Exposure to sewage water and the development of allergic manifestations in Finnish children.

Background: The hygiene hypothesis suggests that a decreased microbial load contributes to an increased risk of allergies. In the Finnish municipality of Nokia, sewage water was accidentally mixed with drinking water for 2 days. We studied the association between exposure and the emergence of allergies in children.

The duration of gastrointestinal and joint symptoms after a large waterborne outbreak of gastroenteritis in Finland in 2007--a questionnaire-based 15-month follow-up study.

An extensive drinking water-associated gastroenteritis outbreak took place in the town of Nokia in Southern Finland in 2007. 53% of the exposed came down with gastroenteritis and 7% had arthritis-like symptoms (joint swelling, redness, warmth or pain in movement) according to a population-based questionnaire study at 8 weeks after the incident. Campylobacter and norovirus were the main pathogens.

Excess healthcare costs of a large waterborne outbreak in Finland.

Background: The economic effects of waterborne outbreaks have rarely been reported. A large waterborne outbreak occurred in the town of Nokia in Finland in 2007 with half of the population in the contaminated area suffering from gastroenteritis. We studied the healthcare costs of this outbreak.

Joint symptoms after a large waterborne gastroenteritis outbreak--a controlled, population-based questionnaire study.

Objectives: Waterborne outbreaks offer an opportunity to study joint symptoms after a simultaneous exposure. In November 2007, a gastroenteritis outbreak due to faecal contamination of tap water took place in a Finnish town. The purpose of this study was to evaluate the occurrence of joint symptoms after the outbreak.

Reactive arthritis in a population exposed to an extensive waterborne gastroenteritis outbreak after sewage contamination in Pirkanmaa, Finland.

Objectives: To assess the occurrence, clinical picture, and triggering infections of reactive arthritis (ReA) associated with a large waterborne gastroenteritis outbreak.

Methods: After an extensive sewage contamination of the water supply system, an estimated 8453 of the 30 016 inhabitants of the town of Nokia fell ill. General practitioners and occupational physicians were advised to refer any patients with suspicion of new ReA to rheumatological examination including faecal culture, human leucocyte antigen (HLA)-B27 and antibody tests for Campylobacter, Salmonella, and Yersinia.

An extensive gastroenteritis outbreak after drinking-water contamination by sewage effluent, Finland.

An inappropriate cross-connection between sewage- and drinking-water pipelines contaminated tap water in a Finnish town, resulting in an extensive waterborne gastroenteritis outbreak in this developed country. According to a database and a line-list, altogether 1222 subjects sought medical care as a result of this exposure. Seven pathogens were found in patient samples of those who sought treatment.

The effect of hysterectomy or levonorgestrel-releasing intrauterine system on lower abdominal pain and back pain among women treated for menorrhagia: a five-year randomized controlled trial.

Objective: The purpose of this study was to evaluate the changes in lower abdominal pain and back pain among women with menorrhagia treated by hysterectomy or levonorgestrel-releasing intrauterine system (LNG-IUS).

Design: A randomized controlled trial.

Setting: Five university hospitals in Finland.

Depressive symptoms as predictors of discontinuation of treatment of menorrhagia by levonorgestrel-releasing intrauterine system.

It has been shown that levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective treatment of menorrhagia. However, the discontinuation rate of LNG-IUS treatment is high, and little is known about the actual reasons intertwining it. We tested the hypothesis that depressive symptoms is the factor responsible for deciding to have a hysterectomy during LNG-IUS treatment.

Diagnosis and treatment of menorrhagia.

One-third of all women experience heavy menstrual bleeding at some point in their life. In western countries, about 5% of women of reproductive age will seek help for menorrhagia annually. Half of all women who consult for hypermenorrhea have some uterine abnormality, most often fibroids (among patients under 40 years of age) and endometrial polyps (above 40 years of age).

The effect of hysterectomy or levonorgestrel-releasing intrauterine system on sexual functioning among women with menorrhagia: a 5-year randomised controlled trial.

Objective: To compare among women with menorrhagia the effect of hysterectomy or levonorgestrel-releasing intrauterine system (LNG-IUS) on sexual functioning.

Design: A randomised controlled trial.

Setting: Five university hospitals in Finland.

A cost-effectiveness analysis of tension-free vaginal tape versus laparoscopic mesh colposuspension for primary female stress incontinence.

Background: Evaluation of cost-effectiveness of new surgical techniques is important. As the data on incontinence procedures are scarce, we evaluated the cost-effectiveness of tension-free vaginal tape procedure and laparoscopic mesh colposuspension as a primary surgical treatment for female stress urinary incontinence.

Methods: In four university teaching hospitals and two central hospitals 128 stress incontinent women were randomized to tension-free vaginal tape procedure (n=70) or laparoscopic mesh colposuspension (n=51) in order to investigate the clinical performance of these two procedures.

Bilateral notching of uterine arteries at 12--14 weeks of gestation for prediction of hypertensive disorders of pregnancy.

Objective: To assess the value of transvaginal uterine artery Doppler ultrasound at 12--14 weeks of gestation in predicting hypertensive disorders of pregnancy in high-risk women.

Methods: One hundred and twenty high-risk women were evaluated prospectively by Doppler ultrasound of uterine and umbilical arteries at 12--14 weeks of gestation. The presence of bilateral notches, resistance and pulsatility index (PI), mean and maximum flow velocities of uterine arteries, and resistance and PI of umbilical arteries were investigated.

A randomized trial among women with heavy menstruation -- impact of a decision aid on treatment outcomes and costs.

Objective: To evaluate the effects of a decision aid for menorrhagia on treatment outcomes and costs over a 12-month follow-up.

Design: Randomized trial and pre-trial prospective cohort study.

Setting And Participants: Gynaecology outpatient clinics in 14 Finnish hospitals, 363 (randomized trial) plus 206 (cohort study) patients with menorrhagia.

The relationship between clinical parameters and health-related quality of life as measured by the 15D in incontinent women before and after treatment.

Background: The purpose of this study was to correlate the clinical parameters with a health-related quality of life (HRQoL) measure and to describe the change of HRQoL caused by treatment and its modifying factors among urinary incontinent women.

Methods: Eighty-two incontinent women, referred to a tertiary gynecologic department, underwent clinical evaluation to establish diagnosis and severity of urinary incontinence (UI) and completed the generic 15D HRQoL instrument. Sixty-nine women were re-evaluated 13 months after treatment.

Gabapentin for the prevention of postoperative pain after vaginal hysterectomy.

Gabapentin alleviates and/or prevents acute nociceptive and inflammatory pain both in animals and volunteers, especially when given before trauma. Gabapentin might also reduce postoperative pain. To test the hypothesis that gabapentin reduces the postoperative need for additional pain treatment (postoperative opioid sparing effect of gabapentin in humans), we gave 1200 mg of gabapentin or 15 mg of oxazepam (active placebo) 2.

Tension-free vaginal tape and laparoscopic mesh colposuspension for stress urinary incontinence.

Objective: To compare objective and subjective outcomes after the tension-free vaginal tape procedure (TVT) with laparoscopic mesh colposuspension as a primary treatment for female stress urinary incontinence. Objective outcome measures were stress test and 48-hour pad test.

Methods: In 6 departments of gynecology in Finland, including 4 university teaching hospitals and 2 central hospitals, 128 women with urodynamic stress incontinence were randomly allocated to 2 treatment groups.

Is physical activity influenced by urinary incontinence?

Objective: To evaluate physical activity among urinary incontinent women seeking treatment and to assess the change of physical activity after treatment.

Design: Part of a prospective observational intervention study to examine the factors influencing the severity of urinary incontinence.

Setting: Tampere University Hospital-referral unit.

Impact of patient information booklet on treatment decision--a randomized trial among women with heavy menstruation.

Objective: Does a patient information booklet influence treatment for menorrhagia?

Design: Randomized trial and a pre-trial prospective cohort study.

Setting: Gynaecology outpatient clinics in 14 Finnish hospitals.

Participants: A total of 363 (randomized trial) plus 206 (cohort study) patients with menorrhagia.

Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up.

Context: Because menorrhagia is often a reason for seeking medical attention, it is important to consider outcomes and costs associated with alternative treatment modalities. Both the levonorgestrel-releasing intrauterine system (LNG-IUS) and hysterectomy have proven effective for treatment of menorrhagia but there are no long-term comparative studies measuring cost and quality of life.

Objective: To compare outcomes, quality-of-life issues, and costs of the LNG-IUS vs hysterectomy in the treatment of menorrhagia.

Levonorgestrel-releasing intrauterine system or hysterectomy in the treatment of essential menorrhagia: predictors of outcome.

Levonorgestrel-releasing intrauterine system (LNG-IUS) has been advocated as an effective alternative to hysterectomy in the treatment of menorrhagia. The outcome predictors have been poorly known. In this study the amount of menstrual blood loss (MBL) turned out to be the single most important outcome predictor of these treatments.

Do objective urodynamic or clinical findings determine impact of urinary incontinence or its treatment on quality of life?

Objectives: To correlate the clinical and urodynamic parameters with two measures of incontinence-specific quality of life (QOL), to describe the changes in those measures after treatment, and to explore the factors determining these changes.

Methods: A total of 82 incontinent women (mean age 52 years, range 28 to 80) underwent urodynamics testing and a 48-hour pad test. They also completed the frequency/volume chart, estimated the degree of bother from urinary incontinence using the visual analog scale (VAS), and completed a validated QOL instrument--the Urinary Incontinence Severity Score (UISS).

A randomized controlled trial of hysterectomy or levonorgestrel-releasing intrauterine system in the treatment of menorrhagia-effect on FSH levels and menopausal symptoms.

Background: The purpose of this study was to compare the effects of hysterectomy and a levonorgestrel-releasing intrauterine system (LNG-IUS) on serum FSH levels and menopausal symptoms.

Methods: A total of 236 women referred for menorrhagia to five university hospitals were randomly assigned to treatment with hysterectomy (n = 117) or LNG-IUS (n = 119). Menopausal symptoms were characterized by the Kupperman menopausal distress test.

Severe depression determines quality of life in urinary incontinent women.

Aims: The purpose of this study was to assess depression and anxiety in urinary incontinent women and to investigate factors influencing their self-perception of urinary incontinence severity.

Methods: In this prospective study, 82 incontinent women estimated the severity of urinary incontinence using a visual analogue scale and completed a validated quality of life instrument: urinary incontinence severity score. Psychiatrists evaluated depression and anxiety using a structured interview of Hamilton Depression and Hamilton Anxiety Scales.