Adolescent with caries and experienced interaction with dental staff.

BACKGROUND: There is a lack of studies about how adolescents experience the interaction during dental visits. The experienced interaction during dental visits will influence how adolescents take care of their oro-dental health, and how they attend at the dentist's office. AIM: To explore the interaction experiences during dental visits of 18-year-olds with or without a history of caries. DESIGN: The dental health status at age 15 years was used as a predictor of subsequent interaction experiences with the dental staff. The dental health status was assessed by the Decayed Missed Filled Teeth index and interaction experiences by the Patient Dental Staff Interaction Questionnaire. RESULTS: Adolescents with a history of caries experienced the interaction at dental visits significantly more often negatively than adolescents with healthy teeth. The association was significant after adjustment for potential confounding factors (sense of coherence, gender, and duration of maternal basic education). CONCLUSIONS: Understanding, encouraging, and appropriate interaction with adolescents with caries may make patients more positive and receptive for treatment and self-care.

Migraine predicts hypertension--a cohort study of the Finnish working-age population.

BACKGROUND: Migraine has been suggested to be associated with hypertension. The aim of the present 5-year prospective cohort study was to examine whether self-reported migraine in 1998 predicted hypertension in 2003 in a Finnish working-age population. METHODS: This cohort study consisted of 13 454 randomly selected initially non-hypertensive working-age participants of the prospective postal survey of the Health and Social Support. A total of 13 426 responses of the initial participants were linked with the register data of the Social Insurance Institution on the special reimbursement medication for hypertension. The outcome variable, hypertension, was determined according to the survey data and the register data of the Social Insurance Institution. The statistical analysis was carried out using logistic regression. RESULTS: In a multivariate model adjusted for gender, age, occupational training, living alone, metabolic equivalent of task, body mass index and alcohol consumption, self-reported migraine predicted hypertension (odds ratio 1.39; 95% confidence interval 1.19-1.64) for the self-reported and (odds ratio 1.42; 95% confidence interval 1.13-1.77) for the register data of the Social Insurance Institution. CONCLUSION: The findings may indicate a focus on hypertension screening for the working-age population with migraine.

Change in the frequency of HRT use from 2000 to 2005 and reasons to discontinue: follow-up of a normal cohort in Finland.

OBJECTIVE: To examine frequencies of the use of hormone replacement therapy (HRT) in a follow-up cohort of women aged 57-61 years in 2005 and to discover reasons why the women who used HRT in 2000 discontinued it. DESIGN: Questionnaire survey. SETTING: Five-year cross-sectional follow-up study. SAMPLE: Cohort of 52- to 56-year-old Finnish women. METHODS: Single- and multi-predictor model analyses. MAIN OUTCOME MEASURES: Frequency of HRT users and quitters and reasons behind the discontinuation. RESULTS: Altogether, 35.9% of the women aged 57-61 years used HRT in 2005. Main reasons for the initial use of HRT among users and among those who discontinued included the perceived experience of severe climacteric symptoms as well as maintenance of health and prevention of mostly cardiovascular diseases. Main reasons to discontinue HRT included desire to stay without medication, side-effects, reaction to recent controversial findings in 'HRT publications' and fear of cancer. Those women who used but discontinued HRT had used it for less time than those who continued. Women who discontinued were older and initially started using HRT to maintain health. Neither the severity of climacteric symptoms nor reporting on positive or negative effects prior to starting use had influence on the women's discontinuance of HRT. CONCLUSIONS: The use of HRT was still frequent in Finland in 2005 despite the impact of controversial research results from the early 2000s. For those who discontinued HRT, these reports played an important role.

Quality of life as an outcome of fall prevention interventions among the aged: a systematic review.

BACKGROUND: Measuring quality of life (QOL) is an important part in assessing the effects of treatments and health services on patients' well-being. This kind of an assessment should be included when assessing the effects of preventive programmes. The aim was to explore whether QOL has been used as an outcome measure in fall prevention trials and to provide a systematic review of randomized controlled trials (RCTs) that involve fall prevention interventions with an assessment of the effects on QOL among the aged. No previous systematic review about this topic among the aged was found. METHODS: A search covering various medical databases was conducted to identify RCTs about the effects of fall prevention programmes on QOL. The 12 included studies were classified according to an appraisal of the population, the method of randomization, the intervention and control programmes, the QOL measures and the results. Methodological quality was assessed in relation to blinding at outcome assessment, length of follow-up and using intention to treat analysis. RESULTS: Six studies out of 12 showed a positive effect on some dimensions of QOL (physical function, social function, vitality, mental health, environmental domain). The methods of interventions showing a positive effect varied. CONCLUSION: Only a few fall prevention studies reported a positive effect on QOL. Studies with larger sample sizes, longer follow-ups and multiple outcome measures are needed. QOL should be taken into account as an secondary outcome measure.

Treatment of climacteric symptoms in Finland prior to the controversial reports on hormone therapy.

OBJECTIVE: To examine the use of hormone therapy (HT) or alternative treatments for climacteric symptoms among women aged 52-56 years in 2000. DESIGN: Questionnaire study. SETTING: Cross-sectional Finnish female cohort in the year 2000. SAMPLE: Random sample of women aged 52-56 years. METHODS: Univariate and multivariate analysis. MAIN OUTCOME MEASURES: HT explained by 12 physical and 9 background and social variables. RESULTS: The use of HT was significantly (p<0.001) associated with the severity of climacteric symptoms, a history of not having breast cancer, oophorectomy, low body mass index, high professional education and high alcohol intake. A total of 66% of the women used some form of treatment for their climacteric symptoms. Of them, 71% used systemic HT, 25% alternative treatments (hypnotics, antidepressants, tranquillizers\, trace elements, vitamins, lifestyle modifications) and 4% local estrogens only. Altogether 33% of the women with severe climacteric symptoms did not use HT at all, whereas 27% without any symptoms used HT. CONCLUSIONS: In early 2000, almost half of the Finnish female population at menopause used HT to alleviate their climacteric symptoms. The impact of the controversial reports on HT use after the time of data collection needs further study.

Gender differences in sex life issues - a population-based study of migraine sufferers.

BACKGROUND: Migraine is considered to have a negative influence on sex life. The present study was to analyse the perceptions of importance of and satisfaction with sex life as well as the expression of interest in sex among people having migraines in a prospective follow-up mail survey in 1998 and 2003. METHODS: The random sample was stratified according to gender and age in four age groups (20-24, 30-34, 40-44, and 50-54 years). Altogether 25 898 individuals responded to the baseline and 19 626 to the follow-up questionnaire (75.8% response rate). We examined as to how the perceptions of sex life of those suffering from migraine changed during a 5-year follow-up. Conditional logistic regression was used to analyse the data of the responses on self-reported migraine in the baseline and follow-up surveys (N = 2 977, 79.2% women). Each person with migraine was assigned a gender- and age-matched control in the analysis. RESULTS: All three outcome variables tended to decrease in value. Importance of sex life was higher among men with migraine than among their controls. Among women migraine lessened interest in sex life. CONCLUSION: Our findings suggested that migraine has a different impact on sex life among women from that among men.

Effects of an intervention on health behaviors of older coronary artery bypass (CAB) patients.

Coronary artery bypass (CAB) patients are older increasingly more often than before. Effectiveness of cardiac rehabilitation among the elderly is not yet adequately known about. The purpose was to describe short-term (3-month), intermediate (6-month), and long-term (12-month) effects of health counseling, guidance, and adjustment education in groups on health, health behaviors, and functional abilities among older CAB patients. The study population was randomized to an intervention group (IG=49) and a control group (CG=68). Prior to CAB, intervention included one guidance and counseling group session and four sessions within 12 months following CAB. Intervention had positive effects on exercise activities, use of alcohol, and functional abilities among all participants, and on frequency of eating visible fat, fresh greens and vegetables among men. The intervention was effective with some exercise activities and functional abilities persisting for at least 1 year following CAB. Similar interventions may be arranged for older people. Health care professionals need to guide and encourage older people in their efforts to participate in them.

Sexual activity and perceived health among Finnish middle-aged women.

BACKGROUND: An increasing awareness of the need to address sexual and orgasm experiences as part of life quality and an understanding of the great individual differences between women play roles in women's health and medical care across the specialities. Information is lacking as to how negative attitude toward self (NATS) and performance impairment (PI) are associated with sexual activity of middle-aged women. We examined the associations of sexual experience, orgasm experience, and lack of sexual desire with perceived health and potential explanatory variables of NATS and PI. METHODS: Questionnaire was mailed to 2 population-based random samples of menopausal or soon-to-be menopausal women (n = 5510, 70% response) stratified according to age (42-46 and 52-56 years). In multivariate analyses of the associations with the outcome variables, perceived health, NATS, and PI were used as covariates in 6 models in which exercise, menstrual symptoms, and illness indicators were taken into account as well. RESULTS: Sexual activity variables were associated with perceived health. When present, NATS formed associations with sexual and orgasm experiences, whereas strenuous exercise formed associations with orgasm among 42-46-year-old women alone. Strenuous exercise was not associated with orgasm experience among older women. CONCLUSION: NATS and PI are closely tied to orgasm experiences and the meaning of the roles needs to be exposed. Sexual activity deserves to be addressed more actively in patient contact at least with perimenopausal women.

To have or not to have a pet for better health?

BACKGROUND: Pet ownership is thought to have health benefits, but not all scientific explorations have been founded on proper applications of representative samples or statistically correct methodologies. Databanks have been too small for proper statistical analyses; or, instead of a random sample, participation has been voluntary. The direction of causality has been evaluated incorrectly or control of relevant factors noted deficient. This study examined the associations of pet ownership with perceived health and disease indicators by taking into account socio-demographic background factors together with health risk factors, including exercise. METHODOLOGY/PRINCIPAL FINDINGS: The present study used baseline data from the 15-year Health and Social Support Study (the HeSSup Study). The Finnish Population Register Centre was used to draw population-based random samples stratified according to gender and four age groups (20-24, 30-34, 40-44, and 50-54 years). A total of 21,101 working-aged Finns responded to the baseline survey questionnaire of the 15-year HeSSup Study in 1998. Ordinal and binary logistic regression was used to analyze the cross-sectional data. Pet ownership was associated with poor rather than good perceived health. BMI surfaced as the risk factor most strongly associated with pet ownership. CONCLUSIONS/SIGNIFICANCE: Pet owners set in their ways and getting older were found to have a slightly higher BMI than the rest. Additional research is needed for the testing of hypotheses involving effects of pet ownership with various health dimensions within population groups that are composed of different kinds of background characteristics.

Effects of a controlled family-based health education/counseling intervention.

OBJECTIVE: To describe the effects of a controlled family-based health education/counseling intervention on health behaviors of children with a familial history of cardiovascular diseases (FH-CVDs). METHODS: The intervention group (IG, n=432) received 5 counseling sessions. The control groups 1 (CG1, n=200) and 2 (CG2, n=423) received no counseling. Outcome measures comprised changes in diet, exercise, and cigarette smoking. RESULTS: The changes in the use of fats and salt, and in exercise, were more favorable in IG than in CG1 and/or CG2. CONCLUSION: Health education/counseling produced positive effects on diet and nutrition in particular and in part in exercise.

Will the role of family influence dental caries among seven-year-old children?

The present study analyzed the prevalence of dental caries as well as associations of dental health and family competence among 7-year-old children and their families. Dental caries status was the outcome variable of the 7-year prospective follow-up study. Pre-tested questionnaires were used to gather data individually from the parents at six points in time (at the public maternity health-care clinic during the mother's pregnancy and at childbirth, at the well-baby clinic at 18 months, and at ages 3, 5, and 7 years). Clinical examinations at dental health-care clinics were used to record dental status indicators of the child at ages 3, 5, and 7 years. A child had caries more often when the mother did not regard it as important to teach a healthy lifestyle right from birth; when the mother undervalued consistent action in child-rearing; when the father preferred merely to explain the causes and consequences during child-rearing (giving no examples); when the father had several new carious teeth per year; when the child consumed sweets several times a week; or when the child's toothbrushing was infrequent. The child's daily dental health behaviors and a strong influence of family competence emerged in the final logistic regression analysis. Dental and well-baby clinic staff members need to discuss consistency in child-rearing with the parents and there is a need for modeling adult dental health behaviors at the time of the mother's pregnancy if the child's future preventive dental health is to function properly.

Associations of social support and sex life--the HeSSup Study.

The present study characterized the associations of three sex life issues (importance of, satisfaction with, and ease in talking about sex life) with social support and reciprocity. We utilised survey data of working-aged men and women (n = 21,101) from the population-based random sample of the Health and Social Support (HeSSup) Study (40% response). The respondents with abundant social support considered sex life important, were satisfied with it, and found it easy to talk about sex life more often than those with less social support. Social support in sex life offered by one's own spouse/partner was important particularly to women, not available from the other sources to the same extent. Friends functioned as significant positive sources of support in sex life particularly among women, but relatives did not. Mutual reciprocity was associated with favourable perceptions of sex life. Persons lacking established primary social support should have easy access to services.

Effects of a health advocacy, counselling, and activation programme on depressive symptoms in older coronary heart disease patients.

OBJECTIVES: To describe the effects of a health advocacy, counselling, and activation programme on depressive symptoms among older coronary heart disease (CHD) patients. METHODS: A randomised, controlled intervention study in Lieto, South-western Finland. Older (65 years and older) patients with CHD were randomly divided into an intervention group (IG) (n = 116) and a control group (CG) (n = 106). Outcome measures comprised changes in depressive symptoms (Zung Self-rating Depression Scale, ZSDS). RESULTS: Depressive symptoms tended to decrease in IG and to increase in CG among men scoring 45 ZSDS sum points or more at baseline. The differences of the changes between IG and CG were significant in favour of IG. No similar changes were found among women. CONCLUSIONS: A health advocacy, counselling, and activation programme aimed to increase knowledge about CHD, social activities, contacts, roles, support, and exercising was effective in reducing depressive symptoms among male CHD patients suffering from a moderate or high amount of depressive symptoms.

Effects of health advocacy, counseling, and activation among older coronary heart disease (CHD) patients.

BACKGROUND AND AIMS: Coronary heart disease (CHD) is common and the majority of CHD patients are 65 years or older. There exist only a few randomized, controlled intervention studies on secondary prevention of CHD among elderly CHD patients. Our study assessed the effects of health advocacy, counseling, and activation programs with outcome variables of changes in the use of fats, lipid-lowering medications, frequency of exercise, cigarette smoking, serum cholesterol and triglyceride concentrations, blood pressure, and symptoms of late-life CHD among CHD patients of the Lieto Study. METHODS: Randomized, controlled intervention study. Late-life (> or = 65 yrs) CHD patients were randomized into intervention group (IG) (n = 118) and control group (CG) (n = 109). Intervention consisted of 16 lectures by experts, eight group discussions, six group exercise sessions, and three social activity events. RESULTS: The use of lipid-lowering medications became more common in IG than in CG among men (p = 0.041), with a similar tendency among women. Among women, decreases in the means of total serum cholesterol (p = 0.009) and LDL-cholesterol (p = 0.049) were greater in IG than in CG. CONCLUSIONS: The program produced no positive effects on health behavior. Positive effects were gained by the increase in lipid-lowering medications, which reduced mean total serum cholesterol and LDL-cholesterol concentrations. More intensive counseling on health behavior should be planned, implemented, and evaluated.

Analysing the use of hospital care services in Finland.

Hospital care captures more than one half of the funds allocated for health care within municipalities in Finland. Municipal administrators perceive that there is little they can do as far the quantity and quality of services are concerned. This case study was to analyse the utilization of hospital care within a coalition of two municipalities (Paimio and Sauvo) for one year. By using the Diagnosis Related Groups and Main Diagnostic Categorizations and by comparing the data with the existing physician visits, health care decisions may be made regarding the general morbidity and the use of medical services. While the databases number among the most extensive in the world, the existing information has not been fully utilized for planning, implementation and evaluation of services within the municipalities.

Sexual activity and background variables among Finnish middle-aged women.

OBJECTIVE: To characterize the associations of sexual experience, orgasm experience, and lack of sexual desire with background variables. METHODS: Questionnaire was mailed to population-based samples (n=5510, 70% response) of soon-to-be-menopausal (aged 42-46 years) and menopausal (aged 52-56 years) women. RESULTS: Being married/having a spouse meant more sexual activity for both groups but also the likelihood to experience lack of sexual desire. Hormones emerged as the most important perceived reason for lack of sexual desire. CONCLUSION: The findings indicated a discrepancy between the reported frequencies of sexual experiences/orgasms with spouse and lack of desire.

Recurrent antibiotic use in a small child and the effects on the family.

OBJECTIVE: To determine the typical characteristics of small children on recurrent therapy with antibiotics (RTA) and the effects RTA have on the families. DESIGN: Stratified randomised cluster sampling. SETTING: An unselected population-based questionnaire study in Finland. SUBJECTS: Parents (n = 1443) expecting their first child were followed prospectively from the mother's early pregnancy until the child was 18 months of age. MAIN OUTCOME MEASURES: The outcome measure was the number of courses of antibiotic therapy (options: 011-51 > or = 6) during the child's first 18 months of life. Six or more courses were considered RTA. Associated variables were child- and family-related factors during the child's first 18 months of life. RESULTS: Children on RTA were taken to see a physician more often than other children when they had fever or a common cold. RTA was significantly associated with the child's day care outside the home, allergy and need for a special diet. The father's severe stress was associated with the child's RTA. Breastfeeding lasting more than 3 months was found to have a protective effect against RTA. CONCLUSION: The threshold for seeking medical help was low in the families of children on RTA, which is best avoided by breastfeeding and day care at home. Health care staff should not forget to support families, especially the fathers, with children experiencing recurrent infections.

Change in the prevalence of coronary heart disease among Finnish elderly men and women in the 1990s.

OBJECTIVE: To characterise the prevalence of, and changes in, coronary heart disease (CHD) among men and women aged between 64 and 71 years in the 1990s. DESIGN: A study of clinical epidemiology involving two cohorts of elderly persons in 1990-1991 and 1998-1999. SETTING: Primary health care in the municipality of Lieto in southwestern Finland. SUBJECTS: Persons between 64 and 71 years of age in the southwest of Finland in 1990-1991 and 1998-1999. MAIN OUTCOME MEASURES: The occurrences of CHD were estimated using the history of a previous myocardial infarction or coronary revascularisation procedure evident in the medical records and with ischaemia or infarction as established on ECG according to the Whitehall criteria. RESULTS: The prevalence of 'probable' CHD decreased among men and women aged between 64 and 71 years, whereas the prevalence of 'possible' CHD decreased among women alone. Silent myocardial infarctions were common among women of both cohorts. Many more men of the second cohort, compared to the first one, had undergone a coronary angioplasty or bypass operation. CONCLUSION: The prevalence of CHD decreased among elderly women more clearly than among young elderly men. The favourable development illustrating a decrease in the prevalence of CHD among women should be sustained, while health promotion activities will need to be directed more actively towards men.

Social support, early retirement, and a retirement preference: a study of 10,489 Finnish adults.

The aim of the study was to examine associations of social support with early retirement and reported retirement preference. Logistic regression analyses of early retirement (retired before the age of 55) were based on a cohort of 10,489 respondents (5960 female, 4529 male) aged 40-55 years. Analyses of retirement preference (planning of early retirement) were based on a sub-cohort of 7759 full-time employees (4233 female, 3526 male). The measures for social support were the social network size (number of close personal relationships) and social network heterogeneity (number of different roles as sources of social support). Among women, early retirement was associated with small social networks (OR 5.1, 95% CI = 2.8-9.2) and low social network heterogeneity (OR 9.1, 95% CI = 3.2-25.9). Among men, the corresponding associations were somewhat smaller (1.5; 0.9-2.6 and 8.0; 1.8-35.7, respectively). Adjustments for age, occupational training, and spouse at home did not considerably affect these associations. Among men, the association between social network heterogeneity and early retirement was not statistically significant after additional adjustments had been made for marital status and perceived health status. The characteristics of the social network were not associated with a retirement preference among employed men. Among women, the lack of social relations was associated with low retirement preference. Our findings suggested that social support is not independently associated with a retirement preference among men. Socially isolated women prefer retirement less often than other women do. Being retired before the age of 55 years may be predicted by limited social support or it may restrain one's possibilities to establish and maintain social relationships.