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Biomedical subjects

E Hemminki

Publications and source records attributed to E Hemminki.

At least 127 records · Page 7Linked to original sources
PubMed1992

Mother's education and perinatal problems in Finland.

This study using nationwide data expands a previous study from one area in Finland. The purpose was to study how perinatal problems (mortality, short gestation, low birthweight and low Apgar scores) vary by mother's social class, which is measured by level of education. Outcomes of all births in the 1987 Medical Birth Register were linked to the 1988 National Education Register with gives the estimated number of years of completed education. In unadjusted analyses, the lowest educational groups (less than 9 years) had the worst results for outcomes other than neonatal mortality. Results in the two highest educational groups (greater than or equal to 13 and 12 years of education) were similar and if anything, better in the second highest group. Excluding twins and adjusting for confounding variables (age, parity, county, urbanization of residence) by logistic regression analysis did not alter the results much. Adjustment for possible mechanisms correlated with social class (marital status, smoking, time of first antenatal visit) decreased the higher occurrence of low birthweight infants in the low educational groups. Reported previous miscarriages were more common in the higher educational groups. Based on the available background characteristics one would expect to have found the usual social gradient in perinatal problems to have persisted between the two highest educational groups. Further studies on factors causing the plateau in the gradient between these groups might be useful.

Abortion, Spontaneous↗
PubMed1992

Variation in obstetric interventions by midwife.

This paper reports variation in birth interventions by 25 midwives among 2,135 births in a Finnish hospital. The rate of cesarean sections varied from 0 to 18%, and that of instrumental deliveries from 0 to 8%. Mother's and infant's characteristics and rates of vaginal breeches suggest that a low rate of cesarean sections was not explained only by selection to easy births. This study suggests that the skills, attitudes and routines of midwives may explain part of the variation found in birth interventions.

Cesarean Section↗
PubMed1992

Hysterectomy among Finnish women: prevalence and women's own opinions.

This article describes the prevalence of hysterectomy, women's own opinions of it, and socioeconomic characteristics of hysterectomized women compared to non-hysterectomized ones. The questionnaire was sent in spring 1989 to 2000 45 to 64-year-old Finnish women picked randomly from the Population Census. After two reminders, 1713 (86%) had responded. One fifth of the women had had a hysterectomy and 5% had also had both ovaries removed. Among the highest educated there were less hysterectomized women than among the less educated. The largest differences in the prevalence of hysterectomy were between counties, not between socioeconomic groups. Fourty-one percent of the hysterectomized women had themselves wished hysterectomy, 25% did not have any specific opinion about the operation. Results raise further questions about clinical decision making and regional variation of hysterectomy.

Adult↗
PubMed1992

Midwives as providers of prenatal care in Finland--past and present.

This study analyzes the role of the midwife in prenatal care by exploring the history of the midwifery profession in Finland and by interviewing midwives. Midwifery education started in Finland in the beginning of the 19th century due to the utilitarian population policy aiming to reduce the high infant mortality rate. Because of a shortage of physicians professional midwives attained an important status in the care of births. With industrialization a state-directed welfare policy with state-subsidized health care developed. After World War II, the midwifery were legally defined as care during pregnancy, delivery, and the postpartum period. In the 1950s, the scope of work of midwifery was further altered because hospital deliveries had become routine. Some midwives provided prenatal care in ambulatory maternity health centers while others worked in hospitals managing normal childbirths. Separate midwifery education ended in 1968 and resumed 1986. Since 1972, public health nurses have increasingly provided prenatal and postnatal care in maternity centers, and specialized nurses have managed normal childbirths. In the future, public health nurses may totally replace midwives in prenatal care, and the role of midwives may return to care of normal deliveries. Midwife interviews revealed the "medicalization" of pregnancy caused both by physicians and midwives' own medical concept of pregnancy and by clients' demands for good care.

Female↗
PubMed1992

Need for and influence of feedback from the Finnish birth register to data providers.

Data for the Finnish medical birth register (established 1987) are collected by local hospital personnel as a part of their routine work. The purpose of this study was to study the need of personnel for feedback and the impact of feedback on later data quality. Furthermore, we studied whether such feedback tends to modify extreme cesarean section rates. Data on attitudes towards the birth register and on the need for feedback of data providers were collected through interviews and observations. In March 1988, an information package describing births, birth procedures and infant outcomes in each hospital compared with other hospitals was sent to a random stratified sample of 26 hospitals out of a total of 53. Opinions of the package were obtained by questionnaire from 104 physicians and nurses (82% response rate). Most hospital personnel, especially physicians, had negative attitudes towards the birth register. Comparison of the hospitals which had received feedback with other hospitals in terms of quality of data furnished in 1987 and 1988 suggested that feedback may improve the technical quality of data. There was no evidence, however, that feedback caused hospitals to change their practices in regard to cesarean sections.

Attitude of Health Personnel↗
PubMed1991

A randomized comparison of routine versus selective iron supplementation during pregnancy.

This trial compares routine and selective iron supplementation during pregnancy to determine whether routine supplementation adversely affects fetal growth, increases infections and subjective adverse effects, and/or delays birth. At their first prenatal visit, 2912 pregnant women were randomized into two groups (2694 gave birth). Compliance was satisfactory as measured by self-reports by mothers and hematocrit values in the third trimester. More women in the routinely supplemented group had subjected adverse effects. The groups were similar in regard to most of the other outcomes. In the selectively supplemented group, there was weak evidence for increase in sick-days, referrals to hospital outpatient clinic, cesarean section, blood transfusions, and infants who were diagnosed as having hyperviscosity. In the routine group, there were somewhat more women with gestations greater than or equal to 41 weeks and more dead infants. The subgroup analyses suggest that some of the apparently worse outcomes in the selective group were due to reactions of midwives and physicians to low hematocrit values.

Anemia, Hypochromic↗
PubMed1991

Iron supplementation, maternal packed cell volume, and fetal growth.

Previous studies have found that there is a correlation between mothers' haemoglobin concentration or packed cell volume and infants' birth weight, and that iron supplementation increases mothers' haemoglobin concentration. The purpose of this study, using the data of a large randomised trial on iron prophylaxis during pregnancy, was to find out whether iron supplementation causes fetal growth to deteriorate. At their first antenatal visit, 2912 pregnant women were randomised into non-routine iron and routine iron supplementation. The mean length of gestation was shorter in the non-routine group. Birth weight did not differ between the groups, but due to longer gestations boys in the group receiving routine iron were taller than in the non-routine group. In both groups, whether studied by various values of packed cell volume or correlation coefficients, the lower the packed cell volume, the heavier and taller the infant and heavier the placenta. These negative correlations could be seen even with a packed cell volume measured early in pregnancy. Standardising for blood pressure did not influence the correlation coefficients. The correlation between a high ratio for packed cell volume and poor fetal growth thus may not be caused by iron supplementation, nor mediated by blood pressure, but by some other mechanism.

Anemia↗
PubMed1991

Long term maternal health effects of caesarean section.

OBJECTIVE: The aim was to study whether women having had caesarean sections (index women) have more subsequent health problems, measured by hospital admissions, than women having had vaginal deliveries (control women). DESIGN: The study involved comparison of hospital admissions before (2-5 years) and after (7-10 years) the first caesarean section (exposure) among two cohorts of index and control women. SETTING: National data from the Swedish birth and hospital discharge registries were used. PARTICIPANTS: About 75% of all Swedish primiparas who had a caesarean section in 1973 (n = 2578) and in 1976 (n = 3822), and their age-matched controls, were studied; non-Swedish women and women with certain specific problems at their first birth were excluded. MEASUREMENTS AND MAIN RESULTS: Numbers of discharges from general and mental hospitals excluding discharges relating to birth, and in some analyses to pregnancy, were determined. Total numbers of discharges from general and mental hospitals, and the numbers of discharges with operations, were higher among index than control women both before and after exposure. In analyses by diagnosis, a caesarean section was a risk factor for ectopic pregnancies and sterilisations. CONCLUSIONS: The analyses suggest that the higher rate of hospital admission after caesarean section than after vaginal delivery is not due to the section itself, but to a continuation of a previous pattern of health service use. However, because this was not so for all diagnoses and alternative interpretations are possible, further studies on long term maternal morbidity are needed.

Cesarean Section↗
PubMed1991

Use of hormone replacement therapy in 1976-89 by 45-64 year old Finnish women.

STUDY OBJECTIVE: The aim was to describe changes in the use of hormone replacement therapy (HRT) in Finland during the period 1976-1989. DESIGN: The study involved four separate cross sectional population surveys in the years 1976, 1978-1980, 1987, and 1989. Three of them involved interviews and one a questionnaire. Sales figures of hormones in 1981-1989 were used. PARTICIPANTS: Participants were national samples of non-institutionalized Finnish women 45-64 years of age. Participation rates ranged from 85% to 96%. MEASUREMENTS AND MAIN RESULTS: Current reported hormone use in the surveys of 1976, 1978-1980, and 1987 was assessed, together with reported hormone use in the last month in the 1989 survey. During the study period the proportion of HRT users increased fivefold. In 1989, 20% of women reported current use of HRT, and the highest rate of use was found among 50-54 year old women in the Helsinki area. In 1976, users were mainly women around the age of menopause, those living in the capital area, and those having a rather high level of education. By 1989 use had spread to postmenopausal women, those in rural areas, and those with less education. CONCLUSIONS: Use of HRT has increased in Finland. It is difficult to evaluate whether the level of current use is too high, optimal, or too low, because recommendations are contradictory and the long term effects of HRT are unkown.

Age Factors↗
PubMed1991

Use of estrogens among middle-aged Massachusetts women.

This study describes estrogen use among 45- to 55-year-old white women in Massachusetts from 1981 to 1987. In a 1981 cross-sectional survey, 7705 white women (77 percent response rate) returned a questionnaire or were interviewed by phone. Premenopausal women were invited into a 4.5-year follow-up study including telephone interviews every nine months, and 2236 (approximately 91 percent of the eligible women) had a complete follow-up. In the cross-sectional survey, 7.9 percent had used oral estrogens in the last two weeks, but most (77 percent) had had a hysterectomy; use varied notably from one area to another. Vaginal estrogens were used by 2.9 percent. Users and nonusers of oral estrogens were quite similar in regard to sociodemographic background. Data from the follow-up surveys showed that estrogen use increased throughout the study period and by the final follow-up women with higher education status reported more estrogen use than those with lower education status. Most women used estrogens only for a short time.

Drug Utilization↗
PubMed1991

Different contraceptive practices: use of contraceptives in Finland and other Nordic countries in the 1970s and 1980s.

Contraceptive practices, especially oral contraceptive and intrauterine device use, were studied in four Nordic countries by recalculating published and unpublished data from previous surveys and statistics and by collecting new data from Finland. The sales of oral contraceptives were presented in defined daily doses, and the percentages of women using oral contraceptives were estimated from them. The percentages of intrauterine device users were calculated taking into account the number of intrauterine devices sold each year and the continuation of use from previous years. The results of the surveys were reanalysed. We found clear differences in contraceptive practices. Oral contraceptive use was most prevalent in Sweden and Denmark, and, especially at the end of the 1970s, Finnish intrauterine device use was very high. In the 1980s the differences dimished somewhat. These disparities in culturally and economically similar countries indicate that further research is needed to evaluate the factors influencing contraceptive practices.

Adolescent↗
PubMed1991

A survey on the use of alternative drugs during pregnancy.

OBJECTIVE: To describe the use of alternative drugs during pregnancy. DESIGN: A trial including 3 surveys on drug use during pregnancy in maternity centers in one area of Finland in 1985-86 (study 1), and a retrospective survey in 2 maternity hospitals in Finland in 1988 (study 2). PATIENTS AND METHODS: Study 1: 2912 pregnant women (about 94% of pregnant women in the area during the study period); 97-88% returned questionnaires. Study 2: 180 out of 181 consecutive women giving birth. In study 1, drug use (including drug-like products) in the last two weeks was asked by questionnaires around 12th, 28th, and 36th gestation weeks. In study 2, women were interviewed 2-3 days after birth asking about any drugs used during pregnancy. Due to the method of asking, our studies underestimate the level of using alternative drugs. RESULTS: In study 1, a total of 97 (3.6%) pregnant women reported use of alternative drugs. Most drugs were dietary supplements, and by current knowledge harmless. But a few women had used (potentially) dangerous drugs. The users were from the higher social class and they had also used pharmaceutical specialties more often than non-users. In study 2, 14% had used alternative drugs at some time during pregnancy. CONCLUSION: Because our surveys showed that alternative drugs are used, possibly with increasing frequency, during pregnancy, further studies on safety are needed.

Adult↗