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Biomedical subjects

M Linna

Publications and source records attributed to M Linna.

At least 19 recordsLinked to original sources
PubMed2004

Cost-benefit analysis of Helicobacter pylori screening.

BACKGROUND: Helicobacter pylori screening may markedly reduce mortality and morbidity in the decades ahead. AIMS: This study explores the costs and benefits of population-based H. pylori screening in terms of health care cost taking into account all relevant H. pylori-related diseases. MATERIAL AND METHODS: The computer-based decision analysis compared two strategies: (1) screen for H. pylori and treat those individuals who test positive, and (2) do not screen for H. pylori, and test and treat H. pylori only if related clinical symptoms appear. The model estimated the discounted H. pylori-related accumulative health care costs from screening age to death in both strategies. The baseline case estimates cost-benefit for screenees aged 15-45 years. The main outcome measure is the incremental health care cost per case in the screening compared with the no-screening alternative. The probability estimates were obtained from the Finnish Vammala H. pylori screen and treat project, including 5288 subjects in the years 1996-1998, published studies, national statistics and hospitals' internal accounts. RESULTS: The incremental cost per case was 26 US dollars in the screening compared with the no-screening alternative. It was lowest in the group aged 45 years, where H. pylori screening showed cost savings per case. CONCLUSIONS: H. pylori screening is more favourable in the older age cohorts. The estimated cost per screenee can be considered to be very acceptable if the current pathophysiological evidence on the potential effects of H. pylori eradication are confirmed in the future. However, there is uncertainty about the possible negative effect of eradicating H. pylori infection on gastro-esophageal reflux disease and esophageal adenocarcinoma. This could change the balance of benefits against risks of eradicating H. pylori infection.

Adolescent↗
PubMed2003

Perception of melting and flavor release of ice cream containing different types and contents of fat.

Temporal effects of dairy and vegetable fats (0 to 18%) on perception of strawberry flavor release and melting of ice cream were studied using the time intensity sensory method. Also, aroma and flavor attributes of the ice cream samples were evaluated. Only slight effects of fat on the rate of flavor release and flavor intensity were perceived. A slightly faster flavor release from the vegetable fat compared with dairy fat was noticed. Polydextrose and maltodextrin as bodying agents in the fat-free ice cream significantly increased flavor release and melting rate of the ice cream. Increasing fat content slightly retarded melting of ice cream in the mouth. No significant effect of the fat quality on perceived melting was noticed. Significant differences in aroma and flavor attributes of the fat-free and other samples were perceived. Intensity and sharpness of the strawberry aroma and flavor were greater in fat-free samples and they were perceived as nontypical. Fattiness and creaminess were highly correlated. Maltodextrin and polydextrose increased perceived fattiness and creaminess of fat-free ice cream.

Adult↗
PubMed2001

Measuring efficiency of long-term care units in Finland.

Data Envelopment Analysis (DEA) was used to measure the nursing care efficiency of 64 long-term care units in Finland. New approaches introduced for evaluating efficiency were unit/ward level analysis, and the case-mix classification Resource Utilization Groups (RUG-III). Efficiency determinations were based on four DEA measures: cost, technical, allocative, and scale efficiency. The results indicated considerable variation in efficiency between units, suggesting that efficiency could be improved through better management and allocation of resources. Larger units seemingly operated more efficiently than smaller units. Allocative inefficiency resulted from using too many registered nurses and aides, and too few licensed practical nurses.

Cost-Benefit Analysis↗
PubMed2001

Oral symptoms at menopause--the role of hormone replacement therapy.

OBJECTIVE: A questionnaire was used to investigate the prevalence of self-assessed sensations of painful mouth (PM) and dry mouth (DM) in menopause-aged women. Special attention was paid to the association of the use of hormone replacement therapy (HRT) with oral symptoms. Our hypothesis was that women using HRT have fewer oral symptoms than those who do not use HRT. STUDY DESIGN: Patients were selected from among 50- to 58-year-old women attending a communal mammography screening program in Helsinki, Finland. Every fifth woman was offered a structured questionnaire. RESULTS: Completed questionnaires were received from 3173 women (response rate, 65%). Of the total sample, 46.8% (n = 1486) used HRT. The occurrence of PM was 8.2% (n = 259) and DM, 19.9% (n = 631). Climacteric symptoms were reported by 24% (n = 761) of the total sample and by 19.2% (n = 285) of the HRT users. According to logistic regression analyses, climacteric symptoms were found to be predictive of PM (P =.000) and DM (P =.000). The use of HRT also increased the occurrence of PM (P =.03). However, as a single covariate in our statistical model, the use of HRT was not a predictor of PM. The use of HRT also did not correlate with the occurrence of DM. CONCLUSIONS: The occurrence of PM and of DM seemed to be associated with climacteric symptoms in general, and the use of HRT did not prevent the oral symptoms studied.

Age Factors↗
PubMed2000

Health care financing reform and the productivity change in Finnish hospitals.

The purpose of this study was to analyze productivity and efficiency changes in the production of hospital care in Finland during the period 1988-1994. A special interest was directed to years 1993-1994 because of health care financing reform that took place in 1993. The analysis is based on the Malmquist index approach using linear programming. Positive productivity changes were found particularly towards the end of the observation period, although a few years did not show significant improvements in productivity and efficiency. There was a significantly higher rate of productivity change in 1992-1993 and 1993-1994, suggesting that the state subsidy reform in 1993 may have strengthened hospitals' efforts to improve performance.

Diagnosis-Related Groups↗
PubMed1998

An econometric study of costs of teaching and research in Finnish hospitals.

In this study we used stochastic frontier cost functions to estimate the teaching and research costs of Finnish hospitals. Average and marginal cost estimates were used to evaluate the current reimbursement system as well as to calculate the total expenditure on teaching and research in hospitals. The efficiency adjustment had significant impact on the marginal and average cost estimates of the teaching and research output. The main policy implication of this study is that university teaching hospitals are able to produce both teaching and research output at significantly lower marginal and average incremental costs than other hospitals. According to our results 55% of the total state reimbursement budget for teaching and research (FIM 665 million) should be allocated to teaching and 45% to research.

Education, Medical, Graduate↗
PubMed1998

Measuring hospital cost efficiency with panel data models.

This paper investigated the development of hospital cost efficiency and productivity in Finland in 1988-1994 using a comparative application of parametric and non-parametric panel models. Stochastic cost frontier models with a time-varying inefficiency component were used as parametric methods. As non-parametric methods various DEA models were employed to calculate efficiency scores and the Malmquist productivity index. The results revealed a 3-5% annual average increase in productivity, half of which was due to improvement in cost efficiency and half due to technological change. The results by parametric and non-parametric methods compared well with respect to individual efficiency scores, time-varying efficiency and technological change. The state subsidy reform of 1993 did not seem to have any observable effects on the hospital efficiency.

Cohort Studies↗
PubMed1998

User charges and the demand for acute paediatric traumatology services.

The city of Helsinki in 1991 introduced moderate patient charges for certain acute paediatric services. This provided the framework for a natural, partially controlled experiment on price elasticity of demand for acute paediatric trauma services. A cross-sectional time-series analysis of a partially controlled natural experiment was done for the period 1989-1994. The findings suggest that moderate user charges may reduce the demand for paediatric trauma services measurably. The effect was diagnosis-specific and, on average, stronger in older than in pre-school children. It probably had a negligible impact on long-term health.

Adolescent↗
PubMed1998

Impact of user charges and socio-economic environment on visits to paediatric trauma unit in Finland.

In this report we (i) measure the strength of the association between paediatric trauma visit rates and regional socioeconomic and demographic variables, and (ii) quantify any selective impact of user charges on service demand in socioeconomically and demographically different areas. During the period 1989-94, a total of 30,362 home and leisure injury visits were made to the Aurora City Hospital. The visit rates are analysed using a random effects model. In addition, the areas are ranked into three groups in accordance with a socioeconomic index measure, and the annual visit rates of the three groups are calculated. We found fairly minor differences in children's visit rates between unequal socioeconomic areas, and it is apparent that socioeconomic status cannot explain the change in visit rates as a result of the introduction of user charges. We speculate that these changes in emergency visit rates will not lead to long-term health problems among any segment of the city population.

Adolescent↗
PubMed1998

The socio-economic and demographic context of children's emergency injury visits in Helsinki in 1991-1994.

The aim is to study the association between age- and diagnosis-specific trauma visit rates and socio-economic and demographic variables in the city of Helsinki, Finland. A total of 19,772 home and leisure injury visits were analysed by random effects (REM) and Poisson regression models. Visit rates were calculated for age- and diagnosis-specific groups for each of the city's 33 health districts using the corresponding age-specific census data. In addition, the areas were ranked into three groups according to a socio-economic index measure. The annual visit rates of the three groups were calculated and the effect of distance on visit rates by socio-economic groups was analysed. In the case of pre-school children no correlation was found between explanatory variables and trauma visit rates. In the school-aged children group distance from the hospital (p < 0.001) correlated with childhood ambulatory visit rates. We found a rather modest difference in children's visit rates between unequal socio-economic areas. However, the demand for care was elastic for travelling distance (p < 0.05) in poorer suburbs but not in more affluent areas in the case of school-aged children. The probability of significant inequalities in children's trauma visit rates was small in Helsinki during 1991-94.

Adolescent↗
PubMed1997

PROGNOSTICATION OF BREAST CANCER BY MULTIVARIATE METHODS.

Three multivariate prognostic models based on Cox's regression were tested in terms of how they predicted prognosis in a material of 134 patients with breast cancer. The multivariate models all incorporated tumor size, mitotic activity index (MAI), and axillary lymph node status in their formulas, and were originally produced through studies on different patient materials. The predictive behavior of MAI was also tested separately in the same material. The multivariate models gave roughly parallel predicted percentages of survival at two years (CV=5.2%), but showed clearly greater variation later (12.3% and 24.4% at 5 and 9 years, respectively). The results were more uniform between the multivariate models, than between the prediction by MAI and the multivariate models. The variation between repeated estimates was smaller within multivariate models than within the estimation of one of their components (MAI). We found the use of the multivariate models easy. However, traditional hospital practice does not necessarily favor the use of multivariate models, although they seem to group patients more reliably than single prognostic features.

Journal Article↗
PubMed1989

Carvedilol and atenolol once daily in the treatment of hypertension.

Fifty milligrams of carvedilol and 100 mg atenolol were administered in a random order once a day for 2 months to 43 patients with mild to moderate hypertension, in a double-blind crossover study. Blood pressure, heart rate and peripheral blood flow parameters (n = 11) were recorded 2 and 24 h after the drug administration. Supine blood pressure was the same 2 h after both carvedilol and atenolol administration, but carvedilol caused a greater decrease in standing systolic blood pressure 2 h after the administration (P less than 0.05). The heart rate decreased less with carvedilol (P less than 0.01). There was no difference in the effects exerted by the two therapies on systolic blood pressure and the heart rate 24 h after drug administration, but the diastolic blood pressure was higher in patients given carvedilol (92 versus 88 mmHg; P less than 0.05). Forearm blood flow, forearm vascular resistance and calf blood flow did not change significantly with either of the therapies. In conclusion, 50 mg carvedilol once a day is an effective antihypertensive therapy, though its duration of action did not reach that of 100 mg atenolol once a day. Peripheral vasodilation was similar with both therapies.

Adrenergic beta-Antagonists↗
PubMed1985

Subrenal capsule assay in human breast cancer. Response to cytostatic drug combinations and correlation with receptor status.

The subrenal capsule assay (SRCA) was used to study the sensitivity of breast cancer to cytostatic drug combinations. The results were compared with steroid receptor status. Forty-five of 46 SRCAs (98%) were macroscopically evaluable. However, a histological study implied that the transplants should also be evaluated histologically, because in only 14/21 (67%) of the control SRCAs examined were histologically viable tumor cells seen. An inflammatory cell reaction was noticed in half of the cases. In the groups treated with cytostatics only 3/21 (14%) had vital tumor cells, whereas inflammation was evident in 4/21 (19%) of the cases. The rate of resistance to A + CTX was 30%. By testing several drug combinations against each tumor the rate of chemoresistance was reduced to 10%. The differences between A + CTX and the best combination were statistically significant (P less than 0.05). Of the tumors 79% were ER-positive and 67% PR-positive. Receptor-negative tumors tended to be more sensitive to cytostatics than receptor-positive tumors (100 vs 85%). The difference was not, however, statistically significant. It can be concluded that the SRCA under standardized conditions is a good method for studying the response of individual breast cancers to chemotherapy.

Adult↗
PubMed1981

Treatment results in mammary carcinoma stages I-IV.

A retrospective review of 590 patients with breast carcinoma of all clinical stages is presented. The patients were treated mainly with radical mastectomy and postoperative irradiation. The overall 5- and 10-year survival rates were 59% and 45%, in stage I 83% and 76%, in stage II 64% and 47%, in stage III 29% and 14% and in stage IV 5% and 0%, respectively. Treatment methods, prognostic factors and differentiation grade of infiltrating ductogenic carcinoma have been analysed and the effect of these factors on the treatment results in different clinical stages is presented.

Adult↗
PubMed1979

Abdominal gynaecological emergencies in the surgical unit.

We have studied two types of emergency cases that occurred in the surgical unit who were found to have gynaecological aetiology: 1) patients with the so-called "morbus acutum dexter", i.e. appendicitis, or a gynaecological disease and 2) late complications in patients who had earlier benign gynaecological disease, usually such as tumour and surgery for it. The material with seven years follow-up consisted of 97 patients, who were treated during the periods 1959--60 and 1969--70. The relative numbers in both groups increased during the latter period. Of the patients in the reproductive age with suspected appendicitis, gynaecological diseases--mostly ovarian tumours with complications--constituted 7.6% of patients who had undergone appendicectomy in the surgical unit during the former period and 9.6% during the latter. The late complications consisted mainly of small bowel obstruction, resulting from adhesions caused by previous gynaecological surgery. The time interval between initial surgery and the obstruction was rather long, 3.5 years on the average. In the surgical unit the surgery was carried out in about two thirds of these patients. Our analysis demonstrates the necessity of recognizing cases with gynaecological aetiology as a significant factor in surgical practice; it has to be taken into consideration both in surgical and gynaecological education.

Abdomen, Acute↗