BackgroundNarcolepsy is a rare neurological sleep disorder especially in children who are younger than 10 years. In the beginning of 2010, an exceptionally large number of Finnish children suffered from an abrupt onset of excessive daytime sleepiness (EDS) and cataplexy. Therefore, we carried out a systematic analysis of the incidence of narcolepsy in Finland between the years 2002–2010.MethodsAll Finnish hospitals and sleep clinics were contacted to find out the incidence of narcolepsy in 2010. The national hospital discharge register from 2002 to 2009 was used as a reference.FindingsAltogether 335 cases (all ages) of narcolepsy were diagnosed in Finland during 2002–2009 giving an annual incidence of 0.79 per 100 000 inhabitants (95% confidence interval 0.62–0.96). The average annual incidence among subjects under 17 years of age was 0.31 (0.12–0.51) per 100 000 inhabitants. In 2010, 54 children under age 17 were diagnosed with narcolepsy (5.3/100 000; 17-fold increase). Among adults ≥20 years of age the incidence rate in 2010 was 0.87/100 000, which equals that in 2002–2009. Thirty-four of the 54 children were HLA-typed, and they were all positive for narcolepsy risk allele DQB1*0602/DRB1*15. 50/54 children had received Pandemrix vaccination 0 to 242 days (median 42) before onset. All 50 had EDS with abnormal multiple sleep latency test (sleep latency <8 min and ≥2 sleep onset REM periods). The symptoms started abruptly. Forty-seven (94%) had cataplexy, which started at the same time or soon after the onset of EDS. Psychiatric symptoms were common. Otherwise the clinical picture was similar to that described in childhood narcolepsy.InterpretationA sudden increase in the incidence of abrupt childhood narcolepsy was observed in Finland in 2010. We consider it likely that Pandemrix vaccination contributed, perhaps together with other environmental factors, to this increase in genetically susceptible children.

This paper investigated the development of hospital cost efficiency and productivity in Finland in 1988-1994 using a comparative application of parametric and non-parametric panel models. Stochastic cost frontier models with a time-varying inefficiency component were used as parametric methods. As non-parametric methods various DEA models were employed to calculate efficiency scores and the Malmquist productivity index. The results revealed a 3-5% annual average increase in productivity, half of which was due to improvement in cost efficiency and half due to technological change. The results by parametric and non-parametric methods compared well with respect to individual efficiency scores, time-varying efficiency and technological change. The state subsidy reform of 1993 did not seem to have any observable effects on the hospital efficiency.

Varenicline dominated over its comparators, i.e. it was more effective and resulted in cost saving compared with bupropion and unaided cessation.

OBJECTIVE. Our goal was to test the hypothesis that the level of the delivery hospital affects 1-year mortality of very preterm infants in Finland.PATIENTS AND METHODS. This retrospective national medical birth-register study included 2291 very preterm infants (gestational age of Ͻ32 weeks at birth or birth weight of Յ1500 g) born in 14 level II (central) and 5 level III (university) hospitals in 2000 -2003. The main outcome measures were adjusted total mortality (including stillbirths) and mortality of live-born infants until the age of 1 year.RESULTS. Both the total 1-year mortality and the 1-year mortality of live-born infants were higher in level II hospitals compared with level III hospitals. Total mortality was higher in very preterm infants who were not born during office hours. In theory, delivery of all very preterm infants in level III instead of level II hospitals translates into an annual prevention of 69 of the 170 total deaths and prevention of 18 of the 45 deaths of live-born infants.CONCLUSIONS. Resources in neonatal intensive care should be increased, especially during non-office hours, to have an equally distributed service through the 24-hour day. More efficient regionalization of very preterm deliveries may improve 1-year survival of very preterm infants in Finland.

ABSTRACT.Purpose: To assess the cost effectiveness and cost utility of an organized screening programme for glaucoma. The previous cost-effectiveness studies of screening show inconsistent results, and the cost utility of screening has not been assessed. Methods: An organized screening programme was simulated using Markov modelling in a population aged 50-79 years at 5 year intervals. The programme ended when the subjects reached the age of 80 years. The comparator was opportunistic case finding. The main outcome measures were cases and years of severe visual disability avoided, quality-adjusted life years (QALYs) gained and direct healthcare and non-healthcare costs. Results: The incremental cost of 1 year of avoided visual disability by screening was €32 602. The cost of one QALY gained by screening was €9023 with a discount rate of 5%. During the average 20 year time horizon considered, the cumulative incremental costs of screening in a population of 1 million people would be €30 million, producing 3360 incremental QALYs and 930 years of avoided visual disability for 701 persons. The results were sensitive to the estimates of several parameters, especially screening cost and specificity of screening tests (96-99% specificity required). Conclusion: An organized screening programme could be a cost-effective strategy especially in older age groups, in which screening is clearly more likely to be acceptable to decision makers at any level in terms of their willingness to pay for a QALY. Modelling includes some uncertainty especially concerning the specificity of diagnostic tests and screening cost.