The Finnish National Programme for Chronic Bronchitis and Chronic Obstructive Pulmonary Disease (COPD) 1998-2007 was set up to reduce the prevalence of COPD, improve COPD diagnosis and care, reduce the number of moderate to severe cases of the disease, and reduce hospitalisations and treatment costs due to COPD. Over 900 events for 25,000 participating healthcare workers were arranged. The major strengths of this programme included multidisciplinary strategies and web-based guidelines in nearly all primary health care centres around the country.
Data from national registries, epidemiological studies and questionnaires were used to measure whether the goals had been reached.
The prevalence of COPD remained unchanged. Smoking decreased in males from 30% to 26% (p
Comment In: Prim Care Respir J. 2011 Jun;20(2):109-1021603847
Chronic obstructive pulmonary disease (COPD) has been associated with coronary mortality. Yet, data about the association between COPD and acute myocardial infarction (MI) remain scarce. We aimed to study airway obstruction as a predictor of MI and coronary mortality among 5576 Finnish adults who participated in a national health examination survey between 1978 and 1980. Subjects underwent spirometry, had all necessary data, showed no indications of cardiovascular disease at baseline, and were followed up through record linkage with national registers through 2011. The primary outcome consisted of a major coronary event-that is, hospitalization for MI or coronary death, whichever occurred first. We specified obstruction using the lower limit of normal categorization. Through multivariate analysis adjusted for potential confounding factors for coronary heart disease, hazard ratios (HRs) (with the 95% confidence intervals in parentheses) of a major coronary event, MI, and coronary death reached 1.06 (0.79-1.42), 0.84 (0.54-1.31), and 1.40 (1.04-1.88), respectively, in those with obstruction compared to others. However, in women aged 30-49 obstruction appeared to predict a major coronary event, where the adjusted HR reached 4.21 (1.73-10.28). In conclusion, obstruction appears to predict a major coronary event in younger women only, whereas obstruction closely associates with the risk of coronary death independent of sex and age.
Mortality correlates with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria of airway obstruction. Yet, little data exist concerning the long-term survival of patients presenting with different levels of obstruction.
We studied the association between all-cause and cause-specific mortality and GOLD stages 1-4 in a 30-year follow-up among 6636 Finnish men and women aged 30 or older participating in the Mini-Finland Health Study between 1978 and 1980.
After adjusting for age, sex, and smoking history, the GOLD stage of the subject showed a strong direct relationship with all-cause mortality, mortality from cardiovascular and respiratory diseases, and cancer. The adjusted hazard ratios of death were 1.27 (95% confidence interval (CI) 1.06-1.51), 1.40 (1.21-1.63), 1.55 (1.21-1.97) and 2.85 (1.65-4.94) for GOLD stages 1-4, respectively, with FEV1/FVC =70% as the reference. The association between GOLD stages 2-4 and mortality was strongest among subjects under 50 years of age at the baseline measurement. Cardiovascular mortality increased consistently for all GOLD stages.
Airway obstruction indicates an increased risk for all-cause mortality according to the severity of the GOLD stage. We found that even stage 1 carries a risk for cardiovascular death independently of smoking history and other known risk factors.
There is little information on lung function and respiratory diseases in people with psychosis.
To compare the respiratory health of people with psychosis with that of the general population.
In a nationally representative sample of 8028 adult Finns, lung function was measured by spirometry. Information on respiratory diseases and symptoms was collected. Smoking was quantified with serum cotinine levels. Psychotic disorders were diagnosed utilising the Structured Clinical Interview for DSM-IV (SCID-I) and medical records.
Participants with schizophrenia and other non-affective psychoses had significantly lower lung function values compared with the general population, and the association remained significant for schizophrenia after adjustment for smoking and other potential confounders. Schizophrenia was associated with increased odds of pneumonia (odds ratio (OR) = 4.9), chronic obstructive pulmonary disease (COPD, OR = 4.2) and chronic bronchitis (OR = 3.8); and with high cotinine levels.
Schizophrenia is associated with impaired lung function and increased risk for pneumonia, COPD and chronic bronchitis.
The multidrug-resistant tuberculosis (MDR-TB) epidemic in Eastern Europe bordering Finland has raised worries concerning the risk of disease in near-frontier contacts.
Our aim was to find out the amount of multidrug resistance, characterise the resistance profiles and evaluate the outcome of treatment. In addition, we analysed the isolates by molecular genotyping methods in order to evaluate the origins of the resistant isolates.
All culture-verified new MDR-TB cases diagnosed during the years 1994-2005 were included. Treatment outcome categories of the World Health Organization collected 36 months from the beginning of the treatment were used for outcome monitoring. The IS6110 restriction fragment length polymorphism (RFLP) test and spoligotyping were carried out according to standard recommendations.
There were 19 culture-confirmed MDR-TB cases during the study period. The mean age was 39.9 years. The proportion of foreign-born patients was 73.7%. The outcome of the treatment was favourable in 14 cases (73.7%). When the spoligotypes were compared with the international spoligotype database, a corresponding spoligotype was found in 17 cases. Seven (36.8%) patients were infected by an isolate belonging to the Beijing genotype (SIT1).
It is very probable that cases of MDR-TB in Finland are mostly caught abroad. Risk of gaining disease in near-frontier contacts seems to be very low.
Autopsy confirmed deaths due to miliary tuberculosis in Finland were analysed in order to improve the diagnosis of the disease. Tuberculosis deaths from mortality statistics were examined in order to identify miliary tuberculosis deaths, and the medical records of the autopsied cases were studied. The deceased were divided into 2 groups, 'overt' disease and 'cryptic' disease, on the basis of chest X-ray findings. There were 114 overt (mean age 79 y) and 140 cryptic (mean age 78 y) miliary tuberculosis cases. The majority of patients in both groups were females. There was no difference between the groups in history of previous tuberculosis, in predisposing factors or in symptoms. Suspicion of tuberculosis was recorded before death in 86% in overt form and in 53% in cryptic form. In overt disease 50% of the patients received chemotherapy, but in cryptic form only a quarter were treated. In one third of cases autopsy had been carried out without suspicion of tuberculosis. Suspicion of tuberculosis had arisen too seldom, especially in the cryptic group. On the other hand, those suspected to have tuberculosis were not promptly treated with the appropriate chemotherapy. Absence of suspicion and delayed diagnosis mean increased risk in health care and at autopsy.
The number of tuberculosis cases in Finland has decreased. Cases among immigrants have, however, increased, and the disease may not be recognized early enough.
We describe four group exposures to tuberculosis that occurred in Finland, the index patient coming from a country with a high incidence rate of tuberculosis.
Over 900 persons were exposed to tuberculosis. Coordination of the surveys was hampered by the fact that several healthcare operators participated in the study. Three index patients had drug-resistant tuberculosis, one of which was multidrug resistant.
Extensive operations of tracking and prevention could have been avoided, if the symptoms would have been recognized earlier.
We investigated the epidemiology and prevalence of potential risk factors of tuberculosis (TB) recurrence in a population-based registry cohort of 8084 TB cases between 1995 and 2013.
An episode of recurrent TB was defined as a case re-registered in the National Infectious Disease Register at least 360 days from the date of the initial registration. A regression model was used to estimate risk factors for recurrence in the national cohort. To describe the presence of known risk factors for recurrence, patient records of the recurrent cases were reviewed for TB diagnosis confirmation, potential factors affecting the risk of recurrence, the treatment regimens given and the outcomes of the TB episodes preceding the recurrence.
TB registry data included 84 patients, for whom more than 1 TB episode had been registered. After a careful clinical review, 50 recurrent TB cases (0.6%) were identified. The overall incidence of recurrence was 113 cases per 100,000 person-years over a median follow up of 6.1 years. For the first 2 years, the incidence of recurrence was over 200/100000. In multivariate analysis of the national cohort, younger age remained an independent risk factor at all time points, and male gender and pulmonary TB at 18 years of follow-up. Among the 50 recurrent cases, 35 patients (70%) had received adequate treatment for the first episode; in 12 cases (24%) the treating physician and in two cases (4%) the patient had discontinued treatment prematurely. In one case (2%) the treatment outcome could not be assessed.
In Finland, the rate of recurrent TB was low despite no systematic directly observed therapy. The first 2 years after a TB episode had the highest risk for recurrence. Among the recurrent cases, the observed premature discontinuation of treatment in the first episode in nearly one fourth of the recurrent cases calls for improved training of the physicians.
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