Päivi Rautava

Cohort Profile: Steps to the Healthy Development and Well-being of Children (the STEPS Study)

The STEPS Study aims to search for the precursors and causes of problems in child health and well-being by using a multidisciplinary approach. The cohort consists of all mothers (Finnish or Swedish speaking) who had live deliveries in the Hospital District of Southwest Finland from January 2008 to April 2010 and their children (n=9811 mothers, n=9936 children). Of these, 1797 mothers and their 1827 children were recruited to an intensive follow-up group during the first trimester of pregnancy or soon after delivery. Information about the whole study cohort is based on pregnancy follow-up data from maternity clinics, National Longitudinal Census Files and child welfare clinics. Data from multiple sources are used to obtain a picture of the overall well-being of the child and the family. After birth, study visits include several clinical examinations. Collaboration is encouraged, and access to the data will be available when the data set is complete.

Parental Psychological Well-Being and Behavioral Outcome of Very Low Birth Weight Infants at 3 Years

OBJECTIVE: The purpose was to explore whether poor parental psychological well-being is associated with behavioral problems of very low birth weight (VLBW, ≤1500 g) infants at 3 years of age. METHODS: In this prospective cohort study, 189 VLBW preterm infants born between January 2001 and December 2006 at the Turku University Hospital, Finland, were followed. Validated questionnaires (Beck Depression Inventory, Parenting Stress Index, and Sense of Coherence Scale) were mailed to the parents when their children were 2 years corrected age. A total of 140 parents evaluated the behavior of the child at 3 years by filling out the Child Behavior Checklist. RESULTS: There were significant associations between most of the measures of parental symptoms of depression, parenting stress, and sense of coherence and the behavioral outcome of the VLBW infants. The concomitant symptoms of both parents were associated with more problematic child behavior. CONCLUSIONS: Parents report more behavioral and emotional problems in VLBW children at age 3 if they themselves have had symptoms of depression, parenting stress, or weak sense of coherence 1 year earlier. The new finding of this study was to show the significance of the father’s psychological well-being on the behavioral development of a preterm child.

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 64u2008797 working-aged individuals in Finland (20–24, 30–34, 40–44, 50–54u2005years of age; 32u2008059 women and 32u2008716 men), yielding 25u2008898 (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.

Dental fear and sense of coherence among 18‐yr‐old adolescents in Finland

The aim was to investigate whether dental fear was associated with the sense of coherence (SOC) among 18-yr-old adolescents (n = 777). Cross-sectional data from a prospective cohort of a random sample of families from Finland and their first-born children were used. Dental fear was measured using the Modified Dental Anxiety Scale and categorized as high dental fear for scores of 19-25 and as no to moderate dental fear for scores of 5-18. Sense of coherence was measured using a 13-item version of Antonovskys Sense of Coherence Questionnaire, dichotomized as scores 13-63 for weak SOC and as scores of 64-91 for strong SOC. Gender and education were included as background factors in the logistic regression analyses. The prevalence of high dental fear was 8%. Those reporting high dental fear reported more often a weaker SOC than did those with no to moderate dental fear (69% vs. 31%, OR = 2.5, 95% CI = 1.4-4.4), also when adjusted for gender and education (OR = 2.2, 95% CI = 1.2-3.9). According to the theory of salutogenesis, as proposed by Antonovsky, SOC is a resource instrument especially in situations of tension or strain and hence a strong SOC might protect against high dental fear.

Preterm infants' early growth and brain white matter maturation at term age.

BackgroundNormal intrauterine conditions are essential to normal brain growth and development; premature birth and growth restriction can interrupt brain maturation. Maturation processes can be studied using diffusion tensor imaging.ObjectiveThe aim of this study was to use tract-based spatial statistics to assess the effect that early postnatal growth from birth to 40 gestational weeks has on brain white matter maturation.Materials and methodsA total of 36 preterm infants were accepted in the study. Postnatal growth was assessed by weight, length and head circumference. Birth weight z-score and gestational age were used as confounding covariates.ResultsHead circumference catch-up growth was associated with less mature diffusion parameters (Pu2009<u20090.05). No significant associations were observed between weight or length growth and diffusion parameters.ConclusionGrowth-restricted infants seem to have delayed brain maturation that is not fully compensated at term, despite catch-up growth.

Do Antenatal and Postnatal Parental Psychological Distress, and Recognized Need of Help Predict Preadolescent’s Psychiatric Symptoms? The Finnish Family Competence Cohort Study

In a prospective population-based study, mothers and fathers of 1,247 children reported their physical and mental health during pregnancy, after delivery, within the child’s first 18xa0months of life, and at 12xa0years. Additionally, maternal health clinic nurses rated parents’ well-being and perceived need for support. At age 12, child outcomes were also measured using CBCL and YSR externalizing and internalizing scales. Results indicate that both ante- and postnatal maternal distress predicted future externalizing problems in offspring. Conversely, fathers’ postnatal distress predicted subsequent internalizing problems. Furthermore, mother’s depressed mood in the first trimester best predicted the child’s externalizing problems at age 12. Nurses’s ratings of mother’s antenatal and perinatal need for support, perinatal distress, and family’s need for support were associated with both internalizing and externalizing problems at age 12. Maternal antenatal distress increases the risk of offspring’s externalizing problems in preadolescense, and postnatal distress in either parent increases the risk of internalizing problems. Parental self-reports and indirect ratings from health care providers during pregnancy and infancy may therefore reliably recognize offspring at risk for subsequent psychiatric symptomatology.

Childhood adversities and adult-onset asthma: a cohort study.

Objectives Childhood adversities may be important determinants of later illnesses and poor health behaviour. However, large-scale prospective studies on the associations between childhood adversities and the onset of asthma in adulthood are lacking. Design Prospective cohort study with 7-year follow-up. Setting Nationally representative study. Data were collected from the Health and Social Support (HeSSup) survey and national registers. Participants The participants represent the Finnish population from the following age groups: 20–24, 30–34, 40–44, and 50–54u2005years at baseline in 1998 (24u2005057 survey participants formed the final cohort of this study). The occurrence of childhood adversities was assessed at baseline with a six-item survey scale. The analyses were adjusted for sociodemographic characteristics, behavioural health risks and common mental disorders. Primary and secondary outcomes The survey data were linked to data from national health registers on incident asthma during a 7-year follow-up to define new-onset asthma cases with verified diagnoses. Results A total of 12u2005126 (59%) participants reported that they encountered a childhood adversity. Of them 3677 (18% of all) endured three to six adversities. During a follow-up of 7u2005years, 593 (2.9%) participants were diagnosed with incident asthma. Those who reported three or more childhood adversities had a 1.6-fold (95% CI 1.31 to 2.01) greater risk of asthma compared to those without childhood adversities. This hazard attenuated but remained statistically significant after adjustment for conventional risk factors (HR 1.33; 95% CI 1.06 to 1.67). Conclusions Adults who report having encountered adversities in childhood may have an increased risk of developing asthma.

Electronic medical records for appropriate timing of arthroplasty.

OBJECTIVEnThe objective of this study was to analyse whether electronic medical records (EMRs) of total hip and knee arthroplasty can be used to manage the optimal time of surgery.nnnDESIGNnRetrospective registry study.nnnSETTINGnData on waiting time for operation, age, gender, body mass index (BMI), operable condition pre-operatively and the functional scores at 3 and 12 months after arthroplasty were obtained from EMRs and from an electronic implant database.nnnPARTICIPANTSnThe participants of the study were 162 arthroplasty patients.nnnRESULTSnAn increase in waiting time of hip patients decreased significantly the change in functional scores at 3 months (P = 0.006, n = 56). The score reductions of older patients were more marked than of younger patients and of patients of normal weight compared with overweight patients. In patients undergoing knee arthroplasty, the association between a longer waiting time and profound change in functional score was statistically significant after 1 year (P = 0.03, n = 75). After adjustment of the results for pre-operative scores, age group, BMI class, American Society of Anesthesiologists class and gender, the waiting time turned out to affect only the scores of patients undergoing hip arthroplasty at 3 months post-operatively.nnnCONCLUSIONSnData from electronic patient entries complemented with data of the operable condition can be used for defining the optimal operation time with regard to the pre-operative condition of the patients. The implication of prolonged waiting times was not very profound, but elderly patients benefit from a short waiting time.

Does the organizational model of the maternity health clinic have an influence on women’s and their partners’ experiences? A service evaluation survey in Southwest Finland

BackgroundIn high-income countries, great disparities exist in the organizational characteristics of maternity health services. In Finland, primary maternity care is provided at communal maternity health clinics (MHC). At these MHCs there are public health nurses and general practitioners providing care. The structure of services in MHCs varies largely. MHCs are maintained independently or merged with other primary health care sectors. A widely used organizational model of services is a combined maternity and child health clinic (MHC & CHC) where the same public health nurse takes care of the family from pregnancy until the child is at school age. The aim of this study was to determine how organizational model, MHC independent or combined MHC & CHC, influence on women’s and their partners’ service experiences.MethodsA comparative, cross-sectional service evaluation survey was used. Women (Nu2009=u2009995) and their partners (Nu2009=u2009789) were recruited from the MHCs in the area of Turku University Hospital. Four months postpartum, the participants were asked to evaluate the content and amount of the MHC services via a postal questionnaire. Comparisons were made between the clients of the separate MHCs and the MHCs combined to the child health clinics.ResultsWomen who had used the combined MHC & CHCs generally evaluated services more positively than women who had used the separate MHCs. MHC’s model was related to several aspects of the service which were evaluated “good” (the content of the service) or “much” (the amount of the service). Significant differences accumulated favoring the combined MHC & CHCs’ model. Twelve aspects of the service were ranked more often as “good” or “much” by the parents who had used the combined MHC & CHC, only group activities regarding delivery were evaluated better by women who had used the separate MHCs.ConclusionsBased on the women’s and partners’ experiences an organizational model of the combined MHC & CHC where the same nurse will take care of family during pregnancy and after birth of the child was preferred. This model also provides greater amount of home visits and peer support than the separate MHC.

The Missing Evaluation at the End of GP’s Consultation

Evaluation at the end of a consultation is an element of a successful encounter. The doctor should inquire if patients expectations were fulfilled and sum up the information given, the examinations performed, and the decisions made with the patient. This way the patient would be fully aware of what has been decided and that the problems and expectations of the patient had been taken into account. Twenty consultations of four general practitioners (GPs) in Finland were videotaped. The doctors were men and women, two of them had a long experience and two were trainees in general practice. The data (videotapes, questionnaires, and interviews) were analysed by multiple research methods with investigator and methodological triangulation. MAAS-Global Rating List was used as an assessment tool. The evaluation of the consultation was often missing or having shortages; only one-third was assessed to be better than doubtful. The assessments done by experienced GPs and the medical student were similar. According to the result of this study as well as the information in the current literature, doctors in all periods of their career should repeatedly be reminded about the importance of the evaluation at the end of the consultation.