• 【在芬兰筛查石棉引起的疾病。】 复制标题 收藏 收藏
    DOI:10.1002/(SICI)1097-0274(199609)30:3<241::AID-AJIM1 复制DOI
    作者列表:Koskinen K,Rinne JP,Zitting A,Tossavainen A,Kivekäs J,Reijula K,Roto P,Huuskonen MS
    BACKGROUND & AIMS: Screening for asbestos-induced diseases in Finland was carried out in 1990-1992 as a part of the Asbestos Program of the Finnish Institute of Occupational Health. The aim of the present study was to find the workers who had developed an asbestos-induced disease in certain occupations. Examination of active or retired workers included a personal interview on work history and asbestos exposure, and a chest X-ray. The target group for the screening comprised workers under 70 years of age who had worked at least for 10 years in construction, 1 year in a shipyard or in the manufacture of asbestos products. A preliminary questionnaire was sent to 54,409 workers, 18,943 of whom finally participated in the screening examination. The mean age of the workers was 53 years; 95% were employed in construction, 2% in shipyards, and 3% in the asbestos industry. The criteria for a positive screening result were (1) a radiographic finding clearly indicating lung fibrosis (at least ILO category 1/1), (2) a radiographic finding indicating mild lung fibrosis (ILO category 1/0) with unilateral or bilateral pleural plaques, (3) marked abnormalities of the visceral pleura (marked adhesions with or without pleural thickening), or (4) bilateral pleural plaques. The positive cases totalled 4,133 (22%) and were sent for further investigation. In addition to the screening, information on the presence of asbestos in the work environment, prevention of asbestos exposure, as well as on the health effects of asbestos exposure and smoking were given to the participating workers. The screening acted as a preliminary survey to prompt further national follow-up of asbestos-induced diseases among the workers who have been exposed to asbestos. This article presents the material, methods, and overall results of the screening.

    背景与目标: 1990-1992年,作为芬兰职业健康研究所石棉计划的一部分,对芬兰的石棉诱发疾病进行了筛查。本研究的目的是寻找在某些职业中患有石棉诱发疾病的工人。对现役或退休工人的检查包括对工作经历和石棉暴露的个人访谈,以及胸部X光检查。筛查的目标人群包括70岁以下的工人,这些工人至少在建筑业工作了10年,在造船厂工作了1年,或者在制造石棉产品中工作了至少1年。初步调查表已发送给54,409名工人,其中18,943名工人最终参加了筛查。工人的平均年龄为53岁;建筑业雇用了95%,造船厂雇用了2%,石棉行业雇用了3%。阳性筛查结果的标准是(1)影像学检查明确表明肺纤维化(至少是ILO 1/1类),(2)影像学检查表明患有轻度肺纤维化(ILO 1/0类)伴有单侧或双侧胸膜斑块,(3)内脏胸膜明显异常(明显的粘连伴或不伴有胸膜增厚),或(4)双侧胸膜斑。阳性病例总计4,133(22%),并已送去进一步调查。除筛查外,还向参加活动的工人提供了有关工作环境中石棉的存在,石棉暴露的预防以及石棉暴露和吸烟对健康的影响的信息。筛查是一项初步调查,目的是促使在接触石棉的工人中进一步对石棉诱发的疾病进行全国性的随访。本文介绍了筛选的材料,方法和总体结果。

  • 【基于众包的全国性壁虱采集揭示了芬兰的臭x和紫花and以及相关病原体的分布。】 复制标题 收藏 收藏
    DOI:10.1038/emi.2017.17 复制DOI
    作者列表:Laaksonen M,Sajanti E,Sormunen JJ,Penttinen R,Hänninen J,Ruohomäki K,Sääksjärvi I,Vesterinen EJ,Vuorinen I,Hytönen J,Klemola T
    BACKGROUND & AIMS: :A national crowdsourcing-based tick collection campaign was organized in 2015 with the objective of producing novel data on tick distribution and tick-borne pathogens in Finland. Nearly 20 000 Ixodes ticks were collected. The collected material revealed the nationwide distribution of I. persulcatus for the first time and a shift northwards in the distribution of I. ricinus in Finland. A subset of 2038 tick samples containing both species was screened for Borrelia burgdorferi sensu lato (the prevalence was 14.2% for I. ricinus and 19.8% for I. persulcatus), B. miyamotoi (0.2% and 0.4%, respectively) and tick-borne encephalitis virus (TBEV; 0.2% and 3.0%, respectively). We also report new risk areas for TBEV in Finland and, for the first time, the presence of B. miyamotoi in ticks from mainland Finland. Most importantly, our study demonstrates the overwhelming power of citizen science in accomplishing a collection effort that would have been impossible with the scientific community alone.
    背景与目标: :2015年组织了一次全国性的基于众包的tick收集运动,目的是在芬兰收集有关tick分布和tick传播病原体的新数据。收集了近20 000个I极x。收集到的材料首次揭示了Persulcatus的全国分布,而芬兰的I. ricinus的分布向北偏移。筛选了包含这两种物种的2038个滴答样本的子集,以检出伯氏疏螺旋体(流行度为:蓖麻毒杆菌为14.2%,百日咳杆菌为19.8%),宫本芽孢杆菌(分别为0.2%和0.4%)和壁虱-传染性脑炎病毒(TBEV;分别为0.2%和3.0%)。我们还报告了在芬兰TBEV的新风险领域,以及首次在芬兰大陆的壁虱中出现了宫本芽孢杆菌。最重要的是,我们的研究表明,公民科学在完成收集工作方面具有压倒性的力量,而这是仅凭科学界就不可能做到的。
  • 【芬兰西部综合症的流行病学数据。】 复制标题 收藏 收藏
    DOI:10.1016/s0387-7604(01)00263-7 复制DOI
    作者列表:Riikonen R
    BACKGROUND & AIMS: :The present study examined whether changes in the incidence of West syndrome (WS) could be used to evaluate changes in the quality of prenatal care over time. The incidence of WS in Finland did not change (1960-1991) in spite of increased survival of low-birth-weight infants. Small-for-gestational age (SGA) infants were more apt to develop infantile spasms than preterm average-for-gestational age infants. The number of SGA infants with neonatal hypoglycemia and infantile spasms decreased significantly. The number of cases of brain malformation and tuberous sclerosis increased; this probably reflects the development of more refined neuroradiological screening methods. Early prenatal factors seem to play a major role in the genesis of infantile spasms. Little can be done to reduce the incidence of WS, but every effort should be made to reduce the number of SGA infants by good prenatal care and treating neonatal hypoglycemia carefully.
    背景与目标: :本研究检查了西方综合症(WS)发病率的变化是否可用于评估随时间变化的产前护理质量。尽管低出生体重儿的存活率增加,但芬兰的WS发病率没有变化(1960-1991年)。小于胎龄儿(SGA)的婴儿比早产胎平均年龄的婴儿更容易发生婴儿痉挛。患有新生儿低血糖和婴儿痉挛症的SGA婴儿数量显着减少。脑畸形和结节性硬化症病例增加;这可能反映了更精细的神经放射学筛查方法的发展。早期的产前因素似乎在婴儿痉挛的发生中起主要作用。减少WS的发病率几乎无济于事,但应尽一切努力通过良好的产前护理并仔细治疗新生儿低血糖来减少SGA婴儿的数量。
  • 【具有临床显着吸烟史的哮喘患者的症状控制:芬兰的一项横断面研究。】 复制标题 收藏 收藏
    DOI:10.1186/s12890-020-1127-9 复制DOI
    作者列表:Kiljander T,Poussa T,Helin T,Jaakkola A,Venho K,Lehtimäki L
    BACKGROUND & AIMS: BACKGROUND:Surprisingly little is known about asthma control among asthmatics who smoke. The aim of this cross-sectional study was to investigate asthma symptom control according to the GINA guidelines among asthmatics with a clinically significant smoking history. METHODS:One hundred ninety asthmatics from primary care in Finland were investigated. The patients were current or previous cigarette smokers with a history of 10 or more pack-years. They completed a questionnaire including questions on asthma symptoms and reliever use so that their level of asthma symptom control (well controlled, partly controlled, or uncontrolled) according to GINA could be determined. RESULTS:Sixty-six (34.7%) patients had their asthma well controlled, 81 (42.6%) had their asthma partly controlled, and 43 (22.6%) had uncontrolled asthma. Current smokers had uncontrolled asthma more often than ex-smokers, OR 2.54 (95% CI 1.25-5.14, p = 0.01). Patients with moderate to severe asthma exacerbation during the previous year had uncontrolled asthma more often than patients without an exacerbation, OR 2.17 (95% CI 1.06-4.47, p = 0.04), and patients with FEV1 <  80% of predicted had uncontrolled asthma more often than patients with FEV1 > 80% of predicted, OR 2.04 (95% CI 1.02-4.08, p = 0.04). CONCLUSIONS:Asthmatic patients with a clinically significant smoking history often do not have well controlled asthma. Poor asthma symptom control was associated with current smoking status, history of exacerbations and impaired lung function. Therefore, every attempt should be made to help asthmatics who smoke to quit smoking.
    背景与目标: 背景:令人惊讶的是,吸烟的哮喘患者对哮喘控制知之甚少。这项横断面研究的目的是根据GINA指南调查具有临床显着吸烟史的哮喘患者的哮喘症状控制。
    方法:对芬兰一百九十名来自初级保健的哮喘病患者进行了调查。这些患者是现时或以前的吸烟者,有10年或以上的包装年历史。他们填写了一份问卷,包括有关哮喘症状和缓解剂使用的问题,以便可以根据GINA确定他们的哮喘症状控制水平(良好控制,部分控制或不控制)。
    结果:66例(34.7%)的患者的哮喘得到了良好的控制,81例(42.6%)的患者得到了部分控制的哮喘,43例(22.6%)的患者得到了不受控制的哮喘。目前的吸烟者比前吸烟者更容易患上不受控制的哮喘,即OR 2.54(95%CI 1.25-5.14,p = 0.01)。上一年中度至重度哮喘急性发作的患者比没有急性发作的患者更容易控制哮喘,或为2.17(95%CI 1.06-4.47,p = 0.04),而FEV1 <80%的预期患者患有不受控制的哮喘的比例更高通常比FEV1>预测值的80%或OR 2.04的患者高(95%CI 1.02-4.08,p = 40.04)。
    结论:具有临床显着吸烟史的哮喘患者通常没有良好控制的哮喘。哮喘症状控制不佳与当前吸烟状况,病情加重和肺功能受损有关。因此,应尽一切努力帮助吸烟的哮喘患者戒烟。
  • 【芬兰北部人群的支气管高反应性,以前没有诊断为哮喘或慢性支气管炎,可通过组胺和乙酰甲胆碱测试进行评估。】 复制标题 收藏 收藏
    DOI:10.3402/ijch.v67i4.18343 复制DOI
    作者列表:Juusela M,Poussa T,Kotaniemi J,Lundbäck B,Sovijärvi A
    BACKGROUND & AIMS: OBJECTIVES:To assess the prevalence of bronchial hyperresponsiveness (BHR) in a population of north Finland among subjects with no previous diagnosis of asthma or chronic bronchitis by using histamine and methacholine challenges. The agreement between the methods was also evaluated. STUDY DESIGN:An epidemiological study assessing the prevalence of BHR measured with 2 direct dosimetric challenge methods. METHODS; Seventy-nine randomly selected subjects (21-73 years) were studied; 67% had respiratory or allergic symptoms. The baseline spirometry was normal or showed mild obstruction. Bronchial challenges to methacholine and histamine were performed on each subject in a randomized order. Provocative doses inducing the decrease of FEV1 by 15% and 20% (PD15FEV1 and PD20FEV1) and dose response ratios (DDR) were calculated for both tests. RESULTS; BHR with the methacholine test (PD20FEV1 < or = 2.6 mg) was found in 20% and with the histamine test (PD15FEV1 < or = 1.6 mg) in 28% of subjects; the agreement was 80% (kappa 0.45; 95% CI 0.23-0.68). In staging the severity of BHR the methods had a good agreement (weighted kappa 0.64; CI 95% 0.46-0.82). Prevalence of BHR fulfilling the criteria of the both methods was 14%. CONCLUSIONS:The findings suggest that the prevalence of BHR in the population of north Finland with no previous diagnosis of asthma or chronic bronchitis is at least 14%, probably around 20%, assessed by histamine and methacholine challenge methods. The methods have a good agreement to be used for classifying the severity of BHR.
    背景与目标: 目的:通过使用组胺和乙酰甲胆碱攻击,评估先前未诊断出哮喘或慢性支气管炎的芬兰北部人群中支气管高反应性(BHR)的患病率。还评估了方法之间的一致性。
    研究设计:一项流行病学研究,评估通过2种直接剂量挑战方法测量的BHR患病率。方法;研究了79名随机选择的受试者(21-73岁); 67%有呼吸道或过敏性症状。基线肺活量测定正常或显示轻度阻塞。以随机顺序对每个受试者进行了对乙酰甲胆碱和组胺的支气管激发。两种测试均计算了引起FEV1降低15%和20%的激发剂量(PD15FEV1和PD20FEV1)和剂量反应比(DDR)。结果;在28%的受试者中发现有甲胆碱测试(PD20FEV1 <或= 2.6 mg)的BHR和组胺测试(PD15FEV1 <或= 1.6 mg)的BHR。一致性为80%(kappa 0.45; 95%CI 0.23-0.68)。在评估BHR的严重程度时,这些方法具有很好的一致性(加权Kappa为0.64; CI为95%0.46-0.82)。符合两种方法标准的BHR患病率为14%。
    结论:研究结果表明,通过组胺和乙酰甲胆碱激发方法评估,在先前未诊断出哮喘或慢性支气管炎的芬兰北部人群中,BHR的患病率至少为14%,可能约为20%。该方法具有良好的一致性,可用于对BHR的严重程度进行分类。
  • 【芬兰回声病毒11株的分子流行病学和双重血清型特异性检测。】 复制标题 收藏 收藏
    DOI:10.1016/j.virusres.2008.10.003 复制DOI
    作者列表:Savolainen-Kopra C,Al-Hello H,Paananen A,Blomqvist S,Klemola P,Sobotova Z,Roivainen M
    BACKGROUND & AIMS: :Echovirus 11 (E-11) has been one of the most frequently discovered human enterovirus (HEV) in Finland during the past few years. We have studied molecular epidemiological patterns of E-11 from 1993 to 2007 exploiting the 257-nucleotide region in the 5'-part of the VP1 used for genetic typing of HEV. Designated genogroup D strains had a striking prevalence among the Finnish strains, a finding in accordance with the recent data from other geographical regions. The subgroup D4, harboring the oldest strains, had become extinct in the beginning of the millennium and D5 strains had taken over. Similarly, a new subgroup of D5 had started to diverge from the main D5 in 2006. However, in addition to endemic D strains, few single strains clustered also to genogroups A and C suggesting importation from more distant locations. The relatively large amino acid sequence variability between and within the genogroups favored the idea of antigenic differences. Neutralization assays confirmed that antigenic differences existed, although all studied E-11 strains were neutralized with antisera against the prototype strain Gregory. Five of the six studied strains belonging to genogroup D were, unexpectedly, also neutralized with antisera against coxsackievirus A9 Griggs.
    背景与目标: :Echovirus 11(E-11)在过去几年中一直是芬兰最常发现的人类肠道病毒(HEV)之一。我们已经研究了1993年至2007年E-11的分子流行病学模式,利用了用于HEV遗传分型的VP1 5'部分的257个核苷酸区域。指定的基因组D菌株在芬兰菌株中流行率很高,这一发现与其他地理区域的最新数据一致。拥有最古老菌株的D4亚组在千年初已灭绝,D5菌株已被接管。同样,D5的一个新亚组已于2006年开始与主要D5分离。但是,除了地方性D毒株外,几乎没有单个毒株也聚集到基因组A和C,提示从更远的地方输入。基因组之间和之内相对较大的氨基酸序列变异性支持抗原差异的想法。中和测定法确认存在抗原差异,尽管所有研究的E-11菌株均用针对原型菌株Gregory的抗血清中和。出乎意料的是,属于基因组D的六个研究菌株中的五个也被抗柯萨奇病毒A9 Griggs的抗血清中和。
  • 【芬兰核电厂工人的职业暴露。】 复制标题 收藏 收藏
    DOI:10.1093/oxfordjournals.rpd.a006603 复制DOI
    作者列表:Alm-Lytz K,Riihiluoma V,Hyvönen H
    BACKGROUND & AIMS: :In Finland, the Radiation and Nuclear Safety Authority (STUK) maintains a central dose register where all occupational doses of radiation workers are recorded. The computerised register enables easy control of personal doses, including annual, 5 year and lifetime doses. The type of radiation work is also recorded in the dose register. Finland was one of the first countries in the world to introduce dose limits based on the recommendations of ICRP 60. In this article, the radiation dose data of the Finnish nuclear power plant workers are analysed. The majority of the radiation doses are received during the maintenance outages. The trend of the 5 year doses and their distribution are presented. Doses received during different work assignments were averaged over the years 1996-1999 and they are also discussed in this article.
    背景与目标: :在芬兰,辐射与核安全局(STUK)维护着一个中央剂量登记簿,用于记录辐射工作人员的所有职业剂量。电脑记录仪可轻松控制个人剂量,包括年剂量,5年剂量和终生剂量。放射功的类型也记录在剂量寄存器中。芬兰是世界上最早根据ICRP 60的建议引入剂量限值的国家之一。在本文中,分析了芬兰核电站工作人员的辐射剂量数据。在维护中断期间会收到大部分辐射剂量。给出了5年剂量的趋势及其分布。在1996年至1999年期间,对不同工作任务中获得的剂量进行了平均,并在本文中进行了讨论。
  • 【KLF6 IVS1 -27G>变体与芬兰患前列腺癌的风险。】 复制标题 收藏 收藏
    DOI:10.1016/j.eururo.2006.11.019 复制DOI
    作者列表:Seppälä EH,Autio V,Duggal P,Ikonen T,Stenman UH,Auvinen A,Bailey-Wilson JE,Tammela TL,Schleutker J
    BACKGROUND & AIMS: OBJECTIVES:A recent report demonstrated that KLF6 IVS1 -27G>A substitution increases the transcription of alternatively spliced isoforms; this action was suggested to be associated with prostate cancer (pCA). To evaluate these findings among the Finnish population, a total of 3348 samples were analysed. METHODS:The variant was genotyped in 164 patients with familial pCA, 852 patients with unselected pCA, 459 patients with benign prostate hyperplasia (BPH), 923 male population controls, and 950 men from a Finnish prostate-specific antigen (PSA) screening trial with PSA levels less than 1.0ng/ml. Odds ratios (ORs) and corresponding 95% confidence intervals (95%CIs) were calculated by using logistic regression to estimate pCA risk. RESULTS:Association testing revealed no significant differences between familial prostate cancer patients and population controls (OR: 0.84; 95%CI, 0.56-1.28; p=0.42), unselected cases and controls (OR: 0.95; 95%CI, 0.76-1.19; p=0.63), or BPH cases and controls (OR: 1.12; 95%CI, 0.86-1.46; p=0.39). pCA and BPH cases were also compared with PSA-screened controls. None of these analyses revealed any significant associations. CONCLUSIONS:Our results do not support the suggested association of KLF6 IVS1 -27G>A germline polymorphism with pCA risk and also suggest that the variant is not a risk allele for BPH in the Finnish population.
    背景与目标: 目的:最近的一份报告表明,KLF6 IVS1 -27G> A取代可增加其他剪接同工型的转录。提示该作用与前列腺癌(pCA)有关。为了评估芬兰人群中的这些发现,共分析了3348个样本。
    方法:该变异体在164例家族性pCA患者,852例未选择pCA患者,459例良性前列腺增生症(BPH),923名男性人群对照和950名来自芬兰前列腺特异性抗原(PSA)筛查试验的男性中进行了基因分型。 PSA含量低于1.0ng / ml。通过使用逻辑回归估计pCA风险来计算赔率(OR)和相应的95%置信区间(95%CI)。
    结果:关联测试显示家族性前列腺癌患者与人群对照(OR:0.84; 95%CI,0.56-1.28; p = 0.42),未选定病例和对照(OR:0.95; 95%CI,0.76-1.19)无显着差异; p = 0.63)或BPH病例和对照(OR:1.12; 95%CI,0.86-1.46; p = 0.39)。 pCA和BPH病例也与PSA筛查的对照进行了比较。这些分析均未显示任何重大关联。
    结论:我们的结果不支持建议的KLF6 IVS1 -27G> A种系多态性与pCA风险的关联,也暗示该变异体不是芬兰人群BPH的风险等位基因。
  • 【我们在32年中对高密度脂蛋白胆固醇的测量学到了什么? 1980-2012年在芬兰的经验。】 复制标题 收藏 收藏
    DOI:10.1016/j.cca.2012.10.027 复制DOI
    作者列表:Leiviskä J,Sundvall J,Alfthan G,Tähtelä R,Salomaa V,Jauhiainen M,Vartiainen E
    BACKGROUND & AIMS: BACKGROUND:High-density lipoprotein cholesterol (HDL-C) is important in risk assessment for cardiovascular disease or metabolic syndrome; however, different direct HDL-C assays may lead to erroneous risk estimates and potentially misclassify people. METHODS:Data for 30-year HDL-C trends in Finland were obtained from the national FINRISK surveys during 1982-2012 (n=45766) taking into account biases from three external quality assessment programs (EQA). We also compared two different direct HDL-C and turbidimetric apolipoprotein A-I methods using 413 fresh serum samples. RESULTS:HDL-C concentrations in the Finnish population were on average 1.33 (±0.04) mmol/l for men and 1.62 (±0.05) mmol/l for women after bias-correction. Positive HDL-C trends were observed for both sexes with original data, but trends disappeared after bias-correction. Comparison of two direct HDL-C methods demonstrated concentration-dependent difference. When HDL-C concentrations were <1.0 mmol/l, the mean bias was -12.0% (95% CI -13.5 to -10.0) whereas HDL-C concentrations >1.55 mmol/l showed mean bias of 9.0% (95% CI 7.0-10.5). CONCLUSIONS:Accurate reporting of HDL-C concentrations at the population level requires proper and regular attendance to reliable EQA programs. We found evidence for a concentration-dependent difference between some direct HDL-C methods, which may cause misclassification of people in cardiovascular risk assessment.
    背景与目标: 背景:高密度脂蛋白胆固醇(HDL-C)在心血管疾病或代谢综合征的风险评估中很重要。但是,不同的直接HDL-C分析可能会导致错误的风险估计并可能对人员进行错误分类。
    方法:芬兰30年HDL-C趋势的数据是从1982年至2012年的全国FINRISK调查中获得的(n = 45766),其中考虑了三个外部质量评估计划(EQA)的偏差。我们还比较了使用413种新鲜血清样本的两种不同的直接HDL-C和浊度载脂蛋白A-I方法。
    结果:校正偏倚后,芬兰人群中HDL-C的平均浓度为男性1.33(±0.04)mmol / l,女性为1.62(±0.05)mmol / l。具有原始数据的两性均观察到HDL-C呈阳性趋势,但偏差校正后该趋势消失。两种直接HDL-C方法的比较显示出浓度依赖性差异。当HDL-C浓度<1.0 mmol / l时,平均偏差为-12.0%(95%CI -13.5至-10.0),而HDL-C浓度> 1.55 mmol / l则显示平均偏差为9.0%(95%CI 7.0) -10.5)。
    结论:要在人群中准确报告HDL-C浓度,需要适当定期参加可靠的EQA计划。我们发现一些直接HDL-C方法之间存在浓度依赖性差异的证据,这可能会导致心血管风险评估中人员分类错误。
  • 【多发性硬化症妇女的妊娠结局:芬兰一项前瞻性全国研究的结果。】 复制标题 收藏 收藏
    DOI:10.1177/1352458510372629 复制DOI
    作者列表:Jalkanen A,Alanen A,Airas L,Finnish Multiple Sclerosis and Pregnancy Study Group.
    BACKGROUND & AIMS: :The majority of individuals obtaining the diagnosis of multiple sclerosis are women of childbearing age. They are naturally concerned as to how multiple sclerosis affects the course of pregnancy and the developing foetus. The objective of this study was to prospectively evaluate the incidence of pregnancy complications and delivery risks, and to follow the natural course of multiple sclerosis during and after pregnancy in a cohort of Finnish patients with multiple sclerosis. Sixty-one patients with multiple sclerosis who became pregnant during the years 2003-2005 were prospectively followed-up from early pregnancy until 6 months postpartum. Multiple sclerosis relapses, Expanded Disability Status Scale rates and obstetric details were recorded. The results were compared with the statistics obtained from Finnish Medical Birth Register from the year 2004. We found that patients with multiple sclerosis were no more likely to experience pregnancy complications than Finnish pregnant women generally, but they had a greater likelihood for a need of artificial insemination (4.9% vs. 0.9%; p = 0.0009). Subjects with multiple sclerosis were more likely to undergo assisted vaginal delivery than the at-large cohort (16.4% vs. 6.5%; p = 0.0017). We conclude that pregnancy does not seem to pose a woman with multiple sclerosis to a greater risk for pregnancy complications when compared with women in general. The potential need for instrumental delivery should, however, be taken into account when planning the delivery of a mother with multiple sclerosis.
    背景与目标: :诊断出多发性硬化症的大多数人是育龄妇女。他们自然关心多发性硬化症如何影响妊娠过程和胎儿发育。这项研究的目的是前瞻性评估一组芬兰多发性硬化症患者的妊娠并发症和分娩风险的发生率,并遵循妊娠期间和之后多发性硬化的自然过程。从2003年早期怀孕到产后6个月,对61例在2003-2005年期间怀孕的多发性硬化症患者进行了随访。记录多发性硬化症复发,扩大的残疾状态量表比率和产科细节。将结果与2004年芬兰医疗出生登记处的统计数据进行了比较。我们发现,多发性硬化症患者的发生并发症的可能性不比芬兰孕妇高,但他们更有可能需要人工干预受精(4.9%vs. 0.9%; p = 0.0009)。多发性硬化症患者比一般人群更有可能接受辅助阴道分娩(16.4%vs. 6.5%; p = 0.0017)。我们得出的结论是,与一般女性相比,怀孕似乎不会使多发性硬化症患者的妊娠并发症风险更高。但是,在计划分娩多发性硬化症的母亲时,应考虑到器械分娩的潜在需求。
  • 【芬兰东部的2型糖尿病和囊状颅内动脉瘤破裂的风险。】 复制标题 收藏 收藏
    DOI:10.2337/dc12-1048 复制DOI
    作者列表:Lindgren AE,Kurki MI,Riihinen A,Koivisto T,Ronkainen A,Rinne J,Hernesniemi J,Eriksson JG,Jääskeläinen JE,von und zu Fraunberg M
    BACKGROUND & AIMS: OBJECTIVE:Type 2 diabetes is a risk factor for other forms of stroke, but its association with subarachnoid hemorrhage (SAH) from ruptured saccular intracranial aneurysm (sIA) has remained unclear. RESEARCH DESIGN AND METHODS:Kuopio Intracranial Aneurysm Database (www.uef.fi/ns) includes all ruptured and unruptured sIA cases from a defined catchment population in eastern Finland since 1980. We compared the age-adjusted incidences of type 2 diabetes in 1,058 ruptured and 484 unruptured sIA patients during 1994-2008, using the national registry of prescribed medicine purchases. RESULTS:Of the 1,058 ruptured sIA patients, 43% were males and 57% females, with a median age at rupture of 51 and 56 years, respectively. From 1994 to 2008 or until death, 9% had been prescribed antidiabetes medication (ADM) with a median starting age of 58 years for males and 66 years for females. Of the 484 unruptured sIA patients, 44% were males and 56% females, with a median age at the diagnosis of 53 and 55 years, respectively, and 9% had used ADM, with a median starting age of 61 years for males and 66 years for females. The incidence of type 2 diabetes was highest in the age-group 60-70 years, with no significant differences between the ruptured and unruptured sIA patients. CONCLUSIONS:Our study suggests that type 2 diabetes does not increase the risk of rupture of sIA, which is by far the most frequent cause of nontraumatic SAH.
    背景与目标: 目的:2型糖尿病是其他形式的中风的危险因素,但其与囊状颅内动脉瘤破裂(sIA)与蛛网膜下腔出血(SAH)的关系尚不清楚。
    研究设计和方法:Kuopio颅内动脉瘤数据库(www.uef.fi/ns)包括1980年以来芬兰东部特定集水区所有破裂和未破裂的sIA病例。我们比较了1,058例破裂的2型糖尿病的年龄校正发病率使用国家处方药购买登记表,在1994年至2008年期间,有484名未破裂的sIA患者。
    结果:在1,058例sIA破裂患者中,男性43%,女性57%,破裂时的中位年龄分别为51岁和56岁。从1994年到2008年或直至死亡,已开出9%的抗糖尿病药物(ADM),男性的平均起始年龄为58岁,女性的平均起始年龄为66岁。在484例未破裂的sIA患者中,男性分别为44%和56%,诊断时的中位年龄分别为53岁和55岁,使用ADM的患者为9%,男性的起始年龄为61岁,男性为66岁。女性的岁月。 2型糖尿病的发病率在60-70岁年龄段最高,在破裂和未破裂的sIA患者之间没有显着差异。
    结论:我们的研究表明2型糖尿病不会增加sIA破裂的风险,而sIA破裂是迄今为止非创伤性SAH的最常见原因。
  • 【通过营养和体育锻炼来降低2型糖尿病的风险-在芬兰,其有效性和生活方式干预措施的实施。】 复制标题 收藏 收藏
    DOI:10.1017/S1368980010000960 复制DOI
    作者列表:Lindström J,Absetz P,Hemiö K,Peltomäki P,Peltonen M
    BACKGROUND & AIMS: BACKGROUND:The prevalence of type 2 diabetes has been increasing in Finland, in parallel with a gradual increase in overweight and obesity during the past decades. The expanding prevalence of type 2 diabetes brings along complications, most importantly CVD. Therefore, it is extremely important to implement activities to prevent type 2 diabetes. OBJECTIVE:In the present paper, the clinical evidence for the prevention of type 2 diabetes is presented with the Finnish diabetes prevention study. In addition, the paper discusses the practical implementation of prevention of type 2 diabetes using three different types of prevention programmes as examples: FIN-D2D, including risk-screening and repeated consultation in primary health-care; FINNAIR, a workplace-targeted intervention project involving airline employees; and the good ageing in Lahti region (GOAL) programme, a community-based prevention programme. CONCLUSIONS:FIN-D2D, the FINNAIR project and the GOAL programme have shown that screening for type 2 diabetes risk and implementing large-scale lifestyle intervention in primary health-care are feasible. However, the crucial questions still are whether it is possible to replicate the results concerning effectiveness of lifestyle intervention in primary and occupational health-care systems. Furthermore, it remains to be shown whether it is possible to achieve the same results in different health-care settings, cultures, regions and age groups, especially in adolescents and young adults among whom the increase in the incidence has been the highest. In addition, the importance of co-operation among all sections of society, citizens' awareness of healthy lifestyles and the social inequalities in health must be emphasised because the diabetes epidemic cannot be solved only by concentrating on preventive actions carried out by health-care systems.
    背景与目标: 背景:在过去的几十年中,芬兰2型糖尿病的患病率一直在上升,与此同时超重和肥胖也逐渐增加。 2型糖尿病患病率的增加带来了并发症,最重要的是CVD。因此,开展预防2型糖尿病的活动极为重要。
    目的:本文通过芬兰糖尿病预防研究提供了预防2型糖尿病的临床证据。此外,本文以三种不同类型的预防计划为例,讨论了2型糖尿病预防的实际实施:FIN-D2D,包括风险筛查和初级保健中的反复咨询; FINNAIR,一个针对航空公司员工的针对工作场所的干预项目;以及以社区为基础的预防计划Lahti地区的良好老龄化计划(GOAL)。
    结论:FIN-D2D,FINNAIR项目和GOAL计划表明,筛查2型糖尿病的风险并在初级卫生保健中实施大规模的生活方式干预是可行的。但是,关键问题仍然是,是否有可能在初级和职业卫生保健系统中复制有关生活方式干预效果的结果。此外,还有待证明在不同的医疗机构,文化,地区和年龄组中是否有可能获得相同的结果,特别是在青少年和年轻人中,其发病率增加最高。此外,必须强调社会各部门之间合作的重要性,公民对健康生活方式的认识以及健康方面的社会不平等,因为仅通过集中医疗保健系统的预防行动就无法解决糖尿病的流行。
  • 【芬兰非典型长效抗精神病药治疗慢性精神分裂症的成本-效果分析。】 复制标题 收藏 收藏
    DOI:10.3111/13696998.2013.823869 复制DOI
    作者列表:Einarson TR,Pudas H,Zilbershtein R,Jensen R,Vicente C,Piwko C,Hemels ME
    BACKGROUND & AIMS: OBJECTIVE:In Finland, regional rates of schizophrenia exceed those in most countries, impacting the healthcare burden. This study determined the cost-effectiveness of long-acting antipsychotic (LAI) drugs paliperidone palmitate (PP-LAI), olanzapine pamoate (OLZ-LAI), and risperidone (RIS-LAI) for chronic schizophrenia. METHOD:This study adapted a decision tree analysis from Norway for the Finnish National Health Service. Country-specific data were sought from the literature and public documents, guided by clinical experts. Costs of health services and products were retrieved from literature sources and current price lists. This simulation study estimated average 1-year costs for treating patients with each LAI, average remission days, rates of hospitalization and emergency room visits and quality-adjusted life-years (QALY). RESULTS:PP-LAI was dominant. Its estimated annual average cost was €10,380/patient and was associated with 0.817 QALY; OLZ-LAI cost €12,145 with 0.810 QALY; RIS-LAI cost €12,074 with 0.809 QALY. PP-LAI had the lowest rates of hospitalization, emergency room visits, and relapse days. This analysis was robust against most variations in input values except adherence rates. PP-LAI was dominant over OLZ-LAI and RIS-LAI in 77.8% and 85.9% of simulations, respectively. Limitations include the 1-year time horizon (as opposed to lifetime costs), omission of the costs of adverse events, and the assumption of universal accessibility. CONCLUSION:In Finland, PP-LAI dominated the other LAIs as it was associated with a lower cost and better clinical outcomes.
    背景与目标: 目的:在芬兰,精神分裂症的区域发病率超过大多数国家,影响了医疗保健负担。这项研究确定了长效抗精神病药(LAI)帕潘立酮棕榈酸酯(PP-LAI),奥氮平棕榈酸酯(OLZ-LAI)和利培酮(RIS-LAI)治疗慢性精神分裂症的成本效益。
    方法:本研究采用了挪威国家芬兰卫生局的决策树分析方法。在临床专家的指导下,从文献和公共文件中寻求特定国家的数据。卫生服务和产品的成本是从文献来源和当前价格表中获取的。这项模拟研究估计了每个LAI患者的平均1年治疗费用,平均缓解天数,住院率和急诊室就诊率以及质量调整生命年(QALY)。
    结果:PP-LAI占主导地位。它的估计年平均成本为每位患者10,380欧元,并与0.817 QALY相关; OLZ-LAI的价格为12,145欧元,QALY为0.810; RIS-LAI的费用为€12,074,QALY为0.809。 PP-LAI的住院,急诊就诊和复发天数最低。该分析对于除依从率之外的输入值的大多数变化都具有鲁棒性。在仿真中,PP-LAI分别优于OLZ-LAI和RIS-LAI。局限性包括1年时间跨度(相对于终生成本),不良事件成本的遗漏以及普遍可及性的假设。
    结论:在芬兰,PP-LAI主导了其他LAI,因为它具有较低的成本和更好的临床效果。
  • 【在1997年至2017年期间,芬兰在心血管疾病危险因素同时存在方面存在教育和婚姻状况方面的不平等现象。】 复制标题 收藏 收藏
    DOI:10.1038/s41598-020-65959-1 复制DOI
    作者列表:Paalanen L,Härkänen T,Kontto J,Tolonen H
    BACKGROUND & AIMS: :Understanding on sociodemographic variation of the co-occurrence of cardiovascular disease risk factors is crucial for planning future prevention strategies. We aimed at examining (1) the co-occurrence of smoking, obesity, hypertension and elevated serum cholesterol by education and marital status, and (2) its trends in different sociodemographic groups in Finland. We used data from cross-sectional health examination surveys among the general population (25-64 years): for 1997-2012 the National FINRISK Study and for 2017 the FinHealth 2017 Survey (n = 25036). A risk factor accumulation score with categories (1) zero, (2) one, (3) two, and (4) three or four elevated risk factors was the outcome in multinomial logistic regression. The risk factor score was more favourable among women, among high education groups, and slightly among participants living with a spouse. Among men, the lowest risk factor score class became more prevalent especially in the intermediate education group, which approached the highest education group over time. Our results indicate an overall transition towards a more favourable risk factor distribution. However, risk factor accumulation among the least educated remained emphasizing the need to develop and implement more targeted prevention interventions and public health policies to decrease the risk factor burden particularly in this group.
    背景与目标: :了解心血管疾病危险因素共存的社会人口统计学变异对计划未来的预防策略至关重要。我们的目的是通过教育和婚姻状况来研究(1)吸烟,肥胖,高血压和血清胆固醇升高的共同发生,以及(2)在芬兰不同社会人口学群体中其趋势。我们使用了跨人群健康检查调查(25-64岁)的数据:1997-2012年的国家FINRISK研究和2017年的FinHealth 2017调查(n = 25036)。多项逻辑回归的结果是类别为(1)为零,(2)为,(3)为第二,(4)为三个或四个危险因素的危险因素累积得分。女性,高等教育群体和与配偶同住的参与者中,危险因素评分更为有利。在男性中,最低的危险因素得分等级变得更加普遍,尤其是在中等教育组中,随着时间的推移,中等教育组逐渐接近最高教育组。我们的结果表明总体上正在向更有利的风险因素分布过渡。但是,受教育程度最低的人群中危险因素的积累仍然强调需要制定和实施更有针对性的预防干预措施和公共卫生政策,以减少危险因素的负担,尤其是在这一群体中。
  • 【欧盟的自闭症和受教育权:北欧国家丹麦,芬兰和瑞典的政策定位和范围审查。】 复制标题 收藏 收藏
    DOI:10.1186/s13229-019-0290-4 复制DOI
    作者列表:van Kessel R,Walsh S,Ruigrok ANV,Holt R,Yliherva A,Kärnä E,Moilanen I,Hjörne E,Johansson ST,Schendel D,Pedersen L,Jørgensen M,Brayne C,Baron-Cohen S,Roman-Urrestarazu A
    BACKGROUND & AIMS: Introduction:The universal right to education for people with disabilities has been highlighted by the Universal Declaration on Human Rights and the Convention on the Rights of Persons with Disabilities. In this paper, we mapped policies addressing the right to education and special education needs of autistic children in Denmark, Sweden, and Finland. Methods:A policy path analysis was carried out using a scoping review as an underlying framework for data gathering. Policy mapping was performed independently by both lead authors to increase reliability. Results and discussion:The values of the Universal Declaration of Human Rights and the Convention on the Rights of Persons with Disabilities have been closely translated into the respective education systems of the countries under study, offering special education needs services and support in mainstream education with the aim of including as many children into mainstream education as possible. Even though the education systems are comparable, the approaches between the countries under study are slightly different. Denmark and Sweden have passed several policies specifically geared towards special education needs, while Finland incorporates this more in general education policy. Conclusion:All countries under study have incorporated the values of the Universal Declaration of Human Rights and the Convention on the Rights of Persons with Disabilities in their respective education systems while emphasising the need to include as many children in the mainstream system as possible.
    背景与目标: 简介:《世界人权宣言》和《残疾人权利公约》强调了残疾人的普遍受教育权。在本文中,我们绘制了针对丹麦,瑞典和芬兰自闭症儿童的受教育权和特殊教育需求的政策。
    方法:使用范围界定审查作为数据收集的基础框架进行了策略路径分析。两位主要作者均独立执行策略映射,以提高可靠性。
    结果与讨论:《世界人权宣言》和《残疾人权利公约》的价值观已被紧密地转化为所研究国家的各自的教育体系,为特殊教育需求服务和主流教育提供支持。目的是使尽可能多的儿童进入主流教育。尽管教育系统具有可比性,但所研究国家之间的方法略有不同。丹麦和瑞典通过了几项专门针对特殊教育需求的政策,而芬兰则将其更多地纳入了普通教育政策中。
    结论:所有接受研究的国家均在其各自的教育系统中纳入了《世界人权宣言》和《残疾人权利公约》的价值观,同时强调有必要将尽可能多的儿童纳入主流系统。

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