Cohort profile: Impact of Maternal and Paternal Mental Health - Assessing Concurrent Depression, Anxiety and Comorbidity in the Canadian Family (IMPACT study).

PURPOSE: This paper describes a prospective cohort, Impact of Maternal and Paternal Mental Health: Assessing Concurrent Depression, Anxiety and Comorbidity in The Canadian Family (IMPACT) study, which followed maternal-paternal dyads and their children across the first 2 years post partum. PARTICIPANTS: A total of 3217 cohabitating maternal-paternal dyads were recruited into the study from 2014 to 2018. Each dyad member separately completed online questionnaires at baseline (<3 weeks post partum) and again at 3, 6, 9, 12, 18 and 24 months on a variety of measures, including mental health, parenting environment, family functioning and child health and development. FINDINGS TO DATE: At baseline, the mean maternal age was 31.9±4.2 years and 33.8±5.0 years for fathers. Overall, 12.8% of families had a household income below the poverty line of $C50 000, and 1 in 5 mothers and 1 in 4 fathers were not born in Canada. One in 10 women experienced depressive symptoms during pregnancy (9.7%) and 1 in 6 had markedly anxious symptoms (15.4%) while 1 in 20 men reported feeling depression during their partner's pregnancy and 1 in 10 had marked anxiety (10.1%). Approximately 91% of mothers and 82% of fathers completed the 12-month questionnaire as did 88% of mothers and 78% of fathers at 24 months postpartum. FUTURE PLANS: The IMPACT study will examine the influence of parental mental illness in the first 2 years of a child's life with a focus on understanding the mechanisms by which single (maternal or paternal) versus dual (maternal and paternal) parental depression, anxiety and comorbidity symptoms affect family and infant outcomes. Future analyses planned to address the research objectives of IMPACT will consider the longitudinal design and dyadic interparental relationship.

The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women. METHODS: For the data sources, a structured search of the peer-reviewed literature (English language; 1960-April 2020) was conducted using predefined key terms in PubMed and Embase. Google Scholar was also searched. Peer-reviewed manuscripts that reported on anatomical, physiological or functional differences between females with signs and/or symptoms consistent with SUI and a concurrently recruited control group of continent females without any substantive urogynecological symptoms. Of 4629 publications screened, 84 met the inclusion criteria and were retained, among which 24 were included in meta-analyses. RESULTS: Selection bias was moderate to high; < 25% of studies controlled for major confounding variables for SUI (e.g., age, BMI and parity). There was a lack of standardization of methods among studies, and several measurement issues were identified. Results were synthesized qualitatively, and, where possible, random-effects meta-analyses were conducted. Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. Meta-analyses showed that observed bladder neck dilation and lower functional urethral length, bladder neck support and maximum urethral closure pressures are strong characteristic signs of SUI. CONCLUSION: The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. While there is also evidence of impaired urethral support and levator ani function, standardized approaches to measurement are needed to generate higher levels of evidence.

Body mass index and the risk of disability retirement: a systematic review and meta-analysis.

The aim of this study was to determine the associations of body mass index (BMI) with all-cause and cause-specific disability retirement. Literature searches were conducted in PubMed, Embase and Web of Science from their inception to May 2019. A total of 27 (25 prospective cohort and 2 nested case-control) studies consisting of 2 199 632 individuals qualified for a meta-analysis. Two reviewers independently assessed the methodological quality of the included studies. We used a random effects meta-analysis, assessed heterogeneity and publication bias, and performed sensitivity analyses. There were a large number of participants and the majority of studies were rated at low or moderate risk of bias. There was a J-shaped relationship between BMI and disability retirement. Underweight (hazard ratio (HR)/risk ratio (RR)=1.20, 95% CI 1.02 to 1.41), overweight (HR/RR=1.13, 95% CI 1.07 to 1.19) and obese individuals (HR/RR=1.52, 95% CI 1.36 to 1.71) were more commonly granted all-cause disability retirement than normal-weight individuals. Moreover, overweight increased the risk of disability retirement due to musculoskeletal disorders (HR/RR=1.26, 95% CI 1.15 to 1.39) and cardiovascular diseases (HR=1.73, 95% CI 1.24 to 2.41), and obesity increased the risk of disability retirement due to musculoskeletal disorders (HR/RR=1.66, 95% CI 1.42 to 1.94), mental disorders (HR=1.29, 95% CI 1.04 to 1.61) and cardiovascular diseases (HR=2.80, 95% CI 1.85 to 4.24). The association between excess body mass and all-cause disability retirement did not differ between men and women and was independent of selection bias, performance bias, confounding and adjustment for publication bias. Obesity markedly increases the risk of disability retirement due to musculoskeletal disorders, cardiovascular diseases and mental disorders. Since the prevalence of obesity is increasing globally, disease burden associated with excess body mass and disability retirement consequently are projected to increase. Reviewregistrationnumber: CRD42018103110.

Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe.

OBJECTIVE: To date, little is known about differences in the knowledge, diagnosis making and treatment strategies of health care providers regarding polycystic ovary syndrome (PCOS) across different disciplines in countries with similar health care systems. To inform guideline translation, we aimed to study physician reported awareness, diagnosis and management of PCOS and to explore differences between medical disciplines in the Nordic countries and Estonia. METHODS: This cross-sectional survey was conducted among 382 endocrinologists and obstetrician-gynaecologists in the Nordic countries and Estonia in 2015-2016. Of the participating physicians, 43% resided in Finland, 18% in Denmark, 16% in Norway, 13% in Estonia, and 10% in Sweden or Iceland, and 75% were obstetrician-gynaecologists. Multivariable logistic regression models were run to identify health care provider characteristics for awareness, diagnosis and treatment of PCOS. RESULTS: Clinical features, lifestyle management and comorbidity were commonly recognized in women with PCOS, while impairment in psychosocial wellbeing was not well acknowledged. Over two-thirds of the physicians used the Rotterdam diagnostic criteria for PCOS. Medical endocrinologists more often recommended lifestyle management (OR = 3.6, CI 1.6-8.1) or metformin (OR = 5.0, CI 2.5-10.2), but less frequently OCP (OR = 0.5, CI 0.2-0.9) for non-fertility concerns than general obstetrician-gynaecologists. The physicians aged <35 years were 2.2 times (95% CI 1.1-4.3) more likely than older physicians to recommend lifestyle management for patients with PCOS for fertility concerns. Physicians aged 46-55 years were less likely to recommend oral contraceptive pills (OCP) for patients with PCOS than physicians aged >56 (adjusted odds ratio (OR) = 0.4, 95% CI 0.2-0.8). CONCLUSION: Despite well-organized healthcare, awareness, diagnosis and management of PCOS is suboptimal, especially in relation to psychosocial comorbidities, among physicians in the Nordic countries and Estonia. Physicians need more education on PCOS and evidence-based information on Rotterdam diagnostic criteria, psychosocial features and treatment of PCOS, with the recently published international PCOS guideline well needed and welcomed.

Breastfeeding rates in immigrant and non-immigrant women: A systematic review and meta-analysis.

Breastfeeding benefits mothers and infants. Although immigration in many regions has increased in the last three decades, it is unknown whether immigrant women have better breastfeeding outcomes than non-immigrants. The aim of this study was to conduct a systematic review and meta-analysis to determine whether breastfeeding rates differ between immigrant and non-immigrant women. We searched Medline, Embase, PsycINFO, CINAHL and Google Scholar, 1950 to 2016. We included peer-reviewed cross-sectional and cohort studies of women aged ≥16 years that assessed and compared breastfeeding rates in immigrant and non-immigrant women. Two independent reviewers extracted data using predefined standard procedures. The analysis included 29 studies representing 1,539,659 women from 14 countries. Immigrant women were more likely than non-immigrants to initiate any (exclusive or partial) breastfeeding (pooled adjusted prevalence ratio 1.13, 95% confidence interval [CI] 1.07-1.19; 11 studies). Exclusive breastfeeding initiation was higher but borderline significant (adjusted prevalence ratio 1.20, 95% CI 1.00-1.45; 5 studies, p = 0.056). Immigrant women were more likely than non-immigrants to continue any breastfeeding between 12- and 24-week postpartum (pooled adjusted risk ratio 2.04, 95% CI 1.79-2.32; 3 studies) and > 24 weeks (adjusted risk ratio 1.33, 95% CI 1.02-1.73; 6 studies) but not exclusive breastfeeding. Immigrant women are more likely than non-immigrants to initiate and maintain any breastfeeding, but exclusive breastfeeding remains a challenge for both immigrants and non-immigrants. Social and cultural factors need to be considered to understand the extent to which immigrant status is an independent predictor of positive breastfeeding practices.

Risk Factors for Low Back Pain: A Population-Based Longitudinal Study.

OBJECTIVE: To identify risk factors for low back pain (LBP) and lumbar radicular pain and to assess whether obesity and exposure to workload factors modify the effect of leisure-time physical activity on LBP and lumbar radicular pain. METHODS: The population of this 11-year longitudinal study consists of a nationally representative sample of Finns ages ≥30 years (n = 3,505). The outcomes of the study were LBP and lumbar radicular pain for >7 days or for >30 days in the past 12 months at follow-up. RESULTS: LBP and lumbar radicular pain were more common in women than in men. LBP slightly declined with increasing age, while lumbar radicular pain increased with age. Abdominal obesity (defined by waist circumference) increased the risk of LBP (adjusted odds ratio [OR] 1.40 [95% confidence interval (95% CI) 1.16-1.68] for LBP >7 days and adjusted OR 1.41 [95% CI 1.13-1.76] for LBP >30 days) and general obesity (defined by body mass index) increased the risk of lumbar radicular pain (adjusted OR 1.44 [95% CI 1.12-1.85] for pain >7 days and adjusted OR 1.62 [95% CI 1.16-2.26] for pain >30 days). Smoking and strenuous physical work increased the risk of both LBP and lumbar radicular pain. Walking or cycling to work reduced the risk of LBP, particularly LBP for >30 days (adjusted OR 0.75 [95% CI 0.59-0.95]), with the largest reductions among nonabdominally obese individuals and among those not exposed to physical workload factors. Using vibrating tools increased the risk of lumbar radicular pain. CONCLUSION: Lifestyle and physical workload factors increase the risk of LBP and lumbar radicular pain. Walking and cycling may have preventive potential for LBP.

Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials.

The aim of this systematic review and meta-analysis was to assess the effect of exercise in population-based interventions to prevent low back pain (LBP) and associated disability. Comprehensive literature searches were conducted in multiple databases, including PubMed, Embase, and the Cochrane Library, from their inception through June 2017. Thirteen randomized controlled trials (RCTs) and 3 nonrandomized controlled trials (NRCTs) qualified for the meta-analysis. Exercise alone reduced the risk of LBP by 33% (risk ratio = 0.67, 95% confidence interval: 0.53, 0.85; I2 = 23%, 8 RCTs, n = 1,634), and exercise combined with education reduced it by 27% (risk ratio = 0.73, 95% confidence interval: 0.59, 0.91; I2 = 6%, 6 trials, n = 1,381). The severity of LBP and disability from LBP were also lower in exercise groups than in control groups. Moreover, results were not changed by excluding the NRCTs or adjusting for publication bias. Few trials assessed health-care consultation or sick leave for LBP, and meta-analyses did not show statistically significant protective effects of exercise on those outcomes. Exercise reduces the risk of LBP and associated disability, and a combination of strengthening with either stretching or aerobic exercises performed 2-3 times per week can reasonably be recommended for prevention of LBP in the general population.

Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies.

BACKGROUND: There are plausible mechanisms whereby leisure time physical activity may protect against low back pain (LBP) but there have been no quality systematic reviews and meta-analyses of the subject. OBJECTIVE: This review aims to assess the effect of leisure time physical activity on non-specific LBP. METHODS: Literature searches were conducted in PubMed, Embase, Web of Science, Scopus and Google Scholar databases from their inception through July 2016. Methodological quality of included studies was evaluated. A random-effects meta-analysis was performed, and heterogeneity and publication bias were assessed. RESULTS: Thirty-six prospective cohort studies (n=158 475 participants) qualified for meta-analyses. Participation in sport or other leisure physical activity reduced the risk of frequent or chronic LBP, but not LBP for > 1 day in the past month or past 6-12 months. Risk of frequent/chronic LBP was 11% lower (adjusted risk ratio (RR)=0.89, CI 0.82 to 0.97, I2=31%, n=48 520) in moderately/highly active individuals, 14% lower (RR=0.86, CI 0.79 to 0.94, I2=0%, n=33 032) in moderately active individuals and 16% lower (RR=0.84, CI 0.75 to 0.93, I2=0%, n=33 032) in highly active individuals in comparison with individuals without regular physical activity. For LBP in the past 1-12 months, adjusted RR was 0.98 (CI 0.93 to 1.03, I2=50%, n=32 654) for moderate/high level of activity, 0.94 (CI 0.84 to 1.05, I2=3%, n=8549) for moderate level of activity and 1.06 (CI 0.89 to 1.25, I2=53%, n=8554) for high level of activity. CONCLUSIONS: Leisure time physical activity may reduce the risk of chronic LBP by 11%-16%. The finding, however, should be interpreted cautiously due to limitations of the original studies. If this effect size is proven in future research, the public health implications would be substantial.

Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis.

BackgroundMaternal anxiety negatively influences child outcomes. Reliable estimates have not been established because of varying published prevalence rates.AimsTo establish summary estimates for the prevalence of maternal anxiety in the antenatal and postnatal periods.MethodWe searched multiple databases including MEDLINE, Embase, and PsycINFO to identify studies published up to January 2016 with data on the prevalence of antenatal or postnatal anxiety. Data were extracted from published reports and any missing information was requested from investigators. Estimates were pooled using random-effects meta-analyses.ResultsWe reviewed 23 468 abstracts, retrieved 783 articles and included 102 studies incorporating 221 974 women from 34 countries. The prevalence for self-reported anxiety symptoms was 18.2% (95% CI 13.6-22.8) in the first trimester, 19.1% (95% CI 15.9-22.4) in the second trimester and 24.6% (95% CI 21.2-28.0) in the third trimester. The overall prevalence for a clinical diagnosis of any anxiety disorder was 15.2% (95% CI 9.0-21.4) and 4.1% (95% CI 1.9-6.2) for a generalised anxiety disorder. Postnatally, the prevalence for anxiety symptoms overall at 1-24 weeks was 15.0% (95% CI 13.7-16.4). The prevalence for any anxiety disorder over the same period was 9.9% (95% CI 6.1-13.8), and 5.7% (95% CI 2.3-9.2) for a generalised anxiety disorder. Rates were higher in low- to middle-income countries.ConclusionsResults suggest perinatal anxiety is highly prevalent and merits clinical attention. Research is warranted to develop evidence-based interventions.

Identifying women at risk for sustained postpartum anxiety.

INTRODUCTION: To describe the prevalence of sustained postpartum anxiety and to develop a multifactorial predictive model to assist in targeted screening procedures. METHODS: In a population-based cohort in a health region near Vancouver, Canada, 522 mothers completed a mailed questionnaire at 1, 4, and 8 weeks postpartum measuring socio-demographic, biological, pregnancy-related, life stressor, social support, obstetric, and maternal adjustment factors. We undertook a sequential logistic regression analysis to develop a multifactorial predictive model of sustained postpartum anxiety, as measured by a State Trait Anxiety Inventory (STAI) score >40 at 1 week and/or 4 weeks, and 8 weeks postpartum. RESULTS: The prevalence of sustained postpartum anxiety was 12.6% (95% CI 9.6-16.2). In the multivariable model, predictors of sustained anxiety in the postpartum period were perceived stress at 1 week (1 SD increase; aOR 3.74, 95% CI 2.17-6.44) and partner social support at 1 week (1 SD increase; aOR 0.59, 95% CI 0.40-0.85). Depression symptomatology at 1 week, child care stress, and maternal self-esteem were non-significant. LIMITATIONS: Single women and women from ethnic minority backgrounds were underrepresented in the sample. CONCLUSIONS: A large proportion of women experience sustained postpartum anxiety. High perceived stress and low partner social support can be used to facilitate early identification of women likely to experience persistent anxiety in the postpartum period and suggest the need for urgent access to psychotherapeutic services for these women. These factors may also be potential targets for individual or couples therapy to treat postpartum anxiety.

Prevalence and risk factors for comorbid postpartum depressive symptomatology and anxiety.

BACKGROUND: To date, little is known about the prevalence and risk factors for comorbid postpartum depression and anxiety. The aims of this study were to estimate the prevalence of comorbid depressive symptomatology and anxiety during the first 8 weeks postpartum and to identify risk factors. METHODS: As part of a longitudinal study conducted in a health region near Vancouver, British Columbia, a sample of 522 women completed mailed questionnaires at 1, 4, and 8 weeks postpartum. The presence of comorbid postpartum depressive symptomatology and anxiety was defined as having an Edinburgh Postnatal Depression Scale (EPDS) score of ≥10 and a State Trait Anxiety Inventory (STAI)-state anxiety score of ≥40 at the same time point. Risk factors associated with comorbidity were examined using generalized estimating equations (GEE). RESULTS: The prevalence of comorbid depressive symptomatology and anxiety was 13.1% during the first 8 weeks postpartum. In multivariable analysis, immigration within past 5 years (adjusted odds ratio (AOR)=8.03, 95% CI 3.43-18.77), maternal vulnerable personality (AOR=1.42, 95% CI 1.02-1.97 for 1 SD increase), child care stress (AOR=1.66, 95% CI 1.18-2.35 for 1 SD increase) and perceived stress (AOR=3.00, 95% CI 2.01-4.47 for 1 SD increase) predicted a higher risk of comorbidity. Conversely, high breastfeeding self-efficacy (AOR=0.66, 95% CI 0.49-0.88 for 1 SD increase), maternal self-esteem (AOR=0.66, 95% CI 0.45-0.97 for 1 SD increase), and partner support (AOR=0.73, 95% CI 0.55-0.98 for 1 SD increase) were associated with a lower risk of developing comorbidity. LIMITATION: In this study, women who were single or from non-Caucasian ethnic groups were underrepresented. CONCLUSIONS: Comorbid postpartum depressive symptomatology and anxiety is a common condition with little known about risk factors. Additional research is warranted to develop strategies to reliably identify women with this comorbid condition and to determine effective treatment options.

The Effect of Smoking on the Risk of Sciatica: A Meta-analysis.

BACKGROUND: The role of smoking in sciatica is unknown. This study aimed to estimate the effect of smoking on lumbar radicular pain and clinically verified sciatica. METHODS: Comprehensive literature searches were conducted in PubMed, Embase, Web of Science, Scopus, Google Scholar, and ResearchGate databases from 1964 through March 2015. We used a random-effects meta-analysis, assessed heterogeneity and publication bias, and performed sensitivity analyses with regard to study design, methodological quality of included studies, and publication bias. RESULTS: Twenty-eight (7 cross-sectional [n = 20,111 participants], 8 case control [n = 10,815], and 13 cohort [n = 443,199]) studies qualified for a meta-analysis. Current smokers had an increased risk of lumbar radicular pain or clinically verified sciatica (pooled adjusted odds ratio [OR] 1.46; 95% confidence interval [CI], 1.30-1.64, n = 459,023). Former smokers had only slightly elevated risk compared with never smokers (pooled adjusted OR 1.15; 95% CI, 1.02-1.30, n = 387,196). For current smoking the pooled adjusted OR was 1.64 (95% CI, 1.24-2.16, n = 10,853) for lumbar radicular pain, 1.35 (95% CI, 1.09-1.68, n = 110,374) for clinically verified sciatica, and 1.45 (95% CI, 1.16-1.80, n = 337,796) for hospitalization or surgery due to a herniated lumbar disc or sciatica. The corresponding estimates for past smoking were 1.57 (95% CI, 0.98-2.52), 1.09 (95% CI, 1.00-1.19), and 1.10 (95% CI, 0.96-1.26). The associations did not differ between men and women, and they were independent of study design. Moreover, there was no evidence of publication bias, and the observed associations were not due to selection or detection bias, or confounding factors. CONCLUSIONS: Smoking is a modest risk factor for lumbar radicular pain and clinically verified sciatica. Smoking cessation appears to reduce, but not entirely eliminate, the excess risk.

Prevalence of postpartum depression among immigrant women: A systematic review and meta-analysis.

The aims of this systematic review and meta-analysis were threefold: to estimate the prevalence of postpartum depressive symptoms in immigrant women, compare this prevalence to non-immigrant women, and determine risk factors for postpartum depressive symptoms in immigrant women. Literature searches were conducted in PubMed, Embase, PsycINFO, Web of Science, Scopus, ResearchGate and Google Scholar databases from 1950 until October 2014. Twenty-four studies met the inclusion criteria of which 22 (12 cross-sectional and 10 prospective cohort) contributed data for meta-analyses. Heterogeneity and publication bias were assessed. The prevalence of postpartum depressive symptoms in immigrant women was 20% (95% confidence interval [CI] 17-23%, 18 studies, N = 13,749 women). Immigrant women were twice more likely to experience depressive symptoms in the postpartum period than non-immigrant women (pooled unadjusted odds ratio [OR] = 2.10 [95% CI 1.62-2.73, 15 studies, N = 50,519 women] and adjusted OR = 2.18 [95% CI 1.60-2.96, 7 studies, N = 35,557 women]). There was, however, evidence of publication bias with the pooled adjusted OR reduced to 1.63 (95% CI 1.22-2.17) after adjustment for bias. Risk factors associated with postpartum depressive symptoms among immigrant women included shorter length of residence in the destination country, lower levels of social support, poorer marital adjustment, and perceived insufficient household income. This study suggests that postpartum depression is a common condition among immigrant women. Moreover, immigrant women are at higher risk of postpartum depression than non-immigrant women. Further prospective studies on the risk factors of postpartum depression among immigrant women verified by a clinical diagnosis are needed.

Computer use and carpal tunnel syndrome: A meta-analysis.

BACKGROUND: Studies have reported contradictory results on the role of keyboard or mouse use in carpal tunnel syndrome (CTS). This meta-analysis aimed to assess whether computer use causes CTS. METHODS: Literature searches were conducted in several databases until May 2014. Twelve studies qualified for a random-effects meta-analysis. Heterogeneity and publication bias were assessed. RESULTS: In a meta-analysis of six studies (N=4964) that compared computer workers with the general population or other occupational populations, computer/typewriter use (pooled odds ratio (OR)=0.72, 95% confidence interval (CI) 0.58-0.90), computer/typewriter use ≥1 vs. <1h/day (OR=0.63, 95% CI 0.38-1.04) and computer/typewriter use ≥4 vs. <4h/day (OR=0.68, 95% CI 0.54-0.87) were inversely associated with CTS. Conversely, in a meta-analysis of six studies (N=5202) conducted among office workers, CTS was positively associated with computer/typewriter use (pooled OR=1.34, 95% CI 1.08-1.65), mouse use (OR=1.93, 95% CI 1.43-2.61), frequent computer use (OR=1.89, 95% CI 1.15-3.09), frequent mouse use (OR=1.84, 95% CI 1.18-2.87) and with years of computer work (OR=1.92, 95% CI 1.17-3.17 for long vs. short). There was no evidence of publication bias for both types of studies. CONCLUSIONS: Studies that compared computer workers with the general population or several occupational groups did not control their estimates for occupational risk factors. Thus, office workers with no or little computer use are a more appropriate comparison group than the general population or several occupational groups. This meta-analysis suggests that excessive computer use, particularly mouse usage might be a minor occupational risk factor for CTS. Further prospective studies among office workers with objectively assessed keyboard and mouse use, and CTS symptoms or signs confirmed by a nerve conduction study are needed.

The use of the vaginal ring and transdermal patch among adolescent girls in Finland.

OBJECTIVE: Little is known about the use of the vaginal ring and transdermal patch in representative adolescent populations although these contraceptives are supposed to be a good option for that age group. The aim of this study was to determine the use of the vaginal ring and that of the transdermal patch and to compare these with the use of oral contraceptives (OCs) and emergency contraception in adolescent girls residing in Finland. METHODS: As part of the Adolescent Health and Lifestyle Survey a questionnaire was mailed to a representative sample of girls aged 14, 16 or 18 years residing in Finland. Of these 3029 (72%) responded. RESULTS: The use of the vaginal ring (0.9%) and that of the transdermal patch (0.1%) were uncommon whereas OCs were commonly resorted to (20%). Only 0.6% of girls aged 16 and 2.5% of those aged 18 used the vaginal ring or the transdermal patch. Fifteen percent of girls had ever used emergency contraception. CONCLUSION: The vaginal ring and the transdermal patch are rarely used by adolescents. Our findings suggest that these novel contraceptive methods have not been adopted by family planning services.

Adolescent sexual behavior during periods of increase and decrease in the abortion rate.

OBJECTIVE: To study changes in adolescent sexual behavior in periods of increase (1994-2000) and decrease (2001-2007) in the abortion rate. METHODS: School surveys with self-administered questionnaires were carried out annually among eighth graders (mean age 14.8 years) and ninth graders (mean age 15.8 years) (N=286,665) in 1996/1997 and 2006/2007. Schools participated biennially. The proportions of respondents reporting noncoital (kissing, light petting, heavy petting) and coital (ever had sexual intercourse, intercourse at least 10 times, at least three partners) sexual experience and nonuse of contraception were studied. RESULTS: Among adolescents, both coital and noncoital sexual experiences and the proportion of those not using contraception increased between 1996-1997 and 2000-2001 (P for trend <.01, all) and decreased from 2000-2001 onward (P<.001, all), except the proportion of at least 10 coital events, which did not decrease. Among sexually experienced adolescents, a similar increase in coital experiences (intercourse at least 10 times from 38.2% to 41.5%, at least three partners from 27.8% to 30.7%, P<.001) and in not using contraception (from 17.2% to 19.1%, P=.002) was seen before 2000-2001, but after that the only significant change was a further increase in the proportion of those reporting intercourse at least 10 times (from 41.5% to 47.8%, P<.001). CONCLUSION: The proportion of adolescents reporting noncoital sexual experiences, intercourse, or not using contraception increased in the 1990s and decreased in the 2000s, reflecting the changes in the abortion rate. However, as the abortion rate decreased, the intensity of sexual activity further increased among sexually experienced adolescents, suggesting that the fall in the abortion rate may be due to contraception and more effective sexual education. LEVEL OF EVIDENCE: : III.

Emergency contraception among Finnish adolescents: awareness, use and the effect of non-prescription status.

BACKGROUND: Adolescents need to be aware that there is a method of preventing pregnancy even after an unprotected intercourse. Limited information is available on the awareness of young adolescents and the effects of selling emergency contraception (EC) over-the-counter, and the findings are controversial. The aims of this study were to investigate awareness and use of EC among Finnish girls aged 12-18 years in 1999-2003, and to assess the effect of the 2002 non-prescription status on the use. METHODS: A self-administered questionnaire was sent to a population-based sample of 12-18-year-olds girls in 1999, 2001, and 2003. Response rate was 83% in 1999 (N = 4,369), 79% in 2001 (N = 4,024) and 77% in 2003 (N = 3,728), altogether N = 12,121. Logistic regression model was used to examine the association of unawareness and use of EC with socio-economic background and health behaviour. RESULTS: In 2001, nearly all 14-18-year-olds and a majority of 12-year-olds were aware of EC. Among 12-14-year-olds, a slight increase in awareness between 1999 and 2003 was observed but this was not related to non-prescription status. Health-compromising behavior (alcohol use, smoking), dating and having good school achievement were related to higher awareness of EC.Nine percent of 14-18-year-olds had used EC once and 1% three times or more. No statistically significant change in EC use was found after non-prescription status. EC use increased with increasing alcohol consumption, particularly at age 14. Smoking, dating, and poor school achievement were related to increased use as well as not living in nuclear family. A lower use was observed if living in rural area or father's education was high. Mother's education was not related to use. CONCLUSION: Adolescent girls were well aware of the existence of emergency contraception even before the non-prescription status. Over-the-counter selling did not increase the use.

Lead poisoning and recurrent abdominal pain.

Severe abdominal colic because of lead poisoning is an uncommon condition in adults. The diagnosis of lead toxicity is often delayed and abdominal pain is mistaken for acute abdomen. We describe three blood brothers who were involved in pottery glazing and suffered from repeated episodes of severe abdominal pain, nausea, vomiting, constipation and anemia due to lead toxicity. The patients had a history of several hospitalizations and one or two unnecessary laparotomies. One patient had wrists drop and weakness of the fingers extensors. All three patients had microcytic microchromic anemia with basophilic stippling of the erythrocytes, lead lines in X-ray of the knee joint and high blood lead levels. A diagnosis of lead poisoning was made and a course of chelating treatment started. Motor neuropathy, anemia and all gastrointestinal symptoms disappeared. Our report highlights the importance of taking a detailed occupational history and considering lead poisoning in the differential diagnosis of acute abdominal colic of unclear cause.