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T Klaukka

Publications and source records attributed to T Klaukka.

At least 19 recordsLinked to original sources
PubMed2006

Utilisation of antihyperglycaemic drugs in ten European countries: different developments and different levels.

AIMS/HYPOTHESIS: The aim of this study was to compare developments in the utilisation of antihyperglycaemic drugs (AHGDs) in ten European countries. SUBJECTS AND METHODS: Data on the yearly utilisation of insulin and oral AHGDs were collected from public registers in Denmark, Finland, Norway, Sweden, Belgium, England, Germany, Italy, Portugal and Spain, and were expressed as defined daily doses per 1,000 inhabitants per day. RESULTS: Total AGHD utilisation increased everywhere, but at different rates and levels. Insulin utilisation doubled in England and Germany, but hardly changed in Belgium, Portugal or Italy. Sulfonylurea utilisation doubled in Spain, England and Denmark but was reduced in Germany and Sweden. Metformin utilisation increased greatly everywhere. There were two- to three-fold differences in AHGD utilisation even between neighbouring countries. In Finland, there were more users of both insulin (+120%) and oral AHGDs (+80%) than in Denmark, and the daily oral AHGD doses were higher. In Denmark and Sweden, AHGD utilisation was equal in subjects aged <45 years, but in those >or=45 years of age, both insulin and oral AHGD utilisation were twice as high in Sweden. CONCLUSIONS/INTERPRETATION: The ubiquitous increase in AHGD utilisation, particularly metformin, seems logical, considering the increasing prevalence of type 2 diabetes and the results of the UK Prospective Diabetes Study. However, the large differences even between neighbouring countries are more difficult to explain, and suggest different habits and attitudes in terms of screening and management of type 2 diabetes.

Adolescent↗
PubMed2006

A 10 year asthma programme in Finland: major change for the better.

BACKGROUND: A National Asthma Programme was undertaken in Finland from 1994 to 2004 to improve asthma care and prevent an increase in costs. The main goal was to lessen the burden of asthma to individuals and society. METHODS: The action programme focused on implementation of new knowledge, especially for primary care. The main premise underpinning the campaign was that asthma is an inflammatory disease and requires anti-inflammatory treatment from the outset. The key for implementation was an effective network of asthma-responsible professionals and development of a post hoc evaluation strategy. In 1997 Finnish pharmacies were included in the Pharmacy Programme and in 2002 a Childhood Asthma mini-Programme was launched. RESULTS: The incidence of asthma is still increasing, but the burden of asthma has decreased considerably. The number of hospital days has fallen by 54% from 110 000 in 1993 to 51 000 in 2003, 69% in relation to the number of asthmatics (n = 135 363 and 207 757, respectively), with the trend still downwards. In 1993, 7212 patients of working age (9% of 80 133 asthmatics) received a disability pension from the Social Insurance Institution compared with 1741 in 2003 (1.5% of 116 067 asthmatics). The absolute decrease was 76%, and 83% in relation to the number of asthmatics. The increase in the cost of asthma (compensation for disability, drugs, hospital care, and outpatient doctor visits) ended: in 1993 the costs were 218 million euro which had fallen to 213.5 million euro in 2003. Costs per patient per year have decreased 36% (from 1611 euro to 1031 euro). CONCLUSION: It is possible to reduce the morbidity of asthma and its impact on individuals as well as on society. Improvements would have taken place without the programme, but not of this magnitude.

Adult↗
PubMed2005

Use of antimicrobials and risk of type 1 diabetes in a population-based mother-child cohort.

AIMS/HYPOTHESIS: The aim of this study was to investigate whether the use of antimicrobials is associated with the risk of childhood type 1 diabetes. MATERIALS AND METHODS: The study population included all children born in Finland between 1996 and 2000 who were diagnosed with type 1 diabetes by the end of 2002. For each case (n=437), four matched controls were selected. Data on diabetes and the maternal use of antimicrobials was derived from nationwide registries. RESULTS: Maternal use of phenoxymethyl penicillins (odds ratio [OR]=1.70, 95% CI 1.08-2.68, p=0.022) or quinolone antimicrobials (OR=2.43, 95% CI 1.16-5.10, p=0.019) before pregnancy was associated with an increased risk of type 1 diabetes in the child, whereas the use of other specific antimicrobials was not related to the risk. The risk was also higher among mother-child pairs where macrolides were used both by the mother before pregnancy and by the child, compared with pairs where neither used macrolides (OR=1.76, 95% CI 1.05-2.94, p=0.032). Maternal use of antimicrobials during pregnancy was not associated with an increased risk. The high use of antimicrobials by the child (more than seven vs seven or less purchases) was related to greater risk (OR=1.66, 95% CI 1.24-2.24, p=0.001). CONCLUSIONS/INTERPRETATION: Overall, the use of antimicrobials before pregnancy, during pregnancy or during childhood was not related to the risk of childhood type 1 diabetes. However, the use of some specific antimicrobials by the mother before pregnancy and by the child may be associated with an increased risk. Further studies are needed to confirm these associations and to elucidate the underlying mechanisms of action.

Adult↗
PubMed2005

Adoption of celecoxib and rofecoxib: a nationwide database study.

BACKGROUND AND OBJECTIVE: Cyclooxygenase 2-selective non-steroidal anti-inflammatory drugs (NSAIDs, coxibs) are recommended primarily for patients at high risk of gastrointestinal bleeding, most of them being elderly. Our objective was to describe and analyse patient- and physician-related factors affecting the adoption of celecoxib and rofecoxib 2 years after their launch in Finland. METHODS: Retrospective analysis of the nationwide Prescription Register. Physicians who had issued at least 200 reimbursed prescriptions in 2002 (n = 12 033, 80% of working-age Finnish physicians) were involved in the analysis. RESULTS AND DISCUSSION: Excluding patients with rheumatoid arthritis (RA), almost one-fifth (18%) of NSAIDs prescriptions were for coxibs. In patients with RA the share was 25%. The share of coxib prescriptions of all NSAIDs increased with age of the patient. Over one half (58%) of coxib prescriptions were issued for patients under 65 years of age. Specialists in physical and rehabilitation medicine were the fastest adopters of coxibs: one-third of their NSAID prescriptions in 2002 were for coxibs. Primary care physicians were the most conservative both in adopting and favouring coxibs. CONCLUSIONS: Coxibs have gained the status of standard prescription NSAIDs within a few years. Their use should be restricted to patients who could benefit most from the use. Routine prescribing of expensive new drugs increases the drug bill without additional health gain.

Age Factors↗
PubMed2004

Do inhaled steroids differ from cromones in terms of hospital admission rates for asthma in children?

AIM: The aim of the present study was to investigate the characteristics of hospital admissions in two child populations receiving different types of drugs as their regular medication for steady-state asthma. METHODS: Annual data on children aged under 16 y treated for asthma, including consumption of regular medication for asthma, numbers of hospital periods, lengths of hospitalizations and annual proportions of readmissions, were collected using patient-specific medical records from 1995 to 1999. In the Kuopio province, on average, 35.6-36.7/1000 children were on maintenance for asthma, of which 23% were receiving cromones, 51% were taking inhaled steroids and 26% were treated with cromones plus intermittent steroids. In the Oulu province, the respective prevalence was 32.7-34.9/1000, and the respective proportions were 5%, 93% and 2%. RESULTS: Total and first admissions, as well as hospital days were clearly less in the Oulu province. In the children aged > or = 6y, the average annual total admissions were 0.3/1000 (Oulu) vs 1.2/1000 (Kuopio) (p < 0.001). Similarly, the first admissions were 0.2/1000 vs 1.0/1000 (p < 0.001), proportions of readmissions 6.3% vs 19.3% (p < 0.05), and numbers of hospital days 0.7/1000 vs 3.8/1000 (p < 0.001). The differences were in the same direction, though less prominent, also among children 2-5 y of age. CONCLUSION: Our results suggest that inhaled steroids are better than cromones in preventing admissions for asthma when two provinces with different practices for maintenance medication of steady-state asthma were compared.

Administration, Inhalation↗
PubMed2003

The IL1A genotype is associated with nasal polyposis in asthmatic adults.

BACKGROUND: Nasal polyposis (NP) is a chronic inflammatory disease often found coexisting with asthma. As this disorder tends to cluster in families, a genetic predisposition has been suggested. Interleukin-1 (IL-1) has been proposed to play a role in the pathogenesis of NP. METHODS: We analysed the single G-to-T base exchange polymorphism in exon 5 at +4845 of the gene encoding IL-1alpha (IL1A) and the C-to-T base exchange polymorphism at -511 of the gene encoding IL-1beta (IL1B) in a population-based sample of adult asthma patients (n = 245). The data were assessed for correlation with data on history of NP and other phenotype-related characteristics. RESULTS: The prevalence of NP in our study group was 14.3%. The distribution of the IL1A genotype differed significantly between asthmatics with and without NP (P = 0.005). The risk of NP was markedly increased in allele G homozygous subjects (OR = 2.73; 95%CI = 1.40-5.32). In the case of IL1B we found no significant associations. Asthmatics with NP had more symptoms than others, but lung function and blood eosinophil counts were similar. CONCLUSIONS: Our study demonstrates an association of IL1A with NP inasthmatic patients and addresses the role of IL-1alpha as an inflammatory modulator in the pathogenesis of this disease.

Asthma↗
PubMed2003

Interleukin-10 gene promoter region polymorphism is associated with eosinophil count and circulating immunoglobulin E in adult asthma.

BACKGROUND: IL-10 has several functional effects relevant to asthma. It can modulate IgE production and induce apoptosis in eosinophils. Polymorphisms of IL-10 gene have been shown to affect IL-10 production. OBJECTIVE: To establish whether IL-10 polymorphisms are associated with asthma and phenotype-related characteristics. METHODS: The frequency of three single base exchange polymorphisms (at positions - 1082, - 819 and - 592) and corresponding haplotypes of the IL-10 gene were analysed in 245 adult asthmatic subjects and 405 controls using PCR and restriction fragment length polymorphism (RFLP). The data were assessed for correlations with the eosinophil count, serum IgE and lung function. RESULTS: The IL-10 haplotype frequencies were similar in asthmatics and controls. Eosinophil count median was 2.0- to 3.2-fold higher among asthmatics with rare ATA/ATA genotype than in asthmatics with other genotypes. No such difference was seen in the control group. When analysed by IL-10 haplotype carrier state and gender, male asthmatics with ATA haplotype had 2.8-fold higher serum IgE than those without ATA. A converse association was found in male controls with ATA haplotype, who had 1.9-fold lower serum IgE than their ATA-negative counterparts. The high IL-10-producing GCC haplotype was associated with impaired lung function in smoking male controls while in asthmatics no clear effect on lung function was found with any of the haplotypes studied. CONCLUSION: These results suggest that the eosinophil counts and serum IgE are differently regulated by IL-10 genotype in asthmatic and in normal subjects. However, IL-10 polymorphism is not related to susceptibility in asthma.

Aged↗
PubMed2003

Prevalence of work-aggravated symptoms in clinically established asthma.

This population-based cross-sectional survey assessed the prevalence of work-aggravated asthma symptoms and the effect of the work environment on the aggravation of symptoms of established asthma. A questionnaire was sent to 2,613 persons (aged 20-65 yrs) with asthma. The analyses were restricted to the 969 respondents who were currently employed. The effect of occupational exposure on the aggravation of asthma symptoms at work was assessed according to both self-reported and expert-evaluated exposure. Approximately 21% of the respondents reported work-aggravated asthma symptoms at least weekly during the past month. The prevalence of those with work-aggravated symptoms increased by age, self-reported occupational exposure to dusts, abnormal temperatures or poor indoor air quality, physically strenuous work, and chemicals, and expert-evaluated probability of daily occupational exposure to airborne dusts, gases or fumes. Aggravation of asthma symptoms at work is common among employed adults with asthma. Both self-reported and expert-evaluated exposure to dusts, abnormal temperatures or poor indoor air quality, physically strenuous work, and chemicals explained the significant worsening of symptoms. The findings suggest a marked role of the work environment in the aggravation of symptoms of established asthma.

Adult↗
PubMed2003

The asthma programme of Finland: an evaluation survey in primary health care.

OBJECTIVE: To evaluate the basic structures and processes of asthma care 6 years after the launch of the Finnish Asthma Programme. The evaluation will serve as the baseline for the implementation of the evidence-based guidelines for asthma published in 2000. DESIGN: A descriptive type-2 evaluation (managerial monitoring of a policy implementation), based on operationalised statements of the Asthma Programme. RESULTS: A co-ordinating doctor for asthma, usually a general practitioner (GP), was interviewed in 248 (91%) health centres; 83% of the health centres have at least one GP nominated as the local asthma co-ordinator and 94% have a nurse. Asthma education for the professionals had been organised in 71% of the health centres in the previous 2 years. First-line treatment consists of an inhaled corticosteroid. Guided self-management is used in 98% of the health centres, but its components were not clear to the doctors. CONCLUSION: The basic structure of equipment and organisation for the diagnosis and treatment of asthma has been set up in the primary health care services.

Asthma↗
PubMed2002

Psychotropics among the home-dwelling elderly--increasing trends.

OBJECTIVE: To assess the level of and changes in the use of psychotropics among the home-dwelling elderly in the 1990s. METHODS: A descriptive analysis based on data from two cross-sectional interview and health examination surveys of elderly persons aged 64 years or over conducted in Lieto, a typical semi-rural Finnish municipality, in 1990-91 and 1998-99. National prescription data were utilized to compare the use of psychotropics in the late 1990s by all Finnish home-dwelling elderly and the elderly in Lieto. In Lieto drug information was obtained from 1131 persons in 1990-91 and from 1197 in 1998-99, and the mean age of the informants was 73 years in both surveys. The brand names of the prescription drugs (both irregular and regular medication) taken by each interviewee during seven days prior to the interview were recorded and categorized by the Anatomical Therapeutic Chemical (ATC) classification system. RESULTS: Every fourth person was taking at least one psychotropic drug in both surveys. Most users were on regular psychotropic medication. The use of hypnotics and antidepressants increased most during the study period. Polypharmacy and the use of psychotropics were most prevalent among those aged 85 years or over, with women predominating. Concomitant use of two or more psychotropics increased statistically significantly from 7% to 10% between the surveys. The young elderly, aged 64-71 years, used cyclic antidepressants equally commonly in both surveys. None of the young elderly used new atypical antipsychotics in 1998-99. CONCLUSIONS: Psychotropics tend to be overprescribed and overused among the elderly, a group at the highest risk of adverse drug reactions. The tendency of prescribing for the elderly is not going in a better direction. New-generation psychotropics were not used. The need for long-standing use of psychotropics should be assessed regularly.

Aged↗
PubMed2002

Excess incidence of asthma among Finnish cleaners employed in different industries.

The incidence and risk of asthma among female cleaners employed in different industries was explored. An increased risk of asthma has been associated with the cleaning profession, in some but not all studies. All Finnish females employed as cleaners and all those employed in administrative work were followed for asthma incidence through a record linkage in 1986-1998. An individual was defined as an "incident case of asthma" if they received rights for special reimbursement of asthma medication from the national health insurance or were recognized as having occupational asthma. Age-adjusted relative risks (RR) were estimated for cleaners in comparison with those employed in administrative work. There were 2,414 and 5,235 cases of asthma among the cleaners and administrative workers, respectively. The RR was 1.50 (95% confidence interval (CI) 1.43-1.57) in cleaners. The risk was increased in cleaners working in nearly all major sectors of economic activity, but cleaners employed by companies concerned with the manufacture of basic metals (RR 2.47; 95% CI 1.68-3.64) and food products (RR 2.19; 95% CI 1.69-2.85) had the highest risk. Only 25 of the "cases of asthma" among cleaners had been recognized as being occupational asthma. It could be concluded that cleaners have an increased risk of persistent adult-onset asthma. Factors inherent to the environment where cleaning is performed or differences in the cleaning agents used may explain the observed differences between industries.

Adult↗
PubMed2002

Hospitalization trends for paediatric asthma in eastern Finland: a 10-yr survey.

The prevalence of childhood asthma has increased during the past 20 yrs in eastern Finland. The use of regular medication for asthma has, consequently, also risen at the same time. The aim of the present study was to assess how these factors have influenced hospitalization for asthma in children. Data concerning the annual number of children aged <16 yrs treated for asthma, their number of hospital periods, and length of hospitalization were collected using patient-specific medical records for the years 1988-1997. Admissions for asthma more than doubled (from 1.2 in 1,000 to 2.7 in 1,000) (p<0.001), whereas re-admissions decreased from 28.1% to 8.7% (p<0.001) during the study period. The greatest increase was seen among children aged <2 yrs, whereas during recent years the admission rate among children aged >2 yrs has declined by one-third. Despite the increased prevalence of asthma, the decline in admissions seen in all but the youngest children may, at least partly, be attributed to the decrease in re-admissions, resulting from the early onset and increased use of inhaled steroids.

Adolescent↗
PubMed2001

Work is related to a substantial portion of adult-onset asthma incidence in the Finnish population.

There are no population-based follow-up studies to estimate the fraction of asthma incidence that is attributable to work. In Finland, individuals with clinically well-established persistent asthma are registered for reimbursement of medication from the national health insurance scheme. We combined, at an individual level, these data with the population census data of 1985, 1990, and 1995 to estimate the attributable fraction of work in adult-onset persistent asthma. Our follow-up study covered the entire 25- to 59-yr-old employed population of Finland in 1986-1998. Relative risks (RR) for occupational categories were estimated in comparison to those employed in administrative work. There were 49,575 incident cases of asthma. The attributable fraction of occupation was 29% (95% CI 25-33%) for men and 17% (95% CI 15-19%) for women. The risk was increased especially in agricultural work, manufacturing work, and service work. In addition to already established risk occupations of occupational asthma, such as food and beverage work, the analysis identified a large number of occupations with significant excess of asthma incidence. The results indicate that the impact of occupational factors in the inception of adult-onset persistent asthma, and consequently the potential for prevention, is much larger and more widely spread than generally assumed.

Adult↗
PubMed2001

Macrolide-resistant Streptococcus pneumoniae and use of antimicrobial agents.

The prevalence of isolates of Streptococcus pneumoniae (pneumococcus) that are resistant to antimicrobial agents is increasing globally. We studied the connection between antimicrobial resistance of pneumococci and regional use of antimicrobial agents in Finland. In 1997, a total of 6106 pneumococcal isolates were identified in clinical microbiology laboratories in Finland. Most of the pneumococci were isolated from respiratory tract samples, 8% were from blood culture samples, and 0.5% were from cerebrospinal fluid samples. The regional levels of resistance for pneumococci in 1997 were compared with the regional rates of use of antimicrobial agents from 1995 through 1996. We found that resistance to macrolides correlated highly significantly with macrolide use (P=.006). A significant correlation was also found between resistance to trimethoprim-sulfamethoxazole and trimethoprim-sulfamethoxazole use (P=.043). We did not find a correlation between penicillin resistance and the use of any antimicrobial agent. The positive correlation between macrolide-resistant pneumococci and the use of macrolides is worrying, because macrolides are used worldwide in the treatment of patients with respiratory tract infections, which are often caused by pneumococci.

Adolescent↗
PubMed2001

Mechanical ventilation in children with severe asthma.

Hospital admissions for childhood asthma have increased during the past few decades. The aim of this study was to describe the need for mechanical ventilation for severe asthma exacerbation in children in Finland from 1976 to 1995. We reviewed medical records and collected data retrospectively from all 5 university hospitals in Finland, thus covering the entire population of about 5 million. The endpoints selected were the number of admissions and readmissions leading to mechanical ventilation, duration of stay in the hospital, and mortality. Moreover, asthma medications prescribed prior to admission and administered in the intensive care unit (ICU), as well as the etiology of the exacerbation associated with mechanical ventilation were examined. Mechanical ventilation was required in 66 ICU admissions (59 patients). This constituted approximately 10% of all 632 admissions for acute asthma to an ICU. The number of admissions decreased from 1976 to 1995: 41 admissions between 1976 and 1985 vs. 25 admissions during the next 10-year period. The mean age at admission to the ICU was 3.6 years, and 46% of the patients were boys. Prior to the index admission, 70% of the patients had used asthma medication such as oral bronchodilator (50%), inhaled bronchodilator (20%), theophylline (38%), inhaled glucocorticoid (18%), oral glucocorticoid (5%), and cromoglycate (7%). Respiratory infection was by far the most common cause of all the exacerbations (61%), followed by food allergy (8%) and gastroesophageal reflux (3%). In 28% of cases the cause of the severe asthma exacerbation could not be identified. In the mechanically ventilated patients readmissions occurred 38 times between 1976 and 1985 vs. 5 times between 1986 and 1995. Five of the patients who received mechanical ventilation died, and in 3 of these patients asthma was the event causing death. In conclusion, there has been decrease in the number of first and repeat ICU admission for asthma requiring mechanical ventilation between 1970 and 1995. This trend occurred despite a simultaneous 5% yearly increase in hospital admissions for childhood asthma during these 2 decades.

Adolescent↗
PubMed2001

Reasons for and costs of hospitalization for pediatric asthma: a prospective 1-year follow-up in a population-based setting.

The aims of this study were to examine the frequency of, and the reasons for, emergency hospitalization for asthma among children. In addition, the costs of hospital treatment, preventive medication, and productivity losses of the caregivers were evaluated in a population-based setting during 1 year. Data on purchases of regular asthma medication were obtained from the Social Insurance Institution. In total, 106 (2.3/1000) children aged up to 15 years were admitted 136 times for asthma exacerbation to the Kuopio University Hospital in 1998. This represented approximately 5% of all children with asthma in the area. The trigger for the exacerbation was respiratory infection in 63% of the episodes, allergen exposure in 24%, and unknown in 13%. The age-adjusted risk for admittance was 5.3% in children on inhaled steroids, 5.8% in those on cromones, and 7.9% in those with no regular medication for asthma. The mean direct cost for an admission was $1,209 (median $908; range $454-6,812) and the indirect cost was $358 ($316; $253-1,139). The cost of regular medication for asthma was, on average, $272 per admitted child on maintenance. The annual total cost as a result of asthma rose eight-fold if a child on regular medication was admitted for asthma.

Administration, Inhalation↗