Jorma Kiuttu

Comorbidity and medication load in adult asthmatics

Objective To examine comorbidity and the medication load among asthmatics. Design A self-administered postal inquiry. Setting A national register-based random sample of 6000 subjects aged 16 years or older entitled to special reimbursement for anti-asthmatic medication in Finland. Subjects A total of 4690 subjects with clinically diagnosed asthma. Main outcome measures Reporting of doctor-diagnosed chronic diseases and the number of prescription medicines used by asthmatics. Results Two-thirds of the subjects (n=2952, 63%) reported other diseases in addition to other chronic pulmonary diseases and allergies. Musculoskeletal and cardiovascular disorders were the most common, increasing with age. Allergies were most frequent among the young asthmatics. Nearly all the subjects (n=4444, 95%) took at least one anti-asthmatic medicine, and two out of every three (n=3051, 65%) received other prescription medicines, most commonly cardiovascular drugs or analgesics. Some 41% (n=1938) of all the asthmatics and as many as 21% of the young adults (n=269) were taking at least five prescription medicines concomitantly. The total medication load increased with age. Conclusion The load of comorbidity and prescribed medication is heavy in adult asthmatics of all ages. Thus asthmatic patients should best be treated by GPs, while pulmonary specialists work as consultants and take care of the most severe cases.

Family systems medicine: A new field of medicine

Family systems medicine is a relatively new and interesting field of medicine which developed mainly from the integration of systems theory, family therapy, general practice, and modern clinical medicine. The authors describe its concepts and present a literature review documenting the issues related to the subject. Family systems medicine ideas have been applied in practice and taught to physicians principally in the United States and Canada during the past 10 years. The first 2-year continuing education course in family systems medicine for general practitioners in Finland was started at the University of Oulu in 1989. The authors have collaborated with family therapists and family physicians of the University of Rochester in the USA for improving further Finnish courses.

Achievements and shortcomings of Finnish asthma care.

Background: The Finnish National Asthma Programme was launched in 1994. Aim: A postal self-completion questionnaire study was undertaken to evaluate how the guideline is working in the Finnish healthcare system. Methods: A postal inquiry was sent to a random sample of 6,000 subjects aged 16+ years who were entitled to special reimbursement for anti-asthmatic medication and 4,657 subjects with self-reported asthma were included. Results: The subjects comprised 38% men (n=1,781) and 62% women (n=2,876). In all, 62% of all the subjects and 78% of those with severe asthma had visited a doctor on account of asthma in the past 12 months. Some 83% of the respondents had a given physician who was responsible for treating their asthma, and 75% of these were under observation by a primary healthcare physician. Visits to asthma nurses were relatively rare. Inhaled glucocorticoids were used by 83% of the subjects, but short-acting beta-2-agonists were still the most commonly used asthma drug in monotherapy regardless of the severity of asthma. Inhaled glucocorticoids and a short-acting beta-2-agonist was the most frequent combination. Every tenth subject used this combination supplemented by a long-acting beta-2-agonist. Conclusion: Asthma care in Finland seems to be compatible with the national guidelines in terms of continuity and the common use of inhaled glucocorticoids. The primary care sector has adopted the main responsibility for the treatment of asthma. The common use of short-acting beta-2-agonists is an exception to an otherwise positive trend.

Obsessive-compulsive personality disorder is common among occupational health care clients with depression.

Objective: To study how common personality disorders (PDs) are among employed subjects with first-episode depression. Depression is the single most common cause of working disability in Finland. Personality disorders are associated with depression. Methods: Subjects were screened using the Beck Depression Inventory scale, with a cutoff point greater than 9. The structured clinical interview for Diagnostic and Statistical Manual, fourth revision, was used to assess mental disorders. Inclusion criterion was major depressive disorder. Results: Most of the 272 participants were female (83%) and the majority (74%) were older than 40 years. The main finding was that one third of the participants had obsessive-compulsive PD. The prevalence of obsessive-compulsive PD was 50% among men and 28% in women. Conclusion: It is important to recognize comorbid PDs when assessing working-age persons experiencing depression.

From biomedical teaching to biopsychosocial education: a process of change in a Finnish medical school

A group of clinicians, teachers and researchers in the University of Oulu have been worried for years about the predominantly biomedical orientation in the local Faculty of Medicine. Therefore, a project group was founded in 1992 to develop the medical degree programme towards a more comprehensive model. This article introduces the main strategies used in the process of change and describes the challenges encountered during the process. There are still many problems in the education of medical students towards a patient and family orientation and in the effort to change the whole medical culture of the university from a biomedical to a biopsychosocial approach. However, in the postgraduate education of general practitioners, we no longer prefer to teach only doctors, but education on the biopsychosocial model will also be arranged to the interdisciplinary teams working in the municipalities in the Province of Oulu in Finland.A group of clinicians, teachers and researchers in the University of Oulu have been worried for years about the predominantly biomedical orientation in the local Faculty of Medicine. Therefore, a project group was founded in 1992 to develop the medical degree programme towards a more comprehensive model. This article introduces the main strategies used in the process of change and describes the challenges encountered during the process. There are still many problems in the education of medical students towards a patient and family orientation and in the effort to change the whole medical culture of the university from a biomedical to a biopsychosocial approach. However, in the postgraduate education of general practitioners, we no longer prefer to teach only doctors, but education on the biopsychosocial model will also be arranged to the interdisciplinary teams working in the municipalities in the Province of Oulu in Finland.

The Effect of an Early Rehabilitation on Alexithymia among First Ever Depressive Occupational Health Care Clients

Objectives: Depression is a common psychiatric disorder. Alexithymia and depression are highly associated. We explored the impact of an early vocationally orientated, eclectic rehabilitative intervention on alexithymia among clients with first ever diagnosed depressive episode. Methods: Clients from occupational health care units were screened for depression with the Beck Depression Inventory (BDI) and diagnosed with the Structured Clinical Interview for DSM-IV. The participants were randomized into intervention and control groups. The intervention group received eclectic early rehabilitative intervention and the control group was treated as usual. The intervention (N=134) and control groups (N=100) were compared using the Toronto Alexithymia Scale (TAS-20) at the baseline and after one year follow-up. Results: The prevalence of alexithymia decreased both in the intervention group (from 20.1% to 18.9%) and in the control group (from 16.0% to 7.1%). The prevalence of alexithymia was significantly lower at the follow up in the control group than in the intervention group (p=0.010). The changes in the mean scores of the four alexithymia variables between the groups were not statistically significant after adjusting for confounding factors. Conclusions: The findings were against our hypothesis that alexithymia would diminish in the intervention group more than in the control group. There are several explanations for this unexpected result. We believe that the reasons were that the intervention was too short and that the group-shaped method was too demanding for the subjects with alexithymia.

Enhancing sense of coherence via early intervention among depressed occupational health care clients

Abstract Background: Research on interventions improving psychological adjustment has suggested that sense of coherence (SOC) could be improved. Aims: In the present study, we measured the impact of an intervention on the SOC among adults with first-episode depression. We also examined whether rehabilitation, depression, occupational stressors, life situation stressors and socio-demographic characteristics are associated with a change in the SOC. Methods: Occupational health care clients were screened for depression using the Beck Depression Inventory (BDI) and a structured clinical interview (the The Structured Clinical Interview for DSM-IV: SCID-I). The participating subjects were randomized into a rehabilitation group (n = 134) and control group (n = 100) receiving treatment as usual. The Sense of Coherence Scale (SOC-13) was used at the baseline and in a 1-year follow-up to compare the change of the SOC between the groups. Results: The increase in the mean SOC score was statistically significant both in the rehabilitation group (54.91 compared with 62.85, P < 0.001) and in the control group (55.29 compared with 61.64, P < 0.001). There was no significant difference in the mean SOC scores between the groups at the follow-up. The improved SOC was associated with less severe depression (P = 0.003) and greater decreasing in BDI (P = 0.041) in the rehabilitation group. Conclusions: The results suggest that both rehabilitation and conventional depression treatment in a first episode of depression may enhance the SOC and that rehabilitation itself enhances the SOC more effectively among those with less severe depression or those whose BDI scores had further decreased at the 1-year follow-up.

The Impact of an Early Eclectic Rehabilitative Intervention on Symptoms in First Episode Depression among Employed People.

Objective. To evaluate the effect of an early vocational-orientated eclectic intervention on beck depression inventory (BDI) scores compared to treatment as usual in first ever depressive episode among employed people. Design. A randomized controlled trial comparing the rehabilitative intervention and the conventional treatment. Subjects. The subjects came from occupational health care units. Methods. Employees were sent to a rehabilitation center after being screened for depression using the BDI. They were diagnosed using the structured clinical interview for DSM-IV. The participating subjects (N = 283) were randomized into intervention and control groups. The intervention group received eclectic early depression intervention treatment (N = 134) and the control group was treated in the conventional way (N = 100). They were followed for one year. Results. The mean decrease in BDI scores within the intervention group was from 20.8 to 11.6 and within the control group from 19.3 to 10.8. BDI score decreased by 10 or more points in 64% of the participants in the intervention group and in 53% of the control group (P = 0.013). Conclusions. There was some evidence that early eclectic intervention in first ever episode depression may be more effective than conventional treatments among working age people in employment.