Non malignant daily pain and risk of disability among older adults in home care in Europe.

Aim of the present observational study was to evaluate the association between daily pain and incident disability in elderly subjects living in the community. We used data from the AgeD in HOme Care (AD-HOC) project, a 1 year longitudinal study enrolling subjects aged 65 or older receiving home care in 11 European countries. Daily pain was defined as any type of pain or discomfort in any part of the body manifested every day in the seven days before the baseline assessment.

Justice at work and cardiovascular mortality: a prospective cohort study.

Objectives: Previous studies have suggested that the extent to which employees are treated with justice at the workplace contributes to their health. We examined whether justice at work predicted incidence of deaths from cardiovascular disease.

Methods: Participants were 804 factory workers whose mortality data were collected from the Finnish national mortality register (73 deaths; mean follow-up, 25.

The Antimicrobial Treatment Strategies (MIKSTRA) program: a 5-year follow-up of infection-specific antibiotic use in primary health care and the effect of implementation of treatment guidelines.

Background: A national 5-year follow-up study of infection-specific antibiotic use in primary care was conducted to see if prescribing practices change after implementing new treatment guidelines.

Methods: The data were collected during 1 week of November each year from 1998 to 2002 from 30 health care centers that covered a total population of 819,777 persons and in 2002 from 20 control health care centers that covered a population of 545,098 persons. National guidelines for 6 major infections (otitis media, sinusitis, throat infection, acute bronchitis, urinary tract infection, and bacterial skin infection) were published in 1999-2000.

Blinding decreased recruitment in a prevention trial of postmenopausal hormone therapy.

Purpose: To compare the effect of blind design (active drug and placebo) and nonblind design (active drug and no treatment) on recruitment.

Setting: A primary prevention trial with postmenopausal hormone therapy in Estonia.

Methods: Women who were eligible and willing to participate on the basis of the questionnaire survey were randomized into blind and nonblind groups.

Births and perinatal health of infants among women who have had silicone breast implantation in Finland, 1967-2000.

Background: Potential problems with breast implants have been widely discussed, but few data exist on the childbearing and offspring of women with implants. The purpose of this study was to investigate the occurrence and conditions of pregnancies of women who have had cosmetic breast implantation (exposed women), and the health of their newborns.

Methods: Women who had breast implants for cosmetic reasons in the period 1967-1999 (n = 2236) were identified from hospital surgical records.

Are health expectations of term breech infants unrealistically high?

Background: The aim of this study was to compare the effect of fetal presentation and mode of delivery on infant outcome in a nation-wide study.

Methods: In a retrospective observational cohort study, we compared, with the help of Finnish Medical Birth Register and other nation-wide registers, the short-term and long-term outcome of infants born by breech vaginal (n = 1270) or by vertex vaginal delivery (n = 128,683) or through planned cesarean section (CS) in breech (n = 1640) or vertex (n = 4997); the pregnancies were otherwise entirely normal.

Results: One perinatal death occurred in the breech vaginal group and 23 deaths in the vertex vaginal group (p = 0.

Social support, early retirement, and a retirement preference: a study of 10,489 Finnish adults.

The aim of the study was to examine associations of social support with early retirement and reported retirement preference. Logistic regression analyses of early retirement (retired before the age of 55) were based on a cohort of 10,489 respondents (5960 female, 4529 male) aged 40-55 years. Analyses of retirement preference (planning of early retirement) were based on a sub-cohort of 7759 full-time employees (4233 female, 3526 male).

The World Health Report 2000: World Health Organization health policy steering off course-changed values, poor evidence, and lack of accountability.

The World Health Report 2000 on health systems has raised concerns about its political biases, its methods and indicators, and its lack of reliable data. Tracing the origins of the Report, this article argues that it counteracts many of the concerns that gave rise to preparation of the Report in the first place. The mutually agreed-upon value-base, expressed in the Health for All strategy, has been largely abandoned.

Oral contraceptive use before first birth and risk of breast cancer: a case control study.

BACKGROUND: The aim of this study was first, to investigate whether women starting oral contraceptive (OC) use at a young age and before first birth have an increased risk for breast cancer and second, to report difficulties encountered in studying long-term health impacts of medical technologies. METHODS: Breast cancers occurring up until 1997 among 37153 Helsinki students born between 1946 and 1960 were identified by record linkage from the Finnish Cancer Registry; for each cancer case, five age-matched random controls were picked from the same student population. Those who had used the Helsinki Student Health Service (HSHS) at least three times (150 cases and 316 controls) form the final study subjects.

Effects of dental attendance frequency in heavy and low private care-using young adults.

In Finland, adults born in 1961 or later were progressively entitled to subsidies for dental care from private practitioners during 1986-90, while at the same time having access to care in the Public Dental Service. The aim of this study was to compare the effects of attendance frequency of private dental care on treatment costs and treatment spectrum for the heaviest and lowest users over a period. Three separate cohorts of recipients of reimbursements were formed, using the Social Insurance Register.

Probabilistic sensitivity analysis for evaluating cost-utility of entacapone for Parkinson's disease.

The objective was to assess uncertainty in a cost-utility analysis of adjunct entacapone treatment with levodopa among Parkinson's disease patients by probabilistic sensitivity analysis using second-order simulation methods. The cost-effectiveness of two treatment alternatives of Parkinson's disease - levodopa with or without entacapone - was compared in a cost-utility analysis employing a Markov model. Monte Carlo simulation was used to quantify the uncertainty due to sampling variation.

Organizational justice: evidence of a new psychosocial predictor of health.

Objectives: This study examined the justice of decision-making procedures and interpersonal relations as a psychosocial predictor of health.

Methods: Regression analyses were used to examine the relationship between levels of perceived justice and self-rated health, minor psychiatric disorders, and recorded absences due to sickness in a cohort of 506 male and 3570 female hospital employees aged 19 to 63 years.

Results: The odds ratios of poor self-rated health and minor psychiatric disorders associated with low vs high levels of perceived justice ranged from 1.

Day-to-day reactogenicity and the healthy vaccinee effect of measles-mumps-rubella vaccination.

Objective: Revaccination policies adopted in many countries to control measles have raised various safety issues including those concerning the second vaccine dose. We performed a prospective, double-blind, crossover trial among twins receiving a measles-mumps-rubella (MMR) vaccine.

Study Design: The study comprised 1162 monozygous and heterozygous twins, each of whom randomly received placebo and then vaccine, or vice versa, 3 weeks apart, at 14 to 83 months of age.

Organizational and individual factors affecting mental health and job satisfaction: a multilevel analysis of job control and personality.

This study evaluated variation at the individual and work unit levels in the relations of job control, hostility, and trait anxiety to mental health and job satisfaction. Questionnaire data from a sample of 2,900 employees working at 152 hospital wards were analyzed by means of multilevel regression analyses. Results showed that mental health (General Health Questionnaire-12), varying mainly at the individual level, was explained mostly by hostility and trait anxiety.

International actors and population policies in India, with special reference to contraceptive policies.

The international population policy agenda has traditionally been dominated by demographically driven population control policies. However, in the population policy development that preceded the International Conference on Population and Development in 1994, people's reproductive needs and rights received more emphasis. The aim of this study was to analyze how the new emphasis in population policies has been interpreted at the country level.

The Finnish case: community prevention in a time of rapid change in national and international trade.

This article looks at the present Finnish situation in planning and development of community-level prevention of alcohol and drug problems, and the experiences gained so far. Results from the first extensive evaluated project of this kind in Finland, the Lahti Project, and the program and evaluation plans for a new project in the Helsinki metropolitan area are also described. It is argued that in the present Finnish context there is need for detailed theoretical and well-measured evaluation on why the results of community-based prevention are or are not achieved.

Cosmetic and postmastectomy breast implants: Finnish women's experiences.

The purpose of this study was to compare women's satisfaction with and short-term problems of silicone breast implants after cosmetic breast augmentation and after mastectomy. Women (n = 224) were recruited through advertising in mass media, and 91% responded to a questionnaire asking for their experiences, both positive and negative, with silicone breast implants. Approximately equal numbers of women received their implants for cosmetic reasons (augmentation group) and postmastectomy (113 and 111, respectively).

Epidemiology of miscarriage and its relation to other reproductive events in Finland.

Objective: This study investigates the occurrence of miscarriages over the reproductive life span of women in a population-based study.

Study Design: A questionnaire was sent in 1994 to a random sample of 3000 Finnish women aged 18 to 44 years (73% response rate). Age-adjusted percentages of women having had miscarriages, and age- and other pregnancy event-adjusted odds ratios were calculated.

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%).

Climacteric hormone therapy in medical and lay texts in Finland from 1955 to 1992.

The "social shaping of technologies" approach holds that a technology is both socially embedded and that it shapes the social environment. The aim of this study was to investigate how hormone therapy use during the climacterium and subsequently was socially shaped in texts published in the main Finnish medical journals and lay magazines during 1955-1992. In these two arenas physicians, especially gynecologists, played the major role in the debate and their professional knowledge on hormone therapy was mixed with their views on women's status and roles, the quality of life and fears about aging when they were promoting hormone use, especially in the lay magazines.