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T Keistinen

Publications and source records attributed to T Keistinen.

At least 19 recordsLinked to original sources
PubMed2005

Long-term hospital treatment for patients with chronic obstructive pulmonary disease.

The aim of this study is to describe the long-term hospital treatment provided for chronic obstructive pulmonary disease (COPD) patients in Finland in 1972-2001 and changes over that period. Data on all treatment periods for persons aged over 45 years with a primary or secondary diagnosis of COPD (International Classification of Diseases - ICD 8: 491 and 492, ICD 9: 491, 492 and 496, ICD 10: J41-J44) beginning in the years 1972-2001 were gathered from the treatment register of the Finnish National Research and Development Centre for Welfare and Health and examined particularly with respect to long treatment periods (over 90 days). A total of 10,176 long treatment periods were recorded as having begun during the years in question. The number of treatment periods for men dropped by 65.8% over the time interval 1972-2001, while that for women increased by 4.7%. The number of treatment periods in university and central hospitals dropped by 97.6%. The total number of hospitalization days in the long treatment periods over the years 1972-2001 was 3,844,521, the men accounting for 82.9% in 1972-1976 and 67.3% in 1997-2001. The number of days required by men dropped by 82.1% and that for women by 57.8%. The number of days in university and central hospitals decreased by 98.4%, and that in health centre hospitals by 47.6%. COPD is a cause of repeated hospitalization, but it less and less often leads to long-term hospital treatment nowadays. The number of treatment days required for men has fallen more rapidly than that for women, and both the lengths and numbers of treatment periods have decreased at all levels of hospital, although with a tendency for treatment to be concentrated nowadays in the health centre hospitals. Long-term treatment for COPD has virtually disappeared from the sphere of specialized health care. The trends observed here are attributable to marked changes in the structure of the health service, with more accent being placed on open care, and a decrease in the numbers of male smokers.

Aged↗
PubMed2004

Mortality after first hospitalization for chronic obstructive pulmonary disease: changes in 1980-1998.

The prognosis of a hospitalized patient for chronic obstructive pulmonary disease (COPD) is poor. The aim of this study was to determine changes in the prognosis for patients entering hospital for the first time on account of COPD in ten years. Data were gathered from the hospital treatment records maintained by the National Research and Development Centre for Welfare and Health in Finland on periods spent in hospital by persons over 44 years of age with a principal diagnosis of COPD over the interval 1972-1994. Two groups of patients were then distinguished separately those first treated in 1980-1984 and those first treated in 1990-1994, and mortality data sought for these persons in the records of Statistics Finland up to the end of 1998. A total of 11,739 men and 3,048 women were found to have been admitted to hospital with a diagnosis of COPD for the first time in the period 1980-1984. The corresponding figures for the interval 1990-1994 were 8,941 men and 3,628 women. The Cox regression model standardized for age showed mortality to have increased in ten years among both the men [Hazard Ratio 1.093 (95% CI 1.055 - 1.133)] and the women [HR 1.138 (95% CI 1.061 - 1.221)]. This worsening of the prognosis was most pronounced in the age group 45-64 years, where the men had an HR of 1.145 (95% CI 1.060 - 1.236) and the women of 1.412 (95% CI 1.208 - 1.650). The prognosis for men and younger women in particular entering hospital for the first time for COPD deteriorated significantly over a period of ten years. This may partly be attributed to the increased frequency of diagnosis and treatment of COPD in outpatient departments and to the reduction in rehabilitation. The apparent more rapid worsening of the prognosis for women relative to men can largely be attributed to their increased smoking.

Age Factors↗
PubMed2003

Impact of comorbidities on the duration of COPD patients' hospital episodes.

The duration of inpatient episodes due to COPD and the factors that affect it have recently been an object of increasing attention, as the aim has been to shorten inpatient periods and thereby to cut health-care costs. All hospital episodes of patients aged over 45 for a primary diagnosis of COPD equal or less than 150 days in duration were drawn from the treatment register maintained by the National Research and Development Centre for Welfare and Health. The lengths of these 152569 inpatient periods were analysed for sex, age and secondary diagnoses by covariance analysis. The mean age of men at the beginning of the hospital episode was 70.6 years and that of women 70.1 years. Men accounted for 76.9% of all inpatient episodes. Covariance analysis ofthe data with age standardised as 70.5 years yielded a mean hospital episode length of 8.9 (95% confidence interval (CI) 8.8-9.0) days. The mean length of hospital episodes without a secondary diagnosis was 7.7 (95% CI 7.6-7.7) days and that with a secondary diagnosis was 10.5 (95% CI 10.5-10.6) days. The longest inpatient episodes were recorded for the patients with secondary diagnoses of pneumonia, 14.7 (95% CI 14.2-15.2) days, and cerebral ischaemia, 14.2 (95% CI 13.5-14.9) days. Concurrent diseases prolonged the hospital episodes of COPD patients. At the beginning of a hospital episode, it is possible to estimate its duration and the need for different treatments based on the patients age and secondary diagnoses.

Age Factors↗
PubMed2001

Seasonal fluctuations in hospitalisation for pneumonia in Finland.

The purpose of this paper is to describe seasonal fluctuations in hospitalisation for pneumonia in Finland over the period 1972-1993. Treatment periods with pneumonia as the main or secondary diagnosis were collected from the national hospital discharge register. The seasonality of monthly hospital admissions was analysed using the X11 ARIMA procedure. The population of Finland numbered 5 million during the period concerned, and there were a total of 453,393 pneumonia treatment periods, 17.9% in the age-group under 16 years, 29.6% among working-age persons and 52.5% among persons aged over 64 years. The number was greatest in the total population in December (20.5%) and January (25.1%) and lowest in July (-19.7%) and August (-24.3%). Seasonal fluctuations in pneumonia hospitalisations pointed to the same trend in both the sexes, in that the number increased in winter and decreased in summer. Children's admissions began to increase a month earlier than those of the other age groups, however, in November, while a transient increase in admissions of working age persons in March is attributable to the more extensive use of hospital services by army conscripts. Admissions of persons aged over 64 years fell more slowly from the winter peak than did those of the other segments of the population. The winter peak in hospital admissions for pneumonia can be anticipated administratively by increasing the number of hospital beds and intensifying outpatient care. It may not be necessary to increase health care resources to achieve this, however, as the necessary resources can be obtained through reductions in the summer months. Proper recognition of admission peaks, the points in time at which these regularly occur and the target groups within the population can contribute greatly to health care planning and its economy.

Adolescent↗
PubMed1999

Incremental effectiveness of pneumococcal vaccine on simultaneously administered influenza vaccine in preventing pneumonia and pneumococcal pneumonia among persons aged 65 years or older.

The effectiveness of simultaneously administered influenza and pneumococcal vaccines vs. influenza vaccine alone in preventing pneumonia, pneumococcal pneumonia and pneumococcal bacteraemia among the elderly was studied. The vaccines were offered to all persons aged 65 years or older (N=43,500) living in 35 administrative districts in Northern Finland. A total of 26,925 persons (62%) decided to participate. Allocation to the vaccination groups took place by year of birth (odd/even). The total follow-up of those vaccinated consisted of 38,037 person years. The incremental effectiveness of the pneumococcal vaccine was -20 (95% CI -50- + 10%) for pneumonia, -20 (95% CI -90- + 20%) for pneumococcal pneumonia and + 60% (95% CI -40- +90%) for pneumococcal bacteraemia. Thus the pneumococcal polysaccharide vaccine did not offer any additional protection from pneumonia among elderly people in Finland although it reduced the incidence of bacteraemia.

Aged↗
PubMed1998

Survival experience of the population needing hospital treatment for asthma or COPD at age 50-54 years.

The aim was to evaluate the differences of mortality among asthma and COPD patients on the basis of the first period of hospitalization of these diseases. A total of 576,916 treatment periods for asthma and COPD between 1972 and 1992 were identified in the discharge register maintained by the National Research and Development Centre for Welfare and Health. Patients aged 50-54 years first treated in hospital in 1977 or later were analysed. There were 6655 new asthma patients of this age, 2727 new COPD patients and 701 new patients in a mixed group (with both diagnoses). Mortality up to the end of 1993 was analysed based on mortality and cause of death data provided by the Central Statistical Office of Finland. Estimated cumulative survival after 10 yr was higher among the asthma patients (83.5% for men and 93.2% for women) and lower among the COPD patients (60.1% and 78.0%) and in the mixed group (62.5% and 74.4%). The main cause of death among the asthmatics was asthma in 12.1% of cases, that among the COPD patients was COPD in 22.1% of cases and that in the mixed group was one or other of these diseases in 39.1% of cases. The prognosis for COPD patients aged 50-54 years requiring hospital treatment is poor. Combination of the data available from the cause of death and hospital discharge registers indicates that obstructive pulmonary diseases may well be of more significance from a public health point of view than the mortality statistics would lead us to believe. The very first hospitalization for COPD calls for a thorough evaluation of the prospects for active treatment and prevention.

Asthma↗
PubMed1998

Seasonal variations in hospital treatment periods and deaths among adult asthmatics.

The purpose of this study was to examine possible seasonal variations in relations between hospital treatment periods and in deaths (asthma-related and other) among adult asthmatics. Out of a total of 364,871 asthma-induced hospitalization periods (diagnosis No. 493, International Classification of Diseases) recorded in the hospital discharge register maintained by the National Research and Development Centre for Welfare and Health during 1972-1992, all of those applying to persons aged >24 yrs during 1987-1992 were analysed here. The discharge file was linked to the register of deaths on the basis of the patients' social security numbers in order to analyse all deaths among the same patients during 1987-1993. A total of 81,243 asthma-related treatment periods were analysed. The monthly variation in the number of such periods showed a peak in January (18.2% above the mean number of monthly deaths in the study period) and a trough in July (26.1% below the mean). Of the 7,622 hospitalized asthmatics who died during the period examined here, 1,274 died of obstructive pulmonary diseases, with asthma as the primary cause in 489 cases. The majority of the deaths were caused by cardiovascular diseases. Mortality was highest in January (+14.7%) and lowest in August (-12.3%). The similarity in the seasonal variation observed between the treatment periods and deaths recorded for adult asthmatics may be taken to indicate a genuine need for treatment.

Adult↗
PubMed1998

Evaluation of the incidence and age distribution of bronchiectasis from the Finnish hospital discharge register.

The incidence and age distribution of bronchiectasis is at present poorly known. The aim here was to describe the use made of hospital services by bronchiectasis patients in Finland over ten years and to estimate the incidence of this disease. Data on hospital admissions for bronchiectasis were obtained from the register maintained by the National Research and Development Centre for Welfare and Health. Admissions and new cases during the period 1983-1992 were calculated by age and sex in relation to the total population. There were 5,710 admissions for bronchiectasis and 1,928 new cases. The occurrence of cases treated in hospital was 4.9 per million person-years at age 0-14 years, 103.8 at 65 years or over and 38.9 in the total population. The estimated incidence of bronchiectasis is low in Finland, especially in childhood, and efforts aimed at its treatment should now be directed specifically at the elderly population, which continues to exert considerable pressure on even a relatively well developed health service in this respect.

Adolescent↗
PubMed1998

The course of childhood bronchiectasis: a case report and considerations of hospital use.

This paper discusses the clinical history of a Finnish person from the area north of the Arctic Circle with childhood-onset bronchiectasis. It covers a period of 30 years and is aimed at analysing the significance of the disease for the use of hospital services. Childhood bronchiectasis is a rare disease nowadays and difficult to diagnose, but it still leads to serious disability in some children, requiring regular hospitalisation. The prognosis for these cases with advancing age is not known.

Adenoviridae Infections↗
PubMed1997

Seasonal variation in childhood asthma hospitalisations in Finland, 1972-1992.

UNLABELLED: All hospital treatment periods caused by asthma in children under 15 years in Finland during 1972-1992 were examined. The data were obtained from the Hospital Discharge Register, covering all hospitalisations in Finland. A total of 59,624 asthma related treatment periods were recorded. The monthly variation in hospitalisations peaked in May (35.6% above the trend) and in autumn and early winter (41.3% above the trend in October), whereas the monthly variations were low in late winter and in summer. The overall profile of seasonal variation was similar in both sexes, although admissions were lower for boys than for girls in winter and higher in autumn. The average monthly deviation was highest in the age group 0-4 years in May, 42.8% above the trend, and highest in the age group 5-9 years in October, 53.9% above the trend. Closer examination of the seasonal variation gives indirect information on possible trigger factors for acute asthma. CONCLUSION: A clear seasonal variation could be observed in childhood asthma hospital admissions, together with age and sex-related differences in this seasonality. Preventive treatment for asthma should be used effectively in order to avoid acute attacks leading to hospitalisation in children who are allergic to birch pollen and also at times of viral respiratory infections.

Acute Disease↗
PubMed1997

The impact of vaccination strategy and methods of information on influenza and pneumococcal vaccination coverage in the elderly population.

We compared the coverage achieved with either an age-based, free-of-charge vaccination program offering influenza vaccine alone or with pneumococcal vaccine with a restricted risk disease-based influenza vaccination program supplemented by self-funded immunization. We also compared two means of informing the public, either using mailed personal reminders or through the mass media only. Forty-one administrative districts with a total of 41,500 persons aged 65 years or older participated in the study during three consecutive seasons from 1992 to 1994. The average vaccination coverage achieved by the risk disease-based program was 20%, by the age-based program with mass media information, 52%, and by the age-based program with mailed personal reminders 82%. The availability of free-of-charge vaccines is thus not sufficient to ensure a high vaccination rate. The effect of the personal reminders was restricted to the year they were sent. The addition of pneumococcal vaccine to the age-based influenza vaccination program had little influence on the acceptance rate.

Age Factors↗
PubMed1997

Bronchiectasis in Finland: trends in hospital treatment.

The incidence of bronchiectasis has probably declined in developed countries in recent years, but no reliable statistical data on this are available. The present paper describes the use made of hospital services by bronchiectatic patients in Finland. Data on a total of 12,539 treatment periods for bronchiectasis that had occurred between 1972 and 1992 were collected from the discharge register maintained by the National Research and Development Centre for Welfare and Health (diagnosis 518 in the International Classification of Diseases up to 1986, and 494 from 1987 onwards). The number of admissions, new occurrences of bronchiectasis and days in hospital were calculated by sex and age in relation to the total population at the end of each year. There were 143 and 87 admissions per million inhabitants in 1972 and 1992, respectively. The admissions, new occurrences and the days in hospital all decreased, at annual rates of 1.3, 4.2 and 5.7%, respectively. Thus, where the number of new occurrences was 50 per million persons in 1977, it was 27 per million in 1992. In summary, bronchiectasis-related hospital treatment declined markedly between 1972 and 1992. Trend is attributed to effective treatment of pulmonary infections and the reduction in tuberculosis.

Bronchiectasis↗
PubMed1997

Hospital discharges for pneumonia in Finland between 1972 and 1993 in the population aged 65 years or over.

AIM: to describe the use of hospital services by Finnish adults aged 65 or over with pneumonia from 1972 to 1993. MATERIAL AND METHODS: the study was based on nation-wide hospital discharge records. Patients in hospital for over 150 days were excluded. The number of persons aged 65 or over was 458,156 in 1972 and 707,341 in 1993. RESULTS: pneumonia caused 237,330 periods of hospital treatment and a total of 3,826,986 hospitalization days in elderly people during the 22-year period. Annual hospital treatment periods increased from 15.5 to 23.9 per 1000 of population aged 65 years or over within this interval. The average annual change in the age-adjusted rate of hospital admissions for pneumonia was 1.45% [95% confidence interval (CI) 1.03 to 1.87] for males and 0.83% (95% CI 0.39 to 1.28) for females. The increase was highest in the oldest male group, those aged 85 years or over. In 1972 the number of hospitalization days recorded was 126,690 (277 per 1000) and in 1993 it was 242,638 (343 per 1000), implying an absolute increase of 91.5%. However, the average annual change in the age-adjusted rate of hospitalization days for pneumonia showed a decrease of 0.62% (95% CI 1.04 to 0.19). CONCLUSION: the recorded increase in the use of hospital services by elderly patients with pneumonia, combined with the current increase in size of the elderly population, suggests that the prevention and treatment of pneumonia in this sector of the population will pose a challenge for the health service in the future.

Aged↗
PubMed1997

Links between hospital diagnoses of bronchiectasis and asthma.

In view of the conflicting notions of the relationship between bronchiectasis and asthma, we have analysed the use of hospital services by bronchiectasis and asthma patients and evaluated the links between these diseases, employing data from the Finnish Hospital Discharge Register of over 21 million hospitalization periods recorded in 1972-92. We conclude that asthma is common in hospitalized bronchiectasis patients and appears to be consequent upon this disease.

Asthma↗
PubMed1997

Survival and cause of death among elderly chronic obstructive pulmonary disease patients after first admission to hospital.

Those patients with chronic obstructive pulmonary disease (COPD) who require hospital treatment are severely ill. We have studied the survival and cause of death among COPD patients in Finland after their first admission to hospital due to COPD. COPD-related treatment periods in all hospitals during 1972-1992 were collected from the national discharge register, and a subgroup was defined consisting of 2,237 patients aged 65-69 years who had their first admission during 1986-1990. Survival and causes of death were analysed for this group using the data contained in the national mortality statistics. The mortality data were recorded up to the end of 1993. By the end of 1993, 1,070 persons (48%) in the study group had died. The median survival time was 5.71 years (95% CI 5.27-6.15). Female COPD patients had a more favourable prognosis than males. COPD had been certified as the main cause of death for 33.3% of the women and 29.4% of the men. The proportion of COPD as main cause of death increased with an increasing number of treatment periods prior to death. In conclusion, the first hospital admission for COPD indicates a poor prognosis. A high incidence of pulmonary cancer contributes to the poor outcome in the case of men. COPD is obviously underrated on death certificates as the cause of death among COPD patients.

Aged↗