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Biomedical subjects

A R Aro

Publications and source records attributed to A R Aro.

At least 19 recordsLinked to original sources
PubMed2005

Psychological risk factors of incidence of breast cancer: a prospective cohort study in Finland.

BACKGROUND: Belief that depression and other psychological factors predict breast cancer is common, but there have been few prospective epidemiological studies on this relationship. METHOD: The relationship between depression, personality traits, illness attitudes, life events and health history, and breast cancer risk was studied in a prospective, 6-9 year follow-up of a cohort study of 10892 Finnish women of 48-50 years of age at the baseline. Cancer cases were obtained from the Cancer Registry of Finland. Multivariate logistic regression analysis was performed controlling for socioeconomic factors, family history of cancer, parity, and health behaviours. RESULTS: Breast cancer incidence in the cohort was 1.15 times the average in age group 50-59. There was no evidence of depression, trait anxiety, cynical distrust, or coping being significant predictors of breast cancer incidence. CONCLUSION: In this cohort study with the 6-9 year follow-up, psychological factors such as depression, trait anxiety, cynical distrust, or coping did not increase breast cancer risk.

Adaptation, Psychological↗
PubMed2004

Is the evaluation of the global quality of life determined by emotional status?

The present study investigated relationships between global QOL perceptions and well-being dimensions. Especially our goal was to evaluate the impact of generally recognised four broad dimensions of QOL (physical, functional, social and emotional well-being) on global QOL perceptions, additionally person's satisfaction with life achievements and economical situation were measured as well as social demographic variables. The subjects were a representative sample of Finns (n = 4613, from 25 to 65 years) of the FINRISK-97 study. Correlation coefficients and models of hierarchical regression indicated that physical, functional and social well-being as well as sociodemographic factors and satisfaction with life achievements are important factors of global QOL perceptions both among males and females. However percentages of variances explained with these measures were only moderately high, ranging from 1 to 10%. After measures of emotional well-being were entered into the models of hierarchical analyses of regression, variances explained grew dramatically over 20%. The results of the study indicated that global QOL judgements are likely to be based on current emotional state.

Adult↗
PubMed2001

Women's satisfaction with information at breast biopsy in breast cancer screening.

Information needs, satisfaction with information and information sources of women referred for surgical biopsy in mammography screening were explored. Forty-five Finnish women (23 benign and 22 malignant finding) replied to a mailed questionnaire containing fixed-choice and open-ended questions 10 weeks after biopsy. Information was regarded an important form of support. In response to fixed-choice questions the women expressed a general satisfaction with the information received at the hospital, but answers to open questions revealed shortcomings in the ways of being informed. The results underscored the active role of the staff in giving information, in matching the information to women's needs and abilities at the time and in encouraging patients to express their concerns. Up to the point of diagnosis the needs of women with benign and malignant finding were similar. Regardless of diagnosis the women should be provided with reassuring information throughout and after the examination period.

Adult↗
PubMed2001

Two distinct groups of non-attenders in an organized mammography screening program.

OBJECTIVE: To find out reasons for non-attendance and to study subgroup differences of the non-attenders in an organized mammography screening program. DESIGN: Prospective for background and psychosocial factors, retrospective for reasons of non-attendance. SETTING: Finnish screening based on personal first round invitations, with 89% attendance rate. PARTICIPANTS: Four hundred thirty six women with both pre-screening response to socioeconomic and psychosocial measures, and post-screening response reporting reasons of non-attendance. MAIN RESULTS: Most common single reason for non-attendance was previous recent mammogram (53%), but also reasons related to practical obstacles, worry and fear, knowledge and attitudes, and organization of screening were mentioned. Two distinct groups of non-attenders were found based on the reasons for non-attendance. Those who did not attend because a mammogram taken elsewhere (ELSE, n = 233) were urban, well-to-do women, who took care of their health by own initiation and felt more susceptible to breast cancer, and also expected mammogram to be painful. Other (real) non-attenders (REAL, n = 155) were less compliant with health recommendations and services, more socially isolated, depressed and anxious than ELSE. Level of depression among REAL was clearly higher (10.80) than the mean value (7.91, SD = 7.28) of the age group, and was also slightly above the cut-off score of 10 indicating mild or moderate depression. Trait anxiety was also markedly higher (40.18) than that of the same age group (37.76, SD = 8.95). CONCLUSIONS: Further research should clarify determinants and consequences of depression and anxiety among real non-attenders. Knowledge gaps and attitudinal barriers among non-attenders require more targeted campaigns.

Breast Neoplasms↗
PubMed2001

Depressive symptoms in middle-aged women are more strongly associated with physical health and social support than with socioeconomic factors.

The association of socioeconomic factors, health-related factors, and social support with depressive symptoms has been extensively studied. However, most epidemiological studies have focused on a few factors such as marital status, social class, and employment. In this study of middle-aged women we analyzed both univariate and multivariate associations of socioeconomic factors, perceived physical health factors, and social support with self-rated depressive symptoms measured with the Beck Depression Inventory. A nationwide sample (n = 1851) of Finnish women aged 48-50 years was analyzed. Socioeconomic, health-related, and social support factors were all measured with single items. All variables, except level of urbanization, were significantly associated with depressive symptoms in univariate analyses. Multivariate associations were examined with standard multiple regression analyses in three stages: first with the socioeconomic factors, then with socioeconomic and health factors, and finally entering the social support factors into the regression model. In the first model, being either on a sick leave or at home as working status, being divorced, and having low income reached significance. In the second model, being divorced and having poor perceived physical health were the most powerful among the five significant variables. In the last model, explaining 32% of the variance, the most powerful predictors of depressive symptoms were perceived current physical health, satisfaction with received social support, and quality of intimate relationships. For the prevention or intervention of depressive symptoms among middle-aged women in the population subjects with concurrent subjective or objective health problems and poor social support seem to comprise a particularly important target group.

Depression↗
PubMed2001

Prenatal screening and genetics.

Although the term 'genetic screening' has been used for decades, this paper discusses how, in its most precise meaning, genetic screening has not yet been widely introduced. 'Prenatal screening' is often confused with 'genetic screening'. As we show, these terms have different meanings, and we examine definitions of the relevant concepts in order to illustrate this point. The concepts are i) prenatal, ii) genetic screening, iii) screening, scanning and testing, iv) maternal and foetal tests, v) test techniques and vi) genetic conditions. So far, prenatal screening has little connection with precisely defined genetics. There are benefits but also disadvantages in overstating current links between them in the term genetic screening. Policy making and professional and public understandings about screening could be clarified if the distinct meanings of prenatal screening and genetic screening were more precisely observed.

Amniocentesis↗
PubMed2000

False-positive findings in mammography screening induces short-term distress - breast cancer-specific concern prevails longer.

The aim of this study was to examine psychological distress in a mammography screening process as a consequence of screening after adjusting for background, personality and prescreening distress. Subjects, aged 50 years, were invitees at their first screening. There were three groups; normal findings (n=1407), false-positive findings (n=492) and referents from outside the screening programme (n=1718, age 48-49 years). Distress was measured as illness worry, anxiety, depression, cancer beliefs and early detection behaviour. Measurements were one month before screening invitation with follow-ups at 2 and 12 months postscreening. At 2 months, there was a moderate multivariate effect of group on distress; and intrusive thinking and worry about breast cancer, in particular, were most frequent amongst the false positives. Intrusive thinking still prevailed at 12 months, in addition to a higher perceived breast cancer risk and susceptibility. Distress related to screening and false-positive findings seems to be moderate, but prevailing cancer-specific concerns call for improvements in screening programmes.

Anxiety↗
PubMed2000

Information and communication in the context of a clinical trial.

The aim of this study was to determine the communicative needs of the patients in the context of being invited to participate in a clinical trial. A questionnaire was sent to 299 patients with breast cancer randomised in a trial of adjuvant therapy. It was returned by 261 (87%) of them. Ninety-one per cent (231/255) of the patients regarded the information provided as easy or quite easy to understand. However, the method of treatment allocation was unclear to most patients: 51% (128/251) thought that the doctor had chosen the treatment while only 23% (57/251) knew that they had been randomised. Younger and better educated patients had a better understanding. For 55% (125/226) of the patients written information had been helpful in decision making. This correlated highly with the education of the patient. Sixty-eight per cent (174/255) of the patients thought that they had enough time for decision-making. Less educated patients and older patients had needed more time. Eighty-seven per cent (218/251) were happy with their decision to participate. While most patients are satisfied with the information received, there is a poor understanding of how treatment is allocated. Information should be modified for older and less-educated patients. The needs of the patients when offered participation in a clinical trial are clear information, enough time to consider the options and psychological support.

Adult↗
PubMed1999

Psychosocial predictors of first attendance for organised mammography screening.

OBJECTIVE: To study psychosocial predictors of attendance at an organised breast cancer screening programme. SETTING: Finnish screening programme based on personal first round invitations in 1992-94, and with 90% attendance rate. METHODS: Attenders (n = 946) belonged to a 10% random sample (n = 1680 women, age 50, response rate 64%) of the target population (n = 16,886), non-attenders (n = 641, 38%) came from the whole target population. Predictors were measured one month before the screening invitation. Measures included items for social and behavioural factors, Breast Cancer Susceptibility Scale, Illness Attitude Scale, Health Locus of Control Scale, Anxiety Inventory, and Depression Inventory. Univariate and multivariate logistic regression analyses were used to predict attendance. RESULTS: Those most likely to attend were working, middle income, and averagely educated women, who had not had a mass mammogram recently, but who regularly visited gynaecologists, attended for Pap smear screening, practised breast self examination, and who did not smoke. Low confidence in their own capabilities in breast cancer prevention, overoptimism about the sensitivity of mammography, and perception of breast cancer risk as moderate were also predictive of attendance. Expectation of pain at mammography was predictive of non-attendance. CONCLUSION: Mammography screening organised as a public health service was well accepted. A recent mammogram, high reliance on self control of breast cancer, and an expectation of pain at mammography deterred attendance at screening. Further information about these factors and health information on screening are needed.

Breast Neoplasms↗
PubMed1998

Attitudes towards genetic testing: analysis of contradictions.

A survey study was conducted among 1169 people to evaluate attitudes towards genetic testing in Finland. Here we present an analysis of the contradictions detected in people's attitudes towards genetic testing. This analysis focuses on the approval of genetic testing as an individual choice and on the confidence in control of the process of genetic testing and its implications. Our analysis indicated that some of the respondents have contradictory attitudes towards genetic testing. It is proposed that contradictory attitudes towards genetic testing should be given greater significance both in scientific studies on attitudes towards genetic testing as well as in the health care context, e.g. in genetic counselling.

Adolescent↗
PubMed1998

Combination chemotherapy versus single-agent therapy as first- and second-line treatment in metastatic breast cancer: a prospective randomized trial.

PURPOSE: We report results of a randomized prospective study that compared single agents of low toxicity given both as the first-line and second-line chemotherapy with combination chemotherapy in advanced breast cancer with distant metastases. PATIENTS AND METHODS: Patients in the single-agent arm (n = 153) received weekly epirubicin (E) 20 mg/m2 until progression or until the cumulative dose of 1,000 mg/m2, followed by mitomycin (M) 8 mg/m2 every 4 weeks, and those in the combination chemotherapy arm (n = 150) were first given cyclophosphamide 500 mg/m2, E 60 mg/m2, and fluorouracil 500 mg/m2 three times per week (CEF) followed by M 8 mg/m2 plus vinblastine (V) 6 mg/m2 every 4 weeks. Exclusion criteria included age greater than 70 years, World Health Organization (WHO) performance status greater than 2, prior chemotherapy for metastatic disease, and presence of liver metastases in patients younger than 50. RESULTS: An objective response (complete [CR] or partial [PR]) was obtained in 55%, 48%, 16%, and 7% of patients treated with CEF, E, M, and MV, respectively. A response to CEF tended to last longer than a response to E (median, 12 v 10.5 months; P = .07). Treatment-related toxicity was less in the single-agent arm and quality-of-life (QOL) analysis favored the single-agent arm. No significant difference in time to progression or survival was found between the two arms. Similarly, no difference in survival was found when the patients who received both the planned first-and second-line treatments were compared or when survival was calculated from the beginning of the second-line therapy. CONCLUSION: Patients treated with single-agent E followed by single-agent M had similar survival, but less treatment-related toxicity and better QOL as compared with those treated with CEF followed by MV.

Adult↗
PubMed1998

On what grounds do women participate in prenatal screening?

Along with the rapid biomedical development of prenatal screening tests, target groups' attitudes and decision-making about, and the acceptance of, screening procedures have come into focus. To understand users' decision-making, it is essential to understand users' knowledge and perceptions of a procedure. The aim of this study was to examine Finnish women's knowledge and perceptions of, and stated reasons to participate in, two prenatal screening tests: serum screening and mid-trimester ultrasound screening. Subjects (n=1035) for the serum screening survey were catered for in the maternity care centres of two Finnish towns, where serum screening is available for all pregnant women. After one reminder, 88 per cent returned the questionnaire. Subjects (n=497) for the mid-trimester ultrasound screening survey were catered for in the obstetrical and gynaecological outpatient clinic of the city hospital of another town; the response rate was 85 per cent. Women's perceptions of the studied prenatal screening tests, serum screening and mid-trimester ultrasound screening, differed significantly, even though both are used to detect fetal malformations. Serum screening was far more often perceived to be connected with finding diseases or abnormalities than ultrasound screening. Another interesting finding was that the stated reasons for screening in general and the subjective reasons for participation were different. Reassurance was the personal reason most often mentioned in both the serum screening and the ultrasound group. Almost all women had the most superficial knowledge about serum screening; they knew whether it had been offered and that it is done to screen for Down syndrome. The greatest gaps in knowledge concerned the sensitivity of serum screening, its use in screening for congenital nephrosis, and diagnostic tests and their risks. Knowledge was poorer among women without a high school education. When counselling women about prenatal screening tests, more emphasis should be given to the sensitivity of serum screening, all of its screening uses, and the possible diagnostic tests and their risks. The fact that ultrasound screening can detect conditions which may lead to the possibility of a selective abortion should also be explained more fully.

Amniocentesis↗
PubMed1997

Health related quality of life among insulin-dependent diabetics: disease-related and psychosocial correlates.

This crossectional questionnaire study examined the associations of health factors and psychosocial factors with Health Related Quality of Life (HRQOL) in a sample of adult type I diabetic patients (n = 385). Health related quality of life was measured by the Finnish version of MOS SF-20. Psychosocial measures were general social support, diabetes-specific social support, diabetes locus of control (DCL), self-efficacy, diabetes health beliefs and self-care practices. In multivariate analyses, limitations in physical functioning showed strong associations with perceived health (beta = -0.33, P < 0.001), role functioning (OR = 38.54, 95% CL 10.73-139.56), social functioning (OR = 7.05, 95% CL 2.88-17.27) and pain (OR = 7.89, 95% CL 4.26-14.47), and was moderately associated to mental health (beta = -0.12, P < .01). Duration of diabetes and glycemic control were not related to HRQOL dimensions. Adequacy of social support was related to all HRQOL domains apart from pain and role functioning. The most important diabetes-related psychosocial factors were self-efficacy, and diabetes-related social support. Diabetes-specific factors were more important among those in good physical condition.

Adult↗
PubMed1996

Pain and discomfort during mammography.

The aim of this prospective study was to investigate associations of mammography pain and discomfort with sociodemographics, personal history and psychological and situational factors. Subjects were women with a negative screening finding (n = 883) from a random sample of 50-year-old Finnish women attending their first breast cancer screening. Questionnaires were sent 1 month before the screening invitation and 2 months after screening. Sixty-one per cent reported painful and 59% uncomfortable mammograms (4% severely). Linear regression analyses showed that anticipation of pain and discomfort was the most powerful factor explaining pain and discomfort among women with earlier mammography. However, it had no effect among women without earlier mammography, for whom screening-related nervousness and perceptions of staff were crucial. Suggested interventions include better information before screening, a friendly screening atmosphere and empathetic, supportive staff behaviour, especially towards women having their first mammogram, encouraging them to feel more at ease and distracted from pain.

Attitude to Health↗
PubMed1995

Attitudes toward genetic testing among the general population and relatives of patients with a severe genetic disease: a survey from Finland.

In the present study we explore the attitudes of the Finnish population toward genetic testing by conducting a questionnaire study of a stratified sample of the population as well as of family members of patients with a severe hereditary disease, aspartylglucosaminuria (AGU). The questionnaire evaluated attitudes toward gene tests in general and also respondents' preparedness to undergo gene tests for predictive testing, carrier detection, prenatal diagnosis, and selective abortion, in theoretical situations. The results of the study indicate that both the Finnish population in general and family members of AGU patients have a favorable attitude toward genetic testing. However, a commonly expressed reason against testing was that test results might lead to discrimination in employment or insurance policies. Based on the responses, we predict that future genetic testing programs will most probably be met with a high acceptance rate by the Finnish population.

Adolescent↗
PubMed1995

Fear of AIDS and suicide in Finland: a review.

This review presents data on HIV epidemiology and suicide mortality, and summarizes studies on fear of AIDS in completed suicides in Finland. Finland has a low prevalence of HIV and a high suicide mortality. A 12-month nationwide suicide population, 1987-88 (n = 1397, all HIV negative) at the time of a sensational media campaign against HIV included 28 (2%) cases with fear of AIDS as a contributing factor. Triggers of fear could be classified in 20 cases: persistent symptoms in 10, casual sex contacts in eight, and a TV programme in two. The AIDS fear cases were younger, had more major depression and more health care contacts than the others. Suicidal fear and underlying depression were not being properly identified and treated. Despite recent improvement in media reporting, health education and identification of depression, clinical experience, help line calls and population surveys indicate that AIDS fear still persists in the population, but seems to be less often a contributing factor in committed suicides.

Acquired Immunodeficiency Syndrome↗