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Alexithymia is a personality trait associated with difficulties in identifying feelings, difficulties in describing feelings to other people, constricted imaginal processes, and an externally oriented cognitive style. It has been found to be associated with personality features that may cause interpersonally avoidant behavior and other interpersonal problems. The present study explored, in a sample of primary care patients (N = 491), whether alexithymia is associated with mobile phone usage, and whether the perceived quality and quantity of human relationships mediate its effect. Even controlling for sociodemographic variables and symptoms of depression, mania and psychoses, alexithymia, measured by the 20-Item Toronto Alexithymia Scale, was associated with less frequent mobile phone use. Not having enough relationships or a close friend, and relationships being less satisfactory mediated the effect of alexithymia on less frequent mobile phone use. The results support the findings of earlier studies that have linked interpersonal problems with alexithymia. [ABSTRACT FROM AUTHOR]

Objective: To provide procedure-specific estimates of symptomatic venous thromboembolism (VTE) and major bleeding after abdominal surgery., Background: The use of pharmacological thromboprophylaxis represents a trade-off that depends on VTE and bleeding risks that vary between procedures; their magnitude remains uncertain., Methods: We identified observational studies reporting procedure-specific risks of symptomatic VTE or major bleeding after abdominal surgery, adjusted the reported estimates for thromboprophylaxis and length of follow-up, and estimated cumulative incidence at 4 weeks postsurgery, stratified by VTE risk groups, and rated evidence certainty., Results: After eligibility screening, 285 studies (8,048,635 patients) reporting on 40 general abdominal, 36 colorectal, 15 upper gastrointestinal, and 24 hepatopancreatobiliary surgery procedures proved eligible. Evidence certainty proved generally moderate or low for VTE and low or very low for bleeding requiring reintervention. The risk of VTE varied substantially among procedures: in general abdominal surgery from a median of <0.1% in laparoscopic cholecystectomy to a median of 3.7% in open small bowel resection, in colorectal from 0.3% in minimally invasive sigmoid colectomy to 10.0% in emergency open total proctocolectomy, and in upper gastrointestinal/hepatopancreatobiliary from 0.2% in laparoscopic sleeve gastrectomy to 6.8% in open distal pancreatectomy for cancer., Conclusions: VTE thromboprophylaxis provides net benefit through VTE reduction with a small increase in bleeding in some procedures (eg, open colectomy and open pancreaticoduodenectomy), whereas the opposite is true in others (eg, laparoscopic cholecystectomy and elective groin hernia repairs). In many procedures, thromboembolism and bleeding risks are similar, and decisions depend on individual risk prediction and values and preferences regarding VTE and bleeding., Competing Interests: P.J.K. received a research grant from the Focused Ultrasound Foundation (all unrelated to this manuscript). P.J.D. received research grants from Abbott Laboratories, CloudDX, Philips Healthcare, Roche Diagnostics, and Siemens (all unrelated to this manuscript). R.C., P.D.V., and K.A.O.T. are panel members of the European Society of Anesthesiology and Intensive Care (ESAIC) Task Force for the European Guidelines on Venous Thromboembolism (VTE). The remaining authors report no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The rate of incisional hernia after closure of a temporary loop ileostomy is significant. Synthetic meshes are still commonly avoided in contaminated wounds. The Preloop trial was a multicentre RCT designed to evaluate the benefits of synthetic mesh in incisional hernia prevention, and its safety for use in a contaminated surgical site compared with biological mesh., Methods: Study patients who underwent closure of a loop ileostomy after anterior resection for rectal cancer were assigned to receive either retrorectus synthetic or biological mesh to prevent incisional hernia. The primary outcomes were surgical-site infections within 30 days, and clinical or radiological incisional hernia incidence at 10 months. Secondary outcomes were reoperation rate, operating time, duration of hospital stay, other complications within 30 days of surgery, 5-year quality of life measured by RAND-36, and incisional hernia incidence within 5 years of follow-up., Results: Between November 2018 and September 2021, 102 patients were randomised, of whom 97 received the intended allocation. At 10-month follow-up, 90 patients had undergone clinical evaluation and 88 radiological evaluation. One patient in each group (2 per cent) had a clinical diagnosis of incisional hernia (P = 0.950) and one further patient in each group had a CT-confirmed incisional hernia (P = 0.949). The number of other complications, reoperation rate, operating time, and duration of hospital stay did not differ between the study groups., Conclusion: Synthetic mesh appeared comparable to biological mesh in efficacy and safety for incisional hernia prevention at the time of loop ileostomy closure., Registration Number: NCT03445936 (http://www.clinicaltrials.gov)., (© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Incisional hernia is a frequent complication after loop-ileostomy closure, rationalizing hernia prevention. Biological meshes have been widely used in contaminated surgical sites instead of synthetic meshes in fear of mesh related complications. However, previous studies on meshes does not support this practice. The aim of Preloop trial was to study the safety and efficacy of synthetic mesh compared to a biological mesh in incisional hernia prevention after loop-ileostomy closure., Methods: The Preloop randomized, feasibility trial was conducted from April 2018 until November 2021 in four hospitals in Finland. The trial enrolled 102 patients with temporary loop-ileostomy after anterior resection for rectal cancer. The study patients were randomized 1:1 to receive either a light-weight synthetic polypropylene mesh (Parietene Macro™, Medtronic) (SM) or a biological mesh (Permacol™, Medtronic) (BM) to the retrorectus space at ileostomy closure. The primary end points were rate of surgical site infections (SSI) at 30-day follow-up and incisional hernia rate during 10 months' follow-up period., Results: Of 102 patients randomized, 97 received the intended allocation. At 30-day follow-up, 94 (97%) patients were evaluated. In the SM group, 1/46 (2%) had SSI. Uneventful recovery was reported in 38/46 (86%) in SM group. In the BM group, 2/48 (4%) had SSI (p > 0.90) and in 43/48 (90%) uneventful recovery was reported. The mesh was removed from one patient in both groups (p > 0.90)., Conclusions: Both a synthetic mesh and biological mesh were safe in terms of SSI after loop-ileostomy closure. Hernia prevention efficacy will be published after the study patients have completed the 10 months' follow-up., (© 2023. The Author(s).)

Background: Venous thromboembolism (VTE) and bleeding are serious and potentially fatal complications of surgical procedures. Pharmacological thromboprophylaxis decreases the risk of VTE but increases the risk of major post-operative bleeding. The decision to use pharmacologic prophylaxis therefore represents a trade-off that critically depends on the incidence of VTE and bleeding in the absence of prophylaxis. These baseline risks vary widely between procedures, but their magnitude is uncertain. Systematic reviews addressing baseline risks are scarce, needed, and require innovations in methodology. Indeed, systematic summaries of these baseline risk estimates exist neither in general nor gynecologic surgery. We will fill this knowledge gap by performing a series of systematic reviews and meta-analyses of the procedure-specific and patient risk factor stratified risk estimates in general and gynecologic surgeries., Methods: We will perform comprehensive literature searches for observational studies in general and gynecologic surgery reporting symptomatic VTE or bleeding estimates. Pairs of methodologically trained reviewers will independently assess the studies for eligibility, evaluate the risk of bias by using an instrument developed for this review, and extract data. We will perform meta-analyses and modeling studies to adjust the reported risk estimates for the use of thromboprophylaxis and length of follow up. We will derive the estimates of risk from the median estimates of studies rated at the lowest risk of bias. The primary outcomes are the risk estimates of symptomatic VTE and major bleeding at 4 weeks post-operatively for each procedure stratified by patient risk factors. We will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate evidence certainty., Discussion: This series of systematic reviews, modeling studies, and meta-analyses will inform clinicians and patients regarding the trade-off between VTE prevention and bleeding in general and gynecologic surgeries. Our work advances the standards in systematic reviews of surgical complications, including assessment of risk of bias, criteria for arriving at the best estimates of risk (including modeling of the timing of events and dealing with suboptimal data reporting), dealing with subgroups at higher and lower risk of bias, and use of the GRADE approach., Systematic Review Registration: PROSPERO CRD42021234119., (© 2021. The Author(s).)

An internal hernia is defined as a protrusion of an abdominal viscera through the defects of the gastrointestinal mesentery or peritoneum-lined fossa. Sigmoid mesocolic hernias are an uncommon type of internal hernias, accounting for only 6% of all internal hernias. Furthermore, intramesosigmoid hernia is one of the three subtypes of the sigmoid mesocolic hernias. Internal hernias are potentially fatal conditions with diagnostic challenges. Patients presenting with acute obstruction, no surgical history and no external hernia should receive an urgent CT scan to facilitate early surgery and to minimise the risk of strangulation and bowel resection. Here, we report a case of strangulated small bowel obstruction secondary to an intramesosigmoid hernia with a successful laparoscopic repair. We also present a literature review of all reported cases so far and give an up-to-date perspective on intramesosigmoid hernia., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Amyand's hernia is a rare entity where the appendix is trapped within inguinal canal. For even rarer are the cases where the appendix has perforated and caused an abscess into inguinal canal. Here we report a case where a male patient had Amyand's hernia, acute appendicitis and abscess which were treated by laparotomy. We present the diagnostic process and intraoperative finding leading to diagnosis of Amyand's hernia., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Unnoticed and untreated depression is prevalent among patients with chronic respiratory insufficiency. Comorbid depression causes suffering and worsens patients' outcomes., Objectives: The objective of this evaluation was to assess preliminary outcomes of a depression screening protocol among chronic respiratory insufficiency patients at a tertiary care pulmonary outpatient clinic., Methods: In the depression screening protocol, the patients filled the Depression Scale (DEPS) questionnaire. Patients whose scores suggested depression were offered the opportunity of a further evaluation of mood at a psychiatric outpatient clinic. The outcomes of the protocol were evaluated retrospectively from the patient records., Results: During the period of evaluation, 238 patients visited the outpatient clinic. DEPS was administered to 176 patients (74%), of whom 60 (34%) scored ≥9 (out of 30), thus exceeding the cut-off for referral. However, only 13 patients were referred, as the remainder declined the referral. Finally, seven patients were evaluated at the psychiatric clinic, and they all were deemed depressive. Symptoms of depression were most prevalent among patients with a long smoking history, refractory dyspnoea and a history of depression., Conclusion: Depression screening was positive in a third of the patients. The depression screening protocol improved the detection of depression symptoms, but the effects on the patients' treatment and clinical course were small. Rather than referring patients to a psychiatric unit, the evaluation and management of depression should be undertaken at the pulmonary unit., (© 2018 John Wiley & Sons Ltd.)

Background: Childhood adversities and emotional dysregulation are connected with chronic pain, alexithymia, and depression. Longitudinal studies exploring the impact of their co-occurrence on the pain situation are rare., Aims: The influence of alexithymia, depression, baseline pain situation, and treatment options on the course of chronic pain in a clinical sample was studied., Methods: The baseline data was collected from chronic pain patients (n = 154) before their first pain clinic visit, and the follow-up data after 1 year by self-report questionnaires. Study variables consisted of pain intensity, pain disability, alexithymia (TAS-20), depression (BDI-II), and treatment interventions. Statistical analyses were performed to find out differences between baseline and follow-up, as well as between alexithymic and non-alexithymic patients, and to estimate the effect of the treatment provided., Results: At follow-up, the majority of the patients had pain intensity and disability severe enough to disrupt with their daily living. None of treatment interventions was related to better outcome. Alexithymic patients reported more pain disability and depression at both baseline and at follow-up. The effect of alexithymia on pain disability was mediated by depression. The use of opioids was connected to alexithymia and depressiveness. Alexithymia and depression made a substantial contribution to poorer outcome., Conclusions: Severe pain intensity and disability with depression and alexithymia predicted difficulties in achieving improvement. Depression and alexithymia probably impair compliance with treatment and adherence to interventions. Their co-occurrence with a more severe pain situation and with the use of opioids indicates psychological problems underlying the pain experience.

Objective: The aim of this 8-year follow-up study was to ascertain changes in alexithymia, depressiveness and pain situation in a sample of chronic pain patients and to explore the impact of alexithymia and depression on the outcome., Methods: Participants (n=83) were chronic non-malignant pain patients who completed self-report study questionnaires before their first visit to the pain clinic and again 8years later. Study variables consisted of pain intensity measured by the Visual Analogous Scale, the Pain Disability Scale, the Toronto Alexithymia Scale and the Beck Depression Inventory. The moderate improvement in the pain situation was estimated as a decrease of 30% or more in pain intensity or pain disability., Results: In the whole sample there was a significant decrease in pain intensity, pain disability and depressiveness, but only some of the patients achieved moderate improvement in their pain situation. Alexithymia remained stable during the 8-year period. The alexithymic patients had poorer pain situation and more depressiveness both at baseline and at follow-up. Unfavorable outcome in the pain situation was connected with male gender and alexithymia at baseline but not with depressiveness. Alexithymia and depressiveness were closely related to each other and the connection strengthened during the follow-up period., Conclusion: Alexithymic depressive chronic pain patients represent a special, more disabled subgroup among chronic pain patients. The authors recommend screening for and identifying alexithymia and depression in chronic pain patients. Structural treatment protocols such as cognitive-behavioral therapy may benefit these patients. More research is needed to develop treatment interventions for alexithymic patients., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: We evaluated whether genital deformity has an impact on gender identity and sex role in patients operated on for bladder exstrophy-epispadias complex., Materials and Methods: A total of 62 adolescents and adults operated on for bladder exstrophy-epispadias complex were mailed questionnaires evaluating gender identity (Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults) and sex role (Bem Sex Role Inventory). Of the patients 33 responded and the results were compared with 99 gender matched controls., Results: On the gender identity questionnaire female patients had median scores similar to those of their gender matched controls (4.93 vs 4.89, p = 0.412) but in males the score was lower compared to controls (4.87 vs 4.96, p = 0.023), indicating somewhat more conflicted gender identity. However, no patient had gender dysphoria. Female sex role index was higher in female patients vs controls (5.9 vs 5.3, p = 0.003) but was comparable between male patients and controls (5.2 vs 5.0, p = 0.459). Masculine sex role indices were comparable between female patients and controls as well as between male patients and controls. Of 32 patients 17 were considered to have androgynous sex role, as were 24 of 97 controls (p = 0.004). The exact diagnosis (bladder exstrophy or epispadias) or dissatisfaction with appearance of the genitals had no impact on gender identity or on sex role indices., Conclusions: Male patients had lower gender identity scores compared to controls and female sex role was enhanced among female patients. Androgynous sex role was more common in patients vs controls. Gender dysphoria was not noted in any patient., (Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Depressive disorders are among the most pressing public health challenges worldwide. Yet, not enough is known about their long-term outcomes. This study examines the course and predictors of different outcomes of depressive disorders in an eleven-year follow-up of a general population sample., Methods: In a nationally representative sample of Finns aged 30 and over (BRIF8901), major depressive disorder (MDD) and dysthymia were diagnosed with the Composite International Diagnostic Interview (M-CIDI) in 2000. The participants were followed up in 2011 (n=5733). Outcome measures were diagnostic status, mortality, depressive symptoms and health-related quality of life. Multiple imputation (MI) was used to account for nonresponse., Results: At follow-up, 33.8% of persons with baseline MDD and 42.6% with baseline dysthymia received a diagnosis of depressive, anxiety or alcohol use disorder. Baseline severity of disorder, measured by the Beck Depression Inventory, predicted both persistence of depressive disorder and increased mortality risk. In addition, being never-married, separated or widowed predicted persistence of depressive disorders, whereas somatic and psychiatric comorbidity, childhood adversities and lower social capital did not. Those who received no psychiatric diagnosis at follow-up still had residual symptoms and lower quality of life., Limitations: We only had one follow-up point at eleven years, and did not collect information on the subjects' health during the follow-up period., Conclusions: Depressive disorders in the general population are associated with multiple negative outcomes. Severity of index episode is the strongest predictor of negative outcomes. More emphasis should be placed on addressing the long-term consequences of depression., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Psychological factors have an impact on subjective pain experience. The aim of this study was to explore the occurrence of alexithymia and Early Maladaptive Schemas in a sample of 271 first visit chronic pain patients of six pain clinics. The patients completed the study questionnaire consisting of the Toronto Alexithymia Scale-20, the Finnish version of the Young Schema Questionnaire short form-extended, the Beck Depression Inventory-II, and pain variables. Alexithymic patients scored higher on Early Maladaptive Schemas and had more pain intensity, pain disability and depression than nonalexithymic patients. Both alexithymia and depression correlated significantly with most Early Maladaptive Schemas. The co-occurrence of alexithymia, Early Maladaptive Schemas and depression seems to worsen the pain experience. Screening of alexithymia, depression and Early Maladaptive Schemas may help to plan psychological treatment interventions for chronic pain patients., (© 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Objective: To evaluate health-related quality of life (HRQoL) and psychiatric symptom aspects in patients with bladder exstrophy and epispadias., Methods: Sixty-two adolescents or adults operated for BEE were mailed questionnaires evaluating HRQoL (RAND-36 questionnaire) and psychiatric symptoms (SCL-90 questionnaire). Thirty-two patients with a median age of 28 years responded. The results were compared with national reference values., Results: Overall, RAND-36 scores and SCL-90 scores were comparable in the patients and the referral population. However, 7 patients (21%) had high SCL-90 scores, suggesting mental health problems. The patients with unsatisfactory genital appearance, urinary incontinence, or bladder augmentation tended to have poorer HRQoL and psychiatric symptom scores., Conclusion: Most adults with BEE have satisfactory HRQoL and mental health. However, a possible mental health problem can be found in one-fifth of the patients. Abnormal genitalia and bladder function may have a negative effect on HRQoL and mental health. Bladder augmentation is not associated with better outcome than mild incontinence., (Copyright © 2015 Elsevier Inc. All rights reserved.)

De Garengeot's hernia (DGH) is a rare entity in which the vermiform appendix is located within the femoral hernia sac. Even though DGH is known to be more common in females, we report a case of a male patient having undergone Bassini-type inguinal hernia repair over 40 years ago. We present the preoperative diagnostic measures and an example of the surgical management of this rare entity., (2015 BMJ Publishing Group Ltd.)

Background: Up-to-date epidemiological data on depressive disorders is needed to understand changes in population health and health care utilization. This study aims to assess the prevalence of major depressive disorder (MDD) and dysthymia in the Finnish population and possible changes during the past 11 years., Methods: In a nationally representative sample of Finns aged 30 and above (BRIF8901), depressive disorders were diagnosed with the Composite International Diagnostic Interview (M-CIDI) in 2000 and 2011. To account for nonresponse, two methods were compared: multiple imputation (MI) utilizing data from the hospital discharge register and from the interview in 2000 and statistical weighting., Results: The MI-corrected 12-month prevalence of MDD was 7.4% (95% CI 5.7-9.0) and of dysthymia was 4.5% (95% CI 3.1-5.9), whereas the corresponding figures using weights were 5.4% (95% CI 4.7-6.1) for MDD and 2.0% (95% CI 1.6-2.4) for dysthymia. Women (OR 2.33, 95% CI 1.6-3.4) and unmarried people (OR 1.54, 95% CI 1.2-2.0) had a higher risk of depressive disorders. There was a significant increase in the prevalence of depressive disorders during the follow-up period from 7.3% in 2000 to 9.6% in 2011. Prevalences were two percentage points higher, on average, when using MI compared to weighting. Hospital treatments for depressive disorders and other mental disorders were strongly associated with nonparticipation., Limitations: The CIDI response rate dropped from 75% in 2000 to 57% in 2011, but this was accounted for by MI and weighting., Conclusions: Depressive disorders are a growing public health concern in Finland. Non-participation of persons with severe mental disorders may bias the prevalence estimates of mental disorders in population-based studies., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objective: To investigate the quality of life of men who had been treated for posterior urethral valves (PUV) in childhood., Patients and Methods: Questionnaires were mailed to 108 patients with PUV treated at the Children's Hospital, University of Helsinki, and 67 (62%) of them responded. Three different questionnaires (15D, LSS, and RAND) were used to evaluate the quality of life., Results: The total quality of life in PUV patients was reported as good compared to the general population in the RAND and LSS surveys. However, in the 15D analysis the PUV patients reported lower scores in sleeping, eating, and sexual activity. Those PUV patients who had been treated for renal insufficiency reported lower scores in several dimensions in all three surveys. Patients with urinary incontinence reported more sleeping problems and regarded themselves physically more disabled., Conclusions: The PUV patients with renal insufficiency or urinary incontinence had impaired quality of life in several dimensions., (Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Aims: Previous prison studies show that female prisoners often have more health problems than male prisoners do and that they have many chronic health conditions. Few studies have been made among offenders concerning the use of health services, and even fewer concerning physical diseases. We studied the self-reported lifetime somatic diseases, the use of health services and the current use of prescription medicines among Finnish female prisoners and compared them with males., Methods: The sample consisted of 101 females and 309 male prisoners as controls. The study included several questionnaires and interviews conducted by experienced prison nurses., Results: The women had more commonly genitourinary, virus hepatitis/HIV infections and group "other diseases" than the men. Over 80% of the women and men have had accidents/injuries. Four out of five women, and half of the men, used some medicine regularly. Of the females, 92% (80% of the males) reported lifetime hospital care and 65% (61%) treatment in surgery department, respectively; 70% of the females (53% of the males) reported lifetime use of any psychiatric service; 66% of the women (46% of the men) had received psychiatric out-patient services, and 43% (31%) psychiatric in-patient hospital care and 38% (30%) substance abuse services, respectively., Conclusions: The heavy use of health services among female prisoners resulted mainly from the use of services for substance use and other mental disorders and treatment in surgery department. Compared to men, the difference in using health services was associated with psychiatric services.

Objective: The aim of the present study was to assess the prevalence of alexithymia in a sample of general chronic pain patients, to explore possible differences in depression and pain variables between alexithymic and nonalexithymic chronic pain patients and to analyze if depression is a mediator between alexithymia and pain disability., Methods: Two hundred and seventy-one patients making their first visit to a pain clinic completed the study questionnaire including various pain measures, the Beck Depression Inventory-II (BDI-II) and the 20-item Toronto Alexithymia Scale (TAS-20). The sample was dichotomized to alexithymic and nonalexithymic groups. The means of the study variables were compared between the groups. The correlation analysis of the variables was carried out separately in both groups. Path analysis was done to ascertain the mediation effect of BDI-II between the TAS-20 and pain disability., Results: Every fifth chronic pain patient was alexithymic. The BDI-II and pain variable scores were significantly higher in the alexithymic group than in the nonalexithymic group. Pain variables were not associated with alexithymia when BDI-II was controlled for. BDI-II worked as a full mediator between TAS-20 and pain disability., Conclusion: The alexithymic patient group was more morbid than the nonalexithymic group. The results suggest that depression is the main factor in pain conditions of alexithymic chronic pain patients. The authors recommend screening and treatment of depression in alexithymic chronic pain patients., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: This study investigated the association between dental fear and alcohol use disorder and smoking controlling for age, gender and attained level of education as well as anxiety and depressive disorders., Materials and Methods: Nationally representative data on Finnish adults, 30 + years old (n = 5953), were gathered in interviews. Dental fear was measured in an interview using the question: 'How afraid are you of visiting a dentist?' The alternatives for replying were: 'Not at all', 'Somewhat' and 'Very'. Alcohol use, anxiety and depressive disorders were assessed with a standardized structured psychiatric interview based on DSM-IV criteria. The question on regularity of smoking gave three reply alternatives: smoking 'Daily', 'Occasionally' or 'Not at all'., Results: When socio-demographics and anxiety and depressive disorders were controlled for, those with lifetime alcohol use disorder were more likely to have high dental fear than were those without this disorder. When smoking was added to the model, those who smoked regularly were more likely to have high dental fear than those who smoked occasionally or not at all. In this model, alcohol use disorder was not statistically significantly associated with dental fear., Conclusions: The results of this study support the suggestion that some individuals may have personality traits that make them vulnerable to substance use disorders and dental fear.

Purpose: Gender identity and gender role orientation were assessed in 24 female assigned patients with disorders of sex development., Materials and Methods: A total of 16 patients were prenatally exposed to androgens, of whom 15 had congenital adrenal hyperplasia and 1 was virilized due to maternal tumor. Eight patients had 46,XY karyotype, of whom 5 had partial and 3 had complete androgen insensitivity syndrome. Gender identity was measured by the 27-item Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults with 167 female medical students as controls, and gender role was assessed by the femininity and masculinity subscales of the 30-item Bem Sex Role Inventory with 104 female and 64 male medical students as controls., Results: No patient reached the cutoff for gender identity disorder on the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. However, patients with 46,XY karyotype demonstrated a somewhat more conflicted gender identity, although the overall differences were relatively small. As to gender role orientation, patients with complete androgen insensitivity syndrome had high scores on the femininity and masculinity scales of the Bem Sex Role Inventory, which made them the most androgynous group., Conclusions: Our findings, although clinically not clear cut, suggest that patients with disorders of sex development are a heterogeneous group regarding gender identity and gender role outcomes, and that this issue should be discussed with the family when treatment plans are made., (Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Personality is one of the strongest predictors of subjective well-being and may, according to a few previous studies, affect how people report oral health-related quality of life (OHRQoL). Alexithymia, a personality trait involving difficulties in emotional regulation, is associated with poorer health-related quality of life in the general population. We studied if alexithymia is also associated with poorer OHRQoL in a general population sample of 4,460 adults. Oral health-related quality of life was measured using the 14-item Oral Health Impact Profile (OHIP-14) and alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20). Controlling for clinically assessed dental health, depression, anxiety, and socio-demographic variables, higher scores on the TAS-20 as well as on its three dimensions [difficulties in identifying feelings (DIF), difficulties in describing feelings (DDF), and externally oriented thinking (EOT)] were associated with higher OHIP-14 composite scores according to Poisson regression analyses. In adjusted logistic regression analyses, the TAS-20 and two of its dimensions (DIF and DDF) were positively and significantly associated with the seven OHIP-14 dimensions and the prevalence of those reporting one or more OHIP-14 items fairly often or very often. The study showed that difficulties in emotional regulation might be reflected in poorer OHRQoL, regardless of the dental health status, depression, anxiety, and socio-demographic variables., (© 2012 Eur J Oral Sci.)

Purpose: The aim of the study was to evaluate mental health and quality of life (QoL) aspects in women operated on because of disorders of sexual differentiation (DSDs) in childhood., Methods: Questionnaires were mailed to 45 women older than 15 years who had been operated on because of DSD, of which 24 patients (53%) responded. Of these, 16 had been prenatally exposed to androgens. Eight females had 46,XY karyotype. Mental health was measured with the 90-item Symptom Checklist, QoL with the 20-item Life Situation Survey questionnaire, and health-related QoL (HRQoL) with the 15D questionnaire., Results: The QoL and HRQoL scores appeared normal in most of the patients. Furthermore, mental health of the patients was similar or better compared with previously published scores of a Finnish community sample in all dimensions (somatization, obsessive compulsivity, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism). However, 5 patients had poorer scores in some of the 3 questionnaires. These 5 had either distressful memories because of a too-late operation, the operative treatment itself, or current poor sexual function., Conclusions: The QoL, HRQoL, and overall mental health of female patients with DSD are usually normal., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this paper is to assess the work ability and employment history of Finnish female prisoners and their need for treatment., Design/methodology/approach: The sample consisted of 101 female prisoners, with 309 male prisoners for comparison. The methods included interviews, the Structured Clinical Interview for DSM-IV Axis I, II Disorders and medical examination including ICD-10 diagnoses., Findings: Among women, 78 per cent were unemployed and only 6 percent were employed whereas among men, the proportion of those employed was four times greater than for women. Of women, 42 per cent were unable to work; of men 11 per cent. Substance abuse disorders were the most common reason for impaired work ability (over 70 per cent in both genders). Among women, other mental disorders were the second most common reason (39 per cent), somatic diseases caused impairment in 23 per cent. Basic socio-demographic factors were not associated with impaired work ability among women. Violent crime as the present main offence was significantly more common among prisoners with limited working capacity. Need for treatment was found in 94 per cent of women and 90 per cent of men. In both genders, the majority of treatment needs were for mental disorders. Finnish female prisoners have serious problems with substance abuse, of both alcohol and drugs, which impairs their work ability, employability and is the cause of their need for treatment. In addition, female prisoners have other mental disorders commonly complicating their situation., Originality/value: This paper is a part of the first comprehensive health study of Finnish female prisoners.

While somatization has been investigated as an important variable in relation to excessive health-service utilization, its role in relation to dental visiting and dental fear has received limited attention. It was hypothesized that an excessive focus on physical symptoms might lead somatizers to experience dental treatment as more traumatic, resulting in greater dental fear. The aims of this study were to determine whether somatization was associated with dental fear, reduced dental visiting, and symptomatic visiting. Questionnaire data were collected from 5,806 dentate Finnish adults, with somatization measured using 12 items from the Symptom Check List (SCL-90). Dental fear was measured using a single-item question and dental visiting was assessed by questions relating to time since last dental visit and the usual reason for dental visiting. Multinomial logistic regression analyses indicated that somatization has a statistically significant positive association with both dental fear and symptomatic dental visiting after controlling for age, gender, and education. However, the association between dental-visiting frequency and somatization was not statistically significant. The results were consistent with the hypothesized role of somatization in the development of dental fear. Further investigation of how somatization is related to dental fear and dental-service utilization appears warranted., (© 2011 Eur J Oral Sci.)

population sample, controlling for age, gender, education and marital status as well as depressive and anxiety disorders. An additional aim was to evaluate whether gender modified this association. MATERIAL AND METHODS. The two-stage stratified cluster sample (n = 8028) represented the Finnish population aged 30 years and older. Participants (n = 5241) answered the question 'How afraid are you of visiting a dentist?' They also filled out the 20-Item Toronto Alexithymia Scale (TAS-20), which included three sub-scales, i.e. difficulties in identifying feelings (DIF), difficulties in describing feelings (DDF) and externally oriented thinking (EOT). Anxiety and depressive disorders were assessed with a standardized structured psychiatric interview according to DSM-IV criteria. To evaluate the association between dental fear and alexithymia, multiple logistic regression analyses were performed, adjusting simultaneously for the effects of possible confounding variables. RESULTS. Gender modified the association between dental fear and alexithymia. Among women, those reporting higher scores for TAS-20, DIF and EOT sub-scale scores were more likely to have high dental fear than were those reporting lower scores. Among men no such association was observed. Those participants who reported high DDF sub-scale scores were more likely to have high dental fear than were those reporting lower scores. CONCLUSIONS. Alexithymics are more likely to have high dental fear than non-alexithymics are. The findings support the suggestion that some people with dental fear may have internal personality vulnerability to anxiety disorders.

We studied the association between dental fear and anxiety or depressive disorders, as well as the comorbidity of dental fear with anxiety and depressive disorders, controlling for socio-demographic characteristics, dental attendance, and dental health. Nationally representative data on Finnish adults, ≥ 30 yr of age (n = 5,953), were gathered through interviews and clinical examination. Dental fear was measured using the question: 'How afraid are you of visiting a dentist?' Anxiety and/or depressive disorders were assessed using a standardized structured psychiatric interview according to criteria presented in the Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV).Those with depressive disorders, generalized anxiety disorder or social phobia more commonly reported high dental fear than did those without these disorders. When age, gender, education, dental attendance, and the number of decayed, missing, and restored teeth were considered, those with generalized anxiety disorder were more likely to have high dental fear than were participants with neither anxiety nor depressive disorders. The comorbidity of depressive and anxiety disorders also remained statistically significantly associated with dental fear; those with both depressive and anxiety disorders were more likely to have high dental fear than were those without these disorders. Our findings support the suggestion that some individuals may have a personality that is vulnerable to dental fear., (© 2011 Eur J Oral Sci.)

Objectives: Previous prison studies have shown that the female gender is associated with higher hepatitis C prevalence. However, there are few prison studies of gender differences concerning the risk factors of hepatitis C infections. We studied the prevalence of hepatitis and HIV infections and the risk factors among Finnish female prisoners., Methods: The material consisted of 88 females and 300 male prisoners as controls., Results: The prevalence of hepatitis C virus antibodies was 52%, hepatitis B surface antigen 0%, hepatitis A virus antibodies 38% and HIV antibodies 1% among women, and 44%, 0.7%, 4% and 0.7% respectively among men. Among women, 71% of the age group 16-24 had HCV. There was no significant association between gender and HCV. Women were more commonly sharing syringes/needles and had unsafe sexual habits. Among women, HCV was associated only with IDU and syringe/needle sharing whereas among men also with tattoos, cumulative years in prison and age., Conclusions: Especially young females had a high prevalence of HCV. The study showed that the risk factors are differentiated by gender. This should be taken into account when assessing earlier studies which mainly concentrate on men., (Copyright © 2010 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: In a health survey of Finnish prisoners in 2006, the authors aimed to study frequency and gender differences in childhood physical and sexual abuse, and the connections of maltreatment in childhood to substance abuse and mental health among female and male prisoners., Design/methodology/approach: The sample consisted of 101 female prisoners, with 309 male prisoners for comparison. The subjects participated in a comprehensive field study consisting of several questionnaires, interviews, the Structured Clinical Interview for DSM-IV Axis I and II Disorders (SCID I, II) and a clinical medical examination including ICD-10 diagnoses., Findings: Both forms of abuse were more common among females than males (childhood physical abuse 25 per cent versus 15 per cent and childhood sexual abuse 32 per cent versus 7 per cent). Associations of childhood abuse with substance abuse and mental health were different among males and females. Family integrity was important only for males and in connection with drug dependence and antisocial personality disorder. The gender differences did not concur with those reported in studies on general populations., Originality/value: This is a part of the first comprehensive health survey of Finnish prisoners.

Objective: Earlier studies have shown an association between alexithymia and health-related quality of life (HRQoL). There has been some controversy as to whether this is attributable solely to psycho-social domains of HRQoL or also to physical domains. Furthermore, there are no studies on HRQoL profiles in representative general population samples controlling for sociodemographic variables, mental health and somatic health., Methods: The study forms part of the Health 2000 Study. Altogether 5090 participants from general population, aged 30-97 years, filled in the 20-item Toronto Alexithymia Scale and the 15D HRQoL scale. Depressive and anxiety disorders were assessed in a structured psychiatric interview. Physical health was examined by physicians. The 15-dimension HRQoL profiles of both alexithymic and non-alexithymic subjects were obtained by analysis of covariance, controlling for sociodemographic and health-related variables., Results: The alexithymic group had significantly (P<.001) lower mean scores on every dimension of the 15D even after controlling for confounding demographic variables, somatic diagnoses and depressive and anxiety disorders. The differences were greatest in the psycho-social domains., Conclusions: Alexithymia seems to be a personality trait with a statistically significant association to every dimension of HRQoL, not only to psychosocial domains. However, the associations between alexithymia and some somatic dimensions may be of little clinical significance., (Copyright 2010 Elsevier Inc. All rights reserved.)

Childhood family atmosphere is a frequent topic in psychotherapy. Our aim was to assess the stability of affect associated with autobiographical memories. In a 7-year follow-up study of depression, 414 primary care patients and psychiatric outpatients both at baseline and at follow-up completed the self-inquiry Depression Scale (DEPS) and answered simple questions about the mental atmosphere in their childhood families. The prevalence and the distribution of changes in affect were calculated by cross-tabulation. Logistic regression analyses were used to assess associations between depressiveness and changes in affect. Nearly 50% of the sample had at least one change in the responses. Young age and male gender were significant predictors for changes. Depressiveness was associated with changes in miserable affect of the childhood home. Affect associated with autobiographical memories seems to change over a longer period. The association between depressiveness and changes in recollections is convoluted. The large number of changes of affects concerning autobiographical memories should be taken into account both in psychotherapy and in studies of life-long experiences. Future long follow-up studies with more specific multi-item measures on family atmosphere are needed.

Background: Alexithymia is thought to reflect a deficit in the cognitive processing of emotion, and, therefore, it may predispose individuals to both psychological and somatic symptoms., Objective: The authors investigated the relationship between alexithymia and health-related quality of life (HRQoL) in a nationally representative population sample of 5,418 subjects, age 30 to 97 years., Method: Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20) and HRQoL measured with the 15D, a generic HRQoL measure., Results: Alexithymia was significantly associated with lower HRQoL independently of other variables. The TAS-20 subfactor Difficulties Identifying Feelings was the strongest common denominator between alexithymia and HRQoL., Conclusion: Alexithymia may be a predisposing factor to poorer HRQoL.

Objective: The mortality of psychiatric patients is higher than that of the general population. Earlier studies have typically focused on specific diagnostic categories or causes of death. The aim of this study was to assess the overall mortality in acute psychiatric hospital patients covering all diagnostic groups, with special emphasis on substance abuse., Methods: The sample consisted of all 18-64-year old patients (n = 3,835) treated or evaluated in the acute wards of the Department of Psychiatry at Tampere University Hospital between the years 1999 and 2003, who were followed-up until the end of the year 2005. We assessed the various causes of death according to background variables in bivariate and multivariate analyses and calculated the standardized mortality ratios (SMRs)., Results: During the study period 379 subjects died (9.9% of the sample). Mortality among men was almost twice as high as among women. Of all deaths, 45.6% were considered to be alcohol or drug related. SMR covering all subjects was 6.55. The SMRs for unnatural causes were higher than those for natural causes. The highest SMRs for unnatural causes of death were found in patients with mood disorders and the highest SMRs for natural causes of death in patients with schizophrenia spectrum disorders. Use of coercive measures was associated with increased mortality., Conclusion: Mortality among Finnish psychiatric acute hospital patients is considerably higher than in general population. Excessive alcohol consumption plays a major role in causing excess deaths that could be potentially avoided.

Objective: The objective of this study was to examine how the outcomes of a structured diagnostic interview for depression are related to the results of a self-report scale in alexithymic and nonalexithymic groups., Materials and Methods: Subjects (N=389) recruited from primary care and psychiatric care completed the Depression Scale (DEPS) and the 20-item Toronto Alexithymia Scale. Major depression was diagnosed using the Composite International Diagnostic Interview-Short-Form by telephone., Results: In the group without major depression, the DEPS scores of the alexithymic subjects were significantly higher than those of the nonalexithymic subjects. In the group with major depression, the ideal cutoff points of the DEPS, assessed by receiver operating characteristic analyses, were essentially higher for the alexithymic patients., Conclusions: Alexithymic subjects without major depression may be rated as depressive if the only criterion is the score on a self-report scale. Furthermore, alexithymic patients may require higher cutoff points in a self-report depression scale.

Objective: Depression, psychological problems and the impairment of quality of life are reported to occur in untreated coeliac disease. Alexithymia ("no words for feelings") is associated with various gastrointestinal disorders. The aim of this study was to evaluate whether patients with coeliac disease suffer from psychoneurotic symptoms or alexithymia, and whether a gluten-free diet has an impact on the symptoms., Material and Methods: The Crown-Crisp Experiential Index (CCEI) and its six subscales were applied to measure neurotic psychopathology, and the 20-item version of the Toronto Alexithymia Scale (TAS-20) and its 3-factor scales to measure alexithymia. The testing was carried out in 20 consecutive adult patients with biopsy-proven coeliac disease before and after one year of treatment on a gluten-free diet. The data were compared with those obtained earlier in non-coeliac Finnish subjects., Results: Somatic anxiety was higher in coeliac disease patients before the introduction of the gluten-free diet than after adhering to the diet. Otherwise, the diet had no significant impact on the CCEI scores. The patients were not suffering from alexithymia, but the TAS-20 score improved significantly during the follow-up. The scores did not differ from those published in the Finnish population., Conclusions: Psychological problems were not common in adult coeliac disease patients. Gluten-free diet had only a minor influence on the symptoms. Common knowledge about coeliac disease and the readily available gluten-free products may have had an impact on these results.

The relationship between life satisfaction and alexithymia was studied in a sample of 229 patients as a part of a naturalistic follow-up study of depression in Finnish primary health care. The measures were the abbreviated Life Satisfaction Scale and the 20-item Toronto Alexithymia Scale. Depression was assessed by telephone with the short form of the Composite International Diagnostic Interview. Of all subjects, 19.2% were alexithymic, and 9.2% were depressed. Alexithymia was negatively associated with life satisfaction even when depression and other confounding factors were controlled for. Alexithymia is a risk factor for life dissatisfaction in primary-care patients.

Objective: The relationship between alexithymia and occupational burnout has not previously been studied. We investigated the association between alexithymia and occupational burnout in a representative nationwide population health study., Methods: This study was a part of the Finnish Health 2000 Study. The nationally representative sample comprised 3322 employees aged 30-64 years. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20) and occupational burnout with the Maslach Burnout Inventory-General Survey. Sociodemographic and health-related variables including depression were treated as confounders in the logistic regression analyses, which were performed alternately with TAS-20 total score and the scores of the three TAS-20 factor scales as alexithymia variables., Results: Alexithymia and its three facets were significantly associated with occupational burnout even when controlled for confounding factors., Conclusions: Even though both alexithymia and depression are associated with burnout, alexithymia may be an independent risk factor for occupational burnout.

Objective: We studied the prevalence of alexithymia, its distribution in different age groups in a wide age range, its association with sociodemographic and health-related variables, and its co-occurrence with depression., Methods: The study forms part of the Health 2000 Study. The original sample comprised 8028 subjects representing the general adult population of Finland. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), and depression was measured with the 21-item Beck Depression Inventory. Altogether, 5454 participants filled in TAS-20 in their mother tongue., Results: The prevalence of alexithymia was 9.9%. Men (11.9%) were more commonly alexithymic than women (8.1%). Alexithymia was associated with male gender, increasing age, low educational level, poor perceived health, and depression., Conclusions: The findings were in line with earlier population studies. For the first time, it was possible to analyze the prevalence of alexithymia in a wide age range (30-97 years). International comparative studies are needed.

In Scandinavia transplantations are performed at special units at certain university hospitals, which coordinate donor and recipient operations. Today there is a 24-hour organ retrieval service in the Nordic countries. Transplantation centres exist at Rigshospitalet, Copenhagen, Kommunehospitalet, Arhus and Odense University Hospital in Denmark, at Helsinki University Hospital in Finland, at Rigshospitalet, Oslo in Norway, and at Huddinge University Hospital, Uppsala University Hospital, Sahlgrenska Hospital, Gothenburg, and Malmö General Hospital in Sweden.