Dataset Information

A 10 year asthma programme in Finland: major change for the better.

ABSTRACT:

Background

A National Asthma Programme was undertaken in Finland from 1994 to 2004 to improve asthma care and prevent an increase in costs. The main goal was to lessen the burden of asthma to individuals and society.

Methods

The action programme focused on implementation of new knowledge, especially for primary care. The main premise underpinning the campaign was that asthma is an inflammatory disease and requires anti-inflammatory treatment from the outset. The key for implementation was an effective network of asthma-responsible professionals and development of a post hoc evaluation strategy. In 1997 Finnish pharmacies were included in the Pharmacy Programme and in 2002 a Childhood Asthma mini-Programme was launched.

Results

The incidence of asthma is still increasing, but the burden of asthma has decreased considerably. The number of hospital days has fallen by 54% from 110 000 in 1993 to 51 000 in 2003, 69% in relation to the number of asthmatics (n = 135 363 and 207 757, respectively), with the trend still downwards. In 1993, 7212 patients of working age (9% of 80 133 asthmatics) received a disability pension from the Social Insurance Institution compared with 1741 in 2003 (1.5% of 116 067 asthmatics). The absolute decrease was 76%, and 83% in relation to the number of asthmatics. The increase in the cost of asthma (compensation for disability, drugs, hospital care, and outpatient doctor visits) ended: in 1993 the costs were 218 million euro which had fallen to 213.5 million euro in 2003. Costs per patient per year have decreased 36% (from 1611 euro to 1031 euro).

Conclusion

It is possible to reduce the morbidity of asthma and its impact on individuals as well as on society. Improvements would have taken place without the programme, but not of this magnitude.

SUBMITTER: Haahtela T

PROVIDER: S-EPMC2104683 | biostudies-literature | 2006 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A 10 year asthma programme in Finland: major change for the better.

Haahtela T T Tuomisto L E LE Pietinalho A A Klaukka T T Erhola M M Kaila M M Nieminen M M MM Kontula E E Laitinen L A LA

Thorax 20060801 8

<h4>Background</h4>A National Asthma Programme was undertaken in Finland from 1994 to 2004 to improve asthma care and prevent an increase in costs. The main goal was to lessen the burden of asthma to individuals and society.<h4>Methods</h4>The action programme focused on implementation of new knowledge, especially for primary care. The main premise underpinning the campaign was that asthma is an inflammatory disease and requires anti-inflammatory treatment from the outset. The key for implementa ...[more]

PMID: 16877690

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Project description:Cytokine theory of depression proposes that increased baseline inflammatory activity may accumulate over time and lead to future major depressive disorder (MDD). However, most research conducted on this topic has been cross-sectional and examined between- (vs. within-) persons and symptom severity (vs. diagnosis). Therefore, we tested if elevated inflammatory activity at Time 1 (T1) would predict future within-person 9-year change in MDD diagnosis. Community-dwelling adults (n = 945) participated in the Midlife Development in the United States (MIDUS) study. T1 and Time 2 (T2) MDD status was assessed using the Composite International Diagnostic Interview-Short Form, and markers of inflammatory activity at T1 were measured (e.g., levels of serum interleukin-6 [IL-6], C-reactive protein [CRP], fibrinogen). Latent change score modeling was conducted. Higher T1 IL-6, CRP, and fibrinogen levels of inflammatory activity predicted T1-T2 development/relapse of MDD within persons. This effect occurred more strongly among women (vs. men; d = .149 vs. .042), younger (vs. older) adults (d = .137 vs. .119), persons with more (vs. less) chronic health issues (d = .133 vs. .065), low- (vs. middle- or high-) income earners (d = .161 vs. .050), and persons with more (vs. less) frequent childhood trauma (d = .156 vs. .017). Findings aligned with expanded cytokine theories, which posit that the impact of increased T1 inflammatory activity on future change in MDD status will be larger for subgroups vulnerable to increased stress exposure. Cognitive-behavioral or pharmacological approaches to reduce markers of inflammatory activity may prevent development/relapse of MDD. General Scientific Summary: Increased C-reactive protein (CRP), fibrinogen, and interleukin-6 (IL-6) levels predicted 9-year major depressive disorder (MDD) diagnostic status change more strongly in younger than older adults, women but not men, those with low (vs. high) income, as well as persons with high (vs. low) childhood trauma frequency and number of chronic illnesses. Findings aligned with expanded cytokine theories (e.g., social signal transduction theory of depression), which posit that markers of inflammatory activity predict future change in MDD status especially for populations vulnerable to heightened, chronic, and long-term exposure to environmental stressors. Continued efforts to empirically test expanded cytokine theories of depression may improve delineation of patterns of health disparities and facilitate effective measures to prevent the onset or recurrence of MDD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Dataset Information

A 10 year asthma programme in Finland: major change for the better.

Background

Methods

Results

Conclusion

Publications

A 10 year asthma programme in Finland: major change for the better.

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