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Pirjo Immonen-Räihä

Publications and source records attributed to Pirjo Immonen-Räihä.

15 recordsLinked to original sources
PubMed2006

The effect of correcting for troponins on trends in coronary heart disease events in Finland during 1993-2002: the FINAMI study.

AIMS: The object of this study is to analyse the trends in coronary events in Finland during 1993-2002, correcting for the effect of troponins. METHODS AND RESULTS: A population-based myocardial infarction register recorded all coronary events (n=14 782) in four geographical areas of Finland during 1993-2002. Correction coefficients for the effect of troponins were calculated on the basis of 4359 coronary events, with simultaneous determination of troponins and the 'old' enzymatic markers of myocardial injury. Coronary mortality declined steeply, except in women aged > or = 75 years. The incidence of first coronary events declined 2.0% (95% confidence interval -3.0, -0.9%) per year among men and 1.0% (-2.7, 0.6%) per year among women aged 35-74 years. After correcting for the effect of troponins, also the decline among women became statistically significant: 2.7% (-4.5, -0.8%) per year. The effect of troponins tended to be stronger in women and older individuals than in men and younger individuals. The 28-day case fatality declined among men, but not among women. The effect of troponins on case fatality trends was weak. CONCLUSION: Declining trends in the incidence of coronary events in Finland during 1993-2002 were partly hidden by the effect of troponins. Both incidence and case fatality declines have contributed to the decline in mortality.

Adult↗
PubMed2006

Population-based mammography screening results in substantial savings in treatment costs for fatal breast cancer.

AIMS: The aim was to assess the effect of population-based mammography screening on treatment costs for fatal breast cancer in Turku, Finland. MATERIALS AND METHODS: The study included 556 women with invasive breast cancer, diagnosed at the age of 40-74 years in 1987-1993: 427 in the screened group (screen-detected or interval cancer) and 129 in the unscreened group (not yet invited or refused screening). Both groups were followed up for 8 years from diagnosis. RESULTS: In the unscreened group, 32 (25%) patients died of breast cancer versus 49 (12%) in the screened group (p < 0.001). The non-discounted mean treatment costs were 2.8-fold for those dying of breast cancer compared to survivors: 26,222 euros versus 9,434 euros; the difference between means was 16,788 euros (95% CI 14,915-18,660) (p<0.001). The mean costs for fatal cases were high, irrespective of the way cancer was detected: 23,800 euros in the unscreened group versus 27,803 euros in the screened group; the difference between means was -4,003 euros (-10,810 to 2802) (p=0.245). In the unscreened group, patients with fatal breast cancer accounted for 41% (0.76/1.87 million euros) of the total treatment costs versus 29% (1.36/4.76 million euros) in the screened group. It was estimated that about one third of costs for fatal breast cancer were avoided through mammography screening, accounting for 72-81% of the estimated total treatment cost savings achieved by screening. About 31-35% of the screening costs for 1987 to 1993 were offset by savings in treatment costs. CONCLUSIONS: Treatment costs for fatal breast cancer are high. Mammography screening results in substantial treatment cost savings, in which reduction of fatal disease is the key element.

Adult↗
PubMed2005

A new definition for myocardial infarction: what difference does it make?

AIMS: As a response to changing diagnostic tools of myocardial infarction (MI), new case definitions for acute coronary events were published in 2003 as the American Heart Association Scientific Statement. We assessed the new definition in hospitalized patients in a large population-based MI register study. METHODS AND RESULTS: We identified all suspected acute coronary syndromes with data either on troponin T or on troponin I and at least one of the enzymatic markers of myocardial injury (n=6104). The 2003 definition with the use of troponins identified 83% more definite MIs than the WHO MONICA definition using cardiac enzymes. The additional patients were older, had more often diabetes, and received less often thrombolysis and revascularization than those having MI by both definitions. Adjusting for age, sex, study area, and study year, the additional patients with their first MI aged 25-74 had a higher risk of cardiovascular death within 1 year than patients having definite MI by both definitions (hazard ratio 1.6, 95% CI 1.1-2.2). CONCLUSION: The changing diagnostic criteria present a considerable challenge for the assessment of long-term trends in MI events in the community as well as for longitudinal studies of the natural history of MI. The 2003 definition, when applied using troponins, identified a sizable new group of MI patients, among persons with suspected acute coronary syndrome, at high risk of a recurrent event.

Adult↗
PubMed2005

Diabetes worsens the outcome of acute ischemic stroke.

OBJECTIVE: To characterize acute stroke events in diabetic patients in a population-based stroke register and to determine the influence of diabetes on the outcome of acute stroke. METHODS: Four thousand three hundred and ninety patients were recorded in the FINMONICA and FINSTROKE registers after their first ischemic stroke from 1990 to 1998. We followed mortality and stroke outcome for up to 4 weeks after the onset of acute stroke. RESULTS: Of the 4390 patients who had had an ischemic stroke, 43.6% were male and 25.1% (1103) had diabetes. Their mean age was 72.4 (S.D. 12.0) years and this was similar in patients with and without diabetes (72.9 years versus 72.3 years, p=0.18). Subjects with diabetes were more likely to be hypertensive (55% versus 38%, p<0.001) and have a history of myocardial infarction (20% versus 16%, p<0.001) than the non-diabetic stroke patients. Mortality at 4 weeks from the onset was higher in diabetic than in non-diabetic patients (20.0% versus 16.9% p=0.020). At day 28 after the stroke attack, diabetic patients were more likely to be disabled when compared with non-diabetic subjects (43.3% versus 33.5%, p<0.001). Using logistic regression analysis, adjusted for age-group, sex, previous medical history (MI, AF or TIA), diabetes was found to be a significant predictor of disability after stroke (OR=1.51, 95% CI 1.27-1.81). CONCLUSIONS: Diabetes, which affected one-fourth of the ischemic stroke patients on our register, was associated with a higher risk of death and disability after the onset of stroke. Preventing diabetes in the elderly population improves the short-term prognosis of acute ischemic stroke.

Acute Disease↗
PubMed2005

Mammographic screening reduces risk of breast carcinoma recurrence.

BACKGROUND: The current report is a long-term evaluation of breast carcinoma recurrence, factors predicting recurrence, and postrecurrence prognosis in relation to patients' use of service screening, which has been provided in Turku, Finland, since 1987 for women ages 40-74 years. METHODS: The current study included 527 invasive breast carcinomas: 418 in the screening group (which included screen-detected and interval malignancies) and 109 in the nonscreening group (which included breast carcinomas detected before initial screening and those detected in patients who chose not to undergo screening). These breast carcinomas were diagnosed among women ages 40-74 years between 1987 and 1993, with follow-up extending until the end of 2001. RESULTS: In the screening group, the risk of recurrence was only approximately half of the corresponding risk in the nonscreening group (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.39-0.83; P = 0.003). Five years after the primary diagnosis, 16% of patients in the screening group and 28% of patients in the nonscreening group (P = 0.001) had experienced recurrence; 10 years after diagnosis, the corresponding rates were 21% and 34%, respectively (P = 0.001). Postrecurrence prognosis was comparable for both detection groups (HR, 1.17; 95% CI, 0.70-1.94; P = 0.551), with approximately half of all patients dying of disease 5 years after recurrence. Detection of breast carcinoma via a method other than mammographic screening was associated with a high risk of recurrence on univariate analysis. On Cox multivariate analysis, risk factors for recurrence included lobular histologic type (HR, 2.23; 95% CI, 1.44-3.48; P < 0.001), poor histologic grade (HR, 2.02; 95% CI, 1.20-3.39; P = 0.008), and large tumor size (HR, 1.60; 95% CI, 1.07-2.37; P = 0.021). CONCLUSIONS: Long-term data from a population-based program demonstrated that mammographic screening reduced patients' risk of breast carcinoma recurrence. Specifically, the risk for patients with screen-detected disease was only approximately half of the risk for patients with non-screen-detected disease. Nonetheless, postrecurrence prognosis was comparable for patients in both detection groups.

Adult↗
PubMed2005

Liver echogenicity: relation to systemic blood pressure and other components of the metabolic syndrome.

We studied the impact of liver echogenicity among other potential predictors of systemic blood pressure (BP) and the metabolic syndrome. 38 persons (32 males, six females, aged 29 to 66) had their liver echogenicities scored, BPs measured and standard serum laboratory tests studied. There was a significant correlation between both systolic (r=0.438, p=0.006) and diastolic (r=0.498, p=0.001) BP and liver echogenicity. Liver echogenicity was the strongest predictor for systolic BP and the second strongest (after body mass index, BMI) for diastolic BP. Body height may modify the relation between liver echogenicity and systolic BP. Liver echogenicity also correlated significantly with BMI (r=0.527, p=0.001), serum triglycerides (r=0.472, p=0.003) and, to a lesser degree, with serum total cholesterol (r=0.305, p=0.066). Incidentally found increased liver echogenicity should alert the US performer and the clinician reading the report on the possibility of elevated BP or other features of the metabolic syndrome.

Adult↗
PubMed2005

The validity of the Finnish Hospital Discharge Register and Causes of Death Register data on coronary heart disease.

BACKGROUND AND DESIGN: The recent introduction of sensitive markers of myocardial injury is likely to affect the epidemiology of coronary heart disease (CHD). The American Heart Association together with other societies and research agencies have recently published a new definition on acute CHD to improve consistency in epidemiological and clinical studies (referred here as the '2003 definition'). METHODS: In this study we compare the data on CHD events in the Finnish National Hospital Discharge Register (HDR) and the Causes of Death Register (CDR) with the population-based myocardial infarction (MI) register, FINMONICA/FINAMI. The FINMONICA/FINAMI events were classified according to the 2003 definition. The relevant International Classification of Diseases (ICD) codes from the HDR and CDR were used. RESULTS: Using the 2003 definition as the reference, the overall sensitivity of the ICD codes for MI in the combined HDR and CDR was 83% and the positive predictive value (PPV) was 90%. When the ICD codes for unstable angina were added to the analyses, the sensitivity improved to 85% and the PPV declined to 83%. In the age group 35-74 the sensitivity of the MI codes improved over time, in men from 64% in 1988-1992 to 81% in 1998-2002, and in women from 61 to 78%, respectively. The oldest age group, 75 years or older, had sensitivity and PPV values comparable to those of the younger. CONCLUSION: Diagnoses of fatal and non-fatal CHD events in the Finnish HDR and Causes of Death register were reasonably valid indicators for hard CHD events when compared with the FINMONICA/FINAMI register data.

Adult↗
PubMed2004

Continuous 15-year decrease in incidence and mortality of stroke in Finland: the FINSTROKE study.

BACKGROUND AND PURPOSE: The purpose of this study was to analyze the incidence and mortality trends in stroke events among persons 25 to 74 years of age in Finland during 1983 to 1997. METHODS: The population-based FINSTROKE register recorded 5650 new strokes among persons 25 to 74 years of age in 2 geographical areas of Finland: 2770 in the Kuopio area (east central Finland) and 2880 in Turku (southwestern Finland). Of these, 3065 were men and 2585 were women. RESULTS: The rates of acute stroke events fell during the whole study period in both men and women. In both FINSTROKE areas combined, the average annual decline in the age-standardized incidence of first stroke events was 2.0% (95% confidence interval [CI], -2.8 to -1.2; P<0.001) among men and 1.7% (95% CI, -2.6 to -0.8; P<0.001) among women. The decline in the incidence of ischemic stroke was even steeper, 2.9%/y (95% CI, -4.9 to -1.1; P<0.001) among men and 3.1%/y (95% CI, -5.0 to -1.1; P<0.001) among women, whereas the incidence of intracerebral hemorrhage and subarachnoid hemorrhage did not change. Mortality from all stroke events declined in the FINSTROKE areas by 3.7%/y (95% CI, -5.3 to -2.0; P<0.001) among men and by 4.1%/y (95% CI, -5.9 to -2.4; P<0.001) among women. The 28-day case fatality of all stroke events also tended to decline, but the decline was of borderline statistical significance only (P=0.07 among men, P=0.05 among women). CONCLUSIONS: Incidence and mortality of stroke events declined significantly in these 2 register areas in Finland during the 15-year period of 1983 to 1997.

Adult↗
PubMed2004

Lower costs of hospital treatment of breast cancer through a population-based mammography screening programme.

BACKGROUND: The objective of this study was to evaluate the hospital treatment costs of invasive breast cancer in relation to the mode of detection, i.e. by mammography screening, between screenings or without screening during a population-based mammography screening programme, which started in 1987 among 36,000 women aged 40 to 74 years in the city of Turku, Southwest Finland. METHODS: The treatment costs and survival days of 556 women diagnosed with invasive breast cancer at the age of 40 to 74 years in 1987 to 1993 were followed up for five years from diagnosis or until death, whichever occurred first. RESULTS: Screen-detected cancers had the lowest average costs. The mean treatment costs per patient were 1.4-fold for clinical cancers and 1.3-fold for interval cancers compared to screen-detected cancers (p<0.001). The corresponding ratios in the mean treatment costs per survival day were 3.5 for clinical cancers and 1.9 for interval cancers (p<0.001). The mean treatment costs per patient were 1.3-fold for the non-screened group (clinical cancers) compared to the screened group (screen-detected and interval cancers) (p<0.001). The corresponding ratio was 3, when the mean treatment costs per survival day were compared (p<0.001). The estimated savings resulting from early treatment were 26-30% measured as a proportion of the screening costs for 1987 to 1993. CONCLUSION: The treatment costs of screen-detected cancers are lower than those of cancers detected by other methods. The study shows the potential for reducing treatment costs through early detection of breast cancer by mammography screening.

Adult↗
PubMed2004

Secondary prevention of coronary heart disease is disappointing among patients of working age.

BACKGROUND: The risk factors underlying coronary heart disease (CHD) are well known. OBJECTIVE: The purpose of this study was to evaluate risk factors related to secondary prevention of working-age CHD patients. METHODS: CHD patients with (n = 139) and without (n = 203) myocardial infarction were selected from a postal questionnaire study (n = 21 101) of randomly selected Finns aged 20-54 years (HeSSup study). Four age- and sex-matched controls were chosen for every patient. RESULTS: CHD patients still smoke, are obese and suffer hangovers more frequently than the control population. CONCLUSION: The health care system has not succeeded in the secondary prevention of CHD.

Adult↗
PubMed2004

Declining incidence and mortality of stroke in persons aged > or = 75 years in Finland; the FINSTROKE study.

BACKGROUND: The average life expectancy of a person aged 75 in Finland is approximately 10 years. A substantial threat to the quality of life during these years is stroke, which is common among the elderly, may hamper independent living and places a substantial burden on health care resources. The aim of the present study was to analyse the trends in incidence, mortality and prognosis of acute stroke events in persons aged > or = 75 years in Finland. DESIGN: A population-based stroke register study. METHODS: The FINSTROKE register recorded all stroke events in persons aged > or = 75 years (n=5493) among inhabitants of the town of Turku from 1982 to 1992 and again from 1996 to 1998, and in the Kuopio area from 1990 to 1997. RESULTS: At the end of the study period, the age group > or = 75 years constituted 3.8% of the population of study areas among men and 8.7% among women. This population segment contributed 35% of strokes among men and 66% among women. Of all strokes in this age group, 73% occurred among women. Data suggested that the mortality and incidence of acute stroke events were declining, but the 28-day case fatality did not change. At day 28 after the onset of stroke, only 26% of men and 19% of women had recovered well enough to be capable of independent living. CONCLUSIONS: Stroke mortality among the elderly is declining in Finland, which is mainly due to the decline in the incidence of stroke events.

Aged↗
PubMed2003

Significant improvement in breast cancer survival through population-based mammography screening.

The purpose of this study was to evaluate the effect of population-based mammography screening on survival. A total of 176 908 screening examinations were performed in 36 000 women aged 40-74 during the years 1987-1997. Screen-detected and interval primary invasive breast cancers (n=685, screened) were more often smaller (P<0.0001), localised (P<0.0001) and histologically better differentiated (grade I vs II-III, P<0.0001) than pre-screening cancers and cancers detected after the defined interval from the last screening (n=184, clinical). Survival was far better in the "screened" group than in the "clinical" group (P<0.0001, HR 2.55; CI 95% 1.77-3.67). Cox's multivariate analysis revealed axillary lymph node negativity (P<0.0001), histological grade I (P=0.0005) and size less than or equal to 20mm (P=0.0118) as explanations of the beneficial effect of screening. A new observation we recorded was that screening had a beneficial effect even in women whose cancer had already spread into the axillary lymph nodes.

Adult↗
PubMed2002

The risk of stroke following coronary revascularization -- a population-based long-term follow-up study.

OBJECTIVE: To study the incidence and risk factors of stroke after coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA). DESIGN: During 1983-1992, coronary revascularization procedures (n = 2160) were recorded in patients aged 35-64 years as part of the population-based FINMONICA Myocardial Infarction Register. The FINMONICA Stroke Register and National Hospital Discharge Register were used to ascertain subsequent stroke events in such patients. RESULTS: During the average follow-up of 5.83 years, 155 patients (7.2%) had a stroke. The cumulative incidence of stroke was 1.55% in the first year after revascularization and varied between 0.8 and 1.4% during subsequent years. In Cox proportional hazard models the relative risk of stroke was 3.01 (p = 0.0007) for a previous stroke, 2.61 (p = 0.0001) for diabetes mellitus, 2.15 (p = 0.007) for low income (compared with high income), 2.06 (p = 0.03) for male sex, and 1.43 (p = 0.02) for a 10-year increment in age. CONCLUSION: The incidence of stroke during the first year after revascularization was five times higher than among the age- and sex-matched general population. Patients with a previous stroke, diabetes mellitus, advanced age, male sex and low socioeconomic status need special attention because of increased risk of stroke after CABG or PTCA.

Adult↗
PubMedDate not supplied

Eleven-year trends of stroke in Turku, Finland.

The Turku Stroke Register included stroke events at all ages during the years 1982-1992. The incidence of stroke declined in all age groups, even in the oldest one. An even steeper decline was observed in mortality from stroke. Ischemic strokes contributed most to the observed decline, while subarachnoid and intracerebral hemorrhage showed mainly flat trends. Flat trends were also observed for recurrent strokes. The absolute number of strokes remained stable through the study years, but the population above 75 years of age doubled. More than half of the strokes occurred in people aged 75 years or older, and three fourths of them occurred in women. The incidence and mortality rate of ischemic stroke declined steeply in all age groups. Due to an increase in elderly people in the background population, the total number of strokes remained stable. Thus, in spite of the observed declining trends in incidence, the need for stroke care has not diminished.

Adult↗