Obesity, Smoking and Dieting

Lihavuus ja ylipaino ovat viime vuosikymmeninä yleistyneet; jo yli puolet länsimaiden väestöstä on ylipainoisia ja viidennes lihavia. Varsinkin nuorilla ylipainon lisääntyminen on ollut nopeaa. Ylipaino, erityisesti yhdistettynä vyötärölihavuuteen, sekä tupakointi lisäävät sairastavuutta sydän- ja verisuonisairauksiin, metabolisiin sairauksiin, kuten diabetekseen, sekä moniin syöpiin. Lihavuus ja tupakointi ovatkin kehittyneiden maiden tärkeimpiä ehkäistävissä olevia kuolinsyitä. Samanaikaisesti ylipainon kanssa laihduttaminen ja jopa terveydelle haitalliset laihdutusmenetelmät, kuten tupakointi painonhallintakeinona on tullut yhä yleisemmäksi. Nopeaan painonpudotukseen tähtäävällä laihduttamisella on usein terveydelle haitallisia seurauksia kuten painon nousu yli alkuperäisen painon ja kehon rasvajakauman muuttuminen epäterveellisemmäksi. Kolme neljännestä merkittävästi laihduttaneista kertoo painon nousseen takaisin. Tupakoinnin ja toistuvan laihduttamisen vaikutukset ylipainon ja lihavuuden kehittymiselle kytkeytyvät toisiinsa. Tässä väitöskirjatyössä tutkittiin toistuvan laihduttamisen ja tupakoinnin vaikutusta kehon painoon ja lisäksi tupakoinnin vaikutusta vyötärölihavuuden kehittymiseen. Työn toisena tavoitteena oli tutkia, kuinka voimakkaasti tupakointi ja toistuva laihduttaminen liittyvät toisiinsa suomalaisilla ja onko tämä yhteys erilainen eri ikäryhmissä ja sukupuolilla. Työ perustuu kolmeen laajaan kyselyaineistoon: Nuorten Kaksosten Terveystutkimuksen (englanniksi FinnTwin16) aineistossa on seurattu 1975-79 syntyneitä kaksosia 16, 17, 18 ja 24 vuoden ikäisinä (N=5563). Suomen kaksoskohortin aineisto (N= 12 793) on kerätty vuonna 1990 samaa sukupuolta olevilta, vuosina 1930-57 syntyneiltä kaksosilta. Entisten huippu-urheilijoiden (N=1838) ja heille kaltaistettujen verrokkien (N=834) seurantatutkimuksessa tiedot on kerätty vuosina 1985, 1995 ja 2001. Pituus, paino ja tupakointi on kysytty kaikissa kyselyissä. Kaksoset vastasivat laihdutuskäyttäytymistä koskeviin kysymyksiin. Urheilijoiden laihdutuskäyttäytyminen pääteltiin lajin perusteella, sillä toistuvan laihduttamisen tiedetään olevan yleistä painoluokissa urheilevilla urheilijoilla (esim.painijat, nyrkkeilijät). Nuoruusiän tupakointi ennusti vyötärölihavuutta molemmilla sukupuolilla ja lisäksi ylipainoisuutta naisilla. Toistuva laihduttaminen oli yhteydessä myöhempään painonnousuun ja lihavuuteen miehillä. Lisäksi toistuvan laihduttamisen ja tupakoinnin todettiin liittyvän toisiinsa nuorilla aikuisilla. Vanhemmissa ikäluokissa miehet, jotka tupakoivat, laihduttivat harvemmin kuin tupakoimattomat. Lihavuuteen ja vyötärölihavuuteen liittyvän oheissairastavuuden ennaltaehkäisyssä tupakoinnin ja toistuvan laihduttamisen vähentäminen saattavat olla aiemmin luultua tehokkaampia keinoja.Overweight and obesity have become more prevalent during the last decades; more than half of the western population is now overweight and a fifth obese. Especially among adolescents has the increase in overweight prevalence been rapid. Overweight combined with a large waist circumference (i.e. abdominal obesity) and smoking increase the morbidity of cardiovascular disease, metabolic diseases, like diabetes, and many cancers. Obesity and smoking are two leading causes of preventable death in developed countries. Paralleling the escalating trends in obesity, dieting and especially health compromising dieting methods, including smoking motivated by weight control reasons, are becoming more prevalent. Dieting for rapid weight loss usually leads to weight regain with possible extra pounds and detrimental effects in fat distribution or other health measures. Three quarters of those with intentional weight loss more than 5 kg reports regaining it all. Smoking and dieting seem to be intertwined with the way that they affect the development of overweight and obesity. In this study the effects of recurrent dieting and smoking on body weight were examined. In addition the effect of smoking on the development of abdominal obesity was studied. A further aim was to clarify how strongly smoking and recurrent dieting are associated among Finnish men and women at different ages. Three different data sets were used in this study. FinnTwin16 consists of virtually all twins born between 1975 and 1979 (N=5563), surveyed at ages 16, 17, 18.5 and 24 years. The Finnish Twin Cohort includes 12 793 same-sex twins born between 1930 and 1957 surveyed in 1990. The Cohort of male elite athletes consists of 1838 athletes and 834 matched referents surveyed at 1985, 1995 and 2001. Self-reported height, weight and smoking are included in all questionnaires. Dieting behaviour was self-reported in twin data and based on sport among athletes. It is known that recurrent dieting with regains is common among sportsmen in sports with weight classes like boxing and wrestling. Smoking in adolescence predicted later abdominal obesity in both sexes and overweight among women. Recurrent dieting among men was found to predispose for later weight gain and obesity. Smoking was associated with recurrent dieting among young men and women, but among older men the association was the opposite. Smoking prevention and discouragement of unnecessary dieting might be more effective tools against later morbidity associated with obesity and abdominal obesity than previously thought

The effects of mandatory home quarantine on mental health in a community sample during the COVID-19 pandemic

Objective Major public and scientific interest exists on, whether quarantine as a containment measure, could have adverse effects on individual's mental health. We investigated psychic well-being and distress, symptoms of depression and anxiety among individuals imposed to home quarantine. Methods By total population sampling in a Finnish suburban city, a total of 57 quarantined cases (participation rate 97%) were identified and followed up for two weeks until expiration of the quarantine. A randomized control group (n = 53) was formed of people seeking laboratory testing for suspected Sars-CoV-2 infection. Primary outcome was the psychic well-being and distress experienced during quarantine measured by the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM). The cases were followed up by the Clinical Outcomes in Routine Evaluation-10 (CORE-10), Patient Health Questionnaire-9 (PHQ-9), and by the Overall Anxiety Severity and Impairment Scale (OASIS). Results The median CORE-OM score for the cases was 3.53 (95% CI: 2.23-4.66), and for the controls 3.24 (1.76-3.82), being mostly in the nonclinical to mild range. The difference between the groups was statistically nonsignificant (p = .19). Higher levels of psychic distress were explained by previous psychiatric disorders and living alone, but not having been quarantined. In comparison to controls, the quarantined participants experienced significantly, but slightly lower level of life functioning. At the follow-up, the quarantined participants rated further low on the CORE-10 (median 2.00; 95% CI: 1.00-3.00), the PHQ-9 (1.50; 0.00-3.00), and the OASIS (0.00; 0.00-0.00). Conclusions The distress associated with short-term home quarantine may not be to the degree of a mental disorder.Peer reviewe

Lähete nettiterapiaan onnistuu kaikkialta Suomesta

Nettiterapiaan voi ohjata kaikkialta Suomesta lääkärin lähetteellä. Lähetteen voi kirjoittaa niin julkisen kuin yksityisenkin tahon lääkäri eikä maksusitoumuksia tarvita

Feasibility of generic, short, and easy-to-use assessment of psychological distress during psychotherapy : Longitudinal measurement invariance of CORE-10 and -OM

Objective: While the CORE-10 inventory for Clinical Outcome Routine Evaluation has shown good psychometric properties in cross-sectional assessment, the feasibility of generic, short, and easy-to-use longitudinal assessment of a broadband construct such as the targeted "general psychological distress" remains to be psychometrically demonstrated. Therefore, we investigated longitudinal measurement invariance (LMI) of CORE-10. For comprehensiveness, we also analyzed its parent inventory, CORE-OM. Method: We investigated the LMI of pre- and post-therapy CORE-10 and -OM assessments in a naturalistic treatment register of 1715 patients' short psychotherapies, testing whether the construct of "psychological distress" remained the same across the treatments. Results: We observed good psychometric properties and no violations of LMI for CORE-10 in chi-squared equivalence tests, nor in effect-size-based evaluations. Only the highly sensitive chi-squared difference tests detected LMI violations but these had little practical influence. The CORE-OM data did not fit well with factorial models but this was cross-sectional rather than a genuinely longitudinal (LMI-related) issue. Conclusions: CORE-10 appeared a structurally valid measure of general psychological distress and suitable for longitudinal assessment, whereas the CORE-OM had a less clear factorial structure. Regarding psychometrics, these findings support the use of CORE-10 in longitudinal assessment during psychotherapy and do not support CORE-OM.Peer reviewe

Psykososiaalisten hoitojen saatavuutta voidaan parantaa

Teema : psykoterapia lääketieteessä

Associations between specific depressive symptoms and psychosocial functioning in psychotherapy

Background: Psychotherapy for depression aims to reduce symptoms and to improve psychosocial functioning. We examined whether some symptoms are more important than others in the association between depression and functioning over the course of psychotherapy treatment.Methods: We studied associations between specific symptoms of depression (PHQ-9) and change in social and occupational functioning (SOFAS), both with structural equation models (considering liabilities of depression and each specific symptom) and with logistic regression models (considering the risk for individual patients). The study sample consisted of adult patients (n symbolscript 771) from the Finnish Psychotherapy Quality Registry (FPQR) who completed psychotherapy treatment between September 2018 and September 2021.Results: Based on our results of logistic regression analyses and SEM models, the baseline measures of depression symptoms were not associated with changes in functioning. Changes in depressed mood or hopelessness, problems with sleep, feeling tired, and feeling little interest or pleasure were associated with improved func-tioning during psychotherapy. The strongest evidence for symptom-specific effects was found for the symptom of depressed mood or hopelessness. Limitations: Due to our naturalistic study design containing only two measurement points, we were unable to study the causal relationship between symptoms and functioning. Conclusions: Changes in certain symptoms during psychotherapy may affect functioning independently of un-derlying depression. Knowledge about the dynamics between symptoms and functioning could be used in treatment planning or implementation. Depressed mood or hopelessness appears to have a role in the dynamic relationship between depression and functioning.Peer reviewe

Lyhyeen ostopalvelupsykoterapiaan ohjattujen potilaiden hoitoon pääsyn kesto : HUS Psykoterapian laaturekisteriaineisto vuosilta 2018-2019

Vertaisarvioitu. English summary. Teema : psykoterapia lääketieteessä.JOHDANTO : Psykoterapia on keskeinen mielenterveyden häiriöiden hoitomuoto. Hoitoon pääsyn kestoa voidaan pitää yhtenä sen saatavuuden ja saavutettavuuden tärkeimmistä indikaattoreista. Aihetta koskeva tieto on kuitenkin hyvin puutteellista kotimaisten psykoterapiapalveluiden osalta. Tässä tutkimuksessa tarkasteltiin HUS:n lyhyiden ostopalvelupsykoterapioiden odotusaikoja ja niihin liittyviä tekijöitä. MENETELMÄT : HUS Psykiatrian psykoterapian laaturekisterin aineistosta muodostettiin 819 potilaan aineisto. Analyyseissä käytettiin Kaplan-Meierin estimaattoria ja Coxin suhteellisen vaaran regressiomallia. TULOKSET : Mallin perusteella 20 % potilaista aloittaa psykoterapian noin kuukauden ja puolet noin kolmen kuukauden kuluessa lähetteestä. Perusterveydenhuollosta lähetetyt potilaat ja ne, joille on päädiagnoosin lisäksi kirjattu oheisdiagnoosi, pääsevät muita hitaammin hoitoon. PÄÄTELMÄT : Hoitoon pääsyä kolmen kuukauden kuluessa voidaan pitää kohtuullisena lyhyen ostopalvelupsykoterapian osalta. Vain noin puolet potilaista aloittaa hoidon tässä ajassa, mikä kertoo merkittävästä kehittämistarpeesta. Psykoterapiaan pääsyn seurantaa tulee kehittää valtakunnallisesti.Peer reviewe

The Finnish therapy navigator – Digital support system for introducing stepped care in Finland

Introduction: The need to improve quick access to effective psychological treatments is urgent. Success requires effective tools for identifying what kind of therapies an individual is likely to benefit from and managing a comprehensive therapy offering that matches an individual’s needs. First-line therapies initiative (Terapiat etulinjaan–toimintamalli) is a national initiative started 2020 in Finland. It aims to help Finnish regions in building locally sustainable stepped care systems and providing the support services needed. One key service of First-line therapies initiative is the Finnish therapy navigator (FTN). The FTN is a digital tool to help assess individual needs for psychosocial treatments and to build a regionally sustainable stepped care treatment offering, as part of the national reform of social and health services. This paper describes the development, content, implementation and feasibility of the FTN. Materials and Methods: The system was piloted in six regions in Finland between October 2021 and May 2022, with a catchment area of around 600 000. The feasibility data was collected from professionals (n = 48) using the system at 1 and 4 months after implementation, and from the anonymous FTN responses (n = 2630). Results: Professionals estimated the FTN had a positive impact on their work, quality of assessment and notes, and patient experience at 1 month after starting to use the FTN. Satisfaction scores improved further at 4 months, and 93% of users wanted to keep FTN as a permanent tool. The mean time patients used to fill the FTN was 24 minutes; 75% of clinical interviews lasted under 30 minutes. The FTN provides important data on treatment seekers. In our sample 57% of respondents scored between 10-19 points on PHQ-9 and 59% between 5-14 on GAD-7, suggesting mild-to-moderate depressive and anxiety symptoms. 28% reported no previous psychosocial treatments and 33% previous treatments shorter than 6 months. Thus, it seems that a significant proportion of treatment seekers in Finland could benefit from readily available, short-term, evidence-based psychosocial treatments that the First-line therapies initiative supports. Conclusions: FTN is a feasible tool for first assessment of mental health issues in primary care. Implemented and localized using the manualized co-creation process results in very high user satisfaction and acceptability of the system. The FTN provides important real-time data on mental health treatment seekers to support service development and planning. The First-line therapies model that includes introducing FTN in combination with regionally adapted care pathway development, education in short evidence-based psychological interventions and increase in use of digital support systems appears a feasible way to build regionally sustainable stepped systems.publishedVersionPeer reviewe

Validation of the Finnish version of the SCOFF questionnaire among young adults aged 20 to 35 years

<p>Abstract</p> <p>Background</p> <p>We tested the validity of the SCOFF, a five-question screening instrument for eating disorders, in a general population sample.</p> <p>Methods</p> <p>A random sample of 1863 Finnish young adults was approached with a questionnaire that contained several screens for mental health interview, including the SCOFF. The questionnaire was returned by 1316 persons. All screen positives and a random sample of screen negatives were invited to SCID interview. Altogether 541 subjects participated in the SCID interview and had filled in the SCOFF questionnaire. We investigated the validity of the SCOFF in detecting current eating disorders by calculating sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for different cut-off scores. We also performed a ROC analysis based on these 541 persons, of whom nine had current eating disorder.</p> <p>Results</p> <p>The threshold of two positive answers presented the best ability to detect eating disorders, with a sensitivity of 77.8%, a specificity of 87.6%, a PPV of 9.7%, and a NPV of 99.6%. None of the subjects with current eating disorder scored zero points in the SCOFF.</p> <p>Conclusion</p> <p>Due to its low PPV, there are limitations in using the SCOFF as a screening instrument in unselected population samples. However, it might be used for ruling out the possibility of eating disorders.</p

The Finnish therapy navigator – Digital support system for introducing stepped care in Finland

Introduction: The need to improve quick access to effective psychological treatments is urgent. Success requires effective tools for identifying what kind of therapies an individual is likely to benefit from and managing a comprehensive therapy offering that matches an individual’s needs. First-line therapies initiative (Terapiat etulinjaan–toimintamalli) is a national initiative started 2020 in Finland. It aims to help Finnish regions in building locally sustainable stepped care systems and providing the support services needed. One key service of First-line therapies initiative is the Finnish therapy navigator (FTN). The FTN is a digital tool to help assess individual needs for psychosocial treatments and to build a regionally sustainable stepped care treatment offering, as part of the national reform of social and health services. This paper describes the development, content, implementation and feasibility of the FTN. Materials and Methods: The system was piloted in six regions in Finland between October 2021 and May 2022, with a catchment area of around 600 000. The feasibility data was collected from professionals (n = 48) using the system at 1 and 4 months after implementation, and from the anonymous FTN responses (n = 2630). Results: Professionals estimated the FTN had a positive impact on their work, quality of assessment and notes, and patient experience at 1 month after starting to use the FTN. Satisfaction scores improved further at 4 months, and 93% of users wanted to keep FTN as a permanent tool. The mean time patients used to fill the FTN was 24 minutes; 75% of clinical interviews lasted under 30 minutes. The FTN provides important data on treatment seekers. In our sample 57% of respondents scored between 10-19 points on PHQ-9 and 59% between 5-14 on GAD-7, suggesting mild-to-moderate depressive and anxiety symptoms. 28% reported no previous psychosocial treatments and 33% previous treatments shorter than 6 months. Thus, it seems that a significant proportion of treatment seekers in Finland could benefit from readily available, short-term, evidence-based psychosocial treatments that the First-line therapies initiative supports. Conclusions: FTN is a feasible tool for first assessment of mental health issues in primary care. Implemented and localized using the manualized co-creation process results in very high user satisfaction and acceptability of the system. The FTN provides important real-time data on mental health treatment seekers to support service development and planning. The First-line therapies model that includes introducing FTN in combination with regionally adapted care pathway development, education in short evidence-based psychological interventions and increase in use of digital support systems appears a feasible way to build regionally sustainable stepped systems.publishedVersionPeer reviewe