Use of My Kanta in Finland 2010-2022

In Finland, descriptive performance indicators point towards increasing and sustained use of the national Kanta Services among adults from May 2010 to December 2022. Adult users have accessed the web-based My Kanta, sent electronic prescription renewal requests to healthcare organizations, and caregivers and parents have acted on behalf of their children. Furthermore, adult users have recorded consents, consent restrictions, organ donation testaments and living wills. In this register study, 11% of the young person cohorts (<18-year-olds) and over 90% of the working age cohorts had used the My Kanta portal in 2021, whereas 74% of the 66-75-year-olds and 44% of the at least 76-year-olds.publishedVersionPeer reviewe

Implementation, Adoption and Use of the Kanta Services in Finland 2010-2022

Nationwide implementation and adoption of the Prescription Centre and the Patient Data Repository services required 5.5 years since May 2010 in Finland. The Clinical Adoption Meta-Model (CAMM) was applied in the post-deployment assessment of the Kanta Services in its four dimensions (availability, use, behavior, clinical outcomes) over time. The CAMM results on the national level in this study suggest 'Adoption with Benefits' as the most appropriate CAMM archetype.publishedVersionPeer reviewe

Suomen lääkemääräysten seurannan ensimmäiset yksitoista kuukautta vuonna 2017

Electronic prescription is mandatory in Finland since 1 January, 2017. A physician or a dentist can issue a written or a telephone prescription under exceptional circumstances, and the reason for issuing must be given. Because of the administrative nationwide change it was the first time possible to find out prescription volume in Finland. Written and telephone prescriptions were typed in to the national Prescription Centre at the 815 pharmacies. Electronic prescriptions were sent to the Prescription Centre (ePrescription Service) from electronic patient data systems, or Kelain web prescription service. Data from the Prescription Centre were extracted from 1 January till 30 November, 2017. There were 29.477 Million (100%) new electronic prescriptions, of which 96.6% were from electronic patient data systems and 1.0% from Kelain web service. Altogether 0.375 Million (1.3%) prescriptions were typed in at the pharmacies, of which 0.246 Million (0.8%) were written and 0.122 Million (0.4%) telephone prescriptions. Approximately half of the prescriptions typed in at the pharmacies were written prescriptions that were issued because of a technical failure. In this study we report the first time prescription volume in Finland. All the prescriptions in the national Prescription Centre are electronic, and only 1.3% of the prescriptions were typed in at the pharmacies in the first eleven months since the electronic prescription became mandatory 1 January, 2017. Written prescriptions were issued because a technical failure occurred in local or areal data or software systems.Lääkemääräys on laadittava sähköisesti 1.1.2017 alkaen. Laissa määriteltyjen poikkeustapausten perusteella laaditussa kirjallisessa ja puhelinlääkemääräyksessä on perusteltava, miksi sitä ei ole annettu sähköisesti. Valtakunnallisen toiminnallisen muutoksen myötä on mahdollista selvittää ensimmäisen kerran lääkemääräysten kokonaismäärä Suomessa. Tutkimusaineistona ovat reseptikeskukseen tallennetut potilastietojärjestelmissä ja Kelaimessa laaditut sähköiset lääkemääräykset sekä apteekeissa tallennetut (sähköistetyt) kirjalliset, puhelin- ja erityislupavalmisteiden lääkemääräykset tutkimusjaksolla 1.1.–30.11.2017. Reseptikeskukseen tallennettiin tutkimusjaksolla 29,477 (100 %) milj. sähköistä lääkemääräystä, joista 96,6 % oli laadittu potilastietojärjestelmissä ja 1,0 % Kelaimella. Apteekeissa sähköistettiin 0,375 (1,3 %) milj. lääkemääräystä, joista 0,246 (0,8 %) milj. oli kirjallisia ja 0,122 (0,4 %) milj. puhelinlääkemääräyksiä. Apteekeissa sähköistetyistä lääkemääräyksistä yli puolet oli kirjallisia lääkemääräyksiä, jotka oli laadittu teknisen häiriön perusteella. Tutkimuksessa selvitettiin ensimmäisen kerran Suomessa lääkemääräysten kokonaismäärää vuoden 2017 yhdentoista kuukauden tietojen perusteella. Valtakunnallisessa seurannassa ilmeni päivittäin teknisiä häiriöitä, joiden perusteella laadittiin kirjallisia ja puhelinlääkemääräyksiä

Analytical evaluation of the performance of contact-based messaging applications

Communications in mobile opportunistic networks, instead of using the Internet infrastructure, take place upon the establishment of ephemeral contacts among mobile nodes using direct communication. In this paper, we analytically model the performance of mobile opportunistic networks for contact-based messaging applications in city squares or gathering points, a key challenging topic that is required for the effective design of novel services. We take into account several social aspects such as: the density of people, the dynamic of people arriving and leaving a place, the size of the messages and the duration of the contacts. We base our models on Population Processes, an approach commonly used to represent the dynamics of biological populations. We study their stable equilibrium points and obtain analytical expressions for their resolution. The evaluations performed show that these models can reproduce the dynamics of message diffusion applications. We demonstrate that when the density of people increases, the effectiveness of the diffusion is improved. Regarding the arrival and departure of people, their impact is more relevant when the density of people is low. Finally, we prove that for large message sizes the effectiveness of the epidemic diffusion is reduced, and novel diffusion protocols should be considered. © 2016 Elsevier B.V. All rights reserved.This work was partially supported by Ministerio de Economia y Competitividad, Spain (Grants TEC2014-52690-R & MTM2013-47093-P & SEV-2013-0323), Generalitat Valenciana, Spain (Grants AICO/2015/108 & ACOMP/2015/005) and by the Basque Government through the BERC 2014-2017 program.Hernández Orallo, E.; Murillo Arcila, M.; Tavares De Araujo Cesariny Calafate, CM.; Cano Escribá, JC.; Conejero Casares, JA.; Manzoni, P. (2016). Analytical evaluation of the performance of contact-based messaging applications. Computer Networks. 111:45-54. https://doi.org/10.1016/j.comnet.2016.07.006S455411

Ecosystem functioning along gradients of increasing hypoxia and changing soft-sediment community types

Marine ecosystems world-wide are threatened by oxygen deficiency, with potential serious consequences for ecosystem functioning and the goods and services they provide. While the effects of hypoxia on benthic species diversity are well documented, the effects on ecosystem function have only rarely been assessed in real-world settings. To better understand the links between structural changes in macro- and meiofaunal communities, hypoxic stress and benthic ecosystem function (benthic nutrient fluxes, community metabolism), we sampled a total of 11 sites in Haystensfjord and Askerofjord (Swedish west coast) in late summer, coinciding with the largest extent and severity of seasonal hypoxia in the area. The sites spanned oxic to anoxic bottom water, and a corresponding gradient in faunal diversity. Intact sediment cores were incubated to measure fluxes of oxygen and nutrients (NO3-, NO2-, NH4+, PO43-, SiO4) across the sediment-water interface. Sediment profile imaging (SPI) footage was obtained from all sites to assess structural elements and the bioturbadon depth, and additional samples were collected to characterise sediment properties and macro- and meiofaunal community composition. Bottom-water O-2 concentration was the main driver of macrofauna communities, with highest abundance and biomass, as well as variability, at the sites with intermediate O-2 concentration. Meiofauna on the other hand was less sensitive to bottom-water O-2 concentration. Oxygen was the main driver of nutrient fluxes too, but macrofauna as well meiofauna were also significant predictors; DistLM analyses indicated that O-2 concentration, macrofaunal abundance or biomass, and meiofaunal abundance collectively explained 63%, 30% and 28% of the variation in sediment O-2 consumption, NH4+ flux and PO43+ flux, respectively. The study provides a step towards a more realistic understanding of the link between benthic fauna and ecosystem functioning, and the influence of disturbance on this relationship, which is important for management decisions aimed at protecting the dwindling biodiversity in the coastal zones around the world.Peer reviewe

Fair content dissemination in participatory DTNs

International audienceThanks to advances in the computing capabilities and added functionalities of modern mobile devices, creating and consuming digital media on the move has neverbeen so easy and popular. Most of the DTN routing protocols proposed in theliterature to enable content sharing have been exploiting users’ mobility patterns,in order to maximise the delivery probability, while minimising the overall network overhead (e.g., number of message replicas in the system, messages’ pathlength). Common to all these protocols has been the assumption that devices arewilling to participate in the content distribution network; however, because of battery constraints, participation cannot be taken for granted, especially if the verysame subset of devices are continuously selected as content carriers, simply because of their mobility properties. Indeed, we demonstrate that state-of-the-artDTN routing protocols distribute load in a highly unfair manner, with detrimentaleffects on delivery once the assumption of unconditional participation is lifted. Toovercome this limitation, we propose a load-balancing mechanism whereby nodesmaintain local estimates of network workload, and use them to direct traffic towards the least loaded portion of the network. We implement the mechanism ontop of a source-based DTN routing protocol, and demonstrate, by means of simulation using a variety of real mobility traces, that high delivery is now achievedwithout compromising fairness

Coma in adult cerebral venous thrombosis:The BEAST study

Background and purpose: Coma is an independent predictor of poor clinical outcomes in cerebral venous thrombosis (CVT). We aimed to describe the association of age, sex, and radiological characteristics of adult coma patients with CVT. Methods: We used data from the international, multicentre prospective observational BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis) study. Only positively associated variables with coma with &lt;10% missing data in univariate analysis were considered for the multivariate logistic regression model. Results: Of the 596 adult patients with CVT (75.7% women), 53 (8.9%) patients suffered coma. Despite being a female-predominant disease, the prevalence of coma was higher among men than women (13.1% vs. 7.5%, p = 0.04). Transverse sinus thrombosis was least likely to be associated with coma (23.9% vs. 73.3%, p &lt; 0.001). The prevalence of superior sagittal sinus thrombosis was higher among men than women in the coma sample (73.6% vs. 37.5%, p = 0.01). Men were significantly older than women, with a median (interquartile range) age of 51 (38.5–60) versus 40 (33–47) years in the coma (p = 0.04) and 44.5 (34–58) versus 37 (29–48) years in the non-coma sample (p &lt; 0.001), respectively. Furthermore, an age-and superior sagittal sinus-adjusted multivariate logistic regression model found male sex (odds ratio = 1.8, 95% confidence interval [CI] = 1.0–3.4, p = 0.04 to be an independent predictor of coma in CVT, with an area under the receiver operating characteristic curve of 0.61 (95% CI = 0.52–0.68, p = 0.01). Conclusions: Although CVT is a female-predominant disease, men were older and nearly twice as likely to suffer from coma than women

Antibody Response to Shiga Toxins in Argentinean Children with Enteropathic Hemolytic Uremic Syndrome at Acute and Long-Term Follow-Up Periods

Shiga toxin (Stx)-producing Escherichia coli (STEC) infection is associated with a broad spectrum of clinical manifestations that include diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome (HUS). Systemic Stx toxemia is considered to be central to the genesis of HUS. Distinct methods have been used to evaluate anti-Stx response for immunodiagnostic or epidemiological analysis of HUS cases. The development of enzyme-linked immunosorbent assay (ELISA) and western blot (WB) assay to detect the presence of specific antibodies to Stx has introduced important advantages for serodiagnosis of HUS. However, application of these methods for seroepidemiological studies in Argentina has been limited. The aim of this work was to develop an ELISA to detect antibodies against the B subunit of Stx2, and a WB to evaluate antibodies against both subunits of Stx2 and Stx1, in order to analyze the pertinence and effectiveness of these techniques in the Argentinean population. We studied 72 normal healthy children (NHC) and 105 HUS patients of the urban pediatric population from the surrounding area of Buenos Aires city. Using the WB method we detected 67% of plasma from NHC reactive for Stx2, but only 8% for Stx1. These results are in agreement with the broad circulation of Stx2-expressing STEC in Argentina and the endemic behavior of HUS in this country. Moreover, the simultaneous evaluation by the two methods allowed us to differentiate acute HUS patients from NHC with a great specificity and accuracy, in order to confirm the HUS etiology when pathogenic bacteria were not isolated from stools

Cost-Effectiveness of a Telephone-Delivered Intervention for Physical Activity and Diet

Background: Given escalating rates of chronic disease, broad-reach and cost-effective interventions to increase physical activity and improve dietary intake are needed. The cost-effectiveness of a Telephone Counselling intervention to improve physical activity and diet, targeting adults with established chronic diseases in a low socio-economic area of a major Australian city was examined. Methodology/Principal Findings: A cost-effectiveness modelling study using data collected between February 2005 and November 2007 from a cluster-randomised trial that compared Telephone Counselling with a “Usual Care” (brief intervention) alternative. Economic outcomes were assessed using a state-transition Markov model, which predicted the progress of participants through five health states relating to physical activity and dietary improvement, for ten years after recruitment. The costs and health benefits of Telephone Counselling, Usual Care and an existing practice (Real Control) group were compared. Telephone Counselling compared to Usual Care was not cost-effective ($78,489 per quality adjusted life year gained). However, the Usual Care group did not represent existing practice and is not a useful comparator for decision making. Comparing Telephone Counselling outcomes to existing practice (Real Control), the intervention was found to be cost-effective ($29,375 per quality adjusted life year gained). Usual Care (brief intervention) compared to existing practice (Real Control) was also cost-effective ($12,153 per quality adjusted life year gained). Conclusions/Significance: This modelling study shows that a decision to adopt a Telephone Counselling program over existing practice (Real Control) is likely to be cost-effective. Choosing the ‘Usual Care’ brief intervention over existing practice (Real Control) shows a lower cost per quality adjusted life year, but the lack of supporting evidence for efficacy or sustainability is an important consideration for decision makers. The economics of behavioural approaches to improving health must be made explicit if decision makers are to be convinced that allocating resources toward such programs is worthwhile

Genome-Wide Association Study Identifies First Locus Associated with Susceptibility to Cerebral Venous Thrombosis

Objective Cerebral venous thrombosis (CVT) is an uncommon form of stroke affecting mostly young individuals. Although genetic factors are thought to play a role in this cerebrovascular condition, its genetic etiology is not well understood. Methods A genome-wide association study was performed to identify genetic variants influencing susceptibility to CVT. A 2-stage genome-wide study was undertaken in 882 Europeans diagnosed with CVT and 1,205 ethnicity-matched control subjects divided into discovery and independent replication datasets. Results In the overall case-control cohort, we identified highly significant associations with 37 single nucleotide polymorphisms (SNPs) within the 9q34.2 region. The strongest association was with rs8176645 (combined p = 9.15 x 10(-24); odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.76-2.31). The discovery set findings were validated across an independent European cohort. Genetic risk score for this 9q34.2 region increases CVT risk by a pooled estimate OR = 2.65 (95% CI = 2.21-3.20, p = 2.00 x 10(-16)). SNPs within this region were in strong linkage disequilibrium (LD) with coding regions of the ABO gene. The ABO blood group was determined using allele combination of SNPs rs8176746 and rs8176645. Blood groups A, B, or AB, were at 2.85 times (95% CI = 2.32-3.52, p = 2.00 x 10(-16)) increased risk of CVT compared with individuals with blood group O. Interpretation We present the first chromosomal region to robustly associate with a genetic susceptibility to CVT. This region more than doubles the likelihood of CVT, a risk greater than any previously identified thrombophilia genetic risk marker. That the identified variant is in strong LD with the coding region of the ABO gene with differences in blood group prevalence provides important new insights into the pathophysiology of CVT. ANN NEUROL 2021Peer reviewe