Biomedical subjects

Anna-Maija Koivisto

Publications and source records attributed to Anna-Maija Koivisto.

At least 19 recordsLinked to original sources

PubMed2006

Cost-utility of routine cataract surgery.

BACKGROUND: If decisions on health care spending are to be as rational and objective as possible, knowledge on cost-effectiveness of routine care is essential. Our aim, therefore, was to evaluate the cost-utility of routine cataract surgery in a real-world setting. METHODS: Prospective assessment of health-related quality of life (HRQoL) of patients undergoing cataract surgery. 219 patients (mean (SD) age 71 (11) years) entering cataract surgery (in 87 only first eye operated, in 73 both eyes operated, in 59 first eye had been operated earlier) filled in the 15D HRQoL questionnaire before and six months after operation. Direct hospital costs were obtained from a clinical patient administration database and cost-utility analysis performed from the perspective of the secondary care provider extrapolating benefits of surgery to the remaining statistical life-expectancy of the patients. RESULTS: Mean (SD) utility score (on a 0-1 scale) increased statistically insignificantly from 0.82 (0.13) to 0.83 (0.14). Of the 15 dimensions of the HRQoL instrument, only seeing improved significantly after operation. Mean utility score improved statistically significantly only in patients reporting significant or major preoperative seeing problems. Of the subgroups, only those whose both eyes were operated during follow-up showed a statistically significant (p < 0.001) improvement. Cost per quality-adjusted life year (QALY) gained was euro5128 for patients whose both eyes were operated and euro8212 for patients with only one eye operated during the 6-month follow-up. In patients whose first eye had been operated earlier mean HRQoL deteriorated after surgery precluding the establishment of the cost per QALY. CONCLUSION: Mean utility gain after routine cataract surgery in a real-world setting was relatively small and confined mostly to patients whose both eyes were operated. The cost of cataract surgery per quality-adjusted life year gained was much higher than previously reported and associated with considerable uncertainty.

Aged↗

PubMed2006

Laboratory parameters predictive of developing necrotizing enterocolitis in infants born before 33 weeks of gestation.

PURPOSE: The aim of this study was to identify laboratory findings predictive of necrotizing enterocolitis (NEC). METHODS: Prospective follow-up of 140 infants of less than 33 weeks of gestation. Twenty-six infants developed NEC (grades I to III, criteria of Bell et al [Ann Surg 1978;187:1-7]) (NEC group). For each, 2 birth-weight, gestational age- and postnatal age-matched controls were selected (control group). Blood counts, glucose and electrolyte levels, C-reactive protein, and acid-base balance 3 days, 2 days, and 1 day before and at the onset of NEC and at corresponding ages from the controls were recorded. RESULTS: Metabolic acidosis occurred, the platelet levels decreased, and the blood glucose increased on successive days in the infants with grade NEC II-III. At the onset of NEC, the infants had significantly lower platelet and higher blood glucose levels compared with controls. More than half of infants with intestinal perforation had leukocyte levels above 30 x 10(9)/L and pH less than 7.25, and their mean blood glucose levels increased to more than 1.5 mmol/L in 24 hours. The remaining parameters were not useful. CONCLUSION: A persistent metabolic acidosis, decreasing platelet, and increasing blood glucose level on several successive days might predict a developing NEC, and leukocyte values above 30 x 10(9)/L, pH less than 7.25, and a blood glucose rise by 1.5 mmol/L or more within 24 hours predict NEC with intestinal perforation. Such findings should alert the physician to look for signs of NEC in a preterm infant.

Enterocolitis, Necrotizing↗

PubMed2006

Bone mineral density is reduced in brain tumour patients treated in childhood.

AIM: To determine the prevalence of low bone mineral density among children surviving brain tumours and to identify possible factors underlying impaired bone health. METHODS: Cross-sectional study; total body bone mineral density (TBBMD), fat mass (FM) and lean body mass (LBM) were measured by dual-energy X-ray absorptiometry (DXA) in 46 brain tumour patients aged from 3.8 to 28.7 y (mean 14.9 y) treated in childhood 1.4-14.8 y (mean 6.4 y) after end of treatment for brain tumour. Low bone mineral density was defined as TBBMD z score < - 2.0. RESULTS: Fifteen patients had TBBMD z scores < - 2.0, indicating a 33% prevalence of low bone density. The TBBMD z score ranged from -5.7 to 0.6 (mean -1.7). Out of several potential factors, only combined craniospinal irradiation was significantly associated with low z score (p=0.034, according to multiple regression analysis), while exclusive cranial irradiation showed a borderline statistical association (p=0.100, according to multiple regression analysis). CONCLUSION: One third of brain tumour patients treated in childhood had reduced bone mineral density. The reasons for this condition are apparently multifactorial, including craniospinal irradiation.

Bone Density↗

PubMed2006

Subjective life satisfaction and living situations of persons in Finland with long-term schizophrenia.

OBJECTIVE: This study measured subjective life satisfaction among patients with long-term schizophrenia who were living in the community. METHODS: A representative national sample of 2,221 persons with schizophrenia who were discharged from psychiatric hospitals in Finland in 1986, 1990, and 1994 were interviewed three years after discharge. Subjective life satisfaction was measured; patients were asked about their current level of satisfaction and the level of satisfaction they recalled having at the time of discharge. RESULTS: Patients tended to report more satisfaction at follow-up if they were female, had good psychosocial functioning, had several confidants, or were living in group homes or dormitories. Patients tended to be less satisfied at follow-up if they were divorced or had mental and physical symptoms. Patients with depressive symptoms or with low psychosocial functioning and those who were currently hospitalized reported the smallest changes in levels of satisfaction between the two time points. Patients with low psychosocial functioning who were living with their parents, in group homes or dormitories, or in institutions were relatively satisfied, whereas patients with good psychosocial functioning were more satisfied if they lived with their spouse or partner. CONCLUSIONS: Being female and having good psychosocial functioning, confidants, good physical health, and living arrangements in the community that offer support corresponding to the patient's psychosocial state are important factors of life satisfaction among patients with long-term schizophrenia.

Adaptation, Psychological↗

PubMed2006

Cost-utility analysis of routine neurosurgical spinal surgery.

OBJECT: Cost-utility analysis is currently the preferred method with which to compare the cost-effectiveness of various interventions. The authors conducted a study to establish the cost-utility results of routine neurosurgery-based spinal interventions by examining patient-derived values. METHODS: Two hundred seventy patients undergoing surgery for cervical or lumbar radicular pain filled in the 15-dimensional health-related quality of life (HRQOL) questionnaire before and 3 months after surgery. Quality-adjusted life years (QALYs) were calculated using the utility data and the expected remaining life years of the patients. The mean HRQOL score (scale, 0-1) increased after cervical surgery (169 patients, mean age 52 years, 40% women) from 0.81 +/- 0.11 preoperatively, to 0.85 +/- 0.11 at 3 months, and after lumbar surgery (101 patients, mean age 54 years, 59% women) from 0.79 +/- 0.10 preoperatively, to 0.85 +/- 0.12 at 3 months (p < 0.001). Of the 15 dimensions of health, improvement in the following was documented in both groups: sleeping, usual activities, discomfort and symptoms, depression, distress, vitality, and sexual activity (p < 0.05). The cost per QALY gained was Euro 2774 and 1738 for cervical and lumbar operations, respectively. In cases in which surgery was delayed the cost per QALY was doubled. CONCLUSIONS: Spinal surgery led to a statistically significant and clinically important improvement in HRQOL. The cost per QALY gained was reasonable, less than half of that observed, for example, for hip replacement surgery or angioplasty treatment of coronary artery disease; however, a prolonged delay in surgical intervention led to an approximate doubling of the cost per QALY gained by the treatment.

Adult↗

PubMed2005

Psychopathological distress predicts suicidal ideation and self-harm in adolescent eating disorder outpatients.

OBJECTIVE: This study evaluated the differences in suicidal behaviour between adolescent anorexia nervosa (AN) and bulimia nervosa (BN), and the association of age, menarche timing, duration of eating disorder (ED), depression and general psychopathological symptoms (GSI) with suicidal behaviour in adolescent ED. METHODS: The study group comprised 57 adolescent outpatients (girls) attending for assessment because of eating disorders. Suicidal ideation, deliberate self-harm and suicidal attempts were assessed in self-report questionnaires. RESULTS: In both ED groups, one adolescent had attempted suicide before assessment. Suicidal ideation and/or deliberate self-harm were reported in over half of the cases. Bulimics had significantly more suicidal ideation and deliberate self-harm than anorectics. In multivariate analysis, BN and depression predicted suicidal ideation, but only GSI persisted as predicting deliberate self-harm. CONCLUSIONS: Suicidal behaviour is common in adolescent ED. Type of ED (BN), depression and higher GSI are strongly associated with suicidal ideation and deliberate self-harm. Our results point to the need to evaluate psychopathological symptoms in adolescent ED, especially in BN, in the initial assessment to prevent severe suicidal behaviour.

Adolescent↗

PubMed2005

Apolipoprotein E polymorphism is not a predictor for repeated coronary artery bypass surgery.

OBJECTIVES: Factors leading to the occlusion of coronary grafts are diverse and may at least partially be inherited. We aimed to study the possible genetic predisposition and especially the role of apoE epsilon4 allele as a risk factor for repeated coronary artery bypass grafting (CABG) in a case-control setting. DESIGN: All patients (n=184) who underwent repeated CABG between 1990 and 1998 were identified in the computed registry of the Department of Cardiothoracic Surgery in Tampere University Hospital. Age, sex and operation date matched controls with first time CABG were selected from the same registry. DNA samples were collected by sample stick sent via the mail for buccal smear. The final analysis included 137 surviving matched pairs. RESULTS: In patients <62 years of age (median age), family history emerged as the only significant (OR=3.4; 95% CI=1.5-7.8, p=0.004) predictor for repeated surgery. Among older patients, repeated CABG was no longer predicted by family history but by hypercholesterolemia (OR=2.1; 95% CI=1.1-4.0, p=0.027), modified by apoE genotype. CONCLUSIONS: Our results suggest that medium-term survivors after redo CABG have a strong genetic predisposition unrelated to hypercholesterolemia or apoE genotype, leading to more severe coronary artery disease at earlier age. In the older age group, redo coronary artery bypass surgery is associated with hypercholesterolemia, which, although modified by apoE genotype, may mainly be due to other genetic or acquired factors.

Aged↗

PubMed2005

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

OBJECTIVE: To assess the value of transvaginal uterine artery Doppler ultrasound at 12--14 weeks of gestation in predicting hypertensive disorders of pregnancy in high-risk women. METHODS: One hundred and twenty high-risk women were evaluated prospectively by Doppler ultrasound of uterine and umbilical arteries at 12--14 weeks of gestation. The presence of bilateral notches, resistance and pulsatility index (PI), mean and maximum flow velocities of uterine arteries, and resistance and PI of umbilical arteries were investigated. Those with bilateral notching were randomized to acetylsalicylic acid (n=43) or placebo groups (n=43) and were followed up twice during pregnancy with the same ultrasound measurements. The women without bilateral notches (n=29) served as controls. In this study, we compared 43 women in the placebo group to 29 controls without bilateral notches. The outcome measures were pregnancy-induced hypertension, pre-eclampsia and intrauterine growth restriction. RESULTS: The sensitivity of bilateral notching in predicting hypertensive disorders of pregnancy decreased with advancing pregnancy from 91 to 35%, and the specificity and the positive predictive values increased from 41 to 94% and from 7 to 70%, respectively. The negative predictive values ranged from 86 to 97%. CONCLUSION: Bilateral notching of uterine arteries at 12--14 weeks is a useful tool in predicting the development of hypertensive disorders in high-risk pregnancies. It is also a suitable test for surveillance of high-risk pregnancies.

Adult↗

PubMed2005

Insulin resistance, LDL particle size, and LDL susceptibility to oxidation in pediatric kidney and liver recipients.

BACKGROUND: Dyslipidemia is common after solid organ transplantation. We have described hypertriglyceridemia in about 50% of our pediatric kidney, and in about 30% of our liver recipients. The aim of the present study was to find out whether this post-transplantation hypertriglyceridemia after pediatric solid organ transplantation is associated with insulin resistance and the occurrence of small, dense low-density lipoprotein (LDL). METHODS: Fifty kidney and 25 liver recipients (aged 4 to 18 years) on triple immunosuppression, and 181 control children participated in the study for an average of 5.3 and 6.4 years after kidney and liver transplantation (range 1 to 11 years), respectively. Homeostasis model assessments for insulin resistance (HOMA) were calculated and fasting lipoprotein lipid profile, apolipoprotein A-I and B concentrations, LDL particle diameter, and indices of LDL susceptibility to copper-induced oxidation determined. RESULTS: Kidney patients had significantly higher serum total, high-density, and low-density lipoprotein cholesterol, triglyceride, apolipoprotein A-I and B concentrations than liver patients or control subjects (P < 0.003 for all). HOMA indices higher than the 95th percentile of Canadian normal children were seen in 50.0% of kidney (of liver 41.2%) recipients younger than 11 years, and in 27.3% of older recipients (of liver 37.5%). Smaller sized LDL or LDL of increased oxidizability was not more frequent in patients than in control children. CONCLUSION: Pediatric kidney recipients had significantly higher lipid and insulin concentrations than healthy control children. Combined hyperlipidemia and features of the dysmetabolic syndrome were common in children after kidney and liver transplantation. However, no small, dense LDL, or LDL prone to oxidation was seen in either group.

Adolescent↗

PubMed2004

Serum lipids in children 3 to 5 years after kidney, liver, and heart transplantation.

Although dyslipidemia is common after solid organ transplantation (Tx), there are few long-term studies in children. We investigated the prevalence of dyslipidemia up to 5 years after Tx in 125 children on triple immunosuppression with one of three different well-functioning grafts, kidney, liver, and heart, and 181 controls. Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) concentrations were measured annually. Low-density lipoprotein cholesterol concentrations were also calculated. The risk factors for dyslipidemia were determined at 3 years. There was a high prevalence of hypertriglyceridaemia in all three groups, 50% in the kidney transplantation (KTx) and heart transplantation (HTx) groups and 30% in the liver transplantation (LTx) group. In addition, 50% of KTx patients had high TC. In the Tx groups taken together, the following independent associations were observed: KTx and high pre-Tx TC were associated with high TC, high trough concentration of blood cyclosporine with low HDL-C, and older age at Tx accounted for higher TG. Dyslipidemia, especially hypertriglyceridaemia, was common 3-5 years after Tx. The aetiology is multifactorial and depends on the transplanted organ.

Body Height↗

PubMed2004

Violent victimization in schizophrenia.

BACKGROUND: We investigated the 3-year prevalence, and the sociodemographic and clinical correlates of violent victimization in a large and unselected nationwide sample of deinstitutionalized patients with schizophrenia. METHODS: The sample comprised 670 schizophrenic patients aged 15-64 years, who had been discharged from psychiatric hospitals in Finland in 1994. Comprehensive data were collected from psychiatric case records on the patients' sociodemographic factors and psychiatric history, as well as the patients' overall level of functioning. The patients were interviewed 3 years after discharge by each district's psychiatric professionals using a structured interview schedule specifically designed for the purposes of the present study project. RESULTS: The prevalence of self-reported violent victimization during the 3-year follow-up was 5.6%. In the multivariate analysis, a poor financial situation, alcohol abuse and being a perpetrator of a violent or some other crime were associated with violent victimization. CONCLUSIONS: The prevalence of violent victimization among schizophrenic patients in Finland was markedly lower than that reported on patients in the United States or Great Britain, but correlates were similar. Patients with a poor financial situation and a history of alcohol misuse, as well as of violent behaviour, seem to have an increased risk for violent victimization, and constitute a vulnerable subgroup in this respect. This subgroup of deinstitutionalized patients with schizophrenia may need additional care and protection from the danger posed to them from other members of the society.

Adolescent↗

PubMed2004

Urinary excretion of interleukin-6 correlates with proteinuria in acute Puumala hantavirus-induced nephritis.

BACKGROUND: Nephropathia epidemica (NE) is a mild type of hemorrhagic fever with renal syndrome caused by Puumala Hantavirus. Cytokines are thought to have an important role in the pathogenesis of NE. The aim of this study is to evaluate whether cytokines contribute to renal involvement in NE. METHODS: Overnight urinary excretion of interleukin-1beta (IL-1beta), IL-1 receptor antagonist (IL-1Ra), IL-6, tumor necrosis factor-alpha (TNF-alpha), albumin, immunoglobulin G (IgG), and alpha1-microglobulin and quantitative 24-hour urinary protein excretion were measured for 3 consecutive days from 70 hospitalized patients with acute NE (49 men, 21 women; age, 15 to 70 years; median age, 39 years). Plasma levels of the respective cytokines also were measured. Urinary collections were repeated after 1 year. The control group for blood samples included 400 healthy blood donors. RESULTS: Maximum median urinary IL-6 excretion in the acute phase of NE was increased compared with values detected after 1 year (49.5 versus 0.7 pg/min; P < 0.001). Correspondingly, maximum median plasma IL-6 concentration in patients was increased compared with controls (14.6 versus 1.2 pg/mL; P < 0.001). Urinary IL-6 excretion correlated with urinary albumin, IgG, and protein excretion (r = 0.79; P < 0.001; r = 0.76; P < 0.001; and r = 0.65; P < 0.001, respectively), but not plasma IL-6 levels (r = 0.18; P = 0.148). CONCLUSION: Plasma IL-6 concentrations and urinary IL-6 excretion were markedly increased in patients with acute NE, but there was no correlation between plasma and urinary IL-6 levels. The high urinary IL-6 levels might reflect local production of this proinflammatory cytokine in the kidneys during acute infection.

Adult↗

PubMed2004

Fathers' and mothers' perceptions of their child and maternal depressive symptoms.

Fathers' reports concerning their children have seldom been considered in the previous studies on maternal depression and child development. The literature on parental reports in general suggests that discrepancies in mothers' and fathers' perceptions are associated with the psychological state of the parent and the gender of the child. As part of a prospective follow-up study, fathers' and mothers' perceptions of children's social competence and behavioural/emotional problems were assessed by the Child Behavior Checklists (CBCLs) when the firstborn children were 8-9 years old. The depressive symptoms of the mothers were screened by the Edinburgh Postnatal Depression Scale (EPDS) at the same time point. The level of children's social competence and behavioural/emotional problems reported by the fathers were analysed by background factors. The reports of both parents were explored by the gender of the child and by the presence of maternal depressive symptoms. The concordance of parental reports concerning child's social competence was high, but fathers usually reported lower problem levels than mothers, particularly for boys' problems. The presence of maternal depressive symptoms was associated with child's high problem levels from both fathers' and mothers' perspective. Parental ratings of children's externalizing problems in particular were associated with high maternal depressive symptom level.

Adult↗

PubMed2004

Is fixed-term employment a new risk for adverse physical working conditions?

Relationships between employment type and the physical work environment were studied among blue-collar workers (n = 1,127). Based on survey data, we set out to compare the evaluations of environmental load and physical strain at work given by fixed-term (17% of all) and permanent workers. The type of employment was not related to environmental load. However, working on a fixed-term basis increased the risk of physical strain at work. Analyses revealed that this connection was evident only among fixed-term construction workers. The results did not support the much-cited view that the disintegration of standard employment has given rise to a new series of work environment problems. Such problems are concentrated in an area with a long tradition of work environment problems, that is, in the construction industry.

Adolescent↗

PubMed2004

Prostacyclin, thromboxane A and the effect of low-dose ASA in pregnancies at high risk for hypertensive disorders.

BACKGROUND: The aim of this study was to investigate the prostanoid production in pregnancies at high risk for hypertensive disorders, and the effect of low-dose acetylsalicylic acid (ASA) on prostanoids. MATERIAL AND METHODS: Ninety women with a bilateral notching in uterine arteries screened by Doppler ultrasound at 12-14 gestational weeks were randomized to the ASA (0.5 mg/kg/day) or placebo group. Forty-three women in both groups were followed up throughout the pregnancy. Urine samples were taken at baseline, and at 24-26 and 32-34 weeks of gestation to determine the urinary 11-dehydrothromboxane B(2) (u-11-dehydro-TxB(2)) and 2,3-dinor-6-keto-prostaglandin F(1alpha) (u-2,3-dinor-6-keto-PGF(1alpha)), the metabolites of thromboxane A(2) and prostacyclin, respectively. RESULTS: In the pregnancies with pregnancy-induced hypertension (PIH) before 37 gestational weeks, the 2,3-dinor-6-keto-PGF(1alpha)/11-dehydro-TxB(2) ratio did not increase as much as in other pregnancies (P = 0.028). In the placebo group pregnancies with preeclampsia had significantly lower 2,3-dinor-6-keto-PGF(1alpha) (P = 0.019) at 12-14 weeks of gestation compared to other pregnancies. In the placebo group the 2,3-dinor-6-keto-PGF(1alpha)/11-dehydroTxB(2) ratio remained unchanged throughout the pregnancy, with no significant difference between pregnancies with a normal or an adverse outcome. In the ASA group the 2,3-dinor-6-keto-PGF(1alpha)/11-dehydro-TxB(2) ratio increased (P < 0.001, early vs. midpregnancy). Again, the changes were similar in pregnancies with a normal or an adverse outcome. CONCLUSION: The balance of prostacyclin and thromboxane A(2) shifted in an unfavorable direction in pregnancies complicated by PIH. ASA had a favorable effect on the prostanoids.

6-Ketoprostaglandin F1 alpha↗

PubMed2003

Puberty, sexual development and eating disorders in adolescent outpatients.

This study examined puberty and psychosexual state in a clinical sample of adolescents attending for assessment because of eating disorders (ED). A total of 57 adolescents (girls) aged 14-21 years (mean age 16.9 years) having either anorexia nervosa (AN) or bulimia nervosa (BN) were studied by semi-structured interviews and structured self-report questionnaires considering the timing of menarche, dating and attitudes to sexuality. The age at menarche did not differ statistically significantly between AN and BN. It was significantly lower in the BN group than in the normal population, but no statistically significant difference was found between the AN group and normal population. The general attitudes to sexuality were more negative in the AN group than in the BN group. In the AN group, there were also fewer dating experiences and interest in dating than in the BN group. After controlling for the effect of age, age at menarche and duration of ED, negative attitudes to sexuality and no dating experiences were still best predicted by AN. The results suggest different ways of coping with the developmental challenges in sexuality in AN and BN during adolescence.

Adolescent↗

PubMed2003

Smoking-dependent association between paraoxonase 1 M/L55 genotype and coronary atherosclerosis in males: an autopsy study.

High-density lipoprotein-associated paraoxonase 1 (PON1) enzyme can retard the oxidation of lipids. The methionine for leucine substitution at position 55 (M/L55) of the PON1 protein is associated with lower (MM genotype) or higher (ML or LL genotype) expression of the gene affecting serum level of PON1. We studied the association of the PON1 M/L55 genotype with the extent of atherosclerosis in an autopsy series of Finnish males. Areas of the coronary arteries and the aorta covered with fatty streaks and fibrotic and complicated lesions were measured from a total of 700 cases. Carriers of the MM genotype (14.4% of subjects) had larger percentual areas of fatty streaks in their left anterior descending coronary artery (P=0.014) and right coronary artery (P=0.004), as well as in thoracic (P<0.001) and abdominal aorta (P=0.010) compared to carriers of the LL or ML genotype. A PON1 genotype-by-smoking interaction was observed on the area of fatty streaks in left anterior descending coronary artery (P=0.011) and right coronary artery (P=0.005); the association between fatty streaks and MM genotype was evident only among non-smokers, whereas in smokers this association was abolished. The areas of more advanced atherosclerotic lesions did not vary significantly between the genotype groups. These data suggest that the genetic variation of PON1 affects the formation of early atherosclerotic lesions and that the effect is modified by smoking.

Adult↗

PubMed2003

Geographical differences in the prevalence of hypospadias in Finland.

Hypospadias is one of the most common congenital anomalies but the etiology is not fully understood. There seem to be genetic, endocrinological, and environmental factors involved. Great geographical variation in the prevalence of hypospadias has been reported both between and within countries. We studied the determinants of geographical variation in the prevalence of hypospadias in Finland. All patients treated for hypospadias in 1970-1996 before the age of 9 years among boys born in 1970-1986 were identified in the national hospital discharge registry. Prevalence of hypospadias was calculated for each of the 355 municipalities in Finland. Demographic data were obtained from Statistics Finland. Association of the explanatory factors with prevalence of hypospadias was assessed using Poisson regression methods. The prevalence of operated hypospadias varied between provinces and between university hospital districts, from a ratio of 0.65 to a ratio of 1.01. An association between the prevalence of hypospadias and the remoteness from the closest city was observed. There was no association with level of education, social class, or occupation. The observed differences in the prevalence of operated hypospadias in Finland may have several explanations. Different levels of ascertainment and both genetic and environmental factors can not be ruled out.

Child↗