The Finnish national hospital discharge registers from 1985 and 1988 have been analysed by the National Board of Health. Results are provided for all the 21 Finnish hospital districts and central communal organizations. The small area variation phenomenon in hospital utilization cannot be explained by demographic or epidemiological factors. Rather, the variations seem to be largely due to organizational factors. The project aims to develop a data processing system capable of handling information on one million patients rapidly and economically, and show the results in an intelligible form as a table with standard headers or as a map illustration. Maps are superior to traditional statistical tables in demonstrating regional variations in health care utilization and in mortality. Maps based on small administrative units are useful for many purposes. These maps are, however, relatively 'noisy' due to substantial random variation. Coordinate-based mapping is a method to overcome some of these difficulties. It is based on linking hospital discharge and mortality data with exact address data. The method allows mapping independent of administrative boundaries. Several examples of coordinate-based maps are given. The method is used in Finland for annual analysis of hospital use.
To date, two major familial breast cancer predisposition genes, BRCA1 and BRCA2, have been identified with hundreds of germ‐line mutations, accounting for 5–10% of all breast cancer and 40–60% of all inherited breast cancer. Unexpectedly elevated incidence of breast cancer, especially in the older age classes, was observed in a Western Finnish region representing a relatively homogeneous population. This study was designed to test the hypothesis that there are inherited BRCA1 or BRCA2 mutations, which confer variable and/or age‐dependent penetrance on carriers. Expecting a founder effect, we searched for geographical clustering of breast cancer cases and searched for associations between the affected phenotype and shared genomic segments in the BRCA1 and BRCA2 genomic regions. Our haplotype association study did not reveal any founder effects for either BRCA1 or BRCA2. However, there were two mutations prevalent in this geographical area with minor founder effects, BRCA2 T8555G and 999del5. This is one of the few geographically ascertained, population‐based studies that indicate an overall frequency of BRCA1 and BRCA2 mutations at about 2–3% in all breast cancer cases. The geographical clustering of breast cancer cases was not explained by BRCA1 or BRCA2 genes. Genet. Epidemiol. 20:239–246, 2001. © 2001 Wiley‐Liss, Inc.
In western countries, the so-called demographic time bomb, that is, the ageing of the baby-boom generation, has become one of the most challenging issues. Although it has become almost clichéd in health care planning, its effects are being felt rather acutely in reality. The situation in Finland, as in many other western countries, is compounded by the fact that as demand for elderly care is increasing, the service systems are suffering from severe labor and tax funding shortages. In fact, population in Finland is aging faster than any other OECD country (Antolin, Oxley, & Suyker, 2001). Elderly care centers have difficulties in hiring qualified professional staff. Nursing staff are also burdened by heavy workloads. The situation will worsen by time as the number of elderly people in our population increases further, leading to increased strain on health care resources. The present service structure is not going to be able to respond to this demand. Yet health care funding, which depends on public financing, will decrease as the number of taxpayers declines due to the aging of our workforce. “Elderly dependence ratio,” a key demographic indicator, will approximately double over the next two decades (Eurostat, 2005).
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