[Pregnancy contraception (Current Care Guideline)]. / KÄYPÄ HOITO -SUOSITUS (Tiivistelmä). Raskauden ehkäisy.

There are no age limits for the start or use of contraception. Prior gynecological examination or cervical smear is not needed. Condom is the only method that protects from sexually transmitted diseases. An increase in the risk of venous thromboembolism (VTE) is associated only with combined contraceptives. However, the risk is remarkably higher with pregnancy, puerperium or with smoking. The most effective reversible methods are intrauterine devices (IUD) and implants, as these do not depend on daily memory. Natural family planning methods are not reliable, and effective contraception should be easily available for all at all times.

Is nicotine replacement therapy overvalued in smoking cessation? Analysis of smokers' and quitters' communication in social media.

BACKGROUND: Internet discussion forums provide new, albeit less used data sources for exploring personal experiences of illness and treatment strategies. OBJECTIVE: To gain an understanding of how discussion forum participants value nicotine replacement therapy (NRT) in smoking cessation (SC). SETTING: Finnish national Internet-based discussion forum, STUMPPI, supporting SC and consisting of ten free discussion areas, each with a different focus. The analysis was based on STUMPPI forum participants' postings (n = 24 481) in five discussion areas during January 2007-January 2012. DESIGN: Inductive content analysis of the postings concerning NRT use or comparing NRT to other SC methods. RESULTS: Three major themes related to NRT in SC emerged from the discussions. These were as follows: (I) distrust and negative attitude towards NRT; (II) neutral acceptance of NRT as a useful SC method; and (III) trust on the crucial role of NRT and other SC medicines. The negative attitude was related to following perceptions: NRT use maintains tobacco dependence, fear of NRT dependence or experience of not gaining help from NRT use. NRT was perceived to be useful particularly in the initiation of SC attempts and in dealing with physiological dependence. The most highlighted factors of successful quitting were quitters' own psychological empowerment and peer support from the discussion community. CONCLUSIONS: The majority of STUMPPI forum participants had low or balanced expectations towards the role of NRT in SC. More research from the smokers' and quitters' perspective is needed to assess the real value of NRT compared to other methods in SC.

Is pharmaceutical policy evidence-informed? A case of the deregulation process of nicotine replacement therapy products in Finland.

OBJECTIVE: This qualitative study aims to identify the key dimensions of the political argumentation in the debate leading up to the deregulation of nicotine replacement therapy products (NRT) in Finland in 2006. The deregulation was introduced by the Amendment of larger package of changes in medical legislation prepared in 2005. METHODS: All publicly available documents of the legislative process introducing NRT deregulation and interviews of 12 Members of Finnish Parliament conducted in spring 2006 were analyzed by inductive content analysis. RESULTS: NRT deregulation was introduced to decision-makers as a safe intervention to increase smoking cessation and thus provide public health benefits. However, a whole variety of other features were brought into debate: NRT characteristics, principle change in prevailing medical legislation, use of evidence and the political process. Finally, the expected public health benefits of the decision were not directly informed by any evidence. CONCLUSIONS: This study provides an example of the use of public health benefits as justification for decision-making. However, the decision can include other aspects, less brought up in its preparation stage. Our study addresses the need for policymakers to critically evaluate the evidence, its suitability in decision-making context and raise awareness of the principles of evidence-informed policy-making.

Community pharmacists' involvement in smoking cessation: familiarity and implementation of the National smoking cessation guideline in Finland.

BACKGROUND: Guidelines on smoking cessation (SC) emphasize healthcare cooperation and community pharmacists' involvement. This study explored the familiarity and implementation of the National SC Guideline in Finnish community pharmacies, factors relating to Guideline familiarity, implementation and provision of SC services. METHODS: A nationwide mail survey was sent to a systematic, sample of community pharmacy owners and staff pharmacists (total n = 2291). Response rate was 54% (n = 1190). Factors related to the SC Guideline familiarity were assessed by bivariate and multivariate analysis. RESULTS: Almost half (47%) of the respondents (n = 1190) were familiar with the SC Guideline and familiarity enhanced Guideline implementation. The familiarity was associated with the respondents' perceptions of their personal SC skills and knowledge (OR 3.8); of customers' value of counseling on nicotine replacement therapy (NRT) (OR 3.3); and regular use of a pocket card supporting SC counseling (OR 3.0). Pharmacists' workplaces' characteristics, such as size and geographical location were not associated with familiarity. In addition to recommending NRT, the pharmacists familiar with the Guideline used more frequently other Guideline-based SC methods, such as recommended non-pharmacological SC aids, compared to unfamiliar respondents. CONCLUSIONS: SC Guideline familiarity and implementation is crucial for community pharmacists' involvement in SC actions in addition to selling NRT products. Pharmacists can constitute a potential public health resource in SC easily accessible throughout the country.

Nicotine replacement therapy practices in Finland one year after deregulation of the product sales--has anything changed from the community pharmacy perspective?

OBJECTIVE: According to the Finnish national Current Care Guideline of smoking cessation (SC), pharmacists' task is to support rational and safe use of NRT products. In 2006, the Medical Act releasing NRT from pharmacy only to general sales was amended. This study assesses the Finnish pharmacy owners' and staff pharmacists' perceptions of NRT products' role and usage patterns about a year after the deregulation. METHODS: A nationwide survey was conducted, targeting every second Finnish pharmacy owner and staff pharmacist (n=2291), working in community pharmacies. Response rate 54% (n=1190). RESULTS: According to respondents, inappropriate usage of NRT, like possible addiction, products' misuse or use in harm reduction purposes, exists in Finland. NRT sales have decreased at pharmacies and clients obtain only the counselling for NRT at pharmacy but buy the products elsewhere. The motivation to counsel NRT customers has diminished among 30% of pharmacy owners and 17% of staff pharmacists. Still the respondents found that it is pharmacists' duty to offer SC counselling and NRT important in SC. CONCLUSIONS: Despite NRT products' sales at pharmacies having decreased and especially pharmacy owners' motivation to counsel NRT usage having diminished, pharmacists still see it as their duty to guide and support SC.

Utilization of a community pharmacy-operated national drug information call center in Finland.

BACKGROUND: Provision of drug information has been identified as a key strategy to prevent adverse drug events; however, provision of drug information in face-to-face consultations between patients and health professionals is often suboptimal. OBJECTIVE: The objective of the study was to analyze and describe utilization of a community pharmacy-operated national drug information call center. The special focus was on calls concerning prescription drugs. METHOD: Trained pharmacists (n=20) recorded data from all telephone calls made to the Helsinki University Pharmacy drug information call center over a 1-week period by using a structured data collection instrument. Data of this cross-sectional study were quantitatively content-analyzed to compute descriptive statistics. RESULTS: Data were recorded for 2196 calls, 56% of which were drug-related. Of the drug-related calls, 79% were related to prescription drugs. The majority (83%) of these calls were therapeutic or pharmaceutical inquiries, with 26% concerning costs and reimbursements, 14% interactions, 14% dosages, and 11% adverse effects. Nervous system drugs (Anatomical Therapeutic Chemical [ATC] classification N), anti-infectives (J), and musculoskeletal drugs (M) accounted for 20%, 18%, and 13% of the calls, respectively. Nonsteroidal anti-inflammatory drugs (NSAID) (9% of the calls), antidepressants (6%), and penicillin (5%) were the most often inquired about ATC-subgroups. A majority (82%) of the callers were estimated to be between 20 and 60 years of age. CONCLUSION: Consumers appear to have multiple unmet drug information needs. This may especially be the case for certain population groups, and in regard to nervous system drugs, anti-infectives and NSAID. Drug information call centers operated by community pharmacies could complement face-to-face information provided by health professionals.

Medicine use by Finnish female conscripts during voluntary military service.

OBJECTIVE: The goal was to assess the prevalence of prescribed and nonprescribed medicine use, use predictors, and origin of medicines for Finnish female conscripts during their voluntary military service. METHODS: An anonymous mail survey was conducted in April 1999 among all Finnish female conscripts on duty. RESULTS: Of the respondents (N = 177; response rate, 68%), 61% had used at least one medicine in the 2 weeks preceding the study, 44% prescribed and 31% nonprescribed medicines. Most of the prescribed medicines were provided by Finnish Defence Forces health care, whereas most of the nonprescribed medicines were of civilian origin. The consumption of prescribed and nonprescribed medicines was differently related to respondents' background variables. Common overall medicine use and use of over-the-counter analgesics and stimulants and their association with potentially negative health behaviors may contribute to inappropriate medicine use. CONCLUSION: Finnish female conscripts commonly use prescribed and nonprescribed medicines. The importance of sufficient medication information for female conscripts is emphasized.

Immigration within European Union - Does health immigration make a difference in analgesic use?

European integration has facilitated the emigration inside Europe and it has been predicted that the amount of immigrants in Southern European countries will increase in the future. As these people age and their morbidity increases, they will demand more services from local health care than immigrants do at the moment. The aim of this study is to determine the amount of Finnish people who have moved to Spain for health reasons (health immigrants) and whether their health service and analgesic usage patterns differed from those of non-health immigrants. Methods: This study was carried out among Finnish people living in Costa del Sol area, southern Spain. The data were collected by questionnaire during 2002 by using a convenience sample of 1,000 Finns living permanently in the area (response rate 53%, n=530). Statistical analyses were conducted using statistical software SPSS 11.5. Results: Two-thirds of the respondents were categorised as health immigrants. Health immigrants were more often suffering from chronic morbidity, their perceived health status was poorer and they used public health services more often than the non-health immigrants. Half (50%) of the all respondents had used some analgesics during the two weeks before the survey. There were more analgesic users among the health immigrant group (54 % vs. 43 %, p = 0.034) and they also used analgesics more frequently than the non-health immigrants (27 % vs. 9 %, p= 0.020). Conclusions: Our study indicates, that high amount of Finnish immigrants suffer from some degree of health problems and the health state factors have a large influence on the emigration into Spain. As this kind of trend might also exist among immigrants from other EU-nations, immigrants might burden the local Spanish health care services in the future. Therefore the Providers of health care services in immigrant areas should consider these trends in planning health care in the future (AU)

La integración europea ha facilitado la emigración dentro de Europa y se ha previsto que la cantidad de emigrantes en los países del sur se incrementará en el futuro. A medida que esta gente envejezca y su morbilidad aumente, demandarán más servicios de la sanidad local de lo que lo hacen en la actualidad. El objetivo de este estudio es determinar la cantidad de finlandeses que se han trasladado a España por razones de salud (inmigrantes de salud) y si sus servicios sanitarios y patrón de uso de analgésicos difieren de los no inmigrantes de salud. Métodos: Este estudio se llevó a cabo entre los finlandeses que viven en el área de la Costa del Sol, sur de España. Los datos se recogieron con un cuestionario durante el 2002 utilizando una muestra de conveniencia de 1.000 finlandeses que viven permanentemente en el área (tasa de respuesta 53%, n=530). Se realizaron análisis estadísticos usando la aplicación SPSS 11.5. Resultados: dos tercios de los respondedores fueron calificados de inmigrantes de salud. Los inmigrantes de salud sufrían con mas frecuencia enfermedades crónicas, percibían que si salud era peor, y usaban los servicios sanitarios públicos más que los no inmigrantes de salud. La mitad (50%) de todos los respondedores habían usado algún analgésico en las dos semanas entes del estudio. Había más usuarios de analgésicos entre los inmigrantes de salud que en los otros (54 % vs. 43 %, p = 0.034) y también utilizaban analgésicos con más frecuencia (27 % vs. 9 %, p= 0.020). Conclusiones: Nuestro estudio indica que una elevada proporción de inmigrantes finlandeses sufren problemas de salud en algún grado y que las variables del estado de salud tienen una gran influencia en la emigración a España. Como este tipo de tendencia puede existir en inmigrantes de otras naciones de la UE, en el futuro los inmigrantes pueden dañar los servicios sanitarios españoles. Por tanto, los proveedores de servicios sanitarios en las áreas de inmigrantes deberían considerar esta tendencia para planificar la sanidad en el futuro (AU)

Effect of quinpirole on striatal dopamine release and locomotor activity in nicotine-treated mice.

The effect of chronic oral nicotine treatment which in its intermittent delivery resembles human smoking was studied on the sensitivity of dopamine autoreceptors in mice. On the 50th day of nicotine administration in the drinking water or after 23-25 h withdrawal quinpirole (D2/D3 agonist, 0.01-0.1 mg/kg s.c.) was given, and accumbal and dorsal striatal dopamine outflow, locomotor activity and body temperature were measured. Dorsal striatal extracellular dopamine concentration and locomotor activity were found to be elevated during nicotine administration. Chronic nicotine did not alter the effects of small, autoreceptor preferring doses of quinpirole on accumbal or dorsal striatal dopamine, locomotor activity or body temperature. However, quinpirole's locomotor activity reducing effect was slightly diminished in mice treated repeatedly with nicotine (0.4 mg/kg twice daily for 10 days s.c.). Thus, although repeated nicotine treatment for 5-14 days decreases dopamine autoreceptor sensitivity, after long-term oral nicotine treatment such a decrease is not seen. Thus, the changes occurring in the sensitivity of D2-like dopamine receptors probably play a minor role in regulating the dopaminergic transmission during long-term nicotine administration.

Self-medication with antibiotics--does it really happen in Europe?

AIMS AND METHODS: The aim of this study was to determine whether antibiotics are used for self-medication in southern Spain, a region belonging to European Union. The data were collected by a survey in the Costa del Sol region, Spain during 2002 by using a convenience sample of 1000 Finns living permanently in the area (response rate 53%, n=530). RESULTS: Antibiotics were used by 28% of the respondents during the previous 6 months before the query. Of the antibiotic users, 41% had bought their antibiotics without a prescription. Clearly the most common indication for antibiotic use was common cold, with almost half (45%) of the antibiotic users reporting it as purpose of medication, followed by sore throat (17%). The number of courses did not differ between prescription and non-prescription antibiotic users, most (64%) of the users having used one course. Neither did the groups differ according to background variables used, including the frequency of experiencing adverse reactions. CONCLUSIONS: Unnecessary and unrational self-medication with antibiotics seems to be common in southern Spain among Finnish immigrants. This may indicate that Spanish health care system, including community pharmacies are failing their task in enhancing rational use of medicines. It is important that all the member countries within EU will take their responsibility in promoting public health goals in their national policy, e.g., in minimising the antibiotic resistance for expanding.

Immigration within European Union - Does health immigration make a difference in analgesic use?

UNLABELLED: European integration has facilitated the emigration inside Europe and it has been predicted that the amount of immigrants in Southern European countries will increase in the future. As these people age and their morbidity increases, they will demand more services from local health care than immigrants do at the moment. The aim of this study is to determine the amount of Finnish people who have moved to Spain for health reasons (health immigrants) and whether their health service and analgesic usage patterns differed from those of non-health immigrants. METHODS: This study was carried out among Finnish people living in Costa del Sol area, southern Spain. The data were collected by questionnaire during 2002 by using a convenience sample of 1,000 Finns living permanently in the area (response rate 53%, n=530). Statistical analyses were conducted using statistical software SPSS 11.5. RESULTS: Two-thirds of the respondents were categorised as health immigrants. Health immigrants were more often suffering from chronic morbidity, their perceived health status was poorer and they used public health services more often than the non-health immigrants. Half (50%) of the all respondents had used some analgesics during the two weeks before the survey. There were more analgesic users among the health immigrant group (54 % vs. 43 %, p = 0.034) and they also used analgesics more frequently than the non-health immigrants (27 % vs. 9 %, p= 0.020). CONCLUSIONS: Our study indicates, that high amount of Finnish immigrants suffer from some degree of health problems and the health state factors have a large influence on the emigration into Spain. As this kind of trend might also exist among immigrants from other EU-nations, immigrants might burden the local Spanish health care services in the future. Therefore the Providers of health care services in immigrant areas should consider these trends in planning health care in the future.

Self-medication among Finnish young men in the beginning of common military service.

PURPOSE: Little is known about self-medication in adolescent and young adult males, particularly in ones exposed to increased stress. The objective of this article is to analyze self-medication and its predictors in young Finnish men at entry into common military service. METHODS: The responding men (n = 857) from nine brigades anonymously completed a self-administered questionnaire during the first conscription days before active military training in July 1999. The effect of pre-disposing, need and health behavior variables on self-medication was assessed using Andersen et al. theoretical health care utilization model. RESULTS: In the 2 weeks preceding the survey, 65% of the men reported self-medication. Self-medication for pain or common cold symptoms was reported by 54% while 8% had taken caffeine tablets or other stimulants. Multivariate analysis on overall self-medication showed an association with brigade and using health services before the conscription. Along with pre-disposing variables, need variables were associated with self-medication for pain or common cold symptoms and self-medication with stimulants. Stimulant use was also associated with health behaviors such as trial with illegal drugs during lifetime. CONCLUSIONS: Young men frequently self-medicate at the initial stage of conscription that may pose them at an increased risk for adverse effects of medicines or other medical problems. The military and civilian primary health care providers should discuss the proper use of self-medication with young men.

Asthma medication in Finnish olympic athletes: no signs of inhaled beta2-agonist overuse.

INTRODUCTION: Occurrence of asthma has been reported to be frequent in endurance athletes and especially high in winter sport athletes. Recently, the International Olympic Committee has restricted the use of inhaled beta2-agonists and requires documentation for their use. However, epidemiologic data comparing the use of antiasthmatic medication in different sport events are mostly missing. METHODS: A cross-sectional questionnaire survey was carried out in 2002. All the athletes (N = 494) financially supported by National Olympic Committee comprised the study group. Of them, 446 (90.3%) filled in a structured questionnaire concerning asthma and allergies, use of medication, characteristics of sport activities, and smoking habits. A representative sample of Finnish young adults (N = 1 504) served as controls. RESULTS: Physician-diagnosed asthma was more common in athletes as compared with controls (13.9% vs 8.4%). Use of any asthma medication was reported by 9.6% of the athletes and by 4.2% of the controls. No difference was observed in the frequency of asthma medication used by winter or summer sport athletes (10.0% vs 9.4%). Inhaled beta2-agonists were used by 7.4% and 3.0% of the athletes and controls, respectively. After adjusting for age, sex, and smoking, odds ratio with 95% confidence interval for use of any asthma medication was 0.69 (0.17-2.92) for motor skills demanding events, 1.87 (0.85-4.11) for speed and power sports, 3.00 (1.68-5.37) for team sports, and 4.16 (2.22-7.78) for endurance events as compared with controls. None of the athletes used antiasthmatic medication without physician diagnosis. CONCLUSIONS: The frequency of antiasthmatic medication is clearly lower than the occurrence of physician-diagnosed asthma in Finnish Olympic athletes. No evidence of overuse of inhaled beta2-agonists is found.

Pineal melatonin and brain transmitter monoamines in CBA mice during chronic oral nicotine administration.

The effects of chronic oral nicotine administration on the pineal melatonin and brain transmitter monoamines were studied in male CBA mice, which possess a clear daily rhythm of melatonin secretion. On the 50th day of nicotine administration, pineal melatonin as well as cerebral dopamine (DA), 3,4-dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), norepinephrine (NE), 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG), serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) concentrations were determined at various times. The chronic nicotine treatment did not alter the timing of the pineal melatonin peak, which occurred at 10 h after the light offset. However, in mice drinking nicotine solution, the nocturnal pineal melatonin levels were lower than in control mice drinking tap water. The chronic nicotine treatment increased the striatal DA, DOPAC, HVA and 5-HIAA levels, the hypothalamic NE, MHPG and 5-HIAA and the cortical MHPG. Most prominent effects of nicotine were found at 8 h after the light offset, when the striatal levels of DA and HVA, hypothalamic NE and MHPG as well as cortical MHPG were significantly elevated in the nicotine-treated mice compared with the control mice. No direct correlation between nicotine's effects on brain transmitter monoamines and on pineal melatonin levels was apparent. The results suggest that chronic nicotine treatment slightly suppresses the melatonin production but does not alter the daily rhythm of pineal melatonin in mice maintained on a light-dark cycle. However, the results indicate that nicotinic receptors might be involved in the regulation of pineal function.

Patient counselling profile in a Finnish pharmacy.

The present study assessed the patient satisfaction on Finnish community pharmacy services with a special focus on patient counselling. Two different study methods were performed in one Finnish community pharmacy to clarify the patient counselling profile. In autumn 1996, 200 of local citizens were interviewed and a questionnaire has been filled by the pharmacists after counselled episodes. The patient opinion of counselling showed that counselling by pharmacists is beneficial for their medication. Furthermore, pharmacists seem to be more active with the patients receiving prescription drugs. According to our results pharmacists should adjust more counselling to every patients needs. Thus, pharmaceutical information and support of self-care were found to be important areas in patient counselling.

A qualitative study of the difficulties of smoking cessation; health care professionals' and smokers' points of view.

OBJECTIVE: To obtain a deeper understanding of smokers feelings and to establish co-operative networking groups, the opinions about smoking cessation of health care professionals and smokers were studied. DESIGN: Focus group discussions were held in order to gain ideas and tools to be used in smoking cessation work, in particular in network groups. Two focus group discussion for health care professionals (n = 7) and one focus group discussion for ex-smokers/smokers (n = 3) were held. RESULTS: The study suggests that problems exist in smoking cessation work among health care professionals. The main issues among the health care professionals were lack of motivation and consistency of approach. Information concerning the health risk related to smoking no longer reaches people. New ways of health promotion are desired. Smokers feel that lack of positive support and nicotine dependence are the main problems in their attempts to quit. CONCLUSIONS: Society and smokers have the same goal: smoking cessation. However, both parties do not seem to agree on ways of achieving this goal. A local network among health care professionals could motivate and give rise to new methods of smoking cessation counselling. Positive support and nicotine replacement therapy could significantly improve smokers success rates. Trained personnel have better opportunities for meeting smokers and that is why cessation should be part of the core curriculum and basic training for health care professionals.