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Biomedical subjects

E Hemminki

Publications and source records attributed to E Hemminki.

At least 73 records · Page 4Linked to original sources
PubMed1997

Patient managed clinical trial.

We describe a trial design of postmenopausal hormone therapy. Our goal was to design a trial that allows more patient management than usual, would include placebo effect in the therapy, would imitate the normal practices of health care as much as possible, and would be based on ordinary health services. We gave women a randomized recommendation to use or not use hormone therapy, invited them to two discussion groups, and sent them two questionnaires. They were asked to consult their own physician and to pay for the therapy themselves. The design worked well regarding recruitment, but compliance after 6 months was not satisfactory. The main problems were the women's aversion to randomization, the attitudes of the women's own physicians, and the difficulty in stopping the use of hormone therapy. The last-mentioned problem could be avoided by different inclusion criteria. Unless societal perception of research can be changed, most solutions to improve compliance would lead toward traditional trial designs.

Chi-Square Distribution↗
PubMed1997

Sterilization in Finland: from eugenics to contraception.

The purpose of this paper was to describe the transition of sterilization in Finland from an eugenic tool to a contraceptive. Historical data were drawn from earlier reports in Finnish. Numbers of and reasons for sterilizations since 1950 were collected from nationwide sterilization statistics. Prevalence, characteristics of sterilized women, and women's satisfaction with sterilizations were studied from a 1994 nationwide survey (74% response rate). Logistic regression was used for adjustments. In the first half of the 20th century, eugenic ideology had influence in Finland as in other parts of Europe, and the 1935 and 1950 sterilization laws had an eugenic spirit. Regardless of this, the numbers of eugenic sterilizations remained low, and in practice, family planning was the main reason for sterilization. Nonetheless, prior to 1970 not all sterilizations were freely chosen, because sterilizations were sometimes used as a precondition for abortion. Female sterilizations showed remarkable fluctuation over time. Male sterilizations have been rare. The reasons stipulated by the law did not explain the numbers of sterilizations. In a 1994 survey, 9% of Finnish women reported they were using sterilization as their current contraceptive method (n = 189). Compared to women using other contraceptive methods, sterilized women were older, had had more births and pregnancies, and came from lower social classes. Sterilized women were satisfied with their sterilization, but there were women (8.5%) who regretted it. In conclusion, sterilizations have been and are likely to continue to be an important family planning method in Finland. The extreme gender ratio suggests a need for promoting male sterilizations, and women's expressed regrets suggest consideration of a higher age limit.

Adolescent↗
PubMed1997

Alternative drug use for the climacteric in Finland.

OBJECTIVES: To investigate the use of alternative drugs for the climacteric in Finland, which products are used, and who are the women using them. METHODS: The study was based on a population-based survey conducted in 1989 among 2000 Finnish women aged 45-64 (response rate 86%). RESULTS: 11% of the women reported the use of alternative drugs for the climacteric. Food supplements and bee products were the most common types of alternative drugs used. Some of them may have allergic or other side effects. Users differ little from other women judging by health habits and the utilization of health care services. The best predictors for alternative drug use were urban residence, more than 9 years of general education, and among 50 54-year olds, the use of prescription or OTC drugs for menopause. Over half of the users of alternative drugs had also used hormone therapy. CONCLUSIONS: Women using alternative drugs during and after the climacteric represent a large group. More information is needed about the clinical effects of alternative drugs, and the characteristics of alternative drug users.

Climacteric↗
PubMed1997

Nordic Medical Birth Registers in epidemiological research.

This review discusses the use of Nordic Medical Birth Registers (MBRs) in epidemiological studies, paying special attention to the topics that have been investigated and to other data sources that increase the usefulness of MBRs. We divided the reviewed studies into four groups according to the data sources on which they were based: (1) studies using MBR data only; (2) studies combining maternal or paternal background information, obtained from other data sources, with MBR data; (3) studies combining MBR data with subsequent outcome information on newborns; and (4) studies using information about consecutive pregnancies and generations. Our review shows that MBRs are good sources for studying the following topics: maternal biological and obstetric background; interventions and health care during pregnancy and birth; newborns' short-term outcome; and the relations between these factors. In addition, the usefulness of MBRs increases when the data they contain are combined with data from other sources. We found that data from more than twenty different sources have been linked with MBR data in the Nordic counties. As time passes, national MBRs become a useful source of information for studies on consecutive pregnancies or generations. In addition, the associations between pregnancy, delivery, perinatal health and long-term outcome can be studied by using an MBR as the basic data source.

Birth Certificates↗
PubMed1997

Experience of Finnish women with Norplant insertions and removals.

OBJECTIVE: Norplant and Norplant-2 have been available for use by Finnish women since 1984 and 1986, respectively. The objective of this study was to explore Norplant users' experiences of insertions, removals and medical treatments. DESIGN: A questionnaire was sent to women who had received Norplant or Norplant-2 implants one to two years earlier (n = 262) in normal clinical settings; the response rate was 79%. RESULTS: At insertion, problems were experienced by 9% and at least some pain by 23% of women. During the first year 20% of all users (14% of Norplant and 33% of Norplant-2 users) had their implants removed. Problems were experienced at removal by 33% of women and pain was experienced by 40%; nevertheless most users were satisfied with the device. Findings were similar for the two types of Norplant. Forty-two percent of the women had received minipills containing levonorgestrel before Norplant insertions in an attempt to assess Norplant's suitability, and 8% had received drugs for adverse effects caused by Norplant. CONCLUSIONS: Studies including perspectives of Norplant users and the whole lifespan of Norplant (including removal) should be conducted in all clinical settings where Norplant is provided.

Contraceptive Agents, Female↗
PubMed1997

Quality of contraceptive services in Finland.

OBJECTIVE: To investigate whether the quality of contraceptive services in Finland varies by the type of care provider. DESIGN: A cross sectional questionnaire survey. PARTICIPANTS: A random sample of 3000 Finnish women aged 18-44 years (response rate 74%) in 1994. RESULTS: Almost all women (94%) had used contraception at some time and 75% were current users. Although self care was common (29% had obtained their latest method outside the health services), 83% had sometimes used the health services for contraception. For their last visit, 55% of women had chosen a health centre (a publicly administered and funded health service), and 33% a private unit. In the health centre, the care provider was usually a general practitioner or a public health nurse, whereas in private care the providers were gynaecologists. Women who used private care were more likely to be from higher social classes and urban areas. After adjustment for a women's background, the two groups were similar for most indicators of the quality of care, but access to care and woman's experiences of treatment were better with private care. CONCLUSIONS: In terms of availability and choices the current system of contraceptive services in Finland is adequate. It is not always an integral part of municipal primary health care, and many women prefer private care for gynaecological services; this may case problems of comprehensiveness and equality of care.

Adolescent↗
PubMed1997

Physicians' gender and clinical opinions of reproductive health matters.

The purpose of this study was to investigate the effect of physicians' gender when sex-specific conditions are being treated in a country where almost half of the physicians are women. Five Finnish surveys originally conducted for other purposes were reanalyzed. Two surveys examined physicians' and medical students' views about hormone therapy during and after menopause, one survey examined medical students' attitudes about medicines, one survey examined physicians' obstetric practices, and one examined contraceptive counselling. All the surveys showed more similarities than differences in the clinical decision-making of women and men physicians. In opinions about menopause the physician's medical specialty was more important than gender. Physicians' obstetrical practices were also similar in five cases out of six, but in one situation where medical factors were not a deciding issue, women physicians acted differently. These results suggest that socialization into the medical profession makes physicians' practices more alike and diminishes gender differences.

Attitude of Health Personnel↗
PubMed1997

Does licensing of drugs in industrialized countries guarantee drug quality and safety for Third World countries? The case of norplant licensing in Finland.

Norplant implantable contraceptives were developed mainly for use in Third World countries, but first were approved for marketing in Finland in 1983 and in Sweden in 1985. Since then Norplant has been approved in more than 40 countries, most of them in the Third World. The authors analyzed the clinical documentation submitted to the Finnish and Swedish drug control authorities, and the assessments made of the data. The Finnish review process lasted for three years, and the number of data increased substantially during that time. The authors have not been allowed to publish the clinical data submitted in Finland, but a reconstruction from the Swedish data showed that the clinical data were of poor quality and were mainly focused on assessing efficacy. Side effects, acceptability, and requirements of the health care system for proper use of Norplant were poorly studied. This example of Norplant licensing in Finland shows that licensing of drugs in industrialized countries is insufficient for guaranteeing their safety in Third World countries.

Contraceptive Agents, Female↗
PubMed1997

Pregnancy-associated deaths in Finland 1987-1994--definition problems and benefits of record linkage.

BACKGROUND: Our aim was to study the impact of record linkage and different classification principles on maternal mortality rate. METHODS: The death certificates of all fertile-aged women who died in 1987-94 in Finland (n = 9,192) were linked to the Birth, Abortion, and Hospital Discharge Registers (n = 513,472 births, 93,807 induced abortions, and 71,701 other ended pregnancies) to identify the women who had been pregnant during their last year of life. All deaths that occurred up to 1 year after the end of pregnancy were classified according to their connection to pregnancy. RESULTS: In total, 281 qualifying deaths were found. Only in 22% of the death certificates was the pregnancy or its end mentioned. The mortality rate was 41 per 100,000 registered ended pregnancies (27 for births, 48 for miscarriages or ectopic pregnancies, and 101 for abortions). The maternal mortality rate depended greatly on which of these 281 cases were defined as maternal deaths. The early maternal mortality rate varied between 5.6 and 6.8 per 100,000 live births, and the late maternal mortality rate between 0.6 and 2.5 depending on the definition used. The classification of other than direct maternal deaths was ambiguous, especially in case of late cancers, cardio- and cerebrovascular diseases, and early suicides. The official Finnish figure for early maternal mortality (6.0/100,000 live births) seems to be a good estimate, although only 65% of individual deaths were unambiguously classified. CONCLUSIONS: Register linkage is necessary to identify late maternal deaths and pregnancy-associated deaths. The current official classification of maternal deaths as indirect, direct and fortuitous is arbitrary and allows much variation in defining a maternal death.

Adult↗
PubMed1997

Self-medication of dyspepsia: how appropriate is it?

BACKGROUND: The scope of self-medication is increasing in many countries, and drugs for dyspepsia are a popular group for deregulative activities. This study investigated what kind of upper gastrointestinal symptoms people self-medicate and how appropriate this self-medication is. METHODS: An anonymous questionnaire was give to 50 consecutive customers buying antacids, alginates, or sucralfates in 10 pharmacies in the capital area in Finland in 1995. In half of the pharmacies the questionnaire was returned by mail, and in the other half the questionnaire was filled out at the pharmacy. The response rate was 53% (n = 292). RESULTS: The commonest reasons for self-medication were heartburn (88%), gastrointestinal pain (31%), and acid regurgitation (32%). Seventy-five per cent of respondents had used dyspepsia drugs for more than a year. The commonest way to self-medicate was to interchange regular and occasional use. Knowledge about the proper use of dyspepsia drugs was poor, and 6% of respondents had symptoms contraindicating self-medication but had not visited a physician during the past year. Patients more than 60 years old were especially at risk of potential inappropriate use. CONCLUSIONS: Over-the-counter (OTC) drugs for dyspepsia are likely to be used improperly. A physician's advice on the use of OTC dyspepsia drugs, in addition to detailed printed information about drug action and proper administration, would be important means to guarantee appropriate use of these drugs.

Adult↗
PubMed1997

Prescribing of hormone therapy in menopause and postmenopause.

This article describes the use and prescribing of menopausal and postmenopausal hormone therapy (HT) in one example country, Finland, and the trends and levels of HT use in other western countries for comparison. Previously published studies were reviewed and reanalyzed, and some additional unpublished data from Finnish surveys were compiled. The use of HT increased in Finland up to 1994. In Finland the initiative for HT use came more often from physicians than women themselves, physicians valued HT more than women, women's period of use of HT was shorter than physicians' recommendations, women's reasons for using HT were usually to treat symptoms, but physicians considered HT also useful in the prevention of later diseases. Gynecologists were more favorable toward HT than other physicians. HT has become common in very different times in different countries, but with the exception of the US experience in the 1970s, the trend has been towards increasing use. One motivation to do surveys on physicians' prescribing or women's use of HT has been to facilitate HT use. The large variation in HT use may reflect the uncertainty concerning its true value. The reasons for the large-scale prevention with HT have not been systematically studied, but it is likely due to various social and commercial forces.

Climacteric↗
PubMed1996

Suicides after pregnancy in Finland, 1987-94: register linkage study.

OBJECTIVE: To determine rates of suicide associated with pregnancy by the type of pregnancy. DESIGN: Register linkage study. Information on suicides in women of reproductive age was linked with the Finnish birth, abortion, and hospital discharge registers to find out how many women who committed suicide had had a completed pregnancy during her last year of life. SETTING: Nationwide data from Finland. SUBJECTS: Women who committed suicide in 1987-94. RESULTS: There were 73 suicides associated with pregnancy, representing 5.4% of all suicides in women in this age group. The mean annual suicide rate was 11.3 per 100,000. The suicide rate associated with birth was significantly lower (5.9) and the rates associated with miscarriage (18.1) and induced abortion (34.7) were significantly higher than in the population. The risk associated with birth was higher among teenagers and that associated with abortion was increased in all age groups. Women who had committed a suicide tended to come from lower social classes and were more likely to be unmarried than other women who had had a completed pregnancy. CONCLUSIONS: The increased risk of suicide after an induced abortion indicates either common risk factors for both or harmful effects of induced abortion on mental health.

Abortion, Spontaneous↗
PubMed1996

Epidural analgesia as a risk factor for operative delivery.

OBJECTIVE: To study the relationship between epidural analgesia and instrumental and non-elective cesarean delivery in the 1990s in Finland. METHODS: The data was extracted from a nationwide birth register in 1991-1993. To adjust for other factors, hospital-based analyses were made separately for different types of hospitals and in individual-based analyses logistic regression was used. RESULTS: In the hospital-based analyses there was no systematic correlation between rates of epidural analgesia and operative delivery, but on the individual level there was. Comparison of hospitals with different levels of epidural rates and different types of hospitals suggests that the contradictory findings in the hospital and individual-based analyses are partly due to selection bias, and partly to different hospital policies. CONCLUSIONS: The results in previous studies and our results suggest that epidural analgesia is a risk factor for an operative delivery, but not a sufficient one, and its impact is likely to be modified by other obstetric practices and interventions.

Analgesia, Epidural↗