Cardiovascular disease and all-cause mortality are increased in men with the metabolic syndrome, even in the absence of baseline CVD and diabetes. Early identification, treatment, and prevention of the metabolic syndrome present a major challenge for health care professionals facing an epidemic of overweight and sedentary lifestyle.

This study aims to demonstrate the prevalence of pain as a reason for seeing a physician in primary care. We also performed an analysis of the localization, duration and frequency of pains, as well as the diagnoses of patients having pain. A total of 28 physicians at 25 health centers in Finland collected the data, comprising 5646 patient visits. Pain was identified as the reason for 2237 (40%) of the visits. The most common localizations were in the lower back, abdomen and head. One-fifth of the pain patients had experienced pain for over six months. Analysis of the diagnoses revealed half of the pains to be musculoskeletal. Patients experienced considerable limitations in various activities of life due to pain. A quarter of the pain patients of active working age received sick leave. Our results confirm that pain is a major primary health care problem, which has an enormous impact on public health.

Most researchers agree that obesity is an important modulator of the metabolic syndrome, 1 2 which is a clustering of cardiovascular risk factors associated with insulin resistance-such as hypertension, hypertriglyceridaemia, a low concentration of high density lipoprotein cholesterol, abnormal glucose metabolism, and hyperinsulinaemia.3 Little is known, however, about the association between relative weight change from childhood to adulthood and the development of metabolic syndrome in adulthood. Material, methods, and resultsWe recently published data of a population study for the metabolic syndrome, performed during 1993-4 in Pieksämäki, Finland. All subjects (n = 1008) born in the years 1947, 1952, and 1957 were examined according to a protocol described elsewhere.4 Data on both weight and height at age 7 years (the start of primary school) were also collected.Altogether, 712/1008 (70.6%) subjects participated in the study. Weights and heights at age 7 were traced for 439/712 (61.7%) participants. Obesity was defined both in childhood and in adulthood as a sex specific highest third of the body mass index (weight(kg)/ (height (m) 2 )). The metabolic syndrome was defined as a cluster of (a) hypertension (a systolic blood pressure >140 mm Hg, a diastolic blood pressure >90 mm Hg, or treatment with antihypertensive drugs); (b) dyslipidaemia (hypertriglyceridaemia (>1.70 mmol/l) or a high density lipoprotein cholesterol concentration of < 1.00 mmol/l ( < 1.20 mmol/l in women), or both dyslipidaemia and hypertriglyceridaemia); and (c) insulin resistance (abnormal glucose metabolism according to the World Health Organisation's criteria or hyperinsulinaemia (>78 pmol/l), or both). 2-4Of the 439 subjects, 75 had been obese and 219 not obese in both childhood and adulthood; 71 had not been obese as children but were obese as adults; and 74 had been obese as children but were not obese as adults. The metabolic syndrome was present in 18/219 (8%) men and in 12/220 (5%) women. Of the 30 subjects having this syndrome, 28 were obese as adults; 21 of them had also been obese as children (table). In exact logistic regression analysis (LogXact), the risk of metabolic syndrome was 2.9 (95% confidence interval 1.1 to 7.6) for the subjects who had been obese as children and 26.7 (6.4 to 237) for the subjects who were obese as adults, compared with their non-obese controls. None of the 74 subjects who had been obese as children but who were not obese as adults had the metabolic syndrome. The increased risk of the metabolic syndrome was still present when the population was split into thirds for weight but not when it was split into thirds for height. CommentOur results show that half of the obese children had become obese adults with an especially high risk of the metabolic syndrome and that childhood obesity overall increases the risk for the metabolic syndrome in adulthood. The risk of the syndrome was lower among the obese adults who had not been obese as children than among the obese adults who had also been obese as childr...

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Statistics and prescription database studies show that analgesics are widely utilized, but do not tell anything about either the factors behind analgesic use or how over-the-counter (OTC) analgesics are being used. We aimed to study the prevalence of frequent use of prescribed and OTC analgesics. We also investigated the background factors related to frequent analgesic use and assessed rationality of analgesic usage patterns. We addressed a postal survey to a random stratified population sample of 6500 Finnish people aged 15-74 years. The response rate was 71% (n=4542) after exclusion of unobtainable addressees (n=68). Individuals reporting analgesic use 'daily' or 'a few times a week' were categorized as frequent users. After adjusting for age and sex, the overall prevalence of daily analgesic use was 8.5%, and the prevalence of analgesic use a few times a week 13.6%. The adjusted prevalence of using exclusively prescribed analgesics daily or a few times a week was 8.7%, and that of utilizing purely OTC analgesics 8.8%. The overall prevalence of concomitant frequent use of both prescribed and OTC analgesics was 4.6%. Multinominal logistic regression analyses showed that frequent analgesic use was related especially to daily or continuous pain and high pain intensity. Low mood and not being employed also increased the probability for daily analgesic use. Frequent analgesic use seems to be common at population level. Concomitant use of both prescribed and OTC analgesics can be considered irrational, as it increases the risk of adverse events.

The higher risks for MetS in females with depressive symptoms at baseline suggest that depression may be an important predisposing factor for the development of MetS.

Musculoskeletal pain is an outstanding symptom among the patients of primary health care. However, there are few studies of management and costs of musculoskeletal pain at primary health care level. The aim of this study was to describe the diagnostic investigations, management, referral rate and sick leaves related to visits prompted by musculoskeletal pain as well as to assess their costs. A total of 28 general practitioners (GPs) at 25 randomly selected health centres throughout Finland collected the data for this 4 week study, which covered 1 week from each of the four seasons. All visits, except those occurring after hours, were recorded. Altogether 1123 patients visited GPs because of musculoskeletal pain. Laboratory tests were ordered for 12% and imaging investigations for 24%. A total of 16% of the patients suffering from musculoskeletal pain received a prescription for physiotherapy, and analgesics were prescribed to 61% of them. Physicians referred 7% of the pain patients to specialist care. One out of every four patients was prescribed sick leave. The mean cost of the investigations, therapy, referrals, and sick leaves was as high as 530 EUR per visit, with absenteeism from work constituting two-fifths of the total costs. Musculoskeletal pain is not just a frequent complaint but also has extensive economic consequences for society. Investigations and therapy at the primary health care level play a minor role in the costs as compared with specialist care and sick leaves.

The objectives were to study the associations of perceived health care-related and patient-related factors with self-reported noncompliance with antihypertensive treatment. General practitioners identified all of their hypertensive patients in 26 health centres during 1 week in 1996 (n = 2219). A total of 1782 (80%) patients participated in the study, of whom 1561 were on antihypertensive medication. Based on 82 opinion statements in two questionnaires, 14 problem indices were formed by using factor analysis. Out of these, summary variables concerning problems related to the health care system and the patients were formed. Logistic regression models, including interaction analyses, were used to study the associations with non-compliance. The results were