Maili Malin

Selection to postmenopausal therapy by women's characteristics.

Many surveys have shown that women using postmenopausal hormone therapy have a lower incidence of cardiovascular diseases and lower overall mortality. The purpose of this study was to compare past and non-users with current users of hormone therapy in regard to characteristics known to, or assumed to, predict poor subsequent health (indicators). The main data source was a survey in 1989 of a random sample (n = 2000, 86% response rate) of 45-64 year-old Finnish women. Among women with their uterus, after adjusting for age and urbanism, of the 21 indicators studied, 10 suggested a poorer and none a better health prognosis for the non-users than for current users. Many differences were greater among older women, suggesting a cohort effect or long-term users being an especially selected group. Among hysterectomized women, differences between users and non-users were similar or smaller than among women with uteri. The past users were more similar to non-users than current users. Our study suggests that women with a better health prognosis are selected or select themselves for hormone therapy, and that may impede interpretation of observational studies on hormone therapy and health.

A Survey on the use of Alternative Drugs During Pregnancy

Objective. To describe the use of alternative drugs during pregnancy. Design. A trial including 3 surveys on drug use during pregnancy in maternity centers in one area of Finland in 1985–86 (study 1), and a retrospective survey in 2 maternity hospitals in Finland in 1988 (study 2). Patients and methods. Study 1: 2912 pregnant women (about 94% of pregnant women in the area during the study period); 97–88% returned questionnaires. Study 2: 180 out of 181 consecutive women giving birth. In study 1, drug use (including drug-like products) in the last two weeks was asked by questionnaires around 12th, 28th, and 36th gestation weeks. In study 2, women were interviewed 2–3 days after birth asking about any drugs used during pregnancy. Due to the method of asking, our studies underestimate the level of using alternative drugs. Results. In study 1, a total of 97 (3.6%) pregnant women reported use of alternative drugs. Most drugs were dietary supplements, and by current knowledge harmless. But a few women had used (potentially) dangerous drugs. The users were from the higher social class and they had also used pharmaceutical specialties more often than non-users. In study 2, 14% had used alternative drugs at some time during pregnancy. Conclusion. Because our surveys showed that alternative drugs are used, possibly with increasing frequency, during pregnancy, further studies on safety are needed.

Impact of iron fortification of milk formulas on infants growth and health

Abstract The current controversy over the need of iron supplementation lead us to study the growth and health of infants given iron-fortified (6.5mg/l) and non-fortified (0.5mg/l) milk-based formulas during the first six months. The two formulas were identical except for iron content. Healthy, term infants with a mean age of 1.3 months and not being breast-fed were randomly allocated to receive iron-fortified formula (n=164) and non-fortified formula (n=158), being followed up to the age of one year. Data were compiled by health visitors and physicians from their notes and by asking the parents. Our results give no clear evidence of clinical benefit from iron fortification. It is suggested, that iron is not needed in the formula consumed during the first six months of life. Because formulas are widely and increasingly used, further trials of iron fortification in different circumstances are needed.

Prenatal care in Finland: from primary to tertiary health care?

Traditionally, the Finnish prenatal care system has been based on special maternity centers outside hospitals. In recent years, however, the use of hospital outpatient clinics has increased. The purpose of this study was to describe the use of the clinics and to see whether clinics serve as an addition or as an alternative to maternity centers. We used several different data sources (statistics, documents, interviews, questionnaires). The main source was data on visits for all women who gave birth in Helsinki in a five-week period in 1987. The content of care and means of care delivery differ between clinics and maternity centers. Clinics are technologically and provider-oriented without continuity of care. Clinics are not just referral centers for high-risk mothers; at least half of pregnant women visit them. Ultrasound screening is an important reason for use of the clinic. Background characteristics as well as the outcome of pregnancy were similar among women visiting a hospital clinic a maximum of one time (low users), two to three times, or four times or more (high users). Standardizing for the length of gestation, high users made fewer visits to maternity centers than did low users. Hospital clinic care now seems to replace care in maternity centers, and we found a weak trend toward a pluralistic prenatal care.