Elina Hemminki

Review of literature on the factors affecting drug prescribing

Abstract A review of the literature on the factors affecting drug prescribing in Western countries is given. Factors discussed are education, advertising, colleagues, control and regulation measures, demands from society and patients and doctors characteristics. On the basis of the available literature the role of the drug industry seems especially important. Suggestions for further studies are given.

The timing of hospital admission and progress of labour

We set out to study the relationship between the timing of hospital admission and the progress of labour. In all there were 591 healthy primiparous women with normal pregnancies and who anticipated normal deliveries; 436 of them had come because of contractions. When the intrinsic speed of labour (estimated from the status of the cervix at the time of admission in relation to the duration of regular contractions) was allowed for, women coming early (regular contractions for 4 h or less before admission) as compared to those coming late stayed longer in the hospital before delivery but had a shorter total length of labour. They had more interventions during labour, more caesarean sections, longer postpartum hospital stay, and their children had more diagnoses of difficult delivery. Women who came because of ruptured membranes without contractions had shorter labours, more interventions during labour, longer postpartum stay and their children had more discharge diagnoses and longer hospital stay than women coming late. This study suggests that too early admission to the hospital may negatively affect the progress of labour, and controlled trials are needed to confirm or to disprove this suggestion.

Use of Estrogens among Middle-Aged Massachusetts Women

This study describes estrogen use among 45- to 55-year-old white women in Massachusetts from 1981 to 1987. In a 1981 cross-sectional survey, 7705 white women (77 percent response rate) returned a questionnaire or were interviewed by phone. Premenopausal women were invited into a 4.5-year follow-up study including telephone interviews every nine months, and 2236 (approximately 91 percent of the eligible women) had a complete follow-up. In the cross-sectional survey, 7.9 percent had used oral estrogens in the last two weeks, but most (77 percent) had had a hysterectomy; use varied notably from one area to another. Vaginal estrogens were used by 2.9 percent. Users and nonusers of oral estrogens were quite similar in regard to sociodemographic background. Data from the follow-up surveys showed that estrogen use increased throughout the study period and by the final follow-up women with higher education status reported more estrogen use than those with lower education status. Most women used estrogens only for a short time.

Ambulation versus oxytocin in protracted labour: a pilot study.

We compared ambulation with oxytocin in the treatment of protracted labour with a randomized, controlled trial of 57 patients. Sixty percent of the women in the ambulant group delivered their babies without oxytocin. In the ambulant group, the mean length of the second stage of labour was shorter and the women themselves held relatively positive views on their experiences. In the oxytocin group, on the other hand, the women experienced stronger contractions before pushing and also suffered from more excessively strong contractions. Our trial included too few women to judge which treatment is better for the infants health. Nevertheless, the womens opinions and the quality of their contractions demonstrate that more attention should be paid to ambulation as a treatment for protracted labour.

Postmenopausal hormone drugs and breast and colon cancer: Nordic countries 1995–2005

OBJECTIVES The purpose of this study was to utilize the variation in the level and timing of the change in postmenopausal hormone therapy (HT) use between the Nordic countries to assess the population-level impact of decline in HT use on the breast and colon cancer incidences. METHODS Nationwide HT-sales data in defined daily doses (DDDs) per 1000 inhabitant in 1995-2005 in Finland, Iceland, Norway and Sweden were obtained from drug control authorities. Breast and colon cancer incidence data by 5-year age-groups were obtained from the National Cancer Registers. By time series analysis we estimated in each age-group and country how much a change in HT-sales changes cancer incidence. RESULTS The decline of HT-sales varied; the decline from the highest sales was 61% in Sweden, 51% in Norway, 43% in Iceland and 25% in Finland. With the exception of Finland, the breast cancer incidence increased from 1995 to the year following the year with maximum HT-sales and decreased after that year. In the model combining countries and years, changes in HT-sales predicted the change in breast cancer incidence, an average 7% for each 10 DDD units of HT-sales. No clear association between HT-sales and colon cancer incidence was found. CONCLUSIONS The time and country specific data suggest, that on the population level, a notable drop from high level of HT use somewhat decreases breast cancer incidence or breaks its increasing trends. The suggested protective effect of HT for colon cancer was not seen.

Content analysis of drug-detailing by pharmaceutical representatives

Drug detailing is important in drug prescribing. This report describes a study made on drug presentations to groups of doctors in Helsinki. The method was silent observation of presentations given by medical representatives. Analysis of the content of the presentations revealed that side‐effects and contraindications were often neglected; the drug presented was always recommended as the drug of choice; other forms of treatment were seldom mentioned. References to Finnish doctors doing clinical trials with the drugs were often made. Even though this study was restricted, its results show that drug detailing and its significance in post‐graduate education call for more attention.

Resource allocation of in vitro fertilization: a nationwide register-based cohort study

BackgroundInfertility is common and in vitro fertilization (IVF) is a widely used treatment. In IVF the need increases and the effectiveness and appropriateness decrease by age. The purpose of this study was to describe allocation of resources for IVF by womens age, socioeconomic position, area of residence and treatment sector (public vs. private) and to discuss how fairly the IVF resources are allocated in Finland.MethodsWomen who received IVF between 1996 and 1998 (N = 9175) were identified from the reimbursement records of the Social Insurance Institution (SII). Information on IVF womens background characteristics came from the Central Population Register and the SII, on treatment costs from IVF clinics and the SII, and on births from the Medical Birth Register. The main outcome measures were success of IVF by number of cycles and treated women, expenditures per IVF cycles, per women, per live-birth, and per treatment sector, and private and public expenditures. Expenditures were estimated from health care visits and costs.ResultsDuring a mean period of 1.5 years, older women (women aged 40 or older) received 1.4 times more IVF treatment cycles than younger women (women aged below 30). The success rate decreased by age: from 22 live births per 100 cycles among younger women to 6 per 100 among older women. The mean cost of a live birth increased by age: compared to younger women, costs per born live birth of older women were 3-fold. Calculated by population, public expenditure was allocated most to young women and women from the highest socioeconomic position. Regional differences were not remarkable.ConclusionChildren of older infertile women involve more expense due to the lower success rates of IVF. Socioeconomic differences suggest unfair resource allocation in Finland.

The function of drug company representatives.

The drug industry has a major influence on drug prescribing habits through their medical representatives. We therefore set out to see whether their work was more concerned with providing information or with selling, more with demand or with supply, and how much it cost in Finland. We interviewed currently employed and former representatives and contact persons in health institutions, and analysed advertisements for vacancies for medical representatives. It seems that companies regard detailing more as a sales activity than as public relations and that this trend towards selling has gained in importance in recent years. The number of representatives engaged in the pharmaceutical industry exceeds the demand for their services. The drug companies allotted in 1975 detailing at least 5000 Fmk (

Perinatal mortality distributed by type of hospital in the central hospital district of Helsinki, Finland

1300) per physician per year. Our conclusion is that drug detailing is neither necessary nor beneficial for the health services.

A trial of delivery in a birth chair

In Finland as in many other countries, perinatal mortality is higher in those institutions having a higher level of care. To explain this phenomenon, mortality by weight groups was studied in different hospitals in the Central Hospital District of Helsinki in Finland in 1977–81. Among infants weighing less than 2 500 g, perinatal mortality was higher in the local hospital than in the university hospital, the higher mortality being due to the higher rate of stillborn infants. Among babies weighing over 2 500 g, the mortality was lower in local hospitals than in the university hospital. Further studies to explain the higher mortality of infants weighing over 2 500 g in the university hospital are needed.