Ilkka Vohlonen

Smoking does affect fecundity

A total of 2198 mothers were interviewed at the 20th week of pregnancy and their smoking habits before pregnancy and the time from discontinuation of contraception to the beginning of the pregnancy were registered. This information was used to investigate whether smoking affects conception delay; i.e., fecundity and a multifactorial analysis were used. The longer the conception delay, the more significant was the deleterious effect of even light smoking, the odds ratio shifting from 1.1 at 6 months to 3.2 at 18 months. The effect of smoking on fecundity seemed to be mostly dose-dependent. In mothers becoming successfully pregnant in 12 months, both maternal and paternal smoking increased the risk of conception delay (OR 1.5 and 1.3), and the effect was potentiated by increasing age (OR 2.3 and 1.6). In addition to smoking, previous recurrent spontaneous abortions were also associated with fecundity.

Risk factors for fever, endometritis and wound infection after abdominal delivery

Risk factors for postoperative fever, endometritis and wound infection were analyzed in 761 consecutive cesarean sections. Postoperative fever was observed in 12%, endometritis in 4.7% and wound infection in 3% of cases. The relative risk for postoperative fever was increased in cases with postoperative hematoma (relative risk = 16.0), in cases with blood loss over 500 g (relative risk = 1.8) and if the duration of labor exceeded 6 h (relative risk = 1.9). The only significant risk factors for endometritis were amnionitis (relative risk = 8.7), postoperative hematoma (relative risk = 5.0) and age under 24 years (relative risk = 3.0). Wound infections were less frequent in cases with previous cesarean sections (relative risk = 0.15) and after elective cesarean sections (relative risk = 0.22), but duration of operation over 1 h (relative risk = 2.8), induction of labor (relative risk = 3.2) and puerperal endometritis (relative risk = 7.9) increased the risk of wound infection. By elimination of amnionitis and postoperative hematomas the rate of endometritis would have diminished only from 4.7% to 3.8%, a percentage equally unacceptable; diagnostics and prevention should be directed to young patients undergoing caesarean section. Besides technical procedures prevention of endometritis is important for the prevention of wound infection. In hospitals with low postcesarean infectious morbidity antibiotic prophylaxis seems to be unwarranted.

Increase of specific symptoms after long-term use of chlorophenol polluted drinking water in a community

Chlorophenols contaminated the drinking water system and a local lake in the village of Järvelä in southern Finland. Period prevalence rates of symptoms, signs and diseases among the residents 15 years or older who responded (69%) to a survey in the contaminated area (1773 subjects) were compared with the rates of three uncontaminated areas (2018 subjects). Gastrointestinal and skin symptoms, in particular, were significantly (p < 0.05) more common in the contaminated area than in each control area. Nausea, general malaise, headache, anorexia, exceptional tiredness, and respiratory infections were significantly increased compared to the control areas combined. A dose–response was also observed: higher consumption of drinking water and contaminated fish further significantly increased (p < 0.05) reported symptoms. In conclusion, long-term use of chlorophenol polluted household water and fish can cause symptoms already familiar in connection with occupational chlorophenol exposures.

Parallel Importation of Pharmaceuticals in Finland

AbstractBackground: Parallel importation of pharmaceuticals is illegal in many countries. In the European Union it is allowed, as it is consistent with the principles of free trade and the community exhaustion of intellectual property rights. Parallel importation is assumed to affect pharmaceutical expenditures in two ways. First, parallel imported pharmaceuticals are typically priced lower than brand-name pharmaceuticals, which may reduce pharmaceutical expenditures. Secondly, parallel imported pharmaceuticals may trigger price competition, which might also reduce prices of brand-name products and pharmaceutical expenditures. Objective: To measure reductions in pharmaceutical expenditures due to the entry of parallel imported pharmaceuticals in Finland. Methods: Both realized reductions in expenditures (realized savings) and potential reductions (potential savings) were estimated. Savings were estimated using a method that measures differences in pharmaceutical expenditures when prices of pharmaceutical products differ as a result of price differences between parallel imported and brand-name pharmaceuticals (direct effect) and the effect of parallel imported products on the prices of brand-name products (competitive effect). Potential savings were estimated under different assumptions concerning the price development of pharmaceutical products. It was assumed that prices of brand-name pharmaceuticals would decrease either by 22% or 10% as a result of competition from parallel imports. Results: Realized savings due to parallel importation were approximately €294 000 in the years 1998–2001. The savings remained low since parallel imports have not intensified price competition in Finland. Potential savings for the period between March 2000 and March 2001 were estimated to vary in the range of €3.4–10.2 million depending on the assumptions made on the price development of pharmaceutical products.

Risk of gastric cancer in Helicobacter pylori infection in a 15-year follow-up

Abstract Objective: We investigated the risk of gastric cancer among men with Helicobacter pylori (H. pylori) infection or atrophic gastritis (AG) in a 15-year follow-up. Materials and methods: Study population consists of 12,016 men aged 50–65 years at the beginning of the follow-up in 1994–1996. Serum levels of pepsinogen I (SPGI) and antibodies (IgG) to H. pylori (HpAb) were assayed from serums collected in 1994–1996. Incidence of gastric cancer in the study population was assessed in follow-up from 1994 to 2011 by data from the nationwide cancer registry. Based on SPGI and HpAb values, standardized incidence ratios (SIRs) of gastric cancer were calculated in three subgroups, that is, in those with a healthy stomach, those with H. pylori infection but without AG and those with AG. Risk ratios (RR) of gastric cancer were calculated using SIR of subgroups. Results: During 15 years, seven gastric cancers appeared per 79,928 person years among men with healthy stomachs, 50 cancers per 92,533 person years in men with H. pylori infection but without AG, and 8 per 8658 person years in men with AG. Risk ratio (RR) of stomach cancer in men with H. pylori infection was 5.8 (95%CI: 2.7–15.3) compared to men with healthy stomachs, and 9.1 (95%CI: 2.9–30.0) in men with AG. There were no differences in cancer risk between cardia and distal stomach. Conclusions: Risk of gastric cancer is low in men with healthy stomachs. It is significantly increased in those with H. pylori infection and more in those with AG.

Ear disease and hearing sensitivity in mentally retarded children

The population screened for mental retardation consisted of 12,882 children, 8 years old. One hundred and fifty-one mentally retarded children were clinically studied. No borderline case was included. One hundred and one children were randomly chosen to form a control group. On clinical examination the children were 9-10 years old. Tympanograms were obtained from 206 children (81.8%). The tympanograms in respect to 30.9% of ears were classed as abnormal in the case of mentally retarded children, but in only 17.8% of non-retarded children. The difference is statistically significant (P less than 0.01). Pure tone audiometry was performed in 213 children. Thirty children were tested in open sound field, and 9 children remained untested. The examinations revealed 31 children with decreased hearing sensitivity (24 with conductive impairment, 7 with sensorineural hearing loss). Three children with profound sensorineural hearing loss and 21 with conductive impairment were among the mentally retarded. The threshold values were also examined using two-way analysis of variance. The groups were classified according to findings in psychological tests and according to the clinical findings in relation to the tympanic membrane. These two sets of findings constituted the two independent variables. These two factors had a highly significant (P less than 0.001) effect, but their interaction was not significant. Mentally retarded children clearly have middle ear disease much oftener than non-retarded children, and such ear disease is accompanied by decreased hearing sensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Improving health security: a pilot study from Finland linking disability and health expenditures

a Centre for Pharmaceutical Policy and Economics, University of Kuopio, PL 1627, 70211 Kuopio, Finland b Department of Health Policy and Management, The Rollins School of Public Health of Emory University, Atlanta, GA, USA c Efektia Ltd, Helsinki, Finland d Department of Public Health and General Practice, PL 1627, 70211 Kuopio, Finland e Department of Health Policy and Management, PL 1627, 70211 Kuopio, Finland f Department of Public Health and General Practice, University of Kuopio, PL 1627, 70211 Kuopio, Finland

Discrepancies between the assessed urgency and the actual time taken to obtain a consultation with an internist

OBJECTIVE To compare postreferral waiting times to hospital in internal medicine with the urgency of the cases as assessed by a panel of doctors. DESIGN Retrospective evaluation of referrals to three hospitals during 1 week. SETTING Referrals to internal medicine departments of Kuopio University Hospital, Kajaani central hospital and Pieksämäki regional hospital in Finland. PARTICIPANTS Two specialists in internal medicine working in university hospital and four specialists in general practice, two of whom were private sector general practitioners (GPs), the other two being public health centre chief physicians. OUTCOME MEASURES Postreferral waiting times, assessment of the urgency of the referral by a panel of doctors, and the reliability of this assessment. RESULTS Mean delay to specialist consultation was 36 days. There were no significant differences between the assessors in their opinions regarding the degree of urgency of referrals. Interobserver agreement between assessors was moderate or substantial (kappa values 0.46-0.62) and intraobserver agreement varied from moderate to almost perfect (kappa values were between 0.57 and 0.88). However, of those patients who were assessed to require examination by a consultant within 1 week only 34% actually saw the specialist within that time. Of those patients who were assessed to be require the treatments within 8-30 days, 48% were examined by a specialist within that time. CONCLUSION It is possible to reliably assess the urgency of referrals to internal medicine departments. There is a need to improve the referral process for those patients requiring consultation with a hospital specialist within 30 days.

Challenges in evaluation of screening for gastric cancer among men based on nonrandomized design

Abstract Background: Objective was to quantify biases in screening for gastric cancer when comparing attenders to nonattenders using serum pepsinogen I (SPGI) level as primary test. Methods: In mid 1990s, all men aged 51–65 years from two Finnish cities were invited to SPGI screening. Mortality and premature mortality in attenders were compared to nonattenders. Efficacy of screening was studied by 15 years’ follow-up of standardized mortality ratio (SMR) and potential years of life lost (PYLL) due to gastric cancer. Bias due to selective attendance was quantified using corrective coefficients based on total cancer incidence and mortality, and gastric cancer-specific incidence and mortality for total population and nonattenders. Results: In 1994–1996, men aged 51–65 years (16,872) were invited to SPGI assay and 12,175 men (72%) attended. SPGI was 25 microg/l or less in 610 (5%) men, indicating severe atrophic gastritis (AG). Post-screening gastroscopy was performed to 435 men with low SPGI. Of these, 168 men were referred for treatment due to abnormal focal lesions. Attributable proportions in reductions of SMR and PYLL from gastric cancer due to screening were 59% and 67%. After correcting for selective participation, attributable proportions were reduced to 23% and 39%. Conclusions: Biomarker screening by low SPGI among middle-aged men followed by upper gastrointestinal endoscopy decreased long-term and premature mortality due to gastric cancer. However, in spite of methodological corrections done, the results do not justify any firm conclusions or recommend general screening programs. Randomized trials are warranted for this purpose.