Päivi Santalahti

Women's decision-making in prenatal screening

With serum screening (MS-AFP and hCG testing for Downs syndrome) women have to make several decisions in a limited time: whether to participate in the screening in the first place; then, if increased risk for fetal abnormality is detected, whether to have a diagnostic test, and finally, what to do if fetal abnormality is detected. The aim of this study was to examine how women themselves in an unselected population describe their decision-making in the different phases of serum screening. Women receiving a positive result from serum screening in two Finnish towns from September 1993 to March 1994 and a group of individually matched controls were invited to semistructured interviews; 45 index and 46 control women (79% of those invited) participated between their 29th and 37th weeks of gestation (mean 31 weeks). Although serum screening was most often presented as voluntary or as an option, half the women described participation as a routine or self-evident act; only one-fourth of the women described actively deciding about participation. After a positive screening result, womens reactions to diagnostic tests, and their intentions if disability would be detected, varied greatly. Most of the women actively decided about having diagnostic tests, but for 23% participation in diagnostic testing was called a self-evident act. Womens intentions regarding abortion varied from a firm decision to abort to a firm decision not to abort, and many remained ambivalent. Prenatal screening, which demands the making of several decisions in a limited time and is offered to all pregnant women as part of established maternity care, is not based on every participants active decision-making and thus creates an ethical problem. This problem should receive special attention from those who develop, introduce and decide on new health care practices.

Prevalence Changes of Pain, Sleep Problems and Fatigue Among 8-Year-Old Children: Years 1989, 1999, and 2005

OBJECTIVES To study prevalence changes of self-reported pain, sleep problems, and fatigue among 8-year-old children, and to examine the co-occurrence and associated psychosocial variables of these symptoms. METHODS 3 cross-sectional representative samples were compared in 1989, 1999, and 2005. The frequency of headache, abdominal pain, other pains, sleep problems, and fatigue were studied. In addition, sociodemographic information and childs psychiatric problems were inquired. RESULTS The prevalence of abdominal pain, sleep problems, and fatigue, in addition to headache in boys and other pains in girls increased significantly (p < .05) from 1989 to 2005, with cumulative odds ratio (95% confidence intervals) varying from 1.6 (1.2-2.1) to 2.4 (1.7-3.3). All symptoms were associated with each other and with the childs psychiatric problems. However, psychiatric problems did not explain the observed increase in the symptom frequencies. CONCLUSIONS Finnish childrens self-reported pain, sleep problems, and fatigue have increased remarkably. Studies providing information on the causes and prevention possibilities are warranted.

Victimization and bullying among 8-year-old Finnish children : A 10-year comparison of rates

ObjectiveThere are only few population-based time-trend studies on changes in prevalence of bullying and victimization among children. The main aim of this study was to find out whether changes have occurred in prevalence rates of bullying and victimization from 1989 to 1999 among eight-year-old children. The associations between victimization and bullying and psychiatric symptoms and their possible differences in the statistical strengths of associations between the years 1989 and 1999 were also studied.MethodTwo cross-sectional, representative samples from southern Finland were compared. All children born in 1981 (1989 sample, n = 985, response rate 95%) and 1991 (1999 sample, n = 962, response rate 86%) and living in the selected school district were included in the study samples. Children, parents and teachers were asked about bullying and victimization. The Children’s Depression Inventory and Rutter’s parent and teacher scales were used to study psychiatric symptoms.ResultsIn 1999, fewer 8-year-old children were victims of bullying than in 1989. There was a decrease in the number of bullies but the change was statistically significant only in the parental reports. The statistical strengths of associations of victimization and bullying with psychiatric symptoms were mainly the same in 1989 as in 1999.ConclusionsSlightly decreased levels of victimization among 8-year-old Finnish children is a promising result, but further time-trend studies are needed, as well as qualitative studies, to obtain a deeper understanding of the bullying phenomenon and the factors reducing it. It might be that especially young children are suspectible to influences diminishing victimisation and bullying.

Children of Parents with Cancer: A Collaborative Project Between a Child Psychiatry Clinic and an Adult Oncology Clinic

This article describes the development of a collaborative relationship between a child psychiatry clinic and an adult oncology clinic within a university hospital. The interest of the child psychiatry clinic was to pay attention to children of parents with cancer, and to propose an intervention to support them. A child-centred family counselling model was designed for this purpose. The preparation, implementation, and results of this project are described. Positive results, as well as mistakes and failures are discussed, and recommendations are made regarding this kind of collaboration.

Participation in prenatal screening tests and intentions concerning selective termination in Finnish maternity care.

Aims: The study examined how prenatal screening tests are presented to women, factors associated with women’s participation in screening, their experience of decision-making and intentions concerning pregnancy termination, and hospital data on rates of selective terminations. Methods: Questionnaires were given to pregnant women visiting maternity centres in two Finnish towns in which serum screening was offered (n = 1,035) and in one town where midtrimester ultrasound screening was offered (n = 497). Response rates to the questionnaires were 88 and 85%, respectively. Other questionnaires asking about selective terminations following detected fetal disorders were sent in 1993 to all public hospitals with obstetrics or gynaecology departments (response rate 100%). Results: The serum screening test had usually been offered to women as a free choice, but for 22% of them it was presented as a routine procedure. Most women (92%) underwent serum screening and most (86%) found the decision to participate or not easy. In almost every aspect of presentation and participation studied, serum and ultrasound screening differed from each other. 85% of respondents to ultrasound screening answered that it was offered as a routine procedure. Close acquaintance with a person with congenital disability was negatively associated with participation in serum screening and with the intention to terminate pregnancy in case of a detected disability. 27% of women in the serum screening survey and 22% in the ultrasound survey declared that they would have declined pregnancy termination if a fetal disorder had been detected. However, according to the hospitals’ data, only 13% of pregnancies with a serious fetal disorder detected were continued. Conclusions: All prenatal screening tests, including ultrasound examinations, require an adequate process of informed consent. Because the aim of such tests is to detect fetal malformations and syndromes, health care professionals should discuss the implications with women before they decide. Because acquaintance with a disabled person was found to associate with participation in screening and with intentions about selective termination, women’s perceptions of lives of the disabled should receive more attention in future studies.

“Together at school” - a school-based intervention program to promote socio-emotional skills and mental health in children: study protocol for a cluster randomized controlled trial

BackgroundSchools provide a natural context to promote children’s mental health. However, there is a need for more evidence-based, high quality school intervention programs combined with an accurate evaluation of their general effectiveness and effectiveness of specific intervention methods. The aim of this paper is to present a study protocol of a cluster randomized controlled trial evaluating the “Together at School” intervention program. The intervention program is designed to promote social-emotional skills and mental health by utilizing whole-school approach and focuses on classroom curriculum, work environment of school staff, and parent-teacher collaboration methods.Methods/DesignThe evaluation study examines the effects of the intervention on children’s socio-emotional skills and mental health in a cluster randomized controlled trial design with 1) an intervention group and 2) an active control group. Altogether 79 primary school participated at baseline. A multi-informant setting involves the children themselves, their parents, and teachers. The primary outcomes are measured using parent and teacher ratings of children’s socio-emotional skills and psychological problems measured by the Strengths and Difficulties Questionnaire and the Multisource Assessment of Social Competence Scale. Secondary outcomes for the children include emotional understanding, altruistic behavior, and executive functions (e.g. working memory, planning, and inhibition). Secondary outcomes for the teachers include ratings of e.g. school environment, teaching style and well-being. Secondary outcomes for both teachers and parents include e.g. emotional self-efficacy, child rearing practices, and teacher-parent collaboration. The data was collected at baseline (autumn 2013), 6 months after baseline, and will be collected also 18 months after baseline from the same participants.DiscussionThis study protocol outlines a trial which aims to add to the current state of intervention programs by presenting and studying a contextually developed and carefully tested intervention program which is tailored to fit a national school system. Identification of effective intervention elements to promote children’s mental health in early school years is crucial for optimal later development.Trial registrationClinicalTrials.gov register: NCT02178332.

Have psychiatric problems of children in children's homes increased?

This time-trend study was conducted during and after the severe economic recession and the period of high unemployment in Finland in the 1990s. The changes in the behavioral and emotional problems of children and adolescents placed in childrens homes were studied in the same area using the Child Behavior Checklist questionnaire at three different time points (1993, 1996 and 1999), and the Childrens Global Assessment Scale in 1996 and 1999. Internalizing symptoms of the children increased significantly. The level of psychosocial problems among boys was already high at the first rating in 1993, and it remained high during the whole study period. Behavioral and emotional problems of the girls placed in childrens homes increased significantly, being at the same level as the boys’ by the end of the study period.

Views of Finnish doctors on fetal screening

Objective To investigate the views of Finnish doctors concerning fetal screening.

Determinants of underage induced abortion - the 1987 Finnish Birth Cohort study

Although underage pregnancies often end in induced abortion, data on girls who undergo termination of pregnancy are lacking. Our aim was to identify determinants of underage induced abortion and compare them with those of childbirth.

Impact of prenatal screening on maternity services - Finnish physicians' opinions

BACKGROUND The purpose of this survey was to find out whether Finnish physicians had thought about or had observed resource or organizational effects due to the offering of prenatal screening. METHODS A mailed questionnaire survey sent in 1996-1997 in Finland to all leading Finnish obstetrician-gynecologists, to a random sample of obstetrician-gynecologists providing prenatal care, to general practitioners providing maternity care, and to other general practitioners. The number of respondents was 322 (response rate 70%). RESULTS Most physicians supported the screening programs currently in wide use in Finland (serum screening for Downs syndrome and ultrasound for malformations), and over a third wanted to introduce the two genetic carrier screenings asked about. Most thought Downs screening took up resources, but they did not consider this to be important. The impact of screening on public or customer images of prenatal care was not an important issue. Instead, a diversity of opinions was expressed on whether the increasing numbers of prenatal screenings require organizational changes in current prenatal care provided within primary care, or whether a shift to hospital clinics is necessary to achieve more specialized care. CONCLUSIONS Most physicians were not concerned by the potential organizational and resource implications of prenatal screening, and apparently they judge screening more from a health and individual patient point of view.