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Elise Kosunen

Publications and source records attributed to Elise Kosunen.

12 recordsLinked to original sources
PubMed2006

The use of oral contraceptives among Finnish teenagers from 1981 to 2003.

PURPOSE: The teenage abortion rate has increased in Finland since 1995, after a long-term decrease. We studied changes in the use of oral contraceptives (OC) among 14-18-year-old Finnish girls from 1981 to 2003. METHODS: A self-administered questionnaire (the Adolescent Health and Lifestyle Survey) was sent biennially to a representative sample of 14-18-year-olds from 1981-2003. Numbers of respondents varied between 1200 and 4100 and response rates between 77% and 90%. Altogether, 35,939 girls participated. OC use, and individual, family, and place of residence factors were examined. Logistic regression models were run separately for 1981-1991 and 1993-2003. RESULTS: The proportion of OC users doubled from 1981 to 1991, from 9.5% to 19.3%. The rising trend leveled off after 1991 and settled down at around 19% to 20%. During both periods, OC use was higher among girls with early age at menarche, still in school at age 16-18 years, poor school achievement, living in one-parent families or with a stepparent, and girls whose parents had a low level of education. OC use decreased in the capital area in the early 1990s, unlike in other areas. CONCLUSIONS: Adolescent OC use increased in the 1980s. A decade later, despite known increase in sexual activity, OC use remained unchanged. This was probably a result of deteriorated access to contraceptive counseling after changes in health service, and may have contributed to the increased abortion rate. Except for a decrease in OC use in the capital area, the association of individual, family, and regional factors with OC use remained mostly stable during 1981-2003.

Abortion, Induced↗
PubMed2006

Enrolment of 22,000 adolescent women to cancer registry follow-up for long-term human papillomavirus vaccine efficacy: guarding against guessing.

Human papillomaviruses (HPVs, most notably types 16 and 18) cause cervical carcinoma, the second most common cancer among women. Vaccination of adolescents against HPV16/18 might prevent large proportion of cervical and other anogenital cancers. However, because of ethical reasons this cannot be proven by clinical studies. To determine the long-term vaccine efficacy (VE) of HPV16/18 virus-like-particle (VLP) vaccine against cervical carcinoma in situ (CIS+) and invasive cervical carcinoma, the following three population-based cohorts of adolescent women have been enrolled: (1) women vaccinated with the HPV vaccine; (2) women vaccinated with hepatitis A control vaccine; and (3) unvaccinated control women. These cohorts will be passively followed for cumulative incidence of CIS+ endpoints by population-based cancer registry. Overall 24,046 16- to 17-year-old adolescent women from 18 cities in Finland were invited between May 2004 and June 2005 to participate in a phase III trial with bivalent HPV16/18 VLP vaccine. A total of 58,996 18- to 19-year-old women were invited in May 2005 to participate as unvaccinated controls. Women who reported their willingness to participate in an HPV vaccination trial had they been 1-2 years younger were eligible. Cumulative incidence (CI) of CIS+ in our cohorts over 15 years is approximately 0.45%. VE of 70% against CIS+ with 80% power requires 3357-3189 HPV16/18 vaccine recipients, 3357-3189 other vaccine recipients, and 6714-9567 unvaccinated controls. We have now enrolled 2404 HPV16/18 vaccine recipients, 2404 hepatitis A-vaccine recipients, and 5130 unvaccinated controls. This enrolment in addition to our earlier enrolment in another phase III trial guarantees enough power so that by 2020 we can ultimately provide data on the efficacy of HPV16/18 vaccination against CIS+.

Adolescent↗
PubMed2006

[Not Available].

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Journal Article↗
PubMed2003

Attitudes to terminal patients' unorthodox therapy: Finnish doctors' responses to a case scenario.

We carried out a postal survey of a sample of Finnish doctors ( n=1182) concerning their attitudes and ethical decisions in end-of-life care. A scenario was presented in which a patient with terminal cancer wished to obtain unorthodox treatment. Factors possibly influencing decision making such as general attitudes, life values and demographics were investigated. The response rate was 62%. The patient's plan to use unorthodox treatment was accepted by 54% of doctors. Gender or speciality did not influence the decision, but doctor's age was a significant factor ( P=0.0005). Doctors aged 35-49 years were more accepting; younger and older ones less accepting. Doctors who had clinical experience in terminal care were more compliant to the patient's plan ( P=0.034). A stepwise logistic regression analysis was used to create a model for explaining not accepting versus accepting the treatment with the background variables. Altogether eight independent significant variables were included in the final model of explaining a doctor's choice in the presented scenario. According to the model the patient's wish was more frequently accepted if the doctor was middle-aged, had clinical experience in terminal care, valued a high standard of living, considered terminal care satisfying, was less critical of health economics, considered advance directives helpful, had a high fear-of-death index score, and valued professional status less.

Adult↗
PubMed2003

Pubertal timing, sexual behaviour and self-reported depression in middle adolescence.

The associations between pubertal timing, sexual activity and self-reported depression were analysed in a population sample of 17,082 girls and 15,922 boys aged 14-16 as a par of a classroom survey. Pubertal timing was assessed by age at onset of menstruation (menarche) or ejaculations (oigarche). Sexual experiences elicited included kissing, light petting, heavy petting and intercourse. Self-reported depression was measured by the 13-item Beck Depression Inventory. Among girls, self-reported depression was associated with early puberty and intimate sexual relationship. Among boys depression was associated with very early and late puberty and experience of intercourse. Early puberty is a risk factor for self-reported depression. Intimate sexual relationships in middle adolescent are likely to indicate problems in adolescent development rather than successful adolescent passage.

Adolescent↗
PubMed2003

Trends in teenage fertility, abortion, and pregnancy rates in Iceland compared with other Nordic countries, 1976-99.

BACKGROUND: Iceland is often considered very similar to the other Nordic countries. The purpose of this study was to explore trends in teenage fertility, abortion, and pregnancy rates in Iceland, compare these trends with corresponding rates in Denmark, Finland, Norway, and Sweden during the period 1976-99, and to evaluate similarities and dissimilarities. METHODS: The study is based on data about fertility, abortion, and pregnancy rates obtained from the Icelandic and Nordic national population and abortion registers for the age group 15-19 years years. RESULTS: Teenage fertility and pregnancy rates in the five Nordic countries declined over the study period by 57-67% and 31-50%, respectively, and in Iceland they remained significantly higher than in the Nordic countries. In 1999 almost every other teenage pregnancy in Iceland (45.9/1000) resulted in a childbirth (24.4/1000). Regional fertility rates were highest in the countryside. While the abortion rate has been declining in the four Nordic countries by 20-41%, they have concurrently been rising in Iceland by 133% (9.4/1000 in 1976-80, 21.9/1000 in 1996-99) and are presently higher than in the other Nordic countries. Regionally, abortion rates in Iceland were highest in the Capital area. CONCLUSIONS: The teenage pregnancy rate is higher in Iceland than in the other Nordic countries. This may be explained by cultural norms in Iceland's society regarding childbearing, early initiation of sexual intercourse, more limited sex education, and less effective delivery and use of contraceptive methods. There is a need to promote sexual and reproductive health to young people in Iceland by combining diverse preventive approaches.

Abortion, Induced↗
PubMed2002

General practitioners' attitudes and ethical decisions in end-of-life care after a year of interactive Internet-based training.

BACKGROUND: Personal characteristics affect physicians' end-of-life decisions. Education in palliative care (PC) faces a challenge in influencing doctors' attitudes and decision making in PC. A one-year Internet-mediated education project was arranged for general practitioners in Finland to provide postgraduate education in PC. METHODS: A questionnaire was sent before and after the project to the education group (EG, n = 79) and a control group (CG, n = 100). Treatment decisions for presented scenarios and attitudes toward PC were elicited. RESULTS: EG doctors had previously participated in postgraduate training in PC more often than had CG doctors (93% vs 29%). For a young terminal cancer patient, EG doctors chose CPR less often than did CG doctors (7% vs 33%, p = 0.004); 30% of EG doctors would have continued antibiotic treatment in the case of a terminal cancer patient, vs 55% of CG doctors (p = 0.023). EG doctors more often agreed with the statement "Terminal care is satisfying" (p < 0.001). Treatment decisions or attitudes did not change significantly in either group during the year, the EG doctors were more satisfied with their work after the project. CONCLUSION: There are substantial differences in decision making between those who have experience and special interest in the subject and those who do not. To achieve the goals of education in PC, the most difficult target group, the "silent majority" of doctors, should be reached.

Attitude of Health Personnel↗
PubMedDate not supplied

Teenage contraceptive use in Iceland: a gender perspective.

Different gender beliefs toward contraception may affect contraceptive use among teenagers and need to be explored for the development of sexuality education and services aimed at this age group. A cross-sectional national survey was conducted. A random sample of 1,405 sexually active teenagers, 1,181 girls, and 224 boys was studied. One quarter of the girls and one fifth of the boys had often/always used unsafe methods (withdrawal and natural methods), and about one third of the teenagers used contraceptive methods sporadically or not at all. Generally, teenage girls had more positive beliefs toward use of contraceptives, more positive friends, and more supportive parents regarding contraception than boys. Both genders were more likely to use contraceptives if they recognized the seriousness of pregnancy and easiness of making contraceptive plans. Additionally, teenage girls were more likely to use contraceptives if they were older at the time of sexual debut, were in a steady sexual relationship, considered contraceptive services good, believed in not taking chances, and their parents knew about their contraceptive use. Preventive strategies must primarily target those teenagers who start sexual debut early, are not in a steady relationship, and are not receiving parental support.

Adolescent↗
PubMedDate not supplied

Risk of postpartum induced abortion in Finland: a register-based study.

CONTEXT: Half of Finnish abortion patients already have children, and one in 10 pregnancies ending in abortions started within 12 months of a birth. Thus, many women may not practice contraception effectively during the postpartum period. METHODS: Data from national registers were used to create ajoint data file on pregnancies occurring in Finland over the period 1987-1998. The abortion risk (the risk of a conception that leads to an induced abortion) and abortion ratio (the number of conceptions leading to abortions divided by the number leading to deliveries) were analyzed in follow-up periods after all live births to women younger than 45 (684,922), using hazard regression and logistic regression. RESULTS: Pregnancies starting within eight months postpartum were more likely to end in abortion than were those starting later. Within the first eight months, the shorter the interval to the next pregnancy, the more likely the pregnancy was to end in abortion. Abortion risk was higher 6-18 months postpartum than at later periods and was highest at 6-8 months postpartum, particularly among unmarried women and teenagers. Between 1987-1988 and 1995-1996, the abortion risk within the first eight months postpartum rose significantly among women aged 25-29 and 30-34 (relative risks, 1.5 and 1.2, respectively). The abortion risk and abortion ratio were higher among teenagers than among women in other age-groups. CONCLUSIONS: The findings are consistent with the hypothesis that contraceptive practice is less effective postpartum, suggesting room for improvement in postpartum contraceptive counseling in Finland.

Abortion, Induced↗