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Biomedical subjects

E Hemminki

Publications and source records attributed to E Hemminki.

At least 109 records · Page 6Linked to original sources
PubMed1994

Amount of antenatal care and infant outcome.

The connection between the amount of antenatal care and pregnancy outcome was studied using the 1987 Finnish Medical Birth Registry. A total of 57,108 women were included in the analysis. The timing of initiation of antenatal care and the relative number of antenatal visits (adjusted by gestation length), were used as measures of amount of antenatal care. Nine outcome variables measuring infant health and interventions were studied. Logistic regression was used to adjust for differences in maternal background characteristics. Women beginning antenatal care after the 16th week of gestation had the poorest outcome. Early attending multiparous women had a higher risk of low birthweight, premature infants, caesarean section and instrumental delivery than did those with average timing of their first attendance. For primigravidas, the increased risk was of prematurity only. A U-shaped curve was found for most of the outcome variables in regard to relative number of visits. The women with many visits had the poorest outcome, and also the highest rates of caesarean section and induction of labour. One reason for the unexpectedly high risks for early attenders may be connected with the content of antenatal care. In Finland, it might be possible to reduce the total number of antenatal visits without having any negative effect on infant health.

Birth Weight↗
PubMed1994

Impact of induced abortions and statistical definitions on perinatal mortality figures.

Two problems originating from the advanced use of medical technology in screening for malformations and in the care of preterm and low birthweight infants are presented: the impact of the increasing number of induced medical abortions and the differences in statistical definitions on perinatal mortality (PNM) figures. Data on 186,562 births registered in the Finnish Medical Birth Registry between 1987 and 1989 were studied, and 65,554 medical abortions (of which 1647 were performed after the sixteenth week of gestation) registered in the Abortion Registry between 1985 and 1990. A 115% increase in abortions for medical reasons in the period 1985-1990 was found. It was estimated that the trend accounted for up to one-third of the decline in PNM rate during that time. The perinatal mortality rate was strongly influenced by very small infants. The application of the Finnish version of the International Classification of Diseases, Ninth Revision (ICD-9) (including all livebirths and using both birthweight of 500 g and gestational age of 22 weeks as the criteria) resulted in PNM rates which were about 5% higher than according to ICD-9. We suggest that the impact of medical abortions on perinatal statistics has reduced the value of the perinatal mortality rate as an indicator of the standard of care.

Abortion, Induced↗
PubMed1994

Variation in obstetric care within and between hospital levels in Finland.

OBJECTIVE: In obstetrics, both area and hospital variation has previously been documented for operative procedures, but not for other treatments or diagnostic procedures. This study investigated the extent of variation in care during pregnancy, at birth and after birth. DESIGN AND METHODS: The variation was studied by hospitals (n = 52) by hospital level. To account for differences in women's background characteristics, logistic regression analyses were done. The data came from the 1991 Finnish Birth Register which records data on all births (n = 64,171). RESULTS: All interventions and care practices studied varied notably from one hospital to another, with the variation usually being greater within hospitals of the same level than between hospitals of different levels. Each of the seven non-operative interventions showed a larger variation than did each of the four operative interventions. Standardisation for mothers' background characteristics did not eliminate this variation. Some interventions, but not all, were clustered in the same hospitals. CONCLUSIONS: Such large variation indicates a need for further studies on the benefits of obstetric interventions and of care practices, and on better application of research results to obstetric care.

Female↗
PubMed1994

Birth outcomes by level of obstetric care in Finland: a catchment area based analysis.

STUDY OBJECTIVE: To study whether hospitals of different levels are equally safe places to give birth in a regionalised system of care. DESIGN: This was a population based, cross sectional survey comparing birth outcomes in nationwide catchment areas of different levels of hospital care. All women and low risk women were examined separately. SETTING AND SUBJECTS: The study population comprised all women who gave birth in Finland in 1987-88. The data were obtained from the Finnish Medical Registry, complemented by official data. MAIN RESULTS: No statistically significant differences were found in crude or birthweight specific perinatal mortality rates between the catchment areas, nor did the other outcomes studied favour tertiary care compared with other levels of care in the area based analysis. CONCLUSIONS: In a regionalised system of birth care with a proper referral system, small local hospitals are as safe places to give birth as tertiary care hospitals.

Catchment Area, Health↗
PubMed1994

Who uses Norplant. A study from Finland.

OBJECTIVE: Although Norplant implantable contraceptives were introduced first in Finland, their use has been infrequent. The objective of this study was to investigate what kind of women use Norplant in Finland, who suggested its use, and from what source women get their information on Norplant. METHODS: A questionnaire was mailed to all women having had Norplant inserted one to two years before the study initiation (June 1992) in seven family-planning clinics in the Helsinki city area (n = 262). After one reminder, the response rate was 82%. RESULTS: Most of the users were 25-34 years old, and many of them had had a previous abortion. Half of the women were still considering a (subsequent) child. All the women had used some birth control method before Norplant and reported several problems with it. Women reported that they themselves had chosen Norplant, but physicians and nursing staff in the family-planning clinic were their most important information sources. Most women considered that they had received sufficient information before insertion regarding both the good and bad aspects of the method. CONCLUSIONS: Women with previous abortions are a special users' group for Norplant, even though most users are in no way exceptional women.

Abortion, Induced↗
PubMed1994

Pros and cons of intrauterine contraception--do perceptions of users and physicians differ?

OBJECTIVE: To investigate women's and physicians' opinions of IUD use. DESIGN: Two cross-sectional postal surveys; on women in 1987-1988, on physicians in 1988. SETTING: Survey on women: southernmost Uusimaa province (including Helsinki). Survey on physicians: whole of Finland. PARTICIPANTS: Of a stratified random sample of 1000 women aged 18-44 years 84% returned the questionnaire (N = 844). Of a sample of 480 physicians (including GPs and gynaecologists) 418 were eligible, 74% of whom responded (N = 311). MAIN OUTCOME MEASURES: Women's and physicians' opinions of and experiences with IUD use as reported in postal questionnaires. RESULTS: Most women considered that IUDs were a good method of contraception. Users' and physicians' reports on benefits and disadvantages of IUDs metched each other; both most often mentioned ease of use, efficacy, and lack of systemic effects. Major disadvantages reported by women were bleeding, pain, infection, and pregnancy. Physicians further pointed to the risk of ectopic pregnancy. Though reports of side-effects were commonplace, there was reasonable satisfaction with IUD use. CONCLUSION: This study reveals that most women, and physicians, have a realistic picture of the common problems related to intrauterine contraception. It also emphasizes that, when making contraceptive choices, one is bound to compare possible disadvantages with benefits offered.

Adult↗
PubMed1993

Reporting of malformations in routine health registers.

The utility of three national registers--the malformation, birth, and hospital in-patient discharge registers--in identification of malformations among 60,255 children born in 1987 in Finland was compared. Information in the malformation register is collected by specific reporting of physicians; information on the malformed children in the other two registers in 1987 through 1990 was routinely collected and identified by ICD 9-codes (740-759, 7886A). From October 1990 on, the ICD-9 codes were omitted from the birth register and malformation data were asked only in a yes-no question. In 1987, the malformation register included 1,032, the birth register 3,084 and the in-patient register 2,003 malformed infants identified up to the age of 1 year. There was underrepresentation of almost all malformation diagnoses in the malformation register. Individual linkage of the three registers showed that the malformation register revealed very few cases not recorded in the birth and the in-patient registers. With the adoption of the new recording method in the birth register beginning in October 1990, reports of malformation declined by 75%. Our analyses showed that data sources based on diagnoses collected routinely and not requiring an explicit decision on whether or not a problem is a malformation, can be more useful for routine surveillance of occurrence of malformations.

Congenital Abnormalities↗
PubMed1993

Women's satisfaction with maternity health care services in Finland.

The purpose of this study was to describe the Finnish maternity health care system and to determine the level of satisfaction in general with maternity health care services and specifically with hospital clinic visits in Helsinki, Finland. Information was collected using both interviews (N = 63) and questionnaires (N = 408). Care during pregnancy takes place in maternity centers, and risk pregnancies are referred to hospital clinics for consultation. The maternity health care system in Finland is regarded internationally as effective and well functioning. In recent years, however, increasingly more prenatal visits have taken place in hospital clinics. This change may lead to a system similar to Great Britain's where a large part of prenatal care takes place in hospital clinics. Although the women in this study are satisfied in general with the content of maternity health care services and regard them necessary for their well-being during pregnancy, data also indicated that women are more satisfied with visits to maternity centers than with visits to hospital clinics. The factors women complained most about in hospital clinic visits, were long waiting times, unsatisfactory doctor-patient communication, the 'assembly-line' routine of the clinic, and seeing a different doctor at each visit. The lack of social and psychological support involved in the care given at hospital clinics was also evident. In planning and evaluating maternity health care, it is important to consider women's views and experiences.

Adult↗
PubMed1993

Physicians' views on hormone therapy around and after menopause.

Estrogens and progestins are commonly and increasingly used during and after menopause. We studied Finnish physicians' views of this hormone therapy based on their specialty. A questionnaire was sent to a stratified random sample of gynecologists, internists, general practitioners and nonspecialists (n = 500; response rate 74%). Reported prescription habits and opinions concerning benefits and harms of hormones were asked and compared to current literature. Combined therapy was much more popular than was estrogen alone. One fourth of the physicians said hormones should be preventively given to all or to all those at risk for osteoporosis. Long therapies were accepted by many and for our patient cases hormones were recommended much more commonly than were other medical therapies. Most considered prevention of osteoporosis to be a benefit of combined therapy, but opinions of other benefits and harms varied. Gynecologists had the most favourable opinions and most of them considered hormone therapy very useful; the other physicians' opinions were characterized by uncertainties about hormone therapy and its long term effects.

Attitude of Health Personnel↗
PubMed1993

Selection to postmenopausal therapy by women's characteristics.

Many surveys have shown that women using postmenopausal hormone therapy have a lower incidence of cardiovascular diseases and lower overall mortality. The purpose of this study was to compare past and non-users with current users of hormone therapy in regard to characteristics known to, or assumed to, predict poor subsequent health (indicators). The main data source was a survey in 1989 of a random sample (n = 2000, 86% response rate) of 45-64 year-old Finnish women. Among women with their uterus, after adjusting for age and urbanism, of the 21 indicators studied, 10 suggested a poorer and none a better health prognosis for the non-users than for current users. Many differences were greater among older women, suggesting a cohort effect or long-term users being an especially selected group. Among hysterectomized women, differences between users and non-users were similar or smaller than among women with uteri. The past users were more similar to non-users than current users. Our study suggests that women with a better health prognosis are selected or select themselves for hormone therapy, and that may impede interpretation of observational studies on hormone therapy and health.

Cardiovascular Diseases↗
PubMed1993

Patterns of use of obstetrical interventions in 12 countries.

Recent obstetrical practice trends in 12 countries were surveyed. There was a 3-fold difference in caesarean section rates and a 10-fold difference in instrumental vaginal delivery rates among countries. There was a net increase in the caesarean section rate of all countries over the study period and a net decrease in the instrumental vaginal delivery rate of some countries. There was a decrease in the caesarean section rate during the last year of observation in Australia, Denmark and Finland. In general, countries with high caesarean rates also had high instrumental vaginal delivery rates. There was no consistent relationship between use of caesarean section and use of instrumental vaginal delivery, although in several countries increasing use of caesarean section was accompanied by decreasing use of instrumental vaginal delivery. Oxytocin use rates were associated positively with instrumental delivery but not with caesarean section rates. While it was not possible to determine the proportions of women who received appropriate obstetrical care, we can infer that a significant proportion of interventions were unnecessary or only marginally beneficial. Continued increases in rates of obstetrical intervention are unlikely to result in improvements in birth outcome overall and may pose a risk to mothers and their newborns.

Australia↗
PubMed1993

Careprovider and obstetrical interventions--a comparative study of four European countries.

The purpose of this study was to compare the treatment recommendations of obstetricians and midwives in four European countries: the Czech Republic, Finland, Hungary, and Slovenia. Intervention orientation was examined with six hypothetical patient cases. We wanted to learn whether midwives differ from obstetricians in their choices, and whether there is any variation among countries regarding the willingness of staff to intervene. In Finland the two professions were quite similar in their recommendations for interventions, but in Hungary and Slovenia, midwives and obstetricians differed from each other. There were also differences between the countries in the treatment recommendations, and there was disparity between opinions and actual obstetrical practices. Slovenian obstetrical staff were the most interventionistic in many cases, compared with others, although the actual frequency of interventions was no greater than in other countries. In Finland the staff were the most passive in their opinions, yet the actual proportion of interventions was greatest.

Adult↗
PubMed1993

Quantity and targetting of antenatal care in Finland.

The paper describes the timing of starting antenatal care and the number of visits and their variation measured against women's background characteristics in Finland. The main data source was the 1987 nationwide Medical Birth Registry, while some data were from published statistics and the 1988-90 Medical Birth Registries. These registries cover all antenatal visits, over 80% of which were to special out-patient maternity centers. In 1987, women started antenatal care early (22% before the eighth and 4% in the 16th or later gestation weeks), and the number of visits was high (mean 15.2 visits). Use of antenatal services has been high at least since the early 1970s. Women coming early (< 8 weeks) and at average time (8-12 weeks) were similar to each other, but women coming late (> 12 weeks) were more often socially disadvantaged and had had more previous births, both in analyses stratified by parity, and in logistic regression analyses adjusting for various confounders. When the relative numbers of visits adjusted for gestation length were considered, the differences between the women with many and few visits were similar to the differences between early and late comers. Timing of starting antenatal care did not correlate with the pregnancy outcome. Women having many visits, adjusted for gestation, had poorer outcomes than women with average visits, and women with few visits were in between.

Adult↗
PubMed1993

A review of postmenopausal hormone therapy recommendations: potential for selection bias.

OBJECTIVE: To survey the advice given to physicians in regard to postmenopausal hormone therapy, and thus to find out indirectly whether selective prescribing may have contributed to the findings of health effects. DATA SOURCES: Surveys on the health benefits of postmenopausal therapy were identified from previous reviews. Experts in various fields were consulted regarding relevant textbooks, and recommended booklists were used. METHODS OF STUDY SELECTION: Most of the surveys were conducted in the United States and concerned only estrogens; therefore, we focused on these data. Advice given to United States physicians on estrogen prescribing was abstracted from the Physicians' Desk Reference, five textbooks, and other sources written between 1945-1990. DATA EXTRACTION AND SYNTHESIS: In advice given to physicians, there was concern that estrogens could cause cancer. In addition, it was not recommended to give estrogens to women in poor general health. Advice concerning cardiovascular diseases and estrogens was contradictory and variable. CONCLUSIONS: If the advice observed reflects the prescribing practices of physicians, then surveys on the health impact of estrogen therapy may have underestimated the risk of breast cancer and overestimated the prevention of fractures. The impact on studies of cardiovascular diseases is less clear, and other mechanisms of selection bias may have been more important.

Breast Neoplasms↗
PubMed1992

Is users' knowledge about contraceptives adequate? A case study of Finnish IUD users.

Intrauterine contraceptive devices (IUDs) are popular: in Finland, in 1987, about 25% of women of childbearing age used them. We studied Finnish women's knowledge about contraindications for and side-effects of IUD use, with emphasis on current users. In December 1987-January 1988, a postal questionnaire was sent to a random sample of 1000 women of childbearing age, in Uusimaa province, which includes the capital, Helsinki. After three reminders, the response rate was 84%. We compared the answers of current and past users and nonusers of IUDs, and analyzed the associations between IUD use, education, age, and knowledge about side-effects. In contrast to the recommendations for use and information to be given to the contraceptive users, a substantial proportion of current IUD users assumed there are few limitations for IUD use. Some side-effects possibly leading to severe consequences were not considered to be connected with IUD use, not even by users. Although risk of infection was a quite well known fact, infertility was seldom associated with IUD use, and 22% of current IUD users did not associate ectopic pregnancy with IUDs. The results thus suggest that contraceptive counseling is not fully adequate and should receive more attention.

Adolescent↗