Anna-Mari Aalto

National Institute for Health and Welfare, Finland, Helsinki, Southern Finland Province, Finland

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Publications (31)93.14 Total impact

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    ABSTRACT: Although international migration of physicians is increasing, research information on their adjustment to working in a new country is scarce. This study examined the differences in employment, perceptions of psychosocial work environment and well-being between migrant and native physicians in Finland. A cross-sectional survey was sent to a random sample of physicians in Finland (N = 7000) and additionally to all foreign-born physicians licensed to practice in Finland (N = 1292). The final response rates were 56% (n = 3646) among native Finns and 43% (n = 553) among foreign-born physicians. Migrant physicians worked more often in primary care and on-call services and less often in leadership positions than native Finns. They more often experienced lack of professional support and lower work-related well-being compared with native Finns. Those migrant physicians who had lived for a shorter time in Finland perceived less stress related to electronic patient records systems and higher organizational justice compared with native physicians or those foreign physicians who had migrated earlier. Foreign-born physicians are more often employed in the primary care sector, where there are most difficulties in recruiting from the native workforce in Finland. Attention should be paid to enhancing equitable career opportunities and well-being among foreign-born physicians working in Finnish health care. Although migrant physicians are relatively well adjusted to Finnish health care in terms of perceptions of psychosocial work environment, their lower well-being calls for attention.
    The European Journal of Public Health 03/2014; · 2.52 Impact Factor
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    ABSTRACT: OBJECTIVES Previous studies suggest that psychiatrists may be more stressed than other medical specialists and mental health professionals. This study examined differences in stress factors, job resources, psychological distress, and job satisfaction between psychiatrists and other medical specialists. In addition, the study examined whether stress factors or job resources accounted for possible differences between the groups in psychological distress or job satisfaction. METHODS In 2010, the authors obtained cross-sectional, Web-based survey data from a random sample of 2,776 Finnish physicians, including 1,647 women (59%), ranging in age from 25 to 69 years old. Comparisons between the two groups used analyses of covariance adjusted for gender, age, and employment sector. RESULTS Psychiatrists were less satisfied with their jobs, felt more stressed about patients, and experienced more psychological distress compared with other medical specialists. However, psychiatrists had more opportunities to control their jobs and better team climate compared with other medical specialists. High psychological distress among psychiatrists was partly accounted for by high patient-related stress. The differences in psychological distress and job satisfaction between the two groups were not accounted for by work-family conflicts or optimism. CONCLUSIONS It is important to try to alleviate the high levels of patient-related stress among psychiatrists and to further increase their job resources. Doing so may enhance the attractiveness of psychiatry as a specialty choice.
    Psychiatric services (Washington, D.C.) 03/2014; · 2.81 Impact Factor
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    ABSTRACT: International mobility of health care professionals is increasing, though little is known about how working in a culturally diverse team affects the native physicians’ psychosocial work environment. We examined Finnish physicians’ perceptions of work-related wellbeing according to whether they had foreign-born colleagues (FBCs) in their work unit. We also examined whether work-related resources moderate the potential association between work-related wellbeing and working alongside FBCs. A cross-sectional survey was conducted for a random sample of physicians in Finland in 2010 (3826 respondents, response rate 55%). Analyses were restricted to native Finnish physicians working in public health care. The results were analyzed by ANCOVA. In unadjusted analyses, having FBCs was related to poor team climate (p < 0.001) and poor job satisfaction (p = 0.001). Those physicians who reported high procedural justice and high job control perceived also higher job satisfaction even if they had many FBCs in the work unit (p = 0.007 for interaction between FBCs and procedural justice and p<.001 for interaction between FBCs and job control). These associations were robust to adjustments for age, sex, health care sector, specialization, on-call duty, employment contract, full-time employment and leadership position. The results indicate that culturally diverse work units face challenges related to team climate and job satisfaction. The results also show that leadership plays an important role in culturally diverse work units. The potential challenges of culturally diverse teams for native physicians may be reduced by fair decision-making and by increasing physicians’ job control.
    Health Policy 01/2014; · 1.51 Impact Factor
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    ABSTRACT: We examined whether organizational justice is associated with sleep quality and performance in a population-based sample of 1,729 Finnish registered nurses working full time. In addition, we tested psychological mechanisms mediating the potential association. The results of multivariate linear regression analyses showed higher organizational justice to be associated with fewer sleeping problems (β values range from -.20 to -.11) and higher self-reported performance (β values range from .05 to .35). Furthermore, psychological distress (related to the psychological stress model) and job involvement (related to the psychosocial resource model) mediated the association between organizational justice and sleep. Sleeping problems partly mediated the association between organizational justice and performance. Psychological distress explained 51% to 83% and job involvement explained 10% to 15% of the total effects of justice variables on sleeping problems. The findings provide support for the psychological stress model and offer practical implications for reducing nurses' sleeping problems. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Journal of Occupational Health Psychology 10/2013; 18(4):481-491. · 2.07 Impact Factor
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    ABSTRACT: Menorrhagia is a common problem impairing the quality of life (QoL) of many women. Both levonorgestrel-releasing intrauterine system (LNG-IUS) and hysterectomy are effective treatment modalities but no long-term comparative studies of QoL and costs exist. The objective of this study was to compare QoL and costs of LNG-IUS or hysterectomy in the treatment of menorrhagia during 10 years follow-up. A total of 236 women, aged 35-49 years, referred for menorrhagia to five university hospitals in Finland were randomly assigned to treatment with LNG-IUS (n=119) or hysterectomy (n=117) and were monitored for 10 years. The main outcome measures were health-related quality of life (HRQoL), psychosocial well-being, and cost-effectiveness. 221 (94%) women were followed for 10 years. Although 55 (46%) women assigned to the LNG-IUS subsequently underwent hysterectomy, the overall costs in the LNG-IUS group ($3423) were substantially lower than in the hysterectomy group ($4937). Overall, levels of HRQoL and psychosocial well-being improved during first 5 years but diminished between 5 years and 10 years and the improved HRQoL returned close to the baseline level. There were no significant differences between LNG-IUS and hysterectomy groups. Both LNG-IUS and hysterectomy improved HRQoL. The improvement was most striking during the first 5 years. Although many women eventually had hysterectomy, LNG-IUS remained cost-effective.
    American journal of obstetrics and gynecology 08/2013; · 3.28 Impact Factor
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    ABSTRACT: Aims: Physicians' high dropout rate is a significant problem in primary care in many countries. One solution to this issue is to recruit internationally mobile physicians. This study explores the role of psychosocial factors in explaining intention to leave among GPs including potential differences between foreign-born and Finnish GPs. Methods: A cross-sectional questionnaire was sent to randomly-selected Finnish physicians (n = 7000) and all foreign-born physicians (n = 1297) living in Finland in the year 2010. The questionnaire was returned by 4333 physicians, of whom 832 were GPs. Of those 176 were foreign-born GPs. Results: Intention to leave was more common among foreign-born GPs (59%) than among Finnish GPs (52%). High job demands were associated with higher intention to leave from primary care both in foreign-born (OR 1.90) and Finnish GPs (OR 2.20). This association remained among foreign-born GPs after adjusted the model for the country of origin or the reason for migration (OR 1.80, 1.82). Lack of job control, patient-related stress, and stresses related to teamwork were associated with higher intention to leave only among Finnish GPs (ORs 0.45, 1.75 and 1.99). Conclusions: There may be cultural differences in the psychosocial factors that enhance or prevent job involvement among physicians. Thus, novel thinking is needed in organizational development of GP work in order to better understand foreign-born physicians' specific needs in a target country. This study also suggests that lightening workload could help to attract more GPs, both foreign-born and Finnish, to primary care.
    Scandinavian Journal of Public Health 03/2013; · 1.97 Impact Factor
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    ABSTRACT: The present study examined whether job resources (job control, social support, and distributive justice) moderate the associations of high job demands induced by physical and mental workload with musculoskeletal symptoms among geriatric nurses. The data were drawn in Finland from 975 female nurses working in 152 geriatric units who responded to a survey questionnaire. Information on the objective workload in terms of resident characteristics and structural factors was also collected at the unit level. After adjusting for the objective workload, multilevel logistic regression analyses showed that self-reported physical workload was associated with higher risk of musculoskeletal symptoms (OR = 1.93, 95 % CI [1.38, 2.72]) among nurses with low social support. In addition, mental workload was associated with higher risk of musculoskeletal symptoms (OR = 1.72, 95% CI [1.12, 2.62]) for those with low distributive justice. The results suggest that social support and fair reward systems may help to buffer against the detrimental effects of heavy job demands on nurses' musculoskeletal symptoms. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Journal of Occupational Health Psychology 03/2013; · 2.07 Impact Factor
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    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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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; · 2.52 Impact Factor
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    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. · 2.46 Impact Factor
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    ABSTRACT: The aim of this study was to study the role of menopausal status and physical activity on quality of life. A total of 1,165 Finnish women aged 45-64 years from a national representative population-based study were followed up for 8 years. Study participants completed the Health 2000 study questionnaire and follow-up questionnaire in 2008. Ordinal logistic regression analysis was used to measure the effect of menopausal status on global quality of life (QoL). Other variables included in the analyses were age, education, change of physical activity as assessed with metabolic equivalents, change of weight and hormone therapy (HRT) use. Peri- and postmenopausal women increased their physical activity (28% and 27%) during the eight-year follow up period slightly more often than premenopausal (18%) women (p = 0.070). Menopausal status was not significantly correlated with change of QoL. QoL of the most highly educated women was more likely to improve than among the less educated (eb = 1.28, 95%CI 1.08 to 1.51 p = 0.002). Women whose physical activity increased or remained stable had greater chances for improved QoL than women whose physical activity decreased (eb = 1.49, 95%CI 1.23 p < 0.001 to 1.80, eb = 1.46, 95%CI 1.24 to 1.73 p < 0.001 respectively). Women whose weight remained stable during follow-up also improved their QoL compared to women who gained weight (eb = 1.26, 95%CI 1.07 to 1.50 p > 0.01). Women who had never used HRT had 1.26 greater odds for improved QoL (95%CI 1.02 to 1.56 p = < 0.05). Improvement of global QoL is correlated with stable or increased physical activity, stable weight and high education, but not with change in menopausal status.
    Health and Quality of Life Outcomes 01/2012; 10:8. · 2.27 Impact Factor
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    ABSTRACT: To examine the well-being differences among physicians working in different health care sectors and to test whether psychosocial stressors account for these differences. The well-being indicators used were psychological distress, self-rated health, and work ability. A total of 2,841 randomly selected Finnish physicians (response rate 57 percent) returned the postal questionnaire, of which 2,047 (1,241 women) fulfilled all the participant criteria. This is a cross-sectional questionnaire study. General practitioners and medical specialists experienced lower well-being than private physicians and this difference was partly explained by differences in psychosocial stressors. General practitioners and medical specialists report more problems in well-being than private physicians. It is of particular importance to be aware of the sector-specific difficulties in work environments.
    Health Services Research 08/2011; 47(1 Pt 1):68-85. · 2.29 Impact Factor
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    ABSTRACT: To develop and test the validity of a short version of the original questionnaire measuring organizational justice. The study samples comprised working physicians (N = 2792) and registered nurses (n = 2137) from the Finnish Health Professionals study. Structural equation modelling was applied to test structural validity, using the justice scales. Furthermore, criterion validity was explored with well-being (sleeping problems) and health indicators (psychological distress/self-rated health). The short version of the organizational justice questionnaire (eight items) provides satisfactory psychometric properties (internal consistency, a good model fit of the data). All scales were associated with an increased risk of sleeping problems and psychological distress, indicating satisfactory criterion validity. This short version of the organizational justice questionnaire provides a useful tool for epidemiological studies focused on health-adverse effects of work environment.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 11/2010; 52(11):1068-74. · 1.88 Impact Factor
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    ABSTRACT: This paper is a report of an investigation into whether insecure work contract and shiftwork are associated with reduced wellbeing indicators, such as psychological distress, low job involvement and low work ability. Insecure work contracts and shiftwork have repeatedly been found to contribute to the development and continuation of negative outcomes among healthcare professionals. In particular, nurses are generally considered as being at high risk of work-related stress and reduced wellbeing. Cross-sectional survey data from the Finnish Health Care Professional Study collected in 2006 were used. The random sample of Finnish Registered Nurses comprised 2100 women and men aged 22-65 years. Information on the work contract and shiftwork were self-reported. The wellbeing indicators used were psychological distress (GHQ-12), work ability and job involvement. Psychosocial work characteristics were measured using the Job Content Questionnaire and an organizational justice scale. Variance and linear regression analyses showed that insecure work contract was associated with lower work ability and job involvement. Shiftwork was related to psychological distress, low job involvement and low work ability. Support for a mediating role of job demands and job control and a moderating role of relational justice was obtained. To reduce the negative effects of environmental stressors, such as insecure work contract and shiftwork, it may be better to focus on improving psychosocial work characteristics than on nurses' health-related behaviour.
    Journal of Advanced Nursing 03/2010; 66(5):1080-91. · 1.53 Impact Factor
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    ABSTRACT: In Finland, electronic decision support is evolving from searchable knowledge bases toward integration of the knowledge modules into the electronic health record in the Evidence‐Based Medicine electronic Decision Support project. We conducted a baseline survey on the extent of use of second‐generation decision support (electronic databases) by the various categories of health care professionals. The results showed that the majority of health care professionals used the electronic databases in their clinical practice; more than 80% of participating physicians, registered nurses, public health nurses, and ward nurses used at least four databases. In addition, the respondents considered these databases clinical useful in their practice. This indicates that health care professionals seem to be ready for the third‐generation clinical decision support system, producing, for example, automatic reminders. Keywords: evidence‐based medicine, guideline, database, clinical decision support systems
    Finnish Journal of eHealth and eWelfare. 09/2009; 1(3):161.
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    ABSTRACT: To test whether depression is independently associated with elevated levels of C-reactive protein (CRP) in a large nationwide population-based sample. Depression and CRP were assessed in 6005 Finns aged >30 years, as part of the ongoing population-based Health 2000 Study. Depression was determined by responses to the Beck's Depression Inventory (BDI-21) and by Composite International Diagnostic Interview (CIDI). Higher scores on BDI-21 were related to higher CRP levels (beta = 0.12, p < .001) in men and (beta = 0.08, p < .001) in women. In men, but not in women, this relationship persisted after adjustment for a number of other known risk factors. In men, the more recent dysthymic disorder or at least moderate depressive episode defined using CIDI was related to elevated CRP levels (beta = 0.06, p = .006). Depressive symptoms may be partly responsible for inflammatory processes, and inflammatory processes may induce depressive symptoms in men.
    Psychosomatic Medicine 03/2009; 71(4):423-30. · 4.08 Impact Factor
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    ABSTRACT: We studied the impact of comorbidity and recency in psychiatric disorders on psychological well-being, perceived health, and quality of life and compared their effect with the effect of a chronic medical condition, type 2 diabetes mellitus. Established instruments for psychological distress (12-item General Health Questionnaire [GHQ-12]), self-rated general health, and health-related quality of life (EQ-5D and 15D) were administered for the participants of the nationwide Finnish Health 2000 survey. The diagnoses of depressive, anxiety, and alcohol use disorders and their unique comorbid combinations were based on the Munich version of the Composite International Diagnostic Interview (M-CIDI). People with comorbid anxiety and depressive disorders had the highest distress and lowest health and quality-of-life ratings on all scales. The effects of mental disorders on health-related quality of life and self-rated health were comparable to the effects of diabetes. Type 2 diabetes mellitus and alcohol use disorder were associated with minimal, although statistically significant, increase of psychological distress. Symptom recovery from an active depressive disorder associated with improved well-being on all measures, but residual ill-being was also remarkably common among the partly or fully recovered in all disorder categories. Even in comparison with a chronic physical illness such as diabetes, comorbid psychiatric disorders have a high impact on psychological well-being, perceived health, and quality of life, when evaluated by simple, useful, and feasible self-rating scales. The scales used may be useful in monitoring the severity and course of psychiatric conditions. Recognizing and treating psychiatric comorbidity is important in improving the quality of life of psychiatric patients.
    Comprehensive psychiatry 01/2009; 50(2):108-14. · 2.08 Impact Factor
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    ABSTRACT: The aim of this longitudinal study was to examine (a) the causal effect of unemployment 1990-1997 on health 1998-2001 (in-patient periods) and (b) the selection effect of health 1996-1999 on unemployment 2000-2002. We examined the effects of different diagnoses, namely, all causes, circulatory diseases, diseases of the digestive system, musculoskeletal diseases, and mental disorders. The data from the Central Register of Health Care Professionals of persons born 1945-1970 were linked to data from employment statistics and Finnish Hospital Discharge Register including 78,195 women and 12,455 men aged 31 to 56 in 2001. The associations were analyzed with logistic regression analyses and expressed as odds ratios (OR) and their 95% confidence intervals (CI). After adjustments, existence of unemployment periods was associated with lower odds for in-patient periods due to musculoskeletal diseases for both women (OR=0.82, 95% CI=0.76-0.89) and men (OR=0.74, 95% CI=0.60-0.89). Unemployment periods were more likely among women (OR=1.65, 95% CI=1.33-2.04) and men (OR=2.54, 95% CI=1.44-4.48) having had in-patient periods due to mental diseases and among women also due to diseases of the digestive system (OR=1.17, 95% CI=1.04-1.31). The present study found evidence for selection to unemployment according to mental diseases and diseases of the digestive system among health care professionals. In addition, our results show that unemployment periods may protect health care workers from musculoskeletal diseases.
    Journal of Psychosomatic Research 11/2007; 63(4):425-31. · 3.27 Impact Factor
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    ABSTRACT: This study examines sociodemographic differences in myocardial infarction (MI) risk perceptions among people with coronary heart disease (CHD) (N = 3130). Two variables for comparative risk perceptions were computed: (1) own risk compared to that of an average person; and (2) own risk compared to that of an average person with CHD. Comparative optimism in MI risk perceptions was common, particularly among men and those with higher education. CHD severity and psychosocial resources mediated these sociodemographic differences. These results suggest challenges for secondary prevention in CHD, particularly regarding psychosocial interventions for communicating risk information and supporting lifestyle adjustments.
    Journal of Health Psychology 04/2007; 12(2):316-29. · 1.22 Impact Factor
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    ABSTRACT: It has been shown that levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective treatment of menorrhagia. However, the discontinuation rate of LNG-IUS treatment is high, and little is known about the actual reasons intertwining it. We tested the hypothesis that depressive symptoms is the factor responsible for deciding to have a hysterectomy during LNG-IUS treatment. The participants (119 women, ages = 35-49 years) were randomly selected over a 3-year period (1994-1997) to receive the LNG-IUS or a hysterectomy for the treatment of menorrhagia. Depressive symptoms, based on Beck's Depression Inventory measured 6 months after the beginning of the treatment, were related to discontinuation of LNG-IUS use Odds Ratio (OR) = 3.70, 95% Confidence Intervals (CI) 1.55-8.82, p = .003 during a 5-year follow-up. This association was not attenuated after adjustment for other known risk factors. Our findings suggest that diagnosing and treating depression among patients having menstrual problems may improve the continuity of LNG-IUS treatment of menorrhagia.
    International Journal of Behavioral Medicine 02/2007; 14(2):70-5. · 2.63 Impact Factor
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    ABSTRACT: This one-year follow-up study (n = 130 at baseline, n =2745 at follow-up, aged 45-74 years) examined the relationship of patients' perceptions of coronary heart disease (CHD) and illness-related factors with global health status and global quality of life (QOL) ratings. The independent variables were CHD history (myocardial infarction, revascularisation), CHD severity (use of nitrates, CHD risk factors and co-morbidities) and illness perceptions. In multivariate regression analysis, CHD history and severity explained 13% of variance in global health status and 8% in global QOL ratings at the baseline. Illness perceptions increased the share of explained variance by 18% and 16% respectively. In the follow-up, illness perceptions explained a significant but modest share of variance in change in health status and QOL when baseline health status and QOL and CHD severity were adjusted for more symptoms being attributed to CHD, severe perceived consequences of CHD, as well as a weak belief in the controllability of CHD were related to poor global health status and QOL ratings. In structural path models associations of CHD severity factors were mediated by illness perceptions. The association of disease severity with dependent variables was weaker after controlling for illness perceptions. Cognitive representations of CHD contribute to both global health status and QOL ratings and they also mediate the associations between CHD severity and well-being. No gender differences were found in associations of illness perceptions with health status or QOL ratings.
    Quality of Life Research 11/2006; 15(8):1307-22. · 2.41 Impact Factor

Publication Stats

414 Citations
93.14 Total Impact Points

Institutions

  • 2005–2014
    • National Institute for Health and Welfare, Finland
      • Service System Research Unit
      Helsinki, Southern Finland Province, Finland
  • 2004–2013
    • Helsinki University Central Hospital
      • Department of Obstetrics and Gynaecology
      Helsinki, Province of Southern Finland, Finland
    • University of Tampere
      • Department of Obstetrics and Gynaecology
      Tammerfors, Province of Western Finland, Finland
  • 2004–2010
    • University of Helsinki
      • Department of Obstetrics and Gynaecology
      Helsinki, Southern Finland Province, Finland
  • 2003–2006
    • National Public Health Institute
      Helsinki, Southern Finland Province, Finland