Better perceived health among the Swedish-speaking minority as compared with the Finnish-speaking majority in Finland: a cross-sectional study with an intergenerational perspective.

BACKGROUND: Previous research has shown that the Swedish speaking minority in Finland has slightly but significantly better health compared with the Finnish speaking majority. However, a clear explanation for this is lacking. AIM: The aim of the study was to explore differences of perceived health comparing three groups: Swedish speakers with reported dominance of Swedish also in the preceding generation; contemporary Finnish speakers with reported dominance of Finnish in the preceding generation and a group with a reported mixed-language structure of Finnish and Swedish between generations. INDIVIDUALS AND METHODS: Health and Social Support is an on-going population-based survey initiated in 1998 (N = 64,797), aimed at working-age adults. The present study is based on the 2012 follow-up survey, which included a question on the dominating language (Swedish or Finnish) of the respondents and their parents. The outcome was perceived health, which in this study was dichotomized to very good/good and intermediate/poor/very poor. The statistical analysis was carried with logistic regression, using SAS software. Age, gender and occupational training were included as covariates in the multivariable analysis. RESULTS: This study found that the Swedish-speaking group in Finland report better perceived health compared with the Finnish-speaking group (odds ratio 1.28, 95% confidence interval 1.04-1.57, p < 0.001). The health of the mixed language-speaking group fell between the other two groups. CONCLUSIONS: The results gave some support to a culturally mediated mechanism for the health advantage of Swedish speakers. Cultural features of Swedish-speaking groups in Finland may also support health promotion of the Finnish-speaking majority.

Team players and helpers - describing professional identity among finnish physicians in a cross-sectional study.

BACKGROUND: Every physician has a unique professional identity. However, little is known about the diversity of identities among physicians. This study aimed to quantitatively assess the professional identity of physicians in Finland using descriptions of professional identity. METHODS: This study was part of a larger cross-sectional Finnish Physician 2018 Study. The target population consisted of all Finnish physicians under the age of 70 (N = 24,827) in 2018. The sample was drawn from physicians born on even numbered days (N = 11,336) using the Finnish Medical Association register. A total of 5,187 (46%) physicians responded. Professional identity was examined by 27 given characterisations using a five-point Likert scale. Multivariate logistic regression was used in assessing how place of work, graduation year and gender were associated with identity descriptions. RESULTS: The descriptions which most physicians identified with were "member of a working group/team" (82%), "helper" (82%), and "health expert" (79%); the majority reported these as describing them very or quite well. Identity descriptions such as "prescriber of medications" (68% vs. 45%), "prioritiser" (57% vs. 35%) and "someone issuing certificates" (52% vs. 32%) were more popular among junior than senior physicians. The biggest differences between the genders were found in the descriptions "provider of comfort" (62% vs. 40%) and "someone engaged in social work" (45% vs. 25%), with which women identified more frequently than men. CONCLUSIONS: Strong identification as a member of a team is an important finding in the increasingly multiprofessional world of health care. Importantly, most physicians shared several core professional identity descriptions (i.e., helper, health expert) that reflect the traditional image of an exemplary doctor.

A named General Practitioner (GP) is associated with an increase of hospital days in a single predictor analysis: a follow-up of 15 years.

BACKGROUND: Continuity of care constitutes the basis of primary health care services and is associated with decreased hospitalization. In Finland, accessibility to primary care and increased use of hospital services are recognized challenges for the health care system. OBJECTIVES: The aim of the study was to determine whether having a named GP is associated with hospital service use. METHODS: The data are part of the Health and Social Support study (HeSSup) based on a random Finnish working-age population sample. The cohort of the study comprised participants of postal surveys in 1998 (n = 25,898) who returned follow-up questionnaires both in 2003 and 2012 (n = 11,924). Background characteristics were inquired in the questionnaires, and hospitalization was derived from national registries (Hilmo-register). RESULTS: A named GP was reported both in 2003 and 2012 only by 34.3% of the participants. The association between hospital days and a named GP was linearly rising and statistically significant in a single predictor model. The strongest associations with hospital use were with health-related factors, and the association with a named GP was no longer significant in multinomial analysis. CONCLUSION: A named GP is associated with an increased use of hospital days, but in a multinomial analysis the association disappeared. Health related factors showed the strongest association with hospital days. From the perspective of the on-going Finnish health and social services reform, continuity of care should be emphasized.

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.

Attitudes of primary healthcare chief physicians towards research in Finland - a national study.

OBJECTIVE: To illustrate the views of chief physicians in Finnish primary healthcare health centres (HCs) on the existing research capacity of their centres, their attitudes to practice-based research network activity, and research topics of interest to them. DESIGN: A cross-sectional survey study. SETTING: Finnish HCs. SUBJECTS: Chief physicians in Finnish HCs. MAIN OUTCOME MEASURES: We used a questionnaire that included five-point Likert scales and multiple choice and open-ended questions to identify the chief physician's profile, the HC content, the attitudes of chief physicians towards engagement in research, research topics of interest to them, and factors that may influence their motivation. Descriptive methods were used for the analysis of the quantitative data, while the qualitative data were processed using inductive thematic analysis. RESULTS: There was a relatively good representation of all hospital districts. One-third of HCs had at least one person doing research, and 61% of chief physicians would support research in their setting. Their stimulus for research was primarily testing new therapies, protocols, and care processes, as well as effectiveness and healthcare improvement. The expected benefits that motivate engagement in Practice-based research networks (PBRNs) are evidence-based practice and raised professional capacity and profile of the HC. CONCLUSIONS: Chief physicians regard research as an elementary part of the development of primary care practices and health policy. Their motivation to engage in PBRN activity is determined by the relevance of the research to their interests and the management of competing priorities and resource limitations.

The chief physicians of the Finnish primary healthcare centres (HCs) recognize the value of practice-based research and are motivated to participate in practice-based research network activity if: • The research topics are relevant to their interests and problems encountered at their HC; • The research activity entails tangible benefits for their HC, such as evidence-based practice and improvement, an increase in professional competence, or an improvement in HC image; • It is possible to cope with competing priorities and resource limitations.

Occupational health patients' parallel use of primary- and secondary-care services and linkage to work disability: A follow-up study in Finland.

AIMS: This study aimed to investigate occupational health (OH) primary-care patients' use of other health-care services and whether parallel use affects their likelihood to have sickness absences (SA) or disability pensions (DP). METHODS: Primary-care services in Finland are provided through three parallel health-care sectors, all available to the working population: public, private and OH sectors. Patients may also be referred to secondary care. This follow-up study combines real-world medical record data containing SA data from a nationwide OH provider with health-care attendance data from public and private primary-care sectors and public secondary care, sociodemographic data and DP decisions. Patients between 18 and 68 years of age who used OH primary care at least once during the study years 2014-2016 were included. The total study population comprised 59,650 patients. Odds ratios were used to analyse association between parallel service use and SA or DP. RESULTS: Females and patients with a lower educational level were more likely to use services in other health-care sectors in addition to OH than others. Those patients who used any other health-care sector in addition to OH primary care had an increased likelihood of having long SA or receiving DP. CONCLUSIONS: OH primary-care patients using the services of several health-care sectors in parallel have an increased likelihood of receiving disability benefits - either SA or DP. There is need for care coordination to ensure adequate measures for work-ability support.

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.

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.

Sociodemographic characteristics and disability pensions of frequent attenders in occupational health primary care - a follow-up study in Finland.

BACKGROUND: Work disability is a complex issue that requires preventive efforts from healthcare systems and individuals, and that too often results in disability pensions (DP). While many studies have attempted to characterize risk factors of work disability, many showing for example a link between socioeconomic positions, working conditions and frequent attendance to OH primary care it is not known if frequent attendance is associated with DP despite the sociodemographic factors. This study aims to address this gap and examine the association between frequent attendance to OH primary care and DP, when adjusted by sociodemographic factors. METHODS: This study combines routine medical record data of an occupational health service provider with comprehensive national registers. Medical record data were used to define groups of frequent attenders to OH primary care (FA) (1-year-FA, 2-year-FA, persistent-FA and non-FA) from 2014 to 2016. The sociodemographic factors (including i.e. educational level, occupational class, unemployment periods) were derived from Statistic Finland and DP decisions were derived from Finnish Centre for Pensions. Association of frequent attendance to OH primary care with DP decisions were analyzed and adjusted by sociodemographic factors. RESULTS: In total, 66,381 patients were included. Basic and intermediate education along with manual and lower non-manual work predicted frequent attendance to OH primary care. Unemployment in 2013 did not predict frequent attendance to OH primary care. Frequent attendance to OH primary care was associated with DP within next two years, even when adjusted for sociodemographic factors. The association of frequent attendance to OH primary care with DP grew stronger as high service use persisted over time. CONCLUSIONS: Frequent attendance to OH primary care is associated with DP risk in the near future despite the underlying sociodemographic differences. Patients using OH primary care services extensively should be identified and rehabilitative needs and measures necessary to continue in the work force should be explored. Sociodemographic issues that co-exist should be explored and considered when planning interventions.

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.

Research orientation among general practitioners compared to other specialties.

OBJECTIVE: The volume of research work done by general practitioners (GP) is modest compared to other specialties. In order to find out reasons for this we examined the current situation concerning research orientation and factors relating to them among Finnish GPs compared to other specialists. DESIGN AND SETTING: Data from The Physician 2018 Study were used for our research. The study was undertaken in collaboration with all five medical faculties in Finland and the Finnish Medical Association. It compiled information on physicians` social background, work history and career and research plans as well as their views regarding undergraduate and specialist training, values, and professional identity. SUBJECTS: The basic study population comprised all Finnish doctors under 70 years of age (N = 23,131). Questionnaires were sent to doctors born on even-numbered days (n = 11,336). Altogether 5,214 (45.8%) responded. Responses from GPs (n = 796) were compared with those of doctors in other specialties (n = 3,514). MAIN OUTCOME MEASURES AND RESULTS: The respondents were asked about their current intention to undertake a doctoral degree. Factors associated with this were analysed. Only 7.3% of GPs had completed a doctoral degree. The corresponding figure in other specialties was 32.3% (p < 0.001). In general practice the current intention to undertake a doctoral degree had only slightly increased over ten years. Most GPs had also decided not to undertake a doctorate. The main factors associated with the current intention to complete a doctoral degree were interest in attaining a senior position (OR 3.43, 95% CI 2.25-5.24), a position in a university hospital district (OR 2.89, 95% CI 1.69-4.94) or other sector than primary care (OR 1.87, 95% CI 1.18-2.96), one's father being a doctor (OR 2.01, 95% CI 1.09-3.72) and male gender (OR 1.63, 95% CI 1.05-2.54). CONCLUSION: Research work in primary health care has been quite sparse. In general practice there is a need to increase teaching and guidance in research work.Key pointsResearch work in primary health care is not very common.Only 7.3% of GPs had completed their doctorate compared to 32.3% in other specialties.A main factor associated with the current intention to complete a doctoral degree was interest in attaining a senior position.

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.

High cost or frequent attender - both spend resources, but are they linked to work disability? A cohort study from occupational health primary care in Finland.

BACKGROUND: High use of services is associated with ill health and a number of health problems, but more information is needed on whether high use of services presents a risk for future pensions or disability. We aimed to investigate if defining patients as high cost (HC) or frequent attenders (FA) was more useful in occupational health services (OHS) as a predictor of future disability pension (DP). METHODS: This cohort study used medical record data from a large OHS provider and combined it with register data from the Finnish Centre for Pensions including disability pension decisions. A total of 31,960 patients were included and odds ratios for DP were calculated. Frequent attenders (FA10) were defined as the top decile of visitors according to attendance and high cost (HC10) as the top decile according to costs accrued from service use in 2015. Those patients that were not categorized as FA nor HC, but were eligible for the study were used as the control group (non-FAHC). The outcome measure (disability pensions) was analysed for years 2016-2017. RESULTS: FA and HC did not significantly differ in their risk for disability pension. Both groups' risk was higher than average users' risk (adjusted OR 3.47 for FA10, OR 2.49 for HC10 and OR 0.33 for controls). Both HC10 and FA10 received half of their disability pensions based on musculoskeletal disorders, while for non-FAHC only 28% of pensions were granted based on these disorders. The groups overlapped by 68%. CONCLUSIONS: High utilizers (both FA10 and HC10) have an increased likelihood of receiving a future disability pension. The chosen definition is less important than identifying these patients and directing them towards necessary rehabilitation.

My Migraine Voice survey: disease impact on healthcare resource utilization, personal and working life in Finland.

BACKGROUND: A global My Migraine Voice survey was conducted in 31 countries among 11,266 adults who suffered from ≥4 monthly migraine days (MMD). The aim of this retrospective observational survey-based study was to analyse the country specific results in Finland in order to understand the impact of migraine based on disease severity. METHODS: The included participants (3%, n = 338/11,266) were stratified by mean MMDs into 4 ≤ MMD < 8 (n = 133), 8 ≤ MMD < 15 (n = 139) and MMD ≥ 15 (n = 66) subgroups. Comorbidities, migraine-related emotional burden and impact on daily living and work productivity and activity impairment (WPAI) were assessed. Subgroup analysis on healthcare resource utilization (HCRU) due to migraine was assessed by visits to healthcare practitioners (HCPs) during the past 6 months and by hospitalizations and emergency room (ER) visits during the past 12 months. The group difference was tested using the one-way ANOVA and for categorical variables using the Chi-squared test. The association between HCRU and MMD and number of comorbidities was assessed using negative binomial regression analysis. RESULTS: Mean age was 44 years, 93% were women and 67% (n = 227) were employed. Chronic migraine (CM, MMD ≥ 15) was reported in 19.5% of the respondents. The negative impact on daily functioning and emotional burden increased significantly by migraine frequency. Mean number of comorbidities was 2.4, and mean number of HCP visits during the previous 6 months was 5.9. Increase in migraine frequency and comorbidities was associated with higher HCRU. Eighty-eight percent of the respondents reported negative impact on working life and 52% experienced overall work productivity impairment. Over previous month, the mean number of missed working days for all respondents was 2.8 days of which 54% were paid sick leave days, and in CM up to 6.0 days and 30%, respectively. Both absenteeism and presenteeism were higher in the CM group. CONCLUSIONS: The emotional and functional burden was high, and the societal burden increased by frequency and severity of migraine, as shown by higher HCRU and reduced work productivity. There is a need to improve quality of care in migraine and improve migraine management related issues in both healthcare and society in Finland.

Intrahepatic cholestasis of pregnancy and comorbidity: A 44-year follow-up study.

INTRODUCTION: Intrahepatic cholestasis of pregnancy (ICP) is a reversible liver disorder occurring during pregnancy. It has a typical genetic background with known genetic mutations and can be considered an expression of this genetic predisposition. The objective of this study was to determine whether ICP is associated with specific long-term comorbidity. MATERIAL AND METHODS: The study population comprised 571 women with ICP in at least one pregnancy who were compared with 1333 pregnant women without ICP during 1969-1988 at Tampere University Hospital, Finland. The cohort's follow-up time was 44 years. All ICD-10 classification discharge diagnoses were examined for the women in the ICP group from 1998 to 2013 and ICD-10 diagnoses from outpatient care from 1969 to 2013. RESULTS: At least one disease of the digestive system had been diagnosed in 50.4% (288/571) of the ICP mothers compared with 34.4% (459/1333) of the reference group (P < 0.001). In a more detailed analysis, women with a history of ICP had an increased risk for cholelithiasis and/or cholecystitis (odds ratio [OR] 2.88, 95% confidence interval [CI] 2.17 to 3.84), diseases of the pancreas (OR 2.26, 95% CI 1.20 to 4.27) and hypothyroidism (OR 2.38, 95% CI 1.27 to 4.46) compared with the reference group. Arterial diseases were less common in the ICP mothers than in the reference group (OR 0.38, 95% CI .15 to .99). Regarding other diseases, there were no statistically significant differences between the ICP mothers and reference group. CONCLUSIONS: Half of the women with a history of ICP were diagnosed with at least one disease of the digestive system compared with a third in the reference group. The risk of cholelithiasis, cholecystitis, diseases of the pancreas and hypothyroidism was increased compared with the reference group. These are important facts when counseling women after a pregnancy with ICP. Also, this is of importance for the general practitioners and other physicians who take care of these women.

Frequent attenders in occupational health primary care: A cross-sectional study.

AIMS: This study characterizes frequent attenders in primary care provided by occupational health services (OHS) in Finland. METHODS: This is a nationwide cross-sectional study using medical record data from an OHS provider in 2015. Frequent attenders were defined as persons who were within the top decile of annual visits to healthcare professionals (frequent attender 10%, FA10) at any of the OHS's 37 stations. FA10s within this study consulted the OHS primary care unit eight or more times during 2015. We used logistic regression to analyse factors associated with frequent attendance in OHS primary care. The independent variables were age, gender, employer size and industry, health professionals visited and diagnoses given during visits to the OHS. The dependent variable was belonging to the FA10 group. RESULTS: Altogether 31,960 patients met the inclusion criteria and were included in the study. The FA10 group included 3617 patients, who conducted 36% of visits to healthcare professionals. The findings indicate that working within the manufacturing industry, health and social services, or public administration, and being employed in medium or large companies, are associated with frequent attendance. Frequent attendance was also associated with being female, diagnoses of the musculoskeletal system, or mental and behavioral disorders. In particular, depressive episodes and anxiety were associated with FA10s. CONCLUSIONS: This research characterized FA10 clients at a Finnish OHS. Illnesses of the musculoskeletal system and mental and behavioral disorders were accentuated among FA10s. The stability of the FA10 group, along with their sickness absences and work disabilities, should be investigated further.

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.

Comparing occasional and persistent frequent attenders in occupational health primary care - a longitudinal study.

BACKGROUND: The aim of the study was to compare occasional and persistent frequent attenders in occupational health (OH) primary care and to identify the diagnoses associated with persisting frequent attendance. METHODS: This is a longitudinal study using electronic medical record data from 2014 to 2016 from an OH service provider. Frequent attenders were defined as patients in the top decile of annual visits to healthcare professionals (frequent attender 10%, FA10). FA10 were categorized to three groups according to the persistence of frequent attendance (1-year-FA, 2 year-FA, and persistent-FA = frequent attenders in all three years). This was used as the dependent variable. We used patient sex, age, employer size, industry and distribution of visits and diagnostic codes to characterize the different frequent attender groups. RESULTS: In total, 66,831 patients were included, of which 592 persistent frequent attenders (0.9% of the study population) consulted the OH unit on average 13 times a year. They made altogether 23,797 visits during the study years. The proportion of women and employees of medium and large employers increased among persistent-FAs when compared to the other groups. Multinomial logistic regression accentuated musculoskeletal disorders and to a lesser extent diseases of the respiratory and nervous system and mental disorders. One in five FA becomes a persistent-FA. CONCLUSIONS: Our results indicate that in the context of a working population the association of musculoskeletal disorders and persistent frequent attendance is emphasized. Persistent frequent attenders also create a substantial demand on physician resources. When planning interventions aimed at working age frequent attenders, subgroups suffering from musculoskeletal disorders should be identified as they are associated with persisting frequent attendance.

What predicts doctors' satisfaction with their chosen medical specialty? A Finnish national study.

BACKGROUND: In Finland the number of medical specialists varies between specialties and regions. More regulation of the post-graduate medical training is planned. Therefore, it is important to clarify what predicts doctors' satisfaction with their chosen specialty. METHODS: A random sample contained 50% of all Finnish doctors under 70 years of age. The respose rate was 50.5%. Working-age specialists were asked to value their motives when choosing a specialty. They were also asked if they would choose the same specialty again. The odds ratios for not choosing the same specialty again were tested. RESULTS: Diversity of work was the most important motive (74% of respondents). Seventeen percent of GPs would not choose the same specialty again, compared to 2% of ophthalmologists and 4% of pediatricians. A major role of Diversity of work and Prestigious field correlated with satisfaction whereas Chance with dissatisfaction with the specialty. DISCUSSION: Motives and issues related to the work and training best correlate with satisfaction with the specialty. CONCLUSIONS: When the numbers of Finnish postgraduate medical training posts become regulated, a renewed focus should be given to finding the most suitable speciality for each doctor. Information about employment and career advice should play an important role in this.

Factors important in the choice of a medical career: a Finnish national study.

BACKGROUND: Applying for medical school is the first and also one of the most important career choices a physician makes. It is important to understand the reasons behind this decision if we are to choose the best applicants for medical schools and enable them to pursue satisfying careers. METHODS: Respondents to the Finnish Junior Physician 88, Physician 1998 and Physician 2008 studies were asked: "To what extent did the following factors influence your decision to apply for medical school?" In 1998 and 2008 the respondents were also asked: "If you were starting your studies now, would you start studying medicine?" and had to answer "Yes" or "No". The odds ratios for the answer "No" were tested using logistic regression models. RESULTS: "Interest in people" was the main motive for starting to study medicine. "Good salary" and "Prestigious profession" were more important motives for males and "Vocation" and "Interest in people" for females. There were some significant changes in the motives for entering medicine in the 20-year period between studies. "Vocation" and "Wide range of professional opportunities" as important motives for entering medicine predicted satisfaction with the medical profession. DISCUSSION: Strong inner motivation may indicate the ability to adapt to the demands of work as a physician. CONCLUSIONS: Medical schools should try to select those applicants with the greatest vocational inclination towards a medical career.