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Biomedical subjects

Sirpa Hartikainen

Publications and source records attributed to Sirpa Hartikainen.

17 recordsLinked to original sources
PubMed2006

What lies behind relief and worsening of asthma symptoms? A register-based study of adults with asthma and other chronic obstructive pulmonary diseases in Finland.

AIMS: To examine how subjects with relief or worsening of asthma symptoms differ in terms of gender, age, severity and duration of asthma, comorbidity, and difficulties with medication and daily life. METHODS: A postal inquiry among a sample of 6000 adults with clinically diagnosed asthma and/or other chronic obstructive pulmonary diseases. RESULTS: Relief of asthma symptoms over a 12-month period was associated with a recent asthma diagnosis, within five years, in both sexes. Lack of current smoking and lack of problems in using anti-asthmatic treatment were associated with a positive outcome in men, and mild asthma and living alone associated with a positive outcome in women. Severe and moderate asthma predicted worse symptoms in both sexes, as did other obstructive pulmonary diseases, living alone, and medication problems amongst men. CONCLUSIONS: Patients with asthma should be cared for comprehensively, requiring consideration of both clinical and psychosocial factors that can modify the course of the disease.

Adolescent↗
PubMed2006

Increased incidence of hip fractures. A population based-study in Finland.

In Central Finland, the age-specific incidence of hip fractures did not change between the years 1982-1983 and 1992-1993 though the total number of hip fractures increased by 11% due to population aging. The objective of this study was to define the current hip fracture rates and the characteristics of patients with hip fracture. The population at risk consisted of 240,000 persons living in the Central Finland Health Care District. Hip fracture patients were identified by using the hospital discharge register, the operation lists, and the register of the Department of Anesthesiology. Patients' residential status, weight, and height, date and time of hip fracture, place of accident and mechanism and type of fracture were obtained from medical records. A total of 597 patients, 415 (69.5%) women and 182 (30.5%) men, were admitted to the hospital for treatment of an acute hip fracture in 2002-2003. The mean age of the patients was 79 (SD 13) years. Among patients aged > or =50 years (n = 577), 80.8% of the hip fractures had occurred indoors, 97.6% with a low-energetic mechanism, and 22.7% during the nighttime. The ratio of trochanteric to cervical fractures was 2:3. Between 1992-1993 and 2002-2003, the total number of hip fractures increased by 70%, from 351 to 597. The fracture rates per 1000 person-years in the age group > or =55 years were 2.0 and 3.9 in 1992-1993 and 2.8 and 5.6 in 2002-2003 for men and women, respectively. The corresponding age-adjusted incidence rate ratio (IRR) for men was 1.36 (95% CI: 1.06 to 1.76), P = 0.017, and for women 1.25 (95% CI: 1.07 to 1.47), P = 0.006. Among men, the IRR was highest in the age group 75-84 years, IRR = 1.67 (95% CI: 1.08 to 2.65), while among women, it was highest in the age group > or =85 years, IRR = 1.33 (95% CI: 1.02 to 1.75). The total number of hip fractures almost doubled within 10 years, and the age-adjusted incidence rate increased in both sexes. The accretion of the hip fracture incidence was more than could be explained merely by changes in population size and structure.

Age Distribution↗
PubMed2006

Increasing use of medicines in elderly persons: a five-year follow-up of the Kuopio 75+Study.

OBJECTIVE: The aim of this study was to describe the changes in medicine use, polypharmacy and excessive polypharmacy between 1998 and 2003 among a cohort of elderly Finns. METHODS: For this prospective follow-up study, a random sample of 700 participants aged >or=75 years was drawn from the City of Kuopio, Finland. Of them, 601 participated in the study at baseline in 1998. The changes in medicine use among the survivors (n=339), who were re-examined in 2003, were recorded and are described here. Statistical significance of changes in medicine use was evaluated by Student's paired-samples and independent-samples t-test and Fisher's exact test. RESULTS: From 1998 to 2003, the mean number of medicines in use per individual increased from 6.3 to 7.5 (p<0.001). The prevalence of polypharmacy (>5 medicines in use) increased from 54% to 67% and excessive polypharmacy (>or=10 medicines in use) from 19% to 28%. The increase was due to increased use of regularly taken medicines, whereas the use of medicines taken as needed decreased during the follow-up in both sexes. At the time of follow-up survey, persons in institutional care used significantly more medicines (10.9) than community-dwelling elderly persons (7.0) (p<0.001). Central nervous system medicines and cardiovascular medicines were the most commonly used medicines in both years. CONCLUSION: The number of medicines and the prevalence of polypharmacy and excessive polypharmacy increases with advancing age. In order to avoid possible harmful effects and to optimize medication it is necessary to assess the medication regimen at regular intervals.

Age Factors↗
PubMed2005

Community prevalence of alcohol use and concomitant use of medication--a source of possible risk in the elderly aged 75 and older?

AIMS: To explore alcohol use and concomitant use of prescription and over the counter (OTC) medicines in people aged 75 years or over. DESIGN: Community-based randomized survey of home-dwelling elderly persons, Setting: the City of Kuopio, Finland. PARTICIPANTS: Population-based random sample of 700 persons aged 75 years or over, of whom 601 participated (86%). Only home-dwellers (n = 523) were included in this study. MEASUREMENTS: Alcohol use based on responses to questions concerning quantity and frequency, and CAGE questions. Use of prescription and non-prescription medicines. Mean corpuscular volume. RESULTS: Of the participants, 44% used alcohol. Most alcohol drinkers used medications on a regular basis (86.9%) or as needed (87.8%), among them medicines known to have some potential interactions with alcohol. Elevated mean corpuscular volume was more widespread among alcohol drinkers than non drinkers. CONCLUSION: Theoretical risks posed by alcohol use are not minimal in the older elderly, though the quantity of alcohol use is not considerable. Physicians and nurses should pay attention to chronic diseases and medications when counselling aged people about alcohol consumption. The question of clinical importance of alcohol-medication interactions needs to be studied further.

Aged↗
PubMed2005

Comorbidity and medication load in adult asthmatics.

OBJECTIVE: To examine comorbidity and the medication load among asthmatics. Design A self-administered postal inquiry. SETTING: A national register-based random sample of 6000 subjects aged 16 years or older entitled to special reimbursement for anti-asthmatic medication in Finland. SUBJECTS: A total of 4690 subjects with clinically diagnosed asthma. MAIN OUTCOME MEASURES: Reporting of doctor-diagnosed chronic diseases and the number of prescription medicines used by asthmatics. RESULTS: Two-thirds of the subjects (n = 2952, 63%) reported other diseases in addition to other chronic pulmonary diseases and allergies. Musculoskeletal and cardiovascular disorders were the most common, increasing with age. Allergies were most frequent among the young asthmatics. Nearly all the subjects (n = 4444, 95%) took at least one anti-asthmatic medicine, and two out of every three (n = 3051, 65%) received other prescription medicines, most commonly cardiovascular drugs or analgesics. Some 41% (n=1938) of all the asthmatics and as many as 21% of the young adults (n = 269) were taking at least five prescription medicines concomitantly. The total medication load increased with age. CONCLUSION: The load of comorbidity and prescribed medication is heavy in adult asthmatics of all ages. Thus asthmatic patients should best be treated by GPs, while pulmonary specialists work as consultants and take care of the most severe cases.

Adolescent↗
PubMed2005

The use of psychotropics and survival in demented elderly individuals.

The present study aimed to examine the use of psychotropics and its relation to survival in demented elderly persons. A random sample of 700 individuals, aged 75 years or older, was drawn from the population of Kuopio city in January 1998. A geriatrician and a nurse carried out clinical examinations of 601 individuals, of whom 137 suffered from dementia according to DSM-IV criteria. The lifespan was calculated from the date of examination in 1998 to the end of 2003. In survival analyses, subjects were divided according to psychotropic use into groups: (i) users of only one of kind of psychotropics and (ii) concomitant users of all kinds of psychotropics. Psychotropics were classified into antipsychotics, antidepressants and a group of anxiolytics and hypnotics/sedatives. Seventy-one percent (n = 97) of demented elderly individuals used a psychotropic drug. Age- and sex-adjusted survival did not differ by severity of dementia (P = 0.076) or by the diagnosis of dementia (P = 0.54). When survival was compared with nonusers of psychotropics, the hazard ratio was 2.75 (P = 0.002) for individuals who used antipsychotics as their only psychotropic medicine and 1.76 (95% confidence interval 1.09-2.86) for concomitant users of all kinds of psychotropics. The use of several psychotropics or antipsychotics is a risk factor for death in demented elderly persons.

Age Factors↗
PubMed2005

Concomitant use of analgesics and psychotropics in home-dwelling elderly people-Kuopio 75 + study.

AIMS: To investigate the extent of concomitant use of analgesic and psychotropic medicines among home-dwelling elderly people aged at least 75 years in Finland. METHODS: This was a population-based study in Finland, performed as part of Kuopio 75 + study focusing on the clinical epidemiology of diseases, medication and functional capacity. A random sample of 700 persons was drawn from the total population of the city of Kuopio, eastern Finland, aged 75 years on January 1, 1998 (n = 4518). Ninety-nine persons could not be examined and 78 were living in long-term institutions, so that the number of home-dwelling elderly persons amounted to 523. A trained nurse interviewed the participants about their use of medicines, and a geriatrician examined their overall physical and mental status. Dementia and depression were diagnosed according to the DSM IV criteria. Both regular and irregular prescribed and nonprescribed drug use was recorded. RESULTS: Every fourth elderly person (27.2%) used analgesics and psychotropics concomitantly, this use becoming twice as common with advancing age (19.6% in the age group 75-79 years, 38.2% among the oldest, aged 85 + years). Concomitant use of psychotropics and opioids also became more common with increasing age (2.8% in age group 75-79 years and 9.6% in the oldest group, aged 85 + years). The use of opioids was nearly twice as common among concomitant users (19.7%) than among those using only analgesics (11.3%). Concomitant users suffered from interfering daily pain and daily pain at rest more commonly than nonusers of analgesics. Depression, sleeping problems and polypharmacy were more common among the concomitant users, who had also had more hip fractures than the rest. CONCLUSIONS: Concomitant use of analgesics and psychotropics becomes more common with advancing age and is a potential risk factor for adverse drug effects.

Age Factors↗
PubMed2004

Effects of dementia on perceived daily pain in home-dwelling elderly people: a population-based study.

BACKGROUND: Pain is a significant problem in the elderly, but the impact of dementia on perceived pain has not been studied in population-based study settings. OBJECTIVES: To analyse the prevalence of daily pain and analgesic use among home-dwelling older people with and without dementia. DESIGN: A cross-sectional population-based survey. SETTING: Population of Kuopio city, Finland. SUBJECTS: 523 home-dwelling subjects aged 75 years and older. METHODS: Structured clinical examination and interview. RESULTS: Prevalence rates for any pain, any daily pain, pain every day interfering with routine activities, and daily pain at rest were significantly lower in those subjects with dementia (43%, 23%, 19% and 4%, respectively) compared to those subjects without dementia (69%, 40%, 36% and 13%, respectively). The subjects with dementia were less likely to use analgesics (33%) than the non-demented (47%). CONCLUSION: Dementia was related to a lower prevalence of reported pain and analgesic use among home-dwelling elderly people.

Activities of Daily Living↗
PubMed2004

Achievements and shortcomings of Finnish asthma care.

BACKGROUND: The Finnish National Asthma Programme was launched in 1994. AIM: A postal self-completion questionnaire study was undertaken to evaluate how the guideline is working in the Finnish healthcare system. METHODS: A postal inquiry was sent to a random sample of 6,000 subjects aged 16+ years who were entitled to special reimbursement for anti-asthmatic medication and 4,657 subjects with self-reported asthma were included. RESULTS: The subjects comprised 38% men (n=1,781) and 62% women (n=2,876). In all, 62% of all the subjects and 78% of those with severe asthma had visited a doctor on account of asthma in the past 12 months. Some 83% of the respondents had a given physician who was responsible for treating their asthma, and 75% of these were under observation by a primary healthcare physician. Visits to asthma nurses were relatively rare. Inhaled glucocorticoids were used by 83% of the subjects, but short-acting beta-2-agonists were still the most commonly used asthma drug in monotherapy regardless of the severity of asthma. Inhaled glucocorticoids and a short-acting beta-2-agonist was the most frequent combination. Every tenth subject used this combination supplemented by a long-acting beta-2-agonist. CONCLUSION: Asthma care in Finland seems to be compatible with the national guidelines in terms of continuity and the common use of inhaled glucocorticoids. The primary care sector has adopted the main responsibility for the treatment of asthma. The common use of short-acting beta-2-agonists is an exception to an otherwise positive trend.

Adolescent↗
PubMed2003

Use of psychotropics among home-dwelling nondemented and demented elderly.

OBJECTIVE: To describe the use of psychotropics in the nondemented and demented elderly. PARTICIPANTS: The home-dwelling elderly (n=523) among the random sample of 700 subjects from the total population of individuals aged 75 years or more in 1998 and living in the city of Kuopio, Finland. METHODS: A trained nurse interviewed the participants about their health and current use of medicines. A geriatrician performed clinical examinations and diagnosed diseases. Dementia and depression were diagnosed according to the DSM-IV criteria. RESULTS: The demented subjects used more medicines of all kinds (p<0.01), and especially more psychotropics than the nondemented (p<0.001). One in four demented subjects, compared to one in ten nondemented ones used at least two psychotropics (p<0.01). The demented subjects used antipsychotics six times more often than the nondemented ones (p<0.001). Among the nondemented subjects, one out of two antipsychotics users was suffering from depression according to DSM-IV criteria. Three out of four persons who had dementia with Lewy bodies were using psychotropics. Persons with moderate dementia were more commonly using all kinds of psychotropic preparations especially, antipsychotics three times more commonly than persons with mild or severe dementia. CONCLUSION: Psychotropics, especially antipsychotics, are commonly used in the treatment of both nondemented and demented elderly, even without proper indication. Physicians need more training about the appropriate use of psychotropics to minimize their adverse effects.

Aged↗
PubMed2003

Change in the prevalence of coronary heart disease among Finnish elderly men and women in the 1990s.

OBJECTIVE: To characterise the prevalence of, and changes in, coronary heart disease (CHD) among men and women aged between 64 and 71 years in the 1990s. DESIGN: A study of clinical epidemiology involving two cohorts of elderly persons in 1990-1991 and 1998-1999. SETTING: Primary health care in the municipality of Lieto in southwestern Finland. SUBJECTS: Persons between 64 and 71 years of age in the southwest of Finland in 1990-1991 and 1998-1999. MAIN OUTCOME MEASURES: The occurrences of CHD were estimated using the history of a previous myocardial infarction or coronary revascularisation procedure evident in the medical records and with ischaemia or infarction as established on ECG according to the Whitehall criteria. RESULTS: The prevalence of 'probable' CHD decreased among men and women aged between 64 and 71 years, whereas the prevalence of 'possible' CHD decreased among women alone. Silent myocardial infarctions were common among women of both cohorts. Many more men of the second cohort, compared to the first one, had undergone a coronary angioplasty or bypass operation. CONCLUSION: The prevalence of CHD decreased among elderly women more clearly than among young elderly men. The favourable development illustrating a decrease in the prevalence of CHD among women should be sustained, while health promotion activities will need to be directed more actively towards men.

Aged↗
PubMed2003

Kuopio 75+ study: does advanced age predict more common use of psychotropics among the elderly?

The elderly use more psychotropic medication than the general population, and its use has grown during recent decades. The aim of this study was to describe the use of psychotropics in the home-dwelling elderly aged 75 years or older in Finland. This Kuopio 75+ Study is a population-based health survey. A random sample of 700 subjects were drawn from the total population of people aged 75 years or more in January 1998. A geriatrician and a trained nurse carried out clinical examination and interview about the use of medicines for 523 home-dwelling elderly. At least one psychotropic medication was used by 37% of the sample, and 12% were using two or more psychotropics concomitantly. The psychotropic users were older, more often widowed and living alone compared to subjects without psychotropic medication. The probability of psychotropic use increased linearly with age for anxiolytics/hypnotics or antipsychotics, but not for antidepressants. Psychotropics are commonly used in the elderly, particularly among those aged 85 years or more, who are most vulnerable to adverse effects. Careful consideration is needed before prescribing psychotropics to the elderly.

Aged↗
PubMed2002

Use of medications and polypharmacy are increasing among the elderly.

To assess changes in medicine use and polypharmacy, two cross-sectional surveys were carried out among community-dwelling persons aged 64 years or over in 1990-91 (n = 1,131) and 1998-99 (n = 1,197) in the municipality of Lieto in southwestern Finland. In addition to drug use, the questionnaire included items on social background, quality of life, and home nursing services. Among those surveyed, 78% in 1990-1991 and 88% in 1998-1999 (P =.001) used prescription drugs during 7 days prior to the interview. The most commonly used medications were for the cardiovascular and central nervous systems. The number of medications per person increased from 3.1 (SD 2.8) to 3.8 (SD 3.1) (P =.0001), and polypharmacy (concominant use of over five medications) increased from 19 to 25% (P =.006). These changes were most prominent among persons aged 85 years or over, especially among women. Polypharmacy is a complex and worrying phenomenon that merits more research.

Age Factors↗