[Show abstract][Hide abstract] ABSTRACT: Aims:
The present study examined the differences between physicians working in public and private health care in strenuous working environments (presence of occupational hazards, physical violence, and presenteeism) and health behaviours (alcohol consumption, body mass index, and physical activity). In addition, we examined whether gender or age moderated these potential differences.
Cross-sectional survey data were compiled on 1422 female and 948 male randomly selected physicians aged 25-65 years from The Finnish Health Care Professionals Study. Logistic regression and linear regression analyses were used with adjustment for gender, age, specialisation status, working time, managerial position, and on-call duty.
Occupational hazards, physical violence, and presenteeism were more commonly reported by physicians working in the public sector than by their counterparts in the private sector. Among physicians aged 50 years or younger, those who worked in the public sector consumed more alcohol than those who worked in the private sector, whereas in those aged 50 or more the reverse was true. In addition, working in the private sector was most strongly associated with lower levels of physical violence in those who were older than 50 years, and with lower levels of presenteeism among those aged 40-50 years.
The present study found evidence for the public sector being a more strenuous work environment for physicians than the private sector. Our results suggest that public healthcare organisations should pay more attention to the working conditions of their employees.
Scandinavian Journal of Public Health 12/2012; 41(1). DOI:10.1177/1403494812467505 · 1.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Positive associations between physical activity and cognitive test performance in depressed subjects have been proposed in clinical studies. The contribution of severity and recency of depressive symptoms at the population level is not known. Aims: This study aims to examine whether regular physical activity associates with better verbal fluency and psychomotor speed in depressed subjects using a large population-based sample. Methods: Data was obtained from the population-based Finnish Health 2000 Study, gathered in 2000-2001. Depressive symptoms and depressive disorders were assessed by the Beck Depression Inventory (BDI) and the Composite International Diagnostic Interview (CIDI), correspondingly. Cognitive test performance was assessed by the animal naming test and psychomotor speed with a simple and multi-choice reaction time test. Physical activity (Gothenburg scale) was self-reported. Complete data were obtained from 3658 subjects aged 30-64 years. Socio-demographic factors, health behaviours and use of antidepressants and anxiolytics were used as covariates in the linear regression models. Adjusted means were calculated using the predictive margins method. Results: Regular physical activity associated with better performance in reaction time tests and better verbal fluency among men with depressive symptoms or with a major depressive episode. Physical activity also associated with cognitive test performance among non-depressed men and women, but among them the differences between the physical activity groups were smaller. Conclusion: Regular physical activity may be a useful tool in supporting neurocognitive functioning among depressed subjects.
[Show abstract][Hide abstract] ABSTRACT: Personality is a potential factor determining individual differences in body-weight change. The current study examines associations between personality traits and change in body-mass index (BMI) over six years.
The participants were 762 women and 648 men aged 24-39years at the base-line. Personality was assessed with the Temperament and Character Inventory (TCI). For calculating BMI, height and weight were assessed at a clinic.
Longitudinal analyses conducted with linear regressions showed that in men and women, higher Novelty seeking predicted higher BMI (p<.05), whereas lower Reward dependence predicted higher BMI in women (p<.05) when baseline BMI was taken into account. In addition, cross-sectional associations for several TCI traits were found in age and education adjusted analyses. In women, higher Self transcendence (p<.05) was associated with higher BMI. In men, higher Novelty seeking (p<.001) and Self transcendence (p<.01) and lower Self directedness (p<.01) and Cooperativeness (p<.05) were associated with higher BMI. In addition, analyses of variance were conducted for multidimensional trait profiles (trait combinations). Significant temperament profile related differences in BMI were found in all analyses in women. Associations with character profiles and in men were less consistent.
The results give support for personality playing a role in weight gain. Knowledge on personality may be used for motivating weight loss and designing weight management interventions.
Journal of psychosomatic research 11/2012; 73(5):391-7. DOI:10.1016/j.jpsychores.2012.08.012 · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives:
We examined whether childhood disruptive behavior (aggressiveness, hyperactivity and social adjustment), predicts adulthood socioeconomic position (SEP), i.e., educational level, occupational status and income and social mobility.
Social mobility was defined by comparing the participants' adulthood socioeconomic position with that of their parents ("intergenerational social mobility"). The subjects were derived from a population-based cohort study (N = 3,600) and our sample consisted of 782 participants (403 women) aged 3-9 years at baseline and were followed until they were aged 30-36.
High childhood aggression associated with low educational level and occupational status suggesting an early beginning negative tracking of aggressive behavior. High hyperactivity and poor social adjustment predicted adulthood low occupational status proposing a more slow effect on adulthood SEP. No associations between disruptive behavior and income-related mobility were found, but high hyperactivity associated with educational downward drift, whereas high aggression and low social adjustment related with occupational downward drift.
Results suggest that childhood disruptive behavior may have long-lasting negative effects. In order to reduce the adverse effects of disruptive behavior, early intervention of problematic behavior becomes salient.
International Journal of Public Health 09/2012; 58(2). DOI:10.1007/s00038-012-0408-3 · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The causal role of obesity in the development of depression remains uncertain. We applied instrumental-variables regression (Mendelian randomization) to examine the association of adolescent and adult body mass index (BMI) with adult depressive symptoms. Participants were from the Young Finns prospective cohort study (n = 1731 persons, 2844 person-observations), with repeated measurements of BMI and depressive symptoms (modified Beck's Depression Inventory). Genetic risk score of 31 single nucleotide polymorphisms previously identified as robust genetic markers of body weight was used as a proxy for variation in BMI. In standard linear regression analysis, higher adult depressive symptoms were predicted by higher adolescent BMI (B = 0.33, CI = 0.06-0.60, P = 0.017) and adult BMI (B = 0.47, CI = 0.32-0.63, P < 0.001). These associations were replicated in instrumental-variables analysis with genetic risk score as instrument (B = 1.96, CI = 0.03-3.90, P = 0.047 for adolescent BMI; B = 1.08, CI = 0.11-2.04, P = 0.030 for adult BMI). The association for adolescent BMI was significantly stronger in the instrumented analysis compared to standard regression (P = 0.04). These findings provide additional evidence to support a causal role for high BMI in increasing symptoms of depression. However, the present analysis also demonstrates potential limitations of applying Mendelian randomization when using complex phenotypes.
[Show abstract][Hide abstract] ABSTRACT: Background
Type 2 diabetes is an increasingly prevalent illness, and there is considerable variation in the quality of care provided to patients with diabetes in primary care.Objectives
The aim of this study was to explore whether organizational justice and organizational citizenship behaviour are associated with the behaviours of clinical staff when providing care for patients with diabetes.Methods
The data were from an ongoing prospective multicenter study, the 'improving Quality of care in Diabetes' (iQuaD) study. Participants (N = 467) were clinical staff in 99 primary care practices in the UK. The outcome measures were six self-reported clinical behaviours: prescribing for glycaemic control, prescribing for blood pressure control, foot examination, giving advice about weight management, providing general education about diabetes and giving advice about self-management. Organizational justice perceptions were collected using a self-administered questionnaire. The associations between organizational justice and behavioural outcomes were tested using linear multilevel regression modelling.ResultsHigher scores on the procedural component of organizational justice were associated with more frequent weight management advice, self-management advice and provision of general education for patients with diabetes. The associations between justice and clinical behaviours were not explained by individual or practice characteristics, but evidence was found for the partial mediating role of organizational citizenship behaviour.Conclusions
Quality improvement efforts aimed at increasing advice and education provision in diabetes management in primary care could target also perceptions of procedural justice.
Family Practice 08/2012; 30(1). DOI:10.1093/fampra/cms048 · 1.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
To examine whether the activation of indoleamine 2,3-dioxygenase (IDO), an enzyme involved in serotonin production, is associated with depressive symptoms.
The participants were 544 women and 442 men (aged 24-39 years) from the population-based Young Finns Study who participated in a medical examination in 2001 (including IDO and depression) and 2007 (follow-up assessment for depression).
At baseline, IDO was associated with depressive symptoms (in the total cohort: B = 0.23, p < .001; women: B = 0.20, p = .007; men: B = 0.29, p = .002; p for interaction = .19). IDO at baseline was also associated with depressive symptoms at follow-up in women (B = 0.17, p = .03), which remained significant when adjusting for any of the biologic and behavioral risk factors. Adjusting for body mass index attenuated the association by 6%. In the final model including all baseline variables, none of the risk factors (except for baseline depressive symptoms) were associated with depressive symptoms at follow-up.
These data suggest that IDO activity may be a risk factor for future depression especially in women. IDO-induced alterations in serotonergic function may offer one biologic explanation to the well-established associations between inflammation and depression.
Psychosomatic Medicine 08/2012; 74(7):675-81. DOI:10.1097/PSY.0b013e318266d0f5 · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
We examined the effects of leaving public sector general practitioner (GP) work and of taking a GP position on changes in work-related psychosocial factors, such as time pressure, patient-related stress, distress and work interference with family. In addition, we examined whether changes in time pressure and patient-related stress mediated the association of employment change with changes of distress and work interference with family.
Participants were 1705 Finnish physicians (60% women) who responded to surveys in 2006 and 2010. Analyses of covariance were conducted to examine the effect of employment change to outcome changes adjusted for gender, age and response format. Mediational effects were tested following the procedures outlined by Baron and Kenny.
Employment change was significantly associated with all the outcomes. Leaving public sector GP work was associated with substantially decreased time pressure, patient-related stress, distress and work interference with family. In contrast, taking a position as a public sector GP was associated with an increase in these factors. Mediation tests suggested that the associations of employment change with distress change and work interference with family change were partially explained by the changes in time pressure and patient-related stress.
Our results showed that leaving public sector GP work is associated with favourable outcomes, whereas taking a GP position in the public sector is associated with adverse effects. Primary health-care organizations should pay more attention to the working conditions of their GPs, in particular, to time pressure and patient-related stress.
The European Journal of Public Health 08/2012; 23(3). DOI:10.1093/eurpub/cks112 · 2.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although most people with Type 2 diabetes receive their diabetes care in primary care, only a limited amount is known about the quality of diabetes care in this setting. We investigated the provision and receipt of diabetes care delivered in UK primary care.
Postal surveys with all healthcare professionals and a random sample of 100 patients with Type 2 diabetes from 99 UK primary care practices.
326/361 (90.3%) doctors, 163/186 (87.6%) nurses and 3591 patients (41.8%) returned a questionnaire. Clinicians reported giving advice about lifestyle behaviours (e.g. 88% would routinely advise about calorie restriction; 99.6% about increasing exercise) more often than patients reported having received it (43% and 42%) and correlations between clinician and patient report were low. Patients' reported levels of confidence about managing their diabetes were moderately high; a median (range) of 21% (3% to 39%) of patients reporting being not confident about various areas of diabetes self-management.
Primary care practices have organisational structures in place and are, as judged by routine quality indicators, delivering high quality care. There remain evidence-practice gaps in the care provided and in the self confidence that patients have for key aspects of self management and further research is needed to address these issues. Future research should use robust designs and appropriately designed studies to investigate how best to improve this situation.
PLoS ONE 08/2012; 7(7):e41562. DOI:10.1371/journal.pone.0041562 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND:: Organizational justice has been put forward as a measure of leadership quality that is associated with better health among employees. OBJECTIVES:: We extended that idea to test whether perceived organizational justice among health care providers might be positively associated with glycemic control among their diabetic patients. SETTING:: Eighteen primary-care health centers (HCs) in Finland. PARTICIPANTS:: Type 2 diabetes patients (n=8954) and HC staff (n=422). MEASUREMENTS:: Mean of 1 year's measurements of glycated hemoglobin [≥7.0 (the least optimal); 6.5-6.9; 6.0-6.4; and 4.5-5.9 (the most optimal)], health-center psychosocial work characteristics (staff-reported procedural justice and relational justice, effort-reward imbalance, and work-unit team climate), and individual-level and work-unit-level covariates. RESULTS:: Perceptions of higher levels of procedural justice among staff were associated with more optimal glycated hemoglobin levels among patients (cumulative odds ratio per 1-U increase in justice=1.54, 95% confidence interval, 1.08-2.18) after adjustment for patient-level and unit-level covariates. Relational justice, effort-reward imbalance, and work-unit team climate were not associated with glycemic control. CONCLUSION:: The quality of leadership at HCs, as indicated by staff perceptions of procedural justice, may play a role in achieving good glycemic control among type 2 diabetes patients.
Medical care 06/2012; 50(10):831-835. DOI:10.1097/MLR.0b013e31825dd741 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There have been increasing signs of the weakening of universalism in the Nordic welfare system. While earlier research has mainly concentrated on general attitudes towards the welfare state, we aim to examine whether general attitudes and attitudes specific to the organization and funding of services form separate dimensions, as well as to explore the background factors connected to these attitudes. The data comes from a population-based survey ‘Welfare and services in Finland’ in 2009. The survey had 1824 respondents (response rate: 59%). Welfare state attitudes were examined using structural equation modelling, while linear regression analyses were used to examine the associations between background variables and attitudes. In addition to general welfare attitudes, three dimensions of specific attitudes were found. Attitudes concerning the public organization of services and those concerning the tax-based funding of services formed separate dimensions. Both were strongly related to general welfare attitudes. However, attitudes towards private services formed a further dimension. Both general and specific attitudes to the welfare state were affected by sociodemographic factors that can be seen to influence the need for services. The results of the study suggest that the population still seems to want to maintain the most important features of the Nordic welfare state.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Inequality in health and treatment of disease across socioeconomic status groups is a major public health issue. AIMS: To examine differences in socioeconomic status in common mental disorders and use of psychotherapy provided by the public and private sector in the UK between 1991 and 2009. METHOD: During these years, 28 054 men and women responded to annual surveys by the nationally representative, population-based British Household Panel Survey (on average 7 measurements per participant; 207 545 person-observations). In each year, common mental disorders were assessed with the self-reported 12-item General Health Questionnaire and socioeconomic status was assessed on the basis of household income, occupational status and education. RESULTS: Higher socioeconomic status was associated with lower odds of common mental disorder (highest v. lowest household income quintile odds ratio (OR) 0.88, 95% CI 0.82-0.94) and of being treated by publicly provided psychotherapy (OR = 0.43, 95% CI 0.34-0.55), but higher odds of being a client of private psychotherapy (OR = 3.33, 95% CI 2.36-4.71). The status difference in publicly provided psychotherapy treatment was more pronounced at the end of follow-up (OR = 0.36, 95% CI 0.23-0.56, in 2005-2009) than at the beginning of the follow-up period (OR = 0.96, 95% CI 0.66-1.39, in 1991-1994; time interaction P<0.001). The findings for occupational status and education were similar to those for household income. CONCLUSIONS: The use of publicly provided psychotherapy has improved between 1991 and 2009 among those with low socioeconomic status, although social inequalities in common mental disorders remain.
The British journal of psychiatry: the journal of mental science 04/2012; 202(2). DOI:10.1192/bjp.bp.111.098863 · 7.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This large-scale longitudinal study examined the hypothesis that the experienced usefulness of performance appraisal interviews affects justice perceptions and that changes in work life contribute to this effect. Our findings from 6592 employees who were nested in 1291 work groups over a 4-year period and who at baseline had not applied for a performance appraisal interview support this prediction. Specifically, the results of multilevel regression analyses showed that interviews that were experienced as useful improved justice perceptions significantly. In contrast, when the interviews were experienced as unhelpful, the impact on justice perceptions was negative. Furthermore, during negative changes in work life, useful interviews were especially important in helping prevent the deterioration of justice perceptions. The implications for organizational justice and the usefulness of the performance appraisal are discussed.
The International Journal of Human Resource Management 04/2012; 23(7-7):1360-1375. DOI:10.1080/09585192.2011.579915 · 0.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An increasing proportion of the population lives in one-person households. The authors examined whether living alone predicts the use of antidepressant medication and whether socioeconomic, psychosocial, or behavioral factors explain this association.
The participants were a nationally representative sample of working-age Finns from the Health 2000 Study, totaling 1695 men and 1776 women with a mean age of 44.6 years. In the baseline survey in 2000, living arrangements (living alone vs. not) and potential explanatory factors, including psychosocial factors (social support, work climate, hostility), sociodemographic factors (occupational grade, education, income, unemployment, urbanicity, rental living, housing conditions), and health behaviors (smoking, alcohol use, physical activity, obesity), were measured. Antidepressant medication use was followed up from 2000 to 2008 through linkage to national prescription registers.
Participants living alone had a 1.81-fold (CI = 1.46-2.23) higher purchase rate of antidepressants during the follow-up period than those who did not live alone. Adjustment for sociodemographic factors attenuated this association by 21% (adjusted OR = 1.64, CI = 1.32-2.05). The corresponding attenuation was 12% after adjustment for psychosocial factors (adjusted OR = 1.71, CI = 1.38-2.11) and 9% after adjustment for health behaviors (adjusted OR = 1.74, CI = 1.41-2.14). Gender-stratified analyses showed that in women the greatest attenuation was related to sociodemographic factors and in men to psychosocial factors.
These data suggest that people living alone may be at increased risk of developing mental health problems. The public health value is in recognizing that people who live alone are more likely to have material and psychosocial problems that may contribute to excess mental health problems in this population group.
BMC Public Health 03/2012; 12(1):236. DOI:10.1186/1471-2458-12-236 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We examined two alternative hypotheses on the association between low socioeconomic status (SES) and depressive symptoms: social causation and health selection. The latent growth curve (LGC) approach was used to examine trajectories of change in depressive symptoms over a period of 15 years in a dataset (the Young Finns study) consisting of a nationally representative sample of adolescents and young adults (n = 1613). Depressive symptoms were examined at four examination phases between 1992 and 2007. SES was measured as parental SES childhood (baseline of the study in 1980) and as the participants own SES in 2007 when the participants had reached adulthood and were between 30 and 45 years of age. The level of depressive symptoms was associated (r = -.14) with a slower decrease in symptoms during follow-up. Lower age, male gender, higher parental occupational grade but not parental income and lower negative emotionality in childhood were associated with a lower level of depressive symptoms. Higher age was also associated with a slower decrease in depressive symptoms. A lower level of depression and faster decrease in depressive symptoms were associated with a higher socioeconomic position in adulthood. A similar pattern was found in the relationship between the level of depression and income in adulthood. We concluded that the effect of childhood SES on depressive symptoms diminishes over time, but a higher level of, and especially faster decline of, depressive symptoms predicts the adulthood occupational SES gradient.
Social Science [?] Medicine 03/2012; 74(6):923-9. DOI:10.1016/j.socscimed.2011.12.017 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study investigated the prevalence of and factors associated with school bullying and victimization among Finnish international adoptees. The Olweus bully/victim questionnaire was sent to all 9-15-year-old children adopted in Finland between 1985 and 2007 through the mediating organizations officially approved by the Ministry of Social Affairs and Health. The children were identified through official adoption organizations. The response rate in the target sample was 49.4%: the study sample consisted of 364 children (190 girls, 52.2%). The children's background factors and symptoms of reactive attachment disorder (RAD) were evaluated using a FINADO questionnaire. Their learning difficulties and social and language skills were assessed using a standardized parental questionnaire (Five to Fifteen). Of the participants, 19.8% reported victimization by peers while 8% had bullied others. Both victimization and bullying were associated with severe symptoms of RAD at the time of adoption (RR 2.68, 95%CI 1.50-4.77 and RR 2.08, 95%CI 1.17-3.69 for victimization and bullying, respectively). Lack of social skills was associated with victimization (RR 1.74, 95%CI 1.06-2.85) but not independently with being a bully (RR 1.50, 95%CI 0.91-2.45). In a multivariate analysis the child's learning difficulties and language difficulties were not associated with either bullying others or victimization.
Child Psychiatry and Human Development 02/2012; 43(4):592-611. DOI:10.1007/s10578-012-0286-1 · 1.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Beck Depression Inventory (BDI) and the General Health Questionnaire (GHQ) are commonly used in population studies as measures of depression. We examined in a population sample the validity of four scales for depressive symptoms, the GHQ-12, the 21- and 13-item versions of the BDI, and a new 6-item version of the BDI developed for this study. A total of 5561 participants in the "Health 2000" survey (30-79 years) completed the four scales and were assessed with the Composite International Diagnostic Interview (CIDI), which was used as the validation criterion. We selected items for the BDI-6 through an exploratory factor analysis for the BDI-21. The accuracy of the scales, including the BDI-6, was satisfactory (c-statistics 0.88-0.92 for depression within the past 2 weeks and 0.80-0.83 within the past 12 months) and slightly better for men (0.92-0.96 and 0.85-0.87) than for women (0.86-0.88 and 0.78-0.79). Higher scores in all the scales were associated with more severe depression and more recent depressive episodes. This study suggests that various versions of the BDI and the GHQ-12 are useful in detecting depressive disorders in the general population. Even the 6-item version of the BDI showed acceptable criterion validity, although replication in an independent dataset is needed to confirm its validity.
Psychiatry Research 02/2012; 197(1-2):163-71. DOI:10.1016/j.psychres.2011.09.008 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study examined whether organizational justice moderates the association of shift work and employment type with patient-related stress, stress symptoms, and musculoskeletal symptoms. Cross-sectional survey data from 1270 Finnish female elderly care staff aged 18–69 years was used. Analyses of covariance were used to examine the associations adjusted for age,marital status, education, and tenure. Organizational justice was associated with lower levels of patient-related stress, stress symptoms, and musculoskeletal symptoms. Organizational justice mitigated stress symptoms related to working night shift and three shifts. In addition, organizational justice mitigated the patient-related stress associated with working on fixed-term contracts. Organizational justice was also able to alleviate musculoskeletal symptoms associated with working on permanent contracts. Thus, we found evidence for organizational justice being able to mitigate the negative effects of shift work and employment type. Promoting organizational justice in organizations with shift work and lots of fixed-term contracts is of importance.
European Journal of Work and Organizational Psychology 01/2012; 22(2):1-9. DOI:10.1080/1359432X.2011.647408 · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined whether the ownership type is associated with job insecurity and worry about job stability and whether the type of employment contract, positive leadership, and fair management moderated these associations. Survey data from 1249 Finnish female elderly care staff aged 18 to 69 years were used. Job insecurity and worry about job stability were highest in not-for-profit sheltered homes. However, positive leadership and fair management were able to mitigate this insecurity and worry. Job insecurity was highest among fixed-term employees in public sheltered homes or not-for-profit nursing homes. Thus, promoting good leadership and fair management would be of importance.
ANS. Advances in nursing science 01/2012; 35(1):39-50. DOI:10.1097/ANS.0b013e31824454a2 · 0.83 Impact Factor