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

https://arctichealth.org/en/permalink/ahliterature168103
Source
Thorax. 2006 Aug;61(8):663-70
Publication Type
Article
Date
Aug-2006
Author
T. Haahtela
L E Tuomisto
A. Pietinalho
T. Klaukka
M. Erhola
M. Kaila
M M Nieminen
E. Kontula
L A Laitinen
Author Affiliation
Skin and Allergy Hospital, Helsinki University Central Hospital, P O Box 160, FIN-00029 HUS, Finland. tari.haahtela@hus.fi
Source
Thorax. 2006 Aug;61(8):663-70
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Adult
Anti-Asthmatic Agents - therapeutic use
Asthma - economics - epidemiology - therapy
Child
Communication
Cost of Illness
Disabled Persons
Emergency Treatment - statistics & numerical data
Finland - epidemiology
Health Promotion - economics - organization & administration - trends
Hospitalization - statistics & numerical data
Humans
Incidence
Insurance, Disability - economics
Interprofessional Relations
National Health Programs - economics - trends
Pharmaceutical Services - standards
Primary Health Care
Program Evaluation
Smoking - epidemiology
Abstract
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.
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.
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).
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.
Notes
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PubMed ID
16877690 View in PubMed
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Acute childhood asthma in Finland: a retrospective review of hospital admissions from 1976 to 1995.

https://arctichealth.org/en/permalink/ahliterature196376
Source
Pediatr Allergy Immunol. 2000 Nov;11(4):236-40
Publication Type
Article
Date
Nov-2000
Author
K. Malmström
K. Korhonen
M. Kaila
T. Dunder
M. Nermes
T. Klaukka
S. Sarna
K. Juntunen-Backman
Author Affiliation
Hospital for Children and Adolescents, Helsinki University Central Hospital, Finland. kristiina.malmstrom@pp.fimnet.fi
Source
Pediatr Allergy Immunol. 2000 Nov;11(4):236-40
Date
Nov-2000
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Asthma - drug therapy - epidemiology - etiology
Child
Child, Preschool
Female
Finland - epidemiology
Hospitalization
Humans
Infant
Infant, Newborn
Male
Retrospective Studies
Time Factors
Abstract
The prevalence of childhood asthma has increased markedly in many Western societies during recent decades. We wanted to study whether the incidence and severity of childhood asthma in Finland had changed during the time-period 1976-95. Hospital admission rates from 1976 to 1995 were obtained from the National Hospital Discharge Register and the individual intensive care unit (ICU) registers of the five university hospitals in Finland. The number and length of treatment periods for childhood asthma in all Finnish hospitals and at the ICUs of the five university hospitals were analyzed. The number of children receiving special reimbursement for asthma medication costs was obtained from the central register of the Social Insurance Institution. The data showed that during the time-period investigated, hospital admissions as a result of asthma had increased by 2.8-fold, but the mean length of hospital stay had more than halved (from 7.3 to 2.6 days). The increase in hospital admissions showed greatest significance in the 0-4-year age-group among both sexes (p
Notes
Comment In: Pediatr Allergy Immunol. 2001 Jun;12(3):173-411473683
PubMed ID
11110578 View in PubMed
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Adoption of an Internet-based patient education programme in psychiatric hospitals.

https://arctichealth.org/en/permalink/ahliterature129777
Source
J Psychiatr Ment Health Nurs. 2011 Dec;18(10):914-23
Publication Type
Article
Date
Dec-2011
Author
M. Anttila
M. Välimäki
M. Koivunen
T. Luukkaala
M. Kaila
A. Pitkänen
R. Kontio
Author Affiliation
Finnish Post-Graduate School in Nursing Science, University of Turku, Finland. minna.anttila@utu.fi
Source
J Psychiatr Ment Health Nurs. 2011 Dec;18(10):914-23
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Attitude to Computers
Computer-Assisted Instruction - methods
Diffusion of Innovation
Female
Finland
Hospitals, Psychiatric
Humans
Internet
Male
Middle Aged
Patient Education as Topic - methods
Program Evaluation - methods
Psychiatric Nursing - methods
Questionnaires
Young Adult
Abstract
Internet-based patient support systems are widely assumed to predict a future trend in patient education. Coherent information is still lacking on how patient education is adopted in psychiatric hospitals and how information technology is used in it. Our aim was to describe nurses' adoption of an Internet-based patient education programme and the variables explaining it. The study was based on Rogers' model of the diffusion of innovation. The Internet-based patient education sessions were carried out by nurses on nine acute psychiatric inpatient wards in two Finnish hospitals. They were evaluated with reports and analysed statistically. Out of 100 nurses, 83 adopted the programme during the study period. The nurses fell into Rogers' groups, late majority (72%), laggards (17%), early majority (7%), early adopters (3%) and innovators (1%). Three groups were formed according to their activity: laggards, late majority, adopters (including early majority, early adopters, innovators). There was a statistical difference between the nurses' programme adoption between the two hospitals (P= 0.045): more laggards (65% vs. 35%) and adopters (73% vs. 27%) in the same hospital. The findings help to provide insight into the contexts and settings when adopting information technology programmes in the area of mental health care.
PubMed ID
22070578 View in PubMed
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Allergic rhinitis in school-aged children with asthma - still under-diagnosed and under-treated? A retrospective study in a children's hospital.

https://arctichealth.org/en/permalink/ahliterature149718
Source
Pediatr Allergy Immunol. 2010 Feb;21(1 Pt 2):e149-54
Publication Type
Article
Date
Feb-2010
Author
M. Ruokonen
M. Kaila
R. Haataja
M. Korppi
M. Paassilta
Author Affiliation
Paediatric Research Centre, Tampere University and University Hospital, Tampere, Finland. minna.ruokonen@uta.fi
Source
Pediatr Allergy Immunol. 2010 Feb;21(1 Pt 2):e149-54
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Asthma - diagnosis - drug therapy - epidemiology - physiopathology
Child
Disease Progression
Female
Finland
Hospitals
Humans
Male
Nasal Obstruction
Population
Prevalence
Retrospective Studies
Rhinitis, Allergic, Perennial - diagnosis - drug therapy - epidemiology - physiopathology
Rhinitis, Allergic, Seasonal - diagnosis - drug therapy - epidemiology - physiopathology
Abstract
Allergic rhinitis (AR) and asthma can be considered as manifestations of the same disease entity. The treatment of AR may improve also asthma symptoms. The aim of the study was to evaluate, how often AR is diagnosed and treated in patients with asthma. A retrospective chart review in the allergy and asthma unit of a secondary paediatric hospital. From 903 eligible 7- to 15-year-old children with doctor-diagnosed asthma, 372 were randomly included in the study. In all, 229 patients (61.6%, 95% CI: 56.5-66.4%) had symptoms presumptive for AR. The diagnosis of AR was recorded in the patient records only for 87 patients (23.4%, 95% CI: 19.4-28.0). There was evidence that children with AR or nasal symptoms had more severe asthma; 35% of the patients with AR, 23% with nasal symptoms without AR diagnosis and 12% without nasal symptoms required inhaled steroids and long-acting beta-agonists for asthma (p = 0.035). AR was both under-diagnosed and under-treated in school-aged children with doctor-diagnosed asthma.
PubMed ID
19594853 View in PubMed
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Allergic sensitization and microbial load--a comparison between Finland and Russian Karelia.

https://arctichealth.org/en/permalink/ahliterature165130
Source
Clin Exp Immunol. 2007 Apr;148(1):47-52
Publication Type
Article
Date
Apr-2007
Author
T. Seiskari
A. Kondrashova
H. Viskari
M. Kaila
A-M Haapala
J. Aittoniemi
M. Virta
M. Hurme
R. Uibo
M. Knip
H. Hyöty
Author Affiliation
Department of Virology, University of Tampere, Finland. tapio.seiskari@uta.fi
Source
Clin Exp Immunol. 2007 Apr;148(1):47-52
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Allergens - immunology
Animals
Antibodies, Bacterial - blood
Antibodies, Protozoan - blood
Antibodies, Viral - blood
Bacteria - isolation & purification
Betula - immunology
Cats - immunology
Child
Enterovirus B, Human - immunology - isolation & purification
Female
Finland - epidemiology
Helicobacter pylori - immunology - isolation & purification
Hepatitis A virus - immunology - isolation & purification
Humans
Hypersensitivity - ethnology - immunology - microbiology
Immunoglobulin E - blood
Male
Ovalbumin - immunology
Pollen - immunology
Russia - epidemiology
Toxoplasma - immunology - isolation & purification
Viruses - isolation & purification
Abstract
Epidemiological data have indicated that some infections are associated with a low risk of allergic diseases, thus supporting the idea (hygiene hypothesis) that the microbial load is an important environmental factor conferring protection against the development of allergies. We set out to test the hygiene hypothesis in a unique epidemiological setting in two socio-economically and culturally markedly different, although genetically related, populations living in geographically adjacent areas. The study cohorts included 266 schoolchildren from the Karelian Republic in Russia and 266 schoolchildren from Finland. The levels of total IgE and allergen-specific IgE for birch, cat and egg albumen were measured. Microbial antibodies were analysed against enteroviruses (coxsackievirus B4), hepatitis A virus, Helicobacter pylori and Toxoplasma gondii. Although total IgE level was higher in Russian Karelian children compared to their Finnish peers, the prevalence of allergen-specific IgE was lower among Russian Karelian children. The prevalence of microbial antibodies was, in turn, significantly more frequent in the Karelian children, reflecting the conspicuous difference in socio-economic background factors. Microbial infections were associated with lower risk of allergic sensitization in Russian Karelian children, enterovirus showing the strongest protective effect in a multivariate model. The present findings support the idea that exposure to certain infections, particularly in childhood, may protect from the development of atopy. Enterovirus infections represent a new candidate to the list of markers of such a protective environment. However, possible causal relationship needs to be confirmed in further studies.
Notes
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PubMed ID
17302731 View in PubMed
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Asthma Programme in Finland: Did the use of secondary care resources become more rational?

https://arctichealth.org/en/permalink/ahliterature145037
Source
Respir Med. 2010 Jul;104(7):957-65
Publication Type
Article
Date
Jul-2010
Author
L E Tuomisto
M. Erhola
T. Luukkaala
H. Puolijoki
M M Nieminen
M. Kaila
Author Affiliation
Seinäjoki Central Hospital, Huhtalantie 53, FI 60220 Seinäjoki, Finland. leena.tuomisto@epshp.fi
Source
Respir Med. 2010 Jul;104(7):957-65
Date
Jul-2010
Language
English
Publication Type
Article
Keywords
Adult
Asthma - epidemiology - therapy
Female
Finland - epidemiology
Health Resources - utilization
Humans
Male
Medical Audit
Middle Aged
Quality Assurance, Health Care - standards
Referral and Consultation - utilization
Retrospective Studies
Abstract
The aims were to evaluate the profile of newly diagnosed adult asthma cases and the approach adopted to the secondary care management at the launch of the Finnish asthma programme in 1994 and seven years later, in 2001.
A retrospective medical record audit was made of non-acutely referred patients with asthma in 1994 (n=165) and in 2001 (n=133). Clinical profile data, numbers of out-patient visits and periods of in-patient care before and after asthma diagnosis were gathered from referral letters and secondary care records.
The newly diagnosed asthma patients in 2001 were older, more obese and had more co-morbidities. The main asthma symptoms, such as dyspnoea, wheezing and cough, occurred equally in both years but were more often periodic than daily in 2001. Wheezing during auscultation was significantly less common in 2001. The diagnostic process was associated to a history of asthma in first-degree relatives (OR 5.34, 95% CI 1.12-24.49) in 1994 and a visit to a nurse prior to that to a physician (OR 3.13, 95% CI 1.17-8.37) in 2001. Secondary care visits per new case of asthma (7.3 in 1994 vs. 5.4 in 2001) and days in hospital (3.6 in 1994 vs. 0.95 in 2001) decreased significantly.
The profile of asthma diagnosed in secondary care indicates milder disease with more co-morbidities in 2001 than in 1994.Trends towards assigning a more active role on the part of primary care physicians and more rational use of secondary care resources in the management of asthma were found.
PubMed ID
20207125 View in PubMed
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The asthma programme of Finland: an evaluation survey in primary health care.

https://arctichealth.org/en/permalink/ahliterature185016
Source
Int J Tuberc Lung Dis. 2003 Jun;7(6):592-8
Publication Type
Article
Date
Jun-2003
Author
M. Erhola
R. Mäkinen
K. Koskela
V. Bergman
T. Klaukka
M. Mäkelä
L. Tirkkonen
M. Kaila
Author Affiliation
Finnish Lung Health Association, Helsinki, Finland.
Source
Int J Tuberc Lung Dis. 2003 Jun;7(6):592-8
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Asthma - diagnosis - therapy
Clinical Competence - standards - statistics & numerical data
Finland
Health Care Surveys - standards - statistics & numerical data
Humans
Outcome Assessment (Health Care) - standards - statistics & numerical data
Physician's Practice Patterns - standards - statistics & numerical data
Physicians, Family - standards - statistics & numerical data
Practice Guidelines as Topic - standards
Primary Health Care - standards - statistics & numerical data
Program Evaluation - standards - statistics & numerical data
Quality of Health Care - standards - statistics & numerical data
Time Factors
Abstract
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.
A descriptive type-2 evaluation (managerial monitoring of a policy implementation), based on operationalised statements of the Asthma Programme.
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.
The basic structure of equipment and organisation for the diagnosis and treatment of asthma has been set up in the primary health care services.
PubMed ID
12797704 View in PubMed
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Corticosteroid therapy and need for hospital care in wheezing preschool children.

https://arctichealth.org/en/permalink/ahliterature196128
Source
Eur J Clin Pharmacol. 2000 Nov;56(8):591-6
Publication Type
Article
Date
Nov-2000
Author
P. Csonka
J. Mertsola
T. Klaukka
M. Kaila
M R Ståhlberg
P. Ashorn
Author Affiliation
University of Tampere, Medical School, P.O. Box 607, FIN-33101 Tampere, Finland. peter.csonka@uta.fi
Source
Eur J Clin Pharmacol. 2000 Nov;56(8):591-6
Date
Nov-2000
Language
English
Publication Type
Article
Keywords
Adrenal Cortex Hormones - economics - therapeutic use
Anti-Asthmatic Agents - therapeutic use
Anti-Inflammatory Agents - economics - therapeutic use
Asthma - complications - drug therapy - epidemiology
Child
Child, Preschool
Emergency Service, Hospital
Female
Finland - epidemiology
Hospitalization
Humans
Incidence
Infant
Length of Stay
Male
Respiratory Sounds - etiology
Retrospective Studies
Treatment Outcome
Abstract
To study the frequency of corticosteroid therapy and the use of inpatient care for preschool children with wheezing in two regions in Finland.
The Finnish Social Insurance Institution database on refundable asthma medication indicated that 1.18% of children in Tampere and 2.37% in Turku used inhaled corticosteroids regularly. To clarify the difference, hospital records of 800 randomly chosen 0.5-6.9-year-old children who had been treated for wheezing in Tampere or Turku University Hospital during 1995-1996 were retrospectively analysed.
The incidences of wheezing-related emergency room (ER) index visits were 11.0 visits/year/1000 children both in Tampere and Turku. Oral corticosteroids were given to 2.5% versus 24.2% of children in ER and 10.6% versus 89.7% in hospital ward in Tampere and Turku, respectively. Hospitalisation rates were 44.8% in Tampere and 36.8% in Turku (95% confidence interval for the difference 1.2-14.8%). In both regions, children with prior inhaled corticosteroid therapy needed less inpatient care. Mean duration of hospitalisation was 3.4 days in Tampere and only 1.4 days in Turku. Recurrent visits in 6 months were more common in Tampere.
There were marked regional differences in the management of preschool children with wheezing. On a population level, frequent use of corticosteroid therapy was associated with reduced hospital admissions.
PubMed ID
11151750 View in PubMed
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Cow's milk allergy in children: adherence to a therapeutic elimination diet and reintroduction of milk into the diet.

https://arctichealth.org/en/permalink/ahliterature141742
Source
Eur J Clin Nutr. 2010 Oct;64(10):1080-5
Publication Type
Article
Date
Oct-2010
Author
J. Tuokkola
M. Kaila
C. Kronberg-Kippilä
H K Sinkko
T. Klaukka
P. Pietinen
R. Veijola
O. Simell
J. Ilonen
M. Knip
S M Virtanen
Author Affiliation
Department of Public Health, University of Helsinki, Helsinki, Finland. jetta.tuokkola@iki.fi
Source
Eur J Clin Nutr. 2010 Oct;64(10):1080-5
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Animals
Cheese
Child Development - physiology
Child, Preschool
Cohort Studies
Diet
Diet Records
Family
Female
Finland
Humans
Infant
Infant Formula
Male
Milk - adverse effects
Milk Hypersensitivity - diet therapy - physiopathology
Milk Proteins - administration & dosage - adverse effects - immunology
Patient Compliance - statistics & numerical data
Yogurt
Abstract
The basic treatment for cow's milk allergy (CMA) is the elimination of all cow's milk proteins (CMP) from the diet. This study aimed at characterizing the diet of children with a diagnosis of CMA, to assess the degree of adherence to the elimination diet and to evaluate the factors associated with the adherence and age of recovery.
From a birth cohort study, food records of 267 children diagnosed with CMA were studied to define how strictly the elimination diet was adhered to. Subsequent food records were studied to assess the age at reintroduction of milk products in the child's diet.
The families adhered to the elimination diet of the child with extreme accuracy in 85% of the cases. Older and monosensitized children had more often small amounts of CMP in their diet, possibly because of the absence of nutritional information by a dietitian/nutritionist. Adherence to the diet was neither related to any other sociodemographic factor studied nor to the age at reintroduction of milk products into the diet.
The therapeutic elimination diet of children diagnosed with CMA was well adhered to. Low intakes of vitamin D, calcium, and riboflavin are of concern in children who follow or have followed a cow's milk-free diet.
PubMed ID
20683464 View in PubMed
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Diagnosis of food allergy in Finland: survey of pediatric practices.

https://arctichealth.org/en/permalink/ahliterature196375
Source
Pediatr Allergy Immunol. 2000 Nov;11(4):246-9
Publication Type
Article
Date
Nov-2000
Author
M. Kaila
T. Vanto
E. Valovirta
A. Koivikko
K. Juntunen-Backman
Author Affiliation
Department of Pediatrics, Tampere University Hospital, Finland. minna.kaila@uta.fimnet.fi
Source
Pediatr Allergy Immunol. 2000 Nov;11(4):246-9
Date
Nov-2000
Language
English
Publication Type
Article
Keywords
Child
Double-Blind Method
Finland
Food Hypersensitivity - diagnosis
Humans
Abstract
Food-related symptoms are common in the first years of life, and food allergy should be diagnosed using an elimination challenge test. We surveyed Finnish hospital-based pediatricians using a self-completion questionnaire to ascertain the current clinical practice: 24 of the 25 pediatricians (representing 24 of 25 hospitals) so approached gave evaluable responses. Food allergies were diagnosed using a clinical elimination challenge test in patients with suspected allergy to cow's milk or cereals (wheat, rye, barley, oats). Of the 24 departments, four reported that they performed challenge in all patients before diagnosis was confirmed, and 14 performed challenge in most patients before diagnosis was confirmed. The duration of the challenge varied from 0.5 to 7 days (median 4 days). A 1-week challenge was used in eight hospitals. The double-blind placebo-controlled challenge was used in seven of the hospitals, and in none routinely. Altogether, 16 of the respondents agreed that there is a need to establish clinical guidelines for the diagnosis of food allergy. In conclusion, despite a long tradition of medical education on the subject of food allergy, practices vary for its diagnosis. There is therefore a requirement for appropriate clinical guidelines.
PubMed ID
11110580 View in PubMed
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26 records – page 1 of 3.