BackgroundThe aim of patient segmentation is to recognize patients with similar health care needs. The Finnish patient segmentation service Navigator segregates patients into 4 groups, including a self-acting group, who presumably manages their everyday life and coordinates their health care. Digital services could support their self-care. Knowledge on self-acting patients’ characteristics is lacking. ObjectiveThe study aims are to describe how Navigator assigns patients with diabetes to the 4 groups at nurses’ appointments at a health center, the self-acting patient group’s characteristics compared with other patient groups, and the concordance between the nurse’s evaluation of the patient’s group and the actual group assigned by Navigator (criterion validity). MethodsPatients with diabetes ≥18 years old visiting primary care were invited to participate in this cross-sectional study. Patients with disability preventing informed consent for participation were excluded. Nurses estimated the patients’ upcoming group results before the appointment. We describe the concordance (%) between the evaluation and actual groups. Nurses used Navigator patients with diabetes (n=304) at their annual follow-up visits. The self-acting patients’ diabetes care values (glycated hemoglobin [HbA1c], urine albumin to creatinine ratio, low-density lipoprotein cholesterol, blood pressure, BMI), chronic conditions, medication, smoking status, self-rated health, disability (World Health Organization Disability Assessment Schedule [WHODAS] 2.0), health-related quality of life (EQ-5D-5L), and well-being (Well-being Questionnaire [WBQ-12]) and the patients’ responses to Navigator’s question concerning their digital skills as outcome variables were compared with those of the other patients. We used descriptive statistics for the patients’ distribution into the 4 groups and demographic data. We used the Mann-Whitney U test with nonnormally distributed variables, independent samples t test with normally distributed variables, and Pearson chi-square tests with categorized variables to compare the groups. ResultsMost patients (259/304, 85.2%) were in the self-acting group. Hypertension, hyperlipidemia, and joint ailments were the most prevalent comorbidities among all patients. Self-acting patients had less ischemic cardiac disease (P=.001), depression or anxiety (P=.03), asthma or chronic obstructive pulmonary disease (P<.001), long-term pain (P<.001), and related medication. Self-acting patients had better self-rated health (P<.001), functional ability (P<.001), health-related quality of life (P<.001), and general well-being (P<.001). All patients considered their skills at using electronic services to be good. ConclusionsThe patients in the self-acting group had several comorbidities. However, their functional ability was not yet diminished compared with patients in the other groups. Therefore, to prevent diabetic complications and disabilities, support for patients’ self-management should be emphasized in their integrated care services. Digital services could be involved in the care of patients willing to use them. The study was performed in 1 health center, the participants were volunteers, and most patients were assigned to self-acting patient group. These facts limit the generalizability of our results. International Registered Report Identifier (IRRID)RR2-10.2196/20570

Background Fibromyalgia is a functional syndrome. Despite recent findings, there is still considerable uncertainty about its diagnostic process. Objectives This study aimed to explore patients' experiences with fibromyalgia during the diagnostic process in primary health care. Moreover, we tried to determine how diagnostic consultation could be improved. Methods This study is based on data from patients with fibromyalgia in a primary health care study conducted in Nokia, Finland. Patients with fibromyalgia were identified from electronic medical records. Focus-group participants with fibromyalgia diagnoses were selected using a purposive sampling method to gather a maximum variation sample. Qualitative thematic analysis was used for the coded data from four focus-group discussions in 2018. A description of the coding tree was provided and researchers organised the codes. Finally, all researchers identified themes from the data. Results The main unifying entities were the uncertainty and contradictions fibromyalgia patients faced on several occasions. Physicians sometimes offered other diagnoses - like depression - as an explanation for the symptoms, or used repetitive tests to eliminate other possible diagnoses. Furthermore, patients expressed their wishes for a holistic, empathetic, and up-to-date approach to their symptoms. Conclusion In our interviews, a good doctor-patient relationship and continuity of care were necessary, as were the physician's attitude and knowledge of fibromyalgia. Our findings also suggest avoiding repeated or unnecessary rule-out tests and the overdiagnosis of psychiatric disorders is necessary.

Objective From previous studies, it is known that the association between fibromyalgia and thyroid autoimmunity diseases exists. On the other hand, it was recently suggested that in many cases thyroid hormone treatment might be unnecessary. The aim of our study is to explore the thyroid hormone treatment among primary health care fibromyalgia patients. Our study is cross-sectional and based on fibromyalgia study from the city of Nokia Health Center. Clinical examination was performed to participants, patients filled five questionnaires and information from electronic patient records was gathered. In addition to other parameters, we studied patient’s thyroid function levels at the beginning of thyroid hormone treatment. Results From those patients participating in the study (n = 103), 34% (n = 33) had thyroid hormone treatment. From those taking thyroid hormone treatment, 48% (n = 16) had information regarding the initial TSH and T4-V levels at the beginning of the treatment. 37% (n = 6) of them had normal thyroid function. Small sample size and data gathered from single health center effects on the generalizability of our findings. However, we suggest further studies to confirm the potential association between fibromyalgia and inappropriate thyroid hormone treatment.

Aging and multimorbid populations burden health services worldwide. Segmenting patients with similar health service needs into different groups and guiding care providers to tailor services to these groups could reduce this burden. Methods of patient segmentation have been based on, e.g., databases. However, the Finnish patient-segmentation innovation Navigator (Suuntima) considers patients’ perspectives on their coping in everyday life, as well as professionals’ views of the patients’ state of health. The segmentation is based on questions. The resulting care pathway related to the group helps professionals to coordinate patients’ health care and patients to utilize appropriate services. This first part of Navigator’s validation study evaluates its feasibility and content and face validity. We assess the web-service’s user experiences at nurses’ appointments with diabetic patients, time consumption, and Navigator’s question relevance, comprehensiveness, and comprehensibility. This mixed-methods study uses user experience questionnaires for both patients and professionals, and semi-structured focus-group interviews for professionals. We used descriptive statistics in the quantitative data analysis of the questionnaire study and thematic analysis to identify the codes and themes in the interview data. All 304 Navigator queries were completed at appointments. Most patients found Navigator easy to use. It helped in considering their situation better and from new perspectives. Most patients did not find it too time-consuming. Most professionals found it easy to use and suitable for appointments and patient segmentation. The questions were easy and unambiguous, and they assisted in discussing new or sensitive issues. Most queries were completed in less than 19 mins and less time was used if the patient was assigned to the nurse. Thematic analysis raised five main themes: 1) Well-functioning web-service, 2) Stimulus for conversation and action, 3) Rationale to complete Navigator with a professional, 4) Training and experience ease the use of Navigator, and 5) Navigator's room for improvement. Subthemes were identified for three main themes. We consider Navigator’s feasibility and face validity to be favorable. We suggest user instructions and the clarification of concepts to support the questions’ comprehensibility. Some patients may benefit from a nurse’s presence when responding to Navigator’s questions.

BACKGROUND:An aging population and increasing multimorbidity challenge health care systems worldwide. Patient segmentation aims to recognize groups of patients with similar needs, offer targeted services to these groups, and reduce the burden of health care. In this study, the unique Finnish innovation Navigator, a web-based service for patient segmentation, is presented. Both patients and health care professionals complete the electronic questionnaire concerning patients' coping in everyday life and health state. Thus, it considers the patient perspective on self-care. One of four customership-strategy (CS) groups (self-acting, community, cooperating, and network) is then proposed in response to the answers given. This resulting strategy helps both professionals to coordinate patient health care and patients to utilize appropriate health services.OBJECTIVE:This study aims to determine the feasibility, validity, and reliability of the Navigator service in the segmentation of patients with diabetes into four CS groups in a primary care setting. Patient characteristics concerning demographic status, chronic conditions, disabilities, health-related quality of life, and well-being in different CS groups will be described. We hypothesize that patients in the network group will be older, have more illnesses, chronic conditions or disabilities, and require more health care services than patients in the self-acting group.METHODS:In this mixed methods study, data collection was based on questionnaires (user experience of Navigator, demographic and health status, World Health Organization Disability Assessment Schedule 2.0, EuroQol 5D, Wellbeing Questionnaire 12, and the Diabetes Treatment Satisfaction Questionnaire) issued to 300 patients with diabetes and on user-experience questionnaires for and semistructured focus-group interviews with 12 nurses. Navigator-database reports and diabetes-care values (blood pressure, BMI, HbA1c, low-density lipoprotein, albumin-creatinine, smoking status) were collected. Qualitative and descriptive analyses were used to study the feasibility, content, concurrent, and face validity of Navigator. While criterion and concurrent validity were examined with correlations, reliability was examined by calculating Cohen kappa and Cronbach alpha. Construct validity is studied by performing exploratory-factor analysis on Navigator data reports and by hypothesis testing. The values, demographics, and health status of patients in different groups were described, and differences between groups were studied by comparing means. Linear regression analysis was performed to assess which variables affect CS group variation.RESULTS:Data collection was completed in September 2019, and the first feasibility results are expected by the end of 2020. Further results and publications are expected in 2021 and 2022.CONCLUSIONS:This is the first scientific study concerning Navigator's psychometric properties. The study will examine the segregation of patients with diabetes into four CS groups in a primary care setting and the differences between patients in groups. This study will assist in Navigator's further development as a patient segmentation method considering patients' perspectives on self-care. This study will not prove the effectiveness or efficacy of Navigator; therefore, it is essential to study these outcomes of separate care pathways.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/20570.

BACKGROUND:Patient enablement is a concept developed to measure quality in primary health care. The comparative analysis of patient enablement in an international context is lacking.OBJECTIVE:To explain variation in patient enablement between patients, general practitioners (GPs) and countries. To find independent variables associated with enablement.DESIGN:We constructed multi-level logistic regression models encompassing variables from patient, GP and country levels. The proportions of explained variances at each level and odds ratios for independent variables were calculated.SETTING AND PARTICIPANTS:A total of 7210 GPs and 58 930 patients in 31 countries were recruited through the Quality and Costs of Primary Care in Europe (QUALICOPC) study framework. In addition, data from the Primary Health Care Activity Monitor for Europe (PHAMEU) study and Hofstede's national cultural dimensions were combined with QUALICOPC data.RESULTS:In the final model, 50.6% of the country variance and 18.4% of the practice variance could be explained. Cultural dimensions explained a major part of the variation between countries. Several patient-level and only a few practice-level variables showed statistically significant associations with patient enablement. Structural elements of the relevant health-care system showed no associations. From the 20 study hypotheses, eight were supported and four were partly supported.DISCUSSION AND CONCLUSIONS:There are large differences in patient enablement between GPs and countries. Patient characteristics and patients' perceptions of consultation seem to have the strongest associations with patient enablement. When comparing patient-reported measures as an indicator of health-care system performance, researchers should be aware of the influence of cultural elements.

Background: Fibromyalgia is a functional pain syndrome presenting with various psychological symptoms. Several studies have shown that adverse life events are associated with fibromyalgia. The aim of the current study is to explore the association between self-reported bullying victimization in childhood and self-reported fibromyalgia in adulthood. Methods: The basic study setting is cross-sectional- with focused use of retrospective data- derived from a large on-going postal follow up survey (sample N = 64,797) initiated in Finland in 1998. Only respondents having answered the questions on fibromyalgia in both follow ups in 2003 and 2012 were included (N = 11,924). Severity of bullying was divided into three groups starting from no bullying followed by minor and severe Covariates having shown statistically significant associations with fibromyalgia in cross tabulation using Pearson's chi-squared test were included in the final multiple logistic regression analyses. Results: In our study, 50.6% of the respondents reported victimization of minor and 19.6% of severe bullying in childhood. Participants reporting fibromyalgia in adulthood reported more bullying, and in females alone this association was statistically significant (p =.027). In multiple logistic regression analysis statistically significant associations between bullying victimization in childhood (reference: no bullying) and fibromyalgia were found: adjusted odds ratio (OR) for minor bullying was 1,35 (95% CI 1.09-1.67) and for severe bullying 1.58 (95% CI 1.21-2.06). However, in log-linear and logistic regression interaction models the association between bullying and fibromyalgia was not statistically significant when depression was included in the models. Conclusions: Our results suggest that peer bullying victimization might be associated with fibromyalgia. However, in logistic log linear and logistic interaction models there was no statistically significant association when depression was included. As a result, there is need for further, preferably prospective cohort studies. The findings also emphasize the importance of actions to prevent childhood bullying.

Objective: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder during pregnancy. ICP has been associated with morbidity but little is known about women's long-term survival. Our aim was to determine whether ICP is associated with mothers' long-term survival. Study design: The study population comprised 571 women with ICP in at least one pregnancy seen at Tampere University Hospital in Finland between 1969-1988. The reference group comprised 1333 women: the previous and the following participant in the maternity ward diary. The data were obtained from Statistics Finland in March 2017 containing deaths among the study participants between 1971-2015. The follow-up time of the cohort was 27-46 years. The Kaplan-Meier method was used. Results: Totally, 39 of the mothers with ICP (6.8%) and 111 of the reference group (8.3%) had died by the end of 2015 (p = 0.267). The mean survival time of ICP women was 77.4 years and of the reference group 79.2 years (p = 0.288). The mean survival time from labour in the ICP group was 45.0 years and in the reference group 44.8 years (p = 0.259). Conclusions: Based on this study ICP does not seem to be associated with women's survival. There is no need to follow-up ICP mothers' health because of the nonexistent risk of premature death. (C) 2019 Elsevier B.V. All rights reserved.

Intrahepatic cholestasis of pregnancy (ICP) is a reversible liver disorder occurring during pregnancy. It has a typical genetic background with known genetic mutations and can be considered an expression of this genetic predisposition. The objective of this study was to determine whether ICP is associated with specific long-term comorbidity. The study population comprised 571 women with ICP in at least one pregnancy who were compared with 1333 pregnant women without ICP during 1969-1988 at Tampere University Hospital, Finland. The cohort's follow-up time was 44 years. All ICD-10 classification discharge diagnoses were examined for the women in the ICP group from 1998 to 2013 and ICD-10 diagnoses from outpatient care from 1969 to 2013. At least one disease of the digestive system had been diagnosed in 50.4% (288/571) of the ICP mothers compared with 34.4% (459/1333) of the reference group ( P  <   0.001). In a more detailed analysis, women with a history of ICP had an increased risk for cholelithiasis and/or cholecystitis (odds ratio [OR] 2.88, 95% confidence interval [CI] 2.17 to 3.84), diseases of the pancreas (OR 2.26, 95% CI 1.20 to 4.27) and hypothyroidism (OR 2.38, 95% CI 1.27 to 4.46) compared with the reference group. Arterial diseases were less common in the ICP mothers than in the reference group (OR 0.38, 95% CI .15 to .99). Regarding other diseases, there were no statistically significant differences between the ICP mothers and reference group. Half of the women with a history of ICP were diagnosed with at least one disease of the digestive system compared with a third in the reference group. The risk of cholelithiasis, cholecystitis, diseases of the pancreas and hypothyroidism was increased compared with the reference group. These are important facts when counseling women after a pregnancy with ICP. Also, this is of importance for the general practitioners and other physicians who take care of these women.

Intrahepatic cholestasis of pregnancy (ICP) is a reversible liver disorder occurring during pregnancy. It has a typical genetic background with known genetic mutations and can be considered an expression of this genetic predisposition. The objective of this study was to determine whether ICP is associated with specific long‐term comorbidity.

Introduction: Since the early 1990s, the Estonian and Finnish health systems have undergone various changes which are expected to have impacted the type and range of services provided by general practitioners (GPs). Objective: To compare GP services between Estonia and Finland in 1993 and 2012 and draw a parallel with transformations occurred in the health systems of both countries during these two decades. Methods: Data were collected through surveys among 129 and 288 GPs from Estonia and Finland in 2012 and 139 Estonian and 239 Finnish GPs in 1993. Descriptive statistics were used to compare between countries and years. Results: Between 1993 and 2012, the number of working hours per week and consultations per day increased in Estonia and decreased in Finland. In 2012, GPs in were more often the first contact for psychosocial and women's and children's in Estonia, whereas this decreased in Finland. The frequency of treating acute patients mostly decreased in both countries. We observed a decrease in medical procedures in Finland and an increase in Estonia. Finnish GPs still conducted more procedures in 2012. Conclusion: Due to partly opposite changes, the services provided by Finnish and Estonian GPs became more similar. Still, there are large differences in services provided, possibly arising from differences in the organisation of health services, the training of doctors and patients' preferences. (C) 2018 Elsevier B.V. All rights reserved.

BACKGROUND:The Patient Enablement Instrument (PEI) is an established patient-reported outcome measure (PROM) that reflects the quality of appointments with general practitioners (GPs). It is a six-item questionnaire administered to the patient immediately after a consultation. The aim of this study was to evaluate whether a single-item measure could replace the PEI when measuring patient enablement among Finnish health care centre patients.METHODS:Two single-item measures, Q1 and Q2, were chosen for comparison with the PEI. Firstly, a pilot study with questionnaire testing and brief interviews with the respondents were performed in order to assess the content validity of the PEI and the single-item measures. Secondly, a questionnaire study after a single appointment with a GP was carried out in three health care centres in Western Finland in order to evaluate the construct and criterion validity of the single-item measures. A telephone interview was performed 2 weeks after the appointment in order to assess the test-retest reliability of the single-item measures. The sensitivity, specificity, and both positive and negative predictive values of Q1 and Q2 were calculated with different PEI score cut-off points.RESULTS:Altogether 483 patients with a completed PEI were included in the questionnaire study analyses. Altogether 149 and 175 patients had completed Q1 and Q2, respectively, both in the questionnaire and the telephone interview. The correlations between the PEI and Q1 and Q2 were 0.48 and 0.84, respectively. Both the single-item measures had a high sensitivity and a negative predictive value in relation to patients with lower PEI scores. The reliability coefficients were 0.24 for Q1 and 0.76 for Q2. The test-retest values of Q1, Q2, and the PEI were low.CONCLUSIONS:Q2 seems to be a valid and reliable measure of patient enablement. Q1 seems to be less correlated with the PEI, but it also has a high negative predictive value in relation to low enablement scores.

In Finland, the specialization programs in Medicine and Dentistry can be undertaken at all five university medical faculties in 50 specialization programs and in five programs for Dentistry. The specialist training requires 5 or 6 years (300–360 ECTS credits) of medical practice including 9 months of service in primary health care centers, theoretical substance specific education, management studies, and passing a national written exam. The renovation of the national curriculum for the specialization programs was implemented, first in 2008 and officially in August 2009, when theoretical multi-professional social, health management and leadership studies (10–30 ECTS credits) were added to the curriculum. According to European Credit Transfer and Accumulation System (ECTS), 1 ECTS credit (henceforth, simply “ECTS”) means 27–30 h of academic work1 National guidelines for the multi-professional leadership training include the basics of organizational management and leadership, the social and healthcare system, human resources (HR) management, leadership interaction and organizational communication, healthcare economy, legislation (HR) and data management. Each medical faculty has implemented management studies autonomously but according to national guidelines. This paper will describe how the compulsory management studies (10 ECTS) have been executed at the Universities of Tampere and Turku. In Tampere, the 10 ECTS management studies follow a flexible design of six academic modules. Versatile modern teaching methods such as technology-assisted and student orientated learning are used. Advanced supplementary management studies (20 ECTS) are also available. In Turku, the 10 ECTS studies consist of academic lectures, portfolio and project work. Attendees select contact studies (4–6 ECTS) from yearly available 20 ECTS and proceed at their own pace. Portfolio and project comprise 2–5 ECTS each. The renovation of medical specializing physicians' management and leadership education has been a successful reform. It has been observed that positive attitudes and interest toward management overall are increasing among younger doctors. In addition, management and leadership education will presumably facilitate medical doctors' work as managers also. Continuous development of medical doctors' management and leadership education for physicians and dentists is needed while the changing and complex healthcare environment requires both professional and leadership expertise.

Access to care is a multidimensional concept, considered as a structural aspect of health care quality; it reflects the functioning of a health care organization. The aim of this study was to investigate patients’ experiences of access to care and to analyse factors associated with waiting times to GP appointments at Finnish health centres. A questionnaire survey was addressed to Finnish GPs within the Quality and Costs of Primary Care in Europe study framework. Two to nine patients per GP completed the questionnaire, altogether 1196. Main outcome measures were waiting times for appointments with GPs and factors associated with waiting times. In addition, patients’ opinions of access to appointments were analysed.

Objectives From previous studies, it is known that the association between fibromyalgia and thyroid autoimmunity diseases exists. On the other hand, it was recently suggested that in many cases thyroid hormone treatment might be unnecessary. The aim of our study is to explore the thyroid hormone treatment among fibromyalgia patients in cross-sectional study based on data from fibromyalgia patients in the city of Nokia Health Center Finland. Method Fibromyalgia patients were searched from the electronic patient records. Patients filled five questionnaires and information from electronic patient records was gathered. Information from thyroid hormone treatment and thyroid-stimulating hormone (TSH) and free thyroxine (T4-V) levels were gained from patient records. We used the Finnish guidelines for hypothyroidism: TSH level over 4.2 mU/l was defined as subclinical hypothyroidism if the T4-V level was normal. The T4-V level under 11.0 pmol/L was defined as central hypothyroidism if TSH level was normal or low. TSH level over 4.2 mU/l and T4-V level under 11.0 pmol/L was defined as overt hypothyroidism. TSH levels between 0.27–4.2 mU/l and T4-V levels between 11.0–22.0 pmol/L were defined as normal thyroid function. Cross-tabulation and Chi-Square test were used when categorical variables were present and two-sample t-test was performed with variables following a normal distribution. Results Altogether 208 patients were identified. 103 patients returned mailed questionnaires and were included in the study. 96 patients had fibromyalgia according to ACR 2010 criteria. From that group 33 (34%) had thyroid hormone treatment and 63 (66%) had not. Statistical significance was not found between those taking thyroid hormone replacement and those not taking it in functional ability (p=0.36) or depression (p=0.71). From those 33 patients with thyroxine treatment, 16 had information regarding the initial TSH and T4-V levels before thyroid hormone treatment: Ten (63%) patients had hypothyroidism based on the laboratory tests. Subclinical hypothyroidism was present in six cases, central hypothyroidism in three cases and as overt hypothyroidism in one case. Of 16 patients with thyroid hormone treatment, six patients (37%) had normal thyroid function at the beginning of the treatment. Conclusions The occurrence of thyroid hormone treatment was much higher in our study population (34%) than in the previous study in Japan (8%). In our study, over one third of the fibromyalgia patient using thyroid hormone treatment – whose initial thyroid hormone levels were available – did have normal thyroid function. There are likely several explanations to this. One might be that one of the main symptoms of fibromyalgia is fatigue, which also is common with hypothyroidism. Patients are aware of this and some may want to try out the thyroid hormone treatment even though their thyroid function is normal. Further studies are needed to confirm the potential association between functional syndromes like fibromyalgia and inappropriate thyroid hormone treatment.

Objective: In a previous questionnaire study, more breast cancers were reported by women with intrahepatic cholestasis of pregnancy (ICP) than by the controls.The aim of this study was to establish whether ICP is associated with cancer in the Finnish Cancer Registry data, the study population being the same cohort as in the questionnaire study. Methods:The study population comprised 571 women with ICP in at least one pregnancy and 1,333 controls from Tampere University Hospital in Finland during 1969-1988.The cancer data were obtained from the Finnish Cancer Registry.The cancers were classified by ICD-O-3 and diagnosed during the period 1953-2013. Results:In the ICP group, the odds ratio of cancers (OR 1.26, 95% CI 0.96-1.64),and breast cancer in particular (OR 1.36, 95% CI 0.91-2.03),was slightly higher than in the control group.Seven percent of the ICP group and 5.3% of the control group had breast cancer. Conclusion:Based on this study there is not a significant association between ICP and cancer.Earlier observation in the questionnaire study regarding association between ICP and breast cancer cannot be confirmed by this registry based study.

BACKGROUND:Fibromyalgia is a syndrome characterized by widespread pain and a variety of somatic symptoms. The international prevalence of fibromyalgia is 2-5%, but its current prevalence in Finland is unclear. Various adversities are linked to the onset of fibromyalgia. However, there is need for more data regarding the association between childhood physical abuse and fibromyalgia. Further, the association of childhood emotional stressors and fibromyalgia is disputed. The aim of the current study is to produce more information about that relationship using data from the Health and Social Support (HeSSup) Study.METHODS:HeSSup is a postal study consisting of a random sample of the Finnish population. The study setting is cross-sectional. Participants in the study were asked if they have been diagnosed with fibromyalgia. Those responding affirmatively were classified as fibromyalgia patients. Six childhood adversities were enquired, and the relationship between fibromyalgia and these events were analysed by cross tabulation and logistic regression.RESULTS:There were associations between examined adversities and fibromyalgia before and after adjustments for demographic features and depression (being afraid of a family member: odds ratio after adjustment 1.60, 95% CI 1.28-2.01; long-lasting financial difficulties 1.45, 1.18-1.77; serious conflicts in the family 1.40, 1.14-1.72; parental divorce 1.34, 1.05-1.72; serious or chronic illnesses in the family 1.27, 1.05-1.55; alcohol problems in the family 1.25, 1.02-1.53).CONCLUSION:All six enquired adversities were associated with fibromyalgia after adjustments. These findings emphasize the importance of preventing adverse childhood experiences.