Kaislasuo J.,University of Helsinki |
Suhonen S.,City of Helsinki Health Center |
Gissler M.,Finnish National Institute for Health and Welfare |
Gissler M.,Nordic School of Public Health |
And 2 more authors.
Human Reproduction | Year: 2012
STUDY QUESTION What are the incidence and factors associated with uterine perforation by modern copper intrauterine device (Cu-IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS)? SUMMARY ANSWER Perforation incidence was similar to that reported in prior studies and did not vary between Cu-IUD and LNG-IUS groups. Lactation, amenorrhoea and a post-partum period of <6 months were common. WHAT IS KNOWN AND WHAT THIS PAPER ADDS The study supports findings in prior studies. The incidence rate was low and factors associated with uterine perforation were similar to those in earlier reports. DESIGN AND DATA COLLECTION METHOD This retrospective population-based registry study included 68 patients surgically treated for uterine perforation by an intrauterine device (IUD)/intrauterine system (IUS) at clinics in the Helsinki and Uusimaa hospital district. PARTICIPANTS AND SETTING Records of 108 patients with probable uterine perforation by an IUD/IUS were analysed, leaving 68 patients treated for uterine perforation. RECRUITMENT/SAMPLING STRATEGY Patients with diagnostic and surgical treatment codes indicating uterine perforation by an IUD/IUS between 1996 and 2009 were retrospectively selected from the Finnish National Hospital Register. DATA ANALYSIS METHOD Patients with Cu-IUDs (n 17) and the LNG-IUS (n 51) were analysed as one group and also compared using MannWhitney and chi-square tests. IUD/IUS sales numbers were used to calculate incidences. MAIN FINDINGS The overall incidence of perforation was 0.4/1000 sold devices, varying annually from 0 to 1.2/1000. The proportion of both sold and perforating LNG-IUSs increased during the study period, but perforation incidence was not affected. Demographic characteristics in the Cu-IUD and LNG-IUS groups were similar. More than half of the devices (55) were inserted at <6 months post-partum. Breastfeeding at the time of insertion was common, comprising 32 of all patients. Moreover, of the breastfeeding women, 90 had delivered within 6 month prior to insertion. IMPLICATIONS The population-based study setting represents a good overview of patients experiencing uterine perforation with an IUD/IUS. As previously reported, the post-partum period, lactation and amenorrhoea may increase the risk of perforation. BIAS, LIMITATIONS AND GENERALIZABILITY As the study setting revealed only symptomatic patients or those attending regular follow-up, the true incidence might be somewhat higher. As there is no specific diagnostic code for uterine perforation or treatment, it is unlikely that all cases of uterine perforation can be identified in a retrospective study. © The Author 2012.
Tseveenjav B.,University of Helsinki |
Tseveenjav B.,City of Helsinki Health Center |
Suominen A.L.,Finnish National Institute for Health and Welfare |
Suominen A.L.,University of Eastern Finland |
And 3 more authors.
European Journal of Oral Sciences | Year: 2012
The aim of this study was to assess oral health-related behaviours among dentate adults. As part of the comprehensive Finnish Health 2000 Survey, this study included dentate subjects, 30-64yr of age (n=4,417). Based on interview and questionnaire data, information on nine oral health-related habits was elicited. On average, study subjects reported 4.4 (SD=1.5) oral health-promoting behaviours among the nine behaviours investigated, the mean number differing according to subjects' gender, educational level, marital status, and employment status. Older age, higher level of education, cohabiting, and being employed were indications of higher numbers of oral health-promoting habits than were younger age, lower levels of education, being single, or being unemployed. Oral health-promotion activities should be tailored and targeted in terms of adults' socio-economic and demographic characteristics, and directed especially towards men, those with lower education, and those who are single or unemployed. © 2012 Eur J Oral Sci.
Suhonen S.,University of Helsinki |
Suhonen S.,City of Helsinki Health Center |
Tikka M.,University of Helsinki |
Kivinen S.,University of Helsinki |
And 2 more authors.
Contraception | Year: 2011
Background: We studied whether it is possible to predict severity of pain during medical abortion. We also studied how well medical staff recognizes the pain perceived by these women. Study Design: Fifty-four women (mean age 26 years, range 18-42 years) undergoing medical abortion before the 64th day of gestation (mean 47 days, range 32-63 days) were asked to estimate their menstrual pain and the pain perceived during medical abortion by visual analogue scale (VAS). Both the intensity and unpleasantness of pain were evaluated separately. The nurses observing the women undergoing medical abortion at the outpatient clinic were asked to estimate by VAS scores their perception of the intensity of pain of the women. Results: Higher age (magnitude r=-0.30; unpleasantness r=-0.28), increasing number of previous pregnancies (r=-0.34; r=-0.36) and deliveries (r=-0.57; r=-0.60) correlated negatively and advanced gestational length (r=0.31; r=0.32) positively with magnitude and unpleasantness of pain evoked by abortion. Twenty-eight (51.8%) of the women were nulliparous. Pain during medical abortion correlates positively (magnitude r=0.34; unpleasantness r=.0.41) with pain during menstruation. There was no difference between either the intensity or unpleasantness of pain during menstruation and pain during medical abortion. Medical staff accurately assessed the pain women experienced during medication abortion (magnitude r=0.83; unpleasantness r=0.79). Conclusion: Pain during medical abortion correlates with the pain during menstruation. This finding makes counseling of women choosing medical abortion easier and helps in planning the pain relief needed. © 2011 Elsevier Inc.
Saarni S.I.,Finnish National Institute for Health and Welfare |
Saarni S.I.,University of Helsinki |
Anttila H.,Finnish National Institute for Health and Welfare |
Saarni S.E.,Finnish National Institute for Health and Welfare |
And 4 more authors.
Obesity Surgery | Year: 2011
New surgical technologies may challenge societal values, and their adoption may lead to ethical challenges. Despite proven cost-effectiveness, obesity (bariatric) surgery and its public funding have been questioned on ethical arguments relating to, for example, the self-inflicted or non-disease nature of obesity. Our aim was to analyze the ethical issues relevant to bariatric surgery. A comprehensive health technology assessment was conducted on bariatric surgery for morbid obesity using the EUnetHTA method, including a fully integrated ethical analysis. The ethical arguments suggesting that obesity should not be surgically treated because it is self-inflicted were rejected. Medicalization of obesity may have both positive and negative effects that impact the various stakeholders differently, thus being difficult to balance. Informing bariatric surgery patients and actively supporting their autonomy is exceptionally important, as the benefits and harms of both obesity and bariatric surgery are complex, and the outcome depends on how well the patient understands and adheres to the life-long changes in eating habits required. Justice considerations are important in organizing surgical treatment of obesity, as the obese are discriminated against in many ways and obesity is more common in socioeconomically disadvantaged populations who might have problems of access to treatments. Obesity should be treated like other diseases in health care, and obesity surgery rationed like other cost-effective treatments. Positive actions to ensure patient autonomy and just access to surgical treatments may be warranted. © 2011 Springer Science + Business Media, LLC.
Pitkala K.H.,University of Helsinki |
Poysti M.M.,University of Helsinki |
Poysti M.M.,Social Insurance Institution of Finland |
Laakkonen M.-L.,University of Helsinki |
And 6 more authors.
JAMA Internal Medicine | Year: 2013
Importance: Few rigorous clinical trials have investigated the effectiveness of exercise on the physical functioning of patients with Alzheimer disease (AD). Objectives: To investigate the effects of intense and long-term exercise on the physical functioning and mobility of home-dwelling patients with AD and to explore its effects on the use and costs of health and social services. Design: A randomized controlled trial. Setting and Participants: A total of 210 home-dwelling patients with AD living with their spousal caregiver. Interventions: The 3 trial arms included (1) group-based exercise (GE; 4-hour sessions with approximately 1-hour training) and (2) tailored home-based exercise (HE; 1-hour training), both twice a week for 1 year, and (3) a control group (CG) receiving the usual community care. Main Outcome Measures: The Functional Independence Measure (FIM), the Short Physical Performance Battery, and information on the use and costs of social and health care services. Results: All groups deteriorated in functioning during the year after randomization, but deterioration was significantly faster in the CG than in the HE or GE group at 6 (P = .003) and 12 (P = .015) months. The FIM changes at 12 months were -7.1 (95% CI, -3.7 to -10.5), -10.3 (95% CI, -6.7 to -13.9), and -14.4 (95% CI, -10.9 to -18.0) in the HE group, GE group, and CG, respectively. The HE and GE groups had significantly fewer falls than the CG during the follow-up year. The total costs of health and social services for the HE patient-caregiver dyads (in US dollars per dyad per year) were $25 112 (95% CI, $17 642 to $32 581) (P = .13 for comparison with the CG), $22 066 in the GE group ($15 931 to $28 199; P = .03 vs CG), and $34 121 ($24 559 to $43 681) in the CG. Conclusions and Relevance: An intensive and long-term exercise program had beneficial effects on the physical functioning of patients with AD without increasing the total costs of health and social services or causing any significant adverse effects. Trial Registration: anzctr.org.au Identifier: ACTRN12608000037303 ©2013 American Medical Association. All rights reserved.
Pitkala K.,University of Helsinki |
Savikko N.,University of Helsinki |
Poysti M.,University of Helsinki |
Poysti M.,The Social Insurance Institution of Finland |
And 3 more authors.
Experimental Gerontology | Year: 2013
Numerous trials have shown that physical activity and exercise training have beneficial effects in general older populations. However, few have studied its effectiveness among people with dementia. The aim of this systematic review is to examine the efficacy of trials using a rigorous randomised, controlled design and including physical activity or exercise as a major component of intervention on the physical functioning, mobility and functional limitations of people with dementia. We found 20 randomised controlled trials that included a total of 1378 participants. Of these, only three were of high methodological quality, and six of moderate quality. Nevertheless, these studies consistently show that intensive physical rehabilitation enhances mobility and, when administered over a long period, may also improve the physical functioning of patients with dementia. © 2012 Elsevier Inc.
Hietanen J.,University of Helsinki |
Hayrinen-Immonen R.,City of Helsinki Health Center |
Al-Samadi A.,Rabieaa Medical Center Iraqi Ministry of Health |
Trokovic N.,University of Helsinki |
And 4 more authors.
Journal of Oral Pathology and Medicine | Year: 2012
Background: Recurrent aphthous ulcer (RAU) is characterized by acute and painful inflammatory ulcerations, which heal spontaneously but tend to recur. Many pathogens have been proposed as causative agents, but none has been consistently proven. According to our hypothesis, RAU is an autoinflammatory disorder triggered by pathogen-associated molecular patterns (PAMPs) shared by different pathogenic and commensal microbes. Methods: PAMP-reactive Toll-like receptors (TLRs) were mapped in oral epithelium in healthy controls compared to RAU. Results: In controls, the superficial epithelium formed a TLR -, a PAMP non-reactive physical barrier zone, but all TLRs were found deeper in the epithelium, usually restricted to suprabasal and basal cell layers. In RAU, the epithelial TLR polarity was lost: TLRs 1, 2, 5, 7, and 8 were found throughout the epithelium, but also TLRs 4, 6, and 10 extended higher up than normally, whereas TLR-3 was almost lost in RAU. In RAU lesions, connective tissue stroma was heavily infiltrated by TLR + inflammatory cells. Conclusions: Normal TLR architecture prevents inflammatory responses against normal microbes but still contains a deep TLR +, PAMP-reactive dormant defense zone. In RAU, the TLR +, PAMP-reactive zone extends to surface or subsurface exposed to microbial PAMPs. TLR reactivity is further enhanced by recruitment of inflammatory leukocytes forming a new deep line of defense. The organization of the TLR system in healthy mucosa and its changes in RAU are compatible with active pathogenic involvement of TLRs, which together with the typical clinical picture and course suggest that RAU is a TLR-mediated disease. © 2011 John Wiley & Sons A/S.
Pohjoranta E.,University of Helsinki |
Suhonen S.,City of Helsinki Health Center |
Heikinheimo O.,University of Helsinki
Acta Obstetricia et Gynecologica Scandinavica | Year: 2011
Post-abortal follow-up visits are recommended following induced abortion. To assess the rates of attendance and the factors affecting it, we performed a retrospective study of 500 women who had an induced abortion up to 20 weeks of gestation. Altogether, 285 (57%) women attended for the follow-up visit as scheduled. In univariable analysis a history of drug abuse (OR=0.22, 95%CI 0.06-0.81, p=0.02) was associated with non-attendance. Women who underwent medical abortion either at the hospital (OR=3.93, 95%CI 2.61-5.92, p<0.01) or partly at home (OR=3.30, 95%CI 1.86-5.84, p<0.01) and those with a history of human papilloma virus manifestation (OR=2.38, 95%CI 1.04-5.26, p=0.04) were more likely to attend the follow-up visit. The effects of medical abortion and a history of human papilloma virus manifestation persisted in multivariable analysis. We conclude that attendance at post-abortal follow-up visits is low, with only a few clinically significant risk factors predicting non-attendance. © 2011 The Authors.
Hakola T.,Finnish Institute of Occupational Health |
Paukkonen M.,City of Helsinki Health Center |
Pohjonen T.,Helsinki City Occupational Health Center
Industrial Health | Year: 2010
The aim of this study was to design ergonomically improved shift schedules for nurses in primary health care shift worli in order to enhance their health and well-being. The main change made was the reduction of quicli returns (i.e., no more morning sliifts immediately after an evening shift) in order to ensure more recovery time between worli shifts. Six municipal hospital units participated in the intervention. Our aim was to maintain or improve the well-being and work ability of aged workers. The subjects (n=75) were divided into three age groups: 20-40, 41-52, and 53-62 yr. The introduction of more recovery time between evening and morning shifts significantly improved the subjects' sleep and alertness, well-being at worlt, perceived health, and leisure-time activities independently of their age. The effect on social and family life was also positive. Working in shifts was the most disruptive for the youngest group of nurses. The Work Ability Index score depended on the age group: it was lowest among the oldest age group, and did not change during the intervention. Ergonomie working time arrangements show positive effects on the well-being of health care workers of all ages.
Helminen E.-E.,Kuopio University Hospital |
Helminen E.-E.,City of Helsinki Health Center |
Sinikallio S.H.,University of Eastern Finland |
Valjakka A.L.,Kuopio University Hospital |
And 3 more authors.
Clinical Rehabilitation | Year: 2015
Objective: To assess the effectiveness of a six week cognitive-behavioural group intervention in patients with knee osteoarthritis pain. Design: Single-blinded randomized controlled trial. Study setting: Primary care providers in a medium-sized city in Finland. Patients: A total of 111 participants aged from 35 to 75 with clinical symptoms and radiographic grading (Kellgren-Lawrence 2-4) of knee osteoarthritis were included. Interventions: In the intervention group, 55 participants attended a cognitive-behavioural training programme for pain management with six weekly group sessions supervised by a psychologist and a physiotherapist. Concurrently, they and the 56 participants of the control group continued in ordinary GP care that was not altered by the study. Main measures: The primary outcome on three-month and 12-month follow-up was the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis index pain subscale. Secondary outcome measures included self-reports of pain and physical function, health-related quality of life, and a comprehensive set of psychological questionnaires. Results: Mixed model results showed no significant differences between the intervention and control group for any measures of pain or function. A significant difference between the groups was found in the Pain Self-Efficacy Questionnaire (Pr = 0.022) in favour of the control group, and in the RAND-36 emotional well-being subscale in favour of the intervention group (Pr = 0.038). Conventional group comparisons of mean follow-up values showed no significant differences in any of the outcome variables. Conclusion: This trial could not confirm the hypothesized advantage of a cognitive-behavioural training programme over ordinary GP care in knee osteoarthritis pain patients. Trial registration: Current Controlled Trials ISRCTN64794760 © SAGE Publications.