Päivi Kolu - Academia.edu (original) (raw)

Papers by Päivi Kolu

Kansantalouden kannalta on perusteltua pohtia keinoja terveydenhuollon kustannusten jatkuvan kasv... more Kansantalouden kannalta on perusteltua pohtia keinoja terveydenhuollon kustannusten jatkuvan kasvun hillitsemiseksi ja kiinnittää huomiota yhteiskunnan rajallisten voimavarojen mahdollisimman tehokkaaseen käyttöön. Resurssien tehokas käyttö ei kuitenkaan automaattisesti merkitse terveydenhuollon kustannusten leikkauksia ja priorisointia, vaan toiminnan tehostamista, uudelleen organisointia ja voimavarojen uudelleenkohdentamista, jotka voidaan lukea osaltaan kuuluvaksi normaaliin yhteiskunnalliseen kehitystoimintaan. Tutkimuksen tavoitteena oli tarkastella fysioterapian toteutuksesta muodostuvia kustannuksia erikoissairaanhoidon vuodeosastoille nykyisen eli keskitetyn ja hajautetun hallinnollisen fysioterapian organisointimallin välillä. Esimerkkeinä tutkimuksessa olivat Tampereen yliopistollisen sairaalan Lastenklinikka ja Sydänkeskus. Kustannuslaskenta perustui Pirkanmaan sairaanhoitopiirin tilinpäätöstietoihin, sisäisen laskutuksen seurantatilastoihin ja vuoden 2007 kustannushinta...

Journal of Epidemiology and Community Health

BackgroundLow physical activity and high sedentary behaviour are unquestionably relevant for publ... more BackgroundLow physical activity and high sedentary behaviour are unquestionably relevant for public health while also increasing direct and indirect costs.MethodsThe authors examined the direct and indirect costs attributable to low physical activity and high sedentary behaviour in Finland in 2017. Costs related to major non-communicable diseases drawn from Finnish registries covered direct costs (outpatient visits, days of inpatient care, medication and institutional eldercare) and indirect costs (sickness-related absences, disability pensions, unemployment benefits, all-cause mortality and losses of income tax revenue). Prevalences of low physical activity and high sedentary behaviour (≥8 hours per 16 waking hours) were based on self-reports among adolescents or accelerometer data among adults and the elderly from three Finnish population studies: FINFIT 2017, Health 2011 and the Cardiovascular Risk in Young Finns Study. Cost calculations used adjusted population attributable frac...

Methods Assessment of cost-effectiveness: outcomes measures and cost calculations; Results The ca... more Methods Assessment of cost-effectiveness: outcomes measures and cost calculations; Results The calculated costs, Tables S1–S4. and Figure S1. presenting unadjusted cost-effectiveness plane and acceptability curves for sickness absence from work and for QALY. (DOCX 1439 kb)

Background: Annual prevalence of gestational diabetes mellitus (GDM) is 12.5 % among Finnish preg... more Background: Annual prevalence of gestational diabetes mellitus (GDM) is 12.5 % among Finnish pregnant women. The prevalence is expected to rise with the increasing overweight among women before pregnancy. Physical activity and diet are both known to have favourable effects on insulin resistance and possibly on the risk of GDM. We aimed to investigate, whether GDM can be prevented by counseling on diet, physical activity and gestational weight gain during pregnancy. Methods/Design: A cluster-randomized controlled trial was conducted in 14 municipalities in the southern part of Finland. Pairwise randomization was performed in order to take into account socioeconomic differences. Recruited women were at 8-12 weeks ' gestation and fulfilled at least one of the following criteria: body mass index ≥ 25 kg/ m 2, history of earlier gestational glucose intolerance or macrosomic newborn (> 4500 g), age ≥ 40 years, first or second degree relative with history of type 1 or 2 diabetes. M...

Menopause is a period that may predispose one to a decrease in muscle strength, cardiore-spirator... more Menopause is a period that may predispose one to a decrease in muscle strength, cardiore-spiratory fitness, and quality of life. A study was carried out to evaluate the cost-effective-ness of physical activity among women displaying symptoms of menopause. The cost-effectiveness analysis was based on data from a six-month randomised controlled trial (n = 151). The women in the intervention group engaged in an unsupervised session of at least 50 minutes of physical activity four times a week. The control group continued their physical activity as before. An incremental cost-effectiveness ratio (ICER) was calculated in terms of maximal oxygen consumption, lean muscle mass, and quality-adjusted life years (QALYs) gained. A bootstrap technique was utilised to estimate uncertainty around the point estimate for ICER associated with the intervention. The mean total cost in the intervention group was €1,307 (SEM: €311) and in the control group was €1,253 (SEM: €279, p = 0.10) per person. The...

Lihavuus ja terveydenhuollon kustannukset synnytyksen jälkeen Lähtökohdat Tutkimuksessa arvioitii... more Lihavuus ja terveydenhuollon kustannukset synnytyksen jälkeen Lähtökohdat Tutkimuksessa arvioitiin painoindeksin ja siinä seitsemässä vuodessa tapahtuneen muutoksen yhteyttä terveydenhuollon suoriin kustannuksiin ja tuottavuuskustannuksiin. MeneteLMät Aineistona oli 302 naista, jotka osallistuivat raskausdiabeteksen ehkäisytutkimukseen seitsemän vuotta aiemmin. Painoindeksitiedot perustuivat äitiyskorttiin sekä painoon ja pituuteen seurantatutkimuksessa. Terveyspalvelujen käyttöä ja sairauspoissaolopäiviä selvitettiin kyselyllä. tuLokset Äideistä oli lihavia (BMI ≥ 30 kg/m 2) raskauden alussa 19,2 % ja seitsemän vuoden seurannassa 25,5 %. Terveydenhuollon suorat mediaanikustannukset olivat seurantamittauksessa lihavilla 41,4 % suuremmat (454 € vs. 642 €, p = 0,003) kuin muilla. PääteLMät Lisääntymisikäisten naisten lihavuus on yhteydessä terveyspalvelujen, etenkin erikoissairaanhoidon käytöstä aiheutuneisiin kustannuksiin. Lihavuuden ehkäisyyn tarvitaan lisää keinoja, jotta kustannukset eivät jatka kasvuaan.

BMC Public Health, 2018

Background: Registered healthcare workers worldwide have a high prevalence of work-related muscul... more Background: Registered healthcare workers worldwide have a high prevalence of work-related musculoskeletal disorders, particularly of the back. Multidisciplinary interventions among these workers have improved fear avoidance beliefs, but not low back pain (LBP) and related sickness absences, cost-effectiveness studies are scarce. Our purpose was to investigate the effectiveness and cost-effectiveness of three intervention-arms (combined neuromuscular exercise and back care counselling or either alone) compared with non-treatment. Methods: We randomly assigned female healthcare workers with recurrent non-specific LBP to one of four study-arms: Combined neuromuscular exercise and back care counseling; Exercise; Counseling; and no intervention Control. We assessed the effectiveness of the interventions on intensity of LBP, pain interfering with work and fear avoidance beliefs against the Control, and calculated the incremental cost-effectiveness ratios for sickness absence and QALY. Results: We conducted three sub-studies in consecutive years of 2011, 2012, and 2013 to reach an adequate sample size. All together 219 women were randomized within each sub-study, of whom 74 and 68% had adequate questionnaire data at 6 and 12 months, respectively. No adverse events occurred. Compliance rates varied between intervention-arms. After 12 months, the Combined-arm showed reduced intensity of LBP (p = 0.006; effect size 0.70, confidence interval 0.23 to 1.17) and pain interfering with work (p = 0.011) compared with the Control-arm. Work-related fear of pain was reduced in both the Combined-(p = 0.003) and Exercise-arm (p = 0.002). Physical activity-related fear was reduced only in the Exercise-arm (p = 0.008). During the study period (0-12 months) mean total costs were lowest in the Combined-arm (€476 vs. €1062-€1992, p < 0.001) as were the mean number of sickness absence days (0.15 vs. 2.29-4.17, p = 0.025). None of the interventionarms was cost-effective for sickness absence. There was 85% probability of exercise-arm being cost-effective if willing to pay €3550 for QALY gained.

Spine, 2017

A cross-sectional study, part of a randomized controlled trial. To evaluate the association of ph... more A cross-sectional study, part of a randomized controlled trial. To evaluate the association of physical activity, cardiorespiratory fitness, and neuromuscular fitness with direct healthcare costs and sickness-related absence among nursing personnel with nonspecific low back pain. Low back pain creates a huge economic burden due to increased sick leave and use of healthcare services. Female nursing personnel with nonspecific low back pain were included (n = 219). Physical activity was assessed with accelerometry and a questionnaire. In addition, measurements of cardiorespiratory and muscular fitness were conducted. Direct costs and sickness-related absence for a 6-month period were collected retrospectively by questionnaire. Health care utilization and absence from work were analyzed with a general linear model. The mean total costs were 80.5% lower among women who met physical activity recommendations than inactive women. Those with a higher mean daily intensity level of 10-minute a...

PloS one, 2016

There is a link between the pregnancy and its long-term influence on health and susceptibility to... more There is a link between the pregnancy and its long-term influence on health and susceptibility to future chronic disease both in mother and offspring. The objective was to determine whether individual counseling on physical activity and diet and weight gain at five antenatal visits can prevent type 2 diabetes mellitus (T2DM) and overweight or improve glycemic parameters, among all at-risk-mothers and their children. Another objective was to evaluate whether gestational lifestyle intervention was cost-effective as measured with mother's sickness absence and quality-adjusted life years (QALY). This study was a seven-year follow-up study for women, who were enrolled to the antenatal cluster-randomized controlled trial (RCT). Analysis of the outcome included all women whose outcome was available, in addition with subgroup analysis including women adherent to all lifestyle aims. A total of 173 women with their children participated to the study, representing 43% (173/399) of the wome...

BMJ open, Mar 15, 2017

Risk for developing metabolic syndrome (MeS) after delivery is high among women with gestational ... more Risk for developing metabolic syndrome (MeS) after delivery is high among women with gestational diabetes mellitus (GDM), but little is known about development of MeS among women with risk factors for GDM during pregnancy. In the present study, we studied the prevalence of MeS 7 years postpartum among women with GDM risk factors during pregnancy, women with early GDM diagnosis and women without GDM risk factors. We also analysed the early pregnancy risk factors associated with MeS. A Finnish cluster randomised controlled GDM prevention trial was conducted in 2007-2009. The prevalence of MeS according to International Diabetes Federation criteria was determined in the follow-up study 7 years after original trial. Eligible participants (n=289) in 4 study groups (intervention (n=83) and usual care (n=87) with GDM risk factors; early GDM (n=51), and healthy control without GDM risk factors (n=68)) were evaluated for MeS. Binary logistic regression models were used to analyse risk factor...

Osteoporosis International, 2015

This study assessed the cost-effectiveness of vitamin D supplementation and exercise, separately ... more This study assessed the cost-effectiveness of vitamin D supplementation and exercise, separately and combined, in preventing medically attended injurious falls among older home-dwelling Finnish women. Given a willingness to pay of €3000 per injurious fall prevented, the exercise intervention had an 86 % probability of being cost-effective in this population. Introduction The costs of falling in older persons are high, both to the individual and to society. Both vitamin D and exercise have been suggested to reduce the risk of falls. This study assessed the cost-effectiveness of vitamin D supplementation and exercise, separately and combined, in preventing medically attended injurious falls among older Finnish women. Methods Economic evaluation was based on the results of a previously published 2-year randomized controlled trial (RCT) where 409 community-dwelling women aged 70 to 80 years were recruited into four groups: (1) no exercise + placebo (D−Ex−), (2) no exercise + vitamin D 800 IU/day (D+Ex−), (3) exercise + placebo (D−Ex+), and (4) exercise + vitamin D 800 IU/day (D+Ex+). The outcomes were medically attended injurious falls and fall-related health care utilization costs over the intervention period, the latter evaluated from a societal perspective based on 2011 unit costs. Incremental cost-effectiveness ratios (ICER) were calculated for the number of injurious falls per person-year prevented and uncertainty estimated using bootstrapping. Results Incidence rate ratios (95 % CI) for medically attended injurious falls were lower in both Ex+ groups compared with D−Ex−: 0.46 (0.22 to 0.95) for D−Ex+, 0.38 (0.17 to 0.81) for D+Ex+. Step-wise calculation of ICERs resulted in exclusion of D+Ex− as more expensive and less effective. Recalculated ICERs were €221 for D −Ex−, €708 for D−Ex+, and €3820 for D+Ex+; bootstrapping indicated 93 % probability that each injurious fall avoided by D−Ex+ per person year costs €708. At a willingness to pay €3000 per injurious fall prevented, there was an 85.6 % chance of the exercise intervention being cost-effective in this population. Conclusions Exercise was effective in reducing fall-related injuries among community-dwelling older women at a moderate cost. Vitamin D supplementation had marginal additional benefit. The results provide a firm basis for initiating feasible and cost-effective exercise interventions in this population.

PloS one, 2015

Menopause is a period that may predispose one to a decrease in muscle strength, cardiorespiratory... more Menopause is a period that may predispose one to a decrease in muscle strength, cardiorespiratory fitness, and quality of life. A study was carried out to evaluate the cost-effectiveness of physical activity among women displaying symptoms of menopause. The cost-effectiveness analysis was based on data from a six-month randomised controlled trial (n = 151). The women in the intervention group engaged in an unsupervised session of at least 50 minutes of physical activity four times a week. The control group continued their physical activity as before. An incremental cost-effectiveness ratio (ICER) was calculated in terms of maximal oxygen consumption, lean muscle mass, and quality-adjusted life years (QALYs) gained. A bootstrap technique was utilised to estimate uncertainty around the point estimate for ICER associated with the intervention. The mean total cost in the intervention group was €1,307 (SEM: €311) and in the control group was €1,253 (SEM: €279, p = 0.10) per person. The m...

PLoS Medicine, 2011

Background: Our objective was to examine whether gestational diabetes mellitus (GDM) or newborns'... more Background: Our objective was to examine whether gestational diabetes mellitus (GDM) or newborns' high birthweight can be prevented by lifestyle counseling in pregnant women at high risk of GDM. Method and Findings: We conducted a cluster-randomized trial, the NELLI study, in 14 municipalities in Finland, where 2,271 women were screened by oral glucose tolerance test (OGTT) at 8-12 wk gestation. Euglycemic (n = 399) women with at least one GDM risk factor (body mass index [BMI] 25kg/m2,glucoseintoleranceornewborn′smacrosomia(25 kg/m 2 , glucose intolerance or newborn's macrosomia (25kg/m2,glucoseintoleranceornewborn′smacrosomia(4,500 g) in any earlier pregnancy, family history of diabetes, age $40 y) were included. The intervention included individual intensified counseling on physical activity and diet and weight gain at five antenatal visits. Primary outcomes were incidence of GDM as assessed by OGTT (maternal outcome) and newborns' birthweight adjusted for gestational age (neonatal outcome). Secondary outcomes were maternal weight gain and the need for insulin treatment during pregnancy. Adherence to the intervention was evaluated on the basis of changes in physical activity (weekly metabolic equivalent task (MET) minutes) and diet (intake of total fat, saturated and polyunsaturated fatty acids, saccharose, and fiber). Multilevel analyses took into account cluster, maternity clinic, and nurse level influences in addition to age, education, parity, and prepregnancy BMI. 15.8% (34/216) of women in the intervention group and 12.4% (22/179) in the usual care group developed GDM (absolute effect size 1.36, 95% confidence interval [CI] 0.71-2.62, p = 0.36). Neonatal birthweight was lower in the intervention than in the usual care group (absolute effect size 2133 g, 95% CI 2231 to 235, p = 0.008) as was proportion of large-for-gestational-age (LGA) newborns (26/216, 12.1% versus 34/179, 19.7%, p = 0.042). Women in the intervention group increased their intake of dietary fiber (adjusted coefficient 1.83, 95% CI 0.30-3.25, p = 0.023) and polyunsaturated fatty acids (adjusted coefficient 0.37, 95% CI 0.16-0.57, p,0.001), decreased their intake of saturated fatty acids (adjusted coefficient 20.63, 95% CI 21.12 to 20.15, p = 0.01) and intake of saccharose (adjusted coefficient 20.83, 95% CI 21.55 to 20.11, p = 0.023), and had a tendency to a smaller decrease in MET minutes/week for at least moderate intensity activity (adjusted coefficient 91, 95% CI 237 to 219, p = 0.17) than women in the usual care group. In subgroup analysis, adherent women in the intervention group (n = 55/229) had decreased risk of GDM (27.3% versus 33.0%, p = 0.43) and LGA newborns (7.3% versus 19.5%, p = 0.03) compared to women in the usual care group. Conclusions: The intervention was effective in controlling birthweight of the newborns, but failed to have an effect on maternal GDM.

Primary Care Diabetes, 2011

The aim was to evaluate frequency and costs of antenatal health care visits related to risk of ge... more The aim was to evaluate frequency and costs of antenatal health care visits related to risk of gestational diabetes (GDM) using Birth Register. Costs among all GDM risk groups were 10-41% larger than non-risk groups. Primary health care is needed to reduce special health care costs related to GDM.

PLoS ONE, 2013

Aims: The aim was to evaluate the cost-effectiveness of primary prevention of gestational diabete... more Aims: The aim was to evaluate the cost-effectiveness of primary prevention of gestational diabetes mellitus (GDM) through intensified counselling on physical activity, diet, and appropriate weight gain among the risk group. Materials and Methods: The cost-effectiveness analysis was based on data from a cluster-randomised controlled GDM prevention trial carried out in primary health-care maternity clinics in Finland. Women (n = 399) with at least one risk factor for GDM were included. The incremental cost-effectiveness ratio (ICER) was calculated in terms of birth weight, 15D, and perceived health as measured with a visual analogue scale (VAS). A bootstrap technique for cluster-randomised samples was used to estimate uncertainty around a cost-effectiveness acceptability curve. Results: The mean total cost in the intervention group was J7,763 (standard deviation (SD): J4,511) and in the usual-care group was J6,994 (SD: J4,326, p = 0.14). The mean intervention cost was J141. The difference for costs in the birth-weight group was J753 (95% CI: 2250 to 1,818) and in effects for birth weight was 115 g (95% CI: 15 to 222). The ICER for birth weight was almost J7, with 86.7% of bootstrap pairs located in the northeast quadrant, indicating that the intervention was more effective and more expensive in birth weight terms than the usual care was. The data show an 86.7% probability that each gram of birth weight avoided requires an additional cost of J7. Conclusions: Intervention was effective for birth weight but was not cost-effective for birth weight, 15D, or VAS when compared to the usual care.

International Journal of Behavioral Nutrition and Physical Activity, 2012

Background: Women who are physically active during early pregnancy have notably lower odds of dev... more Background: Women who are physically active during early pregnancy have notably lower odds of developing gestational diabetes than do inactive women. The purpose of the intervention was to examine whether intensified physical activity (PA) counseling in Finnish maternity care is feasible and effective in promoting leisure-time PA (LTPA) among pregnant women at risk of gestational diabetes. Methods: Fourteen municipalities were randomized to intervention (INT) and usual care group (UC). Nurses in INT integrated five PA counseling sessions into routine maternity visits and offered monthly group meetings on PA instructed by physiotherapists. In UC conventional practices were continued. Feasibility evaluation included safety (incidence of PA-related adverse events; questionnaire), realization (timing and duration of sessions, number of sessions missed, attendance at group meetings; systematic record-keeping of the nurses and physiotherapists) and applicability (nurses' views; telephone interview). Effectiveness outcomes were weekly frequency and duration of total and intensity-specific LTPA and meeting PA recommendation for health self-reported at 8-12 (baseline), 26-28 and 36-37 weeks' gestation. Multilevel analysis with adjustments was used in testing for between-group differences in PA changes. Results: The decrease in the weekly days of total and moderate-to-vigorous-intensity LTPA was smaller in INT (N = 219) than in UC (N = 180) from baseline to the first follow-up (0.1 vs.-1.2, p = 0.040 and −0.2 vs.-1.3, p = 0.016). A similar trend was seen in meeting the PA recommendation (−11%-points vs.-28%-points, p = 0.06). INT did not experience more adverse events classified as warning signs to terminate exercise than UC, counseling was implemented as planned and viewed positively by the nurses. Conclusions: Intensified counseling had no effects on the duration of total or intensity-specific weekly LTPA. However, it was able to reduce the decrease in the weekly frequency of total and moderate-to-vigorous-intensity LTPA from baseline to the end of second trimester and was feasibly embedded into routine practices. Trial registration: ISRCTN 33885819 (www.isrctn.org