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Biomedical subjects

P Louhiala

Publications and source records attributed to P Louhiala.

17 recordsLinked to original sources
PubMed2007

How tall is too tall? On the ethics of oestrogen treatment for tall girls.

Oestrogen treatment for girls, to prevent psychosocial problems due to extreme tallness, has been available for almost 50 years but uncertainty about its position prevails. The ethical problems of this treatment are focused on in this paper. After a brief overview on historical and medical aspects, ethical issues such as the general justification of oestrogen treatment, evaluation of its success and ethical concerns related to research in this subject are dealt with in detail.

Adolescent↗
PubMed2006

Finnish doctors and the realisation of patient autonomy in the context of end of life decision making.

Patient autonomy is a fundamental principle in end of life decision making. However, its realisation may take a variety of forms. Discourse analysis was conducted in a qualitative interview study of 19 physicians. The physicians made use of three different discourses, each of which contained a specific understanding of patient autonomy and a physician's proper activities in the context of end of life decision making.

Attitude of Health Personnel↗
PubMed2004

End of life decisions: attitudes of Finnish physicians.

OBJECTIVES: This study investigated Finnish physicians' experiences of decisions concerning living wills and do not resuscitate (DNR) orders and also their views on the role of patients and family members in these decisions. DESIGN: A questionnaire was sent to 800 physicians representing the following specialties: general practice (n = 400); internal medicine (n = 207); neurology (n = 100), and oncology (n = 93). RESULTS: The response rate was 56%. Most of the respondents had a positive attitude toward (92%), and respect for (86%) living wills, and 72% reported situations in which such a will would have been helpful, although experience with their use was limited. The physicians reported both benefits and problems with living wills. Thirteen per cent had completed a living will of their own. Half did not consider living wills to be reliable if they were several years old. Do not resuscitate orders were interpreted in two ways: resuscitation forbidden (70%) or only palliative (symptom oriented) care required (30%). The respondents also documented DNR orders differently. Seventy two per cent discussed DNR decisions always or often with patients able to communicate, and even 76% discussed DNR orders with the family members of patients unable to communicate. Most respondents were able to approach a dying patient without difficulty. They also felt that education in general was needed. CONCLUSIONS: In general Finnish physicians accept living wills, but find they are accompanied by several problems. Many problems could be avoided if physicians and patients conducted progressive discussions about living wills. The differing interpretations of DNR orders are a matter of concern in that they may affect patient treatment. The promotion of patient autonomy with respect to treatment seems rather good, but the limitations of the study need to be kept in mind.

Attitude of Health Personnel↗
PubMed1999

Boys have more health problems in childhood than girls: follow-up of the 1987 Finnish birth cohort.

The purpose of this study was to describe gender differences in children's health until the age of 7 y. The study cohort consisted of all children born in Finland in 1987 (n = 60254), of whom 99.9% were identified in the follow-up. Childhood health data were received from five national registers (1987-94), from regional registers of intellectual disabilities (1987-96) and from education registers in the largest county (1996). Boys had a 20% higher risk for a low 5-min Apgar score and an 11% higher risk for being preterm. After the perinatal period, boys had a 64% higher cumulative incidence of asthma, a 43% higher cumulative incidence of intellectual disability, a 22% higher incidence of mortality and a higher, but not statistically significant, incidence of epilepsy and vision disorders. No male excess was found for diabetes or hearing disorders. The healthcare-related indicators showed poorer health for boys, who had a 37% higher mean of hospital days, a 28% higher risk for receiving social benefits due to health problems and a 13% higher risk for long-term medication. The differences in the socially defined indicators were greatest, and boys had a two- to three-fold risk of having delayed development, postponed school start or attendance in special education programmes. Gender differences in different social classes were similar. Boys' shorter gestational age at birth did not explain the gender differences in childhood health. Some of boys' poorer health seemed to be biologically based, but the social causes of health problems are amenable to change. In particular, the potential of the school system to reduce ill health among boys should be investigated.

Absenteeism↗
PubMed1999

Can children's health be predicted by perinatal health?

BACKGROUND: The purpose of this paper was to investigate how well children's health until age 7 years can be predicted by perinatal outcome using routine health registers. METHODS: Follow-up of one year cohort (N = 60192) was performed by record linkages with personal identification number. The data came from the 1987 Finnish Medical Birth Register, from six other national registers and from education registers of one county. RESULTS: All perinatal health indicators showed a strong correlation with subsequent health, and prediction of good health was satisfactory: 85% of children who were healthy in the perinatal period did not have any reported health problems in early childhood, and 91% of children healthy in early childhood had been healthy in the perinatal period. However, it was not possible to predict poor health outcome: 76% of the children with reported perinatal problems were healthy in early childhood, and 87% of the children with long-term morbidity in childhood did not have any perinatal problems. CONCLUSIONS: Our findings suggest that in assessing risk factors and health care technology, monitoring perinatal health is not enough and long-term follow-ups are needed.

Child↗
PubMed1998

Health registers as a feasible means of measuring health status in childhood--a 7-year follow-up of the 1987 Finnish birth cohort.

Follow-up studies on health have usually been based on ad hoc cohort studies in which detailed information is collected specifically for research purposes on a certain group of people. The increasing collection of routine health data provides an alternative method of gathering follow-up data. In this study, the feasibility of using routinely collected health-register data and data linkages to follow up children's health was investigated. Five nationwide registers, 18 regional registers of intellectually disabled children and school administration data in one county were found to be of use for our follow-up and were combined with the 1987 Finnish Medical Birth Register (n = 60,254 births). In the follow-up, 62 children were untraced (0.1%), 327 were stillborn (0.5%), 440 died after birth (0.7%) and 287 emigrated (0.5%) before the age of 7 years. The cumulative incidences for all diseases (8.9% of all children living in Finland at the age of 7 years), for diabetes (3.0/1000), for epilepsy (6.8/1000) and for asthma (34.2/1000) correspond to the estimates of other studies, but our estimate for intellectual disabilities (18.0/1000, of whom 18% were reported to have an IQ of 70 or less) seems to be an underestimate. Our data collection did not provide reliable information on institutionalised children or children taken into care. Data collection conducted by using health registers is a feasible method, and it saves both time and financial resources compared with cohort studies. Potential problems with data linkage studies are variation in the content of data and in data quality of different registers and data protection issues.

Adolescent↗
PubMed1997

Nordic Medical Birth Registers in epidemiological research.

This review discusses the use of Nordic Medical Birth Registers (MBRs) in epidemiological studies, paying special attention to the topics that have been investigated and to other data sources that increase the usefulness of MBRs. We divided the reviewed studies into four groups according to the data sources on which they were based: (1) studies using MBR data only; (2) studies combining maternal or paternal background information, obtained from other data sources, with MBR data; (3) studies combining MBR data with subsequent outcome information on newborns; and (4) studies using information about consecutive pregnancies and generations. Our review shows that MBRs are good sources for studying the following topics: maternal biological and obstetric background; interventions and health care during pregnancy and birth; newborns' short-term outcome; and the relations between these factors. In addition, the usefulness of MBRs increases when the data they contain are combined with data from other sources. We found that data from more than twenty different sources have been linked with MBR data in the Nordic counties. As time passes, national MBRs become a useful source of information for studies on consecutive pregnancies or generations. In addition, the associations between pregnancy, delivery, perinatal health and long-term outcome can be studied by using an MBR as the basic data source.

Birth Certificates↗
PubMed1995

Risk indicators of mental retardation: changes between 1967 and 1981.

The object of this case-control study was to investigate and analyse perinatal risk indicators of mental retardation. Data concerning 33 perinatal factors possibly related to mental retardation were collected retrospectively for the population of an area in Finland. The subjects were 339 cases born between 1967 and 1981 with mental retardation of suspected perinatal or unknown aetiology and 364 controls born in the same period. Independent risk indicators were low maternal social class, multiparity, multiple pregnancy, male sex, being born small for gestational age, asphyxia, hypoglycaemia and hyperbilirubinaemia in the newborn infant. Perinatal problems increased the risk for multiple disabilities. Preterm birth under 33 gestational weeks and very low birthweight (< 1500 g) were associated with considerable risk, but neither was an independent risk indicator. The introduction of neonatal intensive care seems to have altered the risk of death to the risk of surviving with disability.

Adult↗
PubMedDate not supplied

Early clinical symptoms and incidence of aspartylglucosaminuria in Finland.

Early clinical symptoms were analyzed from all known 43 children with aspartylglucosaminuria, born during 1974-1989 in Finland. Pre- and perinatal histories appeared normal for all children, except for muscular hypotonia and weak sucking in some babies. Three infants had abduction stiffness in the hips, needing follow-up. Other abnormalities found in infancy were umbilical or inguinal hernias and unusual susceptibility to respiratory and ear infections. This susceptibility diminished clearly in most patients after six years of age. Episodic diarrhea, described earlier, appeared to be a rather infrequent symptom and a less valuable diagnostic clue. New clinical phenomena were talipes planovalgus or clubfoot, needing surgical treatment, and aggressive behavior, needing, occasionally, child psychiatric consultation or treatment. In addition, angiokeratoma of the skin, not an infrequent phenomenon among adult patients, was found in one child. The main indications for further studies were delayed speech, attention deficit and clumsy or delayed motor functions. The disease is easily misdiagnosed and, universally, probably underdiagnosed. Its incidence in Finland was recalculated and appeared to be at least 1 in 18,500 live-born babies in this country.

Aspartylglucosylaminase↗