Elderly people with chronic diseases are at risk for having severe COVID-19 disease. We were interested whether the drugs prescribed for the chronic diseases are associated with lower mortality in COVID-19 patients. We used Finnish national registry data for analysis of potential associations of 73 prescription drugs to mortality among 6082 adult COVID-19 patients between 1.1.2020 and 30.6.2020, before COVID-19 vaccinations were available. Adjusted odds ratios (aORs) with 95 percent confidence intervals (95% CIs) for different medications are presented. The use of three cardiovascular drugs was associated with lower 30 days all-cause mortality rate: candesartan (aOR 0.34, 95% CI 0.16-0.72, p=0.005), metoprolol (aOR 0.37, 95% CI 0.16-0.88, p=0.024) and rosuvastatin (aOR 0.44, 95% CI 0.21-0.94, p=0.034). In conclusion, COVID-19 patients who used cardiovascular drugs candesartan, metoprolol or rosuvastatin have lower 30 days all-cause mortality than other COVID-19 patients.

Nurse shortages underscore the need to understand how organizational culture and climate affect nurse-focused outcomes in surgical care. This study analyzed how nursing staff and first-line nurse managers perceive organizational culture and climate in surgical domains and explored the differences in their perceptions. Furthermore, it analyzed how these perceptions and discrepancies correlate with nurse-focused outcomes, such as nursing staff sickness absences and gross turnover. Additionally, the study investigated how unit sizes and care settings influence the relationship between the organizational social context and nurse-focused outcomes. A cross-sectional survey was conducted from November 2020 to February 2021 across 52 surgical units in seven Finnish public healthcare organizations. The Organizational Social Context (OSC) measure was used to assess organizational culture and climate. Nurse-focused outcomes, sickness absences and gross turnover were obtained from HR records. Gross turnover was based on all recorded entries into and exits from the unit among employed nursing staff. Statistical methods suitable for group-level investigation were used. Statistical analyses, including Spearman correlations and regression analyses, were used to evaluate relationships between perceptions of the organizational social context and nurse-focused outcomes. Interaction effects of unit size and care settings were analyzed. Participating nursing staff from 52 surgical groups (n = 627) and first-line nurse managers from 7 groups (n = 61) showed within-group consistency in their perceptions of organizational culture and climate based on rWG indices. Nursing staff and first-line nurse managers had significantly different perceptions of organizational culture and climate across most dimensions, with first-line nurse managers providing more positive assessments. Nursing staff’s assessments of functionality negatively correlated with nursing staff gross turnover. For first-line nurse managers, higher resistance, rigidity and stress correlated negatively and engagement positively with nursing staff gross turnover. Additionally, the analysis found statistically significant interaction effects of the care setting, showing that certain relationships between organizational social context dimensions assessed by first-line nurse managers and nursing staff gross turnover varied across different surgical care settings. The findings highlight the importance of fostering a well-functioning work environment and aligning first-line nurse manager and nursing staff perceptions to improve staff retention. First-line nurse managers’ perspectives appear relevant to nursing staff gross turnover, with variation across surgical settings, highlighting the need for tailored approaches.

BACKGROUND:Anaemia is common among patients with traumatic brain injury (TBI), and it might contribute to the development of secondary brain injury. However, the impact of anaemia on outcome among TBI patients remains controversial. The aim of this study was to investigate the association between acute anaemia and short-term neurological outcome and mortality among patients with moderate to severe TBI. METHODS:The retrospective cohort study included all successive patients admitted to Tampere University Hospital's emergency department with moderate to severe TBI between August 2010 and July 2012. Information on patient demographics, trauma-related characteristics and post-traumatic care was collected, including all in-hospital haemoglobin (Hb) values. Hb concentration below 100 g/L at any point during the hospitalisation was defined as severe anaemia. The main outcome variable was the Glasgow Outcome Scale (GOS) at hospital discharge, dichotomized as poor (GOS 1 to 3) and good (GOS 4 to 5) outcome. The secondary outcome variables were mortality rates at 3, 6 and 12 months after TBI. RESULTS:A total of 145 patients with moderate to severe TBI met the inclusion criteria. Severe anaemia was detected in 45.5%. In univariate analyses, severe anaemia was associated with poor unfavourable functional outcome at hospital discharge (83.3% vs. 55.6%, p < 0.001), and higher 3-month, 6-month and 12-month mortality rates (28.8% vs. 13.9%, p = 0.028; 30.3% vs. 16.5%, p = 0.048; 36.4% vs. 17.7%, p = 0.011, respectively). In multivariable analysis, severe anaemia was independently associated with unfavourable functional outcome (OR 4.06, 95% CI 1.54-10.72, p = 0.005), but not with higher long-term mortality. CONCLUSION:Among patients with moderate to severe TBI, severe anaemia with an Hb level below 100 g/L during hospitalisation was independently associated with unfavourable functional outcome at hospital discharge. EDITORIAL COMMENT:For cases with severe traumatic brain injury, managing oxygen carrying capacity is one important factor. In this single center cohort, severe anemia documented at any point in the hospitalization was associated with worse neurological outcome.

Background: The influence of the father’s well-being on child development has been increasingly studied, but longitudinal studies remain few. This study explores how paternal stress and well-being in the offspring’s middle childhood is associated with the child’s internalizing and externalizing problems and competence in adolescence and young adulthood. In addition, it explores the combined effect of paternal stress and maternal depressive symptoms (MDS) trajectories, on child outcomes. Method: The longitudinal study started in 1989 in Tampere, Finland, and included 351 normal population primiparous mothers. MDS were screened prenatally, postnatally at 2 and 6 months, and when the index child was 4–5, 8–9, 16–17, and 27 years old. Fathers participated at the 8–9 years follow-up. The children completed questionnaires when they were 16–17 and 27 years old. Complete data were available from 106 adolescents and 81 young adults. Results: The father’s long term health problems were associated with the child’s poorer competence in adolescence. The simultaneous high maternal depressive symptoms trajectory increased the risk. In young adulthood, the father’s poorer health and life satisfaction were associated with the offspring having a lower level of internalizing problems and better adaptive functioning. The MDS trajectory was not associated with the young adult’s outcomes. Limitations: The sample size was moderate, and high-symptomatic cases were more common among drop-outs. Conclusions: Exposure to paternal stress and poor well-being in middle childhood should be considered as an important risk factor for child development. On the other hand, (mild) childhood adversity may enhance psychosocial functioning in young adulthood.

Most women are satisfied with their delivery experience but the effects of pain relief and different pain relief methods on the birthing experience remain inconsistent. We wanted to evaluate the impact of pain relief on the birthing experience during the first and second stages of labor among primiparous and multiparous women. A total of 2042 parturients (953 primiparous and 1089 multiparous women) completed a questionnaire on the second day after vaginal delivery and, using visual analogue scale (VAS), assessed their experience and satisfaction with their pain management during the first and second stages of labor. The experiences of primiparous and multiparous women were compared, and the factors associated with positive and negative birthing experiences were ascertained. Overall birthing experience was better among multiparous than among primiparous women (VAS 8.6 vs. 8.0; p  < 0.001). Reported satisfaction with pain management revealed no significant differences between multiparous and primiparous women during the first stage of labor (VAS 8.2 vs. 8.1) or the second stage of labor (VAS 7.8 vs. 7.7). Some variation was reported in satisfaction with the various pain management methods, epidural and spinal block having the highest ratings during both stages of labor. However, despite differences in satisfaction with pain management, in overall birthing experience, no difference according to pain relief administered was reported among multiparous and only minor differences in primiparous women in the second stage of labor. Those parturients reporting negative birthing experiences (VAS ≤5) reported relatively high satisfaction with pain management during the first stage of labor (medians 8 and 8 in multiparous and primiparous women respectively) while satisfaction with second-stage pain management was clearly lower (respective medians 2 and 5). In a regression model satisfaction with pain management during the second stage of labor varied significantly with birthing experience. The childbirth experience was slightly better among multiparous than among primiparous women, although there were no significant differences regarding satisfaction with pain management according to parity during the first or second stage of labor. Satisfaction with pain relief during the second stage of labor was significantly associated with overall birthing experience.

INTRODUCTION:Most women are satisfied with their delivery experience but the effects of pain relief and different pain relief methods on the birthing experience remain inconsistent. We wanted to evaluate the impact of pain relief on the birthing experience during the first and second stages of labor among primiparous and multiparous women. MATERIAL AND METHODS:A total of 2042 parturients (953 primiparous and 1089 multiparous women) completed a questionnaire on the second day after vaginal delivery and, using visual analogue scale (VAS), assessed their experience and satisfaction with their pain management during the first and second stages of labor. The experiences of primiparous and multiparous women were compared, and the factors associated with positive and negative birthing experiences were ascertained. RESULTS:Overall birthing experience was better among multiparous than among primiparous women (VAS 8.6 vs. 8.0; p < 0.001). Reported satisfaction with pain management revealed no significant differences between multiparous and primiparous women during the first stage of labor (VAS 8.2 vs. 8.1) or the second stage of labor (VAS 7.8 vs. 7.7). Some variation was reported in satisfaction with the various pain management methods, epidural and spinal block having the highest ratings during both stages of labor. However, despite differences in satisfaction with pain management, in overall birthing experience, no difference according to pain relief administered was reported among multiparous and only minor differences in primiparous women in the second stage of labor. Those parturients reporting negative birthing experiences (VAS ≤5) reported relatively high satisfaction with pain management during the first stage of labor (medians 8 and 8 in multiparous and primiparous women respectively) while satisfaction with second-stage pain management was clearly lower (respective medians 2 and 5). In a regression model satisfaction with pain management during the second stage of labor varied significantly with birthing experience. CONCLUSIONS:The childbirth experience was slightly better among multiparous than among primiparous women, although there were no significant differences regarding satisfaction with pain management according to parity during the first or second stage of labor. Satisfaction with pain relief during the second stage of labor was significantly associated with overall birthing experience.

Existing research has shown that parental exposure to violence has negative consequences on health outcomes, but the effect of such exposure on unmet health care and social service need is unknown. This study aims to investigate the association between unmet health care and social services and parental violence exposure among parents with children. This study used the data of 6289 parents aged 18–60 years who had at least one child under 18 years living in the same household. Parental violence exposure was measured. Unmet child and adult health care and social service need was operationalized through questions on the services needed, those that had not been received, and those that were considered inadequate. Parents who experienced any kind of violence had more unmet service need. There were more women among parents with violence experience (65.4

OBJECTIVES OF THE ARTICLE:Inflammatory bowel disease (IBD) nursing has been identified as a crucial component in the IBD service delivery. This article aims to provide a comprehensive overview of the state of IBD nursing care in Finland, and to identify areas that would benefit from further research. MATERIALS AND METHODS:Tertiary IBD outpatient clinics nationwide were invited to participate in a cross-sectional descriptive study conducted using an electronic survey. The quality of IBD nursing services was assessed using the Nursing Care Quality in IBD (NCQ-IBD) evaluation tool. RESULTS:Of the 34 identified clinics, 27 participated (79.4%) in the study. The NCQ-IBD tool classifies the clinics in four categories, where A indicates the highest level of quality, and D the lowest. In this study, 26 clinics (96.3%) were classified at level C, and one clinic (3.7%) at level D. Nursing responsibilities in IBD management and informing the patients were at a high level of quality, whereas nursing research in IBD was at a low level. An IBD database (i.e. clinical IBD registry) was in use only in 10 clinics. Although training in the clinical aspects of IBD was readily available, there was a lack of training plans for IBD, and clinics seldom held an annual review of the IBD nursing activities and outcomes. There were very few clinics using structured indices and questionnaires, and only 16 clinics (59.3%) applied a written IBD protocol. CONCLUSION:In the Finnish IBD nursing service, as measured with the NCQ-IBD tool, several areas for future improvement were identified.

OBJECTIVES:To elucidate the risk and temporal relationship of cardiovascular (CV) comorbidities in rheumatic diseases. METHODS:Patients in the FinnGen study diagnosed between 2000 and 2014 with seropositive (n = 2368) or seronegative (n = 916) rheumatoid arthritis (RA), ankylosing spondylitis (AS, n = 715), psoriatic arthritis (PsA, n = 923), systemic lupus erythematosus (SLE, n = 190), primary Sjogren's syndrome (pSS, n = 412) or gout (n = 2034) were identified from healthcare registries. Each patient was matched based on age, sex, and birth region with twenty controls without any rheumatic conditions. Overall risk ratios (RR) were calculated by comparing the prevalence of seven CV diseases between patients and controls. Logistic regression models were used for estimating odds ratios (OR) for CV comorbidities before and after the onset of rheumatic diseases. RESULTS:The RR for 'any CVD' varied from 1.14 (95 % confidence interval [CI] 1.02-1.26) in PsA to 2.05 (95 % CI 1.67-2.52) in SLE. Patients with SLE or gout demonstrated over two-fold risks for several CV comorbidities. Among CV comorbidities, venous thromboembolism (VTE) showed the highest effect sizes in several rheumatic diseases. The ORs for CV comorbidities were highest within one year before and/or after the onset of the rheumatic disease. However, in gout the excess risk of CV disease was especially high before gout diagnosis. CONCLUSIONS:The risk of CV comorbidities was elevated in all studied rheumatic diseases, with highest risks observed in SLE and gout. The risk for CV diseases was highest immediately before and/or after rheumatic disease diagnosis, highlighting the increased risk for CV comorbidities across all rheumatic diseases very early on the disease course.

Prospective cohort study. To study the mortality rates of TSCI patients compared to matched controls and to examine possible TSCI-related mortality risk factors and causes of death. Oulu and Tampere University Hospital, Finland. All consecutive patients with a new TSCI were included in a prospective study (n = 344, 2012-16). All patients were followed until death or the end of 2019. Patients were compared to a control group formed by randomly choosing gender, age, municipality, and calendar time-matched controls (5 controls/TSCI patient). Standardized mortality ratios (SMR) were calculated using general population mortality rates. Mortality information was extracted from the Statistics of Finland (Helsinki, Finland). TSCI patients had an increased mortality (SMR = 2.9) compared with the Finnish population. During the observation period, 26

BackgroundWith increasing numbers of people seeking medical gender reassignment, the scientific community has become increasingly aware of the issue of detransitioning from social, hormonal or even surgical gender reassignment (GR). This study aimed to assess the proportion of patients who discontinued their established hormonal gender transition and the risk factors for discontinuation.MethodsA nationwide register-based follow-up was conducted. Data were analysed via cross-tabulations with chi-square statistics and t tests/ANOVAs. Multivariate analyses were performed via Cox regression, which accounts for differences in follow-up times.ResultsOf the 1,359 subjects who had undergone hormonal GR in Finland from 1996 to 2019, 7.9% discontinued their established hormonal treatment during an average follow-up of 8.5 years. The risk for discontinuing hormonal GR was greater among later cohorts. The hazard ratio was 2.7 (95% confidence interval 1.1-6.1) among those who had accessed gender identity services from 2013 to 2019 compared with those who had come to contact from 1996 to 2005. Discontinuing also appeared to be emerging earlier among those who had entered the process in later years.ConclusionsThe risk of discontinuing established medical GR has increased alongside the increase in the number of patients seeking and proceeding to medical GR. The threshold to initiate medical GR may have lowered, resulting in a greater risk of unbalanced treatment decisions.Trial registration number (TRN)Not applicable (the paper does not present a clinical trial).

Shoulder external rotation after brachial plexus birth injury can be restored by transfer of the spinal accessory nerve to the suprascapular nerve, or more distally to its infraspinatus branch. We studied the outcome of these nerve transfers in 52 patients with a minimum postoperative follow-up of 12 months (mean 7.3 years). The median postoperative improvement in shoulder external rotation was 120° (interquartile range [IQR] 45-135) after anterior and 110° (IQR 83-120) after dorsal spinal accessory nerve transfer to the suprascapular nerve main trunk, and 110° (IQR 80-125) after transfer to the infraspinatus branch. Patients operated after 20 months obtained external rotation ≥90° less frequently. The results of this study suggest that a decision about distal nerve transfer for shoulder external rotation is recommended at 1.5 years of age.Level of evidence: III.

Background Thrombolysis should be administered as soon as possible to suitable patients with acute ischaemic stroke. We introduced a new protocol for patients who had a stroke to achieve reduced door-to-needle times for the best possible outcome. Since then, we have closely monitored each patient who had a stroke. Our goal was to assess whether statistical process control charts could be useful in detecting deviations in door-to-needle times when using four well-known rules applied by Western Electric (WE rules 1–4).Methods We analysed retrospectively door-to-needle times of together 200 acute ischaemic stroke patients before and after the implementation of our new stroke protocol. In addition, 25 patients at the time of reorganisation (transition period) were analysed. Statistical process control chart rules WE 1–WE 4 were applied to detect door-to-needle deviations and to monitor process uniformity.Results Before the implementation of the protocol, median door-to-needle time was 53 min and after the implementation 20 min. Statistical process control chart rules were triggered only once in 100 patients before the reorganisation but seven times in 25 patients during the transition period. None of the rules WE 1–4 were activated after the reorganisation, indicating the stability of the reorganised acute ischaemic stroke process.Conclusions The use of statistical process control charts demonstrated a significant reduction in door-to-needle times during the reorganisation. Further, it showed that the acute ischaemic stroke process with a 20 min door-to-needle time is very stable.

Narrow-band TL-01 ultraviolet B phototherapy (TL-01) is an effective and widely used treatment for many skin diseases. The purpose of the investigation was to assess the risk of skin cancers in patients treated with TL-01 phototherapy who have not received any other phototherapy modalities. This cohort study included 4,815 TL-01 treated patients in Finland with psoriasis or atopic dermatitis. Clinical information was collected from the hospital records and linked with Finnish Cancer Registry data. The follow-up started from the first TL-01 treatment and the mean follow-up time was 8.4 years. Standardized incidence ratios were calculated for basal cell carcinoma, cutaneous melanoma, and squamous cell carcinoma. The standardized incidence ratio for basal cell carcinoma was 2.5 (95% confidence interval 1.8–3.5), for cutaneous melanoma 4.0 (95% confidence interval 2.1–6.8) and for squamous cell carcinoma 3.7 (95% confidence interval 1.7–7.0). For basal cell carcinoma and squamous cell carcinoma, the standardized incidence ratios remained similar during the whole follow-up time while the standardized incidence ratio for cutaneous melanoma was markedly higher during the first 5 years of follow-up. In conclusion, an increased incidence of skin cancers was observed among TL-01 treated patients. It should be confirmed in the future whether the skin cancer risk of TL-01 phototherapy will remain high in a longer follow-up.

It is extremely important to have an overall view of nurses’ well-being and anxiety levels during the COVID-19 pandemic to support the well-being and working conditions of workers in optimal ways in future crises. The aim of the study was to describe changes in the anxiety levels of nurses from the beginning of the COVID-19 pandemic to a time point 18 months later, and to describe how the working conditions, interactions between workers, psychological distress, and managers’ actions were associated with the anxiety of nursing staff. The repeated cross-sectional survey was distributed to nurses at two Finnish hospitals. The mean anxiety scores of nurses increased over the examined 18-month period, but still indicated mild anxiety at both time points. Working conditions, interactions between workers, and psychological distress were associated with anxiety. At both measurement points, the nurses who did not receive support from their manager had higher levels of anxiety compared to those who received support. Hospital organizations can take advantage of the results when preparing for new pandemics and producing concrete plans to support nurses’ mental health and coping at work.

Background:Brachial plexus birth injury (BPBI) occurs as a result of a difficult delivery. External rotation (ER) of the shoulder (ER) is usually one of the last movements that may recover. There is no consensus about the predicting factors for spontaneous recovery or the optimal timing for surgical treatment of ER in BPBI patients. The aim of this retrospective study was to describe spontaneous recovery of active ER and evaluate predicting factors for the recovery.Methods:The authors screened 562 patients and identified a consecutive cohort of 103 BPBI patients, who had no active ER at the age of 3 months. The authors systematically collected clinical data on recovery. In addition, the authors assessed whether early recovery of elbow flexion, shoulder abduction, or Narakas grade at 1 month predicts ER recovery.Results:Fifty-two patients (51%) spontaneously recovered ER, 44% of whom recovered by the age of 1 year, 83% by 1.5 years, 92% by 2 years, and 98% by 3 years. A breakpoint in the slope of the curve showing proportion of recovered patients occurred at 2 years of age. Recovery of active ER was significantly associated with early elbow flexion and Narakas grade at 1 month, but not with early active shoulder abduction.Conclusions:Most spontaneous recovery of ER in patients with BPBI occurs until 2 years of age, which thus can be considered a meaningful follow-up period for spontaneous recovery of ER. This information should be considered when making decisions about peripheral nerve transfer surgery to improve ER in BPBI.CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, III.

Objective This study explored the association of childhood-onset epilepsy (COE) with educational attainment, adulthood employment, and income. Methods A population-based cohort of 312 children with COE was identified from Tampere University Hospital, Finland. Population Register Center formed a matched random population sample of 1248 children without COE as a reference cohort. The two cohorts were linked to the Statistics Finland database to obtain information on educational attainment, employment status, and income. Fisher’s exact test was used to compare employment and graduation. Independent samples t-test was used for analyzing graduation grades and the Mann-Whitney test was used for analyzing yearly income. Results were stratified by sex and disability. Results During a follow-up of 25 years, a substantially higher proportion of the patients never entered the workforce, 37 % (109/312) compared with 4 % (44/1248) for the referents without COE (p < 0.001). A two-fold difference was observed for COE patients without other disabilities (7.7 %, 13/169, p = 0.01). No clear difference was found in long-term employment between the COE without disabilities and the referents (67 %, 114/169 versus 74 %, 920/1248, p = 0.087). The patients with COE had worse lower secondary school graduation grade averages (7.36 vs 7.6, p = 0.004) and graduation rates (64 % vs 98 %, p < 0.001), the patients without disabilities had similar results to referents (7.43, p = 0.07, 98 %). Of the patients with COE, 18 % graduated from college compared to 38 % of the referents (p < 0.001). The median income was lower in males and females with COE of all ages compared to the referents. The COE patients without additional mental or physical disabilities had income comparable to the healthy referents. 143 patients (46 %) had additional disabilities. Significance Patients with COE have lower educational attainment, stable employment, and income. Patients without disabilities also have an increased risk of unemployment, but those capable of entering the workforce have stable careers with earnings comparable to the rest of the population.

BACKGROUND:Dietary intake of antioxidants such as vitamins C and E protect against oxidative stress, and may also be associated with altered DNA methylation patterns. METHODS:We meta-analysed epigenome-wide association study (EWAS) results from 11,866 participants across eight population-based cohorts to evaluate the association between self-reported dietary and supplemental intake of vitamins C and E with DNA methylation. EWAS were adjusted for age, sex, BMI, caloric intake, blood cell type proportion, smoking status, alcohol consumption, and technical covariates. Significant results of the meta-analysis were subsequently evaluated in gene set enrichment analysis (GSEA) and expression quantitative trait methylation (eQTM) analysis. RESULTS:In meta-analysis, methylation at 4,656 CpG sites was significantly associated with vitamin C intake at FDR ≤ 0.05. The most significant CpG sites associated with vitamin C (at FDR ≤ 0.01) were enriched for pathways associated with systems development and cell signalling in GSEA, and were associated with downstream expression of genes enriched in the immune response in eQTM analysis. Furthermore, methylation at 160 CpG sites was significantly associated with vitamin E intake at FDR ≤ 0.05, but GSEA and eQTM analysis of the top most significant CpG sites associated with vitamin E did not identify significant enrichment of any biological pathways investigated. CONCLUSIONS:We identified significant associations of many CpG sites with vitamin C and E intake, and our results suggest that vitamin C intake may be associated with systems development and the immune response.

Background/aimsTo assess the frequency of immediate sequential bilateral cataract surgery (ISBCS) and endophthalmitis during 13-year period in Tays Eye Centre, Tampere University Hospital, Tampere, Finland.MethodsAll cataract surgeries performed between 1 January 2008 and 31 December 2020, and all endophthalmitis cases during the same period were searched from electronic patient records. Numbers and frequencies of ISBCS, and complications, including endophthalmitis and vitreous loss, were recorded and compared with unilateral operations.ResultsThe study included 56 700 cataract surgeries in 34 797 patients of whom 39% (n=13 445) had ISBCS. The median age of the patients was 75 (IQR 68–80, range 0.08–99) years at the time of surgery. The proportion of ISBCS patients increased from 4.2% in 2008 to 46% in 2020. Vitreous loss occurred in 480 (0.9%) of cataract surgeries. There were no postoperative endophthalmitis after cataract surgery (n=0) during the 13-year period.ConclusionThe proportion of patients undergoing ISBCS increased from 4.2% in 2008 to 46% in 2020. No endophthalmitis were found to be associated with ISBCS.

Objective: To assess pain relief and overall birth experience in induced vs. spontaneous-onset labours and to clarify variables among induced parturients determining satisfaction and dissatisfaction.Study design: A prospective study of 2042 women. 575 women with induced and 1467 with spontaneous-onset labour answered multiple questions in a questionnaire regarding the experience of birth giving. Satisfaction was numerically assessed via a visual analogue scale (VAS 0-10).Results: Induction of labour (IOL) did not worsen the average experience of pain relief, but the proportion of women dissatisfied with pain relief was slightly higher after IOL compared with spontaneous-onset labour (SOL). IOL was associated with lower satisfaction with overall birth experience compared with SOL (VAS 8.0 vs. 8.4; p < 0.001). Among IOL parturients incorrect timing of pain relief was strongly associated with dissatisfaction with pain relief, as were deficient information and induction with misoprostol. Epidural blockade was the most important factor preventing dissatisfaction with pain relief. Unsatisfactory overall experience of birth was associated with deficient pain relief, its incorrect timing or deficient information, as well as vacuum extraction as the mode of delivery.Conclusions: Induction of labour is a risk factor of dissatisfaction regarding pain relief and overall birth experi-ence. The strongest impact on dissatisfaction among induced parturients concerning pain relief was delayed timing of effective labour analgesia. Poor pain relief, its incorrect timing and deficient information on pain relief were strong predictive factors of dissatisfaction with the overall birth experience.