PubMed Health⌕ Search

Biomedical subjects

E Kumpusalo

Publications and source records attributed to E Kumpusalo.

At least 19 recordsLinked to original sources
PubMed2002

Factors related to non-compliance with antihypertensive drug therapy.

The objectives were to study the associations of perceived health care-related and patient-related factors with self-reported noncompliance with antihypertensive treatment. General practitioners identified all of their hypertensive patients in 26 health centres during 1 week in 1996 (n = 2219). A total of 1782 (80%) patients participated in the study, of whom 1561 were on antihypertensive medication. Based on 82 opinion statements in two questionnaires, 14 problem indices were formed by using factor analysis. Out of these, summary variables concerning problems related to the health care system and the patients were formed. Logistic regression models, including interaction analyses, were used to study the associations with non-compliance. The results were that the majority of patients had at least one perceived health care system-related (88%) and patient-related problem (92%). A high number of both perceived health care system-related problems (adjusted OR 4.77; 95% CI 2.76, 8.26) and patient-related problems (adjusted OR 3.23; 95% CI 1.79, 5.81) were associated with self-reported non-compliance. The experience of adverse drug effects was also associated with non-compliance (adjusted OR 1.41; 95% CI 1.03, 1.94). In conclusion self-reported non-compliance was associated with multiple risks of both perceived health care system-related and patient-related problems.

Aged↗
PubMed2002

Janus faces of the white coat effect: blood pressure not only rises, it may also fall.

For reliable control of hypertension, it is essential to know the prevalence of the white coat effect (WCE), which is defined as either a difference of 10 mmHg or more in systolic blood pressure (BP) and/or a difference of 5 mmHg or more in diastolic BP measured by a general practitioner (GP), a nurse, or the patient him/herself. The objective was to assess the WCE in hypertensive patients visiting GPs in primary healthcare centres. A blinded, randomised study in six primary healthcare centres was conducted, where eight GPs, nine nurses and 210 patients (92 men and 118 women) on a hypertension control regimen participated. Heart rate and BP in GPs', nurses' and self-service rooms were measured twice using a sphygmomanometer and an automatic device. Altogether, 148 patients (70%) performed the self-measurements of BP and heart rate perfectly successfully in all the three rooms. These were included in the final analyses. One out of three patients (33%) showed a marked alerting WCE in the GP's room (systolic BP rose by at least 10 mmHg and/or diastolic BP by at least 5 mmHg). On the contrary, one out of 10 (10%) showed a marked relaxing WCE in the GP's room (systolic BP decreased by at least 10 mmHg and/or diastolic BP by at least 5 mmHg). It can be concluded that the WCE in general practice has two faces: an alerting reaction and a relaxing reaction. This should be taken into account in hypertension control.

Adult↗
PubMed2002

The quantitative insulin sensitivity check index QUICKI predicts the onset of type 2 diabetes better than fasting plasma insulin in obese subjects: a 5-year follow-up study.

The aim of the present study was to evaluate the predictive value of QUICKI and fasting plasma insulin (FPI0 as predictors of the onset of type 2 diabetes mellitus. We performed a five-year follow-up study in a sample of middle-aged subjects with at least one of the following risk factors; hypertension defined as systolic blood pressure >or=160 mmHg and/or diastolic blood pressure >or=90 mmHg or medication for hypertensin, obesity defined as a body mass index >or=30 kg/m(2) and/or a waist-to-hip ratio >or=1.00 in men and >or=0.88 in women, or a family history of type 2 DM. When the QUICKI index was used to compare the tertile with the lowest risk to the tertile of the highest risk of obese subjects. Odd's Ratio (OR) for type 2 diabetes was 7.77 (95% CI 1.39-202.24). For FPI, the respective OR's were 2.84 (95% CI 0.82-9.82) and 3.96 (95% CI 1.02-15.48). QUICKI and fasting insulin did not have a statistically significant predictive value among non-obese subjects. Concerning QUICKI, the subjects in the tertiles at the medium and highest risk had a higher risk for type 2 DM than the corresponding tertiles of FPI among obese subjects.

Adult↗
PubMed2001

Pain as a reason to visit the doctor: a study in Finnish primary health care.

This study aims to demonstrate the prevalence of pain as a reason for seeing a physician in primary care. We also performed an analysis of the localization, duration and frequency of pains, as well as the diagnoses of patients having pain. A total of 28 physicians at 25 health centers in Finland collected the data, comprising 5646 patient visits. Pain was identified as the reason for 2237 (40%) of the visits. The most common localizations were in the lower back, abdomen and head. One-fifth of the pain patients had experienced pain for over six months. Analysis of the diagnoses revealed half of the pains to be musculoskeletal. Patients experienced considerable limitations in various activities of life due to pain. A quarter of the pain patients of active working age received sick leave. Our results confirm that pain is a major primary health care problem, which has an enormous impact on public health.

Activities of Daily Living↗
PubMed2001

Variability in prescribing for musculoskeletal pain in Finnish primary health care.

OBJECTIVE: To assess primary care physicians' prescribing patterns for musculoskeletal pain in different diagnostic categories. METHODS: The data were collected in 25 randomly selected health centres, in which a total of 28 physicians took part in the four-week study. Physicians recorded all the medicines they prescribed for patients visiting due to pain. Visits resulting in a diagnosis of musculoskeletal disease or injury were included in this study. RESULTS: Analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs), were prescribed for 61% of the patients. NSAIDs were prescribed for 46%, topical analgesics for 15% and opioids for 4% of the patients. In general, ibuprofen was the most frequently prescribed drug but back and neck pains were most commonly treated with naproxen. No difference between patients' genders was observed in analgesic prescriptions. Prescribing was associated with patient's age, physician's view on priority of visit, diagnosis and intensity of pain. There was a large variation in prescribing patterns between individual physicians and between different areas of the country. CONCLUSION: NSAIDs are the prevailing treatment for musculoskeletal pain in Finnish primary health care. Different drugs are favoured according to the diagnosis. The large variability in prescribing patterns cannot be explained solely by the characteristics of pain or patients.

Administration, Topical↗
PubMed2001

Prevalence of left ventricular hypertrophy in Finnish primary health care hypertensive patients.

BACKGROUND: Hypertensive patients who present left ventricular hypertrophy (LVH) are at considerable risk of developing cardiovascular complications. Echocardiography, being the best method for assessing of LVH, is too expensive for routine daily practice particularly in primary health care. Therefore, electrocardiogram (ECG) still remains the most feasible method to assess LVH in these settings. OBJECTIVES: The aim of this study was to determine the prevalence of ECG-LVH in Finnish hypertensive primary health care patients and evaluate the quality of their blood pressure control. METHODS: A total of 255 general practitioners in 26 primary health care centres identified all of their hypertensive patients visiting during a 1-week period. A health examination was carried out on these patients by health nurses and laboratory tests, including ECG, were taken. The ECG's were analysed by using the Minnesota Code. Altogether, 1746 hypertensive patients were examined. RESULTS: The prevalence of ECG-LVH when using Sokolow-Lyon criterion was 9.8% for males and 5.7% for females. The corresponding figures, when using the sex-specific Cornell product, were 14.9% for males and 18.8% for females. Only 17% of LVH patients had their blood pressure under good control (BP <140/90 mm Hg) as compared to 25% of non-LVH patients (P < 0.01). CONCLUSION: The prevalence of ECG-LVH in Finnish hypertensive primary health care patients is high. Despite this warning signal, the treatment situation for LVH patients was even worse than that of other hypertensives.

Aged↗
PubMed2001

Patients' perceived problems with hypertension and attitudes towards medical treatment.

OBJECTIVE: To study perceived problems and attitudes in hypertension treatment in primary health care. STUDY POPULATION AND METHODS: A cross-sectional survey of 2219 hypertensive patients, identified by general practitioners, in 26 health centres was carried out during 1 week in 1996. A total of 1782 patients (80%) returned two questionnaires and participated in a health examination. The final study population consisted of 1561 patients currently being medically treated for hypertension and 220 patients not currently on medical treatment. The questionnaires contained 82 questions on different aspects of hypertension care and treatment, which were further elaborated using factor analysis. On the basis of reliability and internal validity analyses, 14 problem indices related to medical treatment of hypertension were formed. RESULTS: The most common perceived problem was related to lack of motivation for follow-up of hypertension (72%). Many patients had difficulties to accept being hypertensive (66%). A careless attitude towards hypertension was also common (63%). Lack of information was experienced by 56% of the patients. About 33% felt hopeless about their hypertension, reported adverse effects of hypertension treatment on sexual functions and lack of support by health care personnel. The least frequent problems were reimbursement problems and modification of dosage instructions. The number of problems identified per person varied between zero and 14 with a mean of 4.9 +/- 2.6 (s.d.). CONCLUSION: Perceived problems concerning hypertension, negative attitudes and experiences are very common among hypertensive patients in primary health care.

Age Factors↗
PubMed2001

Different worlds, different tasks for health promotion: comparisons of health risk profiles in Chinese and Finnish rural people.

The aim of this study was to compare cardiovascular risk factors of working-aged people in Chinese and Finnish rural villages. The surveys were carried out in 1989 in Tianjin, China, and in Kuopio, Finland. Altogether, 897 Chinese inhabitants and 795 Finnish subjects participated in the surveys. Health behaviours were recorded, and height, weight, blood pressure, heart rate and serum lipids were measured. Generally Finns had a significantly higher mean body-mass index, systolic and diastolic blood pressures, and serum total cholesterol, low-density lipoprotein cholesterol, and total cholesterol/high-density lipoprotein ratio than the Chinese. However, no difference was seen between Chinese and Finnish women in diastolic blood pressure and serum triglycerides. Lower high-density lipoprotein cholesterol levels were observed in Finnish men than in Chinese men, whereas a higher mean level was shown in Finnish women than in Chinese women. There were significantly higher mean heart rates and prevalence of smoking in Chinese than in Finnish populations. More people who were overweight, obese and hypertensive were found in the Finnish than in the Chinese populations. Most of the Finns had two or more cardiovascular risk factors compared with the Chinese, the majority of whom were in the group with less than two risk factors. In conclusion, the risk profiles are clearly somewhat different in these two countries. A major task for the Chinese health policy and health care system is to decrease smoking and to prevent obesity and hypertension. In Finland, the biggest task seems to be the reduction of weight and lipid abnormalities, and the prevention of hypertension.

Adult↗
PubMed2001

Patients' versus general practitioners' assessments of pain intensity in primary care patients with non-cancer pain.

Pain is a major cause for visiting a primary care physician. There are, however, few studies on the assessment of pain patients at the primary care level. The aim of this cross-sectional study was to investigate the concordance between general practitioners' (GPs') and patients' assessments of pain intensity and whether this assessment is influenced by the duration or intensity of pain. Seven hundred and thirty-eight patients aged 16 to 75 years, who were visiting a GP because of pain, participated. Both the patients and the GPs rated pain intensity using the horizontal 100 mm Visual Analogue Scale (VAS). Means and correlations were calculated using non-parametric tests. The VAS scales were arbitrarily divided into five grades (one unit = 20 mm) to investigate the concordance between GPs' and patients' assessments of pain intensity. Spearman 's correlation coefficient between GPs' and patients' assessments was 0.31 for non-chronic pain (of duration less than six months) and 0.20 for chronic pain. GPs evaluated graded pain intensity at least one unit lower than patients in 37% of the visits. In one-fifth of the visits (20.5%), the GP's rating was at least two units lower than the patient's rating. The more severe the pain as assessed by patients, the greater the non-concordance between patients' and GPs' assessments. There was considerable non-concordance between GPs' and patients' assessments of pain intensity. GPs tended to estimate their patients' pain intensity as clinically significantly lower than the patients themselves, particularly in chronic and severe pain.

Adolescent↗
PubMed2000

Evaluation of undergraduate medical education in Finnish community-oriented and traditional medical faculties: a 10-year follow-up.

OBJECTIVES: This study focused on Finnish physicians' views of their undergraduate medical education. Differences between traditional and community-oriented medical faculties were examined and changes which had taken place during a 10-year follow-up period were also assessed. METHODS: The study was based on data retrieved from a postal survey made among Finnish physicians in 1998. The study population consisted of all doctors who graduated between 1987 and 1996 (n=4926); those born on odd-numbered days were selected for this study (n=2492). A postal questionnaire and two reminders were sent to those selected, and 1822 questionnaires were returned, giving a response rate of 73.1%. RESULTS: Physicians who graduated from the community-oriented faculties were more satisfied with their undergraduate medical education when compared with their colleagues graduating from traditional faculties. There were some differences between the universities with respect to education for hospital work. The teaching of primary health care, however, was clearly more effective in community-oriented faculties. The proportion of graduates who were satisfied with their primary care education was over 70% in community-oriented faculties, whereas in the traditional faculties it was only 35-45%. CONCLUSIONS: According to graduates, the community-oriented medical school curriculum better meets the needs of practising physicians than that in traditional faculties. In curriculum reforms, more emphasis should be placed on comprehensive medical education, which includes both primary and secondary health care.

Adult↗
PubMed1999

Personal values of male and female doctors: gender aspects.

The aim of this study was to elucidate the personal values of physicians. It was part of the Physician 93 Study, the purpose of which was to shed light on the life situation, career and future plans of young doctors and their views on medical education. The survey population included all the medical doctors registered during the years 1982-1991 in Finland (N = 4671). In the spring of 1993 a postal questionnaire was sent to a random sample of 2341 doctors. After two reminder letters, 1818 questionnaires (78%) were returned. 59% of the respondents were women. Subjects were asked to rate on a 4-point scale each of a set of 17 potentially important values listed in the questionnaire, five of which were seen by the majority of physicians as very important. These values were: family life, health, close friends, success in work or in studies and children's success. The potentially important values were conceptualized as indicative of eight important dimensions of the values of physicians: close friends, health. self actualization, success, universal values, well-being, family and ideology. Women doctors rated close friends, health, success, universalism and ideology as more important than men doctors.

Adult↗
PubMed1998

Becoming a doctor--was it the wrong career choice?

The aim of the study was to investigate the social background of physicians, the reasons that influenced doctors to enter medicine, and the association between those reasons and satisfaction in career choice of young Finnish doctors. An extensive postal questionnaire was mailed to a random sample of 2632 young Finnish doctors in 1988 and to 2332 doctors in 1993. We found out that majority of the respondents reported that interest in people, a wide range of job opportunities, the fact that medicine is a highly-appreciated profession, and success at school had influenced their decision to enter medicine quite a lot or very much. In 1988, 8% and in 1993, 7% of the respondents reported that interest in people had not influenced their career choice at all or only slightly. More women than men were influenced quite a lot or very much by factors like interest in people, success at school and vocation, meaning the lifelong calling to physicians' profession. A total of 22% of respondents would not enter medicine again. Vocation, interest in people and wide range of job opportunities were significantly more rarely mentioned as an important career choice motive by these respondents. It seems that interest in human beings and vocation are important to would-be doctors, and also help them to get along in the physicians' profession. Medical schools should develop their curricula towards more humanistic medicine in order to maintain their students' interest in people.

Adult↗
PubMed1997

Unstable and stable chromosomal aberrations in lymphocytes of people exposed to Chernobyl fallout in Bryansk, Russia.

Analyses of unstable and stable chromosomal aberrations in peripheral blood lymphocytes were used in the assessment of radiation exposure of residents of a village situated in the Chernobyl fallout-contamination zone of Bryansk, Russia. Blood samples were taken from subjects residing in villages with high (> 1100 kBq/m2 137 Cs; Mirnyi) and very low (< 37 kBq/m2 137 Cs; Krasnyi Rog) contamination, 7 years after the Chernobyl accident. The groups were matched by age, sex, smoking habits and previous medical radiological exposures. A total of 200 people (100 exposed, 100 controls) were analysed for the presence of unstable aberrations from Giemsa-stained slides. To study stable aberrations, chromosome painting analyses were performed on 100 subjects (50 exposed, 50 controls), using painting probes for chromosomes 1, 2 and 4 and a pancentromeric probe. People living in the contaminated area showed significantly higher rates of unstable chromosome-type aberrations but not chromatid-type aberrations in their lymphocytes, indicating radiation exposure as a causative factor for the observed difference. No significant differences were found in the aberration rates between the two areas by the chromosome painting method. The levels of chromosome exchanges were low in both populations, but consistently higher in Mirnyi compared with the control area. The magnitude of radiation exposure resulting from Chernobyl fallout was estimated on the basis of excess stable chromosomal aberrations in the lymphocytes of the Mirnyi population compared with the controls.

Adult↗
PubMed1997

Treatment situation of hypertensive patients in Finnish primary health care.

OBJECTIVE: To highlight the present situation in hypertension control in Finnish primary healthcare. SUBJECTS AND METHODS: All health centre doctors from 30 primary health centres were asked to record every consulting patient, pick up hypertensives and evaluate their blood pressure (BP) level, drug treatment, side effects and symptoms related to drug treatment, and compliance during 2 weeks in May 1995. RESULTS: In all, 337 doctors from the 30 health centres participated in the study. They recorded altogether 4405 hypertensive patients, of which 1209 men (83%) and 2311 women (87%) had drug treatment for hypertension. Of all the drug-treated hypertensive men and women, 33% and 37%, respectively were obese (BMI > or = 30.0 kg/m2). Altogether, 13% of the drug-treated hypertensive men and 10% of women were in good control when BP < 140/90 mmHg was used as the criterion. These proportions doubled when BP < 160/90 mmHg and tripled when BP < 160/95 mmHg were applied as criteria. CONCLUSION: The proportion of drug-treated hypertensives under poor control is still high in Finland. Only a quarter of treated hypertensive patients are in good control when the criterion BP < 160/90 mmHg is applied.

Adult↗