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PubMed1989

Do treatment protocols improve end results? A study of survival of patients with multiple myeloma in Finland.

OBJECTIVE: To determine whether patients with multiple myeloma treated in three consecutive clinical trials of chemotherapy of the Finnish Leukaemia Group during 1979-85 had a more favourable prognosis than both patients treated in the trial area before the trials and those treated in the rest of Finland. DESIGN: Comparison of the time trend in survival of patients living in the trial area with that of patients living in the rest of Finland. SETTING: Trial area covered 17 of the 21 main hospital districts in Finland (serving more than two thirds of patients with multiple myeloma). PATIENTS: 663 Men and 690 women in the trial area and 318 men and 307 women in the reference area aged under 71 in whom multiple myeloma was diagnosed during 1959-85. In the trial area the disease was diagnosed in 455 men and 493 women in 1959-78 and in 208 men and 197 women in 1979-85; in the reference area it was diagnosed in 234 men and 227 women in 1959-78 and in 84 men and 80 women in 1979-85. MAIN OUTCOME MEASURES: Five year cumulative relative survival rates during 1959-85, annual relative survival rates in the first seven years of follow up during 1979-85, and fitted annual relative survival rates in the first five years of follow up during 1959-85. RESULTS: During the first two years of follow up the annual relative survival rates did not differ between the two areas, but in the next five years of follow up patients in the trial area did better than those in the reference area. For cases diagnosed in 1979-85 the difference in the five year cumulative relative survival rates between patients in the trial area and those in the reference area was 10%, those in the trial area doing better. Generalised proportional hazards regression analysis of the first five years of follow up showed that the patients in the trial area had a survival advantage over those in the reference area. The model with the best fit included year of follow up, time of diagnosis, the joint effect of year of follow up and time of diagnosis, and the joint effect of area and time of diagnosis. CONCLUSION: The patients in the trial area benefited from the clinical trials, which suggests that the use of a treatment protocol improves the end results of treatment. In other words, the results favour a systematic treatment schedule in preference to a schedule determined by the free choice of a clinician.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Social class, health behaviour, and mortality among men and women in eastern Finland.

OBJECTIVE: To evaluate the associations between social class as defined by occupation, health behaviour, and mortality from all causes and coronary heart disease among middle aged men and women in eastern Finland. DESIGN: Prospective observational study of two independent, random population samples examined in 1972 and 1977. SETTING: North Karelia and Kuopio, Finland. SUBJECTS: 8967 men and 9694 women aged 30-64 years at the beginning of the follow up study. The subjects were followed up for mortality up till 1987 by using the National Death Registry. MEASUREMENTS AND MAIN RESULTS: Altogether 1429 men and 620 women died during the follow up, 603 men and 164 women of coronary heart disease. Among both sexes, compared with white collar workers unskilled blue collar workers had more adverse risk factors and also higher mortality due to coronary heart disease, other cardiovascular diseases, cancer, violent causes, and all other causes. Among men the age adjusted relative risk for all cause mortality in unskilled blue collar workers v white collar workers was reduced from 1.86 (95% confidence interval 1.55 to 2.22) to 1.47 (1.23 to 1.77) when adjusted for smoking, serum cholesterol concentration, hypertension, body mass index, and physical activity in leisure time. Among women the corresponding reduction in hazard ratio was from 1.49 (1.15 to 1.92) to 1.39 (1.07 to 1.81). The respective hazard ratios for coronary heart disease were 1.54 (1.16 to 2.02) and 1.22 (0.92 to 1.61) among men and 1.74 (1.05 to 2.90) and 1.66 (0.99 to 2.79) among women. CONCLUSIONS: Unfavourable cardiovascular risk factors and high mortality are concentrated among lower social classes in Finland. Among men about half of the excess coronary and all cause mortality among unskilled blue collar workers was associated with their unfavourable risk factor profile. The association was smaller in women.

Adult↗
PubMed1992

Comparison of trends in ischaemic heart disease between North Karelia, Finland, and Kaunas, Lithuania, from 1971 to 1987.

OBJECTIVE: To compare the long-term trends in mortality and attack rate of ischaemic heart disease in North Karelia, Finland, and in Kaunas, Lithuania, from 1971 to 1987. DESIGN: Data on routine mortality statistics were obtained from the Central Statistical Office of Finland and from the Central City Archives of Kaunas. In addition, data from the community based myocardial infarction registers were used. The registers used similar diagnostic criteria and had operated in both areas during the entire study period. SETTING: The province of North Karelia in Finland and the city of Kaunas in Lithuania. SUBJECTS: The target populations were the people of North Karelia and Kaunas aged 35-64 years. MAIN OUTCOME MEASURES: Mortality from ischaemic heart disease and the attack rate of acute myocardial infarction. RESULTS: In North Karelia mortality from ischaemic heart disease and the attack rate of acute myocardial infarction declined steeply both in men and women. This decline was accompanied by a decrease in total mortality. In Kaunas, both mortality and the attack rate increased in men but remained unchanged in women. In 1985 to 1987, age standardised total mortality per 100,000 inhabitants was similar in the two populations in men (1081 (95% confidence interval (CI) 1013 to 1149), in North Karelia; 1082 (95% CI 1032 to 1132), in Kaunas). The proportional mortality from ischaemic heart disease was considerably higher in North Karelia (40%) than in Kaunas (28%). In women, age standardised total mortality was lower in North Karelia (350 (95% CI 312-388)) than in Kaunas (440 (95% CI 413 to 467)). The proportional mortality from ischaemic heart disease in women was also higher in North Karelia (28%) than in Kaunas (13%). CONCLUSIONS: Despite the remarkable decline in the occurrence of ischaemic heart disease, it still remains the most important cause of premature mortality in North Karelia. In Kaunas ischaemic heart disease mortality and attack rate increased in men. Experiences from successful cardiovascular disease prevention programmes in western countries, such as the North Karelia Project, should be exploited to prevent an increasing epidemic of ischaemic heart disease in eastern Europe.

Adult↗
PubMed2002

Drowning in Finland: "external cause" and "injury" codes.

BACKGROUND: The International Classification of Diseases (ICD) external codes (E codes) for drowning assist in determining the primary event leading to drowning, but do not alone allow the precise determination of the overall drowning rates. AIMS: To analyze the sensitivity of the ICD E codes for drowning. To describe the pattern and trend of drowning deaths that are classified with E codes other than for drowning. SETTING: Finland, 1969-2000. METHODS: Mortality files of Statistics Finland were searched electronically using the injury codes (I codes) and E codes for drowning. Cross analysis of I and E coded drownings was performed to determine the rate and pattern of drowning cases classified with E codes other than for drowning. Time trends were calculated using the Poisson regression model. RESULTS: Of 13 705 drowning deaths, 644 (4.7%) were not identified with the E codes for drowning. The great majority (n=547, 84.9%) of these cases were traffic accidents resulting in drowning. No significant time trends were found even after the introduction, in 1996, of the ICD 10th revision. CONCLUSIONS: In Finland, underestimation of overall drowning rates using the E code alone is less pronounced than in countries where similar studies have been performed. The relatively high rate of transport accidents resulting in drowning indicates a specific target for preventive countermeasures.

Accidents↗
PubMed1982

Gastroschisis and omphalocele in Finland in the 1970s: prevalence at birth and its correlates.

Information on liveborn and stillborn children with gastroschisis and omphalocele was collected from hospital and register sources in Finland from 1970 to 1979. The apparent prevalence of gastroschisis at birth increased from 0.77/10 000 births in 1970-4 to 1.42/10 000 in 1975-9. The prevalence of omphalocele (1.96/10 000) was unchanged during the decade. Even for gastroschisis the apparent increase in prevalence was noted for northern Finland only, while for southern Finland the prevalence has been stable during the 1970s, possibly suggesting diagnostic or reporting differences between various parts of the country. Some correlates of increased risk of gastroschisis included: low birth weight, low maternal age, urban residence, and maternal employment in commercial and sales work.

Abdominal Muscles↗
PubMed1993

Time trends in mortality in forestry and construction workers in Finland 1970-85 and impact of adjustment for socioeconomic variables.

STUDY OBJECTIVE: This study aimed firstly to describe the development of cause-specific mortality in forestry workers, farmer/forestry workers, and skilled and semiskilled construction workers between 1970 and 1985 in Finland, and to compare this with mortality in the total working male population. The second aim was to evaluate how well the cause-specific mortality differences between the occupations could be explained by differences in socioeconomic status, marital status, or in the region of residence. DESIGN AND SETTING: This is a follow up study based on the 1970, 1975, and 1980 census records in Finland linked with all death certificates for 1971-75, 1976-80, and 1981-85 respectively. Log-linear regression analysis was used. SUBJECTS: All economically active men in Finland aged between 35 and 64 years in 1971-85 were studied. The number of person-years in the period totals about 10 million. MAIN RESULTS: Semiskilled construction workers had the highest mortality rate almost independent of the cause of death. The mortality of forestry workers was the second highest. Compared with the reference population, however, the differences were small with regard to neoplasms and cardiovascular diseases. With regard to other diseases, only the mortality of semiskilled workers was fairly high. Differences in mortality as a result of accidents were the highest. Both suicide and accidental death rates were high in semi-skilled construction workers and forestry workers. During the study total mortality fell by about 30% but mortality differences between groups did not decline. CONCLUSIONS: The high mortality of forestry and semiskilled construction workers is partly explained by socioeconomic factors such as marital status and housing conditions. These factors do not, however, explain the high suicide and accident mortality rates of forestry workers or semiskilled construction workers. More research is needed to explain these findings.

Adult↗
PubMed2003

How did the recent increase in the supply of coronary operations in Finland affect socioeconomic and gender equity in their use?

STUDY OBJECTIVE: To explore how the increased supply of coronary bypass operations and angioplasties from 1988 to 1996 influenced socioeconomic and gender equity in their use. DESIGN: Register based linkage study; information on coronary procedures from the Finnish Hospital Discharge Register in 1988 and 1996 was individually linked to national population censuses in 1970-1995 to obtain patients' socioeconomic data. Data on both hospitalisations and mortality attributable to coronary heart disease obtained from similar linkage schemes were used to approximate the relative need of procedures in socioeconomic groups. SETTING: Finland, 2,094,846 inhabitants in 1988 and 2,401,027 in 1996 aged 40 years and older, and Discharge Register data from all Finnish hospitals offering coronary procedures in 1988 and 1996. MAIN RESULTS: The overall rate of coronary revascularisations in Finland increased by about 140% for men and 250% for women from 1988 to 1996. Over the same period, socioeconomic and gender disparities in operation rates diminished, as did the influence of regional supply of procedures on the extent of these differences. However, men, and better off groups in terms of occupation, education, and family income, continued to receive more operations than women and the worse off with the same level of need. CONCLUSIONS: Although revascularisations in Finland increased 2.5-fold overall, some socioeconomic and gender inequities persisted in the use of cardiac operations relative to need. To improve equity, a further increase of resources may be needed, and practices taking socioeconomic and gender equity into account should be developed for the referral of coronary heart disease patients to hospital investigations.

Adult↗
PubMed2003

Multiple sclerosis in Finland: incidence trends and differences in relapsing remitting and primary progressive disease courses.

OBJECTIVE: To compare the secular trends and geographical differences in the incidence of relapsing-remitting (RRMS) and primary progressive multiple sclerosis (PPMS) in Finland, and to draw inferences about aetiological differences between the two forms of the disease. METHODS: New multiple sclerosis cases in southern Uusimaa and the western districts Vaasa and Seinäjoki of Finland in 1979-1993 were verified from hospital records and classified into RRMS and PPMS. Patients met the Poser criteria for definite multiple sclerosis or otherwise satisfied the criteria for PPMS. Disease course was categorised by the same neurologist. Crude and age adjusted incidence in 1979-1993 was estimated. RESULTS: During 1979-1993 the age adjusted incidence was 5.1 per 100 000 person-years in Uusimaa, 5.2 in Vaasa, and 11.6 in Seinäjoki. The rates in Uusimaa remained stable, while a decrease occurred in Vaasa and an increase in Seinäjoki. Between 1979-86 and 1987-93 the incidence of PPMS increased in Seinäjoki from 2.6 to 3.7 per 10(5) and decreased in Vaasa from 1.9 to 0.2 per 10(5); the trends were similar for RRMS. CONCLUSIONS: There are significant differences in secular trends for multiple sclerosis incidence in Finland by geographical area, but these are similar for PPMS and RRMS. The recent changes point to locally acting environmental factors. The parallel incidence trends for RRMS and PPMS suggest similar environmental triggers for the two clinical presentations of multiple sclerosis.

Adolescent↗
PubMed1993

Prospects of carrier screening of aspartylglucosaminuria in Finland.

The frequency of carriers of the AGUFin mutation, the predominant mutation causing aspartylglucosaminuria in Finland, was determined in a population sample comprising 553 newborns from a delivery hospital in southern Finland, and 607 from a hospital in northern Finland. The AGUFin point mutation was identified from cord blood samples using the PCR-based, solid-phase minisequencing method. Nineteen carriers of the AGUFin mutation were detected, 8 (1:69) in the sample from the southern and 11 (1:55) from the northern population, respectively. The solid-phase minisequencing method proved to be rapid and convenient for the detection of the AGUFin mutation, and can readily be applied in large-scale carrier screening at the population level.

Amino Acid Metabolism, Inborn Errors↗
PubMed2005

Trends in fatal and nonfatal strokes among persons aged 35 to > or =85 years during 1991-2002 in Finland.

BACKGROUND AND PURPOSE: Declining trends in the incidence and mortality of stroke have been observed in Finland since the beginning of the 1980s until 1997. In this study we analyzed the trends in fatal and nonfatal strokes in Finland during 1991-2002. METHODS: The Finnish Hospital Discharge Register was linked to the National Causes of Death Register to produce a Cardiovascular Disease Register, which includes data on 410 760 cerebrovascular events (International Statistical Classification of Diseases, 10th Revision [ICD-10] codes I60-I69) in patients aged > or =35 years in 1991-2002. RESULTS: Age-standardized incidence of first-ever stroke (ICD-10 codes I60-I64, excluding I63.6) per 100 000 persons declined during 1991-2002 annually by 2.2% (95% CI, -2.4% to -1.9%) among men and 2.5% (-2.8% to -2.2%) among women aged 35 to 74 years. In patients aged 75 to 84 years, the change in the incidence of first-ever stroke was -2.6% per year (-3.0% to -2.2%) among men and -3.2% per year (-3.5% to -2.9%) among women. A similar trend was observed also in the oldest age group, in patients aged > or =85 years. Among patients aged 35 to 74 years, the 28-day case fatality of first-ever stroke declined annually by 3.2% (-3.9% to -2.5%) among men and by 3.0% (-3.8% to -2.2%) among women. A significant decrease was found in the 28-day case fatalities of all subtypes of stroke in this age group. CONCLUSIONS: The favorable development in stroke incidence, mortality, and case-fatality has continued in Finland during 1991-2002.

Adult↗
PubMed1997

Trends in case-fatality of stroke in Finland during 1983 to 1992.

BACKGROUND AND PURPOSE: Stroke mortality has been declining in Finland during the past 20 years. It is not known, however, whether this favorable development is attributable to the decline in the incidence or case-fatality of stroke. For this reason we examined the trends in case-fatality of stroke, including trends by subtype of stroke. METHODS: The analyses were carried out using data of the community-based FINMONICA Stroke Register, which was operating in three geographic areas of Finland during 1983 to 1992. All stroke events (n = 11,171) in persons aged 35 to 74 years were included in this register. RESULTS: The 28-day case-fatality of stroke fell yearly by 3.6% (P = .01) in men and by 2.6% (P = .2) in women. At the end of the study period, the average 28-day case-fatality of all strokes was 20% in men and 21% in women. Considerable differences by subtype of stroke were observed. The 28-day case-fatalities at the end of the study period were in men-56% for subarachnoid hemorrhage, 42% for intracerebral hemorrhage, and 14% for cerebral infarction. In women, the corresponding figures were 49%, 49%, and 14%. The 28-day case-fatality of subarachnoid hemorrhage did not change during the study period, but for intracerebral hemorrhage, a significant decline was observed in men and there was a declining trend also in women. The 28-day case-fatality of cerebral infarction declined significantly in both genders. CONCLUSIONS: With the exception of subarachnoid hemorrhage, the 28-day case-fatality of stroke has fallen in Finland. It is likely that this fall has contributed to the decline in stroke mortality.

Adult↗
PubMed1995

A comparative study of trends in mortality rates of the ageing population in Norway, Sweden, Denmark, and Finland, 1966-1986.

The populations of Finland and the three Scandinavian countries (Denmark, Norway and Sweden) have experienced relatively marked differences regarding trends in mortality rates since the Second World War. To assess factors that might contribute to these differences, a cohort analysis was performed based upon vital statistics for the age category 45 years to 89 years, from the four countries, for the period 1966-86. The results of log-linear modelling, which included the effects of age, period, and cohort, on mortality rates, revealed differences in the effect of age parameters on mortality between Finland and the three Scandinavian countries. These differences may be related to a genetic component. Differences in patterns of mortality rates over time relating to period and cohort effects indicate a differential development in lifestyle-related risk factors associated with the major causes of death. Based on differences in goodness-of-fit of the log-linear models, it is suggested that the Finnish population has experienced a more heterogeneous development in mortality over time than has the Scandinavian. This may be related to the greater social inequities that have existed in Finland than in Scandinavia during the decades under study.

Aged↗
PubMed2002

Endovascular treatment of aortic aneurysms in Finland: the first four years' experience.

BACKGROUND AND AIMS: In this study the results of endovascular treatment of aortic aneurysms in Finland are presented and compared to the results of the Eurostar registry. MATERIAL AND METHODS: A total of 229 patients with aortic aneurysm were treated in five different Finnish centres during 1996-2000. The data of these patients were collected prospectively by surgeon or interventional radiologist involved. During the same period of time 2464 patients were registered in the Eurostar registry. RESULTS: The procedure was performed successfully in 97% of patients in Finland, and the 30-day mortality was 0,9%. A graft limb thrombosis was detected in 9% of the patients in Finland. A permanent primary endoleak at the first 30-day control was seen in 23 patients (10%). During the follow-up 17 secondary endoleaks (7%) were detected. A secondary intervention was necessary in 26% of the patients. Three patients (1.3%) had late rupture of the abdominal aortic aneurysm. CONCLUSIONS: According to the Finnish short-time results, endovascular treatment of aortic aneurysms is safe and associated with relatively low morbidity and mortality. The mid-term results are more disappointing with relatively many graft thromboses and endoleaks, and a frequent need of secondary interventions.

Adult↗
PubMed2002

Fatal firearm injuries in Finland: a nationwide survey.

BACKGROUND AND AIMS: Treatment of life-threatening firearm injuries represents major challenges to the involved medical staff. The aim of the study was to assess numbers, natures and injury patterns of fatal incidents by firearms in Finland over a 10-year period. MATERIAL AND METHODS: Retrospective analysis of all firearm-related deaths during the 10-year period from January 1990 to December 1999. Death certificates were obtained and reviewed with detailed analysis of non-suicidal deaths. RESULTS: Over the 10-year period 1990 to 1999, 452 individuals (equivalent to 1.8 cases per 100 000 person-years) died in Finland as a result of accidental or violent shooting. There were no significant changes in numbers of cases from year to year. The male-female ratio was 7:3. The mean age of the victims was 32 years. The shooting incident had been classified as an assault in 78% of cases. Its nature was unspecified in 13% of cases and clearly accidental in 9%. The predominant anatomical site of fatal injury following assault was the chest in 43%, the head in 42% and the abdomen in 8% of the cases. After accidental or unspecified nature shooting, the predominant site of injury was the head in 68%, followed by the chest in 16% and the abdomen in 10% of the cases. Most victims (86%) died at the scene of the shooting. Only 14% were alive at hospital admittance. Most hospitalised victims died within 24 hours of admission. CONCLUSIONS: The annual incidence of fatal non-suicidal firearm injuries did not change significantly in Finland between 1990 and 1999. Victims of such injuries required only minimal hospital resources because in most cases they died at the scene of the shooting. The results of the study reported indicate that efforts to prevent fatal injuries from use of firearms or diminish their number should be focused mainly on prevention of firearm related assault.

Abdominal Injuries↗
PubMed2006

Pelodera (syn. Rhabditis) strongyloides as a cause of dermatitis--a report of 11 dogs from Finland.

BACKGROUND: Pelodera (Rhabditis) strongyloides is a small saprophytic nematode that lives in decaying organic matter. On rare occasions, it can invade the mammalian skin, causing a pruritic, erythematous, alopecic and crusting dermatitis on skin sites that come into contact with the ground. Diagnosis of the disease is based on case history (a dog living outdoors on damp straw bedding) with characteristic skin lesions and on the demonstration of typical larvae in skin scrapings or biopsy. Pelodera (rhabditic) dermatitis cases have been reported mainly from Central European countries and the United States. CASE PRESENTATION: During 1975-1999, we verified 11 canine cases of Pelodera dermatitis in Finland. The cases were confirmed by identifying Pelodera larvae in scrapings. Biopsies for histopathology were obtained from three cases, and typical histopathological lesions (epidermal hyperplasia, epidermal and follicular hyperkeratosis, folliculitis and furunculosis with large numbers of nematode larvae of 25-40 microm of diameter within hair follicles) were present. The Pelodera strongyloides dermatitica strain from the first verified case in Finland has been maintained in ordinary blood agar in our laboratory since 1975. Light microscopy (LM) and scanning electron microscopy (SEM) studies were employed to obtain detailed morphological information about the causative agent. The rhabditiform oesophagus at all developmental stages, the morphology of the anterior end of the nematode, copulatory bursa and spicules of the male and the tail of the female were the most important morphological features for identifying P. strongyloides. CONCLUSION: These cases show that Pelodera dermatitis occurs in Finland, and also farther north than described earlier in the literature. This condition should be considered when a dog living outdoors has typical skin lesions situated at sites in contact with the ground as the main presenting clinical feature. The fastest and easiest way to confirm the diagnosis is to demonstrate typical larvae in skin scrapings. In uncertain cases, skin biopsy and culturing of the worms are recommended as supplementary diagnostic procedures.

Animals↗
PubMed2004

Infant vitamin d supplementation and allergic conditions in adulthood: northern Finland birth cohort 1966.

Allergen-induced secretion of Th2-type cytokines and IgE production have recently been reported to be increased in mice treated with 1,25(OH)(2)D, the active form of vitamin D. Our objective was to investigate whether vitamin D supplementation in infancy is associated with the risk of atopy, allergic rhinitis, and asthma. The Northern Finland Birth Cohort consists of all individuals in the two most northern provinces of Finland who were due to be born in 1966. Data on vitamin D supplementation during the first year of life was obtained in 1967. Current asthma and allergic rhinitis were reported at age 31 years (n = 7,648), and atopy determined by skin-prick test in a sub-sample still living in northern Finland or the Helsinki area (n = 5,007). The prevalence of atopy and allergic rhinitis at age 31 years was higher in participants who had received vitamin D supplementation regularly during the first year compared to others (OR 1.46, 95%CI 1.4-2.0, and OR 1.66, 95%CI 1.1-1.6, respectively). A similar association was observed for asthma (OR 1.35, 95%CI 0.99-1.8). These associations persisted after adjustment for a wide range of behavioral and social factors (adjusted: OR 1.33 for all, P = 0.01 for atopy, P = 0.001 for allergic rhinitis, and P = 0.08 for asthma). We observed an association between vitamin D supplementation in infancy and an increased risk of atopy and allergic rhinitis later in life. Further study is required to determine whether these observations reflect long-term effects on immune regulation or differences in unmeasured determinants of vitamin D supplementation.

Asthma↗
PubMed2001

Smoking, respiratory symptoms, and diseases : a comparative study between northern Sweden and northern Finland: report from the FinEsS study.

STUDY OBJECTIVES: The influences of different smoking categories on the prevalence of respiratory symptoms, asthma, and chronic bronchitis have been examined in the most northern province of Sweden, Norrbotten, and in Lapland, Finland. The two areas have similar geographic and demographic conditions. METHODS AND STUDY POPULATION: The study is a part of the FinEsS studies, which are epidemiologic respiratory surveys in progress in Sweden, Finland, and Estonia. A random sample of 20- to 69-years-olds were invited to answer a postal questionnaire about respiratory symptoms, smoking habits, and occupation. In Norrbotten, 8,333 subjects were invited and 7,104 responded (85%). In Lapland, 8,005 were invited and 6,633 responded (83%). RESULTS: The participation by age and sex was similar in both countries. The prevalence of smokers in Lapland was 32% vs 26% in Norrbotten. Significantly more women than men in Norrbotten were smokers, while the opposite was true for Lapland. Sputum production was the most prevalent symptom in both areas, 25% in Lapland vs 19% in Norrbotten. The prevalence of chronic productive cough was 11% in Lapland and 7% in Norrbotten. Bronchitic symptoms were more prevalent in Lapland among both smokers and nonsmokers. A positive family history of chronic obstructive airway disease together with increased number of consumed cigarettes showed an additive effect for both chronic productive cough and wheezing. The odds ratio (OR) for wheezing during the last 12 months was 3.8 for subjects without a family history of obstructive airway disease who consumed > 14 cigarettes per day compared with nonsmokers, but if the subjects had a family history of obstructive airway disease, the risk for wheezing increased to OR 8.4. CONCLUSION: Bronchitic symptoms were more common in Finland. The difference remained also after correction for demographic variables including smoking habits, age and socioeconomic group, and family history of obstructive airway disease. Identical methods, sample composition, and the high participation rate contribute to the validity of the results. Air pollution, including environmental tobacco smoke, may contribute to the difference. To explain the difference, further analysis and investigations of social and environmental factors as well as genetic factors are needed.

Adult↗
PubMed2005

Deteriorating stage profile of gastrointestinal cancer in Finland.

BACKGROUND: The prognosis of patients with gastrointestinal (GI) cancer is mainly due to the stage of the tumor at the diagnosis. Regardless of several innovations in diagnostic and therapeutic gastroenterology, there is no longitudinal data of the trends of stage profile of patients with gastrointestinal cancer in Finland. AIM: To study the incidence by stage of GI cancer in Finland in the past 15 yr in the entire country as well as in two subpopulations with different population profile: in a population with a small number of residents over 65 yr of age (Jorvi district) and in a population with a large number of residents over 65 yr of age (Kanta-Häme district). METHODS: The hospital discharge records of patients with upper or lower GI cancer between 1986 and 2000 were evaluated in Finland as well as in Jorvi and Kanta-Häme hospital districts. The data were obtained from the National Research and Development Centre for Welfare and Health, from the Centre of Statistics and from the Finnish Cancer Registry. RESULTS: The relative incidence of a localized esophagogastric cancer against more severe stages decreased from 37.9% to 29.3% in the entire country, from 40.8% to 19.1% in Kanta-Häme, and from 44.2% to 33.3% in Jorvi area. Respectively, the relative incidence of localized colorectal cancer decreased from 53.6% to 48.0% in the entire country, from 49.7% to 42.5% in Kanta-Häme, and from 54.5% to 48.4% in Jorvi area. CONCLUSIONS: During the past 15 yr the incidence by stage of both upper and lower GI cancer is deteriorating in the entire country as well as in areas with low and high percentage of residents over 65 yr of age indicating the increase of the more severe cases. The deterioration has become more pronounced in the 1990s, which requires a careful scrutiny of the function of primary diagnostic services.

Aged↗