Background Continuity of care constitutes the basis of primary health care services and is associated with decreased hospitalization. In Finland, accessibility to primary care and increased use of hospital services are recognized challenges for the health care system. Objectives The aim of the study was to determine whether having a named GP is associated with hospital service use. Methods The data are part of the Health and Social Support study (HeSSup) based on a random Finnish working-age population sample. The cohort of the study comprised participants of postal surveys in 1998 ( n = 25,898) who returned follow-up questionnaires both in 2003 and 2012 ( n = 11,924). Background characteristics were inquired in the questionnaires, and hospitalization was derived from national registries (Hilmo-register). Results A named GP was reported both in 2003 and 2012 only by 34.3% of the participants. The association between hospital days and a named GP was linearly rising and statistically significant in a single predictor model. The strongest associations with hospital use were with health-related factors, and the association with a named GP was no longer significant in multinomial analysis. Conclusion A named GP is associated with an increased use of hospital days, but in a multinomial analysis the association disappeared. Health related factors showed the strongest association with hospital days. From the perspective of the on-going Finnish health and social services reform, continuity of care should be emphasized.

Abstract Background Continuity of care strengthens health promotion and decreases mortality, although the mechanisms of these effects are still unclear. In recent decades, continuity of care and accessibility of health care services have both decreased in Finland. Objectives The aim of the study was to investigate whether a named and assigned GP representing continuity of care is associated with the use of primary and hospital health care services and to create knowledge on the state of continuity of care in a changing health care system in Finland. Methods The data are part of the Health and Social Support (HeSSup) mail survey based on a random Finnish working age population sample of 64,797 individuals drawn in 1998 and follow-up surveys in 2003 and 2012. The response rate in 1998 was 40% (n = 25,898). Continuity of care was derived from the 2003 and 2012 data sets, other variables from the 2012 survey (n = 11,924). The principal outcome variables were primary health care and hospital service use reported by participants. The association of the explanatory variables (gender, age, education, reported chronic diseases, health status, smoking, obesity, NYHA class of any functional limitation, depressive mood and continuity of care) with the outcome variables was analysed by binomial logistic regression analysis. Results A named and assigned GP was independently and significantly associated with more frequent use of primary and hospital care in the adjusted logistic regression analysis (ORs 1.53 (95% CI 1.35–1.72) and 1.19 (95% CI 1.08–1.32), p < 0.001). Conclusion A named GPs is associated with an increased use of primary care and hospital services. A named GP assures access to health care services especially to the chronically ill population. The results depict the state of continuity of care in Finland. All benefits of continuity of care are not enabled although it still assures treatment of population in the most vulnerable position.

Background The aim of our study was to evaluate the risk for comorbid cardio- and cerebrovascular diseases in the working-aged migraine population of Finland. Methods A total of 1505 cases who reported diagnosed migraine and 3010 controls from a cohort of 11,596 cases in the Finnish Health and Social Support Study were included. The study material was linked with two registers. ICD diagnoses I63 for ischemic stroke (IS), I21 − I22 for acute myocardial infarction (AMI), and G43 for transient ischemic attack (TIA) among study participants were drawn from the national Finnish Care Register for Health Care at the follow-up in 2012. Reimbursed triptan prescriptions were drawn from the national Social Security Institution (SII) data. The self-reported vascular risk factors were hypertension, high cholesterol values, any diabetes, myocardial infarction, stroke, and TIA. Odds Ratios (OR) with 95% confidence (95% CI) intervals were assessed for diagnosed stroke, myocardial infarction, and TIA. Results Migraineurs were mostly female (82%) and ≥ 54 years old (62%). Triptans were reimbursed among 34.7% of migraineurs. A self-reported hypertension (21%), high serum cholesterol (38%), and any diabetes (7%) were more common among migraineurs vs controls ( p < 0.05). There was no risk for AMI. The risk for TIA (OR 3.20, 95% CI 1.45–7.05) and IS (2.57, 95% CI 1.28–5.17) among migraineurs vs controls remained high after adjustment for self-reported hypertension, obesity, and smoking. The risk was higher among women in two groups ≥54 years (3.25, 95% CI 1.35–7.84 and 5.0, 95% CI 1.94–12.89, respectively). The average age for IS in migraine was 57.5 years and for TIA 58.2 years among women, and 52.8 years and 50.3 years among men, respectively. Conclusion Cardiovascular risk should be screened in the aging migraine population, and hormonal and other migraine-related risk factors should be considered, especially among women. Efficacious attack treatment with triptans should be offered to migraine patients who do not show contraindications.

A Correction to this paper has been published: https://doi.org/10.1038/s41591-020-01185-6.

Abstract 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. Key points Research work in primary health care is not very common. Only 7.3% of GPs had completed their doctorate compared to 32.3% in other specialties. A main factor associated with the current intention to complete a doctoral degree was interest in attaining a senior position.

A correction to this paper has been published and can be accessed via a link at the top of the paper.

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.

Ketjulähettitoiminta on Pirkanmaan sairaanhoitopiirin ja terveyskeskusten täydennyskoulutus- ja yhteistyömuoto. Terveyskeskusten työntekijät eli ketjulähetit työskentelevät erikoissairaanhoidossa viikon ajan etukäteen suunnitellun ohjelman mukaisesti. Tutkimuksen tarkoituksena oli selvittää onko ketjulähettijaksolla opittuja asioita käsitelty omassa terveyskeskuksessa ketjulähettijakson jälkeen ja ovatko ketjulähetit muuttaneet toimintaansa ketjulähettijakson perusteella. Kyselylomakkeet lähetettiin kaikille vuosina 2006–2011 ketjulähettijaksolla käyneille (n = 177) sekä terveyskeskusten johdolle ja koulutusvastaaville (n = 31). Aineiston analyysimenetelminä käytettiin frekvenssijakaumia, ristiintaulukointia, logistista regressioanalyysiä sekä aineistolähtöistä ryhmittelyä teemakokonaisuuksien alle. Ketjulähettijaksot vaikuttivat ketjulähetin omassa työssään tekemiin muutoksiin. Eniten muutettiin työtapoja, potilaan ohjausta, hoitoa tukevia työyhteisön käytäntöjä sekä oman työn arvostusta. Terveyskeskuksissa ketjulähettijaksolla opittuja asioita käsiteltiin satunnaisesti. Ketjulähettijaksoja voisi hyödyntää nykyistä tehokkaammin yksilön osaamisen kehittämisen lisäksi työyhteisön ja koko organisaation toiminnan kehittämisessä. Tässä on haaste terveyskeskusten johtamiselle.

AbstractUpstream open reading frames (uORFs) are important tissue-specific cis-regulators of protein translation. Although isolated case reports have shown that variants that create or disrupt uORFs can cause disease, genetic sequencing approaches typically focus on protein-coding regions and ignore these variants. Here, we describe a systematic genome-wide study of variants that create and disrupt human uORFs, and explore their role in human disease using 15,708 whole genome sequences collected by the Genome Aggregation Database (gnomAD) project. We show that 14,897 variants that create new start codons upstream of the canonical coding sequence (CDS), and 2,406 variants disrupting the stop site of existing uORFs, are under strong negative selection. Furthermore, variants creating uORFs that overlap the CDS show signals of selection equivalent to coding loss-of-function variants, and uORF-perturbing variants are under strong selection when arising upstream of known disease genes and genes intolerant to loss-of-function variants. Finally, we identify specific genes where perturbation of uORFs is likely to represent an important disease mechanism, and report a novel uORF frameshift variant upstream of NF2 in families with neurofibromatosis. Our results highlight uORF-perturbing variants as an important and under-recognised functional class that can contribute to penetrant human disease, and demonstrate the power of large-scale population sequencing data to study the deleteriousness of specific classes of non-coding variants.

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.

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.

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.

Musculoskeletal disorders and depression are common among migraineurs. The aim of our study was to evaluate the occurrence of these disorders among working aged migraineurs.

The aim of this study was to determine whether intrahepatic cholestasis of pregnancy (ICP) is associated with causes of death during on average 35 years follow-up after the delivery.

Objective: Continuity is an essential part of high-quality nursing care. This study is the first systematic follow-up of Finnish primary health care patients assessing continuity of health centre nursing staff. The aim was to ascertain how longitudinal interpersonal continuity of care is related to patients’ characteristics, their consultation experiences, and how continuity had changed over the 15-year study period.Methods: A questionnaire survey was conducted among patients attending the health centres in the Tampere University Hospital catchment area from 1998 to 2013. A total of 157,549 patients responded out of 363,464 in almost 60 health centres. We analysed the opinions of patients (n = 47,470) who had visited a nurse during the survey weeks. Opinions on the continuity of care were assessed with the question: “When visiting the health centre, do you usually see the same nurse”, the alternatives being “yes” or “no”. A binary logistic regression model was used.Results: Almost two thirds of the respondents had met the same nurse when visiting their health care centre. Longitudinal interpersonal continuity of care decreased by 15 percentage (67%-52%) during the study years. Continuity was connected to patient-related items such as a visit in the preceding 12 months (OR 1.32, 95% CI 1.17-1.49) and non-urgency of the visit (OR 1.44, 95% CI 1.27-1.63). The most prominent factor contributing to the sense of continuity of care was how attentively nurses had listened to their patients’ problems and shown an interest in them and a willingness to answer their questions (OR 1.31, 95% CI 1.120-1.43).Conclusions: In the past 15 years patient-reported longitudinal interpersonal continuity of nursing care has declined. However continuity of care proved to enhance the experienced quality of primary health care. Continuity was best realized in nursing care when nurses had listened to their patients’ problems, showed interest toward them and a willingness to answer their questions.

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.