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Pirkanmaa, Finland

Spiegel W.,Medical University of Vienna | Mlczoch-Czerny M.-T.,Wilhelminen Hospital of the City of Vienna | Jens R.,Center for General Practice | Dowrick C.,University of Liverpool
Journal of Evaluation in Clinical Practice | Year: 2012

Rationale, aims and objectives: In Austria, the participation of general practitioners (GPs) in so-called 'quality circles for pharmacotherapy' (QCPs) was taken as a special approach to increase the use of generics and possibly, to improve the quality and efficiency of prescribing patterns in primary care. This study aimes at exploring GPs' perception of QCPs whether they think that taking part has helped to change their prescribing habits, their opinions on generics in general and the issues that arise for them in attempting to promote their use. Methods: Qualitative analysis was used to evaluate QCP protocols for their potential to evoke discussion in the group and for their relevance to our study questions. Results: Of the 821 self-employed GPs in Vienna under contract with the Vienna District Health Insurance Fund 445 took part at least once in the study period. Seven main topics, which provide insight into various aspects of patient care in primary care, were identified: QCPs work, generic drug prescription, problems related to the sale of generics, patient counselling and education, therapy adherence, coordination of care, competence and medical education. From all prescribed drugs for which generics were available in the fourth quarter of the year 2003 GPs prescribed 33.91% generics, in the fourth quarter of 2004 43.97%, in the fourth quarter of 2005 46.31%, and in the fourth quarter of 2006 49.88%. Conclusions: Peer review groups can be an important method of quality improvement in GPs' prescribing behaviour in favour of generics. QCPs also facilitate the exchange between GPs on problems encountered and provide feedback to policy makers. © 2011 Blackwell Publishing Ltd. Source


Turunen K.,University of Tampere | Helander K.,University of Tampere | Mattila K.J.,University of Tampere | Mattila K.J.,Center for General Practice | Sumanen M.,University of Tampere
Acta Obstetricia et Gynecologica Scandinavica | Year: 2013

Intrahepatic cholestasis of pregnancy has been shown to have a genetic predisposition. We studied whether Finnish women who had suffered from the disorder reported their first-degree relatives to have had liver dysfunction during their pregnancies. Questionnaires were sent in autumn 2010 to a total of 544 former intrahepatic cholestasis of pregnancy patients and 1235 controls, all having delivered during 1969-1988. The response rate was 66.2%. The incidence of intrahepatic cholestasis is 0.5-1.5% of pregnancies in Finland. In our survey, altogether 12.8% of mothers (odds ratio 9.2), 15.9% of sisters (odds ratio 5.3) and 10.3% of daughters (odds ratio 4.8) of women who had suffered from intrahepatic cholestasis of pregnancy had had liver dysfunction during pregnancy. Our findings strengthen the earlier knowledge of the genetic component in intrahepatic cholestasis of pregnancy. We suggest that all pregnant women are asked about their family history regarding liver dysfunction during pregnancy. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology. Source


Molsa A.,University of Tampere | Turunen K.,University of Tampere | Mattila K.J.,University of Tampere | Mattila K.J.,Center for General Practice | Sumanen M.,University of Tampere
Contraception | Year: 2012

Background: As conceptions have changed regarding the suitability of oral contraceptives for women with a history of intrahepatic cholestasis of pregnancy (ICP), we studied whether the contraindications formerly in force had affected family planning decisions and mode of contraception among women with such a history. Study Design: ICP women and their controls who gave birth in 1969-1988 in Tampere University Hospital, Finland, were sent a questionnaire in 2010. The inquiry covered items concerning contraception, deliveries, menstruation and sex life. Results: ICP women had limited their number of children for health reasons more often than the controls. They also more often had a single child compared to the controls. The use of oral contraceptives was less common among ICP women. Deliveries were equally successful in both groups. Conclusion: Physicians should provide sufficient and accurate information on ICP to the patients. Proper introduction of suitable contraception methods and successful communication with the patients would also reduce unnecessary problems and confusion regarding future family planning practices. © 2012 Elsevier Inc. Source


Turunen K.,University of Tampere | Sumanen M.,University of Tampere | Sumanen M.,Kangasala Health Center | Haukilahti R.-L.,University of Tampere | And 3 more authors.
Scandinavian Journal of Primary Health Care | Year: 2010

Objective. Pregnant women complaining of itching are screened for intrahepatic cholestasis (ICP) by laboratory tests in primary healthcare. Cases of ICP are referred to specialist care. In Finland, ICP occurs in 1% of pregnancies. The aim was to study the outcome of deliveries. Design. Retrospective study of ICP pregnancies. Data were collected from the hospital discharge register, patient records, and the labour register. Setting. The region of Tampere University Hospital in Finland. Subjects. Altogether 687 ICP cases from 1969 to 1988 and two controls for each. Main outcome measures. ICP patients were compared with controls in terms of mother's age, pregnancy multiplicity, weeks of gestation at delivery, frequency of induction and Caesarean section, length of ward period, child's weight, Apgar scores, and stillbirth. Results. For ICP patients, the risk for hospital stay of 10 days or more was eightfold (OR 8.41), for gestational weeks less than 37 at delivery sevenfold (OR 7.02), for induction threefold (OR 3.26), for baby's low weight at birth almost twofold (OR 1.86), and for Caesarean section one and a half fold (OR 1.47). The possibility of the incidence of multiple pregnancy was two and a half fold (OR 2.49, 95%). ICP was not associated with mother's age, the baby's risk of stillbirth, or low Apgar scores. Conclusion. ICP mothers are found and taken care of appropriately, and thus ICP is only a minor risk for mothers and their children. © 2010 Informa UK Ltd. Source


Turunen K.,University of Tampere | Molsa A.,University of Tampere | Helander K.,University of Tampere | Sumanen M.,University of Tampere | And 2 more authors.
Acta Obstetricia et Gynecologica Scandinavica | Year: 2012

Objective. To establish whether intrahepatic cholestasis of pregnancy (ICP) is associated with other diseases during a woman's lifetime. Design. Prospective controlled cohort study. Setting. University Hospital in Finland. Population. A total of 575 women with ICP and 1374 control women, all having delivered in 1969-1988. Questionnaires were sent to 544 ICP patients and 1235 control women. Responses were received from 1178 (66.4%). Methods. Questionnaire survey in autumn 2010. Main outcome measures. Perceived health, symptoms and complaints, diseases diagnosed by a doctor and use of medicines. Results. No statistically significant differences were detected in perceived health. Differences in recent symptoms and complaints were small. Diagnoses made by a doctor showed higher frequencies in the ICP group than in control women for other hepatobiliary diseases, breast cancer and hypothyreosis. Diagnosed hypertension and high cholesterol requiring medication as well as cardiac arrhythmia were less frequent in the ICP group. Women in this group used antacid medicines more often than control women. Conclusions. There were few differences between the ICP patients and control women except for a higher frequency of later hepatobiliary disease, breast cancer and hypothyreosis. Women with a history of ICP should be screened for hypothyreosis more readily than those without. The higher frequency of breast cancer warrants further research. © 2012 Nordic Federation of Societies of Obstetrics and Gynecology. Source

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