Search PubMed⌕ Search

Biomedical subjects

E Hemminki

Publications and source records attributed to E Hemminki.

At least 37 records · Page 2Linked to original sources
PubMed2000

Views of Finnish doctors on fetal screening.

OBJECTIVE: To investigate the views of Finnish doctors concerning fetal screening. DESIGN: Anonymous, questionnaire survey conducted in 1996-1997. POPULATION: A representative sample of gynaecologists, paediatricians and general practitioners in Finland. Both leading doctors and ordinary practitioners were included. RESULTS: Most doctors said that serum screening for Down's syndrome and ultrasound screening for structural abnormalities should be available for all pregnant women. In response to more direct questions, doctors acknowledged many drawbacks to Down's serum screening, notably the worry due to false positives. Only a few were against abortion, and a fifth said fetal screening is partly based on a eugenic ideology. There were some differences between the different doctor groups, but the overall impression was of similarity rather than divergence, both between the different specialist groups, and by the position of the doctor (leading vs ordinary). CONCLUSIONS: Finnish doctors support current fetal screening, but many acknowledged resulting ethical, psychological, and social problems.

Attitude of Health Personnel↗
PubMed2000

Hormone replacement therapy: discrepancies between evidence and recommendations.

Postmenopausal hormone therapy is widely used to prevent diseases. This is not, however, based on the kind of evidence that is normally required of a preventive drug therapy: it is based on intermediary outcomes of trials and non-experimental studies. Many reasons can be postulated for the fact that we know little of this old and widely used therapy. To remedy the current situation, we should encourage randomised controlled trials, reveal the insufficiency of the current evidence, and challenge the drug industry's biased influence.

Aged↗
PubMed2000

International actors and population policies in India, with special reference to contraceptive policies.

The international population policy agenda has traditionally been dominated by demographically driven population control policies. However, in the population policy development that preceded the International Conference on Population and Development in 1994, people's reproductive needs and rights received more emphasis. The aim of this study was to analyze how the new emphasis in population policies has been interpreted at the country level. In analyzing population policy rhetoric and its practical interpretations in India in 1994, the authors found that the rhetoric was broadening to encompass women's empowerment and reproductive health and that the use of direct method-specific monetary incentives and disincentives for accepting family planning methods was disapproved. However, population policy options were still considered mainly in terms of their ability to reduce fertility. Furthermore, the increased emphasis on the general market agenda was more important than that on reproductive needs and rights in molding population policies, as was evident in the greater stress on cost-recovery systems and nongovernmental actors. The findings suggest that the broader agenda for population policies and reproductive rights has been interpreted so that it can serve the aims of population-growth control and be implemented in the context of more market-oriented social policies and trade liberalization.

Contraception↗
PubMed1999

Declining socioeconomic differences in the use of menopausal and postmenopausal hormone therapy in Finland.

OBJECTIVE: Sales figures for the use of menopausal and postmenopausal hormone therapy in Finland show a rapid increase during the 1980s continued into the first half of the 1990s. Hormone therapy use became very common in Finland compared to many other Western countries. The aim of our study was to investigate the sociodemographic distribution of hormone therapy among Finnish women aged 45-64 years. METHODS: The study is based on population-based surveys conducted in 1989 and 1996 (response rates 87% and 78%). RESULTS: Between 1989 and 1996 the current use of hormone therapy increased from 22% to 27%; in 1989 it was most common in the age group 50-54 years, but in 1996 among 55-59-year-olds. In 1989 it was significantly more common among women with longer education than other women in every age group, but in 1996 this difference was significant only in those 55 years and older. In 1989 the use was more common in the capital area than elsewhere and this difference decreased but remained significant in 1996. CONCLUSION: Our results suggest that hormone therapy has become a routine treatment during the menopause in all educational groups and throughout the country. The lack of socioeconomic differences indicates that among women under 55 year of age the saturation point in short-term hormone use was reached in 1996. However, the persistence of socioeconomic differences among older women suggests that the use of long-term postmenopausal hormone therapy will continue to increase for some time.

Educational Status↗
PubMed1999

Finnish physicians' opinions of vaginal estriol in self-care.

OBJECTIVE: In Finland vaginal estriol drugs became available without prescription in 1992, resulting in widespread advertising of these drugs to lay women and in an increase in sales. The purpose of this study was to find out what Finnish physicians think about the fact that vaginal estriol does not require a prescription, and if they have found any problems resulting from this. METHODS: A questionnaire survey was sent to gynecologists and general practitioners (n = 341, 77% response rate) in Finland in 1996. RESULTS: 60% of the physicians considered vaginal estriol to be suitable for over-the-counter (OTC) status, and to be much more suitable than the other estrogen containing drugs (contraceptive pill and drugs for emergency contraception) we asked about in our study. Opinions varied by specialty, work experience and reported problems relating to OTC status. The most common reasons given for suitability referred to increased access, and those given for unsuitability referred to general dangers of self-care. Of all physicians 12%, and of private gynecologists (n = 33) 49% reported having observed problems with the OTC status, mostly in care-seeking and indications; some gynecologists mentioned adverse effects of the drug itself. 39% of the physicians thought that the best person to provide information about vaginal estriol is a physician. CONCLUSIONS: Pharmacological literature and physicians' opinions suggest a re-evaluation of the role of physician surveillance of vaginal estriol drugs.

Administration, Intravaginal↗
PubMed1999

Use of alternative drugs in Finland.

OBJECTIVES: The purpose of this study was to assess the use of alternative drugs among the adult population in Finland, especially to find out how the health status, health behaviour and use of licensed drugs and health care services are related to the use of alternative drugs. DESIGN: A telephone interview was conducted in March 1992 with a response rate of 85%. SUBJECTS: A random, representative sample of 2134 Finns aged between 15 and 74 years. RESULTS: A total of 39% of the respondents had used one or more types of alternative drugs during the last year. Most common was the use of health food products. Women used all types of alternative drugs more often than men. The use of alternative drugs was more common among educated and urban respondents. Perceived health or existence of a long-standing illness was not related to alternative drugs use whereas reporting of psychosomatic symptoms was. Non-smoking was positively related to the use of alternative drugs and also active exercise among men. The use of non-prescription drugs, official and unofficial health services were positively related to alternative drugs use. CONCLUSIONS: The use of alternative drugs is popular and it may increase in the future. The use of alternative drugs can be considered a form of medicalization. More information on products used and people using alternative drugs is needed.

Journal Article↗
PubMed1999

Epidemiology of miscarriage and its relation to other reproductive events in Finland.

OBJECTIVE: This study investigates the occurrence of miscarriages over the reproductive life span of women in a population-based study. STUDY DESIGN: A questionnaire was sent in 1994 to a random sample of 3000 Finnish women aged 18 to 44 years (73% response rate). Age-adjusted percentages of women having had miscarriages, and age- and other pregnancy event-adjusted odds ratios were calculated. RESULTS: Fifteen percent had at least 1 miscarriage. Miscarriages were more common in the moderately educated group and among women in health and social occupations, but there was no difference according to urbanism or health. By the age of 40 to 44 years, 90% of the women had been pregnant, and for only half had all pregnancies ended in a birth. The sequence of a miscarriage or miscarriages coming first and a birth or births coming later was more common than vice versa. CONCLUSION: In this population-based study miscarriages appeared incidental. Further studies on social class distribution might reveal new clues regarding etiology.

Abortion, Spontaneous↗
PubMed1999

Reproductive effects of in utero exposure to estrogen and progestin drugs.

OBJECTIVE: To determine whether in utero exposure to estrogens and progestins other than diethylstilbestrol reduces fertility in offspring. DESIGN: Retrospective cohort study. SETTING: Helsinki, Finland. PATIENT(S): One thousand eight hundred eighty-eight women and men exposed to female hormone drugs in utero from 1954-1963 and 2,044 age-matched controls. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The numbers and timing of live births and marriages for men and women and of unsuccessful pregnancies for women. RESULT(S): There were no differences between the exposed and control men in most outcome indicators. However, fewer exposed men than control men had their first liveborn child within a short time after getting married, and the mean time from the first to the second live birth was shorter. The former also was found for the women. The overall cumulative proportions of liveborn children and pregnancies were similar in the exposed and control groups, but younger exposed men and women had liveborn children and pregnancies somewhat later. CONCLUSION(S): Estrogen- and progestin-containing drugs as used in the study population did not have much impact on the fertility of offspring.

Abortion, Spontaneous↗
PubMed1999

Do young women have specific problems in contraceptive use and counselling?

OBJECTIVES: To find out if young women have specific problems with the use of contraception or contraceptive services. STUDY DESIGN: A national postal survey was conducted, RR 74%. Women aged 18-34 years (with experience of contraceptive use) were included in this report (n=1239). RESULTS: Weekly need for contraception was highest in the age group 18-24 years (61%), oral contraception being the most widely used method regardless of parity. Condoms were used by 35-37% in all age groups, either alone or combined with oral contraceptives (17% of young nulliparas). Women aged 18-24 years had mainly used public or subsidized services (79%). Of quality characteristics, only satisfaction with the kindness of the service provider varied significantly by age. The cost of contraception was highest in the youngest age group. CONCLUSIONS: The study did not point at any serious problems in family planning among young women, but it did produce several clues for the development of family planning services in general.

Adolescent↗
PubMed1999

Self medication and health habits in the management of upper gastrointestinal symptoms.

Upper gastrointestinal symptoms are a common complaint among the general population but only a small proportion of sufferers seek medical advice. The aim of this study was to examine what kind of perceptions persons using self medication have about the causes of their gastrointestinal symptoms, whether they have made any health-related lifestyle changes, and whether visits to a physician are related to lifestyle changes. A pharmacy-based survey was done in 10 pharmacies in the Helsinki area in 1995. The questionnaire was completed by 292 customers. The response rate was 53%. Respondents in a population-based health interview survey (n = 10,410) were used as a comparison group for poor health-behavior (consumption of tobacco, alcohol, coffee). The most common perceived causes of gastrointestinal symptoms were poor diet, coffee, and stress. Ignorance about possible causes of symptoms was especially common among less educated respondents and among those persons who had never visited a physician due to their symptoms. Respondents were significantly more often smokers and they had attempted to reduce their coffee and alcohol consumption more often than the general population. Those who had visited a physician during past year, less often had poor health-behavior and they had better knowledge about the possible causes of their symptoms. They had also made lifestyle changes more often, but after adjustment for background characteristics, physician visits were positively correlated only with coffee reduction. Counseling about healthy lifestyles, especially about smoking, should be increased in physician consultations and in pharmacies for all patients and customers having gastrointestinal problems.

Adult↗
PubMed1999

Exposure to female hormone drugs during pregnancy: effect on malformations and cancer.

This study aimed to investigate whether the use of female sex hormone drugs during pregnancy is a risk factor for subsequent breast and other oestrogen-dependent cancers among mothers and their children and for genital malformations in the children. A retrospective cohort of 2052 hormone-drug exposed mothers, 2038 control mothers and their 4130 infants was collected from maternity centres in Helsinki from 1954 to 1963. Cancer cases were searched for in national registers through record linkage. Exposures were examined by the type of the drug (oestrogen, progestin only) and by timing (early in pregnancy, only late in pregnancy). There were no statistically significant differences between the groups with regard to mothers' cancer, either in total or in specified hormone-dependent cancers. The total number of malformations recorded, as well as malformations of the genitals in male infants, were higher among exposed children. The number of cancers among the offspring was small and none of the differences between groups were statistically significant. The study supports the hypothesis that oestrogen or progestin drug therapy during pregnancy causes malformations among children who were exposed in utero but does not support the hypothesis that it causes cancer later in life in the mother; the power to study cancers in offspring, however, was very low. Non-existence of the risk, negative confounding, weak exposure or low study-power may explain the negative findings.

Abnormalities, Drug-Induced↗
PubMed1999

Boys have more health problems in childhood than girls: follow-up of the 1987 Finnish birth cohort.

The purpose of this study was to describe gender differences in children's health until the age of 7 y. The study cohort consisted of all children born in Finland in 1987 (n = 60254), of whom 99.9% were identified in the follow-up. Childhood health data were received from five national registers (1987-94), from regional registers of intellectual disabilities (1987-96) and from education registers in the largest county (1996). Boys had a 20% higher risk for a low 5-min Apgar score and an 11% higher risk for being preterm. After the perinatal period, boys had a 64% higher cumulative incidence of asthma, a 43% higher cumulative incidence of intellectual disability, a 22% higher incidence of mortality and a higher, but not statistically significant, incidence of epilepsy and vision disorders. No male excess was found for diabetes or hearing disorders. The healthcare-related indicators showed poorer health for boys, who had a 37% higher mean of hospital days, a 28% higher risk for receiving social benefits due to health problems and a 13% higher risk for long-term medication. The differences in the socially defined indicators were greatest, and boys had a two- to three-fold risk of having delayed development, postponed school start or attendance in special education programmes. Gender differences in different social classes were similar. Boys' shorter gestational age at birth did not explain the gender differences in childhood health. Some of boys' poorer health seemed to be biologically based, but the social causes of health problems are amenable to change. In particular, the potential of the school system to reduce ill health among boys should be investigated.

Absenteeism↗
PubMed1999

Cosmetic and postmastectomy breast implants: Finnish women's experiences.

The purpose of this study was to compare women's satisfaction with and short-term problems of silicone breast implants after cosmetic breast augmentation and after mastectomy. Women (n = 224) were recruited through advertising in mass media, and 91% responded to a questionnaire asking for their experiences, both positive and negative, with silicone breast implants. Approximately equal numbers of women received their implants for cosmetic reasons (augmentation group) and postmastectomy (113 and 111, respectively). Mean time from first implantation was 9 years (SD 7.3) in the cosmetic group and 8 years (SD 4.9) in the postmastectomy group. Women in the postmastectomy group received their implants at an older age than women in the cosmetic group (percent of women 45 and older, 59% and 3%, respectively). Women's overall preoperative knowledge of and postoperative satisfaction with their implants were similar in the two groups; 58% of women said that they had insufficient knowledge of breast implants preoperatively, 26% of women said they would not choose the implants again, and 44% of women expressed no dissatisfaction with their breasts. However, women in the cosmetic group were better informed about possible physical problems. One third of the women in the postmastectomy group had one or more reoperations, most frequently because of implant slippage (30%), encapsulation (26%), or implant size and shape (23%). Because insertion of breast implants is a lifelong decision, in-depth counseling about complication rates and possible risks should be given to women before implantation, and nonsurgical alternatives should be discussed, particularly for cosmetic implantation.

Adult↗
PubMed1999

Can children's health be predicted by perinatal health?

BACKGROUND: The purpose of this paper was to investigate how well children's health until age 7 years can be predicted by perinatal outcome using routine health registers. METHODS: Follow-up of one year cohort (N = 60192) was performed by record linkages with personal identification number. The data came from the 1987 Finnish Medical Birth Register, from six other national registers and from education registers of one county. RESULTS: All perinatal health indicators showed a strong correlation with subsequent health, and prediction of good health was satisfactory: 85% of children who were healthy in the perinatal period did not have any reported health problems in early childhood, and 91% of children healthy in early childhood had been healthy in the perinatal period. However, it was not possible to predict poor health outcome: 76% of the children with reported perinatal problems were healthy in early childhood, and 87% of the children with long-term morbidity in childhood did not have any perinatal problems. CONCLUSIONS: Our findings suggest that in assessing risk factors and health care technology, monitoring perinatal health is not enough and long-term follow-ups are needed.

Child↗
PubMed1999

Maternal predictors of perinatal mortality: the role of birthweight.

BACKGROUND: Many maternal characteristics increase the risk for perinatal death. To locate potential sites for intervention, it is important to identify these risk factors and examine how much of the excess mortality is explained by infants' low birthweight. METHODS: Data on all newborns in Finland born between 1991 and 1993 (N = 199,291, of which 1461 were perinatal deaths) were obtained from the Medical Birth Register. Logistic regression analysis was used to adjust for background variables, both including and excluding infants' birthweight. The percentage reduction in odds ratios after adjustment for infants' birthweight was used to estimate the contribution of infants' low birthweight to the excess mortality. RESULTS: After adjusting confounding factors, increased risk for perinatal death was found for eight maternal characteristics. In the following the increased risk is given as odds ratios and the proportions of the excess mortality explained by infants' low birthweight are in parentheses: in-vitro fertilization 4.12 (> 100%); earlier stillbirth 3.43 (87%); higher maternal age, from 1.21 to 3.08 (38-99%); maternal diabetes 2.87 (50%); lower socioeconomic status, from 1.30 to 1.70 (27-44%); smoking during pregnancy 1.45 (> 100%); single mother 1.44 (50%); first birth 1.36 (75%). CONCLUSIONS: Excess mortality due to maternal risk factors occurred mainly through their tendency to cause low birthweight. However, the excess mortality associated with low socioeconomic status, single motherhood, and diabetes was mediated by other mechanisms in addition to low birthweight.

Adult↗
PubMed1999

Physicians' attitudes toward reclassifying drugs as over-the-counter.

OBJECTIVES: Releasing prescription drugs over-the-counter (OTC) has been a trend in many Western countries. The purpose of this study was to find out about Finnish physicians' attitudes towards OTC switches and to find out whether transfer of drugs that are used in a doctor's own area of specialty increases negative attitudes toward release. For the latter purpose, gynecologists' perceptions about the availability of vaginal antifungal OTC drugs was studied. METHODS: Postal questionnaire to a representative random sample of gynecologists (n = 169) and general practitioners (GPs) (n = 288) in six counties in Finland in 1996. After a reminder, the response rate was 77% (n = 341). Multivariate logistic regression models were used to explore the relationship of factors to attitudes toward OTC drugs. RESULTS: The overall attitude toward the availability of OTC drugs was moderately positive but was more reserved toward those drugs only recently given OTC status. However, physicians were judged in many cases to be the most suitable source of information on OTC drugs. GPs working in health centers, more often than other physicians, found drugs suitable for self medication. Our hypothesis about gynecologists being against the release of vaginal antifungal drugs was not supported. CONCLUSIONS: Physicians' views about OTC drugs are influenced by the current OTC status of the drug and by public discussion. The place of work has an important influence on these opinions, most likely reflecting the effect of case mix and patient load.

Adult↗