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Biomedical subjects

T Tuuponen

Publications and source records attributed to T Tuuponen.

At least 19 recordsLinked to original sources
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↗
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

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

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↗
PubMed1997

Regional differences in long-term mortality among hospital-treated asthma and COPD patients.

Chronic obstructive pulmonary diseases, which have increased due to smoking and ageing of the population, constitute a national health problem, the treatment of which can be expected to arouse considerable discussion in health care organisations currently preoccupied with economic problems. Although extensive medication and easy access to treatment are often regarded as therapeutically desirable, it may be questioned whether they have any impact on objective measures such as mortality. International recommendations for the early treatment of asthma have met with satisfaction and the asthma situation can be said to be under control, even though occurrences tend to be on the increase. It should be noted, however, that the COPD treatment recommendations still remain to be tested and the general attitude towards treatment is still reserved, even pessimistic. By combining data from the Finnish national hospital discharge register and register of deaths with findings regarding the use of medications, differences in the survival of asthmatic and COPD patients can be discerned between areas with different treatment practices. Stressing the fact that effect-differences between different treatment strategies can not be proven on the basis register data and that random clinical trials are needed to gain further knowledge in the field, our results show that extensive medication and easy access to treatment are characteristic of areas where the survival of asthmatics and COPD patients is better.

Asthma↗
PubMed1997

Bronchiectasis: an orphan disease with a poorly-understood prognosis.

The prognosis and risk factors for bronchiectasis are at present poorly known. The aim of this study was to examine the long-term prognosis and cause of death in this disease. The National Hospital Discharge Register was used to search for patients aged 35-74 yrs, with newly-diagnosed bronchiectasis in the period 1982-1986. Each of the 842 patients identified was matched with an asthmatic patient and a patient with chronic obstructive pulmonary disease (COPD), who were of the same age and sex and who had been treated in hospital at the same time. The use of hospital services by these subjects was examined up to the end of 1992, and mortality to the end of 1993. The prognosis for the bronchiectatic patients treated in hospital was better than that for the COPD patients but poorer than that for the asthmatics; the risk of death being 1.25 (95% confidence interval (95% CI) 1.15-1.36) for the COPD patients and 0.79 (95% CI 0.71-0.87) for the asthmatics, relative to the bronchiectatic patients. Bronchiectasis was the main cause of death in 13% of bronchiectatic patients, the risk of death being increased by a factor of 1.21 in the presence of asthma as the main secondary diagnosis, by 1.31 with COPD, by 1.35 with tuberculosis and its sequelae, and by 1.32 with some other secondary diagnosis, as compared with cases for which no secondary diagnosis was indicated. The fact that the prognosis for bronchiectatic patients is poorer than that for asthmatics points to a continued need for focused care and follow-up, particularly in the presence of additional illnesses.

Adult↗
PubMed1997

Asthma-induced hospitalizations among conscripts in Finland in 1982-1992.

The purpose was to examine changes in the numbers of asthma-related hospitalizations among conscripts and possible seasonal fluctuations. Data on treatment periods for asthma among men aged 18-22 years at military hospitals in 1982-1992 were collected from the national hospital discharge register. Monthly numbers of hospitalizations were calculated for each year separately, together with the frequency of such periods per 1000 conscripts. Results. A total of 4894 asthma-related hospitalizations were recorded in 1982-1992, the frequency per 1000 conscripts increasing from 8.5 in 1982 to 27.7 in 1992. Evident seasonal fluctuations were observed in 1982-1989, the peaks being recorded for February (14% above the annual average), July (26%) and November (51%). A change in these seasonal fluctuations was observed in 1990-1992, however. The frequency of asthma-induced hospitalizations among conscripts tripled between 1982 and 1992, evidently indicating a real increase in the number of occurrences. The hospitalization peaks are located at the beginning of military service, a point at which factors tending to aggravate asthma exercise a major impact.

Adolescent↗
PubMed1996

Hospital admissions for chronic obstructive pulmonary disease in the population aged 55 years or over in Finland during 1972-1992.

Hospital admissions for patients with COPD (chronic obstructive pulmonary disease) as the primary diagnosis for the total Finnish population aged 55 years or over were collected from discharge register from 1972 to 1992. Numbers of admissions and days in hospital by sex and age in relation to total population and the duration of stay in hospital were analysed. A total of 188,570 admissions related to COPD were recorded. There was an average of 17.0 admissions per 1,000 persons per year for men and 2.1 for women. The annual increase in the number of such periods, relative to population, was +1.5% for men (95% confidence interval +0.8 to +2.1%) and +5.1% (+4.0 to +6.2%) for women. A steady upward trend was found in all age groups among women and in the age group 65 years or over among men. The mean number of hospitalisation days increased among women but tended to decrease from the late 1980's onwards among men. The average length of stay decreased from 16.4 days (median: 11 days) in 1972 to 9.6 days (median: 7 days) in 1992. An increase in the need of hospital services was consistent feature among women and older men. Preceding smoking prevalence in Finland, ageing of the population and some institutional factors are the probable aspects behind this trend.

Age Distribution↗
PubMed1996

Age distribution of patients treated in hospital for chronic obstructive pulmonary disease.

A discharge register maintained by the National Research and Development Center for Welfare and Health was employed to study the use of hospital services, attributable to chronic obstructive pulmonary disease (COPD), in Finland. From a total population of 5 million COPD caused 113,016 hospital treatment periods during 1983-92 of persons aged 35 years or over. In men the need of hospital treatment for COPD started to rise sharply after the age of 50. Men aged 73 had the highest amount of admissions (3962 admissions per 10-year period). Women aged 68 had the highest amount of admissions (802 admissions per 10-year period). The highest admission rate per 1000 inhabitants was found for men at the age of 82 (37.0 admissions per 1000 population/ year) and for women at the age of 77 (3.8 admissions per 1000 population/year). During the 10-year period a total of 27,008 new COPD patients aged 35 or over received hospital care. The highest number of new admissions occurred among both sexes at the age of 71 (750 admissions per 10-year period in men and 233 admissions per 10-year period in women). This means that most of admissions are due to elderly COPD patients seeking treatment repeatedly. As the populations in the developed countries are ageing, the significance of COPD for the health care system is growing.

Adult↗
PubMed1996

Hospital admissions of asthmatics by age and sex.

Asthma-related hospital admissions and the occurrence of new admissions were studied by age and sex in order to find the groups of asthmatics with high hospital admission rates. Data from the Finnish discharge register for 1972-92 were used to analyze the number of hospital admissions caused by asthma (defined in the International Classification of Diseases, 8th and 9th revisions, code 493) and occurrence of new asthma admissions between 1983 and 1992. A total of 192195 asthma-induced treatment periods were identified, 91223 for males and 100972 for females. Boys were admitted twice as often as girls at the age of 1 year (11.2 in comparison with 5.9 admissions per 1000 per year), whereas the admission rate was consistently higher among women 25-55 years of age. The highest asthma admission rate among the elderly was at age 73 for men (10.3 per 1000) and 75 for women (9.5 per 1000). Occurrences of new asthma admissions were most frequent at the age of 1 year (5.3 per 1000 for boys and 2.9 per 1000 for girls) and remained constant among those aged 50-80 years. Asthma is not only a disease of childhood and adolescence. The number of middle-aged and elderly asthmatics requiring hospitalization is markedly high.

Adolescent↗