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AIMS: This longitudinal study evaluated the association between childhood family structure and health-related quality of life (HRQoL) at middle age. METHODS: The data on childhood family structure at the age of 14 years ('two-parent family', 'one parent not living at home/no information on father' and 'father or mother deceased') and HRQoL (measured by 15D (15-dimensional)) at the age of 46 were collected from the Northern Finland Birth Cohort 1966 using postal questionnaires. We used the binary logistic regression model to estimate the associations between childhood family structures and the lowest 15D quartile (reference: all other quartiles). The associations were adjusted for offspring mothers' factors during pregnancy (mothers' educational and occupational status). RESULTS: Of the 6375 participants, the offspring belonging to the 'one parent not living at home/no information on father' family structure subgroup had higher odds ratio of belonging to the lowest 15D quartile than the offspring of 'two-parent families' (adjusted odds ratio (OR) 1.76, 95% confidence interval (CI) 1.31-2.36, p<0.001 for females; adjusted OR 1.86, 95% CI 1.28-2.70, p=0.001 for males). There were no statistically significant associations between the 'father or mother deceased' subgroup and the lowest 15D quartile among the offspring. CONCLUSIONS: A single-parent family origin (due to reasons other than parental death) in childhood was significantly associated with impaired HRQoL at middle age. These results provide new perspectives for understanding the long-standing associations on living in a single-parent family.
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BACKGROUND: Childhood family structure is considered to play a role in person's health and welfare. This study investigated the relationships between the longitudinal changes of adult health behaviours and childhood family structure. METHODS: From Northern Finland Birth Cohort 1966 questionnaires, we collected data on childhood family structure at the age of 14 ('two-parent family', 'one parent not living at home/no information on father', and 'father or mother deceased'), and on health behaviours (smoking, alcohol consumption and physical activity status) at the ages of 31 and 46. We used the multinomial logistic regression model to estimate the unadjusted and adjusted associations between childhood family structures and the longitudinal changes between 31 and 46 years of health behaviours (four-category variables). RESULTS: Of the study sample (n = 5431; 55.5% females), 7.1% of the offspring were represented in the 'One parent not living at home/no information on father' subgroup, 6.3% in the 'Father or mother deceased' subgroup and 86.6% in the 'Two-parent family'. 'One parent not living at home/no information on father' offspring were approximately twice as likely to smoke (adjusted OR 2.19, 95% CI 1.70-2.81) and heavily consume alcohol (adjusted OR 1.99, 95% CI 1.25-3.16) at both times in adulthood, relative to not smoking or not heavily consume alcohol, and compared with 'two-parent family' offspring. We found no statistically significant associations between childhood family structure and physical activity status changes in adulthood. CONCLUSIONS: Our findings suggest that the offspring of single-parent families in particular should be supported in early life to diminish their risk of unhealthy behaviours in adulthood.
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Conductas Relacionadas con la Salud , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Cohorte de Nacimiento , Estructura Familiar , Finlandia , Estudios Longitudinales , Fumar/epidemiología , Fumar/psicología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Reflective capacity is a prerequisite for transformative learning. It is regarded as an essential skill in professional competence in the field of medicine. Our aim was to investigate the reflective capacity and the objects of action (themes) which revealed reflective writing of medical students during a general practice/family medicine course. METHODS: Second-year medical students were requested to write learning diaries during a compulsory course in general practice/family medicine consisting of the principles of the physician-patient relationship. The course included a group session supervised by a clinical lecturer and a 3-day training period in a local health centre. We conducted data-driven content analysis of the learning diaries. In the learning diaries, student observations were most commonly directed to events during the training period and to group sessions. Occasionally, observation was directed at inner experience. RESULTS: The following themes were related to reflective writing: feelings towards the end of life, demanding situations in practice, physician's attitude to patient, student's inner experiences, and physician's well-being. The entries indicated different types of reflective capacity. Three subgroups were identified: 'simple reporting,' 'reflective writing,' and 'advanced reflective writing.' CONCLUSION: Professional growth requires the development of reflective capacity, as it is essential for successful patient care and better clinical outcomes. To develop and enhance the reflective capacity of medical students during their education, the curriculum should provide frequent opportunities for students to assess and reflect upon their various learning experiences.
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Educación de Pregrado en Medicina , Educación Médica , Estudiantes de Medicina , Humanos , Medicina Familiar y Comunitaria/educación , AprendizajeRESUMEN
BACKGROUND: Little knowledge exists on the prevalence of recurrent sleep medication prescriptions among primary care patients with type 2 diabetes (T2D). Our aims were to examine the prevalence of recurrent sleep medication prescriptions and to elucidate the most often prescribed sleep medications in a Finnish primary care T2D population. METHODS: The study examined 4,508 T2D patients who consulted a primary health care center between 2011 and 2019 in Rovaniemi, Finland. All the data were retrieved from patient records, and recurrent sleep medication was defined as two or more prescriptions within the study period. We used the Chi-square and Kruskal-Wallis tests to compare patients who did and did not have recurrent sleep medication prescriptions. RESULTS: Altogether 28.1% of the T2D patients had been prescribed recurrent sleep medication. Benzodiazepine-like medication, melatonin, and mirtazapine were most often prescribed (to 56.9%, 44.4%, and 35.8%, respectively). Only 22.0% of the patients with recurrent sleep medication prescriptions had been diagnosed with a sleep disorder. CONCLUSIONS: Recurrent sleep medication prescriptions are frequent among primary care T2D patients. It seems that sleep disorders are underdiagnosed in relation to this. Primary care clinicians should carefully estimate the need for sleep medication when treating T2D patients' sleep problems and emphasize the diagnostic patterns of sleep problems.
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Diabetes Mellitus Tipo 2 , Trastornos del Sueño-Vigilia , Humanos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Datos de Salud Recolectados Rutinariamente , Prescripciones de Medicamentos , Trastornos del Sueño-Vigilia/tratamiento farmacológico , Trastornos del Sueño-Vigilia/epidemiología , Sueño , Atención Primaria de SaludRESUMEN
BACKGROUND: Family structure is suggested to be associated with adolescent pain, but evidence on its association with multisite MS pain is sparse. The purpose of this cross-sectional study was to investigate the potential associations between family structure ('single-parent family', 'reconstructed family', and 'two-parent family') and multisite musculoskeletal (MS) pain in adolescence. METHODS: The dataset was based on the 16-year-old Northern Finland Birth Cohort 1986 adolescents with available data on family structure, multisite MS pain, and a potential confounder (n = 5,878). The associations between family structure and multisite MS pain were analyzed with binomial logistic regression and modelled as unadjusted, as the evaluated potential confounder, mother's educational level, did not meet the criteria for a confounder. RESULTS: Overall, 13% of the adolescents had a 'single-parent family' and 8% a 'reconstructed family'. Adolescents living in a single-parent family had 36% higher odds of multisite MS pain compared to adolescents from two-parent families (the reference) (Odds Ratio [OR]: 1.36, 95% Confidence Interval [CI]: 1.17 to 1.59). Belonging to a 'reconstructed family' was associated with 39% higher odds of multisite MS pain (OR 1.39, 1.14 to 1.69). CONCLUSION: Family structure may have a role in adolescent multisite MS pain. Future research is needed on causality between family structure and multisite MS pain, to establish if there is a need for targeted support.
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Dolor Musculoesquelético , Humanos , Adolescente , Estructura Familiar , Finlandia , Cohorte de Nacimiento , Estudios TransversalesRESUMEN
AIMS: To examine the association of the screening frequency of estimated glomerular filtration rate (eGFR) with the substantial reduction in eGFR (≥ 25%) among type 2 diabetes (T2D) patients with normal (eGFR≥60 ml/min/1.73 m2) and impaired kidney function (eGFR< 60 ml/min/1.73 m2). METHODS: A longitudinal study involving 5104 T2D patients with follow-up period of 6.8 years (1.9 SD) were treated at the Rovaniemi Health Center, Rovaniemi, Finland during 2011-2019. The association between the screening frequency of eGFR (yearly vs. non-yearly) and the substantial reduction in eGFR was studied with logistical models and adjusted with biochemical variables and preventive medications. RESULTS: Among the T2D patients with normal kidney function, non-yearly eGFR screening was significantly associated with substantial eGFR reduction in both unadjusted (odds ratio [OR] 3.29, 95% confidence interval [CI] 2.54-4.33) and adjusted models (OR 2.06, 95% CI 1.21-3.73) compared with yearly screening frequency. In the group of patients with impaired kidney function in the unadjusted model, non-yearly eGFR screening was significantly associated with substantial eGFR reduction (OR 2.38, 95% CI 1.30-4.73), but became non-significant after adjustments (OR 1.89, 95% CI 0.61-7.21). CONCLUSIONS: This study underscores the role of regular eGFR screening in the prevention of kidney function decline.
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Diabetes Mellitus Tipo 2 , Nefropatías Diabéticas , Insuficiencia Renal , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/complicaciones , Estudios Longitudinales , Tasa de Filtración Glomerular , Riñón/fisiología , Atención Primaria de SaludRESUMEN
BACKGROUND: Endurance exercise training promotes the catabolism of branched-chain amino acids (BCAAs) in skeletal muscles. We have previously shown that mitochondrial DNA (mtDNA) haplogroups J and K are markers of low responders in endurance training. In this paper, we hypothesize that BCAA catabolism is a surrogate marker of lower respiratory chain activity attributed to these haplogroups. We evaluated whether exercise-induced changes in amino acid concentrations differ between subjects harbouring mtDNA haplogroups J or K and those with non-JK haplogroups. METHODS: Finnish male conscripts (N = 633) undertook the 12-min Cooper running test at the beginning and end of their military service. The intervention during the service mainly included endurance aerobic exercise and sports-related muscle training. Concentrations of seven amino acids were analysed in the serum using a high-throughput 1H NMR metabolomics platform. Total DNA was extracted from whole blood, and restriction fragment analysis was used to determine mtDNA haplogroups J and K. RESULTS: The concentrations of the seven amino acids were higher following the intervention, with the exception of phenylalanine; interestingly, the increase in the concentrations of three BCAAs was larger in subjects with haplogroup J or K than in subjects with non-JK haplogroups (p = 0.029). MtDNA haplogroups J and K share two common nonsynonymous variants. Structural analysis based on crystallographic data on bovine complexes I and III revealed that the Leu18 variant in cytochrome b encoded by m.14798T > C may interfere with ubiquinone binding at the Qi site in complex III. CONCLUSIONS: The increase in the concentrations of serum BCAAs following exercise intervention differs between subjects harbouring mtDNA haplogroup J or K and those harbouring non-JK haplogroups. Lower response in endurance training and difference in exercise-induced increase in the concentrations of serum BCAAs suggest decreased respiratory chain activity. Haplogroups J and K share m.14798T > C in MT-CYB, which may hamper the function of complex III.
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AIMS: To assess the association of diagnosed musculoskeletal (MS) pain (low back, neck, shoulder, and knee pain; and the number of pain sites) with the achievement of targets for glycosylated haemoglobin A1c (HbA1c), low-density-lipoprotein cholesterol (LDL), and systolic blood pressure (SBP) among primary care patients with type 2 diabetes (T2D). METHODS: The cross-sectional study population consisted of 3478 patients with a registry-based T2D diagnosis and available registry-based data on MS pain diagnoses, covariates, and outcomes between 2016 and 2019. Logistic regression analysis was used to evaluate the study aims. RESULTS: Overall, 22% had at least one of the four types of MS pain, and 73%, 57%, and 51% achieved the treatment targets of HbA1c, LDL, and SBP, respectively. T2D patients with or without MS pain did not differ in their achievement of T2D treatment goals. Of pain locations, low back pain was associated with higher rates of achievement of the LDL target (OR 1.29, 95% CI 1.01-1.65), but the association was attenuated in the adjusted model. CONCLUSIONS: MS pain was relatively prevalent among primary care patients with T2D, but did not influence the achievement of T2D treatment goals.
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Diabetes Mellitus Tipo 2 , Dolor Musculoesquelético , Presión Sanguínea/fisiología , Estudios Transversales , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Hemoglobina Glucada/análisis , Humanos , Dolor Musculoesquelético/complicaciones , Dolor Musculoesquelético/diagnóstico , Dolor Musculoesquelético/epidemiología , Atención Primaria de SaludRESUMEN
STUDY DESIGN: Cross-sectional. OBJECTIVE: To study the associations between a family history of surgically treated low back pain (LBP) and adolescent LBP. SUMMARY OF BACKGROUND DATA: A family history of LBP is related to adolescent LBP, but whether a family history of back surgery is relevant to adolescent LBP is not known. METHODS: A subpopulation of the Northern Finland Birth Cohort 1986 was contacted when they were aged between 18 and 19years. The postal questionnaire asked the participants to report their LBP and a relative's (mother, father, sibling) LBP and back surgery, and to provide data on potential covariates. The association between a family history of LBP ("no family history of LBP," "family history of LBP but no surgery," and "family history of LBP and surgery") and adolescent LBP (no LBP, occasional LBP, and frequent LBP) were evaluated using logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for sex, smoking, and psychological distress. RESULTS: Of the 1374 adolescents in the study, 33% reported occasional LBP and 9% frequent LBP. Both the "family history of LBP but no surgery" and "family history of LBP and surgery" categories were associated with frequent LBP (adjusted OR [aOR] 2.09, 95% CI 1.38-3.16; aOR 2.23, 95% CI 1.02-4.90, respectively). Occasional LBP was associated with the "family history of LBP and surgery" category. A subgroup analysis of adolescents with a family history of LBP found no statistically significant associations between family history of back surgery and adolescent LBP. CONCLUSION: Our findings suggest that adolescents who report a family history of LBP have higher odds of frequent LBP irrespectively of a family history of back surgery.Level of evidence: 4.
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Dolor de la Región Lumbar , Adolescente , Adulto , Estudios Transversales , Humanos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/epidemiología , Dolor de la Región Lumbar/genética , Oportunidad Relativa , Factores de Riesgo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: To study the association of personalised care plans with monitoring and controlling clinical outcomes, prescription of cardiovascular and antihyperglycaemic medication and utilisation of primary care services in patients with type 2 diabetes (T2D). PATIENTS: Primary care T2D outpatients from the Rovaniemi Health Centre. SETTING: The municipal health centre, Rovaniemi, Finland. DESIGN: A cross-sectional, observational, retrospective register-based study. The patients were divided into three groups: 'no care plan entries' (usual care); '1-2 care plan entries'; and '3 or more care plan entries'. MAIN OUTCOME MEASURES: Monitoring of clinical and biochemical measures, achievement of treatment targets, prescription of cardiovascular and antihyperglycemic medication, and use of primary care services. RESULTS: A total of 5104 patients with T2D (mean age 65.5 years (SD 12.4)), of which 67% had at least one care plan entry. Compared to usual care, the establishment of a care plan (either care plan group) was associated with better monitoring of glycosylated haemoglobin A1c, low-density-lipoprotein cholesterol, systolic blood pressure (sBP), and renal function, and there was more frequent prescription of all cardiovascular and antihyperglycemic medication. Patients in either care plan group were more likely to achieve sBP target (p < 0.05). Patients without a care plan had more unplanned primary care physician contacts compared to patients in care plan groups (p < 0.001). CONCLUSION: Establishment of a care plan is associated with more intensive and focussed care of patients with T2D. The appropriate use of primary care resources is essential and personalised care plans may contribute to the treatment of patients with T2D.Key PointsCare planning aims to empower patients with type 2 diabetes. This study demonstrates that personalised care planning is associated withmore frequent monitoring for clinical outcomes,more frequent prescription of cardiovascular and antihyperglycemic medication andmore frequent utilisation of planned diabetes consultations when compared to usual care.
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Diabetes Mellitus Tipo 2 , Anciano , Estudios Transversales , Diabetes Mellitus Tipo 2/terapia , Hemoglobina Glucada/análisis , Humanos , Hipoglucemiantes/uso terapéutico , Prescripciones , Atención Primaria de Salud , Estudios RetrospectivosRESUMEN
Aims: Rates of parental separation have increased dramatically in recent decades. We evaluated the association of individuals' childhood family structure with their somatic health over 46 years of follow-up. Methods: Data were drawn from the Northern Finland Birth Cohort, an ongoing project in which 12,058 participants born in 1966 have been followed from their 24th gestational week. Based on information supplied at age 14 years, family structure was categorised as 'single-parent family' and 'two-parent family'. The anthropometric information, data from blood samples and medical history were collected from postal questionnaires and clinical examinations routinely performed at the ages of 31 and 46 years. Results: The study population comprised a total of 10,895 individuals; 85% (n=9253) were offspring of two-parent families and 15% (n=1642) of single-parent families. Type 2 diabetes (P=0.032) or prediabetes (P=0.007), psychoactive drug problems (P<0.001) and sexually transmitted diseases (P<0.001) were more common in the single-parent family group than in the participants from two-parent families. In addition, among men back diseases (P=0.002), and among women hypertension (P=0.003) and ovary infection (P=0.024) were more frequent in individuals affected by parental death than in those from two-parent families. Conclusions: Our results indicate the association of childhood family structure with offspring morbidity during 46 years' follow-up. The lifetime morbidity was observed to be higher among offspring from a single-parent family compared to two-parent family offspring. Public and scientific concern about the consequences of parental separation on the offspring' health exist, therefore support from healthcare professionals and society is warranted.
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Cohorte de Nacimiento , Diabetes Mellitus Tipo 2 , Adolescente , Adulto , Estudios de Cohortes , Femenino , Finlandia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , PadresRESUMEN
BACKGROUND: Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP). METHODS: The study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients' records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets. RESULTS: Altogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01-1.70) and belonging to the Concordant (OR 1.45, CI 1.08-1.95) and Concordant and discordant (OR 1.31, CI 1.00-1.72) subgroups was associated with achievement of the HbA1c treatment target. Belonging to the Concordant and discordant subgroup was related to meeting the LDL treatment target (OR 1.31, CI 1.00-1.72). CONCLUSIONS: Multimorbidity, including cardiovascular risk and the musculoskeletal disease burden, was extremely prevalent among the T2D patients who consulted primary health care. Primary care clinicians should survey the possible co-existence of long-term diseases among T2D patients to help maintain adequate treatment of T2D.
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Diabetes Mellitus Tipo 2 , Objetivos , Estudios Transversales , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Humanos , Multimorbilidad , Atención Primaria de SaludRESUMEN
BACKGROUND: Empathy and self-reflection have been studied among medical students, but fewer studies have examined the presence of these attributes among dental students and investigated the correlation between empathy and self-reflection. METHODS: First-year dental and medical students (n = 198) beginning their studies at the University of Oulu, Finland in August 2017 participated in this study, which was conducted via an internet-based questionnaire. Data were collected on personal characteristics and scores on Davis's Interpersonal Reactivity Index (IRI) and Roberts's Self Reflection and Insight Scale (SRIS). RESULTS: Differences in IRI scores between dental and medical students were significant only in male students and in two IRI domains. Mean (SD) scores for male dental and medical students were personal distress, 8.2 (4.0) and 10.7 (3.1) (p = 0.022); empathic concern, 15.0 (4.0) and 16.9 (3.5) (p = 0.054). Mean SRIS scores did not differ between sexes or training programs. Positive correlations (r = - 0.3-0.65) were observed between some empathy and self-reflection subscales. CONCLUSIONS: A lower degree of empathy was observed among male dental students than in male medical students. A positive correlation between empathy and self-reflection was demonstrated in both study groups and sexes. However, more research in this field is warranted.
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Empatía , Estudiantes de Medicina , Finlandia , Humanos , Masculino , Encuestas y CuestionariosRESUMEN
BACKGROUND: We have previously suggested that some of the mutations defining mitochondrial DNA (mtDNA) haplogroups J and K produce an uncoupling effect on oxidative phosphorylation and thus are detrimental for elite endurance performance. Here, the association between haplogroups J and K and physical performance was determined in a population-based cohort of 1036 Finnish military conscripts. RESULTS: Following a standard-dose training period, excellence in endurance performance was less frequent among subjects with haplogroups J or K than among subjects with non-JK haplogroups (p = 0.041), and this finding was more apparent among the best-performing subjects (p < 0.001). CONCLUSIONS: These results suggest that mtDNA haplogroups are one of the genetic determinants explaining individual variability in the adaptive response to endurance training, and mtDNA haplogroups J and K are markers of low-responders in exercise training.
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Personal Militar , ADN Mitocondrial/genética , Ejercicio Físico , Finlandia , Haplotipos , HumanosRESUMEN
AIMS: To estimate the prevalence of chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) in Finnish primary healthcare, and to evaluate the screening for CKD and the proportions of patients receiving antihyperglycemic and cardiovascular preventive medication. MATERIAL AND METHODS: T2D patients treated at the Rovaniemi Health Center, Finland during the years 2015-2019. Data included patient characteristics, blood pressure, HbA1c, lipid levels, kidney function and albuminuria, and medications prescribed. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.72 m2 and/or albuminuria. RESULTS: The study population comprised of 5112 T2D patients with a mean (SD) age of 66.7 (13.0) years. Of these, 60.2% were screened for CKD with both eGFR and albuminuria, and 30.1% of these patients had CKD. The prevalence of moderately increased and severely increased albuminuria was 19.6% and 3.2%, respectively. A total of 57.0% of the study population received angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB). CONCLUSIONS: Screening for CKD with both recommended measures (eGFR and albuminuria) was insufficiently performed among this T2D population. Additionally, just over half of the study population had been prescribed ACE inhibitors or ARB. These results suggest an incongruity between the gold standard of diabetes care and real-world clinical practice.
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Antagonistas de Receptores de Angiotensina , Inhibidores de la Enzima Convertidora de Angiotensina , Diabetes Mellitus Tipo 2 , Insuficiencia Renal Crónica , Anciano , Albuminuria/diagnóstico , Albuminuria/epidemiología , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Finlandia/epidemiología , Tasa de Filtración Glomerular , Humanos , Riñón/fisiología , Prevalencia , Atención Primaria de Salud , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiologíaRESUMEN
Objective: To analyze the clinical outcomes of patients with type 2 diabetes (T2D) before and after implementation of a personalized care plan in the primary health care setting. Design: Observational, retrospective, real-world study. Setting: All T2D patients with a care plan in Rovaniemi Health Center, Rovaniemi, Finland, for whom data were available from a baseline visit (in 2013-2015 during which the care plan was written) and from a follow-up visit, including an updated care plan by the year 2017. Subjects: In total, 447 patients were included. Mean age was 66.9 (SD 10.1) years, 58.8% were male, 15.4% were smokers, 33.1% had vascular disease, and 17.0% were receiving insulin treatment. The mean follow-up time was 14.4 months. Main Outcome Measures: Glycosylated hemoglobin A1 (HbA1c), low-density lipoprotein (LDL), blood pressure (BP), and body mass index (BMI). Clinical values were taken at both baseline and follow-up. Results: LDL decreased by 0.2 mmol/L, systolic blood pressure by 2.2 mm Hg, diastolic blood pressure by 1.5 mm Hg, and BMI by 0.5 kg/m2 (P < .05 for each). The decrease in HbA1c was 0.8 mmol/mol (P = .07). Conclusion: We observed statistically significant decreases in LDL, BP, and BMI. Our results indicate that, over 14 months of follow-up, implementation of a written care plan was associated with small improvements in the clinical outcomes of T2D patients in a primary health care study population in a real-world setting.
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Diabetes Mellitus Tipo 2 , Anciano , Presión Sanguínea , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Finlandia , Hemoglobina Glucada/análisis , Humanos , Masculino , Estudios RetrospectivosRESUMEN
OBJECTIVES: Our aim in this study was to determine whether the use of a personalized care plan is associated with better clinical outcomes of type 2 diabetes treatment in the real world. METHODS: Quality of treatment was assessed using data from a yearly sample of patients with type 2 diabetes visiting primary care health centres in 2012-2016. Patients were divided into 3 groups as follows: 1) the patient has a copy of their personalized care plan, 2) the care plan exists in the patient record only or 3) the patient has no care plan. Data on smoking, laboratory tests, systolic blood pressure (sBP) and statin use were collected. We compared the outcomes between the 3 groups in terms of proportions of patients achieving the clinical targets recommended by international guidelines. RESULTS: Evaluable data were available for 10,403 patients. Of these, 1,711 (16%) had a copy of their personalized care plan, and 3,623 (35%) had no care plan. Those patients who had a copy of their care plan were significantly more likely than those without to achieve the sBP target (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.29 to 1.51; p<0.001; adjusted for age and gender) and low-density lipoprotein target (OR, 1.46; 95% CI, 1.34 to 1.58; p<0.001), and to use statins (OR, 1.70; 95% CI, 1.57 to 1.85; p<0.001). CONCLUSIONS: Patients who had a copy of their care plan had a better control of sBP and low-density lipoprotein, and were more likely to use statins than patients without a care plan.
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Diabetes Mellitus Tipo 2 , Atención Dirigida al Paciente , Anciano , Anciano de 80 o más Años , Presión Sanguínea/fisiología , LDL-Colesterol/sangre , Estudios Transversales , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Masculino , Persona de Mediana Edad , Factores de Riesgo , Fumar , Resultado del TratamientoRESUMEN
Higher physical activity is associated with a reduced hazard for a plethora of diseases. It has remained unknown how the two primary physical activity-associated health effects, improved physical performance and change in body composition, independently modulate metabolic profiles toward a reduced risk for adverse outcomes. Here, we utilized a prospective cohort of 664 young men undergoing military service. We studied the metabolic associations of changes in muscle performance and body composition during military service (range 6-12 mo). We subsequently replicated our results for body composition change in 234 population-based samples with a 7-yr follow-up. We found that increased physical performance was associated with reduced very-low-density lipoprotein (VLDL)-related measures [change in VLDL cholesterol: beta = -0.135; 95% confidence interval (CI) = -0.217, -0.054, P = 1.2 × 10-3] and lower inflammation (change in glycoprotein acetyls: beta = -0.138, 95% CI = -0.217, -0.059, P = 6.5 × 10-4), independent of change in body composition. Lower body fat percentage, independent of change in muscle performance, was associated with metabolic changes including lower low-density lipoprotein (LDL) cholesterol measures (change in LDL cholesterol: beta = -0.193, 95% CI = -0.295, -0.090; P = 2.5 × 10-4), increased high-density lipoprotein (HDL) cholesterol measures (change in large HDL cholesterol: beta = 0.316, 95% CI = 0.205, 0.427; P = 3.7 × 10-8), and decreased concentrations of amino acids (change in leucine concentration: beta = -0.236, 95% CI = -0.341, -0.132; P = 1.0 × 10-5) that are type 2 diabetes biomarkers. Importantly, all body fat percentage associations were replicated in a general population-based cohort. Our findings indicate that improved muscle performance showed weaker associations on the metabolic profiles than change in body composition and reduction in body fat percentage reduces cardiometabolic risk mediated by atherogenic lipoprotein particles and branched-chain and aromatic amino acid concentrations.
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Composición Corporal , Diabetes Mellitus Tipo 2/metabolismo , Cardiopatías/metabolismo , Músculo Esquelético/fisiología , Rendimiento Físico Funcional , Tejido Adiposo , Adolescente , Adulto , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/metabolismo , HDL-Colesterol/metabolismo , LDL-Colesterol/metabolismo , VLDL-Colesterol/metabolismo , Estudios de Cohortes , Diabetes Mellitus Tipo 2/epidemiología , Impedancia Eléctrica , Finlandia , Cardiopatías/epidemiología , Humanos , Inflamación , Leucina/metabolismo , Masculino , Personal Militar , Estudios Prospectivos , Riesgo , Adulto JovenRESUMEN
AIMS: To evaluate the influences of alcohol consumption frequency and binge drinking on changes in the body composition, lifestyle habits and physical fitness of healthy young men during military service. METHODS: A population-based study of men performing their military service in the Sodankylä Jaeger Brigade, Finland in 2005. Body composition, fitness and lifestyle habits were evaluated at baseline and 6-12 months follow-up. Alcohol consumption frequency and binge drinking were categorized as: 'not at all', 'at least once a month' and 'at least once a week'. RESULTS: Data were available for 983 participants. Mean (SD) age was 19.2 (1.0) years. At baseline, participants who reported binge drinking at least once a week (29.8%) had the most unfavourable body composition, lifestyle habits and physical fitness compared with the group with no binge drinking. Significant (P < 0.05) mean reductions in % body fat (-2.3%) and weight (-1.8 kg), as well as improvements in lifestyle habits and physical fitness were observed in the weekly binge drinking group during the military service. The reductions in relative weight (%) and % body fat were associated with binge drinking at least once a week (regression coefficient for relative weight -1.39, 95% CI [-2.32; -0.45], P = 0.004, and for % body fat -0.68, 95% CI [-1.35; -0.01], P = 0.049). CONCLUSION: Frequent binge drinking is associated with poorer body composition, lifestyle habits and fitness among young men. Frequent binge drinkers may obtain the greatest benefit of military-service-based exercise intervention, as reflected in the improvements in body composition, lifestyle habits and physical fitness. SHORT SUMMARY: Frequent binge drinking is associated with poorer body composition, lifestyle habits and fitness among young men. The greatest benefit of military service comprehending exercise intervention was observed among those with binge drinking once a week at the baseline, with favourable changes in lifestyle factors, body composition and fitness.
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Consumo de Bebidas Alcohólicas , Consumo Excesivo de Bebidas Alcohólicas , Composición Corporal , Personal Militar , Adiposidad , Adolescente , Adulto , Peso Corporal , Ejercicio Físico , Femenino , Finlandia , Humanos , Estilo de Vida , Masculino , Aptitud Física , Población , Valor Predictivo de las Pruebas , Adulto JovenRESUMEN
BACKGROUND: Several studies indicate a great need for improvement in the care of atrial fibrillation (AF). Failures in antitrombotic treatment can result in stroke. MATERIAL: A sample of consecutive patients with AF was gathered from eleven health centers (1,156 patients). RESULTS: 57.5% of all warfarin-treated patients (N = 1 125) were in good balance of anticoagulation. Of patients who had INR (International Normalized Ratio) for a period of at least 90 days (N = 531), 75.3% were in good balance. Severe symptoms of AF were experienced by 5.0% of patients. CONCLUSIONS: Treatment of AF has to be improved, especially in anticoagulation. Anticoagulation should simply be stopped or new anticoagulants should be used, if intensifying of warfarin treatment is not successful.