Biomedical subjects

A S Härö

Publications and source records attributed to A S Härö.

At least 19 recordsLinked to original sources

PubMed1994

Cohort approach in tuberculosis surveillance: comparison of the situation in Sweden and Finland.

SETTING: Finland and Sweden. OBJECTIVE: To present and compare the long-term trends of the tuberculosis situation and especially the experiences of different birth-year cohorts. DESIGN: Analysis of morbidity and mortality statistics since the early 1950s. The grouped birth-year cohorts are followed at 5-year intervals. RESULTS: In both countries the morbidity and mortality rates have diminished in a similar fashion. The Finnish situation follows the Swedish one by a delay of about 15 years. The incidences in the younger age groups have diminished markedly, but in the older ones the progress has been much less rapid. The median age of new cases has increased continuously. In Sweden, obviously due to the great number of immigrants, this trend has ceased in recent years. In each cohort born this century, the highest morbidity rates have been experienced at the age of around 20-30 years. After this they diminish exponentially at about the same speed, at least in recent times. CONCLUSION: The high prevalence of tuberculosis infection reached in early life seems to introduce a high lifelong incidence of the disease. In the older age cohorts the relatively high rates at present still reflect the circumstances in the 1940s or earlier. Age-oriented long-term surveillance can give useful information on the dynamics of the tuberculosis epidemic.

Adolescent↗

PubMed1988

[Not Available].

Explore the source record for details and available documents.

Ecology↗

PubMed1987

Health expenditure by area in Finland--an indicator of equity.

The responsibility of organizing and funding health services has in Finland been delegated to small local government units (to 461 communes, average pop. about 11,000), but not to counties or provinces like e.g. in other Nordic countries. PHC is organized by one or few communes and for the specialist level services they have formed 21 Central Hospital Regions (CHR). The central government pays per cent subsidies which are weighted on the basis of income of each community. In 1982 the average share of central government was 44.3% and the communes were responsible for 28.6% of the total expenditure. The national sickness insurance is subventing mainly private services. Its share was in 1982 about 11%. Direct personal costs were about 16%. There are no marked regional differences in the structure of services, e.g. the average share of inpatient care expenditure was 53% and the differences between regions small (z 6%). Total expenditure varied as indexes between regions from 82 tot 119. One reason is the high costs of some university hospitals which do not receive full compensation for services made available to other regions. The expenditure by region did not correlate at all with indicators of ageing. The same can be said of areal differences in income level. Only SMR, a crude indicator of the level of health, correlated positively with expenditure. It is concluded that the areal equity is acceptable if measured with expenditure. The general structure of services does not markedly differ between CHRs. The total health expenditure has been and will remain at the relatively low level of 6.5-7.0% of the GNP. The involvement of small communes is seen as a favourable basis of controlling the expenditure and developing an efficient service system.

Catchment Area, Health↗

PubMed1986

The effect of BCG-vaccination and tuberculosis on the risk of leukaemia.

The information concerning leukaemia in the Cancer Register in Finland was matched with a BCG vaccination index (FVI) constructed in 1946-49. Male birth year cohorts 1926-41 were analyzed by comparing observed/expected ratios. There were 422 cases of leukaemia (A59) in these cohorts during 1949-78 which was the follow-up period. The expected values were counted on the basis of experience of the whole population of included cohorts. There were approximately 533,000 persons in the cohorts studied. About 315,000 participated in the mass BCG vaccination campaign. 115,000 were tuberculin positive, 200,000 were negative and BCG vaccinated. The cohort analysis techniques were applied and the findings presented as Lexis diagrams. A sample of the population register was used in order to check the matching errors in FVI. Obviously, the presented number of participants is not quite reliable. This is understandable because the register had not been in use from 1953-77 and contact with the organizers is no longer possible. With correction factors the errors can be adjusted, at least to some extent. The register is functioning as expected in relation to general mortality and tuberculosis. The results indicate that there is no marked difference between naturally T. B. infected and BCG vaccinated persons. The participants seem to have considerably less cases of leukaemia than the non-participants of which a great deal are not infected or vaccinated. Structural weaknesses in the FVI do not allow firm conclusions to drawn. There is in any case so much evidence by age, by calendar year and by cohort that a hypothesis of the diminishing long term effects on leukaemia is justified. The interrelationships are long standing and were noticeable during the whole follow-up period about 30 years. It seems that there is no difference in the possible effect between different types of leukaemia. The structural weaknesses, like the real number of participants in the register can be corrected. The analysis can be broadened to cover females as well, which will also facilitate analysis by different types of leukaemia. The possible long standing effect of mycobacterial infections are discussed. Some strategies of further research are outlined.

BCG Vaccine↗

PubMed1984