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author:("lehtinen, L")
1.  A 10 year asthma programme in Finland: major change for the better 
Thorax  2006;61(8):663-670.
Background
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.
Methods
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.
Results
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 which had fallen to €213.5 million in 2003. Costs per patient per year have decreased 36% (from €1611 to €1031).
Conclusion
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.
doi:10.1136/thx.2005.055699
PMCID: PMC2104683  PMID: 16877690
asthma; guidelines; medication programme; costs
2.  Sustained reduction in bronchial hyperresponsiveness with inhaled fluticasone propionate within three days in mild asthma: time course after onset and cessation of treatment 
Thorax  2003;58(6):500-504.
Background: Bronchial hyperresponsiveness (BHR) is characteristic of asthmatic airways, is induced by airway inflammation, and is reduced by inhaled corticosteroids (ICS). The time course for the onset and cessation of the effect of ICS on BHR is unclear. The effect of inhaled fluticasone propionate (FP) on BHR in patients with mild persistent asthma was assessed using time intervals of hours, days and weeks.
Methods: Twenty six asthmatic patients aged 21–59 years were selected for this randomised, double blind, parallel group study. The effect of 250 µg inhaled FP (MDI) administered twice daily was compared with that of placebo on BHR assessed using a dosimetric histamine challenge method. The dose of histamine inducing a decrease in forced expiratory volume in 1 second (FEV1) by 15% (PD15FEV1) was measured before and 6, 12, 24 and 72 hours, and 2, 4 and 6 weeks after starting treatment, and 48 hours, 1 week and 2 weeks after cessation of treatment. Doubling doses of changes in PD15FEV1 were calculated and area under the curve (AUC) statistics were used to summarise the information from individual response curves.
Results: The increase in PD15FEV1 from baseline was greater in the FP group than in the placebo group; the difference achieved significance within 72 hours and remained significant until the end of treatment. In the FP group PD15FEV1 was 1.85–2.07 doubling doses above baseline between 72 hours and 6 weeks after starting treatment. BHR increased significantly within 2 weeks after cessation of FP treatment.
Conclusions: A sustained reduction in BHR to histamine in patients with mild asthma was achieved within 3 days of starting treatment with FP at a daily dose of 500 µg. The effect tapered within 2 weeks of cessation of treatment.
doi:10.1136/thorax.58.6.500
PMCID: PMC1746689  PMID: 12775860
3.  Asthma programme in Finland: a community problem needs community solutions 
Thorax  2001;56(10):806-814.
doi:10.1136/thorax.56.10.806
PMCID: PMC1745939  PMID: 11562522
4.  Social predictors of adult asthma: a co-twin case-control study 
Thorax  2001;56(3):234-236.
BACKGROUND—Environmental factors are needed to explain the observed increase in the prevalence of asthma during recent decades, despite the existence of a recognised genetic component in asthma. A co-twin case-control study was undertaken to examine possible social risk factors for asthma.
METHODS—Asthma diagnoses were based on register data of reimbursed asthma medication. During 17 years follow up of the Finnish twin cohort, 262 twin pairs discordant for incident asthma were identified. Conditional logistic regression for 1-1 matched data was used for risk calculation.
RESULTS—The atopic twin had an increased risk of asthma compared with the non-atopic co-twin (RR 2.91, 95% CI 1.81 to 4.68). The more educated twin had a decreased risk of asthma compared with his/her twin sibling with less education (RR 0.45, 95% CI 0.23 to 0.86), and the twin who participated in conditioning exercise had a decreased risk of asthma compared with the more sedentary co-twin (RR 0.55,95% CI 0.34 to 0.88).
CONCLUSIONS—In addition to allergic diseases, educational level and physical activity are associated with adult onset asthma, which indicates a role for factors associated with life style.


doi:10.1136/thorax.56.3.234
PMCID: PMC1758786  PMID: 11182018
5.  Perinatal risk factors for asthma in Finnish adolescent twins 
Thorax  2000;55(1):25-31.
BACKGROUND—Previous studies have suggested that, in addition to genetic liability and environment in early childhood, intrauterine life also influences the risk for asthma beyond childhood. Low birth weight, prematurity, young maternal age, and maternal smoking have all shown an association with asthma. The effect of perinatal factors on the risk for asthma in relation to familial and social risk factors was studied in a nationwide population-based sample of adolescent twins. In addition to a distribution of birth characteristics among twins which differs from that of singletons, data on twins enable a distinction to be made between genetic and environmental sources of variation.
METHODS—Questionnaires were sent to five consecutive birth cohorts of Finnish 16 year old twins born in 1975-9 and to their parents (3065 families). The outcome measure was life time prevalence of doctor-diagnosed asthma in these adolescents. The association between asthma and potential risk factors was assessed by multiple logistic regression and discordant twin pair analysis.
RESULTS—Risk for asthma increased with increasing ponderal index (p for trend <0.01) and decreasing maternal age (p for trend <0.05). Among the 25% of twins with the highest ponderal index, the odds ratio for asthma was 1.82 (95% confidence interval 1.18 to 2.79) compared with those in the lowest 25%. Neither birth weight, gestational age, nor Apgar score was associated with asthma. When perinatal risk factors were combined with familial and social risk factors, ponderal index, maternal smoking, parental asthma, and sibship size were all significant independent determinants of asthma in these adolescents.
CONCLUSIONS—The risk for asthma in adolescent twins increases with increasing ponderal index when adjusted for familial and social factors.


doi:10.1136/thorax.55.1.25
PMCID: PMC1745589  PMID: 10607798
6.  Prevalence of asthma in Finnish young men. 
BMJ : British Medical Journal  1990;301(6746):266-268.
OBJECTIVE--To determine the prevalence of asthma in cohorts of Finnish young men in the period 1926-89. DESIGN--A retrospective analysis using reports and statistics of Finnish defence forces. SETTING--Call up examinations of candidates for military conscription and examination of conscripts discharged because of poor health. SUBJECTS--Roughly 900,000 men--that is, 98% of men of conscription age--examined in 1966-89 and a proportional but unknown number examined in 1926-61. MAIN OUTCOME MEASURES--Asthma recognised at call up examination, exemption from military service, and discharge from military service because of asthma. RESULTS--During 1926-61 the prevalence of asthma recorded at call up examinations remained steady at between 0.02% and 0.08%. Between 1961 and 1966, however, a continuous, linear rise began, the prevalence increasing from 0.29% in 1966 to 1.79% in 1989--that is, representing a sixfold increase. Compared with 1961 the rise was 20-fold. From 1966 to 1989 the sum of exemptions and discharges from military service due to asthma increased analogously sixfold. CONCLUSIONS--If the apparent increase in asthma detected in Finnish young men was due entirely to improved diagnostic methods and other confounding effects then some 95% of cases must have gone undiagnosed in the years before 1966. This seems inconceivable, which suggests that much of the increase was real. This conclusion is strengthened by the observed rise in exemptions and discharges due to asthma.
PMCID: PMC1663451  PMID: 2390620
7.  Amount and avidity of salivary and serum antibodies against Streptococcus mutans in two groups of human subjects with different dental caries susceptibility. 
Infection and Immunity  1984;43(1):308-313.
Immunoglobulin A (IgA) and IgG antibodies against Streptococcus mutans K1R and 10449 were measured in serum and in stimulated whole saliva from two groups of naval recruits, representing high or low caries susceptibility. The antibody assays were performed by using the enzyme-linked immunosorbent assay, and the results were expressed by a method able to estimate the amount of high-avidity and total specific antibodies. As a control, concentrations of salivary total immunoglobulins were related to the amounts of specific antibodies. Further, antibodies were assayed against three antigens, unrelated to the streptococci. No clear differences were observed in serum antibodies between the subjects with high or low caries susceptibility. However, in saliva, low caries susceptibility was associated with a high amount of total antigen-specific IgA, and possibly IgG, against S. mutans. This difference between the groups still existed when the amounts of specific antibodies were related to the amounts of salivary immunoglobulins. There were no differences in the amounts of total specific antibodies against the unrelated antigens. No differences were observed in the estimates of high-avidity anti-S. mutans antibodies between the groups, either in serum or saliva. Thus, within the limitations of the assays and crude antigen, lack of high-avidity antibodies is not responsible for caries susceptibility. Instead, the amount of anti-S. mutans antibodies seems to be linked with caries protection. The results of the present study indicate that salivary antibodies are linked with the control of human dental caries.
PMCID: PMC263427  PMID: 6690406
8.  Immunohistochemical demonstration of substance P in the lower respiratory tract of the rabbit and not of man. 
Thorax  1983;38(7):531-536.
Substance P (SP)-immunoreactive nerve fibres were searched for at all levels of both fetal and adult human lower respiratory tract. Because the demonstrability of substance P immunoreactivity varies between different animal species, rabbit pulmonary tissue was also subjected to SP immunohistochemistry. Human irises and corneas served as positive human controls. The specimens were taken from 10 human lungs during pulmonary operations. Tracheal tissue was obtained from three patients during bronchoscopy. Five fetal human lungs were examined. Human specimens examined included the trachea, main bronchi, segmental bronchi, and peripheral pulmonary tissue. In addition, the tracheobronchial tissues of four rabbits were studied. SP immunoreaction was demonstrated in formaldehyde-fixed cryostat sections by either the indirect immunofluorescence technique or the peroxidase-antiperoxidase procedure. Both monoclonal and conventional antibodies to SP were tested. In the rabbit SP-immunoreactive nerves were found in both the submucosa and the smooth muscle layer of the main bronchi and trachea. Specimens from human trachea, bronchi, and bronchioli were all negative. Since the SP immunoreaction was easily demonstrated in both human cornea and human iris, it was concluded that there are no SP-immunoreactive nerves in the human pulmonary tissues or that their SP content is very low and below the sensitivity of all the techniques used.
Images
PMCID: PMC459601  PMID: 6193599
9.  Neurosurgery in cerebral palsy 
Stereotaxic subthalamotomy of 55 patients with cerebral palsy gave a good result in 65% of the selected cases. The result was uncertain in 15 and poor in 20%. An independent socio-medical follow-up study confirmed the clinical finding. The more rapid the involuntary movements, the better was the effect of subthalamotomy. Intention tremor was the most suitable symptom for stereotaxic treatment. Rigidospasticity was alleviated in the distal muscles only. Speech and gait were often improved. Good results were obtained in patients with normal intelligence, while feeble-minded patients did not benefit from the operation. Subthalamotomy was followed by transitory side-effects in 20%, of which increased involuntary movements on the ipsilateral side and mental restlessness were the most frequent. The operation had no mortality. Spinal longitudinal myelotomy effectively relieved the spasticity of the lower limbs in the three patients operated upon.
PMCID: PMC493511  PMID: 4918461

Results 1-9 (9)