Health and life style among infertile men and women.

OBJECTIVE: Lifetime prevalence of infertility among couples is approximately 10-15%, but studies addressing their health behavior are few. Our aim was to describe health and life style of Finnish men and women who had experienced infertility. DESIGN: Cross-sectional survey. SETTING: Finland. POPULATION AND METHODS: Data from a population-based survey (n=7021) was utilized. Life style of infertile men (n=289) and women (n=155) were compared to other men and fertile women. MAIN OUTCOME MEASURES: Life style (dietary factors, use of alcohol, physical activity), reproductive factors, other diseases and symptoms. RESULTS: After adjusting for age, area and education, infertile women under 50 years consumed more polyunsaturated fat (OR 1.23, 95% CI 1.03-1.46), less saturated fat (OR 0.83, 95% CI 0.74-0.92) and had experienced more hangovers during previous year (OR 1.02, 95% CI 1.00-1.05) than fertile women. Infertile men under 50 years consumed more total fat (OR 1.06, 95% CI 1.03-1.10), polyunsaturated fat (OR 1.20, 95% CI 1.05-1.37) and monounsaturated fat (OR 1.17, 95% CI 1.06-1.28) compared to other men. Infertile men did not consume more alcohol nor smoke more cigarettes but reported more often allergies than fertile men. Infertile women also had Chlamydia trachomatis infection, benign tumor in their uterus and intestinal disease more often than fertile women. Infertile women over 50 years were more often current smokers than fertile women, but the differences in other age-groups were not significant. CONCLUSIONS: Women with infertility experience reported more diseases and less use of oral contraceptives than other women, possibly reflecting reasons to infertility. Since both infertility and unhealthy use of alcohol are an increasing public health issues in western societies, more attention should be paid towards life style, especially alcohol use of infertile women.

Use of mental health services and complementary and alternative medicine in persons with common mental disorders.

OBJECTIVE: Few studies investigated the use of complementary and alternative medicine (CAM) by subjects with mental disorders. We examined the relationship between depressive, anxiety and alcohol-use disorders and their comorbidity, as well as the relationship between use of CAM and use of mental health services. METHOD: The Finnish adult (> or =30 years) population-based Health 2000 Study (n = 5987) collected information on use of CAM plus health and mental health care services. RESULTS: Generalised anxiety disorder and panic disorder were positively associated and alcohol abuse was negatively associated with use of CAM. The prevalence was highest in persons with comorbidity of anxiety and depressive disorders. The use or perceived usefulness of mental health services did not differ between CAM users and other participants. CONCLUSION: The relationship between the use of CAM and mental disorders appears to vary depending on the type of mental disorder. Use of CAM seems unrelated to the use and the perceived usefulness of mental health services.

Use of health services for major depressive and anxiety disorders in Finland.

Factors associated with people suffering from major depressive disorder (MDD) or anxiety disorders seeking or receiving treatment are not well known. In the Health 2000 Study, a representative sample (n=6005) of Finland's general adult (> or =30 years) population was interviewed with the M-CIDI for mental disorders and health service use for mental problems during the last 12 months. Predictors for service use among those with DSM-IV MDD (n=298) or anxiety disorders (n=242) were assessed. Of subjects with MDD, anxiety disorders, or both, 34%, 36%, and 59% used health services, respectively. Greater severity and perceived disability, psychiatric comorbidity, and living alone predicted health care use for MDD subjects, and greater perceived disability, psychiatric comorbidity, younger age, and parent's psychiatric problems for anxiety disorder subjects. The use of specialist-level mental health services was predicted by psychiatric comorbidity, but not characteristics of the disorders per se. Perceived disability and comorbidity are factors influencing the use of mental health services by both anxiety disorder and MDD subjects. However, still only approximately one-half of those suffering from even severe and comorbid disorders use health services for them.

Women's life cycle and abortion decision in unintended pregnancies.

OBJECTIVE: To study the impact of sociodemographic, financial, and reproductive factors and of characteristics related to intimate relationships on the decisions of women in different age groups about whether or not to continue an unintended pregnancy. DESIGN: Cross sectional population based survey. SETTING: Telephone interview survey between September 2000 and January 2001 in France. From a representative sample (n=14704) of 18 to 44 year old women, those who in the past five years had an abortion or whose last pregnancy was unintended were oversampled (sampling fraction=100%, n=1034) while the other women were randomly selected (sampling fraction =19%, n=1829). Altogether, 2863 women answered the questionnaire. PARTICIPANTS: All women whose last pregnancy was unintended and ended in induced abortion or birth (n=645). MAIN RESULTS: Factors associated with the abortion decision varied strongly according to age. Younger women's abortion decisions were mainly related to being a student and being single. Wanting to stop childbearing when the desired number of children was achieved best explained the decision to have an abortion among 25 to 34 year old women. Older women chose abortion especially when childbearing did not fit their work situation or when the relationship with the partner was unstable. A high level of education of a woman and her partner increased the likelihood of abortion, especially among young women. CONCLUSIONS: The impact of socioeconomic and relationship factors on the decision to have an abortion is not the same at different stages in life, and refers to the social representations and perceptions of what good conditions are for being a mother.

What do women want? Women's experiences of infertility treatment.

Finnish women's experiences of infertility treatment were investigated by examining their satisfaction and dissatisfaction, and their most positive and negative experiences with the treatment. Three hundred and forty four (16%) out of the 2,189 women respondents to a 1994 postal survey (response rate 74%) had experienced difficulties in having a baby. Two-thirds had sought medical help, generally from private gynaecologists. Less than half of the women were satisfied with the infertility treatment, expressing less satisfaction than is generally found among health care clients. Dissatisfied women were more often 35-39 years of age, in treatment during the study period, in treatment in public clinics and not successful in having a baby. However, about one-third of the women were unsure about or did not give their opinion in regard to satisfaction. The subsequent birth of a baby was the most common reason for satisfaction. The most positive treatment experience was respectful, empathic and personal care from the doctor. Unsatisfactory encounters with health care personnel were the main reasons for dissatisfaction and were most often cited as the most negative treatment experience. This dissatisfaction could reflect relatively young and healthy women's assertive attitudes toward infertility care services in the context of the intimacy and vulnerability of childlessness.

Frequency of daily over-the-counter drug use and potential clinically significant over-the-counter-prescription drug interactions in the Finnish adult population.

OBJECTIVE: To explore the frequency of continuous use of over-the-counter (OTC) drugs among the Finnish adult population and the potential for harmful interactions between OTC drugs and prescribed (Rx) drugs. METHODS: Data were extracted from a 1995-1996 population-based interview survey on health care (n = 10,477, response rate 86%). The drug interaction classification system from the Swedish Drug Compendium FASS 1997 was used to identify OTC drugs likely to have clinically significant interactions with prescription drugs. Logistic regression was used to study factors related to continuous use and risks for interactions. RESULTS: Seventeen percent of the population had used OTC drugs and 15% had used OTC vitamins during the 2 days prior to the interview. Daily use of OTC drugs and of vitamins was reported by 7% and 9%, respectively. Continuous use of OTC drugs was related to older age, female gender, higher education, poor health status, long-term morbidity, psychosomatic symptoms (fatigue) and use of prescription drugs, but not to poor lifestyle. Four percent of the OTC drug users had taken drug combinations with potential for clinically significant interactions. Interactions were most common for ketoprofen (15% of ketoprofen users), ibuprofen (10%), and acetylsalicylic acid (ASA) (6%). The number of prescription drugs, long-term illness and lower education best explained the risk for interactions. CONCLUSION: Continuous use and potentially harmful Rx/ OTC drug interactions occur among OTC drug users. Further studies should be done to investigate whether potential combinations will actually lead to clinical problems. The possible interactions of non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics with prescription drugs should especially be taken into account in drug information.

Self-medication with vaginal antifungal drugs: physicians' experiences and women's utilization patterns.

BACKGROUND: In many countries, vaginal antifungal drugs have been released on over-the-counter (OTC) markets, yet little is known about women's management of their symptoms. OBJECTIVES: The aim of this study was to judge the appropriateness of self-medication with vaginal antifungal drugs by examining utilization patterns and physicians' experiences of women's self-medication. METHODS: An anonymous questionnaire survey was carried out in 20 pharmacies in Finland of women buying OTC vaginal antifungal drugs in 1997. Out of the 453 questionnaires distributed, 299 (66%) were returned. A survey of a random sample of gynaecologists (n = 169) and specialists in general practice (n = 288) was carried out in 1996. The response rate was 77%. RESULTS: Nearly all women had used vaginal antifungal drugs previously, 49% during the previous 6 months. Most women did not report any difficulties with treatment, but 44% of women used the drug against recommendations. Half of the women had symptoms that are more likely to be related to infections other than Candida. Physicians had observed several disadvantages of self-treatment, with unnecessary use and use for the wrong indications being the most often reported. In all, 31% of gynaecologists and 16% of GPs reported that these adverse events had been clinically significant, with delay in the treatment of other infections being the most common problem. CONCLUSION: The results raise concerns about inappropriate use and women's ability to self-diagnose correctly. Because vaginal antifungal drugs are likely to remain on OTC markets, two ways to address these concerns are for physicians and pharmacy personnel to provide spontaneous information and to have more informative advertisements on vaginal antifungal drugs.

Physicians' attitudes toward reclassifying drugs as over-the-counter.

OBJECTIVES: Releasing prescription drugs over-the-counter (OTC) has been a trend in many Western countries. The purpose of this study was to find out about Finnish physicians' attitudes towards OTC switches and to find out whether transfer of drugs that are used in a doctor's own area of specialty increases negative attitudes toward release. For the latter purpose, gynecologists' perceptions about the availability of vaginal antifungal OTC drugs was studied. METHODS: Postal questionnaire to a representative random sample of gynecologists (n = 169) and general practitioners (GPs) (n = 288) in six counties in Finland in 1996. After a reminder, the response rate was 77% (n = 341). Multivariate logistic regression models were used to explore the relationship of factors to attitudes toward OTC drugs. RESULTS: The overall attitude toward the availability of OTC drugs was moderately positive but was more reserved toward those drugs only recently given OTC status. However, physicians were judged in many cases to be the most suitable source of information on OTC drugs. GPs working in health centers, more often than other physicians, found drugs suitable for self medication. Our hypothesis about gynecologists being against the release of vaginal antifungal drugs was not supported. CONCLUSIONS: Physicians' views about OTC drugs are influenced by the current OTC status of the drug and by public discussion. The place of work has an important influence on these opinions, most likely reflecting the effect of case mix and patient load.

Finnish physicians' opinions of vaginal estriol in self-care.

OBJECTIVE: In Finland vaginal estriol drugs became available without prescription in 1992, resulting in widespread advertising of these drugs to lay women and in an increase in sales. The purpose of this study was to find out what Finnish physicians think about the fact that vaginal estriol does not require a prescription, and if they have found any problems resulting from this. METHODS: A questionnaire survey was sent to gynecologists and general practitioners (n = 341, 77% response rate) in Finland in 1996. RESULTS: 60% of the physicians considered vaginal estriol to be suitable for over-the-counter (OTC) status, and to be much more suitable than the other estrogen containing drugs (contraceptive pill and drugs for emergency contraception) we asked about in our study. Opinions varied by specialty, work experience and reported problems relating to OTC status. The most common reasons given for suitability referred to increased access, and those given for unsuitability referred to general dangers of self-care. Of all physicians 12%, and of private gynecologists (n = 33) 49% reported having observed problems with the OTC status, mostly in care-seeking and indications; some gynecologists mentioned adverse effects of the drug itself. 39% of the physicians thought that the best person to provide information about vaginal estriol is a physician. CONCLUSIONS: Pharmacological literature and physicians' opinions suggest a re-evaluation of the role of physician surveillance of vaginal estriol drugs.

Do young women have specific problems in contraceptive use and counselling?

OBJECTIVES: To find out if young women have specific problems with the use of contraception or contraceptive services. STUDY DESIGN: A national postal survey was conducted, RR 74%. Women aged 18-34 years (with experience of contraceptive use) were included in this report (n=1239). RESULTS: Weekly need for contraception was highest in the age group 18-24 years (61%), oral contraception being the most widely used method regardless of parity. Condoms were used by 35-37% in all age groups, either alone or combined with oral contraceptives (17% of young nulliparas). Women aged 18-24 years had mainly used public or subsidized services (79%). Of quality characteristics, only satisfaction with the kindness of the service provider varied significantly by age. The cost of contraception was highest in the youngest age group. CONCLUSIONS: The study did not point at any serious problems in family planning among young women, but it did produce several clues for the development of family planning services in general.

Self medication and health habits in the management of upper gastrointestinal symptoms.

Upper gastrointestinal symptoms are a common complaint among the general population but only a small proportion of sufferers seek medical advice. The aim of this study was to examine what kind of perceptions persons using self medication have about the causes of their gastrointestinal symptoms, whether they have made any health-related lifestyle changes, and whether visits to a physician are related to lifestyle changes. A pharmacy-based survey was done in 10 pharmacies in the Helsinki area in 1995. The questionnaire was completed by 292 customers. The response rate was 53%. Respondents in a population-based health interview survey (n = 10,410) were used as a comparison group for poor health-behavior (consumption of tobacco, alcohol, coffee). The most common perceived causes of gastrointestinal symptoms were poor diet, coffee, and stress. Ignorance about possible causes of symptoms was especially common among less educated respondents and among those persons who had never visited a physician due to their symptoms. Respondents were significantly more often smokers and they had attempted to reduce their coffee and alcohol consumption more often than the general population. Those who had visited a physician during past year, less often had poor health-behavior and they had better knowledge about the possible causes of their symptoms. They had also made lifestyle changes more often, but after adjustment for background characteristics, physician visits were positively correlated only with coffee reduction. Counseling about healthy lifestyles, especially about smoking, should be increased in physician consultations and in pharmacies for all patients and customers having gastrointestinal problems.

Contraceptive health risks--women's perceptions.

The aim was to study women's concerns about health risks associated with contraceptives, in particular oral contraceptives and intrauterine devices (IUDs), and to investigate what factors are related to these concerns. A questionnaire was sent to a random sample of 3000 women aged 18-44 years in Finland in 1994. After two reminders, the response rate was 74% (n = 2189). Logistical models were used to examine factors that were related to concerns over oral contraceptives and IUDs. Half (n = 1096) of the respondents had at some time been concerned about the risks of contraceptives. Most concerns (71%) were related to oral contraceptives. Cardiovascular effects, cancer, infertility, mood changes and weight gain were the most commonly specified risks related to oral contraceptives, and infections, effects on menstruation and ectopic pregnancy were most mentioned regarding IUDs. Concerns about oral contraceptives were related to higher education [odds ratio (OR) 1.75; 95% confidence interval (CI) 1.38-2.21], past experience with the method (OR 1.81; 95% CI 1.45-2.26) and to a good knowledge about contraception and fertility (OR 1.68; 95% CI 1.29-2.19). Concern over IUD risks were most strongly related to past use of the method (OR 3.11; 95% CI 2.24-4.32) and higher age (35-44 years old, OR 2.99; 95% CI 1.52-5.87). Unlike women concerned about the risks of oral contraceptives, women with concerns about IUDs had had abortions more often than other women (OR 1.79; 95% CI 1.28-2.48). Women with concerns about oral contraceptives or IUDs used condoms or sterilization as their current contraceptive method significantly more often than other women. Results showed that concern about the risks of contraceptives is strongly related to women's past contraceptive experiences and influences their current use of contraceptives. More attention should be paid to information provided by health care professionals, especially that regarding risk probabilities.

Quality of care in abortion services in Finland.

BACKGROUND: The aim of this study was to describe the quality of abortion services and women's experiences with the care they had received during their abortion. METHODS: A population-based postal survey of 3000 randomly selected 18-44-year old Finnish women in 1994. The response rate was 74% (n=2189). The following were used as indicators of quality of services: referral problems, loss of follow up, adequacy of counseling, and satisfaction with treatment. RESULTS: Fifteen percent (n=320) of the respondents had experienced at least one abortion. After adjusting for age, women who had an abortion were more likely to come from the lower social class, to be divorced, widowed, or in a nonmarital relationship, and to have had previous pregnancies. Fifty-two percent reported not using any contraceptive method when getting pregnant. Altogether 6% reported referral problems and 8% did not have post-abortion follow-up. Twenty-five percent would have preferred more discussion with a physician or a nurse before the abortion and 30% after it. Psychological effects of abortion was the most often mentioned subject upon which they needed discussion. The need for discussion was not influenced by the length of time lapsed since the abortion. The satisfaction with treatment increased from 69% (abortion >10 years ago) to 82% (abortion <5 years ago). Dissatisfaction was related to need for more discussion and the abortion having been performed in a central hospital. CONCLUSION: The overall quality of abortion care was good but there is still a need for improvement, especially in the communication and human part of the care.

The role of gynaecologists in women's health care--women's views.

OBJECTIVE: Reproductive matters are common reasons to use health services, and both primary care providers (general practitioners and public health nurses) and specialists (gynaecologists) can be consulted. The purpose of this study was to find out how Finnish women think about and use specialist care in reproductive matters; gynaecological health checks, contraception, and prenatal care served as examples. METHODS: The data come from a questionnaire survey sent in 1994 to a representative sample (74% response rate) of 18-44-year-old Finnish women (n=2189). RESULTS: Most (87%) women considered regular health checks by a gynaecologist important, and 55% had visited a gynaecologist regularly in the past 5 years. Healthier women and women having more education were more likely to visit gynaecologists regularly. Most women (86%) preferred a gynaecologist to a general practitioner for contraceptive matters, and 54% reported visiting one for their last contraceptive visit. Maternity centres with their public health nurses and general practitioners were the main source of prenatal care. CONCLUSIONS: The results suggest the need to study the benefits of regular gynaecological health checks, and to define the best provider in common reproductive matters. Evaluation should include organizational impacts, such as those of the division of work between primary and secondary health care and small area population responsibility.

Self-medication of dyspepsia: how appropriate is it?

BACKGROUND: The scope of self-medication is increasing in many countries, and drugs for dyspepsia are a popular group for deregulative activities. This study investigated what kind of upper gastrointestinal symptoms people self-medicate and how appropriate this self-medication is. METHODS: An anonymous questionnaire was give to 50 consecutive customers buying antacids, alginates, or sucralfates in 10 pharmacies in the capital area in Finland in 1995. In half of the pharmacies the questionnaire was returned by mail, and in the other half the questionnaire was filled out at the pharmacy. The response rate was 53% (n = 292). RESULTS: The commonest reasons for self-medication were heartburn (88%), gastrointestinal pain (31%), and acid regurgitation (32%). Seventy-five per cent of respondents had used dyspepsia drugs for more than a year. The commonest way to self-medicate was to interchange regular and occasional use. Knowledge about the proper use of dyspepsia drugs was poor, and 6% of respondents had symptoms contraindicating self-medication but had not visited a physician during the past year. Patients more than 60 years old were especially at risk of potential inappropriate use. CONCLUSIONS: Over-the-counter (OTC) drugs for dyspepsia are likely to be used improperly. A physician's advice on the use of OTC dyspepsia drugs, in addition to detailed printed information about drug action and proper administration, would be important means to guarantee appropriate use of these drugs.

Quality of contraceptive services in Finland.

OBJECTIVE: To investigate whether the quality of contraceptive services in Finland varies by the type of care provider. DESIGN: A cross sectional questionnaire survey. PARTICIPANTS: A random sample of 3000 Finnish women aged 18-44 years (response rate 74%) in 1994. RESULTS: Almost all women (94%) had used contraception at some time and 75% were current users. Although self care was common (29% had obtained their latest method outside the health services), 83% had sometimes used the health services for contraception. For their last visit, 55% of women had chosen a health centre (a publicly administered and funded health service), and 33% a private unit. In the health centre, the care provider was usually a general practitioner or a public health nurse, whereas in private care the providers were gynaecologists. Women who used private care were more likely to be from higher social classes and urban areas. After adjustment for a women's background, the two groups were similar for most indicators of the quality of care, but access to care and woman's experiences of treatment were better with private care. CONCLUSIONS: In terms of availability and choices the current system of contraceptive services in Finland is adequate. It is not always an integral part of municipal primary health care, and many women prefer private care for gynaecological services; this may case problems of comprehensiveness and equality of care.

Experience of Finnish women with Norplant insertions and removals.

OBJECTIVE: Norplant and Norplant-2 have been available for use by Finnish women since 1984 and 1986, respectively. The objective of this study was to explore Norplant users' experiences of insertions, removals and medical treatments. DESIGN: A questionnaire was sent to women who had received Norplant or Norplant-2 implants one to two years earlier (n = 262) in normal clinical settings; the response rate was 79%. RESULTS: At insertion, problems were experienced by 9% and at least some pain by 23% of women. During the first year 20% of all users (14% of Norplant and 33% of Norplant-2 users) had their implants removed. Problems were experienced at removal by 33% of women and pain was experienced by 40%; nevertheless most users were satisfied with the device. Findings were similar for the two types of Norplant. Forty-two percent of the women had received minipills containing levonorgestrel before Norplant insertions in an attempt to assess Norplant's suitability, and 8% had received drugs for adverse effects caused by Norplant. CONCLUSIONS: Studies including perspectives of Norplant users and the whole lifespan of Norplant (including removal) should be conducted in all clinical settings where Norplant is provided.

Knowledge and use of hormonal emergency contraception in Finland.

We studied the knowledge and use of hormonal emergency contraception (EC) in Finland by mailing a questionnaire to a national sample of 3000 women aged 18-44 years (response rate 74%). Ten percent of the women aged under 25 and 4% of all respondents had sometimes used EC. Unmarried women were more likely to report having used hormonal EC than were married women, and nulliparous women reported more use than did parous women. However, no statistically significant difference in EC use among women with or without previous abortion history was observed. Older women were less aware of EC than of other methods; only one-third of the women aged over 35 knew about this method. Current contraceptive practices were otherwise similar among ever-users and never-users of EC, but EC users more commonly reported using condom together with oral contraceptives or IUD. Nobody reported using EC as her only contraceptive method. Our findings suggest that EC is appropriately used in Finland, but more information about use of the method is still needed.

Patients excluded from an antidepressant efficacy trial.

BACKGROUND: The impact of exclusion criteria on antidepressant trials is rarely investigated and poorly understood. We describe specific reasons for exclusion from a double-blind comparative trial and analyze the selection procedure and its impact on treatment outcome. METHOD: A 6-week randomized double-blind trial for depressive disorders recruited patients through outpatient psychiatric services, private offices, and health care centers. Of the 612 consecutive patients interviewed for a diagnosis according to DSM-III-R, 209 (34%) finally entered the trial. RESULTS: 86% of the included patients had no comorbid psychiatric disorder, whereas a third of those excluded had at least one (p < .00001). Patients were excluded for having chronic alcohol or drug misuse (17%), receiving antidepressant drugs (15%), or having physical problems precluding their ability to take either of the drugs studied (14%). Some patients could not be included because of a referral to other modes of treatment (19%) or organizational difficulties (16%). The excluded patients less often suffered from major depressive disorder than those who were included in the trial. In particular, patients excluded because of suicidal thoughts or intent more often had a history of previous major depressive episodes (p = .006) compared with the included patients. The most important sociodemographic factors related to exclusion from the trial were male sex and unmarried status. CONCLUSION: Patients with previous depressive episodes or comorbid disorders were more likely to be excluded from the antidepressant efficacy trial. Data on the efficacy of antidepressant drugs on this patient population are still only infrequently obtained.