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PubMed1989

The development of hypertension care in Finland from 1982 to 1987.

The development of hypertension care in Finland was evaluated using the data from two independent population samples of the FINMONICA Project comprising 9350 and 6250 persons examined in 1982 and 1987, respectively. The sampling frame was the population aged 25 to 64 years in the provinces of North Karelia and Kuopio in eastern Finland and in the Turku-Loimaa region in south-western Finland. During the 5-year period, the mean systolic blood pressure levels decreased in all of the groups except the North Karelian men. Mean diastolic blood pressure did not change significantly. The proportion of hypertensive men with adequately controlled blood pressure increased from 22.6 to 29.4% [difference 6.8%, 95% confidence interval (Cl) for the difference 2.4-11.2] during 1982-1987. At the same time, the proportion of hypertensive men unaware of their condition fell from 30 to 20.9% (difference -9.1%, 95% Cl for the difference -13.4- -4.8). There was corresponding falls for women from 39.2 to 41.3% (difference 2.1%, 95% Cl for the difference -3.1-7.3) and from 15.4 to 13.1% (difference -2.3%, 95% Cl for the difference 1.4- -6.0), respectively. Thus, obvious progress had taken place, although the situation remained far from satisfactory. The possibility of overly aggressive treatment of hypertension was also investigated. It was found that only less than 10% of the middle-aged hypertensive men treated with drugs had diastolic pressures less than or equal to 85 mmHg, suggesting that this might not be an issue of concern at community level.

Adult↗
PubMed1999

Prevalence of Meniere disease in Finland.

OBJECTIVES: To assess the prevalence of Meniere disease in the population of 5 million in Finland according to the criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) recommendation. STUDY DESIGN: Retrospective investigation based on patient records of 306 patients treated for Meniere disease and recognized as such according to the International Statistical Classification of Diseases and Related Health Problems (ICD-9 or ICD-10) in seven Finnish hospitals serving a population of 1.5 million people. METHODS: Patients were selected from the computerized patient registers of outpatients and inpatients having received an appropriate diagnosis during the period from 1992 to 1996 and re-evaluated. Definite cases according to AAO-HNS guidelines were identified to calculate the prevalence of Meniere disease in Finland at the end of 1996. RESULTS: A total of 131 definite cases of Meniere disease were identified. The prevalence of at least 43 per 100,000 and an average annual incidence of 4.3 per 100,000 were obtained. The prevalence turned out to be higher (P<.001) in Northern areas (49/100,000) than in the south (38/100,000). The prevalence did not differ in the areas of university hospitals (44/100,000) from those of central hospitals (42/100,000). CONCLUSIONS: The prevalence and incidence in Finland is lower than could be expected from previous international surveys, most of which provide inadequate data for forming a real picture of the epidemiology of Meniere disease. Uniform diagnostic criteria are indispensable for further research.

Finland↗
PubMed2001

A nationwide sentinel clinic survey of chlamydia trachomatis infection in Finland.

BACKGROUND: Chlamydia trachomatis has been recognized as a major sexually transmitted infection in North America and Western Europe during the past two decades. The incidence of C trachomatis in Finland has been continuously high throughout the 1990s. OBJECTIVES: As the epidemic of C trachomatis infection continues in Finland, there is a need to obtain up-to-date information on the prevalence and patient profiles in the planning of preventive strategies. METHODS: A nationwide sentinel clinic network consisting of seven sexually transmitted disease (STD) and five general student health clinics was established in 1995. Data were collected during a 3-year period (1995-1997) from 3,686 patients with and 32,230 patients without C trachomatis using a self-administered questionnaire. RESULTS: The prevalence of chlamydia was 8.4% in the STD clinics and 5.3% in the general clinics; 90% of the infections were endemic. The prevalence was highest in the youngest age group (15-19 years; 16% in females, 14% in males). The patients with chlamydia were significantly younger (mean age: men 26.6 years, women 23.7 years) than those without chlamydia. Women with chlamydia used oral contraceptives or intrauterine devices (IUD) significantly more often (59%) than women without chlamydia (42%). A high number of sex partners and a history of previous chlamydia during the preceding 12 months were also risk factors. Men contracted chlamydia frequently from a casual partner (61%) but rarely from a commercial sex worker (2%). For women, the source partner was most often a regular one (61%). The median time from exposure to attendance was 34 days, and was highest when the source partner was a spouse. One third of the patients could have spread chlamydia to a new partner before the diagnosis. CONCLUSIONS: C trachomatis infection is spread all over Finland, and the risk factors include younger age, high number of sex partners, and use of oral contraceptives or IUDs. Source partner analysis focused attention on the importance of transmission from regular partners, especially in women. The time from transmission to diagnosis was long, and any effort to shorten this period would be an effective preventive strategy.

Adolescent↗
PubMed2004

Declining incidence and mortality of stroke in persons aged > or = 75 years in Finland; the FINSTROKE study.

BACKGROUND: The average life expectancy of a person aged 75 in Finland is approximately 10 years. A substantial threat to the quality of life during these years is stroke, which is common among the elderly, may hamper independent living and places a substantial burden on health care resources. The aim of the present study was to analyse the trends in incidence, mortality and prognosis of acute stroke events in persons aged > or = 75 years in Finland. DESIGN: A population-based stroke register study. METHODS: The FINSTROKE register recorded all stroke events in persons aged > or = 75 years (n=5493) among inhabitants of the town of Turku from 1982 to 1992 and again from 1996 to 1998, and in the Kuopio area from 1990 to 1997. RESULTS: At the end of the study period, the age group > or = 75 years constituted 3.8% of the population of study areas among men and 8.7% among women. This population segment contributed 35% of strokes among men and 66% among women. Of all strokes in this age group, 73% occurred among women. Data suggested that the mortality and incidence of acute stroke events were declining, but the 28-day case fatality did not change. At day 28 after the onset of stroke, only 26% of men and 19% of women had recovered well enough to be capable of independent living. CONCLUSIONS: Stroke mortality among the elderly is declining in Finland, which is mainly due to the decline in the incidence of stroke events.

Aged↗
PubMed2004

Fluoride in the drinking water and the geographical variation of coronary heart disease in Finland.

BACKGROUND: Fluoride in drinking water prevents dental disease, which in turn has been reported to increase the risk of coronary heart disease (CHD). Since mortality from CHD in Finland is high in the north-east where the fluoride content of drinking water is low, the association was examined here in more detail. DESIGN: Mortality from CHD during the period 1961-1995 in 365 rural areas of Finland (188 888 deaths) was linked with 2131 drinking water fluoride determinations performed in 1958 using negative binomial regression, adjustments being made for sex, age, mean income of the resident commune and drinking water magnesium and calcium. RESULTS: An inverse J-shaped relationship was found between drinking water fluoride and CHD, the association being most pronounced in the 1960s and levelling off consistently as a function of time. In 1961-1970, the adjusted mortality from CHD was 22% (95% confidence interval 18-27%) lower in the fourth quintile of fluoride (0.15-0.30 mg/l) than in the first quintile (0.00-0.06 mg/l) but this deficit reduced to 13% (7-18%) in 1991-1995. CONCLUSIONS: Although causality cannot be asserted, the geographical pattern of CHD in Finland is consistent with the concentration of fluoride in drinking water. One mechanism could be that fluoride prevents dental infections, which in turn reduces mortality from CHD. The more widespread use of fluoridated toothpastes, soft drinks and certain food items since the 1960s may have reduced the significance of drinking water as a source of fluoride.

Adult↗
PubMed2004

The use of automated external defibrillators by non-medical first responders in Finland.

OBJECTIVE: To assess the spread of automated external defibrillators and their use by non-medical first responders in Finland. METHODS: A structured survey was mailed to all voluntary and ordinary fire brigades in Finland. The questions were related to the purchase, experience of use and anticipated benefits from the devices. RESULTS: Approximately 90% of all users (133 providers) in the target group of non-medical first responders answered. The number of automated external defibrillators in use by these operators has increased progressively since 1992. Most respondents possessed only one automated external defibrillator, and a median of 12 users were trained to use each device. A total of 85% of the respondents retrained at least once a year, and 94% checked the device on a daily basis. Half of the users had written authorization to use the automated external defibrillator, and two thirds had written instructions on how to operate it. Each automated external defibrillator was used on average five to 10 times annually. Although none of the respondents could provide data on how many cardiac arrests they had attended or the success of resuscitation during the preceding year, 94% reported that they considered the automated external defibrillator useful, and 80% thought that the cost-benefit of the device was either very good or good. CONCLUSION: Although there are many automated external defibrillators in use by non-medical first responders in Finland, the results of this study show that there are large variations between individual fire brigades regarding the use of these devices as part of the first response system. This is considered to be caused by the lack of national standards and regulations, which should define a full integration of first-responder programmes into the emergency medical service system.

Education, Nonprofessional↗
PubMed2005

Fatal gunshot wounds between 1995 and 2001 in a highly populated region in Finland.

Gunshot injuries are a major problem worldwide from the human, medical, and economic perspectives. The number and characteristics of gunshot fatalities have been observed to vary significantly between countries. This study analyzes fatal gunshot wounds in the region of Uusimaa, Southern Finland, between 1995 and 2001. Gunshot wounds were typically found in suicides committed by men aged between 20 and 60 years. In most cases, a handgun was used. Mental disorders were present in the history of almost one quarter of the victims. Alcohol was identified in postmortem toxicology in half of the cases, but drugs of abuse were relatively uncommon. The autopsy rate in Finland is among the highest of the European Union countries, and a medicolegal investigation is performed in virtually all fatal gunshot incidents. This study is therefore representative of forensic investigations of gunshot fatalities in Finland overall.

Adult↗
PubMed2006

Trends in hospitalization for firearm-related injury in Finland from 1990 to 2003.

BACKGROUND: The firearm-related mortality in Finland is one of the highest in Europe. The study objective was to describe the incidence trends and nature of firearm-related injury hospitalizations in Finland between 1990 and 2003. METHODS: We included all firearm-related injury hospitalizations between 1990 and 2003. The data were obtained from the Finnish National Hospital Discharge Register. Only events with traumatic physical injuries were included. RESULTS: The overall incidence of firearm-related injury hospitalization was 5.1 (95% confidence interval [CI]: 34.5-5.7) per 100,000 person-years in 1990 and 2.6 (95% CI: 2.1-3.0) in 2003. The absolute numbers were 254 and 133, respectively. Unintentional injuries accounted for 44% of injuries during the study period. Hospitalization incidence resulting from intentional firearm-related injuries (self-inflicted and assault) remained unaltered over the study period. Men's injury incidence was 10.0 times (95% CI: 8.8-11.4) that of women's. Young men aged 15 to 34 years displayed the highest incidence figures. The most common types of the firearm-related injuries were open wounds (52%) and fractures (17%). Anatomically they involved the head and the neck (35%), the lower limb (28%), and the trunk (19%). CONCLUSIONS: Although the total incidence of firearm-related injuries decreased in Finland during the 14-year study period, the incidence of intentional firearm-related injuries remained at the same level. Finding information on the risk factors of firearm-related injuries and the reasons for the steady level of intentional injuries are the next steps toward preventive measures.

Adolescent↗
PubMed1982

Psychosocial stress and sociodemographic differentials in mortality from ischaemic heart disease in Finland.

This report describes differences in mortality from ischaemic heart disease (IHD) and other selected causes of death according to region, marital status, language group (Finnish vs Swedish), social group and rural-urban divisions in Finland. The data include all deaths in Finland during 1971-75 in the cohorts of men aged 35-64 and women aged 35-74 on January 1st 1971 (33,862 IHD deaths). The sociodemographic characteristics of the decreased were obtained through computerized linkage from the records of the 1970 census by means of personal identification codes. IHD mortality was found to be higher than average in Eastern Finland, in the Finnish speaking population and in lower social groups. There was a higher mortality in non-married than in married categories among men, but among women the differences were smaller. The findings are discussed in the light of differences in stressrelated mortality.

Adult↗
PubMed1992

Dietary intake of 70- to 89-year-old men in eastern and western Finland.

A detailed dietary history interview of 70- to 89-year-old men, 98 from eastern and 129 from western Finland, was obtained as part of a 30-year follow-up survey within the Seven Countries Study. The average energy intake was similar in level, about 2700 kcal, in both areas. The percentage of total energy intake from fat was 39.1% in the west, and 36.5% in the east. The P/S ratio was about the same, 0.27 and 0.29, in eastern and western areas, respectively. The intake of most micronutrients was similar in the two cohorts. Only the intake of vitamins A and C and phosphorus, manganese, copper and zinc was higher in eastern Finland than in western Finland. The nutritional density of the diet of the eastern cohort was slightly higher than that of the western one due to their higher consumption of rye products, vegetables and berries, and also sour milk and fish and fish products. The diet met the general recommendations and was comparable to that of younger age groups.

Aged↗
PubMed1995

High serum alpha-tocopherol, albumin, selenium and cholesterol, and low mortality from coronary heart disease in northern Finland.

OBJECTIVES: The mortality from coronary heart disease (CHD) is exceptionally low in northernmost Finland, the Sámi (formerly known as Lapp) area. To clarify the reasons for this, the levels of serum cholesterol, other classic risk factors, and major antioxidants, alpha-tocopherol, retinol, albumin and selenium were determined in males living in the low-mortality area and in a reference area. DESIGN: A health survey amongst reindeer herdsmen living in the three northernmost communes of Finland (the Sámi area) and in the six neighbouring communities to the south (the reference area). The mortality from CHD in the two areas was determined from death certificates issued during the period 1981-1990. SUBJECTS: A total of 350 participants of the health survey, mean age 46 (SD 14) years. RESULTS: The mortality from CHD was 17% lower in the Sámi area than in the reference area [95% confidence interval (CI) for the difference: 4-29]. Subjects living in the low-mortality area showed higher serum-lipid-adjusted alpha-tocopherol (18.4 vs. 16.1 mumol L-1; 95% CI for difference: 0.7-3.9; P < 0.001), albumin (46.9 vs. 46.2 g L-1; 0.2-1.3; P < 0.02), selenium (1.59 vs. 1.47 mumol L-1; 0.02-0.22; P < 0.02), cholesterol (6.76 vs. 6.34 mmol L-1; 0.12-0.72; P < 0.001) and LDL cholesterol (4.76 vs. 4.45 mmol L-1; 0.05-0.57; P < 0.02) than those in the reference area. The HDL cholesterol:cholesterol ratio was lower in the Sámi area than in the reference area (0.20 vs. 0.21; -0.02-0.00; P < 0.04). The Sámis showed higher serum selenium than the Finns. Serum alpha-tocopherol increased with the consumption of reindeer meat and serum selenium increased with fish consumption. CONCLUSIONS: Alpha-tocopherol, albumin and selenium may play a role in the low mortality from CHD observed in northernmost Finland. The favourable serum antioxidant status in northerners may be credited to the local diet.

Adult↗
PubMed2005

Characteristics and staff resources of child and adolescent psychiatric hospital wards in Finland.

The aim of this study is to describe structural characteristics and staff resources of child psychiatric and adolescent psychiatric hospital wards in Finland. The target group of the survey consisted of 69 child and adolescent psychiatric hospital units in Finland. Information was obtained from 64 units (93%). Most of the wards were based on 24-h-a-day provision. There were only 7-day-treatment programmes including two family wards. When compared internationally, the numbers of units, beds and staff levels were high in Finland, with all members of staff qualified. The nurse-patient ratio and psychiatrist resources were rather satisfactory. However, in many units there was a lack of psychologists, social workers and occupational therapists. General recommendations and guidelines for staff resources in child and adolescent hospital treatment wards are warranted.

Adolescent↗
PubMed2005

The changing epidemiology of esophageal cancer in Finland and the impact of the surveillance of Barrett's esophagus in detecting esophageal adenocarcinoma.

We examined the epidemiology of esophageal cancer in Finland and the role of the surveillance of Barrett's esophagus (BE) in detecting esophageal adenocarcinoma (EA) in our own hospital referral area. We observed that the incidence of EA in men has increased tenfold from the 1970s and was 1.10/100,000/year in 1998-2002. In women, a 4.5-fold increase was observed (incidence 0.11/100,000/year). In 1998-2002, the mean annual number of new EA cases was 57.4 (79.8% men) in Finland with a population of 5.2 million. In our hospital referral area with a mean population of 261 349, 11 EAs were observed in 1996-2001. Of them, two (18.2%) had BE. One EA was detected during surveillance. EA comprised 0.05% of all causes of deaths in our hospital referral area. We conclude that EA incidence has increased significantly in men in Finland, but still EA is seldom detected on BE surveillance. EA is an uncommon cause of death in our hospital referral area.

Adenocarcinoma↗
PubMed1975

The epidemiology of multiple sclerosis and tuberculosis in Finland. A study based on mortality statistics.

Mortality statistics were used to check the previously observed uneven geographical distribution of multiple sclerosis (MS) in Finland, and also to compare the distribution of tuberculosis and MS with each other. In total, 331 MS deaths which could be regarded as deaths primarily due to MS were registered during the period from 1963 to 1971. The mean age at death was 49.9 years. The mean annual mortality rate was 0.8 per 100,000 population. The highest rates due to MS were registered in the western county of Vaasa. The cumulative mortality and birth rates showed a significant accumulation of MS cases to the western county of Vaasa and the southwestern county of Turku and Pori. A previous study revealed a high percentage of familial cases of first-degree kinship in the selected district of Jalasjärvi in the county of Vaasa. The mortality material revealed one additional MS case which raised the familial percentage to 13 among the living patients in this district. Statistics of tuberculosis have shown a constant accumulation of the disease in the western part of the country for more than 100 years. The mean annual mortality rate for tuberculosis was 17.1. The highest rate (23.0) was found in the western county of Vaasa, where the mortality rate (1.34) for MS was highest. Previous immigrant studies in Finland suggest that the uneven geographical distribution of tuberculosis is due to hereditary factors. The population of Finland consists of varying degrees of isolates, and the similarity of the distributions of MS and tuberculosis may thus reflect a common genetic factor in their aetiology.

Adolescent↗
PubMed1997

Decreasing incidence of stroke in central Finland, 1985-1993.

INTRODUCTION: During the last decades the age-standardized stroke mortality has declined in Finland as in many other industrialized countries. Epidemiological studies have, however, not been consistent in explaining this fall in mortality. Our aim was to shed light on this question by using two consecutive, population-based surveys. PATIENTS & METHODS: The target of the two one-year surveys was the population living in the Jyväskylä Region of central Finland, and the surveys were performed in 1985-86 (population 114,669) and 1993 (population 123,547). The case finding methods and the diagnostic criteria were identical in both studies. All hospital records and autopsy reports of patients with ICD (8th and 9th revision) codes 430-438 were collected and perused. Patients with first-ever stroke were included in the study. RESULTS: The number of patients with first-ever stroke in the 1985-86 and 1993 surveys were 219 and 189, respectively, and 92% of them were treated at the Department of Neurology. The age-standardized (European standard population > or = 25 years) annual total stroke incidence showed a statistically significant decline over these 8 years from 317 (95% confidence interval 274-360) to 227 (95% confidence interval 194-260) per 100,000. In both studies the survival was similar with 79% of the patients surviving at 28 days after stroke onset, and 65-69% at 1 year. Recurrent strokes, 52 in 1985-86 and 50 in 1993 also showed a declining trend and no changes in survival were observed. CONCLUSIONS: The decline in stroke mortality in Finland is best explained by the declining incidence of stroke. In the present study we did not find changes in the 1st year survival after stroke onset.

Adult↗
PubMedDate not supplied

Initial validation of the perioperative nursing data set in Finland.

PURPOSE: To explore the relevance of the Perioperative Nursing Data Set (PNDS) in Finland. METHODS: A three-round Delphi technique (10 participants) and content analysis of 134 articles from the Journal of the Finnish Operating Room Nurses Association. FINDINGS: All the PNDS outcomes, 86% of the diagnoses, and 87% of the interventions were found to be relevant. The Delphi panel suggested, and content analysis revealed, 6 new outcomes, 43 new diagnoses, and 11 new interventions. Consensus was achieved on 77%. The phrases used in perioperative articles corresponded with those of PNDS 56%-78% of the time. CONCLUSIONS: PNDS can be used to describe perioperative nursing in Finland. Further conceptualization and validation are needed before using the data set in perioperative practice. IMPLICATIONS FOR PRACTICE: Although PNDS cannot be implemented in Finland as is, it is a valid structure for further development of the terminology, contents, methods, and practice of Finnish perioperative documentation.

Documentation↗
PubMed1996

Incidence of rheumatoid arthritis in Finland during 1980-1990.

OBJECTIVE: To obtain information on the incidence of rheumatoid arthritis and on its recent trends in Finland. METHODS: The study covered those subjects entitled to receive specially reimbursed medication for rheumatoid arthritis under the nationwide sickness insurance scheme in five out of 21 central hospital districts in Finland (population basis about one million adults) during three years: 1980, 1985, and 1990. RESULTS: The annual incidence of rheumatoid arthritis in 1980 and 1985, satisfying the American Rheumatism Association 1987 classification criteria, was 39/100,000 of the population > or = 16 years of age. The combined incidence of rheumatoid factor (RF) positive arthritis and RF negative polyarthritis was 46/100,000. A decline of approximately 40% occurred in the number of RF negative rheumatoid arthritis cases in 1990 compared with the earlier years. The declining trend was statistically significant (P = 0.008). CONCLUSION: The decline in incidence of RF negative rheumatoid arthritis in Finland may reflect changes in the environment specifically affecting the risk of RF negative disease.

Arthritis, Rheumatoid↗
PubMed1986

Decline in cardiovascular mortality in North Karelia and other parts of Finland.

The trends in mortality from ischaemic heart disease, cerebrovascular stroke, and all cardiovascular diseases were analysed for the province of North Karelia and for the rest of Finland. Linear trends in mortality were computed for the population aged 35 to 64 for the period from 1969 to 1982, and changes in mortality between the three year means of 1969-71 and 1980-2 were calculated. In North Karelia, where a community based preventive programme has been carried out since 1972, the annual decline in mortality from ischaemic heart disease in men was on average 2.9%, whereas in the rest of Finland it was 2.0%. For women the respective average annual declines in mortality were 4.9% and 3.0%. The net decline from 1969-71 to 1980-2 in North Karelia was 100 deaths/100,000 men. The annual mortality from all cardiovascular disease in men decreased by 2.9% in North Karelia and by 2.6% in the rest of Finland; in women the decreases were 6.0% and 5.0% a year, respectively. The net decline in North Karelia was 71 deaths/100,000 men. The decline in mortality from all causes was also appreciable in both sexes in North Karelia, but it did not differ significantly from national trends.

Adult↗