Kari J. Mattila

Mortality in Relation to Urinary Characteristics in the Very Aged

The value of urinary characteristics observed in a health survey of people aged 85 years or more was studied in a 5-year follow-up. Of the 561 aged people participating in the initial survey, 167 (30%) were alive after 5 years. Hematuria, pyuria, and albuminuria were associated with high mortality; urinary acidity was associated with low mortality. Positive bacterial staining, glucosuria, and specific gravity of urine were not related to the survival rate. Contrary to earlier observations, bacteriuria found in the urinary bacterial culture did not have any prognostic significance in respect of survival during the follow-up period. Judging from the results, the medical treatment of asymptomatic bacteriuria, with the aim of reducing the mortality of the very aged, appears to be unwarranted.

Use and knowledge of hormonal emergency contraception.

Hormonal emergency contraception (EC) is an acceptable means of postcoital prevention of pregnancy, but potential users should have information and education about it before they need it. The aim of this study was to establish how many women and how many mens partners have used hormonal EC and how well the respondents know the correct time to take EC pills. Random samples (393 women and 395 men) were drawn from the Finnish population register. Response rates were 56% for women and 45% for men. Of all responding women and men, 12% had themselves or together with their partners used EC. The proportion of EC users was highest in the younger age group among both women and men. It was greater among single and cohabiting women than among married women. Only a minority of respondents knew that EC pills could be taken up to 72 h after unprotected intercourse. Women who had used EC were most knowledgeable, as were also the younger age groups among both women and men. Awareness of the availability of EC and of its correct use should be further promoted to avoid unwanted pregnancies.

Non-response in a nationwide follow-up postal survey in Finland: a register-based mortality analysis of respondents and non-respondents of the Health and Social Support (HeSSup) Study

Objective To examine difference in mortality between postal survey non-respondents and respondents. Design A prospective cohort study with baseline survey in 1998 and comprehensive linkage to national mortality registers until 2005, the Health and Social Support study. Setting A population-based postal survey of the working-aged population in Finland in 1998. Participants The original random sample comprised 64 797 working-aged individuals in Finland (20–24, 30–34, 40–44, 50–54 years of age; 32 059 women and 32 716 men), yielding 25 898 (40.0%) responses in the baseline postal survey in 1998. Primary outcome measure Registry-based primary causes of death encoded with the International Classification of Diseases (ICD-10). Results In women, HR for total mortality was 1.75 (95% CI 1.40 to 2.19) times higher among the non-respondents compared with the respondents. In men, non-response was associated with a 1.41-fold (1.21–1.65) excess risk of total mortality. Non-response associated in certain age groups with deaths due to diseases in women and with deaths due to external causes in men. The most prominent excess mortality was seen for total mortality for both genders and for mortality due to external causes among men. Conclusions Postal surveys result in slight underestimation of illness prevalence.

Health history after intrahepatic cholestasis of pregnancy

Objective. To establish whether intrahepatic cholestasis of pregnancy (ICP) is associated with other diseases during a womans lifetime. Design. Prospective controlled cohort study. Setting. University Hospital in Finland. Population. A total of 575 women with ICP and 1374 control women, all having delivered in 1969–1988. Questionnaires were sent to 544 ICP patients and 1235 control women. Responses were received from 1178 (66.4%). Methods. Questionnaire survey in autumn 2010. Main outcome measures. Perceived health, symptoms and complaints, diseases diagnosed by a doctor and use of medicines. Results. No statistically significant differences were detected in perceived health. Differences in recent symptoms and complaints were small. Diagnoses made by a doctor showed higher frequencies in the ICP group than in control women for other hepatobiliary diseases, breast cancer and hypothyreosis. Diagnosed hypertension and high cholesterol requiring medication as well as cardiac arrhythmia were less frequent in the ICP group. Women in this group used antacid medicines more often than control women. Conclusions. There were few differences between the ICP patients and control women except for a higher frequency of later hepatobiliary disease, breast cancer and hypothyreosis. Women with a history of ICP should be screened for hypothyreosis more readily than those without. The higher frequency of breast cancer warrants further research.

Occurrence of symptoms and depressive mood among working-aged coronary heart disease patients

BackgroundThe typical symptoms of coronary heart disease (CHD), chest pain and breathlessness, are well-known. They are considered quite dramatic, and can thus be fairly reliably mapped by a survey. However, people might have other clearly unpleasant symptoms impairing quality of life. The aim of this study is to evaluate the appearance of these complaints of working-aged people with self-reported CHD.MethodsThe study consists of a postal questionnaire of randomly selected Finns in age groups 30–34, 40–44 and 50–54, a response rate of 39% (N = 15,477). The subjects were asked whether or not a doctor had told them that they had angina pectoris or had had myocardial infarction. Four randomly selected age and sex matched controls were chosen for every patient. The occurrence of self-reported dyspnoea, chest pain during anger or other kind of emotion, palpitation and perspiration without physical exercise, irregular heartbeats, flushing, trembling of hands and voice, jerking of muscles, depression and day-time sleepiness were examined. Odds ratios (OR) with 95% confidence intervals (CI), between occurrence of symptoms and CHD with and without heart infarction, were computed by multivariate logistic regression analysis.ResultsThe sample eventually comprised 319 CHD patients. Dyspnoea, chest pain during anger or other kind of emotion, palpitation, perspiration without physical exercise, irregular heartbeats daily or almost daily, trembling of hands and voice, and jerking of muscles occurred statistically significantly more frequently among CHD patients than among controls. The CHD patients also reported more depressive mood according to Becks inventory scores and poorer sleep and more frequent day-time sleepiness than controls. In the multivariate logistic regression analysis chest pain during anger or other kind of emotion (ORs 4.12 and 3.61) and dyspnoea (ORs 2.33 and 3.81) were the symptoms most associated with CHD.ConclusionsWorking-aged people with self-reported coronary heart disease evince a number of symptoms limiting the quality of their every day life. This aspect should be paid attention to when evaluating functional capacity of these patients.

Electrocardiogram, clinical findings and chest X-ray in persons aged 85 years or older

Persons aged 85 years or more (n = 674) living in Tampere, Finland, were surveyed in 1977 and 1978. Five hundred fifty-nine persons (83%) were examined. Electrocardiographic findings, classified according to the Minnesota code, were compared with reported cardiac symptoms, clinical congestive heart failure, clinical coronary heart disease and relative cardiac volume on chest radiograph. Electrocardiographic items had a poor association with cardiac symptoms. ST-segment depression, T-wave inversion, ventricular premature complexes and atrial fibrillation were related statistically highly significantly to clinical congestive heart failure, as were ST-segment depression and T-wave inversion to clinical coronary heart disease. High left R waves, ventricular premature complexes and atrial fibrillation showed a significant association with cardiac enlargement (over 500 ml/m2) and pulmonary congestion in chest radiographs.

Cancer in working-age is not associated with childhood adversities

Abstract Background. Early life events are studied as potential causes of cancer. The objective here was to study childhood adversities in the etiology of cancer. Methods. The material comprised a population based random sample of 25 898 individuals among the Finnish working-aged population. In 1998 they were requested through six questions in a postal questionnaire to recall their childhood adversities. The cases consisted of people with cancer diagnosed 2000–2006 and registered in the Finnish Cancer Registry (n = 384). The rest of the sample consisted of cancer-free controls. Results. The most common adversities were prolonged financial difficulties, serious conflicts in the family and someone in the family having been seriously or chronically ill. The cancer patients reported more prolonged financial difficulties and someone seriously or chronically ill in the family. They reported less parental divorce than the controls. The associations were not statistically significant after adjusting for age, sex, education, and health behaviour. Nor was there a significant difference in the total number of childhood adversities between the study group and the controls. Conclusion. On the whole, these cancer patients had not experienced more childhood adversities than the controls. According to our findings, there is no cause to attribute development of cancer in working age to childhood adversities. This information may also give relief to other family members.

Gender differences in sex life issues – A population-based study of migraine sufferers

BackgroundMigraine 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.MethodsThe 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.ResultsAll 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.ConclusionOur findings suggested that migraine has a different impact on sex life among women from that among men.

Contraceptive methods used and preferred by men and women.

In 1997, a random sample of Finnish men (n = 395) and women (n = 393) aged 18-50 years received a postal questionnaire concerning family planning, in which they were asked which contraceptive methods they had ever used and which three methods they considered to be best. Mens contraceptive preferences were compared to those of women. The response rate for men was 45% and for women 56%. The majority of both men and women had used, together with their partners, condom, oral contraceptives (OCs) and intrauterine devices (IUDs). The use of diaphragm, Norplant, Depo Provera and postcoital IUDs was not common. Among the men, 2-11% did not know whether their partner/partners had used the contraceptives in question. Concerning the three best contraceptive methods, men placed the condom first and women OCs. No male or female respondents rated postcoital emergency pills a superior method. Both men and women appreciated the most reliable means.

Intrahepatic cholestasis of pregnancy is common among patients' first-degree relatives.

Intrahepatic cholestasis of pregnancy has been shown to have a genetic predisposition. We studied whether Finnish women who had suffered from the disorder reported their first‐degree relatives to have had liver dysfunction during their pregnancies. Questionnaires were sent in autumn 2010 to a total of 544 former intrahepatic cholestasis of pregnancy patients and 1235 controls, all having delivered during 1969–1988. The response rate was 66.2%. The incidence of intrahepatic cholestasis is 0.5–1.5% of pregnancies in Finland. In our survey, altogether 12.8% of mothers (odds ratio 9.2), 15.9% of sisters (odds ratio 5.3) and 10.3% of daughters (odds ratio 4.8) of women who had suffered from intrahepatic cholestasis of pregnancy had had liver dysfunction during pregnancy. Our findings strengthen the earlier knowledge of the genetic component in intrahepatic cholestasis of pregnancy. We suggest that all pregnant women are asked about their family history regarding liver dysfunction during pregnancy.