Mauri Isokoski

More women enter medicine: young doctors' family origin and career choice.

Summary. This study is part of the Finnish Junior Physicians 88 Study, the purpose of which was to shed light on the life situation, career choice and future plans of young doctors and their views on medical education. The survey population included all the medical doctors registered during the years 1977‐1986 in Finland (n = 5208). A postal questionnaire was sent to a sample of 2632 doctors born on odd‐numbered days. After a reminder letter, 1745 questionnaires (66%) were returned. Forty‐nine per cent of the respondents were women. Typically both men and women doctors had a father who was an upper‐level white‐collar worker and a mother who was a housewife. More men than women had a father who was a doctor or other health professional. More women than men mentioned that a lifelong calling (42% vs 30%), success at school (58% vs 47%) and an interest in helping people (78% vs 71%) had considerable influence on their decision to become a doctor. Men more often than women emphasized the medical profession being regarded as a highly paid (56% vs 47%) and a high status profession (64% vs 56%) and also that a family member was a doctor (15% vs 11%).

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.

Evaluation of undergraduate medical education in Finnish community‐oriented and traditional medical faculties: a 10‐year follow‐up

This study focused on Finnish physicians’ views of their undergraduate medical education. Differences between traditional and community‐oriented medical faculties were examined and changes which had taken place during a 10‐year follow‐up period were also assessed.

ANTICOAGULANT TREATMENT OF PATIENTS WITH ATRIAL FIBRILLATION IN PRIMARY HEALTH CARE

OBJECTIVE To determine the prevalence of anticoagulant (AC) treatment of patients with atrial fibrillation in primary health care. To identify complications in the same patients during 1 year. DESIGN Cross-sectional study and 1-year follow-up. SETTING Seven health centres with a total population of 164093. SUBJECTS Five hundred and twenty-two anticoagulated patients with atrial fibrillation. RESULTS The age-adjusted prevalence of AC treated patients with atrial fibrillation was 0.30%. Of the 522 patients, 240 were men, mean age 69.6 years; and 282 women, mean age 75.1 years. At the beginning of the study 85% and after 1 year 81% of the latest prothrombin time values were within recommended range. After 1 year 414 out of the 522 patients continued AC treatment. During the 1-year follow-up 62 patients had minor or major complications. Eleven patients (2.1%) had to discontinue AC treatment because of complications. Prothrombin tests were mainly taken at 3-4 week intervals. CONCLUSION High quality AC treatment is possible in the hands of general practitioners.

Anticoagulant treatment in primary health care in Finland

OBJECTIVE To establish the prevalence of anticoagulant (AC) treatment, the indications, and the quality of care in primary health care. DESIGN A cross-sectional study, in which patients on AC treatment were identified from laboratory records. The main and second indications for AC treatment and the last value of the AC-test were taken from medical records. SETTING Eight Finnish health centres with a total population of 182091 inhabitants. RESULTS A total of 1255 patients on AC treatment were identified, 48% of them men. The mean age was 68.9 years. The age-adjusted prevalence of AC treatment was 0.65%. The commonest main indication was atrial fibrillation (38%). It was the main or second indication in 591 patients (age-adjusted prevalence 0.30%). The next commonest main indication was deep vein thrombosis (15%), followed by pulmonary embolism (8%). A total of 274 (22%) patients were anticoagulated for cerebral circulatory disturbances. 86% of the latest prothrombin time values fell within recommended ranges. CONCLUSION The prevalence of AC treatment in Finland seems to be high. The proportion of patients with atrial fibrillation is high, differing from the results in other countries. The monitoring of AC-treatment as the general practitioners responsibility functions well. The quality of care is good, even in older age groups.

Contraceptive methods: knowledge sources rated by women and men

People today live amid a welter of information regarding contraception, and health care professionals have been the most prominent sources to which people turn. This study evaluates the relative importance of various information sources and ascertains the position of the physicians among them. Random samples (393 women and 395 men) were drawn from the Finnish population. Response rates were 56% for women and 45% for men. The respondents were asked to estimate the amount of knowledge they had obtained from various sources on a visual analog scale. The three most important sources for women were literature, physicians, and womens journals. For men, literature and the spouse/partner were the most prominent. The youngest age groups--women and men alike--had received more information from the school nurse and the teacher than older groups. Physicians have a central role as information sources. They should be aware of other information sources in the community and should adapt their own work accordingly.

Factors Associated with Physicians' Choice of Working Sector: A National Longitudinal Survey in Finland

ObjectiveTo analyse factors affecting physicians’ choice to work in either the public or the private sector.MethodWe undertook a longitudinal data analysis in the years 1988, 1993, 1998 and 2003 (n = 12 909) using a multilevel modelling technique. Factors related to economic factors, physician identity, appreciation as well as demographic factors were hypothesised to influence sector choice.ResultsPhysicians seem to make their career choices prior to graduation, at least to some extent. Wage levels, the physician’s personal characteristics and whether or not the physician knew his or her place of work before graduation were the key factors affecting the decision-making process in the years 1988, 1993, 1998 and 2003. Physicians for whom wages were important were less likely to choose the public sector. Also, physicians who regarded themselves as entrepreneurial preferred to work in the private sector. If a physician had worked in the public sector during his or her medical training before graduation, the probability of applying for a vacancy in the public sector was higher.ConclusionIt is not only economic factors, such as salary, that are involved in the physician’s decision to choose the working sector.

Medical education and the corresponding professional needs of young doctors: the Finnish Junior Physician 88 Study

Summary. The Universities of Kuopio and Tampere in collaboration with the Ministry of Social Affairs and Health and Finnish Medical Association carried out the ‘Junior Physician 88’ study in 1988, the purpose of which was to shed further light on the life situation and future plans of young doctors and their views concerning undergraduate and postgraduate medical education. The study concerned all the doctors registered during the years 1977–1986 in Finland (n= 5208). After randomization, a postal questionnaire was sent to one half (n= 2631) of these doctors. After the first reminder letter, 1745 questionnaires (66.3%) were returned. According to the views of the respondents undergraduate hospital teaching was adequate but the teaching of practice in health centres, school health care, team‐work, health care of the elderly, home health care, rehabilitation, environmental health care and administration did not meet the professional needs of doctors. All doctors were satisfied with the hospital teaching in their undergraduate curriculum. However, only the doctors who graduated from the two modern universities in Kuopio and Tampere were satisfied with their undergraduate health centre teaching.

Lactase non-persistent genotype influences milk consumption and gastrointestinal symptoms in Northern Russians

BackgroundMilk is an important source of nutrients. The consumption of milk, however, may cause abdominal complaints in lactose intolerant individuals. The frequency of -13910C/C genotype is known to be high among Northern Russians, exceeding the prevalence in northern Europe. In our study we tested two hypotheses: 1) subjects with lactase non-persistent genotype (-13910C/C) have more gastrointestinal (GI) symptoms associated with milk 2) subjects with lactase non-persistence avoid using milk.MethodsIn total, 518 students aged 17 to 26 years were randomly selected from different departments in the Northern State Medical University (NSMU) for genotyping the lactase activity-defining -13910C/T variant. All subjects filled in a questionnaire covering their personal data, self-reported GI symptoms and milk consumption habits.ResultsNorthern Russians consume very small amounts of milk daily. Among carriers of the lactase non-persistent (LNP) genotype there were 10 percentage units of milk-consumers fewer than among lactase-persistent (LP) subjects (p = 0.03). Complaints of GI disorders caused by milk were different between the genotypes (p = 0.02). Among all types of food analyzed only milk was associated with increased GI symptoms among subjects with the LNP genotype (OR = 1.95, CI 1.03-3.69)ConclusionsSubjects with -13910C/C have more GI symptoms from milk. Subjects with lactase non-persistent genotype avoid using milk. In the case of increasing milk consumption symptoms may increase the need for medical consultation. It is thus important either for people themselves or for health care staff to be aware of lactase persistence/non-persistence.

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.