Sense of coherence and health behaviour in adolescence.

AIM: To explore associations of Sense of coherence (SOC) with health behaviour and social competence among 15-year-old adolescents. METHODS: Study population is a prospective cohort of a randomized cluster sample of families and their first-born children from south-western Finland in 1986-1987. In this study, cross-sectional data of the 15-year-olds were used. The present data were based on mailed, pretested questionnaires. The outcome variable, SOC, was based on the 13-item scale of Antonovsky's Orientation to Life Questionnaire (OLQ). The principal explanatory variables were health behaviour, including experienced oral health, and social competence. The statistical analysis was performed using linear regression modelling. RESULTS: Strong SOC of adolescents associated significantly with lighter use of alcohol, being a non-smoker, better care of oral health and better social competence compared with the others. CONCLUSION: Sense of coherence is a useful tool for identifying adolescents in need of extra support and motivation for their health behaviour.

Attitudes towards and perceptions about contraceptive use among married refugee women of Somali descent living in Finland.

OBJECTIVES: To assess attitudes towards and perceptions about contraceptive use among married refugee women of Somali descent living in Finland. METHOD: A sample of 100 married refugee women of Somali descent (18-50 years of age) were invited to participate in a study on contraceptive use in Finland (30 women refused). Qualitative and quantitative methods were used to collect the data. Questionnaire of the first data set was written in the Somali language. Interviews were conducted in the Somali language. RESULTS: The attitudes and opinions of these women towards contraceptive use (73% did not use contraceptives, 27% did use them) were connected with religious beliefs and issues involving marital relations. Religious or gender issues did not seem to influence those who used contraception. CONCLUSIONS: The findings indicated that the majority of the married refugee women of Somali descent living in Finland did not use contraception. The process of starting the use of contraception was possible because of an access to good reproductive health care and family planning services, changes in life situations, and adaptations to Finnish social and cultural norms.

Behavioural and demographic factors during early childhood and poor dental health at 10 years of age.

The aim was to elucidate whether variables recorded in early childhood would have a long-lasting predictive value of poor dental health at the age of 10 years in a prospectively followed Finnish population-based cohort setting. The second aim was to find new tools for preventive work in order to improve dental health among children. Poor dental health (dmft + DMFT >or= 5) at 10 years of age was associated with child's nocturnal juice drinking at 18 months. It was associated with the following factors at age 3 years: frequent consumption of sweets; infrequent tooth brushing; plaque and caries on teeth. Of family factors, the following were significant: father's young age at birth of the child; mother's basic 9-year education; mother's caries (i.e. several carious teeth per year), and father's infrequent tooth brushing. Early childhood risk factors of poor dental health seem to be stable even after 10 years of life and the changing of teeth from primary to permanent ones. In preventive work, dental health care staff could offer support to those parents with risk factors in their child rearing tasks.

Factors of early infancy and recurrent use of antibiotic therapy.

AIM: To analyse the role of early infant-related, parent-related, family functioning and social relation factors during the infant's first 3 mo of life and their associations with later recurrent treatments with antibiotics. METHODS: In an unselected population-based study, parents expecting their first child were followed from pregnancy until the infant was 18 mo of age. Informed consent to participate was obtained from 1443 women expecting their first child and their spouses. The parents of 817 children reported the number of preceding antibiotic treatments at two times (when the child was 9 and 18 mo old). The outcome measure was the number of antibiotic treatments (options: none, 1-5, > or = 6). The factors associated with later use of antibiotics were collected during the first 3 mo of the infant's life. The variable factors included infant-related, parent-related, family functioning and social relation factors. RESULTS: The final regression analysis showed the potent factors associated with recurrent use of antibiotics: male gender (OR 2.8, 95% CI: 1.6-4.8), frequent physician consultations in early infancy (OR 3.1, 95% CI: 1.8-5.3) and the father's need for outside support (OR 2.2, 95% CI: 1.3-3.8). CONCLUSIONS: In addition to early infant-related medical factors, family factors may be associated with frequent medical consultations and the decision to administer antibiotics to the infant. In the prevention of antibiotic overuse, social and psychological factors should be considered.

Pregnancy and childbirth-related factors associated with recurrent antibiotic use in infants.

AIM: To determine the reasons for the possible overuse of antibiotics by investigating whether family-related medical, behavioural, emotional, and social risk factors during the mother's pregnancy and childbirth are associated with subsequent recurrent antibiotic therapy of infants. METHODS: Subject selection was based on stratified randomized cluster sampling. A total of 1443 women (91%) and their spouses expecting their first child gave informed consent to participate and 1287 infants were born. The parents of 817/1025 infants (80%) reported the number of courses of antibiotic therapy the child had received at the ages of 9 and 18 mo. The outcome measure was the number of courses of antibiotic therapy (none/1-5/=6) given during the first 18 mo of life. The explanatory variables included family-related factors during the pregnancy and immediately after childbirth. RESULTS: In the final multivariate stepwise analysis, parents' long-term illnesses were associated with recurrent antibiotic medication. CONCLUSIONS: Parents with long-term illnesses need special guidance and support from the beginning of the mother's pregnancy in order to minimize the subsequent risk for recurrent antibiotic therapy of their infants. Preventive healthcare workers should be aware of the effects of these factors on parental guidance.

Analysis of primary health care utilisation in south-western Finland--a tool for management.

Long-term health care planning is presently not based on the needs of the population at the local level in Finland but rather, it is based on retroactive economic values and already realised budget in hospital and primary health care. The existing health care structure and its health care practices continue to guide the supply of services. While we have the most extensive databases on primary health care and hospital services, such tools are not used in the broadest possible sense in the present health care planning at the local level. Simple and informative indicators available to health care planners and decision-makers from databases at the local level were used to appraise the use of health care services. Statistical profiles of health care clients were classified by age groups within the health authority area (population of 13,000) of Paimio-Sauvo in south-western Finland with the intent to explain utilisation of primary health care services, their coverage, and repeat visits as well as groups not using those services. Physicians recorded reasons for each patient visit with the ICD-10 categories. In the case municipalities, primary health care services provided 100% coverage to children of 0-6 years of age and more than 70% coverage to other groups. Most primary health care expenditures were assessed for people 65 years or older in 2000. As an example of a municipality, hospital and primary health care expenditures within Paimio varied from 24 to 30.4% of the total obligations for the last 10 years.

Experience of climacteric symptoms among 42-46 and 52-56-year-old women.

OBJECTIVE: The intensity of climacteric symptoms and their connection with sociodemographic background data were assessed among women who are or will soon be menopausal. METHODS: A sample of 5510 Finnish women who were 42-46 or 52-56-years-old was selected to this 'Quality of Life among Middle-aged Women' Study and received a menopause-specific questionnaire. RESULTS: Only 5% of the older and 36% of the younger women were totally asymptomatic. Altogether, 2% of the younger and 11% of the older women had severe climacteric symptoms. In the younger age group, a high symptom intensity was associated with living in town, having a low level of professional education, and being unemployed/laid off, whereas in the older age group, the experience of severe symptoms was associated with those having a couple relationship. CONCLUSION: Altogether 95% of women in the productive working age (52-56-years-old) surprisingly suffer from mild, moderate, or severe climacteric symptoms. Further even up to 64% of the younger women (42-46-years-old) suffered from similar symptoms.

Impact of dental health care on dental health of children with long-term diseases: a nested case-control study.

The objective was to study dental health among nine-year-old long-term ill and disabled children and their matched controls using DMFT/dmft-indices (decayed-missing-filled-teeth, of both permanent and deciduous teeth); to analyze similarities and differences of their family factors; the children's dental health habits which include dietary factors; to assess capabilities of the health care personnel in the identification of the risk groups and in the provision of services; and finally to investigate family satisfaction with the dental health care services provided. One dentist (M-L M) routinely carried out the clinical examinations of the children using the DMFT(dmft)-index. Only cavities extending to dentin were included in the DMF and dmf indices. X-rays were also used. It was found that less than half of the children (46%) had healthy teeth (DMFT and dmft both = 0), with 41% among the study group and 51% among the controls. The DMFS index of the longterm ill children was slightly, but not significantly greater than that of the controls, and these children used dental health care services more but their families were less satisfied with the services. The long-term ill children had less orthodontic care than the controls although they needed it more frequently, and they had a designated candy day significantly more often than the controls. Special diets were associated with long-term ill children, as were the sociodemographic factors of marital status, divorce, or stepfather present. No significant differences existed between the groups in toothbrushing and the use of fluoride products. In the status and health of teeth as measured with the DMFT/dmft indices, there were no statistically significant differences between the group of the long-term-ill children and healthy controls. Estimation of the focusing of care was considered successful concerning dental health, but resource limitations emerged and contributed to parents not being satisfied with the frequency dental care services offered.

Patient education in Finland.

No mandated policies, practices, and procedures of patient education or patient health education exist in Finland but the efforts have been local in nature. Traditionally, primary and secondary health education as a part of maternal health care and during dental appointments have been known to exist. Hospital patient education efforts which may have resulted from past public health problems or legislative endeavors do exist in many hospital units but official hospital policies or strategies still do not. Patient education is often seen as health education. Voluntary agencies tend to emphasize practical issues rather than strategic planning in patient education. Finland complies with the WHO health strategies of 2015, and as a part of the Finnish strategies, it is considered important that large groups of people participate. A recent movement in health care to plan and implement shared decision-making activities (Seamless Macro Project, Path-project) is still short-term in nature. Practical actions are guided by professional skills, ethical practices, professional norms, and habits of the land, and of the three laws (public health law, occupational health law, patient status and rights law) guiding health education activities, the third one is specifically directed to patient education with an intent that when a treatment is not acceptable, another acceptable one must be found. Empowerment is a term seen in many contexts.

Poor performance in the mini-mental state examination due to causes other than dementia.

OBJECTIVE: The aim of this study was to examine the extent to which causes other than dementia contribute to poor performance on the Mini-Mental State Examination (MMSE). DESIGN: Cross-sectional population-based study. SETTING: Municipality of Lieto, Finland. SUBJECTS: The study population consisted of all individuals residing in Lieto and born in or before 1926. A total of 1196 individuals, 93% of those eligible, participated. MAIN OUTCOME MEASURES: The MMSE was implemented following interviews and clinical examinations. Whenever an individual was unable to complete any individual item on the MMSE, the nurse recorded causes and assessed whether poor performance was mainly caused by dementia or other reasons. RESULTS: Poor test performance due to causes other than dementia was recorded in 122 (10.2%) individuals (4% of those in the 64-74 years group, 15% in the 75-84 years group and 42% in the group of 85 years of age or older). The most common causes were poor vision and hearing, deficient schooling and consequences of stroke. CONCLUSION: Ten percent of the elderly population had symptoms contributing to poor performance on the MMSE. Physicians should therefore consider and record co-morbidity in the testing situation, especially in very old individuals.

Caries experience and caries increments at 10 years of age.

The aim of the study was to examine the caries experience of 10-year-olds as measured with dmft/DMFT, to explain how caries increases by the age of 10 years, and which factors would explain caries increments. The setting was a representative population sample of first-born children in southwestern Finland. Dental health at 10 years of age was found to be good in 45%, fairly good in 40% and poor in 15% of the children. The caries index remained stable in 23% of carious children from 7 to 10 years of age. Daily consumption of sweets at the age of 3 years (OR 2.7; 95% CI 1.5-4.8; p < 0.001) was associated with a caries increment between 7 and 10 years of age (both deciduous and permanent teeth). This daily consumption of sweets and a child's late bedtime (OR 1.9; 95% CI 1.1--3.1; p = 0.023) were explanatory factors in the permanent teeth alone. In the deciduous teeth, mother's previous caries and child's earlier tooth brushing habits were explanatory factors of caries. As hypothesized, all five significant factors remaining in the final logistic regression analysis were family-related. Parental ability to care for and educate a child could be seen in dental health still at the age of 10 years. The family-related factors which were associated with caries should be emphasized much more comprehensively in everyday dental health care practice.

Non-response and related factors in a nation-wide health survey.

OBJECTIVE: To analyse selective factors associated with an unexpectedly low response rate. SUBJECTS AND METHODS: The baseline questionnaire survey of a large prospective follow-up study on the psychosocial health of the Finnish working-aged randomly chosen population resulted in 21,101 responses (40.0%) in 1998. The non-respondent analysis used demographic and health-related population characteristics from the official statistics and behavioural, physical and mental health-related outcome differences between early and late respondents to predict possible non-response bias. Reasons for non-response, indicated by missing responses of late respondents, and factors affecting the giving of consent were also analysed. RESULTS: The probability of not responding was greater for men, older age groups, those with less education, divorced and widowed respondents, and respondents on disability pension. The physical health-related differences between the respondents and the general population were small and could be explained by differences in definitions. The late respondents smoked and used more psychopharmaceutical drugs than the early ones, suggesting similar features in non-respondents. The sensitive issues had a small effect on the response rate. The consent to use a medical register-based follow-up was obtained from 94.5% of the early and 90.9% of the late respondents (odds ratio: 1.70; 95% confidence interval: 1.49-1.93). Consent was more likely among respondents reporting current smoking, heavy alcohol use, panic disorder or use of tranquillisers. CONCLUSIONS: The main reasons for non-response may be the predisposing sociodemographic and behavioural factors, the length and sensitive nature of the questionnaire to some extent, and a suspicion of written consent and a connection being made between the individual and the registers mentioned on the consent form.

Healthy reciprocity in sexual interaction.

The purpose of the article is to discuss reciprocity in sexual interaction within a couple relationship in which heterosexual orientation is assumed and satisfaction considered. Reciprocity is modelled as an exchange of services which at its best functions as an unwritten contract, a mutual understanding regarding fairness of returned services, and a desire to comply with this principle together with a loved one/lover. An equal treatment of and balanced attitudes towards one another are present together with a just distribution of benefits and concessions or compromises. Reciprocity involves a relative term although healthy reciprocity can be defined for discussion and assessed as a degree of mutual satisfaction. Sexual interaction issues, skills to obtain satisfaction, and sexual and emotional compatibility are important elements in reciprocity. Understandable communication is an essential contributor in the implementation of reciprocity. Conflict-making dialogue should generally be avoided and connotive meanings of words taken into account. Erotophilia-erotophobia dimensions influence both the learning about and attitudes towards sexuality and contribute to personal and professional abilities to assess sexual problems and to attend to them. Erotic touch is a minimum requirement of love making. Sexual orientation, sexual desire, and intimacy influence sexual compatibility. Equity and exchange models are discussed, and a reciprocity model is proposed.

Familial occurrence of headache.

Associations between the occurrences of headache among parents and their offspring during a 7-year follow-up were studied. Data were collected using a prestructured questionnaire from a representative population-based sample of 1443 families expecting their first child. Seven years later, another questionnaire was sent to 1132 families still included in the study. Questionnaires were returned by 968 families. One or either of the parents had experienced frequent headache in 47% of families (34% of the mothers and 19% of the fathers) before pregnancy. Of the 6-year-old children, 15% had headache disturbing daily activities. Mother's prepregnancy headache was a clear predictor of her child's preschool headache (p = 0.006, OR = 1.7, 95% CI 1.2-2.4). In the clinical interview, the children with headache more often had first-degree and second-degree relatives with headache than the control children.

Changes in dental health and dental health habits from 3 to 5 years of age.

OBJECTIVES: This study sought to determine how dental health and dental health habits change from 3 to 5 years of age and to consider whether preventive dental health care helped in preventing or halting caries in children. METHODS: The study included 67 maternity health care clinics, 72 well-baby clinics, and 69 dental health care clinics. Of the 1,292 newborn children, 1,003 (90.8%) were included in this study. RESULTS: Preventive dental health care contributed to dental caries being halted in only 13.2 percent of those children who had enamel caries at 3 years of age. The dmft index did not increase in 22.6 percent of those children who had dentinal caries at 3 years of age. For all others, the disease became more severe. Toothbrushing habits of 3-year-old children were very consistent over the two years studied. Children were at a risk for caries when their mothers had nine years of basic education, when they already had plaque and caries at 3 years of age, and when the frequency of eating sweets increased the most during the two-year study period. CONCLUSIONS: Among 3-year-old children, plaque is an indicator of caries risk and therefore should be a key element in health education. Those children who already have evidence of caries at 3 years of age should be the target of preventive dental services because of their increased risk.

The use of problem-based learning in dealing with cultural minority groups.

Minority peoples like the Romanies have divergent cultures. Typical cultural aspects for medical personnel to consider would include greetings and other communication, family and social support, dressing and habits of cleanliness, marriage and sexuality, honor, and other issues of importance to any human being. Some minority cultures have no geographic boundaries but they still may adopt the lifestyles of the country they live in. Physicians have to reckon with these different cultural patterns when dealing with patients. Patients must be treated equally at the same time when their personal needs require individual consideration. This consideration is reflected in both verbal and non-verbal communication with the other. Both the sender and the receiver of a message would need to know of the other. Minority groups tend to know more about the majority groups than vice versa. Most health care providers belong to the majority group and would be expected to learn more about the other. Problem-based learning can help students to understand attitudes of minority patients (like the Romanies) and handle the situation. In this instance, the students collected theory base from existing legal, cultural, and other resources and interviewed a Romany woman to verify that the information pertaining to the female case was correct. This combination of theory and experience was considered useful in preparing a case presented to a seminar with 116 medical and dental students in 1994.

Teaching sociology of medicine: the group process.

As a part of any curriculum reorganization, new instructional methods are also tested. When the University of Turku sociology of medicine course was found to need renovation, its goals and objectives, content and instructional methods were closely examined and modified, in order to strengthen institutional and multiprofessional relations and reinforce sociocultural issues in doctors' competence with the patient. This paper discuss this change, emphasizing teaching and learning methodology.

Sexual knowledge, attitudes, fears and behaviors of adolescents in Finland (the KISS study).

In 1986 and 1988, a structured questionnaire on sexual knowledge, attitudes, fears and behaviors was administered to 13, 15 and 17 year olds in Finnish public schools; 5289 (88% response rate) responses were recorded. With the exception of a few small differences in attitudes, no significant regional differences were recorded--suggesting that the results are representative of all Finnish adolescents. Except for 13 year olds, knowledge level was satisfactory. With increasing age, most attitudes showed increasing tolerance towards sexual matters and liberalism. Although several fears increased, AIDS was not perceived as an exceptionally great personal danger. By comparison with data from surveys 20 years previously, the age of first experience of sexual intercourse was lower--especially among women. About a third of the adolescents surveyed used no birth control and about 60% used a condom. Implications for educational policy and planning are discussed.

The ultimate rejection: helping the survivors of teen suicide victims.

Each year, teens who commit suicide leave behind more than 25,000 survivors. In addition to feelings of depression, anger, and guilt, the survivors must cope with societal attitudes toward suicide. Few resources are available to deal with the problem. This paper discusses the impact of teen suicide on survivors, and outlines educational and administrative postincident intervention guidelines for schools.

The impact of chlamydia infections on teen mothers and their children.

Chlamydia trachomatis recently has emerged as the most frequently diagnosed sexually transmitted disease (STD) agent. An estimated three million cases are diagnosed annually in the United States. Because the infection is not reportable, only estimates can be made. The most common STD, it also is often transmitted to infants through infected mothers. Prevention and treatment of the disease in newborns require different procedures from those for gonorrhea, as do diagnostic and treatment methods for infected adults. Chlamydia also appears to pose a threat to pregnancy.