Search

Preterm birth affects lungs in several ways but only few studies have follow-up until adulthood. We investigated the association of the entire spectrum of gestational ages with specialist care episodes for obstructive airway disease (asthma and chronic obstructive pulmonary disease, COPD) at age 18–50 years. We used nationwide register data on 706 717 people born 1987–1998 in Finland (4.8% preterm) and 1 669 528 born 1967–1999 in Norway (5.0% preterm). Care episodes of asthma and COPD were obtained from specialised healthcare registers, available in Finland 2005–2016 and in Norway 2008–2017. We used logistic regression to estimate odds ratios (OR) for having a care episode with either disease outcome. Odds of any obstructive airway disease in adulthood were 2–3-fold for those born

Objective Being born preterm is related to adverse health effects later in life. We studied whether preterm birth predicts the risk of migraine. Methods In this nationwide register study, we linked data from six administrative registers for all 235,624 children live-born in Finland (January 1987 to September 1990) and recorded in the Finnish Medical Birth Register. n = 228,610 (97.0%) had adequate data and were included. Migraine served as primary outcome variable and was stringently defined as a diagnosis from specialised health care and/or ≥2 reimbursed purchases of triptans. We applied sex- and birth year-stratified Cox proportional hazard regression models to compute hazard ratios and confidence intervals (95% confidence intervals) for the association between preterm categories and migraine. The cohort was followed up until an average age of 25.1 years (range: 23.3–27.0). Results Among individuals born extremely preterm (23–27 completed weeks of gestation), the adjusted hazard ratios for migraine was 0.55 (0.25–1.24) when compared with the full-term reference group (39–41 weeks). The corresponding adjusted hazard ratios and 95% confidence intervals for the other preterm categories were: Very preterm (28–31 weeks); 0.95 (0.68–1.31), moderately preterm (32–33 weeks); 0.96 (0.73–1.27), late preterm (34–36 weeks); 1.01 (0.91–1.11), early term (37–38 weeks); 0.98 (0.93–1.03), and post term (42 weeks); 0.98 (0.89–1.08). Migraine was predicted by parental migraine, lower socioeconomic position, maternal hypertensive disorder and maternal smoking during pregnancy. Conclusion We found no evidence for a higher risk of migraine among individuals born preterm.

OBJECTIVES: To study sexually transmitted Chlamydia trachomatis infections (STCTs), teenage pregnancies, and payment defaults in individuals born preterm as proxies for engaging in risk-taking behavior. STUDY DESIGN: Our population-based register-linkage study included all 191 705 children alive at 10 years (8492 preterm [4.4%]) born without malformations in Finland between January 1987 and September 1990 as each mother's first child within the cohort. They were followed until young adulthood. We used Cox regression to assess the hazards of STCTs, teenage pregnancies, payment defaults, criminal offending, and substance abuse by gestational age. Gestational age was considered both as a continuous and categorical (extremely, very, moderately, late preterm, early term, post term, and full term as reference) exposure. RESULTS: A linear dose-response relationship existed between gestational age and STCT and teenage pregnancy; adjusted hazard for STCT decreased by 1.6% (95% CI, 0.7%-2.6%), and for teenage pregnancy by 3.3% (95% CI, 1.9%-4.8%) per each week decrease in gestational age. Those born extremely preterm (23-27 completed weeks) had a 51% (95% CI, 31%-83%) lower risk for criminal offending than their full-term born counterparts, and those born very preterm (range, 28-31 weeks) had a 28% (95% CI, 7%-53%) higher hazard for payment defaults than those born at full term. Gestational age was not associated with substance abuse. CONCLUSIONS: The lower risk-taking that characterizes people born preterm seems to generalize to sexual and to some extent criminal behavior. Those born very preterm are, however, more likely to experience payment defaults. publishedVersion

Background Homelessness is associated with increased mortality, and some predictors of mortality have been previously identified. We examined the overall and cause-specific mortality among homeless men in Helsinki and the associations of social background and health service use with mortality. Methods To assess cause-specific mortality in a competing risks framework, we performed a register-based, case–control study of 617 homeless men and an age-matched control group of 1240 men from the general population that were followed for 10 years between 2004 and 2014. Cox proportional hazards model was used to calculate HR for death and a competing risks model to calculate sub-HRs (sHR) for cause-specific death. Results During the follow-up, 45.0% of the homeless died compared with 10.5% of controls (HR 5.38, 95% CI 4.39 to 6.59). The risk of death was particularly elevated for the homeless aged≤50 years (HR 10.3, 95% CI 7.0 to 15.2). External causes caused 34% of the deaths (sHR 11.2, 95% CI 6.8 to 18.2), but also deaths from medical causes were common (sHR 3.6, 95% CI 2.9 to 4.6). Age and somatic hospitalisation were significant predictors of death both among homeless and controls. Educational attainment, marital status, employment and psychiatric hospitalisation were significant predictors of mortality among the controls, but not among the homeless. Conclusions Homelessness is associated with a fivefold mortality compared with the controls, and especially homeless aged ≤50 years have an increased risk of death. Being homeless eliminates the protective effects of marriage, employment and education on mortality risk.

To review psychosocial and policy interventions which mitigate the effects of poverty and inequality on mental health. Systematic reviews, controlled trials and realist evaluations of the last 10 years are reviewed, without age or geographical restrictions. Effective psychosocial interventions on individual and family level, such as parenting support programmes, exist. The evidence for mental health impact of broader community-based interventions, e.g. community outreach workers, or service-based interventions, e.g. social prescribing and debt advice is scarce. Likewise, the availability of evidence for the mental health impact of policy level interventions, such as poverty alleviation or youth guarantee, is quite restricted. The social, economic, and physical environments in which people live shape mental health and many common mental disorders. There are effective early interventions to promote mental health in vulnerable groups, but it is necessary to both initiate and facilitate a cross-sectoral approach, and to form partnerships between different government departments, civic society organisations and other stakeholders. This approach is referred to as Mental Health in All Policies and it can be applied to all public policy levels from local policies to supranational.

Aims: Homelessness is associated with poor health outcomes and increased use of hospital and emergency department (ED) services. Little is known about the duration of homelessness in relation to health care service use. The aim of this study was to examine the use of hospital and ED services among the homeless in Helsinki, Finland, and for the first time, to examine the relationship between service use and duration of homelessness. Methods: Six hundred and eighty-three persons staying at least one night in a shelter between September 2009 and September 2010 were followed until the end of 2014. Using negative binominal regression analysis we calculated the use of hospital and ED services and compared the use with that of a matched control group ( N = 1361). We also analyzed service use in relation to the time spent homeless during follow-up. Results: The mean time spent homeless during the follow-up was 8.5 months, one third was temporarily homeless (less than 2% of the follow-up time), but recurrent episodes of homelessness were also common. The study group’s incidence rate ratios for medical-surgical hospital days was 6.23 (95% CI: 4.73 to 8.21), for psychiatric hospital days 43.11 (95% CI: 23.02 to 80.74) and for ED visits 10.21 (95% CI: 8.77 to 11.90), compared with controls. The number of medical-surgical hospital days and ED visits/person-year increased as homelessness was prolonged, but the pattern was opposite for psychiatric hospital days. Conclusions: Homeless persons are heavy users of hospital and ED services, and there is also increased use among those temporarily homeless.

Supplemental material, Supplementary_file_B for Duration of homelessness and its relationship to use of hospital and emergency department services in Helsinki, Finland by Agnes Stenius-Ayoade, Johan G. Eriksson, Hannu Kautiainen, Mika Gissler and Peija Haaramo in Scandinavian Journal of Public Health

We reviewed literature on long-term motor outcomes of individuals aged five years or older born very preterm (VP: ≤32 weeks of gestation) or with very low birth weight (VLBW: ≤1500g), without cerebral palsy (CP). PubMed produced 2827 articles, whereof 38 were eligible. Assessed by standardised and norm-based motor tests, the Movement Assessment Battery for Children being the most widely used, VP/VLBW individuals showed poorer motor skills compared with term-born controls with differences of approximately 1 SD in magnitude. Some studies assessed subdomains and differences were present in fine motor/manual dexterity, ball skills and gross motor/balance. Prevalence of motor problems varied largely from 8-37% in studies with cut-off at the 5th percentile or −1.5 SD to 12–71% in studies with cut-off at the 15th percentile or −1 SD. This review shows that the degree of motor impairments continues to be substantial among VP/VLBW individuals who do not develop CP. The work of Dr. Ustad was supported by grant from The Liaison Committee for Education, Research and Innovation in Central Norway. Dr. Evensen has received grant from the Liaison Committee of St. Olavs Hospital and NTNU, Signe and Ane Gyllenberg Foundation and Foundation for Pediatric Research, Yrjö Jahnsson Foundation, Juho Vainio Foundation, Finnish Foundation for Cardiovascular Research, Novo Nordisk Foundation and Finnish Diabetes Research Foundation.

Description of results from studies included in a systematic literature review on psychiatric readmissions and their association with physical comorbidity. (DOC 107 kb)

This study examined the associations of insomnia symptoms with subsequent psychotropic medication, reflecting mental health.Postal baseline surveys among 40- to 60-year-old employees of the city of Helsinki, Finland, were collected in 2000-2002 (N = 6,227, response rate 67%, 78% women) and longitudinally linked with national register data on prescribed reimbursed medication. Insomnia symptoms at baseline comprised difficulties in initiating and maintaining sleep, and non-restorative sleep. All purchased psychotropic medication 5-7 years prior to and 5 years after baseline was included. Outcomes were any psychotropic medication; antidepressants; and anxiolytics, hypnotics, and sedatives. Covariates included socio-demographic and work-related factors, health behaviors, lifetime mental disorders, and prior psychotropic medication. Logistic regression analysis was used to calculate odds ratios (OR) and their 95% confidence intervals (CI).Insomnia symptoms were associated with higher frequency of subsequent psychotropic medication prescriptions. The associations were strongest for frequent insomnia symptoms (women OR 3.55, 95% CI 2.64-4.77; men OR 4.64, 95% CI 2.49-8.66, adjusted for age and prior medication), but also rare and occasional symptoms were associated with psychotropic medication. Further adjustments had negligible effects.Insomnia symptoms were associated with prescribed psychotropic medication during follow-up in a dose-response manner. Attention should be given to the prevention of insomnia symptoms to curb subsequent mental problems.

Background: Pain and insomnia are both independently associated with work disability. Although pain and insomnia often co-occur, their joint associations with subsequent sickness absence and disability retirement have not been studied. We aimed to examine these associations in two prospective occupational cohorts while considering key covariates. Methods: Norwegian Hordaland Health Study (n = 6892, 59% women) and Finnish Helsinki Health Study (n = 6060, 78% women) data were used. Those with only pain, only insomnia or both conditions at baseline were compared with those with no pain and no insomnia. Work disability outcomes were derived from national and employers’ register data. Medically certified sickness absence spells lasting 2 weeks or more and all-cause disability retirement were examined. Register-based follow-up was 4 years for sickness absence and 5 years for disability retirement. Covariates were sex, age, marital status, education, smoking, alcohol use, body mass index and blood pressure. Poisson and Cox regression models were fitted. Results: Both pain and insomnia were associated with subsequent sickness absence and disability retirement, but the associations were stronger for those reporting co-morbid pain and insomnia with support for a synergistic interaction effect, particularly regarding disability retirement. The associations were largely similar in both cohorts and remained after full adjustments. Conclusions: This study is the first to report the separate and combined effects of pain and insomnia on objective health outcomes. Common patterns observed in two separate cohorts suggest that the combination of pain and insomnia might be particularly relevant for subsequent disability retirement.

Sleep disturbances have been associated with an increased risk of cardiovascular disease outcomes. The associations of insomnia with hypertension and dyslipidaemia, the main modifiable cardiovascular risk factors, are less studied. We especially lack understanding on the longitudinal effects of insomnia on dyslipidaemia. We aimed to examine the associations of insomnia symptoms with subsequent prescribed medication for hypertension and dyslipidaemia using objective register-based follow-up data. Baseline questionnaire surveys among 40-60-year-old employees of the City of Helsinki, Finland, were conducted in 2000-2002 (n = 6477, response rate 67%, 78% women) and linked to a national register on prescribed reimbursed medication 5-7 years prior to and 5 years after baseline. Associations between the frequency of insomnia symptoms (difficulties in initiating and maintaining sleep, non-restorative sleep) and hypertension and dyslipidaemia medication during the follow-up were analysed using logistic regression analysis (odds ratios with 95% confidence intervals). Analyses were adjusted for pre-baseline medication, sociodemographic and work-related factors, health behaviours, mental health, and diabetes. Frequent insomnia symptoms were reported by 20%. During the 5-year follow-up, 32% had hypertension medication and 15% dyslipidaemia medication. Adjusting for age, gender and pre-baseline medication, frequent insomnia symptoms were associated with hypertension medication (odds ratio 1.57, 95% confidence interval 1.23-2.00) and dyslipidaemia medication (odds ratio 1.59, 95% confidence interval 1.19-2.12). Occasional insomnia symptoms were also associated with cardiovascular medication, though less strongly. Further adjustments had negligible effects. To conclude, insomnia should be taken into account in the prevention and management of cardiovascular disease and related risk factors.

Background Socio-demographic factors predict the outcome of short-term psychotherapy (STT) in the treatment of mood and anxiety disorders, but information on the prediction for long long-term therapy (LPP) is lacking. We aimed to compare the prediction of changes in psychiatric symptoms afforded by socio-demographic factors across two treatment conditions, short- versus long-term psychotherapy. Methods In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorders, aged 20–46 years, were randomly assigned to STT or LPP. Socio-demographic factors (i.e. age, gender, education, employment status, marital status, and living arrangement) were self-reported. Psychiatric symptoms were measured by the Symptom Check List, Global Severity Index (SCL-90-GSI) and Anxiety scale (SCL-90-Anx), and the Beck Depression Inventory (BDI) at baseline and seven times during a three-year follow-up period. Results Socio-demographic factors were found to predict symptom development during follow-up irrespective of the baseline symptom level. Patients in a relatively good position, i.e. married and highly educated patients benefited from STT, whereas patients in less advantaged positions, i.e. homemakers, lone parents, and divorced patients needed LPP or did not benefit from either therapy. In several categories of socio-demographic factors, the extent to which a patient's background predicted the outcome of the psychotherapy varied according to whether general, anxiety or depressive symptoms were studied. Limitations We were unable to assess widows and pensioners. For ethical reasons, a no-treatment control group with a long follow-up could not be included in the study design. Conclusions Socio-demographic factors may need to be considered in the selection of patients for short- and long-term therapy.

Background Psychiatric services have undergone profound changes over the last decades. CEPHOS-LINK is an EU-funded study project with the aim to compare readmission of patients discharged with psychiatric diagnoses using a registry-based observational record linkage study design and to analyse differences in the findings for five different countries. A range of different approaches is available for analysis of the available data. Although there are some studies that compare selected methods for evaluating questions on readmission, there are to our knowledge no published systematic literature reviews on commonly used methods and their comparison. This work shall therefore provide an overview of the methods in use, their evolution throughout history and new developments which can further improve the research quality in this area. Methods Based on systematic literature reviews realized in the course of the CEPHOS-LINK study, this work is a systematic evaluation of mathematical (statistical and modelling) methods used in studies examining psychiatric readmission. The starting point were 502 papers, of which 407 were analysed in detail; Methods used were assigned to one of five categories with subcategories and analysed accordingly. Our particular interest next to survival analysis and regression models is modelling and simulation. Results As population sizes and follow-up times in the included studies varied widely, a range of methods was applied. Studies with bigger sample sizes conducted survival and regression analysis more often than studies with fewer patients did. These latter relied more on classical statistical tests (e.g. t-tests and Student Newman Keuls). Statistical strategies were often insufficiently described, posing a major problem for the evaluation. Almost all cases failed to provide and explanation of the rationale behind using certain methods. Conclusion There is a discernible trend from classical parametric/nonparametric tests in older studies towards regression and survival analyses in more recent ones. Modelling and simulation were under-represented despite their high usability, as has been identified in other health applications and comparable research areas. Electronic supplementary material The online version of this article (doi:10.1186/s12888-016-1128-7) contains supplementary material, which is available to authorized users.

Background: Homelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland. Methods: The study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs. Results: During the 3 years the 158 homeless persons in the cohort made 1410 visits to a physician in primary health care. The cohort exhibited high rates of mental disorders, including substance use disorders (SUDs); i.e. 141 persons (89%) had a mental disorder. We found dual diagnosis, defined as SUD concurring with other mental disorder, to be strongly associated with daytime primary health care utilization (IRR 11.0, 95% CI 5.9-20.6) when compared with those without any mental disorder diagnosis. The association was somewhat weaker for those with only SUDs (IRR 4.9, 95% CI 2.5-9.9) or with only other mental disorders (IRR 5.0, 95% CI 2.4-10.8). When focusing upon the after hours visits to PHERs we observed that both dual diagnosis (IRR 14.1, 95% CI 6.3-31.2) and SUDs (11.5, 95% CI 5.7-23.3) were strongly associated with utilization of PHERs compared to those without any mental disorder. In spite of a high numbers of visits, we found undertreatment of chronic conditions such as hypertension and diabetes. Conclusions: Dual diagnosis is particularly strongly associated with primary health care daytime visits among homeless persons staying in shelters, while after hours visits to primary health care level emergency rooms are strongly associated with both dual diagnosis and SUDs. Active treatment for SUDs could reduce the amount of emergency visits made by homeless shelter users.

Background High levels of hospital readmission (rehospitalisation rates) is widely used as indicator of a poor quality of care. This is sometimes also referred to as recidivism or heavy utilization. Previous studies have examined a number of factors likely to influence readmission, although a systematic review of research on post-discharge factors and readmissions has not been conducted so far. The main objective of this review was to identify frequently reported post-discharge factors and their effects on readmission rates. Methods Studies on the association between post-discharge variables and readmission after an index discharge with a main psychiatric diagnosis were searched in the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey and Google Scholar. Relevant articles published between January 1990 and June 2014 were included. A systematic approach was used to extract and organize in categories the information about post-discharge factors associated with readmission rates. Results Of the 760 articles identified by the initial search, 80 were selected for this review which included a total number of 59 different predictors of psychiatric readmission. Subsequently these were grouped into four categories: 1) individual vulnerability factors, 2) aftercare related factors, 3) community care and service responsiveness, and 4) contextual factors and social support. Individual factors were addressed in 58 papers and were found to be significant in 37 of these, aftercare factors were significant in 30 out of the 45 papers, community care and social support factors were significant in 21 out of 31 papers addressing these while contextual factors and social support were significant in all seven papers which studied them. Conclusions This review represents a first attempt at providing an overview of post-discharge factors previously studied in association with readmission. Hence, by mapping out the current research in the area, it highlights the gaps in research and it provides guidance future studies in the area. Electronic supplementary material The online version of this article (doi:10.1186/s12888-017-1386-z) contains supplementary material, which is available to authorized users.

Flow chart for study selection: Describes the study selection process and why records were excluded. (DOCX 35 kb)

Among aging employees, sleep problems are prevalent, but they may have serious consequences that are poorly understood. This study examined whether sleep problems are associated with subsequent disability retirement. Baseline questionnaire survey data collected in 2000-2002 among employees of the city of Helsinki, Finland, were linked with register data on disability retirement diagnoses by the end of 2008 (n = 457) for those with written consent for such linkages (74%; N = 5,986). Sleep problems were measured by the Jenkins Sleep Questionnaire. Cox regression analysis was used to calculate hazard ratios and 95% confidence intervals for disability retirement. Gender- and age-adjusted frequent sleep problems predicted disability retirement due to all causes (hazard ratio (HR) = 3.22, 95% confidence interval (CI): 2.26, 4.60), mental disorders (HR = 9.06, 95% CI: 3.27, 25.10), and musculoskeletal disorders (HR = 3.27, 95% CI: 1.91, 5.61). Adjustments for confounders, that is, baseline sociodemographic factors, work arrangements, psychosocial working conditions, and sleep duration, had negligible effects on these associations, whereas baseline physical working conditions and health attenuated the associations. Health behaviors and obesity did not mediate the examined associations. In conclusion, sleep problems are associated with subsequent disability retirement. To prevent early exit from work, sleep problems among aging employees need to be addressed.

Background Homelessness is associated with increased mortality, morbidity and social difficulties and periods of homelessness are sometimes prolonged or repeated. However, there are no long-term follow-up studies focusing upon housing status among homeless people. The aim of this study was to examine morbidity and housing outcomes and to identify factors predicting being independently housed 10 years after shelter use. Methods By combining data from several registers we followed all 552 homeless men who stayed in shelter in Helsinki during 2004 and determined their housing situation and morbidity 10 years later. Their situation was compared with an age-matched control group from the general population (N = 946). Using logistic regression analysis, we assessed the predictive effects of socioeconomic factors and health service use at baseline on becoming independently housed. Results By the end of the follow-up 52.0% of the formerly homeless study group had died, compared with 14.6% of the controls. At 10 years, 6.0% were independently housed, 37.5% lived in supported housing and 4.5% were still or again homeless. Psychiatric disorders, including substance use disorder, were present in 77.5% of the homeless, compared with 16.1% among the controls. Being married (OR 8.3, 95% CI 3.0 to 23.2) and having less than four shelter nights in year 2004 (OR 9.1, 95% CI 2.7 to 30.8) strongly predicted being independently housed 10 years later. Conclusions Homeless staying in shelters have high mortality and morbidity and most of those surviving, are in need of support in their everyday lives even years after the shelter period.

Background Insufficient evidence exists about the effect of different therapies on work ability for patients with psychiatric disorders. The present study compares improvements in work ability in two short-term therapies and one long-term therapy. Methods In the Helsinki Psychotherapy Study, 326 outpatients with depressive or anxiety disorder were randomly assigned to long-term and short-term psychodynamic psychotherapy, and solution-focused therapy. The patients were followed for 3 years from the start of treatment. Primary outcome measures were the Work Ability Index (WAI), the Work-subscale (SAS-Work) of the Social Adjustment Scale (SAS-SR), Perceived Psychological Functioning Scale, the prevalence of patients employed or studying, and the number of sick-leave days. Results Work ability was statistically significantly improved according to WAI (15%), SAS-Work (17%), and Perceived Psychological Functioning Scale (21%) during the 3-year follow-up. No differences in the work ability scores were found between two short-term therapies. The short-term therapies showed 4–11% more improved work ability scores than long-term therapy at the 7 month follow-up point. During the second year of follow-up, no significant differences were found between therapies. After 3 years of follow-up, long-term therapy was more effective than the short-term therapies with 5–12% more improved scores. No differences in the prevalence of individuals employed or studying or in the number of sick-leave days were found between therapies during follow-up. Conclusions Short-term therapies give benefits more quickly than long-term therapy on work ability but in the long run long-term therapy is more effective than short-term therapies. More research is needed to confirm these findings.

Background Psychiatric readmissions have been studied at length. However, knowledge about how environmental and health system characteristics affect readmission rates is scarce. This paper systemically reviews and discusses the impact of health and social systems as well as environmental characteristics for readmission after discharge from inpatient care for patients with a psychiatric diagnosis. Methods Comprehensive literature searches were conducted in the electronic bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management and OpenGrey. In addition, Google Scholar was utilised. Relevant publications published between January 1990 and June 2014 were included. No restrictions regarding language or publication status were imposed. A qualitative synthesis of the included studies was performed. Variables describing system and environmental characteristics were grouped into three groups: those capturing regulation, financing system and governance; those capturing capacity, organisation and structure; and those capturing environmental variables. Results Of the 734 unique articles identified in the original search, 35 were included in the study. There is a limited number of studies on psychiatric readmissions and their association with environmental and health system characteristics. Even though the review reveals an extensive list of characteristics studied, most characteristics appear in a very limited number of articles. The most frequently studied characteristics are related to location (local area, district/region/country). In most cases area differences were found, providing strong indication that the risk of readmission not only relates to patient characteristics but also to system and/or environmental factors that vary between areas. The literature also points in the direction of a negative association of institutional length of stay and community aftercare with readmission for psychiatric patients. Conclusion This review shows that analyses of system level variables are scarce. Furthermore they differ with respect to purpose, choice of system characteristics and the way these characteristics are measured. The lack of studies looking at the relationship between readmissions and provider payment models is striking. Without the link to provider payment models and other health system characteristics related to regulation, financing system and governance structure it becomes more difficult to draw policy implications from these analyses. Electronic supplementary material The online version of this article (doi:10.1186/s12888-016-1099-8) contains supplementary material, which is available to authorized users.

Background High body weight and insomnia are prevalent public health problems, both associated with ill-health. Studies have found positive associations between weight and insomnia. Yet the associations of weight change with insomnia symptoms are poorly understood. We examined the associations of weight gain and loss with subsequent insomnia symptoms among middle-aged women and men. Methods The baseline questionnaire surveys among 40–60-year-old employees of the City of Helsinki were conducted in 2000–2002 (response rate 67%) with a follow-up in 2007 …

Background Psychotherapy is apparently an insufficient treatment for some patients with mood or anxiety disorder. In this study the effectiveness of short-term and long-term psychotherapies was compared with that of psychoanalysis. Methods A total of 326 psychiatric outpatients with mood or anxiety disorder were randomly assigned to solution-focused therapy, short-term psychodynamic and long-term psychodynamic psychotherapies. Additionally, 41 patients suitable for psychoanalysis were included in the study. The patients were followed from the start of the treatment and assessed 9 times during a 5-year follow-up. The primary outcome measures on symptoms were the Beck Depression Inventory, the Hamilton Depression and Anxiety Rating Scales, and the Symptom Check List, anxiety scale. Primary work ability and functional capacity measures were the Work Ability Index, the Work-subscale of the Social Adjustment Scale, and the Perceived Psychological Functioning Scale. Results A reduction in psychiatric symptoms and improvement in work ability and functional capacity was noted in all treatment groups during the 5-year follow-up. The short-term therapies were more effective than psychoanalysis during the first year, whereas the long-term therapy was more effective after 3 years of follow-up. Psychoanalysis was most effective at the 5-year follow-up, which also marked the end of the psychoanalysis. Conclusions Psychotherapy gives faster benefits than psychoanalysis, but in the long run psychoanalysis seems to be more effective. Results from trials, among patients suitable for psychoanalysis and with longer follow-up, are needed before firm conclusions about the relative effectiveness of psychoanalysis and psychotherapy in the treatment of mood and anxiety disorders can be drawn.

Introduction Insomnia symptoms are associated with several health outcomes such as somatic and mental health, sickness absence and disability retirement. However, studies on the association between insomnia symptoms and mortality are few and their results inconsistent. In some studies frequent symptoms are associated with higher mortality risk, some others have found no or even reverse associations. Our aim was to examine the association of insomnia symptoms with all-cause mortality among ageing employees. Materials and methods The Helsinki Health Study baseline questionnaire survey data on 40–60-year-old City of Helsinki employees were collected in 2000–2002 (response rate 67%). These data were linked with register data on mortality until the end of 2011 ( n = 188 deaths) for those with written consent for such linkages (74%; N = 6,464). Insomnia symptoms included difficulties initiating and maintaining sleep, and non-restorative sleep (none, occasional, i.e. 1–14 nights per month, and frequent, i.e. 15 + nights per month). Baseline covariates included age, sex, education, marital status, obesity, alcohol drinking, physical inactivity, and mental health. Cox regression analysis was used to calculate hazard ratios (HR) and their 95% confidence intervals (CI). Results At baseline, 21% of women and 17% of men reported frequent insomnia symptoms. The summary measure examining any insomnia symptoms was not associated with all-cause mortality among men or women. However, difficulties in initiating sleep were strongly associated with mortality among men (HR 4.46, 95% CI 2.03–9.77). After adjusting for all covariates, the association attenuated but remained (HR 2.78, 95% CI 1.19–6.48). No associations could be confirmed among women or for difficulties maintaining sleep and non-restorative sleep. Conclusion Difficulties initiating sleep were associated with mortality among men. Otherwise insomnia symptoms were unassociated with mortality. Studies need to examine insomnia symptoms separately, especially as they may have contrasting associations with mortality. Health care should emphasise early detection and prevention of insomnia symptoms, especially difficulties initiating sleep. Acknowledgements Funding from the Academy of Finland, Finnish Work Environment Fund and University of Helsinki.

ObjectivesLifestyle is less favourable among individuals suffering from psychiatric disorders. We studied whether psychotherapy brings along changes in lifestyle and whether these changes differ between short-term and long-term psychodynamic psychotherapy (SPP and LPP) and solution-focused therapy (SFT).MethodsA total of 326 outpatients, 20–46 years of age, with mood or anxiety disorder were randomly assigned to LPP, SPP and SFT. The lifestyle variables considered were alcohol consumption, smoking, body mass index (BMI), leisure time exercise and serum cholesterol. The patients were monitored for three years from the start of treatment.ResultsDuring the three-year follow-up, BMI and serum cholesterol rose statistically significantly although no statistically significant trends were shown for alcohol consumption, smoking or exercise. SPP showed a disadvantage of increased alcohol consumption and serum cholesterol level when compared with LPP. SFT showed an advantage of reduced smoking in comparison with SPP.DiscussionSmall therapy-specific changes in lifestyle may be a result from psychotherapy treatment. These lifestyle changes are apparently more common in short-term therapy. More studies are needed to verify these findings.

Introduction Sleep disturbances have been associated with increased risk of cardiovascular disease outcomes. The associations of insomnia with hypertension and dyslipidemia, the main modifiable cardiovascular disease risk factors, are less studied. We aimed to examine associations of insomnia symptoms with subsequent prescribed medication for hypertension and dyslipidemia. Materials and methods Baseline questionnaire surveys among 40–60-year-old employees of the City of Helsinki, Finland, were conducted in 2000–2002 (N = 6,477, response rate 67%, 78% women) and linked to a national register on prescribed reimbursed medication 5–7 years prior to and 5 years after baseline. The associations between the frequency of insomnia symptoms (difficulties in initiating and maintaining sleep, non-restorative sleep) and hypertension and dyslipidemia medication during the follow-up were analysed using logistic regression analysis (odds ratios (OR) with 95% confidence intervals (CI)). Analyses were adjusted for pre-baseline medication, sociodemographic and work-related factors, health, and health behaviours. Results Frequent insomnia symptoms were reported by 20%. During the 5-year follow-up 32% had hypertension medication and 15% dyslipidemia medication. Adjusting for age, gender, and pre-baseline medication, frequent insomnia symptoms were associated with hypertension medication (OR 1.57, 95% CI 1.23–2.00) and dyslipidemia medication (OR 1.59, 95% CI 1.19–2.12). Occasional insomnia symptoms were also associated with cardiovascular medication, though less strongly. Further adjustments had negligible effects. Conclusion Insomnia should be taken into account in the prevention and management of cardiovascular disease and related risk factors. Acknowledgements The authors have no conflicts of interests to report. This study has been funded with grants from Academy of Finland, Finnish Work Environment Fund, Juho Vainio Foundation, Emil Aaltonen Foundation, and Doctoral Programs in Public Health.

Background:Demographic factors have been shown to predict the outcome of short-term psychotherapy in the treatment of depressive and anxiety disorders. So far, however, information on the prediction for long- term therapy is missing. to be able to choose an optimal psychotherapy length for the patient, it is essential to know, which demographic factors predict different outcome in short- and long-term therapy.Aim:To compare the prediction of demographic factors on changes in psychiatric symptoms in short- and long-term psychotherapy.Methods:In the Helsinki Psychotherapy Study, 326 psychiatric outpatients, aged 20-46 years, and suffering from depressive or anxiety disorders, were randomly assigned to short-term therapy (short-term psychodynamic psychotherapy or solution-focused therapy combined) or long-term psychodynamic psychotherapy. the demographic factors (i.e. age, gender, education, income, and living arrangement) were assessed at baseline by a questionnaire. Psychiatric symptoms were assessed with the Symptom Check List, Global Severity Index (SCL-90-GSI) at baseline and 7 times during a 3-year follow-up.Results:Demographic factors were found to predict symptom development during follow-up irrespective of baseline symptom level. Female gender, being aged 25 or more, living with a spouse/partner, high education, and medium level personal income predicted benefiting sufficiently from short-term therapy, whereas being aged under 25, medium education, and living with other(s) than a partner or child(ren) predicted the need of long-term therapy.Conclusions:Demographic factors may be a useful tool in the selection of patients for short- and long term therapy.

Detailed search strategies: Contains the search terms for the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey (formerly SIGLE), and Google Scholar. (DOC 45 kb)

Additional information on cohort size and follow-up time of the reviewed studies: Contains tables with Quartiles, Minimum, Maximum and Mean of the patient sample sizes and follow-up time used in the reviewed studies. (DOCX 21 kb)

Bibliography of reviewed studies: Contains the reference list of all 407 included studies in the systematic review. (DOCX 74 kb)

Background Readmission rate is considered an indicator of the mental health care quality. Previous studies have examined a number of factors that are likely to influence readmission. The main objective of this systematic review is to identify the studied pre-discharge variables and describe their relevance to readmission among psychiatric patients. Methods Studies on the association between pre-discharge variables and readmission after discharge with a main psychiatric diagnosis were searched in the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management and OpenGrey. Relevant publications published between January 1990 and June 2014 were included. For each variable, the number of papers that considered it as a predictor of readmission and that found a significant association was recorded, together with the association direction and whether it was found respectively in bivariate and in multivariate analyses. Results Of the 734 articles identified in the search, 58 papers were included in this review, mainly from the USA and concerning patients with severe mental disorders. Analysed variables were classified according to the following categories: patients’ demographic, social and economic characteristics; patients’ clinical characteristics; patients’ clinical history; patients’ attitude and perception; environmental, social and hospital characteristics; and admission and discharge characteristics. The most consistently significant predictor of readmission was previous hospitalisations. Many socio-demographic variables resulted as influencing readmission, but the results were not always homogeneous. Among other patients’ clinical characteristics, diagnosis and measures of functional status were the most often used variables. Among admission characteristics, length of stay was the main factor studied; however, the results were not very consistent. Other relevant aspects resulted associated with readmission, including the presence of social support, but they have been considered only in few papers. Results of quality assessment are also reported in the review. The majority of papers were not representative of the general psychiatric population discharged from an inpatient service. Almost all studies used multivariate analytical methods, i.e., confounders were controlled for, but only around 60% adjusted for previous hospitalisation, the variable most consistently considered associated to readmission in the literature. Conclusions The results contribute to increase knowledge on pre-discharge factors that could be considered by researchers as well as by clinicians to predict and prevent readmissions of psychiatric patients. Associations are not always straightforward and interactions between factors have to be considered. Electronic supplementary material The online version of this article (doi:10.1186/s12888-016-1114-0) contains supplementary material, which is available to authorized users.

Lihavuus on yhteydessä unettomuusoireisiin, mutta painonmuutosten yhteys unettomuusoireisiin tunnetaan huonosti. Tutkimuksen tavoitteena oli selvittää lähtöpainon merkitystä painonmuutosten ja unettomuusoireiden väliseen yhteyteen. Peruskysely toteutettiin vuosina 2000–2002 Helsingin kaupungin keski-ikäisillä työntekijöillä (n=8960) ja seurantakysely vuonna 2007 (n=7332). Tutkimukseen otettiin mukaan ne, joilta oli käytettävissä tiedot pituudesta, painosta ja unettomuusoireista sekä taustatekijöistä (n=6929). Painon ja pituuden perusteella laskettiin painoindeksi (BMI) ja suhteellinen painonmuutos (≥5 %) seuranta-aikana normaali- (BMI 18.5-24.9), ylipainoisilla (BMI 25.0-29.9) ja lihavilla (BMI 30 tai enemmän). Unettomuusoireiksi määriteltiin nukahtamisvaikeudet, vaikeudet pysyä unessa ja väsyneenä herääminen tavallisen yöunen jälkeen vähintään joka toinen yö neljän vastaamista edeltäneen viikon aikana. Logistisessa regressioanalyysissa vakioitiin ensimmäisessä mallissa ikä, toisessa mallissa myös perustilanteen unettomuusoireet ja viimeisessä mallissa edellisten lisäksi siviilisääty, koulutus, työmarkkina-asema, alkoholinkäyttö, tupakointi, liikunta ja koettu terveys. Miehillä suurin unettomuusoireiden riski oli perustilanteen lihavilla, jotka lihoivat seurannan aikana (ikävakioitu OR 2.98, 95 % lv 1.55–5.75). Lisäksi unettomuusoireiden riski oli kohonnut pysyvästi lihavilla (OR 2.23, 95 % lv 1.29–3.84) sekä ylipainoisilla, jotka lihoivat seurannan aikana (OR 2.28, 95 % lv 1.43–3.63). Vakioinnit heikensivät yhteyksiä, mutta ne säilyivät tilastollisesti merkitsevinä. Naisilla ainoastaan pysyvästi lihavilla oli kohonnut unettomuusoireiden riski (ikävakioitu OR 1.64, 95 % lv 1.24–2.18), mutta yhteys katosi vakiointien jälkeen. Tutkimuksen päätelmänä on, että lihavuuden sekä lihavien ja ylipainoisten lihomisen ehkäisy saattaa vähentää unettomuusoireiden riskiä erityisesti miehillä.

Detailed search strategies. (DOC 47Â kb)

Detailed search strategies. (DOC 47Â kb)

General characteristics of the reviewed studies included in a systematic literature review on psychiatric readmissions and their association with physical comorbidity. (DOC 86 kb)

Bibliography of reviewed studies: Contains the reference list of all 407 included studies in the systematic review. (DOCX 74 kb)

Detailed search strategies. Are represented detailed search strategies in term of combinations of keywords (used as MeSH terms or free text) applied in different databases. (DOCX 21 kb)

Detailed search strategies: Contains the search terms for the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey (formerly SIGLE), and Google Scholar. (DOC 45 kb)

Description of results from studies included in a systematic literature review on psychiatric readmissions and their association with physical comorbidity. (DOC 107 kb)

Characteristics and main results of the studies included in the review. (DOCX 53Â kb)

Characteristics and main results of the studies included in the review. (DOCX 53Â kb)

Detailed search strategy for articles on physical comorbidity. Are listed physical comorbidity variables with corresponding keywords which were used for identification of studies addressing the topic of physical comorbidity in patients discharged from psychiatric or general health in-patient care with a psychiatric diagnosis. (DOCX 18 kb)