Esko Kumpusalo's research while affiliated with University of Eastern Finland and other places

Metabolic syndrome (MetS) can be prevented through the promotion of healthy lifestyles. In rural areas, MetS is associated with unhealthy lifestyles and socioeconomic and demographic changes. However, there is scarce evidence on how health views contribute to the unhealthy lifestyles that result in MetS. The study involved adults in 8 birth cohorts between 30 and 65 years of age living in the rural community of Lapinlahti in eastern Finland. We assessed participants' demographic and lifestyle factors and health views. For assessment of health views, we applied factor analysis. For MetS classification, we used the 2005 criteria of the National Cholesterol Education Program. The prevalence of MetS among the participants was 38%. In a backward logistic regression analysis adjusted for other variables, there was a significant association between MetS and older age (odds ratio [OR] 2.91) as well as low level of physical activity (OR 1.99). In a factor analysis, 4 principal factors of lay health views were identified, of which blame-shifting (OR 1.36, 95% confidence interval [CI] 1.21-1.49)and social alienation (OR 1.23, 95% CI 1.24-1.40) were significantly associated with MetS in an unadjusted logistic regression analysis. It is important, particularly in primary health care, to recognize health views behind MetS and to empower communities in the prevention of MetS.

There are sex differences in low-grade inflammation markers in obesity-related disorders. Little is known, however, about a possible sex-specific association of relative weight change from youth to adulthood with actual low-grade inflammation. The aim of this study was to identify possible sex differences in adiponectin, interleukin-1β (IL-1β), interleukin-1Ra (IL-1Ra), and high-sensitivity C-reactive protein (hs-CRP) levels with respect to the relative change in body mass index (BMI) from youth to middle age. The study population consisted of 403 men and 500 women from 1 Finnish town. Weight, height, and adiponectin, IL-1β, IL-1Ra, and hs-CRP levels were measured in 2003 at a mean age of 46 years. Self-reported weight at the age of 20 years was recorded. In women, even after adjustment for BMI in adulthood, a statistically significantly negative linear association was observed between the quartiles of relative change in BMI and adiponectin levels (P < 0.001 for linearity). Significantly positive linear associations were also observed between the change in BMI and IL-1Ra (P = 0.032 for linearity) and hs-CRP (P = 0.029 for linearity) levels. In men, there was no statistically significant association among the quartiles of relative change in BMI and measured inflammatory markers after adjustment for BMI in adulthood. A relative increase in weight may be more harmful in women than in men with respect to adiponectin and inflammatory markers.

Choosing a medical specialty is an important element predefining a physician's career and life. Although there has been some research in this area of interest, there has not been much research where the profession has been researched as a whole, or where trend data over different generations has been presented. The aim of our study was to ascertain the motives affecting physicians' choice of a medical specialty. The study cohort comprised random sample of 7758 doctors who were registered in Finland during the years 1977-2006. Altogether 4167 questionnaires were returned, giving a response rate of 54%. An electronic questionnaire was used in data collection, supported by a traditional postal questionnaire. Of the respondents, 76% thought the diversity of the field had affected their choices of specialty considerably or very much. For physicians under 35 years old, especially the good example set by colleagues (48%), and opportunities for career development (39%) were more important motives compared to those of older physicians. According to this study, diversity of the work is the main motivating factor affecting physicians' choices of specialty. Especially, younger physicians follow the example set by more experienced colleagues.

Metabolic syndrome (MetS) is associated with low-grade inflammation. The connections of adiponectin and inflammatory cytokines with the course of MetS are not well-known. The aim of this study was to investigate the relation of adiponectin and low-grade inflammation with the development or resolution of MetS. In the town of Pieksämäki, Finland, five complete age groups (n = 1.294) were invited for health check-ups in 1997-1998 for the first time and in 2003-2004 for the second time. The final study population included 284 men and 396 women. MetS was defined according to the National Cholesterol Education Program criteria in the beginning and at the end of the 6-year research period, and adiponectin, high-sensitivity C-reactive protein (hs-CRP), interleukin-1 receptor antagonist (IL-1Ra) and interleukin-1 beta (IL-1β) levels were determined from baseline samples. Both male and female study subjects were divided into four groups according to the diagnosis of MetS in the two check-ups: not diagnosed at either check-up (No MetS), diagnosed only at the second check-up (Incident MetS), diagnosed only at the first check-up (Resolute MetS), and diagnosed at both check-ups (Persistent MetS). Baseline adiponectin, IL-1Ra and IL-1β levels and IL-1β/IL-1Ra -ratio were found to predict Incident MetS, when adjusted for the change in BMI, age, smoking status and physical activity. Our data also suggested that a high adiponectin level and low hs-CRP and IL-1Ra levels predict the resolution of MetS. Adiponectin and inflammatory markers can predict the course of MetS.

A Finnish national survey in 2002 revealed that Finnish physicians often feel that working in a primary heath care centre is isolated work. To determine the factors related to perceived isolation in health centre work among general practitioners (GP) working in health centres. A postal questionnaire study of physicians (N = 1829) working in primary health care centres. The majority of GPs (67%) agreed that 'working in a health centre is too often isolated work'. Physicians felt isolated most often when working in the largest health centres (>20 posts), whereas physicians working in health centres with 3-10 posts perceived isolation least often. Difficulty in collaboration with partners or the managerial team was associated with this feeling. Feelings of isolation are common among Finnish health centre physicians, but increasing the size of primary health care units may not prevent these feelings.

It is proposed that isolation in general practice is one of the factors that leads to work-related stress and the low attraction of this work. In Finland, 71% of physicians who worked or had worked in a primary health care centre agreed with the statement 'working as a doctor in a health centre is too often isolated work'. To gain a deeper understanding of this feeling and to find out which factors constitute it. A qualitative in-depth interview study of 32 physicians working in a primary health care centre in Finland. Qualitative analysis of transcribed verbatim interviews using a constant comparison method. The main components of isolation were making decisions alone, lack of collaboration with other workers in the health centre and secondary care specialists, not being a part of the work community and lack of mentoring at work. Enabling flexible teamwork and social and professional support networks are the key issues in solving the problem of occupational isolation in general practice.

Metabolic syndrome (MetS) is a major public health challenge. General practitioners (GPs) could play a key role in its recognition. However, it often remains undiagnosed in primary care. This study assesses how well GPs and patients recognise MetS among patients with coronary heart disease or at least one of its risk factors. Twenty-six health centres around Finland were randomly selected for the purpose of identifying, over a two-week period in April 2005, patients meeting the inclusion criteria of coronary heart disease or one of its risk factors. GPs and identified patients (n = 1880) were asked to complete surveys that included a question about the patient's MetS status. A trained nurse conducted health checks (n = 1180) of the identified patients, utilising criteria of MetS modified from the National Cholesterol Program. Data from the GPs' survey were compared with those from the health check to establish the extent of congruence of identification of MetS. Almost half (49.4%) of the patients met the criteria of MetS as established by objective measures. However, in the GPs' survey responses, only 28.5% of the patients were identified as having MetS. Additionally, these groups of MetS patients were not congruent. The sensitivity of the GPs' diagnosis of MetS was 0.31 with a specificity of 0.73. Only 7.1% of the study patients stated that they were suffering from MetS. Detection of MetS is inaccurate among GPs in Finland. Most patients were not aware of having MetS. The practical relevance of MetS in primary care should be reconsidered.

This report presents the results of a national survey of medical doctors carried out in Finland in 1988. Of the 1,745 physicians who completed the questionnaires, 48 percent worked in hospitals and 39 percent worked in primary care settings. An 18-item, 5-point Likert scale was used to assess the professional identities of the physicians. Principal component factor analysis with varimax rotation produced the following five factors to describe the professional identities of the physicians: humanist, bureaucrat, health promoter, scientist, and healer. The five-factor solution accounted for 60 percent of the total variance. There were marked, statistically significant differences in identity between male and female doctors as well as among hospital, primary care, and other physicians. Female physicians identified themselves more as humanists, health promoters, and bureaucrats, whereas male physicians were more likely to consider themselves healers and scientists. Primary care physicians identified themselves more as humanists and bureaucrats, whereas hospital physicians considered themselves healers and scientists. The report considers the implications of these findings for health care and the medical profession.

Previous studies with selected patient populations have suggested that cytokines, the immune system messengers, may play a role in the aetiology of depression. However, the data concerning the increase or decrease of the plasma cytokine levels in depression is controversial and the effects of the medications and type of depression are largely unknown. We studied the connections between plasma interleukin-1 beta (IL-1 beta) and interleukin 1 receptor antagonist (IL-1RA) levels, and depressive symptomatology measured with the Beck Depression. Inventory in a large, middle-aged population-based sample collected from Central Finland. In addition, the effects of various medications and type of depressive symptomatology on the cytokine levels were scrutinized. In the whole study population, IL-1RA levels were higher in the subgroup with depressive symptomatology. In the males with depressive symptomatology, higher IL-1RA levels and lower interleukin-1 beta levels were observed as compared with the non-depressed males. The IL-1RA/IL-1 beta ratio was significantly higher in males with depressive symptomatology. The IL-1RA levels were also higher and IL-1 beta levels lower in the depressed females, but the trend was not significant. The elevated IL-1RA-levels and IL-1RA/IL-1 beta ratio suggest a role for cytokines in the pathogenesis of depression. The higher IL-1RA levels may reflect an endogenous repairing process against depression.