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.

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.

Efficient transfection of novel bovine papillomavirus 1 expression plasmids.

A series of novel bovine papillomavirus type 1 (BPV-1)-based expression plasmids was constructed and characterized in vitro as a starting point for the development of an in vivo gene therapeutic method. The order of transfection efficiency for different pBPVlacZ plasmids was pCGalBPV > pTKBPV > pSRalphaBPV in CV1-P cells. In the absence of selection pressure, the expression of pCGalBPVlacZ and pTKBPVlacZ was associated with long-term maintenance. In a comparison of pBPVlacZ with pSVlacZ, expression was maintained up to 12-17 and 8-12 days, respectively. The transfection of pBPVlacZ plasmids was efficient in secondary and primary, dividing and nondividing, neural and nonneural, and human cells and, furthermore, independent of the cell cycle as seen in growing as well as resting cells. All these characteristics are likely to be relevant for in vivo conditions, under which the percentage of proliferating cells could be quite low. In conclusion, the pBPV plasmids were efficiently delivered and expressed in different host cells, and therefore their performance in gene therapy is worth testing.