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Biomedical subjects

T Hakulinen

Publications and source records attributed to T Hakulinen.

At least 109 records · Page 6Linked to original sources
PubMed1994

Survival of breast cancer patients after subsequent term pregnancy: "healthy mother effect".

OBJECTIVE: A population-based matched survival study was conducted to assess the risk of death for breast cancer patients in relation to whether they were delivered of a live born child subsequent to the cancer diagnosis. STUDY DESIGN: Among the 2548 women < 40 years old diagnosed with carcinoma of the breast in 1967 to 1989 in Finland there were 91 eligible patients with subsequent deliveries (> or = 10 months after the diagnosis) for whom 471 controls were matched for stage, age, and year of breast cancer diagnosis. The controls had to have survived at least the interval between the diagnosis and the delivery of their matched counterparts. The follow-up started from the date of the first delivery after the diagnosis or after the corresponding interval for the matched controls. A stratified Cox proportional hazards survival analysis was performed. RESULTS: The controls had a 4.8-fold (95% confidence interval 2.2 to 10.3) risk of death compared with those who were delivered after the diagnosis of breast cancer. CONCLUSION: Our interpretation of this result is a "healthy mother effect" (i.e., that only women who feel healthy give birth and those who are affected by the disease do not). Nevertheless, six of eight deaths among the 91 patients who did give birth were related to breast cancer.

Adult↗
PubMed1994

Statistical modelling and prediction of lung cancer mortality in the Czech and Slovak Republics, 1960-1999.

BACKGROUND: The aim of the study was to analyse the pattern of lung cancer mortality from 1960 to 1989 and to predict lung cancer mortality for 1990-1999 for males and females aged > or = 30 years in the Czech and Slovak Republics. METHOD: The mortality pattern of lung cancer was examined and predicted using republic-age-period-cohort models. RESULTS: Trends in lung cancer mortality were upward for both sexes over the study period. In the early 1960s, lung cancer mortality in Slovak males was much lower than that in Czech males, but since the late 1960s lung cancer mortality in males increased more rapidly in Slovakia than in the Czech Republic. It was predicted that mortality due to lung cancer in Slovak males would exceed that in Czech males during the last 5 years of the 20th century. Slovak female lung cancer mortality was lower than that for Czech females throughout the study period, and the trends in both republics were similar.

Adult↗
PubMed1994

The Helsinki Heart Study: an 8.5-year safety and mortality follow-up.

OBJECTIVES: Earlier monitoring of all symptoms, hospital admissions, cancer diagnoses and causes of death during gemfibrozil treatment had raised some suspicions which called for further follow-up. DESIGN: Close monitoring of selected, potentially adverse events amongst treated subjects after a placebo-controlled trial and comparing occurrences to those in various untreated groups. SETTING: All participants of the Helsinki Heart Study (a controlled, 5-year, multi-clinic coronary heart disease (CHD) primary prevention trial with gemfibrozil and placebo) were offered gemfibrozil treatment and twice yearly follow-up for 3.5 years. Untreated groups in the source population and national cancer statistics were utilized in comparisons. SUBJECTS: Of the 2046 dyslipidaemic men initially randomized to gemfibrozil, 2002 survivors entered the 3.5-year follow-up; of the 2035 initial placebo men, 1992 continued to be monitored. INTERVENTIONS: Gemfibrozil was chosen for the follow-up by 66.3% of the gemfibrozil-treated and 68.5% of the placebo-treated men. MAIN OUTCOME MEASURES: Gastrointestinal symptoms, surgery, strokes, cancer incidence, mortality by cause. RESULTS: Gastrointestinal symptoms remained more common in the original gemfibrozil group. After 8.5 years strokes numbered 32 (gemfibrozil) vs. 37 (placebo), violent deaths 16 vs. 14, and cancers 51 in both groups. Total mortality was equal during the original 5 years, but higher in the gemfibrozil group post-trial, leading to an 8.5 year mortality of 101 vs. placebo 83 (P = 0.19). This was mainly a result of higher cancer mortality in the gemfibrozil (30) than the placebo group (18, P = 0.08). An additional 18-month post-study registry follow-up disclosed 13 placebo and five gemfibrozil cancer deaths, altering the cancer mortality to gemfibrozil 35 vs. placebo 31 at 10 years. CONCLUSIONS: The most plausible explanation for the discrepancy between cancer incidence and cancer-specific mortality, based mainly on comparison with untreated groups, is delayed diagnosis. The increased cancer and total mortality is most probably due to chance, based on the later reversal of trends.

Adult↗
PubMed1994

Tumour markers and screening for gastrointestinal cancer: a follow up study in Finland.

BACKGROUND: Screening for gastrointestinal cancer is based mainly on a barium contrast x ray method and on identification of occult blood in stools. The methods are relatively expensive, not always acceptable to the participants, and there is only limited evidence of their effectiveness in reducing the mortality from gastrointestinal cancer. OBJECTIVE: To investigate the validity of several tumour markers as a screening test for stomach cancer and for colorectal cancer. METHODS: A registry of 36,265 serum samples drawn during 1968-72 was linked to the cancer registry. Follow up was during 1968-80 when 94 stomach cancers and 95 colorectal cancers were identified. One to two matched case-control design was applied, and the concentrations of CEA, CA 19-9, CA 50, and TATI were assessed. RESULTS: The mean values of the markers between the cases and the controls were almost the same for the total material. Case-control differences were found between the 11 sets with an interval of less than one year between drawing the sample and diagnosis of the cancer. The highest validity was found in CEA for colorectal cancer (specificity 91%; sensitivity 64%) and in CA 19-9 for stomach cancer (specificity 74%; sensitivity 73%). CONCLUSION: CEA, CA 19-9, CA 50, or TATI are not valid screening tests. Case-control differences were found with a potential one year screening interval, but they were not large enough for sufficient validity.

Adolescent↗
PubMed1994

Evaluation of the effect on breast cancer mortality of population based mammography screening programmes.

OBJECTIVE: To evaluate, by analysis of breast cancer mortality data from all the 26 Swedish counties for the years 1971 to 1990, whether the effect of the introduction of mammography screening in Sweden can be assessed by observation from existing mortality data. METHODS: A Poisson regression model was used to study whether a decrease in breast cancer mortality among women aged 50-74 years was associated with the extent of mammography screening in different counties and periods. RESULTS: In regions where mammography screening had been introduced, breast cancer mortality tended to be decreased, on average, compared with regions without screening. If a 10 year time lag between the start of screening and its full effect on mortality is assumed then the estimated reduction in breast cancer mortality associated with introduction of screening was 19% with a 95% confidence interval ranging from -3% to 37%. CONCLUSIONS: The results suggest that the effect of mammography screening may be studied using existing routine mortality data and appropriate statistical modelling. This way of assessing the outcome of the screening is valuable when continuously monitoring a screening programme that has become a public health routine.

Age Factors↗
PubMed1994

Drinking water mutagenicity and gastrointestinal and urinary tract cancers: an ecological study in Finland.

OBJECTIVES: The purpose of this study was to investigate the relationship between exposure to mutagenic drinking water and cancers of the gastrointestinal and urinary tract. METHODS: Past exposure to drinking water mutagenicity was assessed in 56 Finnish municipalities for the years 1955 and 1970. The cases of bladder, kidney, stomach, colon, and rectum cancers were derived from two periods (1967 to 1976 and 1977 to 1986). Age, sex, social class, urban living, and time period were taken into account in the Poisson regression analysis. RESULTS: Statistically significant exposure-response association was observed between exposure and incidence of bladder, kidney, and stomach cancers. In an ordinary municipality using chlorinated surface water, this exposure would indicate a relative risk of 1.2 for bladder cancer and of 1.2 to 1.4 for kidney cancer compared with municipalities where nonmutagenic drinking water was consumed. CONCLUSIONS: The acidic mutagenic compounds present in drinking water may play a role in the etiology of kidney and bladder cancers, but, because the results are based on aggregate data, they should be interpreted with caution.

Case-Control Studies↗
PubMed1994

Descriptive epidemiology of cancer around the Baltic Sea.

Baltic Sea countries--Denmark, Estonia, Finland, Germany, Latvia, Lithuania, Poland, the Russian Federation and Sweden--have expressed deep interest in developing collaborative research projects chiefly in descriptive epidemiology of cancer. In order to assess potentials for joint studies, an attempt was undertaken to characterize cancer registration, cancer incidence patterns, temporal trends in cancer mortality and research productivity between these countries. Standards of cancer registration are highest in the Nordic countries (Denmark, Finland, Sweden). These countries and Germany are also doing more productive research. Great differences in incidence and in mortality trends around the Baltic Sea offer promising opportunities for epidemiologic studies. Scarcity of well-trained professional epidemiologists and other resources in Latvia, Lithuania, Estonia and the Russian Federation is the main factor limiting the planning of joint large-scale epidemiologic studies of cancer.

Adolescent↗
PubMed1994

Thyroid cancer after radiotherapy for skin hemangioma in infancy.

A Swedish cohort of 14,351 infants exposed to ionizing radiation for skin hemangioma was analyzed with respect to thyroid cancer risk. The subjects were irradiated during the period 1920-1959 and radiotherapy was given with beta particles, gamma rays and/or X rays. The mean absorbed dose to the thyroid was 0.26 Gy (range < 0.01-28.5 Gy). The cohort was matched with the Swedish Cancer Register for the period 1958-1986. Seventeen thyroid cancers were registered (standardized incidence ratio = 2.28; 95% confidence interval 1.33-3.65), and the mean thyroid absorbed dose in those subjects was 1.07 Gy (range < 0.01-4.34 Gy). The effect of different variables on the incidence of thyroid cancer was evaluated with Poisson regression. The excess in thyroid cancer began 19 years after radiotherapy and persisted at least 40 years after irradiation. A statistically significant dose-response relationship was found. The excess relative risk per gray was 4.92 (95% CI 1.26-10.2) and the excess absolute risk was 0.90 x 10(-4) per person-year gray. No significant difference in excess relative or absolute risk could be seen between the sexes.

Female↗
PubMed1994

[Analysis of the concept of family nursing. Family systems nursing and family-centered nursing as closely related concepts].

The article analyses the concept of family nursing, which is defined and described by reference to its key characteristics (e.g. Rodgers 1989, Meleis 1991). Other, closely related and to some extent even substitutable concepts identified in the article are family systems nursing and family-centered nursing. The broad area of family therapy is excluded from the discussion since the purpose is to concentrate on the nursing of healthy families. Family nursing is defined in three different ways depending on the place and the role of the family on practical nursing: family as a context, as a sum of its parts and as a client. Concept of family-centered nursing is included in these three levels, but also levels minimal emphasis on family and family therapy, which are not included in the concept of family nursing. However, it is concluded that the two concepts can be regarded as closely related. Family systems nursing can be regarded either as one sub-concept to family nursing and family-centered nursing or as a kindred concept. It is suggested that a serious debate should be started in Finland on these concepts and that research should be undertaken in different nursing situations to find out how these concepts occur in reality.

Family↗
PubMed1994

[Mutuality as the central dimension of family dynamics].

Mutuality is the central dimension of family dynamics. This study of family dynamics in Finland forms part of an international comparative family dynamics project. The aim of the study was to describe the family dynamics of childbearing and childrearing families using the six dimensions of Barnhill's model of Healthy Family Systems. In addition to this changes in family dynamics after the childbirth were studied. In this article results of the dimension of mutuality are reported. The sample consisted of families expecting (n = 118) and rearing (n = 94) their first or second child in Finland. The data were collected by questionnaires, using the Family Dynamics Questionnaire and Family Dynamics Measure of 62 Likert-type items developed in U.S. (Lasky et al 1985). In generally childbearing and childrearing families were healthy and well-functioning. However, unmarried couples, fathers and families expecting and rearing their second child seemed to be vulnerable and therefore they need more support in adapting to the normal stages of development.

Adult↗
PubMed1993

Cancer incidence in Estonian migrants to Sweden.

Cancer incidence in Estonians who took refuge in Sweden in 1944-1945 has been compared with that in the total Swedish population and that among Estonians in Estonia in 1974-1985 using data from the Swedish and the Estonian countrywide population-based cancer registries. The vast majority of the Estonian immigrants studied had been living in Sweden for 30 years when the follow-up with respect to cancer incidence started in this investigation. In spite of the long residence in Sweden, differences in cancer incidence could be observed between these immigrants and the total Swedish population. The age-standardized incidence of stomach cancer was higher in the Estonian migrants than in the total Swedish population (SIR = 1.6 and 2.1 for males and females, respectively). Breast cancer incidence was lower in the migrant women (SIR = 0.75) and lung cancer incidence higher in migrant men (SIR = 1.5). An increased incidence of colorectal cancer was also found for both sexes in the migrant population (SIR = 1.4 for both males and females). A comparison between Estonians in Estonia and the total Swedish population revealed that the cancer incidence for the Estonians was lower than expected at age 70 and over. Male lung cancer and stomach cancer showed a higher incidence in the Estonian population than in the Swedish and in the migrant populations. The migrant population showed an intermediate incidence relative to Estonians in Estonia and the entire Swedish population. The colon-cancer risk in Estonian migrants to Sweden was higher than the risk for Estonians in Estonia and for the Swedish population. This contrasts with most findings in the present and other studies on intermediate risks of migrants compared to the risks in the country of origin and in the new country of residence.

Adult↗
PubMed1993

Malignant lymphomas and leukemias, and exposures in the wood industry: an industry-based case-referent study.

Jobs and exposures in woodwork may entail an elevated risk of lymphomas and leukemias. Exposures occurring in woodwork were scrutinized in a small industry-based case-referent study of four cases of Hodgkin's disease, eight cases of non-Hodgkin's lymphoma, 12 cases of leukemia, and 152 matched referents, all from the Finnish wood industry. Past exposures to wood dust, chlorophenols, terpenes, and engine exhaust, individually reconstructed through plant- and period-specific job exposure matrices, were unrelated to lymphoma/leukemia risk. Exposures to various solvents were associated with an odds ratio (OR) of 5.6 (95% confidence interval 1.0-32.0). The OR for formaldehyde was 2.5 (nonsignificant). The results are interpreted as providing limited evidence of the role of exposure to some as yet unidentified organic solvents in increasing the risk of malignant lymphomas. Formaldehyde may be another woodwork-related risk factor for some lymphomas, but the power of the study was too low for empirical confirmation of this possibility. Leukemias did not seem to be associated with any of the exposures studied.

Air Pollutants, Occupational↗
PubMed1993

Survival rates in lung cancer patients with and without bronchial asthma.

Bronchial asthma itself or the treatment of asthma may modify the immunological response to cancer. The survival of lung cancer patients with a preceding diagnosis of bronchial asthma was compared with that of non-asthmatic lung cancer patients in Finland during 1970-1989. This was accomplished by linking two nation-wide data registers, the medication reimbursement register and the cancer registry. For 921 out of the 926 asthmatic patients with lung cancer diagnosed after the diagnosis of bronchial asthma, a non-asthmatic referent patient, matching with respect to sex, anatomical site, and histological type of tumour, as well as to age and year of lung cancer diagnosis, was successfully found in the files of the Cancer Registry. Another referent group was formed by using the stage of lung cancer at diagnosis as an extra matching criterion; this search was successful for 895 asthmatic lung cancer patients. The corrected 5-year survival rate of asthmatic lung cancer patients was 8.4% and that of the referent patients, not matched for stage, 9.6%. When stage was included as matching criterion the corresponding rates were 8.5% and 8.1% respectively. None of these differences were significant. The prognosis of asthmatic and non-asthmatic lung cancer patients thus seemed to be similar.

Asthma↗
PubMed1993

[Family dynamics of mothers and fathers expecting their first or second child].

This study forms part of the international family dynamics project. The study was carried out in two stages. In stage one the aim was to determine how expectant mothers and fathers view the family's activity on six bipolar dimensions (Barnhill 1979). Family dynamics was studied during the third trimester of pregnancy with both mothers (118) and fathers (118) participating in the study (N = 236). The data were collected by questionnaires, using the Family Dynamics Measure. Most parents (86%) reported that their family functioning was either very good or quite good. Married parents reported more stability, flexibility and clearer communication than cohabiting parents did. Mothers reported more flexibility, mutuality and clearer communication than fathers did. Families expecting their first child found more mutuality, role reciprocity and clearer communication than did families expecting their second child.

Adolescent↗
PubMed1993

[Cancer registry and data security].

Population-based cancer registration has existed in the five Nordic countries for 35-50 years. With the exception of Sweden, the Nordic cancer registries not only collect figures of annual incidence, but also serve as institutes for cancer statistics and epidemiological research. The article gives an account of the scope of research based on cancer registries in the Nordic countries, as illustrated by examples from Finland.

Computer Security↗