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1.
J Affect Disord ; 259: 150-153, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31445341

RESUMO

PURPOSE: The study aim was to examine association between leisure time physical activity (LTPA) and psychiatric comorbidities among people with depression. METHODS: Total 447 patients aged 35 years and older suffering from depressive symptoms (DS) and who were confirmed depression positive participated this study. The study was conducted between 2008 and 2011 in municipalities within Central Finland Hospital District. DS were determined with Beck Depression Inventory (BDI-21) with cutoff score ≥10 and psychiatric diagnoses were confirmed by Mini-International Neuropsychiatric Interview (M.I.N.I.). LTPA, other diseases as well as use of antidepressant were captured by self-reported questionnaire. Participants also took part in physical examination. The associations between LTPA and psychiatric comorbidities were analyzed using generalized linear models. RESULTS: LTPA level was not related to number of psychiatric comorbidities (after adjustment for age, gender, BMI, BDI and use of antidepressant p = 0.24) among depressed patients. The higher levels of LTPA were linearly associated with lower cardiovascular diseases (p = 0.036) and obesity (p = 0.006) as well as fewer DS (p < 0.001) among depressed patients. LIMITATIONS: Possibility of LTPA level overestimation and study results generalizability to younger persons. CONCLUSIONS: According to this study, LTPA level is not associated with psychiatric comorbidities among depressed patients in Finnish adult population. However, our results showed that the higher the LTPA level was, the less the participants suffered from depressive symptoms. In addition, higher levels of physical activity were associated with fewer heart diseases and obesity outlining the importance of overall health-care and health promotion although other forms of treatment are also needed.

2.
Scand J Prim Health Care ; 37(3): 312-318, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31317810

RESUMO

Objective: To examine health service (HS) utilization profiles among a non-depressive population and patients with depressive symptoms (DS) with and without clinical depression. Design, subjects and setting: The study population was based on primary care patients with DS scoring ≥10 in the 21-item Beck Depression Inventory (BDI) and who were at least 35 years old and had been referred to depression nurse case managers (n = 705). Their psychiatric diagnosis was confirmed with the Mini-International Neuropsychiatric Interview (M.I.N.I.). Of these patients, 447 had clinical depression. The number of patients with DS without clinical depression was 258. The control group consisted of a random sample of 414 residents with a BDI score < 10. Use of HS (visits and phone calls to a doctor and a nurse) was based on patient records. Main outcome measures: Number of visits and calls to physicians and nurses. Results: Patients with DS regardless of their depression diagnosis used primary health care (PHC) services three times more than the controls (p < 0.001). In the secondary care, the differences were smaller but significant. Of the controls, 70% had 0-4 HS contacts per year whereas a majority of the patients having DS had more than 5 contacts per year. The number of contacts correlated with the BDI from a score of 0 to 10 but not as clearly in the higher scores. Conclusion: Depressive symptoms, both with or without clinical depression, are associated with increased HS use, especially in PHC. This study suggests that even mild depressive symptoms are associated with an increased use of HS. KEY POINTS We analyzed the health service (HS) use among primary health care patients screened for depression and non-depressive population. Screen positive patients without clinical depression used as much HS as those having clinical depression. Regardless of depression diagnosis, screen positive patients visited a GP and nurse three times more often than the control population. In the screen negative control population, milder depressive symptoms were correlated with the use of HS. Primary health care was responsible for most of the HS use among patients having depressive symptoms.

3.
Nord J Psychiatry ; 73(3): 195-199, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30929594

RESUMO

BACKGROUND: Screening of depression has been recommended in primary care and Beck's 21-item Depression Inventory (BDI-21) is a commonly used tool for screening. Depression has been shown to be frequently accompanied by comorbidities. AIMS: This study aimed to analyze the characteristics, psychiatric diagnoses, and psychiatric comorbidity of primary care patients who have been screened for depression and referred to a depression nurse. METHODS: The study subjects were primary care patients aged ≥ 35 years with depressive symptoms (BDI-21 > 9). Their psychiatric diagnosis were based on a diagnostic interview (Mini-International Neuropsychiatric Interview; M.I.N.I.) conducted by a trained study nurse. RESULTS: Of the 705 study subjects, 617 (87.5%) had at least one and 66.1% had at least two psychiatric diagnoses. The most common diagnosis was depression (63.4%). The next most common diagnoses were generalized anxiety disorder (GAD) (48.1%) and panic disorder (22.8%). Only 8.8% of the study subjects had depression without other psychiatric disorders. Ten percent of the subjects had both depression and a generalized anxiety disorder (GAD). Also other psychiatric comorbidities were common. Age was inversely associated with the psychiatric diagnosis in the M.I.N.I. CONCLUSIONS: This study suggests that most of the primary care patients with increased depressive symptoms have a psychiatric disorder. Although depression is the most common diagnosis, there are several other concurrent psychiatric comorbidities. Therefore, diagnostic assessment of primary care patients with a screening score over 9 in the BDI-21 should be reconsidered.


Assuntos
Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Transtornos Mentais/psicologia , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Idoso , Comorbidade , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica
4.
J Psychosom Res ; 115: 1-5, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30470307

RESUMO

BACKGROUND: Restless legs syndrome is a sensorimotor disorder associated with several mental illnesses particularly depression. METHODS: A cross-sectional study of primary care patients. The prevalence of restless legs symptoms was studied in 706 patients with depressive symptoms and 426 controls without a psychiatric diagnosis by using a structured questionnaire. The depressive symptoms were evaluated with the BDI and the psychiatric diagnosis was confirmed by means of a diagnostic interview (M.I.N.I.). The subjects with elevated depressive symptoms were divided into two groups subjects with depressive symptoms with and without clinical depression. RESULTS: The prevalence of restless legs symptoms was 24.8% in the controls, 50.0% in the patients with clinical depression and 42.4% in the patients with depressive symptoms. CRP value was significantly higher (p = .003) in the clinically depressed patients than in the other groups. There was a higher concentration of TNF-α in the subjects with restless legs symptoms (7.4 ng/l ±â€¯3.2) compared with the subjects without symptoms (6.7 ng/l ±â€¯2.3)(p < .001). There was a significant difference in the TNF-α levels between the subjects with and without restless legs symptoms in the depression group (p < .001) and among the patients with depressive symptoms but no a depression diagnosis (p = .022). In these groups, restless legs symptoms were associated with elevated levels of TNF-α. CONCLUSIONS: TNF-α level was associated with restless legs symptoms only among subjects with depressive symptoms whether they had clinical depression or not. We suggest that TNF-α could be an underlying factor between restless legs symptoms and comorbidities.

5.
Lipids Health Dis ; 17(1): 10, 2018 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-29321013

RESUMO

BACKGROUND: Alterations in lipoprotein size are associated with increased cardiovascular disease risk. Higher hemoglobin levels may indicate a higher risk of atherosclerosis and was previously associated with obesity, metabolic syndrome, and insulin resistance. No previous studies have investigated an association between hemoglobin concentration and lipoprotein particle size. METHODS: We conducted a population-based, cross-sectional study of 766 Caucasian, middle-aged subjects (341 men and 425 women) born in Pieksämäki, Finland, who were categorized into five age groups. The concentrations and sizes of lipoprotein subclass particles were analyzed by high-throughput nuclear magnetic resonance (NMR) spectroscopy. RESULTS: Larger very low density lipoprotein (VLDL) particle diameter was associated with higher hemoglobin concentrations in men (p = 0.003). There was a strong relationship between smaller high density lipoprotein (HDL) particle size and higher hemoglobin concentration in both men and women as well as with smaller low density lipoprotein (LDL) particle size and higher hemoglobin concentration in men and women (p < 0.001; p = 0.009, p = 0.008). VLDL particle concentration had a moderate positive correlation with hemoglobin concentration (r = 0.15; p < 0.001). LDL particle concentration showed a statistical trend suggesting increasing particle concentration with increasing hemoglobin levels (r = 0.08; p = 0.05). CONCLUSION: Higher hemoglobin levels are associated with larger VLDL, smaller LDL, and smaller HDL particle sizes and increasing amounts of larger VLDL and smaller LDL particles. This suggests that a higher hemoglobin concentration is associated with an unfavorable lipoprotein particle profile that is part of states that increase cardiovascular disease risk like diabetes and metabolic syndrome.


Assuntos
Hemoglobinas/metabolismo , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Lipoproteínas VLDL/sangue , Idoso , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus/diagnóstico , Feminino , Finlândia , Humanos , Resistência à Insulina , Masculino , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Tamanho da Partícula , Fatores de Risco , Triglicerídeos/sangue
6.
Nord J Psychiatry ; 72(1): 51-56, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28990833

RESUMO

BACKGROUND: Restless legs syndrome is a sensorimotor disorder and it is associated with several other diseases especially mental illnesses. AIMS: To analyze the relationship between the symptoms of restless legs syndrome and the severity of depressive symptoms and the prevalence of restless legs symptoms in depression subtypes. METHODS: A cross-sectional study of primary care patients in the Central Finland Hospital District. The prevalence of restless legs symptoms was studied in 706 patients with increased depressive symptoms and 426 controls without a psychiatric diagnosis by using a structured questionnaire. The depressive symptoms were evaluated with the Beck Depression Inventory (BDI) and the psychiatric diagnosis was confirmed by means of a diagnostic interview (Mini-International Neuropsychiatric Interview). The subjects with increased depressive symptoms were divided into three groups (subjects with depressive symptoms without a depression diagnosis, melancholic depression and non-melancholic depression). RESULTS: In the whole study population, the prevalence of restless legs symptoms increased with the severity of depressive symptoms. The prevalence of restless legs symptoms was highest in the melancholic and non-melancholic depressive patients (52 and 46%, respectively) and then in subjects with depressive symptoms without a depression diagnosis (43.4%), but the prevalence was also substantial (24.6%) in subjects without a psychiatric diagnosis. CONCLUSIONS: Restless legs symptoms are very common in primary care among subjects with depression, regardless of the depression type. The prevalence of restless legs symptoms increased with increasing severity of depressive symptoms, regardless of the diagnosis. These findings should be considered in clinical evaluation and treatment of patients visiting their physician due to restless legs or depressive symptoms.


Assuntos
Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Síndrome das Pernas Inquietas/epidemiologia , Síndrome das Pernas Inquietas/psicologia , Adulto , Estudos Transversais , Transtorno Depressivo/diagnóstico , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde/métodos , Escalas de Graduação Psiquiátrica , Síndrome das Pernas Inquietas/diagnóstico , Inquéritos e Questionários
7.
JMIR Mhealth Uhealth ; 5(5): e74, 2017 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-28550004

RESUMO

BACKGROUND: While gains in reducing smoking rates in Finland have been made, prevalence rates are still substantial. Relapse rates among smokers engaged in quit-smoking programs are high. Physical activity has been proposed as one means to help smokers manage cravings. Software and apps on mobile phone and handheld devices offer an opportunity to communicate messages on how to use physical activity to manage cravings as part of quit-smoking programs. OBJECTIVE: We aimed to test the feasibility, acceptability, usability, and preliminary efficacy of an mHealth mobile phone app, Physical activity over Smoking (PhoS), to assist smokers in quitting smoking in a randomized controlled trial. The app was designed to prompt smokers to engage in physical activities to manage their smoking cravings. METHODS: Regular smokers (n=44) attended a group-based behavioral counselling program aimed at promoting physical activity as an additional aid to quit. After quit day, participants were randomly allocated to an intervention (n=25) or to a comparison (n=19) group. Participants in the intervention group were provided with the PhoS app and training on how to use it to assist with relapse prevention. Participants in the comparison condition were provided with generalized relapse prevention training. RESULTS: Some participants reported that the PhoS app was useful in assisting them to successfully manage their cigarette cravings, although compliance across the sample was modest and participants reported low levels of usability. Participants receiving the PhoS app did not report greater abstinence than those who did not receive the app. However, participants receiving the app were more likely to report greater abstinence if they did not use pharmacological support, while those who did not receive the app reported greater abstinence when using pharmacological support. Participants receiving the app reported greater levels of physical activity than those who did not. Results revealed that the app resulted in better retention. CONCLUSIONS: The PhoS app showed some potential to reduce abstinence among participants not using pharmacological therapy and to increase physical activity. However, problems with usability and lack of effects on abstinence raise questions over the app's long-term effectiveness. Future research should prioritize further development of the app to maximize usability and test effects of the intervention independent of quit-smoking programs. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 55259451; http://www.controlled-trials.com/ISRCTN55259451 (Archived by WebCite at http://www.webcitation.org/6cKF2mzEI).

8.
Pain Med ; 18(2): 341-347, 2017 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-28204727

RESUMO

Objective: Pain and depressive disorders often present together, but little is known about the prevalence of pain in depression subgroups. The objective of this study was to examine the possible differences in the prevalence of musculoskeletal pain between participants in melancholic and atypical depression subgroups. Design: Cross-sectional study. Setting: Depression nurse case managers where depression patients receive treatment in primary health care. Subjects: Participants included 413 depression patients and 401 controls. Methods: Depressive symptoms were determined with the Beck Depression Inventory (BDI-21), and diagnosis of depression was confirmed with the Mini-International Neuropsychiatric Interview (MINI). The participants were dichotomized into subgroups with melancholic depression (n = 269), atypical depression (n = 144), and controls (n = 401). Musculoskeletal pain was identified during last four weeks. Participants were enrolled in the study between 2008 and 2009. Results: The prevalence of pain was 37% in controls, 57% in atypical depression, and 71% in melancholic depression (P < 0.001, after adjusting for sex and age). A logistic regression model showed that the odds ratio of pain after adjusting for confounding factors was 2.35 (1.56 to 3.56) with atypical depression compared with controls (P < 0.001) and 4.38 (3.03 to 6.33) with melancholic depression compared with atypical depression (P = 0.006). BDI scores were higher for those with melancholic depression than for those with atypical depression (P < 0.001). Conclusions: Melancholic depression showed to be associated with a higher prevalence of musculoskeletal pain in comparison with atypical depression. This finding highlights the need for further studies about the mechanisms behind the association, particularly in melancholic depression.


Assuntos
Transtorno Depressivo/psicologia , Dor Musculoesquelética/epidemiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
9.
J Am Coll Cardiol ; 67(10): 1200-1210, 2016 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-26965542

RESUMO

BACKGROUND: Statins are first-line therapy for cardiovascular disease prevention, but their systemic effects across lipoprotein subclasses, fatty acids, and circulating metabolites remain incompletely characterized. OBJECTIVES: This study sought to determine the molecular effects of statin therapy on multiple metabolic pathways. METHODS: Metabolic profiles based on serum nuclear magnetic resonance metabolomics were quantified at 2 time points in 4 population-based cohorts from the United Kingdom and Finland (N = 5,590; 2.5 to 23.0 years of follow-up). Concentration changes in 80 lipid and metabolite measures during follow-up were compared between 716 individuals who started statin therapy and 4,874 persistent nonusers. To further understand the pharmacological effects of statins, we used Mendelian randomization to assess associations of a genetic variant known to mimic inhibition of HMG-CoA reductase (the intended drug target) with the same lipids and metabolites for 27,914 individuals from 8 population-based cohorts. RESULTS: Starting statin therapy was associated with numerous lipoprotein and fatty acid changes, including substantial lowering of remnant cholesterol (80% relative to low-density lipoprotein cholesterol [LDL-C]), but only modest lowering of triglycerides (25% relative to LDL-C). Among fatty acids, omega-6 levels decreased the most (68% relative to LDL-C); other fatty acids were only modestly affected. No robust changes were observed for circulating amino acids, ketones, or glycolysis-related metabolites. The intricate metabolic changes associated with statin use closely matched the association pattern with rs12916 in the HMGCR gene (R(2) = 0.94, slope 1.00 ± 0.03). CONCLUSIONS: Statin use leads to extensive lipid changes beyond LDL-C and appears efficacious for lowering remnant cholesterol. Metabolomic profiling, however, suggested minimal effects on amino acids. The results exemplify how detailed metabolic characterization of genetic proxies for drug targets can inform indications, pleiotropic effects, and pharmacological mechanisms.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Previsões , Hidroximetilglutaril-CoA Redutases/genética , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Análise da Randomização Mendeliana/métodos , Metabolômica/métodos , Adulto , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/genética , Feminino , Finlândia , Humanos , Hidroximetilglutaril-CoA Redutases/sangue , Hidroximetilglutaril-CoA Redutases/efeitos dos fármacos , Espectroscopia de Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reino Unido
10.
JMIR Res Protoc ; 4(4): e125, 2015 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-26494256

RESUMO

BACKGROUND: Results from studies on the effects of exercise on smoking-related variables have provided strong evidence that physical activity acutely reduces cigarette cravings. Mobile technology may provide some valuable tools to move from explanatory randomized controlled trials to pragmatic randomized controlled trials by testing the acute effectiveness of exercise on quitters under real-life conditions. An mHealth app was developed to be used as a support tool for quitters to manage their cigarette cravings. OBJECTIVE: The primary aim of this paper is to present the protocol of a study examining the effectiveness of the Physical over smoking app (Ph.o.S) by comparing the point prevalence abstinence rate of a group of users to a comparator group during a 6-month follow-up period. METHODS: After initial Web-based screening, eligible participants are recruited to attend a smoking cessation program for 3 weeks to set a quit smoking date. Fifty participants who succeed in quitting will be randomly allocated to the comparator and experimental groups. Both groups will separately have 1 more counseling session on how to manage cravings. In this fourth session, the only difference in treatment between the groups is that the experimental group will have an extra 10-15 minutes of guidance on how to use the fully automated Ph.o.S app to manage cravings during the follow-up period. Data will be collected at baseline, as well as before and after the quit day, and follow-up Web-based measures will be collected for a period of 6 months. The primary efficacy outcome is the 7-day point prevalence abstinence rate, and secondary efficacy outcomes are number of relapses and cravings, self-efficacy of being aware of craving experience, self-efficacy in managing cravings, and power of control in managing cravings. RESULTS: Recruitment for this project commenced in December 2014, and proceeded until May 2015. Follow-up data collection has commenced and will be completed by the end of December 2015. CONCLUSIONS: If the Ph.o.S app is shown to be effective, the study will provide evidence for the use of the app as a support tool for people who are trying to manage cravings during smoking cessation programs. It is anticipated that the results of the study will provide knowledge of how physical activity affects cigarette craving in real-life situations and inform the development and delivery of relapse prevention in smoking cessation treatment. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN55259451; http://www.controlled-trials.com/ISRCTN55259451 (Archived by WebCite at http://www.webcitation.org/6cKF2mzEI).

11.
BMC Psychiatry ; 15: 163, 2015 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-26199013

RESUMO

BACKGROUND: Disturbances in lipid metabolism have been linked to suicidal behaviour, but little is known about the association between suicide risk and abnormal glucose metabolism in depression. Hyperglycaemia and hyperinsulinaemia may increase the risk of depression and also the risk for suicide, we therefore studied associations between suicidal behaviour and disturbances in glucose metabolism in depressive patients who had been referred to depression nurse case managers. METHODS: Patients aged 35 years and older (N = 448, mean age 51 years) who were experiencing a new depressive episode, who were referred to depression nurse case managers in 2008-2009 and who scored ≥10 on the Beck Depression Inventory were enrolled in this study. The study was conducted in municipalities within the Central Finland Hospital District (catchment area of 274 000 inhabitants) as part of the Finnish Depression and Metabolic Syndrome in Adults study. The patients' psychiatric diagnoses and suicidal behaviour were confirmed by the Mini-International Neuropsychiatric Interview. Blood samples, for glucose and lipid determinations, were drawn from participants after 12 h of fasting, which was followed by a 2-hour oral glucose tolerance test (OGTT) when blood was drawn at 0 and 2 h. Insulin resistance was measured by the Quantitative Insulin Sensitivity Check Index (QUICKI) method. RESULTS: Suicidal ideation (49 %) and previous suicide attempts (16 %) were common in patients with major depressive disorder or dysthymia. Patients with depression and suicidal behaviour had higher blood glucose concentrations at baseline and at 2 hours in the OGTT. Glucose levels associated positively with the prevalence of suicidal behaviour, and the linearity was significant at baseline (p for linearity: 0.012, adjusted for age and sex) and for 2-hour OGTT glucose (p for linearity: 0.004, adjusted for age and sex). QUICKI levels associated with suicidal behavior (p for linearity across tertiles of QUICKI: 0.026). Total and LDL cholesterol and triglyceride levels were also higher in those patients with suicidal behaviour. Multivariate analysis revealed that blood glucose levels, BDI scores and antidepressive medications associated with suicidal behaviour. CONCLUSION: Insulin resistance and disturbances in glucose and lipid metabolism may be more common in middle-aged depressive patients with suicidal behaviour.


Assuntos
Transtorno Depressivo Maior/psicologia , Resistência à Insulina/fisiologia , Síndrome Metabólica/psicologia , Ideação Suicida , Tentativa de Suicídio/psicologia , Adulto , Idoso , Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Métodos Epidemiológicos , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Tentativa de Suicídio/estatística & dados numéricos
12.
Artigo em Inglês | MEDLINE | ID: mdl-25987853

RESUMO

The association between thyroid function and depression is controversial. Both conditions express many similar symptoms, but the studies done give conflicting results. This study draws on a random, population-based sample of 4500 subjects aged 45-75 years old from Finland. The basic clinical study was done in 2007 for 1396 men and 1500 women (64% participation rate). Thyroid stimulating hormone (TSH), free thyroxine (F-T4), and free triiodothyronine (F-T3) were measured in 2013 from frozen samples. The 21-item Beck Depression Inventory (BDI-21) was applied to assess depressive symptoms (score ≥10 points). The prevalence of depressive symptoms was 17.5% in women and 12.5% in men. In women, the mean levels of TSH, F-T4, and F-T3 without depressive symptoms vs. with the presence of depressive symptoms were 1.92/1.97 mU/L, 13.1/13.1 pmol/L, and 3.91/3.87 pmol/L (NS), respectively. In men, the levels were 1.87/1.94 mU/L, 13.5/13.7 pmol/L, and 4.18/4.12 pmol/L (NS), respectively. In multiple regression analysis, TSH had no relationship to BDI-21 total score. We found no association between depressive symptoms and thyroid values.

13.
Eur J Cardiovasc Nurs ; 14(2): 145-52, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24452452

RESUMO

AIMS: The purpose of this study was to assess whether changes in self-rated physical activity and diet during a type 2 diabetes (T2D) prevention program were associated with changes in estimated 10-year risk for cardiovascular disease (CVD) events and mortality in people at high risk for T2D. METHODS: Individuals were identified and offered lifestyle counseling as part of the Finnish diabetes prevention program. Ten-year risk for estimated CVD events and mortality were calculated with Framingham Risk Score (FRS) and Systematic Coronary Risk Evaluation (SCORE) formula. FRS was available for 774 men and 1474 women and SCORE for 961 men and 1766 women. RESULTS: During the one-year follow-up, 9.6% of the men reported both an increase in physical activity and improved dietary pattern, 4.1% an increase in physical activity, 39.3% an increase in improved dietary pattern, while 47.0% reported no lifestyle changes. Corresponding numbers for women were 14.2%, 3.8%, 39.2% and 42.7%. Estimated 10-year risk for CVD events decreased 3.5% in men and 1.5% in women reporting an increase in physical activity and improvement in diet, compared to an increase of 0.15% in men (p<0.001, between groups) and decrease of 0.43% (p=0.027, between groups) in women with no lifestyle changes after adjustment for age and baseline FRS. Numbers needed to treat to prevent one CVD event by lifestyle changes were 25 for men and 59 for women. Lifestyle changes had no effect on estimated CVD mortality risk. CONCLUSIONS: Lifestyle counseling offered in primary health care for one year results in favorable changes in lifestyle, and lowered the estimated 10-year risk for CVD events.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Dieta , Exercício , Estilo de Vida , Atenção Primária à Saúde , Adulto , Diabetes Mellitus Tipo 2/psicologia , Aconselhamento Diretivo , Feminino , Finlândia , Seguimentos , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo
14.
Nord J Psychiatry ; 69(4): 262-7, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25363212

RESUMO

BACKGROUND: Disturbances in lipid and glucose metabolism are associated with depressive symptoms, and may increase suicidal behavior. AIMS: To investigate the prevalence of cardiometabolic risk factors, severity of depressive symptoms, and suicidal thoughts and previous attempts in patients referred to depression nurse case managers. METHODS: Blood cholesterol, triglyceride and glucose levels, depressive symptoms and suicidality were studied in 706 depressed participants and 426 controls. In addition, we compared the Beck Depression Inventory (BDI) with a diagnostic interview. RESULTS: 448 (63%) of the patients scoring ≥ 10 on BDI had major depression or dysthymic disorder, 258 had an anxiety or alcohol use disorder, 137 (19%) had two or more diagnoses in the Mini-International Neuropsychiatric Interview. Suicidal thoughts (49%) and previous suicide attempts (16%) were more common in patients with depressive disorders. Patients diagnosed with depression had highest BDI scores and higher blood glucose levels measured at baseline and at 2 h in the oral glucose tolerance test (OGTT). Both patient groups also had higher triglyceride levels compared with the controls. In addition, metabolic syndrome and type 2 diabetes were most common among the depressed participants. In the whole study population, levels of low-density lipoprotein-cholesterol as well as baseline and 2-h blood glucose in OGTT were higher among patients with suicidal behavior. CONCLUSIONS: Cardiometabolic risk factors and metabolic syndrome are common in patients with depression, and in patients with anxiety and alcohol use disorders. The results imply that disturbance in glucose metabolism may be associated with suicidal thoughts and previous attempts.


Assuntos
Depressão/psicologia , Diabetes Mellitus Tipo 2/psicologia , Síndrome Metabólica/psicologia , Enfermeiras Administradoras , Encaminhamento e Consulta , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/psicologia , Depressão/diagnóstico , Depressão/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Ideação Suicida , Suicídio/psicologia , Tentativa de Suicídio/psicologia
15.
PLoS Med ; 11(12): e1001765, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25490400

RESUMO

BACKGROUND: Increased adiposity is linked with higher risk for cardiometabolic diseases. We aimed to determine to what extent elevated body mass index (BMI) within the normal weight range has causal effects on the detailed systemic metabolite profile in early adulthood. METHODS AND FINDINGS: We used Mendelian randomization to estimate causal effects of BMI on 82 metabolic measures in 12,664 adolescents and young adults from four population-based cohorts in Finland (mean age 26 y, range 16-39 y; 51% women; mean ± standard deviation BMI 24 ± 4 kg/m(2)). Circulating metabolites were quantified by high-throughput nuclear magnetic resonance metabolomics and biochemical assays. In cross-sectional analyses, elevated BMI was adversely associated with cardiometabolic risk markers throughout the systemic metabolite profile, including lipoprotein subclasses, fatty acid composition, amino acids, inflammatory markers, and various hormones (p<0.0005 for 68 measures). Metabolite associations with BMI were generally stronger for men than for women (median 136%, interquartile range 125%-183%). A gene score for predisposition to elevated BMI, composed of 32 established genetic correlates, was used as the instrument to assess causality. Causal effects of elevated BMI closely matched observational estimates (correspondence 87% ± 3%; R(2)= 0.89), suggesting causative influences of adiposity on the levels of numerous metabolites (p<0.0005 for 24 measures), including lipoprotein lipid subclasses and particle size, branched-chain and aromatic amino acids, and inflammation-related glycoprotein acetyls. Causal analyses of certain metabolites and potential sex differences warrant stronger statistical power. Metabolite changes associated with change in BMI during 6 y of follow-up were examined for 1,488 individuals. Change in BMI was accompanied by widespread metabolite changes, which had an association pattern similar to that of the cross-sectional observations, yet with greater metabolic effects (correspondence 160% ± 2%; R(2) = 0.92). CONCLUSIONS: Mendelian randomization indicates causal adverse effects of increased adiposity with multiple cardiometabolic risk markers across the metabolite profile in adolescents and young adults within the non-obese weight range. Consistent with the causal influences of adiposity, weight changes were paralleled by extensive metabolic changes, suggesting a broadly modifiable systemic metabolite profile in early adulthood. Please see later in the article for the Editors' Summary.


Assuntos
Adiposidade/fisiologia , Peso Corporal/fisiologia , Análise da Randomização Mendeliana/métodos , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Adulto Jovem
16.
Diabetol Metab Syndr ; 6(1): 114, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25371712

RESUMO

BACKGROUND: The aim of this study was to investigate the relationship between changes in serum ferritin concentrations and the development of metabolic syndrome (MetS) and its components over a 6.5 year follow-up period in Finnish adults. METHODS: Adults born in Pieksämäki, Finland, in 1942, 1947, 1952, 1957, and 1962 (n = 1294) were invited to health checkups between 1997 and 1998 and 2003 and 2004. All of the required variables for both checkups were available from 691 (53%) subjects (289 men and 402 women). MetS was defined by the National Cholesterol Education Program criteria. RESULTS: During the 6.5-year follow-up period, 122 (18%) subjects developed incident cases of MetS. Increases in serum ferritin levels were significantly higher in both women and men with incident MetS compared with women and men without MetS (p = 0.04, p = 0.03). Also, serum ferritin levels increased significantly less in women in whom the criteria for MetS resolved during the follow-up period (p = 0.01). Increases in serum ferritin levels were significantly lower in women in whom the glucose criterion for MetS resolved, and higher in women for whom the waist criterion developed (p = 0.01 and p <0.001, respectively). Serum ferritin levels decreased significantly more in men in whom the triglyceride criterion for MetS resolved during the follow-up period (p = 0.01). There was a clear and significant correlation between change in serum ferritin level and change in waist circumference both in men and women (p <0.001, p <0.01). In addition, correlations between change in serum ferritin level and change in plasma triglyceride as well as glucose levels were strongly positive in men (p <0.001). There was negative correlation between change in serum ferritin and plasma high density cholesterol level both in men and women. CONCLUSIONS: Increases in serum ferritin over a 6,5 year period are associated with development of MetS in both men and women. Whereas, lower increases in serum ferritin over the same timeframe are associated with resolution of hypertriglyceridemia in men and hyperglycemia in women. Increases in waist circumference was positively correlated with increases in serum ferritin in both men and women.

17.
PLoS One ; 9(7): e100235, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25000408

RESUMO

OBJECTIVES: Low serum 25-hydroxyvitamin D (25OHD) level has been associated with an increased risk of several chronic diseases. Our aim was to determine lifestyle and clinical factors that are associated with 25OHD level and to investigate connection of 25OHD level with metabolic and cardiovascular disease markers. DESIGN: In total, 2868 Finnish men and women aged 45-74 years participated in FIN-D2D population-based health survey in 2007. Participants that had a serum sample available (98.4%; n = 2822) were included in this study. 25OHD was measured with chemiluminescent microparticle immunoassay method. RESULTS: The mean 25OHD level was 58.2 nmol/l in men (n = 1348) and 57.1 nmol/l in women (n = 1474). Mean 25OHD level was lower in the younger age groups than in the older ones (p<0.0001 both in men and women). This study confirmed that low physical activity (p<0.0001 both in men and women), smoking (p = 0.0002 in men and p = 0.03 in women) and high BMI (p<0.0001 in women) are factors that independently associate with low 25OHD level. Of the metabolic and cardiovascular disease markers high triglyceride concentration (p = 0.02 in men and p = 0.001 in women) and high apolipoprotein B/apolipoprotein A1 ratio (p = 0.04 in men and p = 0.03 in women) were independently associated with low 25OHD level. CONCLUSIONS: Higher age did not predict lower 25OHD level in this study population of aged 45-74 years which may derive from a healthy life-style of "active pensioners". Low physical activity and smoking came up as independent lifestyle factors associated with low 25OHD level. Defining the molecular mechanisms behind the associations of 25OHD with low physical activity and smoking are important objective in future studies. The association of 25OHD with BMI, high triglyceride concentration and apolipoprotein B/apolipoprotein A1 ratio may be related to the role of vitamin D in inflammation, but more detailed studies are needed.


Assuntos
Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/metabolismo , Estilo de Vida , Síndrome Metabólica/sangue , Síndrome Metabólica/epidemiologia , Vitamina D/análogos & derivados , Idoso , Biomarcadores/metabolismo , Estudos Transversais , Feminino , Finlândia/epidemiologia , Glucose/metabolismo , Humanos , Masculino , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Vitamina D/sangue
18.
Duodecim ; 130(9): 902-9, 2014.
Artigo em Finlandês | MEDLINE | ID: mdl-24881142

RESUMO

Especially low vitamin B12 or folate and low intake of omega-3-fatty acids, but also low vitamin D may associate with increased risk of depression. B12 and folate may also be useful in the treatment of depression. The importance of individual fatty acids is unclear. The causal relationship between depression and diet, the efficacy of vitamins or dietary supplements in the treatment of depression, or the impact of diet compared with other treatment options need to be scrutinized. An overall healthy diet rich in vitamin B12, D or folate and fish oils may have positive effect also on depression.


Assuntos
Depressão/dietoterapia , Ácidos Graxos Ômega-3/uso terapêutico , Ácido Fólico/uso terapêutico , Humanos , Vitamina B 12/uso terapêutico , Vitamina D/uso terapêutico
19.
J Womens Health (Larchmt) ; 23(6): 506-12, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24787505

RESUMO

BACKGROUND: Lifestyle interventions are effective in preventing type 2 diabetes (T2D). Women with history of gestational diabetes mellitus (GDM) may have barriers to lifestyle changes, and the previous results of lifestyle interventions are contradictory reporting either favorable outcomes or no significant beneficial effects. Our aim was to compare cardio-metabolic risk profile and responses to a 1-year lifestyle intervention program in women with and without history of GDM. METHODS: The Implementation Project of the Program for Prevention of Type 2 Diabetes (FIN-D2D) was conducted in Finland in five hospital districts. Altogether 1,661 women aged ≤45 years participated in the program. One-year follow-up was available for 393 women who did not have screen-detected T2D at baseline, and 265 of them had at least one intervention visit [115 (43.4%) women with history of GDM and 150 (56.6%) without history of GDM]. RESULTS: At baseline, women with GDM had similar baseline glucose tolerance but better anthropometric characteristics, blood pressure, and lipid profile than women without GDM after adjustment for age. Beneficial changes in cardiovascular risk profile existed among women with and without GDM during follow-up and the effect of lifestyle intervention was similar between the groups, except that low-density lipoprotein cholesterol improved only in women with GDM. Altogether, 4.0% of those with GDM and 5.0% of those without GDM developed T2D (p=0.959 adjustment for age). CONCLUSIONS: The effect of a 1-year lifestyle intervention in primary healthcare setting was similar regardless of history of GDM, both women with and without GDM benefitted from participation in the lifestyle intervention.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Gestacional/prevenção & controle , Intolerância à Glucose/terapia , Promoção da Saúde/métodos , Estilo de Vida , Avaliação de Programas e Projetos de Saúde , Adulto , Fatores Etários , Aconselhamento , Diabetes Gestacional/terapia , Feminino , Finlândia , Seguimentos , Teste de Tolerância a Glucose , Comportamentos Relacionados com a Saúde , Humanos , Síndrome Metabólica/epidemiologia , Gravidez , Atenção Primária à Saúde , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
20.
Lipids Health Dis ; 13: 28, 2014 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-24507090

RESUMO

BACKGROUND: Cross-sectional studies have suggested that serum omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFAs) are related to favorable lipoprotein particle concentrations. We explored the associations of serum n-3 and n-6 PUFAs with lipoprotein particle concentrations and sizes in a general population cohort at baseline and after 6 years. FINDINGS: The cohort included 665 adults (274 men) with a 6-year follow-up. Nutritional counseling was given at baseline. Serum n-3 and n-6 PUFAs and lipoprotein particle concentrations and the mean particle sizes of VLDL, LDL, and HDL were quantified by nuclear magnetic resonance (NMR) spectroscopy for all baseline and follow-up samples at the same time. Concentrations of n-3 and n-6 PUFAs were expressed relative to total fatty acids. At baseline, n-3 PUFAs were not associated with lipoprotein particle concentrations. A weak negative association was observed for VLDL (P = 0.021) and positive for HDL (P = 0.011) particle size. n-6 PUFA was negatively associated with VLDL particle concentration and positively with LDL (P < 0.001) and HDL particle size (P < 0.001). The 6-year change in n-3 PUFA correlated positively with the change in particle size for HDL and LDL lipoproteins but negatively with VLDL particle size. An increase in 6-year levels of n-6 PUFAs was negatively correlated with the change in VLDL particle concentration and size, and positively with LDL particle size. CONCLUSION: Change in circulating levels of both n-3 and n-6 PUFAs, relative to total fatty acids, during 6 years of follow-up are associated with changes in lipoprotein particle size and concentrations at the population level.


Assuntos
Ácidos Graxos Ômega-3/sangue , Ácidos Graxos Ômega-6/sangue , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Lipoproteínas VLDL/sangue , Adulto , Estudos Transversais , Dislipidemias/sangue , Dislipidemias/tratamento farmacológico , Feminino , Seguimentos , Humanos , Hipolipemiantes/uso terapêutico , Lipoproteínas HDL/química , Lipoproteínas LDL/química , Lipoproteínas VLDL/química , Masculino , Pessoa de Meia-Idade , Tamanho da Partícula , Resultado do Tratamento
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