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Psychiatric patients' awareness of treatments options and their possibilities to influence their care has increased. For the clinicians, the management of evidence-based care, as well as organizational and resource aspects, set different goals for the clinical encounter. In this article we are focusing on the clinicians' experiences and ask: How do the clinicians view situations in which there is a conflict between patients' individual needs and goals and other aspects in decision-making? We implemented a qualitative study of 13 thematic semi-structured interviews with clinicians working in psychiatry. We used discourse analysis to investigate how the clinician view the doctor–patient interaction. We identified three discources which were termed the medical standpoint, the psychodynamic standpoint and the standpoint of the patient's experience. In their talk, the clinicians use the three discources to make sense of the diverse expectations from both the patient and the mental health care system. The three discources also reflect different aspects in psychiatric treatment cultures, such as evidence-based medicine, the ideal of patient-centeredness, therapeutic interaction and organizational requirements. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of hypertension awareness and depressive symptoms, and to analyse factors predisposing aware hypertensives to depressive symptoms. Design: Cross-sectional study in a primary care population. Setting: Cardiovascular risk factor survey in two semi-rural towns in Finland. Subjects: Two thousand six hundred seventy-six middle-aged risk persons without an established cardiovascular or renal disease or type 2 diabetes. Main outcome measures: Depressive symptoms, previous and new diagnosis of hypertension. Results: Hypertension was diagnosed in 47.9% of the subjects, of whom 34.5% (442/1 282) had previously undetected hypertension. Depressive symptoms were reported by 14% of the subjects previously aware of their hypertension, and by 9% of both unaware hypertensives and normotensive subjects. In the logistic regression analysis, both the normotensive (OR 0.62, 95% CI 0.45-0.86) (p = 0.0038) and the unaware hypertensive subjects (OR 0.54, 95% CI 0.35-0.84) (p = 0.0067) had lower risk for depressive symptoms than the previously diagnosed hypertensives. Among these aware hypertensives, female gender (OR 3.61, 95% CI 2.06-6.32), harmful alcohol use (OR 2.55, 95% CI 1.40-4.64) and obesity (OR 2.50, 95% CI 1.01-6.21) predicted depressive symptoms. Non-smoking (OR 0.57, 95% Cl 0.33-0.99) and moderate leisure-time physical activity compared to low (OR 0.53, 95% CI 0.33-0.84) seemed to buffer against depressive symptoms. Conclusion: Depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension. Many modifiable, lifestyle associated factors may contribute to the association of hypertension and depressive symptoms. Key Points: Hypertension and depressive symptoms are known to form a toxic combination contributing even to all-cause mortality. Comorbidities or the labelling effect of the diagnosis of hypertension can confound their association. Our study shows that depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension. Many modifiable, lifestyle-associated factors may contribute to the association of hypertension and depressive symptoms. When treating hypertensive patients, consideration of depressive symptoms is important in order to promote favorable lifestyle and control of hypertension. [ABSTRACT FROM AUTHOR]

Objective: Childhood adversities have been linked to elevated high-sensitivity C-reactive protein (hsCRP), which has been associated with increased morbidity. Low social support has been reported to worsen the prognosis in heart disease and cancer, and high social support has been linked to lower hsCRP. We hypothesized that social support could be a mediating factor between childhood adversities and hsCRP. Methods: The sample was drawn from the data of the nationwide Health and Social Support Study (HeSSup Study) to which 25,898 Finns had responded in 1998. The cohort was stratified into groups of high and low social support, and the study group consisted of 100 women in both groups. Additionally, we invited a randomly drawn group of 50 subjects and a group of 62 women who had reported depressive symptoms. Of the 312 women, 116 participated in the study. Results: Social support score (Social Support Questionnaire, SSQ) was lower when the number of adverse experiences in childhood was high ( r = − 0.251, P = 0.007). hsCRP and SSQ were inversely associated ( r = − 0.188, P = 0.046). In the adjusted general linear model, the level of social support was significantly associated with hsCRP and there was a statistically significant interactive effect of small effect size of childhood adversities and the level of social support on hsCRP (ES = 0.123, P = 0.004). Conclusion: This finding suggests that childhood adversity may affect social relationships and that high social support may attenuate the health risks caused by childhood adverse experience. [ABSTRACT FROM AUTHOR]

Several previous reforms decentralized Finnish psychiatric services to a great extent. The Ministry of Social Affairs and Health is outlining a proposal for Health Care Law, which makes an effort to centralize and reorganize healthcare. It is not yet possible to see what this will mean for the psychiatric services. In general, the health status of the Finnish population has improved. Although rates of suicides have declined considerably, rates of alcohol-related deaths have risen. Moreover, disability related to major depression has increased drastically, which has lead to a nationwide project called MASTO, which has the aim to improve early detection and treatment of depression. The Ministry of Social Affairs and Health set up a work group, MIND 2009, to draft local working models for mental health and addiction services. To study the significance of psychotherapy in a private practice psychiatric context, the Finnish Psychiatric Association conducted a survey amongst its members. Most psychiatrists in private practice conduct psychotherapy. [ABSTRACT FROM AUTHOR]

This study examined Finnish psychiatric trainees’ views on their education. This was a survey study of nationwide data on Finnish psychiatric trainees in 2001. The quality of training was considered at least moderate by 84% of the respondents. Training on epidemiology, on taking history and status, and on psychopharmacology was considered the best. Quality was rated bad for training in leadership and administration, and educating the community. Research was done by 20%, and a personal clinical supervisor was appointed to 52% of the respondents. Offensive treatment had been experienced by 49% of the trainees in this study. Generally, studies of training also reflect strengths and weaknesses of the profession. Based on our results, it seems especially that training in leadership and in educating the community need to be improved; both of these are quintessential skills to survive in the struggle for economic and human resources. Furthermore, treatment of the trainees could still be better; attention should be paid to supervision of all trainees. Moreover, research must become more attractive. Psychiatry can be developed by the development of psychiatric training. [ABSTRACT FROM AUTHOR]

The prevalence of use of seclusion and restraints in psychiatric treatment has varied dramatically among institutions, according to previous studies. We investigated the factors predicting overall and "heavy use" of restrictive measures and differences in the population-based rates of use of seclusion and restraints in three university psychiatric centres in Finland (Turku, Tampere and Oulu) using a retrospective chart review. The material comprised all civil admissions to the study hospitals of working-aged people during a period of 6 months in 1996. There were significant differences among the studied centres as to the population-based level of use of seclusion and restraints. Oulu used significantly less seclusion but had a significantly higher level of use of restraints than Turku and Tampere. The individual institutions best predicted the overall use of restrictive interventions, whereas previous commitments and involuntary legal status on admission were factors predicting "heavy use" of these measures. Our results suggest that the implementation and monitoring of restrictive measures could be further harmonized. [ABSTRACT FROM AUTHOR]

This study set out to evaluate overall patient satisfaction with psychiatric community care and to study the factors predicting level of satisfaction with the services. The level of overall satisfaction was fairly high and at the same level as in some other studies. There did not seem to be great difficulties in accessing the community care. Our results indicate that patients would prefer receiving more information about their disorder and its treatment. The stepwise logistic regression model indicated that the odds were 6.8-fold that the problems of mental health would become easier if the views of the patient were taken into consideration (P<0.05). The odds were 12.8-fold that the patient would recommend community care if he/her had felt him/herself understood and cared for (P<0.05). The odds were 5.9-fold that the patient experienced community care as effective if the therapist had understood the patient in the discussions (P=0.01). Evaluating the satisfaction of the patients should become routine practice throughout the services. Consequently, the views of the service users would be brought into decision-making procedures, and the services could be better modified on the basis of such views. [ABSTRACT FROM AUTHOR]

Information on involuntary psychiatric hospital treatment of all 12- to 17-year-old minors in 1990 and 1993 in Finland was collected from the national hospital discharge register. Involuntary treatment was associated with older age, psychosis diagnosis, and treatment in adult psychiatric ward. Treatment year, sex, and having previous psychiatric hospital treatment were not associated with involuntary treatment. Considerable differences were found when different health care districts were compared. In 12 of 22 districts there were no minors in involuntary treatment in 1993. For ethical and legal reasons the involuntary treatment of minors in adult settings can hardly be justified. [ABSTRACT FROM AUTHOR]

Hospital discharge register information was collected on length of stay (LOS) of all those children and adolescents less than 18 years old in psychiatric inpatient treatment in 1990 (n=818) and 1993 (n=958) in Finland. The predictors for LOS > 60 days included previous psychiatric inpatient treatment, involuntary treatment, and treatment in adolescent psychiatric unit. No psychiatric diagnosis was associated with shorter LOS. Girls and the under-school-age group had significantly shorter LOS. There were only rather minor differences in LOS between different diagnostic groups. [ABSTRACT FROM AUTHOR]

To assess the availability and flexibility of psychiatric services as seen by primary care physicians, a questionnaire was mailed to 190 general practitioners working in public health centers in two Finnish university towns with populations of 180,000 and 160,000. The response rate of the GPs was 64%. The primary care physicians were dissatisfied with the amount of psychiatric services and found problems in transferring information from specialist care to primary care. Admission to psychiatric hospital was considered difficult to arrange even when found necessary by primary care, and the delay between referral and entering specialist-level services was seen as too long. Satisfaction was expressed about special teams that respond quickly to crisis situations. In improving collaboration between primary care and specialized care, better transfer of information and flexible consultations are needed. [ABSTRACT FROM AUTHOR]

The author focuses on the impact and the economy of science. He points out that science has become an industry of information-making, but the research of science as a form of industry is still young. Furthermore, he states that science can be viewed as a highly specialized form of market economy in where information is exchanged to attention.