases are overrepresented among women with a history of ICP.

The relationship between childhood adversities and fibromyalgia in the general population.

BACKGROUND: Fibromyalgia is a syndrome characterized by widespread pain and a variety of somatic symptoms. The international prevalence of fibromyalgia is 2-5%, but its current prevalence in Finland is unclear. Various adversities are linked to the onset of fibromyalgia. However, there is need for more data regarding the association between childhood physical abuse and fibromyalgia. Further, the association of childhood emotional stressors and fibromyalgia is disputed. The aim of the current study is to produce more information about that relationship using data from the Health and Social Support (HeSSup) Study. METHODS: HeSSup is a postal study consisting of a random sample of the Finnish population. The study setting is cross-sectional. Participants in the study were asked if they have been diagnosed with fibromyalgia. Those responding affirmatively were classified as fibromyalgia patients. Six childhood adversities were enquired, and the relationship between fibromyalgia and these events were analysed by cross tabulation and logistic regression. RESULTS: There were associations between examined adversities and fibromyalgia before and after adjustments for demographic features and depression (being afraid of a family member: odds ratio after adjustment 1.60, 95% CI 1.28-2.01; long-lasting financial difficulties 1.45, 1.18-1.77; serious conflicts in the family 1.40, 1.14-1.72; parental divorce 1.34, 1.05-1.72; serious or chronic illnesses in the family 1.27, 1.05-1.55; alcohol problems in the family 1.25, 1.02-1.53). CONCLUSION: All six enquired adversities were associated with fibromyalgia after adjustments. These findings emphasize the importance of preventing adverse childhood experiences.

Men's Health Is Not Affected by Their Mothers' Intrahepatic Cholestasis of Pregnancy.

Little is known about the effects of mother's intrahepatic cholestasis of pregnancy (ICP) on the health of sons born to these mothers. The purpose of the present study was to explore the health of sons born to mothers with ICP. The study design was a retrospective study of ICP mothers' sons. In the region of Tampere University Hospital in Finland, 365 sons of mothers with ICP during 1969 to 1988 and 617 sons of mothers without ICP were sent a questionnaire in 2010. The response rates were 37.8% (n = 138) and 36.6% (n = 226), respectively. Only minor differences were reported between the two groups. Self-evaluated health was similar. There were no significant differences between the groups regarding symptoms and complaints, diagnosed diseases, mental health, and use of medicines. Cough was 10.8 percentage points less common among ICP mothers' sons than among controls (p = .034). Urticaria was more common among ICP mothers' sons, the difference in percentage points being 2.2 (p = .026). In general, a mother's ICP does not affect her son's health.

Menopause after a history of intrahepatic cholestasis of pregnancy.

OBJECTIVE: Intrahepatic cholestasis of pregnancy is a hormone-provoked disorder that fades quickly after parturition. The aim of this study was to establish whether a history of intrahepatic cholestasis of pregnancy reduces the use of hormone therapy for menopausal symptoms and, irrespective of hormone therapy, whether intrahepatic cholestasis is associated with other health aspects after menopause. METHODS: In 2010, questionnaires were sent to a cohort of women who delivered in Tampere University Hospital, Finland, from 1969 to 1988. The study population comprised postmenopausal women with a history of intrahepatic cholestasis of pregnancy (n = 189) and their controls (n = 416). The main outcome measures were the use of hormone therapy and other means of alleviating menopausal symptoms, and the diseases the women reported. RESULTS: There were no differences in the use of hormone therapy between the two groups. Of the diseases reported, breast cancer, hepatobiliary diseases, and hypothyroidism were more frequent among women with a history of intrahepatic cholestasis of pregnancy, whereas cardiac arrhythmia was less frequent. With respect to other diseases, there were no differences. CONCLUSIONS: A history of intrahepatic cholestasis of pregnancy does not reduce the use of hormone therapy. However, when physicians prescribe hormone therapy for these women, a history of intrahepatic cholestasis of pregnancy calls for attention in view of its association with gallstones.

Self-reported rather than registered cancer is associated with psychosocial strain.

BACKGROUND: Individuals with only a subjective experience of cancer may conceal severe psychological distress and act like patients with verified disease. The purpose of the study was to establish whether some typical psychosocial factors may be linked to subjects with registered cancer (confirmed) and also to those with self-reported cancer lacking accompanying registered data (non-confirmed). METHODS: The material comprised 25,898 working-aged individuals (response rate 40.0%) in 1998. Of these 19,629 also responded at the follow-up in 2003 (response rate 75.8%). The analyses focused on respondents with cancer diagnosis in 2002 or earlier according to data of the Finnish Cancer Registry and self-report of cancer in 2003 (confirmed) (N=330) and on respondents with self-reported cancer only but lacking registered diagnosis (non-confirmed) (N=140). Those who neither reported cancer nor had a diagnosis were included as a control group (N=18,299). RESULTS: Respondents with confirmed cancer belonged more often to the oldest age-group than those with non-confirmed cancer. Respondents with non-confirmed cancer were more often obese, depressed and reported less social support compared to subjects with confirmed cancer. Compared to controls they had a statistically significantly increased risk of depression, lower optimism, lower life satisfaction, more childhood adversities, more negative life events and less social support. CONCLUSIONS: Individuals with only a subjective experience of cancer reported more psychosocial strain than those with accompanying registered cancer. Self-report of a severe disease like cancer without corresponding clinical findings might reflect heavy psychological distress which should be taken into consideration in clinical work.

Health history after intrahepatic cholestasis of pregnancy.

OBJECTIVE: To establish whether intrahepatic cholestasis of pregnancy (ICP) is associated with other diseases during a woman's lifetime. DESIGN: Prospective controlled cohort study. SETTING: University Hospital in Finland. POPULATION: A total of 575 women with ICP and 1374 control women, all having delivered in 1969-1988. Questionnaires were sent to 544 ICP patients and 1235 control women. Responses were received from 1178 (66.4%). METHODS: Questionnaire survey in autumn 2010. MAIN OUTCOME MEASURES: Perceived health, symptoms and complaints, diseases diagnosed by a doctor and use of medicines. RESULTS: No statistically significant differences were detected in perceived health. Differences in recent symptoms and complaints were small. Diagnoses made by a doctor showed higher frequencies in the ICP group than in control women for other hepatobiliary diseases, breast cancer and hypothyreosis. Diagnosed hypertension and high cholesterol requiring medication as well as cardiac arrhythmia were less frequent in the ICP group. Women in this group used antacid medicines more often than control women. CONCLUSIONS: There were few differences between the ICP patients and control women except for a higher frequency of later hepatobiliary disease, breast cancer and hypothyreosis. Women with a history of ICP should be screened for hypothyreosis more readily than those without. The higher frequency of breast cancer warrants further research.

Cancer in working-age is not associated with childhood adversities.

BACKGROUND: Early life events are studied as potential causes of cancer. The objective here was to study childhood adversities in the etiology of cancer. METHODS: The material comprised a population based random sample of 25 898 individuals among the Finnish working-aged population. In 1998 they were requested through six questions in a postal questionnaire to recall their childhood adversities. The cases consisted of people with cancer diagnosed 2000-2006 and registered in the Finnish Cancer Registry (n = 384). The rest of the sample consisted of cancer-free controls. RESULTS: The most common adversities were prolonged financial difficulties, serious conflicts in the family and someone in the family having been seriously or chronically ill. The cancer patients reported more prolonged financial difficulties and someone seriously or chronically ill in the family. They reported less parental divorce than the controls. The associations were not statistically significant after adjusting for age, sex, education, and health behaviour. Nor was there a significant difference in the total number of childhood adversities between the study group and the controls. CONCLUSION: On the whole, these cancer patients had not experienced more childhood adversities than the controls. According to our findings, there is no cause to attribute development of cancer in working age to childhood adversities. This information may also give relief to other family members.

Use of vitamins, trace elements, or herbal products does not differ between cancer patients and population in general.

OBJECTIVE: To examine how widely cancer patients use vitamins, trace elements, and herbal products. METHODS: The Health and Social Support Study (HeSSup) population consisted of a stratified random sample drawn from the Finnish Population Register in four age groups: 20-24, 30-34, 40-44, and 50-54 years. The survey was carried out by postal questionnaire during 1998, with a response rate of 40.0%. Altogether, 19 626 individuals returned the follow-up questionnaire during 2003, a response rate of 75.8%. The sample comprised 167 individuals diagnosed with malignant cancer from 1998 to 2002 according to the Finnish Cancer Registry. Respondents in 2003 were asked about their use of vitamins, trace elements, or herbal products during the last year. Four randomly selected age- and sex-matched controls for comparison were selected for every cancer patient. RESULTS: One in three among both cancer patients and controls had not used vitamins, trace elements, or herbal products at all. In this respect, there were no statistically significant differences between cancer patients and their respective controls. CONCLUSION: If the use of these products is useless, cancer patients act as reasonable as the population in general. If their use is generally recommended for supplementary therapy, cancer patients do not follow recommendations.

Peptic ulcer and childhood adversities experienced by working-aged people.

AIM: To study the association between self-reported peptic ulcer and childhood adversities. METHODS: The Health and Social Support Study (HeSSup) population consisted of a stratified random sample drawn from the Finnish Population Register in four age groups: 20-24, 30-34, 40-44 and 50-54. The survey was carried out by postal questionnaire during 1998, with a response rate of 40.0%. A follow-up questionnaire was sent during 2003 to all those who responded to the first. Altogether 19,626 individuals returned the follow-up questionnaire; a response rate of 75.8%. The subjects were asked whether a doctor had told them that they have or have had peptic ulcer. The analyses covered those who responded affirmatively to both the baseline and the follow-up enquiries (n = 718). Those not reporting a peptic ulcer in either of the two questionnaires (n = 17,677) were taken as controls. The subjects were further requested (through six questions) to think about their childhood adversities. RESULTS: The most common adversities mentioned were long-lasting financial difficulties in the family, serious conflicts in the family, and a family member seriously or chronically ill. All the adversities reported, except parental divorce, were more common among peptic ulcer patients than among controls (P values varied between < 0.001 and 0.003). Age- and sex-adjusted odds ratios (OR) of childhood adversities in the multivariate logistic analysis for self-reported peptic ulcer varied between 1.45 and 2.01. Adjusting for smoking, heavy drinking, stress and nonsteroidal anti-inflammatory drug use had no further influence (ORs between 1.22 and 1.73). CONCLUSION: Our findings suggest that childhood adversities maintain a connection with and have a predictive role in the development of peptic ulcer.

A negative finding in an exercise test is reliable among elderly people: a follow-up study.

BACKGROUND: Coronary heart disease (CHD) is very common among elderly people. OBJECTIVE: To specify the diagnostic value of bicycle exercise tests conducted for elderly patients by trained general practitioners in primary health care. METHODS: We performed a 2-year follow-up study at the Kangasala Health Centre, Finland. The study population comprised all patients at least 60 years old (n = 311) suspected of having CHD without prior diagnosis who were examined by an exercise test carried out by trained general practitioners during a period of 3 years. Specificity and sensitivity as well as positive and negative predictive values of the tests were calculated based on whether or not the participants had a diagnosis of CHD by the end of the follow-up period. The numbers of patients referred for coronary angiography and bypass operation were registered. For analysis, the patients were divided into two age categories: 60-69 years and >or=70 years. RESULTS: A negative finding in the test proved very reliable: CHD manifested in only 3% of these cases in both age groups. The specificity of the test was 72% in the group 60-69 years and 66% in the group >or=70 years; the sensitivity values were 81 and 67%, respectively. The positive predictive values were 26 and 12%, the negative predictive value was 97% in both age groups. 1 in 4 patients yielding a positive finding eventually underwent coronary angiography and 1 in 6 patients coronary bypass surgery. CONCLUSIONS: Exercise tests may predict the clinical outcome of CHD among elderly patients. A negative finding in an exercise test is very reliable.

Childhood adversities experienced by working-aged coronary heart disease patients.

OBJECTIVE: The aim of this study is to investigate associations between childhood adversities and coronary heart disease (CHD). METHODS: This was a case-control study based on a postal questionnaire addressed to randomly selected working-aged Finns, and response rate was 39% (N = 15,477). The sample comprised 319 CHD patients. Four age- and gender-matched controls were selected for every patient. The participants were asked in six questions to think about their childhood adversities. RESULTS: Fear of some family member and someone in the family being seriously or chronically ill were more common during childhood among working-aged CHD patients than among controls. Likewise, among female CHD patients, serious conflicts in the family and someone in the family having had alcohol problems and, among male CHD patients, long-lasting financial problems were more common than among controls. Odds ratios (OR) varied between 1.27 and 2.66. Adjustment for education had no influence among women, but it had an influence among men. Upon adjustment for conventional risk factors (smoking, obesity, and hypertension), the association mostly disappeared. A family member having been seriously or chronically ill was statistically significant after full adjustment among both genders. CONCLUSION: Working-aged CHD patients have experienced more dramatic events during their childhood than did the control population. This issue cannot be solved in doctors' offices. Health-promoting social policies are of vital importance.

Exercise treadmill test may predict clinical outcome among working-aged patients suspected of coronary heart disease in general practice.

OBJECTIVE: To specify the diagnostic value of treadmill tests conducted in primary health care by trained GPs for working-aged patients. DESIGN: A two-year follow-up study. SETTING: Kangasala Health Centre, Finland. SUBJECTS: All patients under the age of 60 (n = 348) examined by exercise treadmill test carried out by trained GPs during a period of three years. MAIN OUTCOME MEASURES: The number of patients having a diagnosis of coronary heart disease at the end of two years' follow-up. Predictive values of the exercise test. RESULTS: During the two years' follow-up period CHD was diagnosed in six of the patients who did not yield a positive finding in the test. A negative finding in the test was very reliable; coronary heart disease manifested in only 2% of these cases. Almost half of the patients yielding a positive finding ended up having coronary angiography and 1 in 10 underwent coronary bypass surgery. CONCLUSION: Among working-aged patients suspected of coronary heart disease an exercise treadmill test may predict clinical outcome in general practice.

Secondary prevention of coronary heart disease is disappointing among patients of working age.

BACKGROUND: The risk factors underlying coronary heart disease (CHD) are well known. OBJECTIVE: The purpose of this study was to evaluate risk factors related to secondary prevention of working-age CHD patients. METHODS: CHD patients with (n = 139) and without (n = 203) myocardial infarction were selected from a postal questionnaire study (n = 21 101) of randomly selected Finns aged 20-54 years (HeSSup study). Four age- and sex-matched controls were chosen for every patient. RESULTS: CHD patients still smoke, are obese and suffer hangovers more frequently than the control population. CONCLUSION: The health care system has not succeeded in the secondary prevention of CHD.