Biomedical subjects

Jouko Miettunen

Publications and source records attributed to Jouko Miettunen.

At least 19 recordsLinked to original sources

PubMed2007

Psychometric properties of the Multifactor Leadership Questionnaire among nurses.

AIM: This paper reports a study investigating the psychometric properties of the Multifactor Leadership Questionnaire among nurses. BACKGROUND: Although the Multifactor Leadership Questionnaire is one of the most widely used instruments to measure the multifactor leadership theory in organizational sciences, inconsistent research findings have been reported for its psychometric properties. Little is known about these properties. METHOD: Data were gathered by postal questionnaires in 2001-2002 with nurses working in different healthcare organizations in Finland. A follow-up study was performed 1-year later. The sample consisted of 601 nurses and nurse leaders, and the follow-up study had 78 respondents. The internal consistency of the Multifactor Leadership Questionnaire was explored using Cronbach's alpha coefficient and item-analysis, and the test-retest reliability using Pearson product moment correlation coefficient and intra-class correlation coefficient (single measure intra-class correlation coefficient). The factor structure was studied using exploratory and confirmatory factor analyses. RESULTS: The internal consistencies of the leadership subscales were satisfactory. The Multifactor Leadership Questionnaire was fairly stable measured at the 1-year interval. Although the data fail to support the full nine-factor model, a reduced set of items from the Multifactor Leadership Questionnaire appears to show evidence of the three- and six-factor structures. Exploratory factor analysis showed evidence for the three-factor structure consisting of three distinctive, yet partly related leadership subscales. Confirmatory factor analysis showed evidence for the six-factor structure. CONCLUSION: The psychometric data suggest that a modified version of the Multifactor Leadership Questionnaire is a highly suitable instrument to measure multidimensional nursing leadership. Validity and reliability were supported. The results can be used in studies applying the Multifactor Leadership Questionnaire.

Adult↗

PubMed2006

Fronto-cerebellar systems are associated with infant motor and adult executive functions in healthy adults but not in schizophrenia.

Delineating longitudinal relationships between early developmental markers, adult cognitive function, and adult brain structure could clarify the pathogenesis of neurodevelopmental disorders such as schizophrenia. We aimed to identify brain structural correlates of infant motor development (IMD) and adult executive function in nonpsychotic adults and to test for abnormal associations between these measures in people with schizophrenia. Representative samples of nonpsychotic adults (n = 93) and people with schizophrenia (n = 49) were drawn from the Northern Finland 1966 general population birth cohort. IMD was prospectively assessed at age 1 year; executive function testing and MRI were completed at age 33-35 years. We found that earlier motor development in infancy was correlated with superior executive function in nonpsychotic subjects. Earlier motor development was also normally associated with increased gray matter density in adult premotor cortex, striatum, and cerebellum and increased white matter density in frontal and parietal lobes. Adult executive function was normally associated with increased gray matter density in a fronto-cerebellar system that partially overlapped, but was not identical to, the gray matter regions normally associated with IMD. People with schizophrenia had relatively delayed IMD and impaired adult executive function in adulthood. Furthermore, they demonstrated no normative associations between fronto-cerebellar structure, IMD, or executive function. We conclude that frontal cortico-cerebellar systems correlated with adult executive function are anatomically related to systems associated with normal infant motor development. Disruption of this anatomical system may underlie both the early developmental and adult cognitive abnormalities in schizophrenia.

Adult↗

PubMed2006

Differentiation of adoptees at high versus low genetic risk for schizophrenia by adjusted MMPI indices.

The aim of this study was to find potential signs of genetic vulnerability to schizophrenia. The differences between adoptees at high genetic risk for schizophrenia (their biological mother had a schizophrenia spectrum disorder) and control adoptees of non-schizophrenia spectrum biological mothers were assessed. The comparisons between these groups were based on the Minnesota Multiphasic Personality Inventory (MMPI) test's subscale scores adjusted by gender, age at MMPI assessment, age at placement into the adoptive family and social class. The subjects were a subsamples of a total of 182 tested adoptees and 136 mentally healthy adoptees in the Finnish Adoptive Family Study. The high-risk group was found to be distinguishable from the low-risk group based on deviant scores on the Hostility, Hypomania and Lie scales. These scales may measure genetic vulnerability and also possibly be indicative of psychometric deviance predicting future onset of schizophrenia.

Adoption↗

PubMed2006

Statistical methodologies in psychopharmacology: a review.

There has been a greatly increased interest in statistical methods in the psychiatric research and its applications over the past few decades, in parallel with advances in computers and statistical software. This review aims to describe the main topics related to statistical methods in psychopharmacology, namely nature of statistics in medicine, problems in data analysis, statistical modelling, developments in statistical technology, statistical reporting and meta-analysis.

Animals↗

PubMed2006

Temperament profiles and somatization--an epidemiological study of young adult people.

OBJECTIVE: We assessed the temperament profiles of young adult somatizers in an epidemiological setting. We hypothesized that somatizers would have a characteristic temperament profile. METHODS: The sample consisted of 984 subjects at the age of 31 years. Data on somatization were gathered from a review of all public health outpatient records. Subjects with four or more somatization symptoms according to the DSM-III-R criteria were classified as somatizers. Temperament profiles were assessed using the Temperament and Character Inventory (TCI). RESULTS: Six males (1.3%) and 61 females (11.5%) met our criteria for somatization. Harm avoidance and reward dependence of the TCI profiles were associated with somatization symptoms in the whole sample. In logistic regression analysis, sex and psychological distress were associated with somatization but not with temperament profiles. CONCLUSION: We did not find a characteristic temperament profile for somatizers. This finding is in contrast to suggestions that somatization is associated with temperament profiles.

Adult↗

PubMed2006

Patterns of psychiatric hospitalizations in schizophrenic psychoses within the Northern Finland 1966 Birth Cohort.

We report patterns of hospitalization in schizophrenic psychoses by age 34 in a longitudinal population-based cohort. We test the predictive ability of various demographic and illness-related variables on patterns of hospitalization, with a special focus on the length of the first psychiatric hospitalization. All living subjects of the Northern Finland 1966 Birth Cohort with DSM-III-R schizophrenia (n=88) and other schizophrenia spectrum cases (n=27) by the year 1997 in the Finnish Hospital Discharge Register were followed for an average of 10.5 years. Measures of psychiatric hospitalization included time to re-hospitalization (as continuous and as re-hospitalization within 2 years) and the number of hospital episodes. Length of the first hospitalization, other illness-related and various socio-demographic predictors were used to predict hospitalization patterns. After adjusting for gender, age at first admission and number of hospital days a short (1-14 days) first hospitalization (reference >30 days; adjusted odds ratio 6.39; 95% CI 2.00-20.41) and familial risk of psychosis (OR 3.36; 1.09-10.39) predicted re-hospitalization within 2 years. A short first hospitalization also predicted frequent psychiatric admissions defined as the first three admissions within 3 years (OR 13.77; 3.92-48.36). A short first hospitalization was linked to increased risk of re-hospitalizations. Although short hospitalization is recommended by several guidelines, there may be a group of patients with schizophrenic psychoses in which too short a hospitalization may lead to inadequate treatment response.

Adult↗

PubMed2006

Factor structure of the Maslach Burnout Inventory among Finnish nursing staff.

The purpose of the study was to investigate the factor structure of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) among Finnish nursing staff. Although the factorial validity of the MBI-HSS has been studied across different countries, the factor structure has never been investigated among Finnish nursing staff. The data were gathered by postal questionnaires from nursing staff working in health-care organizations around Finland. The sample consisted of 627 nurses and nurse managers. The factor structure was studied by using exploratory and confirmatory factor analysis. The fit of the hypothesized three-factor model to the data was superior to the alternative one-factor and two-factor models. The three-factor structure (emotional exhaustion, depersonalization, reduced personal accomplishment) showed the best fit, while the internal consistencies of the subscales were satisfactory. The MBI-HSS is a highly suitable instrument for measuring burnout among nursing staff and it is very applicable to Finnish health-care research.

Adult↗

PubMed2006

A comparative assessment of the factor structures and psychometric properties of the GHQ-12 and the GHQ-20 based on data from a Finnish population-based sample.

The General Health Questionnaire (GHQ) is a self-report questionnaire designed to identify psychological distress. Psychometric properties of two versions of GHQ-12 and GHQ-20 were assessed in a large population-based sample of Finnish twins, ages 22 to 27 (n= 4580). Participants were randomized into two subgroups, namely Twin1 (n= 2294) and Twin2 (n= 2286). The GHQ-12 data were assessed using Confirmatory Factor Analysis (CFA). The factor structure of the GHQ-20 was first assessed with Exploratory Factor Analysis (EFA) in the Twin1 dataset, and the results obtained were then subjected to CFA in Twin1 and Twin2 datasets. The CFA of the GHQ-12 indicated that the best fit and the simplest solution were provided by the three-factor solution in both subpopulations. Analyses of the GHQ-20 suggested that the four-factor structure was superior to the three-factor model. This result is also theoretically justifiable. Compared to the 12-item version, GHQ-20 provides additional fourth factor of anhedonia, suggesting some discriminative power.

Adult↗

PubMed2006

Risk factors for schizophrenia. Follow-up data from the Northern Finland 1966 Birth Cohort Study.

This paper updates single risk factors identified by the Northern Finland 1966 Birth Cohort Study up to the end of year 2001 or age 34. Impaired performance (e.g., delayed motor or intellectual development) or adverse exposures (e.g., pregnancy and birth complications, central nervous system diseases) are associated with an increased risk for schizophrenia. However, upper social class girls and clever schoolboys also have an increased risk to develop schizophrenia, contrasted to their peers. Individuals who subsequently develop schizophrenia follow a developmental trajectory that partly and subtly differs from that of the general population; this trajectory lacks flexibility and responsiveness compared to control subjects, at least in the early stages. We propose a descriptive, lifespan, multilevel systems model on the development and course of schizophrenia.

Journal Article↗

PubMed2005

Predictors of schizophrenia--a review.

Schizophrenia is an aetiologically heterogeneous syndrome that usually becomes overtly manifest in adolescence and early adulthood, but in many cases subtle impairments in neurointegrative function are present from birth; hence it is considered to be a disorder with a neurodevelopmental component. The strongest risk factor that has been identified is familial risk with genetic loading. Other risk factors include pregnancy and delivery complications, infections during pregnancy, disturbances of early neuromotor and cognitive development and heavy cannabis use in adolescence. Unfortunately, to date it has not been possible to utilize the predictors of the disorder that have been identified in primary preventative interventions in a general population. However, some authors have claimed that in future it might be possible to reduce the risk for developing schizophrenia through general health policy. In clinical settings, it is helpful to map out possible early risk factors, at least familial risk for psychosis, especially in child, adolescent and young adult mental patients. Furthermore, in the future we may have predictive models combining data from genetic factors for schizophrenia, antenatal risk factors, childhood and adolescent development and clinical symptomatology, as well as brain structural and functional abnormalities.

Adolescent↗

PubMed2005

Attention and behavioural problems of Finnish adolescents may be related to the family environment.

BACKGROUND: Adolescents' attention and behavioural problems in relation to the family environment were studied in the Northern Finland 1986 Birth Cohort. METHOD: Fifteen-year-old adolescents (N=6888) completed the Youth Self-Report (YSR) questionnaire and their parents (N=6643) completed the Strengths and Weaknesses in ADHD and Normal Behaviours (SWAN) questionnaire. The ratings were compared in relation to gender and family characteristics. RESULTS: Girls scored higher than boys on the YSR attention problems subscale (means 4.61 vs. 3.41), the rule-breaking behaviour subscale (means 4.25 vs. 3.69) and the aggressive behaviour subscale (means 7.18 vs. 5.63). Parents reported more SWAN attention problems in their sons than in their daughters. Living in an other than intact family increased YSR and SWAN attention problems and YSR behavioural problems in both genders. Adolescents living in very large families (11-19 children) had least attention and behavioural problems. CONCLUSIONS: Attention and behavioural problems seem to be common among adolescents in Finland. For both genders, living in other than intact families increases especially behavioural problems. Additionally, a very large family seems to be a protective factor against those problems.

Adolescent↗

PubMed2005

Observing relationships in Finnish adoptive families: Oulu Family Rating Scale.

Adoption studies were intended to separate genetic from environmental "causal" factors. In earlier adoption studies, psychiatric diagnostic labels for the adoptive parents were used as a proxy for the multiple dimensions of the family rearing environment. In the Finnish Adoption Study, research design provided the opportunity to study directly the adoptive family rearing environment. For this purpose 33 sub-scales were selected creating what we call Oulu Family Rating Scale (OPAS, Oulun PerheArviointiSkaala). In this paper, the manual for scoring of these sub-scales is presented.

Adoption↗

PubMed2005

Predictors of schizophrenia: evidence from the Northern Finland 1966 Birth Cohort and other sources.

BACKGROUND: Subtle motor, emotional, cognitive and behavioural abnormalities are often present in apparently healthy individuals who later develop schizophrenia, suggesting that some aspects of causation are established before overt psychosis. AIMS: To outline the development of schizophrenia. METHOD: We drew on evidence from The Northern Finland 1966 Birth Cohort supplemented by selected findings from other relevant literature. RESULTS: The main known risk factors in development of schizophrenia are genetic causes, pregnancy and delivery complications, slow neuromotor development, and deviant cognitive and academic performance. However, their effect size and predictive power are small. CONCLUSIONS: No powerful risk factor, premorbid sign or risk indicator has been identified that is useful for the prediction of schizophrenia in the general population.

Adult↗

PubMed2005

Recovery from schizophrenic psychoses within the northern Finland 1966 Birth Cohort.

BACKGROUND: Because of widely disparate findings from follow-up studies, the likelihood of recovery from schizophrenia remains controversial. We report the extent of recovery from schizophrenia in a population-based cohort. METHOD: Subjects with psychotic disorders were recruited from the Northern Finland 1966 Birth Cohort. Of the 91 subjects who agreed to participate, 59 were diagnosed with schizophrenia and 12 were diagnosed with schizophrenia spectrum disorders (schizophreniform psychosis, schizoaffective or delusional disorder) by DSM-III-R criteria. Diagnoses were established by interviewing the subjects, checking the Finnish Hospital Discharge Register, and reviewing their medical records. To assess recovery, we used the Clinical Global Impressions; the Positive and Negative Syndrome Scale; the Social and Occupational Functioning Assessment Scale; and information about psychiatric hospitalizations, use of antipsychotic medication, and occupational status. RESULTS: Only 1 subject (1.7%) with DSM-III-R schizophrenia and 3 subjects (25%) with schizophrenia spectrum disorders fully recovered; 1 schizophrenia subject (1.7%) and 2 schizophrenia spectrum subjects (16.7%) experienced partial recovery. CONCLUSION: The data indicate that, at least until age 35, complete recovery from schizophrenia is rare, and the prognosis for the disorder is far more serious than suggested by some follow-up studies.

Adult↗

PubMed2004

Early presence of thought disorder as a prospective sign of mental disorder.

The purpose of this study was to assess whether premorbid signs, such as thought disorder, could predict the subsequent manifestation of psychiatric disorders. A group of 75 adoptees at high genetic risk for schizophrenia and 96 low-risk adoptees without any psychiatric disorder at the initial assessment were assessed blindly with the Thought Disorder Index (TDI). Their psychiatric status was re-assessed according to DSM-III-R criteria in a re-interview 11 years later and based on available registers 16 years later. High scores on several TDI variables at the initial assessment predicted a psychiatric disorder of all adoptees at follow-up. Prediction was statistically unsuccessful among the high-risk adoptees because of the small number of cases, but high scores at the 0.50 severity level did predict mental disorders among the low-risk adoptees.

Adoption↗

PubMed2004

Validation of the new Intensive Care Nursing Scoring System (ICNSS).

OBJECTIVES: To validate a new Intensive Care Nursing Scoring System (ICNSS). DESIGN: Retrospective data collection. SETTING: Adult 19-bed intensive care unit (ICU) in a tertiary care university hospital. PATIENTS: A total of 1,538 patient records of which 30 documents were included in the validation. MEASUREMENTS AND RESULTS: Data included admission scores of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Simplified Acute Physiology Scores II (SAPS II), daily Therapeutic Intervention Scores (TISS) and ICNSS scores. Data were compared using Spearman's correlation, t-test and chi-square test. Receiver operating characteristics (ROC) curve analysis was used to assess the ability of ICNSS and TISS to predict mortality. Intra-class correlation, percentage agreement and kappa statistics were used to test the validity of given scores. Nursing workload assessment using ICNSS showed that medical and emergency-operated patients caused a greater nursing workload than electively operated patients (p<0.001). Six variables of the sub-scale that described vital function nursing accounted for 27.4% of the variation of SAPS II and for 37% of the variation of APACHE II. The ICNSS sub-scale of vital function nursing accounted for a ROC area of 0.91. In the validity of the given ICNSS scores, kappa was 0.81 and weighted kappa 0.82. CONCLUSIONS: Nursing workload varied between the different admission types. ICNSS explained a similar percentage of the variation of the admission scores of APACHE II and SAPSS II as TISS and discriminated between non-survivors and survivors. ICNSS is a suitable nursing workload instrument to be used with the TISS score.

APACHE↗

PubMed2004

Developmental precursors of psychosis.

Subtle developmental (motor, emotional, cognitive, and behavioral) abnormalities are often present in apparently healthy individuals who later develop psychosis, suggesting that some aspects of causation are established before overt psychosis. These impairments may restrict information processing and social achievements years before manifesting psychosis. The main known risk factors in the development of schizophrenic psychosis are genetic factors, pregnancy and delivery complications, slow neuromotor development, and deviant cognitive and academic performance. However, their effect size and predictive power are small. Developmental precursors are not necessarily specific to schizophrenia, but also common to other psychotic disorders. No powerful risk factor, premorbid sign, or risk indicator has been identified that is useful for prediction of psychoses in the general population.

Adolescent↗

PubMed2004

Interaction of genetic risk and adoptive parent communication deviance: longitudinal prediction of adoptee psychiatric disorders.

BACKGROUND: In the Finnish Adoptive Family Study of Schizophrenia, adoptee thinking disorders have been shown to be a joint effect of genetic liability for schizophrenia spectrum disorders and adoptive rearing-parent communication patterns. However, longitudinal predictions of clinical psychiatric disorders of the adoptees have not been reported. METHOD: Adoptees (n = 109) who had no DSM-III-R disorder at initial assessment (median age 18 years) were selected from the total sample of the Finnish Adoption Study of Schizophrenia. They were defined as at high versus low genetic risk based upon the lifetime diagnoses of their biological, adopting-away mothers - schizophrenia spectrum disorder versus no spectrum disorder. At initial assessment, adoptive rearing parents were independently evaluated from tape-recorded Rorschach protocols scored as manifesting either high or low Communication Deviance (CD), a composite index of communication patterns that distract and befuddle listeners. Adoptees were independently re-diagnosed after a median interval of 14 years and followed-up from national registers for an additional 7 years. RESULTS: The main effects of genetic liability (G) and CD of the adoptive parents (E), each taken separately, predicted significantly for psychiatric disorders of the adoptees as adults. However, when G, E, and their joint interaction effect were entered into the same logistic model, only the interaction effect was significant. The sample included seven adoptees with schizophrenia spectrum disorders, but a separate analysis to predict them was non-significant. CONCLUSION: Genetic liability for schizophrenia spectrum disorder and an adoptive family rearing variable interact, predicting longitudinally and significantly to broadly defined adoptee psychiatric disorder.

Adoption↗