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PubMed1986

Prevalence of diabetes mellitus in elderly men aged 65 to 84 years in eastern and western Finland.

We studied the prevalence of diabetes mellitus in men aged 65 to 84 years in Finland. The study sample consisted of 763 men, the survivors of the Finnish cohort of the "Seven Countries Study" first examined in 1959. The participation rate in the present survey was 94%. Blood glucose, fasting and 2 h after a 75-g oral glucose load, was determined from capillary blood. Current WHO criteria for diabetes mellitus were used. The mean fasting blood glucose level, adjusted for age and body mass index, was higher in east than west Finland. It rose with age in both areas. The prevalence of diabetes was 38% in the east and 36% in west Finland. About one-third of the men had impaired glucose tolerance. In the age group 75 to 79 years, the prevalence of diabetes was 65% in the east and 50% in the west. No systematic variation in the prevalence of impaired glucose tolerance with age was found. The mean levels of body mass index decreased with age in the same way in men with diabetes, impaired glucose tolerance and normal glucose tolerance. Body mass index was not higher in men with diabetes or impaired glucose tolerance than in men with normal glucose tolerance.

Aged↗
PubMed1987

Male mortality from ischaemic heart disease in Finland: relation to region of birth and region of residence.

"The purpose of the study is to shed light on the causes of the large difference in mortality from ischaemic heart disease (IHD) between East and West Finland. The study is based on the death certificate records on deaths from IHD in 1971-1975 among Finnish men aged 35-64. These records were linked with the records on persons in the 1970 census. Mortality from IHD is analyzed simultaneously by region of birth and region of residence, controlling for several socio-economic and demographic variables, by means of log-linear models. The analysis shows that being born in East Finland and living there both increase the risk of IHD, but that being born in East Finland is a more important risk factor than is living there." (SUMMARY IN FRE)

Cause of Death↗
PubMed2007

Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: the Finnsepsis study.

OBJECTIVE: To determine the incidence and outcome of severe sepsis in the adult Finnish population and to evaluate how treatment guidelines in severe sepsis are applied in clinical practice. STUDY DESIGN: A prospective study in 24 closed multidisciplinary ICUs in 21 hospitals (4 university and 17 tertiary hospitals) in Finland. PATIENTS: All 4,500 consecutive ICU admission episodes were screened for severe sepsis during a 4-month period (1 November 2004 - 28 February 2005). The referral population was 3,743,225. RESULTS: The severe sepsis criteria were fulfilled in 470 patients, who had 472 septic episodes. The incidence of severe sepsis in the ICUs in Finland was 0.38/1000 in the adult population (95% confidence interval 0.34-0.41). The mean ICU length of stay was 8.2+/-8.1 days. ICU, hospital, and 1-year mortality rates were 15.5%, 28.3%, and 40.9%, respectively. Respiratory failure requiring ventilation support was the most common organ failure (86.2%); septic shock was present in 77% and acute renal failure in 20.6% of cases. Activated protein C was given to only 15 of the 55 patients with indication (27%) and low-dose corticosteroids to 150 of 366 (41%) patients with septic shock. CONCLUSIONS: This prospective study found the incidence of ICU-treated severe sepsis in Finland to be 0.38 per 1,000 of the population. The ICU and hospital mortalities were also lower than earlier reported in United States or Australia. Evidence-based sepsis therapies were not used as often as recommended.

Adult↗
PubMed1999

Changing trends in the occurrence and subsite distribution of laryngeal cancer in Finland.

Cancer of the larynx represents worldwide approximately 1-2% of all cancers and generally occurs predominantly in males. Based upon many reports, the age-adjusted incidence of laryngeal cancer has been rising in recent years, especially among women. Squamous cell carcinomas arising in the glottic region are the most common of all laryngeal cancers and more prevalent than the supraglottic ones. Subglottic disease is still rare. The Finnish Head and Neck Oncology Group evaluated the present occurrence of laryngeal cancer by site and gender in Finland. The annual age-standardized incidence of laryngeal cancer is 3.2 per 100,000 for men and 0.3 per 100,000 for women. The proportion of females in the five university centers reviewed was 5%. During the 30-year time period from the early 1960s to the 1990s there has been a significant decrease in the laryngeal cancer incidence rates for males, but no change for females. Finland thus seems to be the only Western country with clearly declining occurrence rates in recent decades. In the same time period a clear decrease in the incidence of bronchial cancer has occurred in males and an increase in females. The results also show that in all five university hospital districts glottic cancer became more common (50-68%) in the late 1980s and 1990s, which is opposite to the situation in the 1960s when supraglottic localizations (65%) dominated in Finland.

Adult↗
PubMed2005

Trends and outcome of nosocomial and community-acquired bloodstream infections due to Staphylococcus aureus in Finland, 1995-2001.

In Finland, Staphylococcus aureus bloodstream infections are caused predominantly (>99%) by methicillin-sensitive strains. In this study, laboratory-based surveillance data on Staphylococcus aureus bloodstream infections occurring in Finland from 1995 to 2001 were analyzed. Preceding hospitalizations for all persons with Staphylococcus aureus bloodstream infections were obtained from the national hospital discharge registry, and data on outcome was obtained from the national population registry. An infection was defined as nosocomial when a positive blood culture was obtained more than 2 days after hospital admission or within 2 days of admission if there was a preceding hospital discharge within 7 days. A total of 5,045 cases were identified. The annual incidence of Staphylococcus aureus bloodstream infection rose by 55%, from 11 per 100,000 population in 1995 to 17 in 2001. The increase was detected in all adult age groups, though it was most distinct in patients >74 years of age. Nosocomial infections accounted for 51% of cases, a proportion that remained unchanged. The 28-day death-to-case ratio ranged from 1% in the age group 1-14 years to 33% in patients >74 years of age. The 28-day death-to-case ratios for nosocomial and community-acquired infections were 22% and 13%, respectively, and did not change over time. The increase in incidence among elderly persons resulted in an increase in the annual rate of mortality associated with Staphylococcus aureus bloodstream infections, from 2.6 to 4.2 deaths per 100,000 population per year. Staphylococcus aureus bloodstream infections are increasing in Finland, a country with a very low prevalence of methicillin resistance. While the increase may be due in part to increased reporting, it also reflects a growing population at risk, affected by such factors as high age and/or severe comorbidity.

Adolescent↗
PubMed2006

Influence of alternative mammographic screening scenarios on breast cancer incidence predictions (Finland).

BACKGROUND: A population-based early detection programme for breast cancer has been in progress in Finland since 1987. Recently, detailed information about actual screening invitation schemes in 1987-2001 has become available in electronic form, which enables more specific modeling of breast cancer incidence. OBJECTIVES: To present a methodology for taking into account historical municipality-specific schemes of mass screening when constructing predictions for breast cancer incidence. To provide predictions for numbers of new cancer cases and incidence rates according to alternative future screening policies. METHODS: Observed municipality-specific screening invitation schemes in Finland during 1987-2001 were linked together with breast cancer data. The incidence rate during the observation period was analyzed using Poisson regression, and this was done separately for localized and non-localized cancers. For modeling, the screening programme was divided into seven different components. Alternative screening scenarios for future mass-screening practices in Finland were created and an appropriate model for incidence prediction was defined. RESULTS AND CONCLUSION: Expanding the screening programme would increase the incidence of localized breast cancers; the biggest increase would be obtained by expanding from women aged 50-59 to 50-69. The impacts of changes in the screening practices on predictions for non-localized cancers would be minor.

Adult↗
PubMed1987

Alcohol and traffic in Finland.

This paper describes historical trends in drunken driving and traffic accidents in Finland since 1930 and discusses the relationship between alcohol policy, alcohol consumption, and drunken driving. It first describes the development of laws dealing with drunken driving and actual punishments for drunken driving. Secondly, it describes quantitative changes in drunken driving and traffic accidents, giving particular attention to alcohol-related traffic accidents. Thirdly, it analyses the connection between alcohol consumption and drunken driving. Finally, the relationship between alcohol policy and alcohol consumption in Finland is discussed. The role of the alcoholic beverages industry is also scrutinized. The paper shows that there are links among alcohol control policy, alcohol consumption, drinking habits, drunken driving, and alcohol-related traffic accidents. However, these ties are manifested through numerous mediating factors and alcohol is not the sole decisive factor. The paper also shows that drunken driving in Finland has increased and that alcohol-related traffic accidents are an important social problem.

Accidents, Traffic↗
PubMed1993

Immunoglobulin E reactivity to latex antigens in the sera of patients from Finland and the United States.

BACKGROUND: Patients with latex sensitivity and latex antigens from the United States and Finland, two countries where allergic reactions to latex have been widely reported, were evaluated to determine the spectrum of immune responses. METHODS: Sera from 27 patients from Finland and 18 from the United States with latex allergy and control sera from nonsensitive individuals were studied for latex-specific IgE antibodies. Four antigen preparations were used: two extracted from gloves and one each extracted from rubber tree sap from Malaysia and India. All 45 patients had skin prick test results that were positive to latex antigens, and all sera were evaluated by enzyme-linked immunosorbent assay (ELISA) with the various antigens. RESULTS: There were considerable differences in the reactivity of patient sera with the different antigens. Only 50% of the sera from patients with latex allergy from Finland demonstrated significant levels of IgE to latex as determined by enzyme-linked immunosorbent assay. These patients showed more reactivity with rubber tree sap antigens than with glove antigens. However, 72% of the patients from the United States demonstrated antibodies to latex, and no marked differences were noted between the antigen extracts. CONCLUSIONS: The results indicate that reagents such as rubber tree sap, which contain multiple clinically significant antigenic components, should be included in evaluation of latex allergy and that differences in patient populations may result in serologic variances.

Adult↗
PubMed1990

Farmers' occupational health programme in Finland, 1979-1987.

At the beginning of 1985, the National Board of Health in Finland issued directives for the initiation of farmers' occupational health services in municipal health care centres. The directives were based on the evaluation study on farmers' occupational health services in Finland. The main aim of this study is to analyse the current problems of the farmers' occupational health care system and to analyse how effective the system is. The efficiency of the occupational health services has been surveyed with postal inquiries twice, first in 1982 and later in 1986. The farmers' knowledge of appropriate means for reducing hazardous exposures had improved significantly since the initiation of the occupational health services. The effect of the occupational health services was evident particularly in the more effective use of personal safety devices. The limited resources at the municipal health care centres form the main obstacle in the provision of occupational health services for all farmers who would like to have them. 25-35% of the farmers in Finland (total 45,000 farmers) are willing to participate in the occupational health care system. Participation is voluntary for self-employed farmers.

Adult↗
PubMed1990

Health and social inequities in Finland and elsewhere.

This review summarizes results of a number of studies on health and social inequities in Finland in comparison with other countries. Comparisons over time have been made when possible. Inequities in mortality in Finland can be compared with data from Denmark, Norway and Sweden as well as England and Wales plus Hungary. All countries show a similar relationship between mortality and level of education. No major changes in this relationship can be observed during the 1970s. Data on morbidity and perceived health complete the picture obtained on the basis of mortality data. Inequities concern various dimensions of health. Taken as a whole, the data suggest that the pattern of health inequities is more accentuated in Finland than in other Nordic countries.

Female↗
PubMed1996

Practice of in-vitro fertilization: a case study from Finland.

In 1978 the first human IVF-baby was born. Today IVF is a standard procedure in the treatment of infertility in industrialized Western countries. In this study we analyzed how IVF reached an established position as a medical innovation in Finland, how IVF-care was organized between 1991-1993, and which kind of women used IVF-services and delivered a child as a result. The data sources were interviews with practicing IVF-physicians, a survey of Finnish IVF-clinics, telephone interviews with a sample of the adult population, and data of mothers from the Finnish Birth Registry. IVF in Finland followed the four stages of a medical innovation from a promising report into a standard procedure. Key factors in the introduction of IVF-methods were the work of andrologists', and later, IVF-physicians' associations, the approval of the method by head gynecologists in university clinics and among other colleagues, and later, the increase in IVF-services without regulatory government policy. IVF has become increasingly available in private clinics because pioneer physicians have established such services. In principle there was no social discrimination in having IVF, because it was available almost free of charge in public clinics. But the costs and availability of private clinics created unequal access to IVF services. IVF-women were more often upper-class white collar employees living in southern Finland than women in the control group. IVF has been a routine treatment option of infertility since the end of the 1980s. It has provided a medical technology solution to infertility. The supply and demand of IVF has increased and its indications have widened in the treatment of infertility. This is the inner logic of a successful technology: after the developmental processes of a revolutionary innovation, the use of technology escalates rapidly and the barriers for its use decrease.

Adult↗
PubMed1992

Prevalence of isthmic lumbar spondylolisthesis in middle-aged subjects from eastern and western Finland.

Isthmic spondylolisthesis of the lumbosacral spine is a common radiologic finding in patients with low back pain, but its prevalence in unselected populations is poorly known. We examined X-ray pictures of the lumbosacral region of 1147 randomly selected 45-64-yr-old subjects living in eastern or western Finland. Of them, 69 subjects were found to have isthmic spondylolisthesis. The finding was more common in men (7.7%) than in women (4.6%; p = 0.026). The prevalence of spondylolisthesis was not age-related; it was higher in women with an occupation causing a high back load than in those with a low load occupation (p = 0.049), but this difference was not seen in men. The prevalence of spondylolisthesis tended to be higher in women with multiple pregnancies than in those with less than or equal to 2 pregnancies (p = 0.074). Women from eastern Finland had a higher prevalence of spondylolisthesis (7.2%) than those from western Finland (2.6%; p = 0.007), whereas no such difference was seen in men. The difference in women may partly be explained by factors causing loading of the low back, i.e. heavier work and a higher number of pregnancies.

Female↗
PubMed2004

Long-term changes of acidifying deposition in Finland (1973-2000).

The long-term changes of acidifying deposition in Finland during the period 1973-2000 were studied using bulk deposition data from 19 stations belonging to the national monitoring network. The regional-scale approach (southern, central and northern Finland) was used for trend assessment with respect to implementation of European sulphur (S) emission reduction amendments involving deposition changes prior to (1973-1985) and after (1986-2000) the agreements (S protocols in 1985 and 1994). There were no marked changes in sulphate deposition between the 1970s and 1980s and consistent trends in 1973-1985 were not observed. Deposition of nitrogen (N) compounds, particularly NO3-N, were increasing between the 1970s and 1980s. Deposition of base cations exhibited a slight decline throughout the 1970s and 1980s. Decrease of calcium and magnesium deposition without corresponding decrease in sulphate resulted in increased acidifying potential (AP) of deposition. Due to successful implementation of S (and N) emission reduction measures, sulphate deposition has decreased substantially (30% in northern and up to 60% in southern Finland) since the late 1980s. N deposition also decreased, but less than S deposition. Base cation deposition has also declined substantially, but this decline appeared to be leveling off during the 1990s, accounting for the decrease of AP in deposition. The observed deposition pattern is in agreement with the on-going biochemical recovery of acidified small Finnish lakes taking place since the early 1990s.

Acid Rain↗
PubMed2006

Customers' and physicians' opinions of and experiences with generic substitution during the first year in Finland.

Medicine expenditures have continuously increased in Finland over the past 25 years. Generic substitution was introduced in Finland in the beginning of April 2003 with the aim of curbing the rise in the medical expenses of society and individuals. Pharmacists are obligated to substitute the cheapest or close to the cheapest medicine for prescribed medicine unless the customer refuses or the physician forbids substitution, which the physician can do for medical or therapeutic reasons. In this study, we explored how customers and physicians view the 2003 reform via two customer questionnaires and by interviewing physicians. The first questionnaires were handed out in 15 pharmacies in 5 geographical areas (hospital districts) in Finland to customers (n=1243, response rate 44%) who had refused generic substitution, and the second in 18 pharmacies in 6 geographical areas to customers (n=453, response rate 47%) who had accepted substituted medicines at least once. The physician interview study was directed to psychiatrists, geriatrists, internists and general practitioners (n=49). Most customers and physicians think generic substitution is a good reform measure. The main reason mentioned for substitution was to save money. The most important reason given for refusing substitution was the customers' positive experiences with medicines they had used previously. About half of the physicians thought not all interchangeable medicines are effective and safe.

Attitude of Health Personnel↗
PubMed2006

Survey of medico-legal investigation of homicides in the city of Turku, Finland.

Finland has one of the highest homicide rates in western Europe but the clear-up rate is also exceptionally high. To create a detailed analysis of homicides (n=161) in a region of western Finland during the 20-year period from 1983 to 2002 all available information was collected retrospectively from multiple sources including medico-legal reports, reports of police investigations, and court proceedings. Among the data collected and analysed were location, time, circumstances, and motives of homicides, forensic pathologists' role at the scene-of-the-crime and in court, autopsy findings, demographics and substance abuse of both victims and offenders, criminal background, forensic psychiatric examinations, and the verdicts of the offenders. A typical homicide was committed without premeditation during the weekend by a drunken male with a knife at hand and with a history of violent crimes. The perpetrator was later found guilty of manslaughter and received a prison sentence. Some noted shortcomings both in the police and the medico-legal investigation procedures are discussed, as well as the forensic pathologist's role in the judicial process in Finland.

Adolescent↗
PubMed2006

Trends in the magnitude of educational inequalities in health in Estonia, Latvia, Lithuania and Finland during 1994-2004.

BACKGROUND: Socioeconomic inequalities in health in the Baltic countries are possibly increasing due to concomitant pressures. This study compared time trends from 1994 to 2004 in the pattern and magnitude of educational inequalities in health in Estonia, Latvia, Lithuania and Finland. METHODS: The data were gathered from cross-sectional postal surveys of the Finbalt project, conducted every second year since 1994 on adult populations (aged 20-64 years) in Estonia (n=9049), Latvia (n=7685), Lithuania (n=11,634) and Finland (n=18,821). Three self-reported health indicators were used: (i) less than good perceived health, (ii) diagnosed diseases, and (iii) symptoms. RESULTS: The existing educational inequalities in health in three Baltic countries and Finland remained generally stable over time from 1994 to 2004. Also, the overall prevalence of all three health indicators was generally stable, but in the Baltic countries improvement in perceived health was mainly found among the better-educated men and women. Diagnosed diseases increased in the Baltic countries, except Lithuania, where diseases decreased among the better-educated women. Symptoms increased among the better-educated Estonian and Finnish women. CONCLUSIONS: The period from 1994 to 2004 of relative stabilization since the worst conditions of the social transition has not been followed by notable changes in self-reported health, and this appears to be the situation across all educational groups in the Baltic countries. While health inequalities did not markedly change, substantial inequalities do remain, and there were indications of favourable developments mainly among the better-educated respondents. The factors contributing towards increasing health inequalities may only be visible in the future.

Adult↗
PubMed2004

A comparative study of the patterning of women's health by family status and employment status in Finland and Sweden.

The main aim of this study is to compare the patterning of health by family status and employment status among women in Finland and Sweden and to explore whether the patterning of health by family status is influenced by employment status and income. An additional aim was to identify which combinations of family status and employment status are especially disadvantageous for women's health . The data derived from comparable interview surveys carried out in 1994/1995. The analyses were restricted to ages 25-49; 2282 women in Finland and 2685 in Sweden. Firstly, age-adjusted prevalence percentages were presented by family status and employment status. Secondly, the patterning of health by family status and employment status, and the influence of adjusting for income, were studied by logistic regression analysis. The main results showed that women living in couples with children had the best health in both countries. Additional analyses showed that in Finland particularly poor health can be found among women who are simultaneously non-partnered and non-employed, whereas in Sweden poor health can be found among all non-employed groups of women. Income did not explain the poor health among the non-partnered and non-employed. This study confirmed that health is patterned by family status and employment status both among Finnish and Swedish women. It was found that non-employed women without a partner are likely to have poor health. In order to reduce inequalities in health among women, more efforts should be put on promoting health among these groups.

Adult↗
PubMed2006

Population dynamics of Bordetella pertussis in Finland and Sweden, neighbouring countries with different vaccination histories.

Pertussis is an infectious disease of the respiratory tract in humans caused by Bordetella pertussis. Despite extensive vaccinations, pertussis has remained endemic and re-emerged. In Finland, a whole-cell pertussis vaccine has been used since 1952 with high coverage. In Sweden, whole-cell vaccinations were introduced in 1953 but ceased in 1979, and pertussis vaccinations with acellular vaccines were introduced in 1996. Two epidemic peaks occurred in Sweden in 1999 and 2002 and in Finland in 1999 and 2003. We compared Finnish (N=193) and Swedish (N=455) B. pertussis isolates circulating in 1998-2003 together with vaccine strains used in these neighbouring countries with different vaccination histories. The isolates were analysed by serotyping, genotyping of pertussis toxin S1 subunit and pertactin, and pulsed-field gel electrophoresis. The results suggest that the sequential epidemics were caused by clonal expansion of a certain B. pertussis strain possibly transmitted from Sweden to Finland. The roles of antigenic variation in immunity-driven evolution of B. pertussis in both countries are discussed.

Adolescent↗