Eurooppalainen yleislääketieteen tutkimusagenda

Minne pitäisi suunnata yleislääketieteen tutkimuksessa? EGPRN:n (European General Practice Research Network) tutkimusagenda on järjestelmälliseen kirjallisuushakuun ja sen monipuoliseen analyysiin perustuva Euroopan yleislääketieteen vahvuudet ja kehittämisalueet kokoava katsaus. Tutkimusagenda on kehyspaperi, joka terävöittää yleislääketieteen määritelmää ja sen tehtäviä sekä merkitystä tutkijoille ja päätöksentekijöille. Agenda on hyödyllinen tutkimuksen jäsentämisessä, tutkimustarpeiden arvioinnissa, infrastruktuurin vahvistamisessa ja uuden tutkimuksen strategisessa suunnittelussa

Short-term impact of co-payment level increase on the use of medication and patient-reported outcomes in Finnish patients with type 2 diabetes

A new reimbursement scheme for non-insulin medications used for treatment of hyperglycemia in type 2 diabetes (T2D) was implemented in Finland on January 1, 2017. The aim of the study was to evaluate the impact of this co-payment increase (i.e. + 35 percentage points) on patient-reported satisfaction for diabetes care, diabetes medication use, and financial difficulties. Baseline data were collected in 114 pharmacies, where patients with T2D were asked to fill in a questionnaire in November 2016. Follow-ups were conducted at 6 and 12 months. In total, 955 participants with T2D attended the baseline examination. During the follow-up, satisfaction with diabetes care decreased significantly (p <0.001). Use of insulin increased (OR 1.16, 95 % CI 1.06-1.27) whereas use of metformin and DPP-4 inhibitors decreased (metformin: OR 0.80,95 % CI 0.70-0.90; DPP-4 inhibitors: OR 0.82, 95 % CI 0.73-0.93). Financial difficulties with the purchase of diabetes medications were reported more often both at 6 (OR 2.44,95 % CI 1.96-3.03) and at 12 months (OR 2.70, 95 % CI 2.18-3.35) than at baseline. These negative short-term effects require future studies. If persistent, the long-term effects of lower treatment satisfaction and increased financial difficulties may imply impaired metabolic control and increased diabetes complication risk and health care costs. Patient perspective should be taken into account in future policy making. (C) 2020 The Author(s). Published by Elsevier B.V.Peer reviewe

Research orientation among general practitioners compared to other specialties

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

Machine Learning and Pathway Analysis-Based Discovery of Metabolomic Markers Relating to Chronic Pain Phenotypes

Recent scientific evidence suggests that chronic pain phenotypes are reflected in metabolomic changes. However, problems associated with chronic pain, such as sleep disorders or obesity, may complicate the metabolome pattern. Such a complex phenotype was investigated to identify common metabolomics markers at the interface of persistent pain, sleep, and obesity in 71 men and 122 women undergoing tertiary pain care. They were examined for patterns in d = 97 metabolomic markers that segregated patients with a relatively benign pain phenotype (low and little bothersome pain) from those with more severe clinical symptoms (high pain intensity, more bothersome pain, and co-occurring problems such as sleep disturbance). Two independent lines of data analysis were pursued. First, a data-driven supervised machine learning-based approach was used to identify the most informative metabolic markers for complex phenotype assignment. This pointed primarily at adenosine monophosphate (AMP), asparagine, deoxycytidine, glucuronic acid, and propionylcarnitine, and secondarily at cysteine and nicotinamide adenine dinucleotide (NAD) as informative for assigning patients to clinical pain phenotypes. After this, a hypothesis-driven analysis of metabolic pathways was performed, including sleep and obesity. In both the first and second line of analysis, three metabolic markers (NAD, AMP, and cysteine) were found to be relevant, including metabolic pathway analysis in obesity, associated with changes in amino acid metabolism, and sleep problems, associated with downregulated methionine metabolism. Taken together, present findings provide evidence that metabolomic changes associated with co-occurring problems may play a role in the development of severe pain. Co-occurring problems may influence each other at the metabolomic level. Because the methionine and glutathione metabolic pathways are physiologically linked, sleep problems appear to be associated with the first metabolic pathway, whereas obesity may be associated with the second.Peer reviewe

Machine Learning and Pathway Analysis-Based Discovery of Metabolomic Markers Relating to Chronic Pain Phenotypes

Recent scientific evidence suggests that chronic pain phenotypes are reflected in metabolomic changes. However, problems associated with chronic pain, such as sleep disorders or obesity, may complicate the metabolome pattern. Such a complex phenotype was investigated to identify common metabolomics markers at the interface of persistent pain, sleep, and obesity in 71 men and 122 women undergoing tertiary pain care. They were examined for patterns in d = 97 metabolomic markers that segregated patients with a relatively benign pain phenotype (low and little bothersome pain) from those with more severe clinical symptoms (high pain intensity, more bothersome pain, and co-occurring problems such as sleep disturbance). Two independent lines of data analysis were pursued. First, a data-driven supervised machine learning-based approach was used to identify the most informative metabolic markers for complex phenotype assignment. This pointed primarily at adenosine monophosphate (AMP), asparagine, deoxycytidine, glucuronic acid, and propionylcarnitine, and secondarily at cysteine and nicotinamide adenine dinucleotide (NAD) as informative for assigning patients to clinical pain phenotypes. After this, a hypothesis-driven analysis of metabolic pathways was performed, including sleep and obesity. In both the first and second line of analysis, three metabolic markers (NAD, AMP, and cysteine) were found to be relevant, including metabolic pathway analysis in obesity, associated with changes in amino acid metabolism, and sleep problems, associated with downregulated methionine metabolism. Taken together, present findings provide evidence that metabolomic changes associated with co-occurring problems may play a role in the development of severe pain. Co-occurring problems may influence each other at the metabolomic level. Because the methionine and glutathione metabolic pathways are physiologically linked, sleep problems appear to be associated with the first metabolic pathway, whereas obesity may be associated with the second.Peer reviewe

Kidney function and nephrotoxic drug use among older home-dwelling persons with or without diabetes in Finland

Background Due to these changes in kidney function, aging kidneys are more prone to drug-induced impairments in renal properties. Diabetes has been associated with the declined kidney function and an elevated risk of renal failure. The aim of this study is to compare kidney function and potentially nephrotoxic drug use among home-dwelling older persons with or without diabetes. Methods A total of 259 persons with and 259 persons without diabetes and aged >= 65 years were randomly selected to participate in a health examination with complete data gathered from 363 individuals (187 with diabetes and 176 without diabetes). The estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Each participant was categorized based on the nephrotoxic profile of their medications. Results There were no differences in mean eGFR values (77.5 +/- 18.8 vs. 80.5 +/- 14.8 ml/min/1.73m(2), p = 0.089) or in the proportion of participants with eGFR <60 ml/min/1.73m(2) among persons with diabetes (16% vs. 10%, p = 0.070), compared to persons without diabetes. Potentially nephrotoxic drug use was similar between the groups. The mean number of potentially nephrotoxic drugs was 1.06 +/- 0.88 in those with and 0.97 +/- 1.05 in those without diabetes (p = 0.39). Conclusions The kidney function of older persons with diabetes does not differ from that of older persons without diabetes and furthermore potentially nephrotoxic drug use seem to play only a minor role in the decline in kidney function among home-dwelling persons in the Inner-Savo district.Peer reviewe

Elevation of tumor necrosis factor alpha levels is associated with restless legs symptoms in clinically depressed patients

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-alpha in the subjects with restless legs symptoms (7.4 ng/l +/- 3.2) compared with the subjects without symptoms (6.7 ng/1 +/- 2.3)(p Conclusions: TNF-alpha level was associated with restless legs symptoms only among subjects with depressive symptoms whether they had clinical depression or not. We suggest that TNF-alpha could be an underlying factor between restless legs symptoms and comorbidities.Peer reviewe

Leisure time physical activity and its relation to psychiatric comorbidities in depression. Findings from Finnish Depression and Metabolic Syndrome in Adults (FDMSA) study

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 <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.Peer reviewe

A longitudinal study of restless legs symptoms among patients with depression

Background The aim of this study was to analyse the relationship between depressive symptoms and clinical depression and restless legs symptoms in a longitudinal primary care setting. Methods The prevalence of restless legs symptoms at baseline and after a six-year follow-up was studied in 474 patients with depressive symptoms and 333 population-based control subjects without depressive symptoms. Depressive symptoms at the baseline and after the six-year follow-up were evaluated with the Beck Depression Inventory (BDI) Second Edition. A psychiatric diagnosis was confirmed with a diagnostic interview (M.I.N.I.). Statistical comparisons between groups were made using analysis of variance (ANOVA) for continuous variables and a chi-square test or logistic models for categorical variables. Repeated measures were analysed using generalizing estimating equations (GEE) models. Results At baseline the prevalence of restless legs symptoms was 24.3% in control subjects, 43.8% in the patients with depressive symptoms without a depression diagnosis, and 49.3% in clinically depressed patients. During the follow-up up the prevalence of restless legs symptoms declined significantly (p = 0.003). In addition to baseline restless legs symptoms, the prognostic factors for restless legs symptoms among patients with clinical depression were age and BDI score. In the control subjects, moderate and high leisure time physical activity was inversely associated with restless legs symptoms at the follow-up. Conclusions A higher level of baseline depressive symptoms was a risk factor for restless legs symptoms in patients with clinical depression. In the prevention and treatment of restless legs symptoms among the patients with depression, the priority is the effective treatment of depression.Peer reviewe

Does baseline leisure-time physical activity level predict future depressive symptoms or physical activity among depressive patients? Findings from a Finnish five-year cohort study

Objectives The aims of this study were to investigate whether baseline leisure-time physical activity (LTPA) is associated with future recovery from depression among patients with a depression diagnosis and whether baseline LTPA is associated with total physical activity after five years of follow-up. Methods A total of 258 patients aged >= 35 years with clinically confirmed depression at baseline participated. The study was conducted between 2008 and 2016 in municipalities within the Central Finland Hospital District. Depressive symptoms (DS) were determined with the Beck Depression Inventory (BDI) with a cutoff score >= 10, and depression diagnoses were confirmed by the Mini-International Neuropsychiatric Interview (MINI). Blood pressure and anthropometric parameters were measured and blood samples for glucose and lipid determinations were drawn at baseline. LTPA, physical activity, and other social and clinical factors were captured by standard self-administered questionnaires at baseline and the five-year follow-up point. Results Of the 258 patients, 76 (29%) had DS at follow-up. Adjusted odds ratio (OR) for future DS was 1.43 (confidence interval [CI] 0.69-2.95) for participants with moderate LTPA and 0.92 (CI 0.42-2.00) for participants with high LTPA, compared with low LTPA at baseline. Higher baseline LTPA levels were associated with higher total physical activity in the future (beta=0.14 [95% CI: 0.02-0.26] for linearity = 0.024). Conclusion Baseline LTPA did not affect the five-year prognosis of depression among depressed patients in a Finnish adult population. Because the baseline LTPA level predicted the future total physical activity, it could be included as a part of the overall health management and treatment of depression in clinical practices.Peer reviewe