Smoking makes asthma expensive: a register-based study in Finland.

SETTING: Chronic bronchitis and chronic obstructive pulmonary disease (COPD)/emphysema occur frequently among middle-aged and elderly asthma patients who smoke. OBJECTIVE: To test how much this comorbidity increases the use and costs of health services in comparison with asthma alone. DESIGN: A sample of 6000 adults with a clinical diagnosis of asthma was extracted from a nationwide health insurance register for a postal inquiry. Comorbidity and the use of health services were measured using a questionnaire. Data on medication expenses were obtained from the national prescription register. RESULTS: Altogether 4956 individuals replied, of whom 3160 asthma patients aged > or =40 years (response rate 85%) were chosen for this investigation. Asthma patients with COPD/emphysema (12% of the series) accounted for 21% of all doctor consultations, 39% of the total number of hospital in-patient days and 27% of the total expenses, of which one third were medication costs. The mean annual gross expenditure on treatment services and anti-asthma medications was euro754 per patient for those with asthma alone and euro2107 for those with concurrent COPD/emphysema. Current smoking further increased costs among COPD patients. CONCLUSION: To prevent pulmonary comorbidity and the related high costs, cessation of smoking should be an integral part of the treatment provided for asthma patients.

The patient-centred interview: the key to biopsychosocial diagnosis and treatment.

The article reports on some ideas and experiences gained from a holistic approach to working with patients and introduces a viewpoint that includes opinions on how postmodernism, the biopsychosocial model and a patient-centred interviewing style can change traditional, biomedical-oriented medicine. During the past 10 years, we have been instructing medical students in the use of this patient-centred interviewing model and have trained experienced general practitioners (GPs) in adopting it in 2-year family-oriented continuing medical education courses. We believe that doctors and other health care providers, particularly in primary care settings, need a comprehensive concept of human health and illness, and that skill in patient-centred interviewing is the product of a deep learning process. In conclusion, we have learned that a successful patient-centred interview helps the GP to better understand the patient and helps to explain the data that the patient presents. Patient-centred orientation and interviewing also change the communication between doctor and patient in a direction which supports the patient's and his/her family members' own resources in the healing process.

The outcome of pregnancy in antinuclear antibody-positive women.

The significance of antinuclear antibodies (ANA) was studied in 51 ANA-positive women who had had a total of 170 pregnancies. 60 ANA-negative age- and parity-matched women with a total of 142 pregnancies served as controls. The perinatal mortality rate in the ANA-positive group was 18.6% (8/43), while there were no perinatal deaths in the ANA-negative control group. All the perinatal losses were stillbirths. The rate of spontaneous abortions was low in both groups, 2.0 vs. 3.3%, respectively. The ANA titer, complement-fixing activity and antigenic specificity did not correlate with the outcome of the pregnancy. Two infants of the ANA-positive women (3.9%) had a congenital atrioventricular heart block. In both cases the ANA was of the complement-fixing type.

Occurrence of antinuclear antibodies in an unselected pregnancy population.

The occurrence of antinuclear antibodies (ANA) in an unselected population of pregnant women was studied by an indirect immunofluorescence method. Six women out of 116 were ANA-positive (5.2%), 2 of them having a moderately high titre (1:160 and 1:320) and 1 complement-fixing ANA. The antigenic specificity of ANA was anti-single-stranded DNA in 2 cases and RNAase-sensitive anti-extractable nuclear antigen in 1 case. Two of the ANA-positive women had pre-eclampsia laevis and 1 had a premature delivery. None of the infants of the ANA-positive women had symptoms of connective tissue disease. The occurrence of ANA among pregnant women was not significantly higher than among 70 non-pregnant female control subjects (7.1%).

Immune function in patients with chromosome deletions.

Non-specific, cell-mediated and humoral immunity were evaluated in six patients with different autosomal deletions, and in two patients with X-chromosome deletions. Six had an increased number of bacterial, viral, and mycotic infections. Mild disturbances were found in the immunological functions of almost every patient. Granulocyte phagocytosis and killing of bacteria were normal in all patients. The chemotactic response was increased in two, and normal in the others. The responses to phytohaemagglutinin and pokeweed mitogen were normal in all patients and the response to concanavalin A was decreased in one patient. The lymphocyte response to purified protein derivative was decreased in the patients as a group when compared to the controls (P less than 0 . 005), but normal to oidiomycin. The number of acid-alpha-naphthyl acetate esterase positive cells was low in four patients. One had a high titre of antinuclear and antithyroid antibodies. One had a low concentration of serum IgA, C3 and C4. One had a high concentration of IgM. Two had elevated levels of C3 and C4. Our results show that several different chromosomal deletions are associated with immunological abnormality.

Organ-specific antibodies in healthy and diabetic children and young adults.

160 children and young adults (aged 7-21 years) and 84 diabetics (aged 2-19 years) were screened for thyroglobulin (TgA), thyroid microsomal (MsA), smooth muscle (SMA), parietal cell (PCA), reticulin (RA), glomerular (GIA) and mitochondrial (MA) antibodies. The diabetics were also screened for islet cell antibodies (ICA). The overall incidence of other antibodies than ICA at the lowest serum titre studied was 18.1 percent for healthy children and 30.9% for diabetic children. The elevation in diabetics is significant (p less than 0.01). Females were overrepresented in both groups and had the highest titres of antibodies. The age group 10-14 years was observed to be a special time at which antibody titres became positive. As compared with the controls, diabetics exhibited an increased incidence of MsA (4.4 and 11.9% respectively, p less than 0.001), PCA (5.0 and 10.7% respectively, p less than 0.05) and RA (3.8 and 9.5% respectively, p less than 0.05). The presence of ICA or the duration of diabetes showed no correlation with other autoantibodies. The results indicate that autoantibodies at a low titre are a common phenomenon. Diabetics seem to be susceptible to react against their own tissue, which is probably associated with their increased frequency of autoimmune diseases.