Elina Hemminki

Publications (109)221.69 Total impact

• Source

  Available from: Jorma I Virtanen

  Article: Clinical research in Finland in 2002 and 2007: quantity and type

  Elina Hemminki, Jorma Virtanen, Piret Veerus, Elena Regushevskaya
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  ABSTRACT: Background: Regardless of worries over clinical research and various initiatives to overcome problems, few quantitative data on the numbers and type of clinical research exist. This article aims to describe the volume and type of clinical research in 2002 and 2007 in Finland.
  Health Research Policy and Systems 05/2013; 11:17. · 1.38 Impact Factor
• Article: Legislative regulation and ethical governance of medical research in different European Union countries.

  Piret Veerus, Joel Lexchin, Elina Hemminki
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  ABSTRACT: OBJECTIVE: To obtain information about the similarities and differences in regulating different types of medical research in the European Union (EU). METHODS: Web searches were performed from September 2009 to January 2011. Notes on pre-determined topics were systematically taken down from the web pages. The analysis relied only on documents and reports available on the web, reflecting the situation at the end of 2010. RESULTS: In several countries, regulatory legislation applied only to clinical trials on drugs and medical devices, in other states various types of research were also regulated but by laws different from those concerning trials, and in many countries, some research areas were not controlled by legislation at all. In very few countries was all medical research handled similarly from a legal point of view. The number of research ethics committees (RECs) in a single country varied from one to 264. Their areas of responsibility, working principles and length of time to grant research permission varied as well as the rules for obtaining informed consent from vulnerable groups. In 10 EU countries, there was no appeal mechanism after a negative decision by an REC. The RECs were not accountable to any organisation in five EU countries. CONCLUSIONS: There is a need for a fundamental debate regarding whether and which kinds of changes are needed for the further harmonisation of medical research governance in the EU and how cross-country medical research could be facilitated in the future.
  Journal of medical ethics 05/2013; · 1.21 Impact Factor
• Source

  Available from: Jorma I Virtanen

  Article: A qualitative study on clinical research in Finland: fragmented governance and volume in the 2000s

  Elina Hemminki, Piret Veerus, Jorma Virtanen, Juhani Lehto
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  ABSTRACT: Objectives: Although concerns over clinical research have been expressed, the governance of clinical research has been little studied. The aim was to describe research policy, volume, funding and concerns over clinical research in Finland. Design: A qualitative study and the data were collected from various sources, including documents, statistics and semistructured expert interviews. Setting: Finland. Results: We found no national policy for clinical research. Many actors were responsible for facilitating, directing, regulating and funding clinical research, but no actor had the main responsibility. Health professionals were the main drivers for clinical research. The role of the health ministry was small. The ministry distributed state money for clinical research in health services (EVO-money), but did not use it to direct research. Municipalities responsible for health services or national health insurance had little interest in clinical research. The Academy of Finland had had initiatives to promote clinical research, but they had not materialised in funding. Clinical research was common and internationally competitive, but its volume had declined relatively in the 2000s. Industry was an important private funder, mainly supporting drug trials made for licensing purposes. Drug trials without an outside sponsor (academic projects) declined between 2002 and 2010. The funding and its targeting and amount were no one's responsibility. Concerns over clinical research were similar as in other countries, but it had appeared late. Conclusions: Our results suggest fragmented governance and funding in clinical research. The unsystematic research environment has not prevented clinical research from flourishing, but the public health relevance of the research carried out and its sustainability are unclear. INTRODUCTION A strengthening of the scientific basis of healthcare has been called for and clinical research is a key element in achieving this. Various definitions and terms have been used for clinical research. Usually, it is defined as a subgroup of medical research
  BMC Open. 02/2013; 3.
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  Available from: Bright I Nwaru

  Article: Comparison of routine prenatal iron prophylaxis and screening and treatment for anaemia: pregnancy results and preliminary birth results from a pragmatic randomised controlled trial (PROFEG) in Maputo, Mozambique

  Saara Parkkali, Fatima Abacassamo, Bright Ibeabughichi Nwaru, Graca Salomé, Orvalho Augusto, Elena Regushevskaya, Martinho Dgedge, Cesar Sousa, Julie Cliff, Baltazar Chilundo, Elina Hemminki
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  ABSTRACT: Objective: To present the pregnancy results and interim birth results of a pragmatic randomised controlled trial comparing routine iron prophylaxis with screening and treatment for anaemia during pregnancy in a setting of endemic malaria and HIV.
  BMJ Open. 02/2013; 3:e001948.
• Article: A qualitative study on clinical research in Finland: fragmented governance and volume in the 2000s.

  Elina Hemminki, Piret Veerus, Jorma Virtanen, Juhani Lehto
  [show abstract] [hide abstract]
  ABSTRACT: Although concerns over clinical research have been expressed, the governance of clinical research has been little studied. The aim was to describe research policy, volume, funding and concerns over clinical research in Finland. A qualitative study and the data were collected from various sources, including documents, statistics and semistructured expert interviews. Finland. We found no national policy for clinical research. Many actors were responsible for facilitating, directing, regulating and funding clinical research, but no actor had the main responsibility. Health professionals were the main drivers for clinical research. The role of the health ministry was small. The ministry distributed state money for clinical research in health services (EVO-money), but did not use it to direct research. Municipalities responsible for health services or national health insurance had little interest in clinical research. The Academy of Finland had had initiatives to promote clinical research, but they had not materialised in funding. Clinical research was common and internationally competitive, but its volume had declined relatively in the 2000s. Industry was an important private funder, mainly supporting drug trials made for licensing purposes. Drug trials without an outside sponsor (academic projects) declined between 2002 and 2010. The funding and its targeting and amount were no one's responsibility. Concerns over clinical research were similar as in other countries, but it had appeared late. Our results suggest fragmented governance and funding in clinical research. The unsystematic research environment has not prevented clinical research from flourishing, but the public health relevance of the research carried out and its sustainability are unclear.
  BMJ open. 01/2013; 3(2).
• Article: Comparison of routine prenatal iron prophylaxis and screening and treatment for anaemia: pregnancy results and preliminary birth results from a pragmatic randomised controlled trial (PROFEG) in Maputo, Mozambique.

  Saara Parkkali, Fatima Abacassamo, Bright Ibeabughichi Nwaru, Graca Salomé, Orvalho Augusto, Elena Regushevskaya, Martinho Dgedge, Cesar Sousa, Julie Cliff, Baltazar Chilundo, Elina Hemminki
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  ABSTRACT: To present the pregnancy results and interim birth results of a pragmatic randomised controlled trial comparing routine iron prophylaxis with screening and treatment for anaemia during pregnancy in a setting of endemic malaria and HIV. A pragmatic randomised controlled trial. Two health centres (1° de Maio and Machava) in Maputo, Mozambique, a setting of endemic malaria and high prevalence of HIV. Pregnant women (≥18-year-olds; non-high-risk pregnancy, n=4326) attending prenatal care consultation at the two health centres were recruited to the trial. The women were randomly allocated to either Routine iron (n=2184; 60 mg ferrous sulfate plus 400 μg of folic acid daily throughout pregnancy) or Selective iron (n=2142; screening and treatment for anaemia and daily intake of 1 mg of folic acid). The primary outcomes were preterm delivery (delivery <37 weeks of gestation) and low birth weight (<2500 g). The secondary outcomes were symptoms suggestive of malaria and self-reported malaria during pregnancy; birth length; caesarean section; maternal and child health status after delivery. The number of follow-up visits was similar in the two groups. Between the first and fifth visits, the two groups were similar regarding the occurrence of fever, headache, cold/chills, nausea/vomiting and body aches. There was a suggestion of increased incidence of self-reported malaria during pregnancy (OR 1.37, 95% CI 0.98 to1.92) in the Routine iron group. Birth data were available for 1109 (51%) in the Routine iron group and for 1149 (54%) in the Selective iron group. The birth outcomes were relatively similar in the two groups. However, there was a suggestion (statistically non-significant) of poorer outcomes in the Routine iron group with regard to long hospital stay after birth (relative risk (RR) 1.43, 95% CI 0.97 to 1.26; risk difference (RD) 0.02, 95% CI -0.00 to 0.03) and unavailability of delivery data (RR 1.06, 95% CI 1.00 to 1.13; RD 0.03, 95% CI -0.01 to 0.07). These interim results suggest that routine iron prophylaxis during pregnancy did not confer advantage over screening and treatment for anaemia regarding maternal and child health. Complete data on birth outcomes are being collected for firmer conclusions. The trial is registered at ClinicalTrials.gov, number NCT00488579 (June 2007). The first women were randomised to the trial proper April 2007-March 2008. The pilot was November 2006-March 2008. The 3-month lag was due to technical difficulties in completing trial registration.
  BMJ open. 01/2013; 3(2).
• Article: Variability of bothersome menopausal symptoms over time -- a longitudinal analysis using the Estonian postmenopausal hormone therapy trial (EPHT).

  Elina Hemminki, Elena Regushevskaya, Riitta Luoto, Piret Veerus
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  ABSTRACT: BACKGROUND: Very little data are available on the natural course or level of disturbance of vasomotor symptoms among middle-aged women. Using readily collected trial data we studied the persistence of vasomotor symptoms among untreated women. METHODS: In a trial comparing combined hormone therapy to placebo or no treatment (control groups), a cohort of women aged 50--59 at recruitment were followed annually by questionnaires. Women in the control groups (n = 486) were grouped by the number of years followed, with the prevalence and severity of symptoms calculated both cross-sectionally and longitudinally. RESULTS: About two thirds of the women (67%) reported vasomotor symptoms and half (46%) bothersome symptoms at recruitment. In the cross-sectional analysis, their prevalence declined between recruitment and 1-year follow-up (32% bothersome symptoms) and 2-year follow-up (27%). Thereafter it remained about the same level. In the longitudinal analysis, there was a notable variation in the prevalence of disturbing vasomotor symptoms over time, time entering the study and the compliance to the surveys. In the two groups having most follow-up times, the proportion of women with bothersome symptoms first increased and then decreased. CONCLUSIONS: There was a notable variability in the development of disturbing vasomotor symptoms over time in a selected group of women aged 50--59. Population-based follow-up studies of untreated women would be useful to estimate the symptom burden.
  BMC Women s Health 12/2012; 12(1):44.
• Article: A pragmatic randomised controlled trial on routine iron prophylaxis during pregnancy in Maputo, Mozambique (PROFEG): rationale, design, and success.

  Bright I Nwaru, Saara Parkkali, Fatima Abacassamo, Graca Salomé, Baltazar Chilundo, Orvalho Augusto, Julie Cliff, Martinho Dgedge, Elena Regushevskaya, Minna Nikula, Elina Hemminki
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  ABSTRACT: The effects of prophylactic iron during pregnancy on maternal and child health in developing settings with endemic malaria and high prevalence of HIV remain unclear. This paper describes the rationale, implementation and success of a pragmatic randomised controlled trial comparing routine iron supplementation vs. screening and treatment for anaemia during pregnancy. The setting was two health centres in Maputo, Mozambique. Pregnant women (≥12-week gestation; ≥18 years old; and not with a high-risk pregnancy, n = 4326) were recruited. The main outcomes are preterm delivery and low birthweight. The women were randomly assigned to one of two iron administration policies: a routine iron group (n = 2184) received 60 mg of ferrous sulphate plus 400 μg of folic acid daily while a selective iron group (n = 2142) had screening and treatment for anaemia and a daily intake of 1 mg of folic acid. The recruitment, follow-up, and collection of follow-up data were successful; both groups were similar to each other in all the trial stages. Collection of delivery data was challenging and data on about 40% of births is missing. These are currently being traced through different hospitals and health centres. The compliance of the study personnel and the women with regard to regular measurement of haemoglobin and intake of the iron and folic acid tablets was high and similar in both trial arms. Taking into account the various constraints encountered, the stages of the present trial prior to delivery were carried out well.
  Maternal and Child Nutrition 10/2012; · 1.61 Impact Factor
• Article: High Caesarean section rate in rural China: is it related to health insurance (New Co-operative Medical Scheme)?

  Qian Long, Reija Klemetti, Yang Wang, Fangbiao Tao, Hong Yan, Elina Hemminki
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  ABSTRACT: The epidemic of Caesarean section (CS) is worldwide, and it has been argued that it is mainly due to non-medical factors, including healthcare financing patterns. We investigated the use of CS in rural China and the related factors, particularly health insurance in the form of the New Co-operative Medical Scheme introduced in 2003. A cross-sectional survey of women who gave birth in 2008-2009 was conducted in five rural counties in central and western China. Of the 5049 new mothers, 73% were interviewed. The association between health insurance coverage and self-reported CS (divided into emergency and non-emergency CS) were examined by cross-tabulation and logistic regression, adjusting for maternal age, education, occupation, household income, previous abortions, parity and type of birth health facility. We found that 46% of all births (3550) were CSs, with 13% having an emergency and 33% a non-emergency CS. Women reported that half of the non-emergency CSs were recommended by a doctor and half were requested by themselves. In those counties with mid-range CS rates (28%-63%), health insurance coverage was associated with having CS, and particularly with having non-emergency CS. In those counties with the highest (82%) and lowest (13%) rate, there was no statistically significant association. The findings suggest that health insurance coverage may have facilitated the overuse of CS. Further studies are needed to develop appropriate interventions to reduce non-medically indicated CS, focussing on payment mechanisms, healthcare provider practice patterns, and maternal requests.
  Social Science [?] Medicine 05/2012; 75(4):733-7. · 2.70 Impact Factor
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  Available from: PubMed Central

  Article: Results from a blind and a non-blind randomised trial run in parallel: experience from the Estonian Postmenopausal Hormone Therapy (EPHT) Trial.

  Piret Veerus, Krista Fischer, Matti Hakama, Elina Hemminki
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  ABSTRACT: The Estonian Postmenopausal Hormone Therapy (EPHT) Trial assigned 4170 potential participants prior to recruitment to blind or non-blind hormone therapy (HT), with placebo or non-treatment the respective alternatives. Before having to decide on participation, women were told whether they had been randomised to the blind or non-blind trial. Eligible women who were still willing to join the trial were recruited. After recruitment participants in the non-blind trial (N = 1001) received open-label HT or no treatment, participants in the blind trial (N = 777) remained blinded until the end of the trial. The aim of this paper is to analyse the effect of blinding on internal and external validity of trial outcomes. Effect of blinding was calculated as the hazard ratio of selected chronic diseases, total mortality and all outcomes. For analysing the effect of blinding on external validity, the hazard ratios from women recruited to the placebo arm and to the non-treatment arm were compared with those not recruited; for analysing the effect of blinding on internal validity, the hazard ratios from the blind trial were compared with those from the non-blind trial. The women recruited to the placebo arm had less cerebrovascular disease events (HR 0.43; 95% CI: 0.26-0.71) and all outcomes combined (HR 0.76; 95% CI: 0.63-0.91) than those who were not recruited. Among women recruited or not recruited to the non-treatment arm, no differences were observed for any of the outcomes studied.Among women recruited to the trial, the risk for coronary heart disease events (HR 0.77; 95% CI: 0.64-0.93), cerebrovascular disease events (HR 0.66; 95%CI: 0.47-0.92), and all outcomes combined (HR 0.82; 95% CI: 0.72-0.94) was smaller among participants in the blind trial than in the non-blind trial. There was no difference between the blind and the non-blind trial for total cancer (HR 0.95; 95% CI: 0.64-1.42), bone fractures (0.93; 95% CI: 0.74-1.16), and total mortality (HR 1.03; 95% CI: 0.53-1.98). The results from blind and non-blind trials may differ, even if the target population is the same. Blinding may influence both internal and external validity. The effect of blinding may vary for different outcome events. [ISRCTN35338757].
  BMC Medical Research Methodology 04/2012; 12:44. · 2.67 Impact Factor
• Article: Impact of Financial and Educational Interventions on Maternity Care: Results of Cluster Randomized Trials in Rural China, CHIMACA.

  Elina Hemminki, Qian Long, Wei-Hong Zhang, Zhuochun Wu, Joanna Raven, Fangbiao Tao, Hong Yan, Yang Wang, Reija Klemetti, Tuohong Zhang, Elena Regushevskaya, Shenglan Tang
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  ABSTRACT: To report on the design and basic outcomes of three interventions aimed at improving the use and quality of maternity care in rural China: financial interventions, training in clinical skills, and training in health education. Community-based cluster randomized trials were carried out in one central and two western provinces between 2007 and 2009: (1) financial interventions covered part of women's costs for prenatal and postnatal care, (2) training of midwives in clinical skills was given by local maternity care experts in two- or three-group training courses, (3) health education training for midwives and village doctors were given by local experts in health education in two- or three-group training courses. A survey was conducted in a stratified random sample of women who had been pregnant in the study period. 73% of women (n = 3,673) were interviewed within 1-10 months of giving birth. Outcomes were compared by the different intervention and control groups. Adjusted odds ratios were calculated by logistic regression to adjust for varying maternal characteristics. Most of the differences found between the groups were small and some varied between provinces. The financial intervention did not influence the number of visits, but was associated with increased caesarean sections and a decrease in many ultrasound tests. The clinical intervention influenced some indicators of care content. There was no consistent finding for the health education intervention. Financial and training interventions have the potential to improve maternity care, but better implementation is required. Unintended consequences, including overuse of technology, are possible.
  Maternal and Child Health Journal 02/2012; · 2.24 Impact Factor
• Source

  Available from: Riitta Luoto

  Article: Physical activity and change in quality of life during menopause--an 8-year follow-up study.

  Jaana M Moilanen, Anna-Mari Aalto, Jani Raitanen, Elina Hemminki, Arja R Aro, Riitta Luoto
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  ABSTRACT: The aim of this study was to study the role of menopausal status and physical activity on quality of life. A total of 1,165 Finnish women aged 45-64 years from a national representative population-based study were followed up for 8 years. Study participants completed the Health 2000 study questionnaire and follow-up questionnaire in 2008. Ordinal logistic regression analysis was used to measure the effect of menopausal status on global quality of life (QoL). Other variables included in the analyses were age, education, change of physical activity as assessed with metabolic equivalents, change of weight and hormone therapy (HRT) use. Peri- and postmenopausal women increased their physical activity (28% and 27%) during the eight-year follow up period slightly more often than premenopausal (18%) women (p = 0.070). Menopausal status was not significantly correlated with change of QoL. QoL of the most highly educated women was more likely to improve than among the less educated (eb = 1.28, 95%CI 1.08 to 1.51 p = 0.002). Women whose physical activity increased or remained stable had greater chances for improved QoL than women whose physical activity decreased (eb = 1.49, 95%CI 1.23 p < 0.001 to 1.80, eb = 1.46, 95%CI 1.24 to 1.73 p < 0.001 respectively). Women whose weight remained stable during follow-up also improved their QoL compared to women who gained weight (eb = 1.26, 95%CI 1.07 to 1.50 p > 0.01). Women who had never used HRT had 1.26 greater odds for improved QoL (95%CI 1.02 to 1.56 p = < 0.05). Improvement of global QoL is correlated with stable or increased physical activity, stable weight and high education, but not with change in menopausal status.
  Health and Quality of Life Outcomes 01/2012; 10:8. · 2.11 Impact Factor
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  Available from: PubMed Central

  Article: Impact of Chinese one-child policy on sibling structure: experience from rural areas in three provinces.

  Elina Hemminki, Qian Long, Zhuochun Wu, Reija Klemetti
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  ABSTRACT: To study the influence of population policy and boy preference on the sibling structure, that is, in which order and combinations boys and girls are born into families. A population-based survey with a representative sample of new mothers in 2008-2009 in rural China. Two provinces (Anhui and Shaanxi) where authorisation for a second child was usually given if the first birth was a daughter and one province (Chongqing) where only one child was authorised. The mothers giving birth in 2008-2009 were identified from family planning and hospital birth registers (including births outside hospitals) (n=5049). Of them, 3673 were interviewed by trained medical university staff members and students using structured questionnaire (response rate 73%). Children's distribution by sex and families' distribution by children's birth order and sex composition were calculated and compared with theoretical values based on the assumption that family planning policy is fully followed. The recommended family policy was varyingly followed in the three provinces. In all provinces, there were more second children than allowed. If the policy allowing a second child only after a first-born girl were fully followed, it would result in a sibling structure in which the one-child family is always with a boy and in the two-child family the first one is always a girl. This sibling structure was partly seen in Anhui but weakly in Shaanxi. The policy allowing only one child would result in an equal number of boys and girls, but in Chongqing, there were more boys. In Anhui, unlike the other provinces, there were many more first-born girls than boys, which the authors could not fully explain. Population policy and boy preference influence the actual and relative number of girls and boys and also sibling structure.
  BMJ open. 01/2012; 2(3).
• Article: Maternal socio-economic indices for prenatal care research in rural China.

  Bright I Nwaru, Reija Klemetti, Huang Kun, Wang Hong, Shen Yuan, Zhuochun Wu, Elina Hemminki
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  ABSTRACT: BACKGROUND: The conceptualization and measurement of socio-economic status (SES) is difficult in developing settings. In the absence of SES indices for women in rural China, we constructed SES indices for prenatal care research, and examined their relation to perinatal care and outcomes. METHODS: This study utilized data of 4364 rural women having recently given birth, collected by a cross-sectional survey in three rural Chinese provinces in 2007. Principal component analysis (PCA) was used to construct the SES indices and multilevel logistic regression was use to relate the indices to low birthweight, short exclusive breastfeeding (≤4 months), childbirth at the county or higher level health facility, caesarean section, inadequate prenatal care and no postnatal care. RESULTS: Three separate SES indices (wealth, occupational and educational indices) were obtained from the PCA analysis, capturing maternal, paternal and household SES characteristics. After adjusting for individual level factors, village and township wealth, higher levels of the indices were inversely associated with inadequate prenatal care. Higher occupational status was positively associated with short exclusive breastfeeding and childbirth at the county or higher level health facility, but inversely associated with no postnatal care. Higher educational status was positively associated with no postnatal care. CONCLUSION: Three SES indices (wealth, occupational and educational) were obtained from this study for prenatal care research. The indices gave mostly varying results on their associations with perinatal care and outcomes, indicating that SES measures may be outcome-specific.
  The European Journal of Public Health 12/2011; · 2.73 Impact Factor
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  Available from: groups.stakes.fi

  Article: Unauthorised pregnancies and use of maternity care in rural China.

  Reija Klemetti, Elena Regushevskaya, Wei-Hong Zhang, Zhuochun Wu, Hong Yan, Yang Wang, Elina Hemminki
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  ABSTRACT: To describe the use of maternity care in rural China by the legal status of the pregnancy. Cross-sectional survey wherein information was obtained about 2576 women who gave birth in 2006. Logistic regression was used to compare women having an unauthorised pregnancy with those having an authorised second birth, adjusting for confounding factors. Almost all respondents had antenatal care and most deliveries occurred in hospitals. Women with unauthorised pregnancies were significantly less likely to have had maternity care, particularly prenatal care, postnatal care, to have been hospitalised during pregnancy, and to have been reimbursed for hospital delivery costs than women with an authorised second birth. They were also more likely to have been hospitalised for seven or more days after delivery. Primiparous women used maternity care services and received financial support more often than women with an authorised second birth. Among the women with an unauthorised pregnancy an important reason for not using hospital care during pregnancy or delivery was financial constraint. Women with unauthorised pregnancies use less maternity care, although pregnancy in such circumstances may adversely impact their health. Primiparous women benefit from more financial support than multiparous women.
  The European Journal of Contraception and Reproductive Health Care 08/2011; 16(5):359-68. · 1.46 Impact Factor
• Article: Is HIV testing normal or special? Opinions of health professionals in four European countries in 2008.

  Elina Hemminki, Elena Regushevskaya, Kristi Rüütel, Henrique Barros, Tomasz Niemiec, Minna Nikula, Hannamaria Kuusio, Jessika Deblonde
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  ABSTRACT: The special norms in testing for HIV infection are not typical of testing or screening for other diseases. In four European countries, we studied health professionals' views on HIV testing This study is based on cross-sectional surveys of two groups of health professionals: presidents of selected health professional societies and head physicians and nurses of selected hospital clinics in Belgium, Estonia, Finland, and Portugal in 2008. A common structured semi-anonymous questionnaire was used in the four countries. The number of societies responding varied from five to 10 and for hospital clinics from six to 18; the response rates were from 32% to 100% and 41% to 100%, respectively. Opinions on whether HIV testing is like any other test and on the value of specific approaches in HIV testing varied both within and between countries. Some professionals thought that HIV testing is different from the testing of other infectious diseases; others thought that such an exceptional approach may be a disservice to people and to the health system. Many professionals thought that HIV testing should not be thought of only from the point of view of the individual to be tested, but also from that of other people (potential patients). Obligatory testing was considered appropriate in certain circumstances. Generally, more HIV testing in health care was called for. Normalization of HIV testing, i.e., considering it like any other diagnostic test, is unlikely to meet much opposition from health professionals. Larger surveys are needed to confirm the results.
  AIDS Care 07/2011; 24(1):91-9. · 1.60 Impact Factor
• Article: Completeness and utility of interview data from proxy respondents in prenatal care research in rural China.

  Bright I Nwaru, Reija Klemetti, Shen Yuan, Huang Kun, Yang Wang, Elina Hemminki
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  ABSTRACT: In household surveys, the use of data provided by relatives can increase response rates and generalisability of research findings. This study assessed the quality of data from relatives and the impact of the data source on the association between the use of prenatal care and pregnancy outcomes. Data for 3,673 new mothers and 293 proxy respondents were available from a house-hold survey in 2008-2009 in rural China. Analyses were performed using chi-square test, ANOVA, Kruskal-Wallis test, and logistic regression models. Differences in the studied variables were small, but proxy respondents were slightly more likely to have missing data than the new mothers. Differences and missing data were more common for the use of prenatal care and outcome variables (mode of delivery, place of delivery, birth weight, use of postnatal care, and gestational age at birth) than for the background characteristics of the participants. Husbands' reports were closer to the index reports than that of the other proxies. The associations between the exposures and outcomes were mostly similar between the proxy and index respondents. Relatives can be interviewed instead of women to study prenatal care without a substantial negative impact on study results. Studies using proxy respondents should stratify the analysis by type of respondents.
  Maternal and Child Health Journal 05/2011; 16(4):867-76. · 2.24 Impact Factor
• Article: Changes and equity in use of maternal health care in China: from 1991 to 2003.

  Zhuochun Wu, Peng Lei, Elina Hemminki, Ling Xu, Shenglan Tang, Xiaoyan Li, Joanna Raven, Jun Gao, Rachel Tolhurst
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  ABSTRACT: To examine changes and equity in use of maternal care in different types of rural and urban areas in China from the early 1990s to early 2000s. Data were drawn from three National Health Household Interview Surveys conducted in 1993, 1998, and 2003. Analysis was based on married women aged between 15 and 49 who had live births within the 24 months prior to the survey. Nationally, the proportion of women receiving their first pre-natal visit within 12 weeks of gestation and the hospital delivery rate increased rapidly from 20.56 and 37.61% in the early 1990s to 52.60 and 74.02% in the early 2000s, respectively, while the proportion of women receiving at least one post-natal care visit dropped slightly from 56.46 to 54.12% in the same time period. There were large disparities in use of maternal care between urban and rural areas and among different sized cities and rural areas with different levels of socio-economic development. But the disparities narrowed over time, especially among different types of rural areas. The proportion of delivery out of hospital attended by trained staff in rural areas decreased considerably from 68.01% in 1991-1993 to 51.57% in 2001-2003. Maternal care utilization made remarkable progress in the study period, and the gap between rural and urban areas and among different classes of cities and rural areas significantly narrowed. This was probably due to both socio-economic development and targeted investments in improving health services. However, significant gaps remained, requiring attention.
  Maternal and Child Health Journal 03/2011; 16(2):501-9. · 2.24 Impact Factor
• Article: Immediate adverse events after second trimester medical termination of pregnancy: results of a nationwide registry study.

  Maarit J Mentula, Maarit Niinimäki, Satu Suhonen, Elina Hemminki, Mika Gissler, Oskari Heikinheimo
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  ABSTRACT: BACKGROUND Increasing gestational age is associated with an increased risk of complications in studies assessing surgical termination of pregnancy (TOP). Medical TOP is widely used during the second trimester and little is known about the frequency of complications. This epidemiological study was undertaken to assess the frequency of adverse events following the second trimester medical TOP and to compare it with that after first trimester medical TOP. METHODS This register-based cohort study covered 18 248 women who underwent medical TOP in Finland between 1 January 2003 and 31 December 2006. The women were identified from the Abortion Registry. Adverse events related to medical TOP within 6 weeks were obtained from the Hospital Discharge Registry. RESULTS When compared with first trimester medical TOP, second trimester medical TOP increased the risk of surgical evacuation [Adj. odds ratio (OR) 7.8; 95% confidence interval (CI) 6.8-8.9], especially immediately after fetal expulsion (Adj. OR 15.2; 95% CI 12.8-18.0). The risk of infection was also elevated (Adj. OR 2.1; 95% CI 1.5-2.9). Within the second trimester, increased length of gestation did not influence the risk of surgical evacuation or infection after medical TOP. CONCLUSIONS Medical TOP during the second trimester is generally safe. Surgical evacuation of the uterus is avoided in about two-thirds of cases, though it is much more common than after first trimester medical TOP. The risks of surgical evacuation and infection do not increase with gestational weeks in the second trimester TOP.
  Human Reproduction 02/2011; 26(4):927-32. · 4.47 Impact Factor
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  Available from: Lennart Bogg

  Article: Giving birth at a health-care facility in rural China: is it affordable for the poor?

  Qian Long, Yaoguang Zhang, Joanna Raven, Zhuochun Wu, Lennart Bogg, Shenglan Tang, Elina Hemminki
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  ABSTRACT: To investigate changes in the expenditure of giving birth in health-care facilities in rural China during 1998-2007, to examine the financial burden on households, particularly poor ones, and to identify factors associated with out-of-pocket expenditure. Cross-sectional data on births between 1998 and 2007 were obtained from national household surveys conducted in 2003 and 2008. Descriptive statistics and log-linear models were used to identify factors associated with out-of-pocket expenditure on delivery. During 1998-2007, the proportion of facility-based deliveries increased from 55% to 90%. In 2007, 60% of births occurred at county-level or higher-level facilities. The Caesarean delivery rate increased from 6% to 26%. Total expenditure on a facility-based delivery increased by 152%, with a marked rise from 2002 onwards with the introduction of the New Cooperative Medical Scheme. In 2007, out-of-pocket expenditure on a facility-based delivery equalled 13% of the mean annual household income for low-income households. This proportion had decreased from 18% in 2002 and differences between income groups had narrowed. Regression models showed that Caesarean delivery and delivery at a higher-level facility were associated with higher expenditure in 2007. The New Cooperative Medical Scheme was associated with lower out-of-pocket expenditure on Caesarean delivery but not on vaginal delivery. Expenditure on facility-based delivery greatly increased in rural China over 1998-2007 because of greater use of higher-level facilities, more Caesarean deliveries and the introduction of the New Cooperative Medical Scheme. The financial burden on the rural poor remained high.
  Bulletin of the World Health Organisation 02/2011; 89(2):144-52. · 4.64 Impact Factor