Biomarkkerit munuaisen ja virtsarakon syövässä

7.6.2003 Helsingin yliopisto

Harri Visapää

Tobacco control in Finland

The paper describes the national tobacco control efforts in Finland during the past three decades, with emphasis on implementation of a comprehensive legislation and related health promotion activities. There has been a gradual reduction of smoking among men and a levelling off of the increase among women according to a national system to monitor the trends in smoking prevalence since 1978. In 2002 some 27 % of men and 18 % of women were daily smokers in the age group 15-64 years; this level is one of the lowest in Europe. Mortality trends due to major tobacco-related major diseases (CHD, lung cancer) have improved remarkably over time. The surveys and experience show much progress and success in restricting smoking and peoples' exposure to environmental tobacco smoke, much in accordance with the respective legislations: smokefree schools and other public places, restrictions of smoking at worksites, and smokefree areas at restaurants. The Finnish tobacco control policy has been based on evidence and research, with gradual implementation and close monitoring. The policy has been quite successful, but there are still challenges to address in the future. International development, based on the successful implementation of FCTC, will be important for Finland to achieve further progress in tobacco control.

Kimmo Leppo, Pekka Puska

Tobacco epidemic in Finland

Finland has implemented a comprehensive strategy to control and constrain tobacco consumption among the population since the 1970s. A virtual epidemic of tobacco consumption with a prevalence in excess of 70 % of smoking among the adult male population has changed to a moderate prevalence of 28 %. Female smoking has become a problem, as is the case in many western countries, and 20 % of all adult women smoke daily. The decrease in male smoking prevalence continued until the 1990s and was due to both a decrease in smoking initiation and an increase in smoking cessation. The consumption of tobacco products peaked in the early 1970s and was annually 1,75 kilos per capita for every Finn aged 15-year and older. The consumption of tobacco decreased from 1973 to 1977 by 10 % and over the next 15 years by one percent annually. The enforcement of the Tobacco Control Act has had a positive effect on supporting the decrease of smoking and tobacco consumption.

Kristiina Patja, Erkki Vartianen

Epidemiology of tobacco related cancers in Finland

The paper reviews the trends in the incidence and mortality of lung cancer and some non-pulmonary tobacco related cancers in Finland and the other Nordic countries. The incidence of lung cancer is declining among men and increasing among women. Smoking is a significant cause of mortality and morbidity.

Risto Sankila

Cardiovascular disease mortality trends in Finland

The prevalence of smoking has changed markedly and rapidly since the 1970s. This paper examines the concomitant changes in cardiovascular mortality since 1973 on the basis of data extracted from the National Causes of Deaths Register (Statistics Finland). For comparison, international mortality data from the World Health Organization's database was used.

Pekka Jousilahti

Trends in adolescents' tobacco use in Finland in 1977-2003

Preventing children's tobacco use was particularly emphasized in the health-focused tobacco control policy expressed in the Tobacco Act of 1977. The effects of the policy on tobacco use have been monitored every second year by the Adolescent Health and Lifestyle Survey. Daily tobacco use by 14-18-year-olds decreased after the 1977 Tobacco Act, but the effect was short-term. A slow increase in daily tobacco use among the girls started in the mid-1980s. Changes were less consistent among the boys. As a consequence, sex differences have nearly disappeared. Today, girls aged 14-16 use tobacco more often than boys. Experimenting with tobacco has been postponed to an older age since the beginning of the 1980s, particularly among boys. The results of 2003 suggest that daily tobacco use is decreasing among the 14-16-year-olds, particularly among boys with the exception of 18-year-olds.

Arja H. Rimpelä, Susanna U. Rainio

How to reduce exposure to environmental tobacco smoke?

Exposure to environmental tobacco smoke (ETS) occurs when a person inhales tobacco smoke originating from the smoking of other people. Tobacco smoke is a mixture of over 4 000 chemical substances of which 40 are carcinogenic. ETS constitutes a serious but preventable cause of morbidity and mortality among exposed individuals.

Kari Reijula

Finnish Current Care Guidelines Now Target Tobacco Cessation

In 1994 the Finnish Medical Society Duodecim initiated the development of national evidence based Current Care Guidelines. The scientific specialist societies can suggest guideline topics. Preference is given to important public health issues. The board of Current Care prioritise the topics. The guideline development group consists of relevant clinical experts, always including a general practitioner. Other health professionals are included when appropriate. The writing group for the guideline on Smoking, Nicotine Dependence and Interventions for Cessation also included a dentist, a nurse and psychological expertise.

Klas Winell, Minna Kaila, Marjukka Mäkelä

Smoking, nicotine dependency and interventions for cessation

- The most recent version of the guideline with evidence summaries and full references can be accessed at www.duodecim.fi/kh (in Finnish). This article compiles the main guideline with abridged references.

Guideline Group Appointed By The Finnish Association For General Practice

Smoking, nicotine addiction and addiction treatment

The aim of this guideline is to help the entire health care system deliver more effective treatment to those suffering from tobacco dependency. The guideline places special emphasis on the doctor's role as a member of a multi-professional team. The guideline does not include prevention of smoking.

Working Group Appointed By The Finnish Association For General Practice

Tobacco in Health Promotion: Experiences from North Karelia

Non-communicable diseases (NCD) have been the major public health problem in the industrialized countries and are a rapidly growing problem also for the developing countries. Risk factors for NCDs have been identified; the most important are smoking, imbalanced diet, excessive alcohol intake and a lack of physical activity. Community-based health programs have been effective in decreasing level of risk factors, including tobacco consumption, and in improving health, as the North Karelia Project has shown. Various practical and effective antismoking activities have been carried out in North Karelia. In concert with reduced smoking rates among males, cancer mortality, and especially lung cancer mortality has decreased greatly in North Karelia. A new type of cardiac outpatient rehabilitation program was conducted in a North Karelian hospital in co-operation with the Finnish Heart Association: the program focused on key risk factor identification among patients with coronary heart disease. In the North Karelian hospital an anti-smoking campaign has been implemented focusing initially on three areas: cardiology, pulmonology and obstectrics.

Vesa Korpelainen, Juha Mustonen

Health-Promoting Hospitals in Finland working to be Smoke-free

The Association of Health Promoting Hospitals in Finland is a member of the worldwide, WHO-led network of Health Promoting Hospitals. The Finnish Association aims to introduce health-promoting models of action into Finnish hospitals. Together with the primary health care organisation, hospitals have the possibility of taking more responsibility for the development of health in the population of their district than what they are currently doing and thus create an effective and economical health care system.

Maria Hallman-Keiskoski, Virpi Honkala, Jarmo Karpakka

Product liability regarding tobacco in Finland

The first European legal case against the tobacco companies was brought up in Finland in 1988, continuing until 2001. The case was based on product liability.

Erkki Aurejärvi

Antitromboosihoidosta ei hyötyä laskimosiirteiden pallolaajennuksessa

Vanhojen, rappeutuneiden laskimosiirteiden pallolaajennushoito on ollut toimenpidekardiologien painajainen. Niinpä glykoproteiini IIb/IIIa -reseptorien salpaajiakin on käytetty varsin paljon pallolaajennustoimenpiteiden yhteydessä, vaikka näyttö hyödystä on ollut kyseenalainen. Viiteen satunnaistettuun tutkimukseen perustuva meta-analyysi osoitti nyt, että kuolleisuus on laskimosiirteiden hoidon yhteydessä yli kaksinkertainen tavalliseen pallolaajennukseen nähden, eikä tämä antitromboottinen hoito vaikuttanut siihen lainkaan. Onneksi toimenpiteen turvallisuutta voidaan nykyään parantaa mekaanisten embolisaatiota estävien laitteiden avulla.

Juhani Airaksinen

Keuhkoahtaumatauti varsin tappava sairaus

Yhdysvaltalaisen tutkimuksen mukaan keuhkoahtaumatauti (COPD) on luonteeltaan varsin tappava. 22 vuotta kestäneessä seurannassa (NHANES I) oli mukana 5 542 aikuista (vaikea COPD 1,7 %, keskivaikea 7,1 %, restriktiivinen keuhkosairaus 9,2 %). Kaikista seuratuista kuoli 1 301. Niillä, joilla oli vaikea COPD, osoittautui kuoleman riski (HR) olevan 2,7- ja keskivaikean osalta 1,6-kertainen; myös restriktiivinen keuhkosairaus lisäsi riskiä (HR 1,7). Pääkirjoituksessa pohditaan, että sairauden vakavuuteen nähden tämä sairausryhmä on unohdettujen joukossa. 30 vuotta tupakoinut sydäninfarktipotilas saa sympatiaa ja terveydenhuollon huomiota toisin kuin vastaavan ajan savutellut COPD-potilas; näin ainakin Englannissa...

Hannu Puolijoki

Progesteronihoito estää ennenaikaista synnytystä

Ennenaikainen synnytys on obstetriikan suurin ongelma ja tärkein perinataalihoidon tuloksia huonontava tekijä. Tilannetta on pyritty ehkäisemään vuodelevolla, tokolyyttisellä hoidolla ja infektioiden hoidolla ja ehkäisyllä, mutta kunnolla vaikuttavaa hoitoa ei ole löytynyt. Nyt julkaistiin monikeskustutkimus, jossa aiemmin ennenaikaisesti synnyttäneitä äitejä hoidettiin viikoittaisilla keltarauhashormonipistoksilla raskauden 16. ja 36. viikon välisenä aikana. Injektio sisälsi 250 mg 17-alfa-hydroksiprogesteronikaproaattia, joka on eräs luonnollisen keltarauhashormonin aineenvaihduntamuoto. Tässä satunnaistetussa, kaksoissokkoutetussa ja lumekontrolloidussa tutkimuksessa todettiin hoitoryhmässä merkitsevä ennenaikaisten synnytysten väheneminen (36,3 % vs. kontrolliryhmässä 54,9 %). Myös alle 32-viikkoisina syntyneiden määrä väheni (11,4 % vs. 19,6 %). Tilastollisesti yhden ennenaikaisen synnytyksen estämiseksi oli hoidettava 5-6 potilasta (95 % CI 3,6-11,1). Hoitoon ei liittynyt merkittäviä sivuvaikutuksia.

Pertti Kirkinen

Hormonikorvaushoitoa obstruktiiviseen uniapneaan?

Jo vuosia on tiedetty, että obstruktiivinen uniapnea on miehillä selvästi yleisempää kuin naisilla. Prevalenssilukujen on kuitenkin todettu usein kasvavan naisilla menopaussin jälkeen. Epäselvää on ollut, onko näihin havaintoihin syynä esim. ikä, painoindeksin muuttuminen vaiko hormonitasapainon aiheuttama modulaatio. Toisaalta on aprikoitu myös hormonikorvaushoidon terapeuttisia mahdollisuuksia asiassa, olletikin nyt kun hormonihoidot muuten ovat sivuvaikutustensa osalta vastatuulessa.

Hannu Puolijoki

Vanha psykoosilääke eroaa uudesta vain annostelussa

Psykoosilääkkeiden optimaalinen annostelu on ollut vilkkaan keskustelun kohteena, ei vähiten siksi, että näihin lääkkeisiin usein liittyy potilaan kokemia hankalia sivuvaikutuksia. Uusien psykoosilääkkeiden etuna on pidetty niiden aiheuttamia vähäisempiä sivuvaikutuksia, minkä vuoksi myöskin potilaat käyttäisivät mieluummin uusia kuin vanhoja lääkkeitä.

Raimo K.R. Salokangas

Testosteronipitoisuus säilyy yli keski-iän

Miehen seerumin vapaan ja valkuaiseen sitoutuneen testosteronin määrä on korkeimmillaan aamulla ja alimmillaan iltapäivällä. Pitoisuuksien on otaksuttu vähenevän miehen ikääntyessä. Sekä testosteronin määrällä että sen vaihtelulla on ilmeisesti merkitystä luun ja lihaksen aineenvaihdunnalle, testisten toiminnalle ja mm. seksuaalisille toimille.

Pertti Kirkinen

Miksi terminaalivaiheessa oleva potilas haluaa kuolla?

Suuren yleisön ja lääkäreiden asenteita eutanasiaa kohtaan on selvitetty paljon. Vähemmälle huomiolle on jäänyt, mitkä tekijät yhdistyvät terminaalisesti sairaiden toiveisiin kuolla ja saada apua kuoleman jouduttamiseksi.

Raimo K.R. Salokangas