Jari Sundell

Childhood adversities, parent-child relationships and dispositional optimism in adulthood.

Abstract.Background:Studies exploring the effects of childhood adversities and parent-child relationship on adulthood dispositional optimism are rather rare, have been performed on small, selected samples and lack analyses of interaction between childhood factors.Method:A total of 19,970 working-aged Finns responded to the population-based HeSSup Study baseline questionnaire in 1998. The level of dispositional optimism (measured with the LOT-R scale) was analyzed according to self-reported childhood adversities, childhood parent-child relationships and their interaction, using multivariate linear regression analysis methods. A number of potential confounding factors (education, living alone, recent life events, somatic health and depressive mood) were taken into account.Results:Childhood adversities were associated with decreasing optimism in a dose-response manner. Good parent-child relationships were associated with increasing optimism, with a partial buffering effect when confronting adversities.Conclusion:Those reporting childhood adversities and poor parent-child relationships had less optimistic expectations, which may need to be addressed in clinical settings.

Sexual activity and perceived health among Finnish middle-aged women

BackgroundAn increasing awareness of the need to address sexual and orgasm experiences as part of life quality and an understanding of the great individual differences between women play roles in womens health and medical care across the specialities. Information is lacking as to how negative attitude toward self (NATS) and performance impairment (PI) are associated with sexual activity of middle-aged women. We examined the associations of sexual experience, orgasm experience, and lack of sexual desire with perceived health and potential explanatory variables of NATS and PI.MethodsQuestionnaire was mailed to 2 population-based random samples of menopausal or soon-to-be menopausal women (n = 5510, 70% response) stratified according to age (42–46 and 52–56 years). In multivariate analyses of the associations with the outcome variables, perceived health, NATS, and PI were used as covariates in 6 models in which exercise, menstrual symptoms, and illness indicators were taken into account as well.ResultsSexual activity variables were associated with perceived health. When present, NATS formed associations with sexual and orgasm experiences, whereas strenuous exercise formed associations with orgasm among 42–46-year-old women alone. Strenuous exercise was not associated with orgasm experience among older women.ConclusionNATS and PI are closely tied to orgasm experiences and the meaning of the roles needs to be exposed. Sexual activity deserves to be addressed more actively in patient contact at least with perimenopausal women.

Sexual activity and background variables among Finnish middle-aged women.

OBJECTIVE To characterize the associations of sexual experience, orgasm experience, and lack of sexual desire with background variables. METHODS Questionnaire was mailed to population-based samples (n=5510, 70% response) of soon-to-be-menopausal (aged 42-46 years) and menopausal (aged 52-56 years) women. RESULTS Being married/having a spouse meant more sexual activity for both groups but also the likelihood to experience lack of sexual desire. Hormones emerged as the most important perceived reason for lack of sexual desire. CONCLUSION The findings indicated a discrepancy between the reported frequencies of sexual experiences/orgasms with spouse and lack of desire.

Determinants of health promotion action in primary health care: Comparative study of health and home care personnel in four municipalities in Finland

Aims: The purpose of this paper is to contribute to understanding which factors influence health promotion action in primary health care (PHC) on the municipal, i.e. local, level. Methods: A cross-sectional mail survey of all PHC personnel in four municipalities in Finland in 2002. The data were analysed by descriptive statistics, and univariate and multivariate logistic regression analyses. Results: A total of 417 (response rate 57%) healthcare professionals participated in the study; 65% of the personnel working in ambulatory care, 52% working in home care and 44% working in inpatient care were engaged in health promotion action (=higher than median engagement). Factors independently associated with engagement in health promotion were organizational values, reflected in perceived skill discretion and social support from coworkers, and the personnels competence, reflected in knowledge about the health and living conditions of the population served. Further, the opportunities, reflected in cooperation with partners outside the organization were strongly associated with engagement in health promotion action. Conclusions: The results suggest that working conditions such as possibilities for skill usage, reflection and development as well as collegial support enable higher engagement in health promotion action in PHC. However, access to data on the local populations health and living conditions, in addition to opportunities to cooperate with decision makers and partners in the community turned out to be as important. This should be taken into consideration when striving to reorient health services to health promotion.

Psychosocial work environment and emotional exhaustion--Does a service provision model play a role?

OBJECTIVES To investigate whether outsourcing of primary health care (PHC) services has affected the psychosocial work environment and emotional exhaustion. METHODS Panel mail study 2000-2002 in Finland, 369 PHC employees. Comparison between Southern municipality (SM) after outsourcing PHC services to a not-for-profit organization and three municipalities with municipal service providers. RESULTS Despite the positive development of the psychosocial work environment in SM, emotional exhaustion had increased there like in the comparison municipalities. However, in 2002 emotional exhaustion was at a lower level in SM than in one of the comparison municipalities. This difference could not be attributed to the production model itself but rather to baseline levels and changes in work demands and work resources. CONCLUSIONS Outsourcing of PHC services may improve employee health and thus effectiveness of health care if a new service provider emphasizes employee health more than a previous one and is more flexible to improve the quality of the psychosocial work environment. However, change itself may be stressful, and frequent changes of service providers should be avoided.

Job involvement of primary healthcare employees: Does a service provision model play a role?

Aim: To investigate whether the development of job involvement of primary healthcare (PHC) employees in Southern Municipality (SM), where PHC services were outsourced to an independent non-profit organisation, differed from that in the three comparison municipalities (M1, M2, M3) with municipal service providers. Also, the associations of job involvement with factors describing the psychosocial work environment were investigated. Methods: A panel mail survey 2000—02 in Finland (n=369, response rates 73% and 60%). The data were analysed by descriptive statistics and multivariate linear regression analysis. Results: Despite the favourable development in the psychosocial work environment, job involvement decreased most in SM, which faced the biggest organisational changes. Job involvement decreased also in M3, where the psychosocial work environment deteriorated most. Job involvement in 2002 was best predicted by high baseline level of interactional justice and work control, positive change in interactional justice, and higher age. Also other factors, such as organisational stability, seemed to play a role; after controlling for the effect of the psychosocial work characteristics, job involvement was higher in M3 than in SM. Conclusion: Outsourcing of PHC services may decrease job involvement at least during the first years. A particular service provision model is better than the others only if it is superior in providing a favourable and stable psychosocial work environment.