Induced abortion and future use of IVF treatment; A nationwide register study

Peer reviewe

Gravidity, parity and knee breadth at midlife: a population-based cohort study

Gestation increases the biomechanical loading of lower extremities. Gestational loading may influence anthropometrics of articular surfaces in similar means as bone diaphyseal properties. This study aimed to investigate whether gravidity (i.e. number of pregnancies) and parity (i.e. number of deliveries) is associated with knee breadth among middle-aged women. The study sample comprised 815 women from the Northern Finland Birth Cohort 1966. The median parity count of our sample was 2 and the median gravidity count 3. At the age of 46, questionnaires were used to enquire gravidity and parity, and posteroanterior knee radiographs were used to obtain two knee breadth parameters (tibial plateau mediolateral breadth (TPML) and femoral condylar mediolateral breadth (FCML)) as representatives of articular size. The associations of gravidity and parity with knee breadth were analyzed using general linear models with adjustments for height, weight, leisure-time physical activity, smoking, and education years. Individuals with osteoarthritic changes were excluded from our sample. The mean TPML in our sample was 70.3 mm and the mean FCML 71.6 mm respectively. In the fully adjusted models, gravidity and parity showed positive associations with knee breadth. Each pregnancy was associated with 0.11–0.14% larger knee breath (p < 0.05), and each delivery accounted for an increase of 0.20% in knee breadth (p < 0.01). Between-group comparisons showed that multiparous women had 0.68–1.01% larger knee breath than nulli- and primiparous women (p < 0.05). Pregnancies and deliveries seem to increase the mediolateral breadth of the knee. This increase is potentially associated with increased biomechanical loadings during gestation.Peer reviewe

Comparison of rates of adverse events in adolescent and adult women undergoing medical abortion: population register based study

Objective To determine the risks of short term adverse events in adolescent and older women undergoing medical abortion

National register data are of value in studies on miscarriage-Validation of the healthcare register data in Finland

Introduction Despite the high prevalence of miscarriages, they are not systematically registered and few epidemiological studies have been done. As Finnish health registries are comprehensive and widely used in research, we validated the Finnish register data concerning diagnostics and treatment of miscarriage, and treatment-related adverse events. Material and methods We conducted a validation study regarding miscarriage-related codes of diagnoses and surgical procedures in a Finnish National Hospital Discharge Registry (NHDR) by comparing the information from the NHDR with that of the hospital records. We selected a random sample of 4 months during 1998-2016 from three hospitals, comprising 687 women aged 15-49 experiencing a first miscarriage during follow-up. Women with diagnoses unrelated to miscarriage, or proven to be other than miscarriage, were excluded. The final sample consisted of 643 women with confirmed miscarriage, which was used for analyses regarding the diagnosis, treatment and adverse events of miscarriage treatment. Results The majority of miscarriages registered in the NHDR were confirmed by the hospital records (positive predictive value [PPV] = 93.6% [95% confidence interval [CI] 91.8%-95.4%]). Different types of miscarriage were also reliably identified; spontaneous abortion with PPV = 85.6% (95% CI 80.9%-89.2%), missed abortion with PPV = 92.7% (95% CI 88.8%-95.3%) and blighted ovum with PPV = 91.1% (95% CI 84.3%-95.1%). The PPV of surgical treatment (62.2% [95% CI 55.7%-68.3%]) was lower than the PPV of non-surgical treatment (93.3% [95% CI 90.5%-95.3%]). The diagnoses regarding adverse events of miscarriage treatment could be reliably identified. The PPV for clinical infections was 76.0% (95% CI 56.6%-88.5%) and for retained products of conception or/and vaginal bleeding 96.8% (95% CI 83.8%-99.4%). Conclusions The coverage of the NHDR was good concerning identification of miscarriages, different types of miscarriages and non-surgical treatment. Nevertheless, there is a need for clearly defined procedural codes concerning to medical treatment of miscarriage. The register-based data are reliable and practicable for both clinical evaluation and research concerning miscarriage.Peer reviewe

Fear of childbirth after medical versus surgical abortion. Population-based register study from Finland

Introduction To evaluate the effect of method of induced abortion and other abortion-associated variables on the incidence of fear of childbirth in subsequent pregnancy. Material and methods This population-based register study cohort includes all nulliparous women with their first pregnancy ending in an induced abortion in 2000-2015 and subsequent pregnancy with live singleton delivery between 2000 and 2017 (n = 21 479). Data were derived from three national registers maintained by the Finnish Institute for Health and Welfare. We divided the study population in three cohorts: (a) medical and (b) surgical abortion during first trimester ( Results The overall incidence of fear of childbirth was 5.6% (n = 1209). Altogether, 19.2% (n = 4121) of women underwent cesarean delivery. The odds were elevated especially for elective cesarean delivery (odds ratio [OR] 9.30, 95% CI 7.95-10.88, P <.001) in women with fear of childbirth. In multivariable analysis, the odds for fear of childbirth (adjusted OR [aOR] 0.80, 95% CI 0.68-0.94) and cesarean delivery (aOR 0.66, 95% CI 0.84-0.90) were decreased in women with a history of first-trimester medical abortion compared with those with first-trimester surgical abortion. Second-trimester medical abortion had no effect on the odds for fear of childbirth (aOR 1.04, 95% CI 0.71-1.50). Maternal age of 30-39 years and interpregnancy interval over 2 years were additional risk factors for both fear of childbirth and cesarean delivery, but surgical evacuation of uterus after the abortion was not. Conclusions One first- or second-trimester medical abortion does not increase the odds for fear of childbirth, and cesarean delivery related to it in subsequent pregnancy when compared with first-trimester surgical abortion. Older maternal age and longer interpregnancy interval emerged as risk factors for fear of childbirth.Peer reviewe

Medical compared with surgical management in induced abortions and miscarriages

Abstract Each year approximately 11,000 induced abortions are performed in Finland, the majority of these women being younger than 25 years of age. Medical abortion with the antiprogestin mifepristone and the prostaglandin analogue misoprostol is increasingly being used instead of surgical method (dilatation of cervix and uterine evacuation with instruments). Similarly, miscarriages can be treated with medical or surgical management. Still, clinical outcomes of the medical treatment of miscarriage are not well established, and various different regimens exist. The aim of this study was to investigate the frequency and risk factors of repeat abortions and immediate post-abortal complications, focusing especially on the impact of the method of abortion. National health registries were used as a data source. Another part of the study was aimed at comparing the efficacy, acceptability and cost-effectiveness of the medical and surgical treatment of miscarriage. In national cohort, the risk of repeat abortion was associated with sociodemographic characteristics (parity, previous abortion, low socioeconomic status, being unmarried but cohabiting or single), but not with the method of abortion. The risk of repeat termination of pregnancy decreased with age, among women living in rural area, and when intrauterine devices or sterilization were planned for future contraception. The overall incidence of adverse events was 4-fold greater in the medical compared to the surgical abortion cohort. Hemorrhage and incomplete abortion were more common following medical abortion, but the incidence of infections did not differ. Medical and surgical treatment of miscarriage were compared in a randomized setting; the efficacy of the treatment did not differ. Medically treated patients were less satisfied with the treatment and had experienced more pain. In the cost analysis, the primary costs of the surgical treatment were higher, but more unexpected events and complications increased the secondary costs in the medical group. In summary, medical abortion offered a good alternative to surgical method without increasing the risk of repeat abortions, but with an increased risk of short-term adverse events. The medical method was efficient in treating miscarriages, and the majority of women were satisfied with the treatment. Neither of the methods was economically superior in treating miscarriage

Quality matters

Purpose Extending the active lifetimes of garments by producing better quality is a widely discussed strategy for reducing environmental impacts of the garment industry. While quality is an important aspect of clothing, the concept of quality is ambiguous, and, moreover, consumers may perceive quality in individual ways. Therefore, it is important to deepen the general understanding regarding the quality of clothing. Design/methodology/approach This paper presents an integrated literature review of the recent discussion of perceived quality of clothing and of the links between quality and clothing lifetimes; 47 selected articles and other literature obtained primarily through fashion/clothing/apparel journals were included in this review. Findings The main ideas from the articles are thematized into the following sections: the process of assessment, levels involved in assessment, multidimensional cues of assessment, and quality and clothing use times. The paper highlights that perceiving quality is aprocess guided by both expectations and experience, and assembles the various aspects into a conceptual map that depicts the connections between the conceptual levels involved in assessing quality. It also illustrates connections between quality and clothing use times. Research limitations/implications This paper focused on perceived quality on a conceptual level. Further studies could examine and establish deeper links between quality, sustainability and garment lifespans. Originality/value The study draws together studies on perceived quality, presenting the foundational literature and key concepts of quality of clothing. It summarizes them in a conceptual map that may help visualize various aspects affecting the assessment of quality and deepen the general understanding of the quality of garments.Peer reviewe

Opening up New Textile Futures through Collaborative Rethinking and Remaking

Textile design is a field where art and technology meet. In the broad field of design, textile design is regarded as a special discipline because it requires not only creative skills, but also a deep understanding of production technology. Textile designers use and sometimes even create materials from a molecular level in collaboration with material scientists. The textile and clothing industry (including technical textiles) is one of the largest industrial sectors globally, with a huge economic and environmental impact. Textiles are designed for many different purposes, and accordingly textile designers have an important role to play as material experts and interpreters of users’ needs. This is not enough, however. In the future, textile experts will need a complete understanding of the complex system of textile commerce, use, and lifecycle. Textiles are an essential part of our everyday life and will be needed to protect aand comfort us even in an increasingly digital future. Textile design education atAalto University School of Art, Design and Architecture (Aalto ARTS) has gone through major transformation during the last decade. Recent developments in textile education are based on three key elements: (a) developing a new, effective pedagogy, which has been essential in opening textile design courses to fashion students as well as other design students; (b) building bridges across disciplinary boundaries to enable collaboration between design, science, and engineering disciplines; and (c) establishing academic research. By opening up textile design courses to other design fields and disciplines, Aalto ARTS has renewed the presence and importance of textile design, not only in academia but also in society. Knowledge creation in the textile field is more dynamic and collaborative than ever before.Peer reviewe