Comparison of new psychiatric diagnoses among Finnish children and adolescents before and during the COVID-19 pandemic : A nationwide register-based study

BackgroundCoronavirus Disease 2019 (COVID-19) restrictions decreased the use of specialist psychiatric services for children and adolescents in spring 2020. However, little is known about the pattern once restrictions eased. We compared new psychiatric diagnoses by specialist services during pandemic and pre-pandemic periods. Methods and findingsThis national register study focused on all Finnish residents aged 0 to 17 years from January 2017 to September 2021 (approximately 1 million a year). The outcomes were new monthly diagnoses for psychiatric or neurodevelopmental disorders in specialist services. These were analyzed by sex, age, home location, and diagnostic groups. The numbers of new diagnoses from March 2020 were compared to predictive models based on previous years. The predicted and observed levels in March to May 2020 showed no significant differences, but the overall difference was 18.5% (95% confidence interval 12.0 to 25.9) higher than predicted in June 2020 to September 2021, with 3,821 more patients diagnosed than anticipated. During this period, the largest increases were among females (33.4%, 23.4 to 45.2), adolescents (34.4%, 25.0 to 45.3), and those living in areas with the highest COVID-19 morbidity (29.9%, 21.2 to 39.8). The largest increases by diagnostic groups were found for eating disorders (27.4%, 8.0 to 55.3), depression and anxiety (21.0%, 12.1 to 51.9), and neurodevelopmental disorders (9.6%, 3.0 to 17.0), but psychotic and bipolar disorders and conduct and oppositional disorders showed no significant differences and self-harm (-28.6, -41.5 to -8.2) and substance use disorders (-15.5, -26.4 to -0.7) decreased in this period. The main limitation is that data from specialist services do not allow to draw conclusions about those not seeking help. ConclusionsFollowing the first pandemic phase, new psychiatric diagnoses in children and adolescents increased by nearly a fifth in Finnish specialist services. Possible explanations to our findings include changes in help-seeking, referrals and psychiatric problems, and delayed service access.Author summary Why was this study done? Healthcare emergencies and conflicts pose real threats to the availability of psychiatric services for children and adolescents.Previous studies compared limited pandemic and pre-pandemic periods or they did not cover the whole spectrum of psychiatric or neurodevelopmental disorders.This study was done to provide a comprehensive overview of the patterns of new diagnoses among children and adolescents during the pandemic. What did the researchers do and find? This study compared the predicted and observed new diagnoses from March 2020 to September 2021 based on pre-pandemic data and analyzed data from 2017 to 2021 among approximately 1 million children and adolescents per year.No significant changes in diagnoses were seen during the first phase of the pandemic, from March to May 2020, but new diagnoses increased by 18.5% from June 2020 to September 2021.Particularly high increases were observed in females, adolescents, and those living in areas with the highest Coronavirus Disease 2019 (COVID-19) rates. The highest increases in diagnoses related to eating disorders, depression and anxiety disorders, and neurodevelopmental disorders. What do these findings mean? The rapid increases in primary and secondary diagnoses by specialist services after the first 3 months of the pandemic raises concerns about gaps in services, accessibility, and continuity after the pandemic.Changes in supply and demand can pose serious challenges for psychiatric services, as they adapt to provide efficient services for children and adolescents.These data emphasize the importance of preparing for sudden changes in service use due to healthcare emergencies or crises, including the ongoing pandemic and the current conflict in Europe.Peer reviewe

Terveydenhuollon kansalliset laaturekisteripilotit loppusuoralla

Pilottiprojektin tulokset laaturekisterien toiminnan organisoimisesta kannustavat ¬jatkamaan työtä moniammatillisesti ja pitkäjänteisesti. Kansallinen koordinaatio on välttämätöntä laatu- ja vaikuttavuustiedon vertailukelpoisuuden ja hyödyntämisen varmistamiseksi

Facebookin käyttö matkailuyrityksen markkinoinnissa

Opinnäytetyön tavoitteena oli tuottaa toimeksiantajalle, Guild Travel Ltd:lle, kehitysehdotuksia markkinointiin Facebookissa. Suomen matkojen myyntiin Iso-Britannian markkinoilla erikoistunut yritys koki tarvetta hyödyntää tehokkaasti uusia markkinointimahdollisuuksia, joita sosiaalisen median nousu on tuonut tullessaan. Tarkoituksena oli auttaa yritystä hyödyntämään Facebook yhteisöpalvelua tehokkaammin näkyvyyden lisäämiseen verkossa ja tätä kautta myynnin kasvattamiseen. Sosiaalinen media on tärkeä osa nykyistä markkinointimaisemaa. Sen tarjoamat monipuoliset kanavat ja työkalut tarjoavat yrityksille mahdollisuuden olla yhteydessä kuluttajiin reaaliaikaisesti, vuorovaikutteisesti ja kustannustehokkaasti. Facebook on tällä hetkellä maailman suosituin sosiaalisen median kanava ja siksi arvokas ympäristö myös yrityksille olla läsnä. Matkailuun liittyen kuluttajat käyttävät Facebookia etenkin kokemusten jakamiseen muiden kanssa. Haastattelemalla yrityksen työntekijää ja havainnoimalla yrityksen toimintaa Facebookissa, saatiin oleellista tietoa Facebook-markkinoinnin nykytilasta yrityksessä. Markkinoinnin tilannetta arvioitiin SWOT-analyysin avulla, josta esiin nousseet Facebookin käytön vahvuudet ja heikkoudet otettiin huomioon kehitysehdotuksissa. Benchmarkingin avulla vertailtiin Guild Travelin toimintaa kahden muun matkailu-alan yrityksen toimintaan Facebookissa ja etsittiin uusia ideoita. Tutkimuksesta kävi ilmi, että yrityksen Facebook-sivustolla toimittiin aktiivisesti ja tuotetut sisällöt olivat merkityksellisiä. Facebookin käyttöä varjosti kuitenkin tavoitteiden ja suunnitelmallisuuden puuttuminen, jonka korjaamiseen ensimmäinen kehitysehdotus suunnattiin. Tavoitteiden selkeyttämisen jälkeen yritys voi hyödyntää Facebookia entistä monipuolisemmin. Toinen kehitysehdotus tarjoaa esimerkin erilaisten sovellusten hyödyntämiseen yrityksessä.The objective of this study was to create suggestions for development regarding the Facebook marketing of Guild Travel Ltd. Guild Travel Ltd, a travel agency specialized in selling trips to Finland in the UK's market, felt the need to efficiently take advantage of the new marketing possibilities the rise of social media has entailed. The purpose was to assist the company on utilizing the social networking tool, Facebook, successfully to increase company's visibility and sales. Social media marketing is an important part of today's marketing landscape. Diverse social media channels and tools allow companies to communicate with consumers in real time, interactively and cost-effectively. Currently, Facebook is the most used social media tool and therefore also valuable for companies. As for matters related to travel, consumers use Facebook mostly for sharing experiences with other users. Essential information was gained concerning the company's current situation by interviewing an employee and by observing how Facebook is used in the company today. The current situation was analyzed by using SWOT-analysis which disclosed the company's strengths and weaknesses that were taken into account when making the final suggestions for development. Benchmarking was used to compare Guild Travel's efforts on Facebook with two other travel agencies and to discover new, useful ideas. The study indicated that the company was actively using Facebook and the contents created were in fact, relevant. However, the lack of objectives and planning prevented the company from getting a full benefit from Facebook marketing. The first suggestion was done to help the company with this. After clarifying the Facebook marketing objectives, the company can make use of the second suggestion for development and get started with the diverse possibilities Facebook offers for marketers

Lapsuuden trauma unenlaadun ja psykoottiskaltaisten kokemusten edeltäjänä nuorisopsykiatrisessa populaatiossa

Tavoitteet: Psykoottiskaltaiset kokemukset ovat yleisiä väestössä ja esiintyvät jatkumona psykoosisairauksien kanssa. Psykoottiskaltaiset kokemukset ovat yhteydessä myöhempiin psykoosisairauksiin ja ei-psykoottisiin mielenterveysongelmiin sekä alentuneeseen toimintakykyyn ja huolestuneisuuteen. Tutkimuksissa on todettu, että lapsuuden trauma on yhteydessä myöhempiin unihäiriöihin ja molemmat ennustavat psykoottiskaltaisten kokemusten korkeampaa esiintyvyyttä. Siitä huolimatta näitä tekijöitä ei juuri ole tutkittu yhdessä. Parempi ymmärrys psykoottiskaltaisiin kokemuksiin liittyvistä riskitekijöitä ja taustalla vaikuttavista mekanismeista mahdollistaa paremman hoidon ja lisähaitan ennaltaehkäisyn. Menetelmät: Tutkimuspopulaatio (N = 681) koostui nuorista psykiatrisessa avohoidossa Suomessa. Itsearviointilomakkeilla kerätty tieto lapsuuden traumasta, unenlaadusta ja psykoottiskaltaisista kokemuksista analysoitiin lineaaristen regressiomallien avulla ja tarkasteltiin unenlaadun mahdollista välittävää vaikutusta lapsuuden trauman ja psykoottiskaltaisten kokemusten välillä. Masennus- ja ahdistusoireet lisättiin analyyseihin mahdollisina sekoittavina tekijöinä. Tulokset: Ensisijaisissa analyyseissa, lapsuuden trauma ja unenlaatu olivat molemmat yhteydessä hallusinaatioihin ja harhaluuloihin minkä lisäksi saatiin viitteitä unenlaadun osittaisesta välittävästä vaikutuksesta. Masennus- ja ahdistusoireiden lisääminen analyyseihin kuitenkin sekoitti yhteyttä, eikä unenlaatu enää näyttäytynyt selittävänä tekijänä. Johtopäätökset: Masennus- ja ahdistusoireet vaikuttivat selittävän lapsuuden trauman ja psykoottiskaltaisten kokemusten yhteyttä unenlaatua paremmin. Tämä voi selittyä oirekuvien päällekkäisyydellä, jolloin unenlaadun mahdolliset vaikutukset jäävät näkymättömiin tai tutkittujen muuttujien jaetuilla taustamekanismeilla, jotka ovat läheisesti yhteydessä myös masennus- ja ahdistusoireisiin.Objective: Psychotic-like experiences (PLEs) are common in general population and exist in a continuum with clinical psychotic disorders. PLEs are associated with later psychotic and non-psychotic disorders as well as concurrent poorer functioning and distress. It has been well established that childhood trauma is a risk factor for later sleep disturbances, and both are predictors for higher occurrence of PLEs. However, these factors are rarely studied together and better understanding of the risk factors and underlying mechanisms behind PLEs is of clinical relevance to ensure better treatment and prevention of further disadvantages. Methods: The study population (N = 681) consisted of adolescent outpatients in psychiatric care in Finland. Results from self-reported questionnaires of childhood trauma, sleep quality, and PLEs were used in multiple linear regression models and the possible mediating effect of sleep quality between childhood trauma and PLEs was tested. Depressive and anxiety symptoms were later added as possible confounding variables. Results: Childhood trauma and sleep quality were both associated with hallucinations and delusions in primary analyses and there were indications of a small, partial mediating effect. However, adding depressive and anxiety symptoms to the models changed the mediating effects and sleep no longer appeared as an explanatory factor. Discussion: Depressive and anxiety symptoms appeared to explain the connection between childhood trauma and PLEs better than sleep quality. This could be due to overlap in symptomology that mask the possible effects of sleep or similar mechanisms behind examined variables that are also closely connected to depressive and anxiety symptoms

Enhancing identification of nonaffective psychosis in register-based studies

Abstract The Finnish Quality of Psychosis Care Register assesses nonaffective psychosis (NAP) care, acknowledging treatment outside specialized psychiatric services. This approach, while providing a holistic view, raises concerns about diagnostic inaccuracies. Here, we studied situations where the register-based diagnosis might be inaccurate, and whether the first episode can be reliably identified using a 14-year wash-out period. People with first register-based NAP (ICD-10 F20-F29) between years 2010 and 2018 and without NAP diagnoses in 1996–2009 were identified from the Care Register for Health Care. A diagnosis of NAP was deemed unreliable before age 7, when dementia preceded NAP diagnosis, and when a NAP diagnosis had been assigned at admission or during psychiatric hospitalization but was not confirmed by discharge diagnosis. Despite a 14-year follow-back the first register diagnosis may miss the first treatment episode in older patients. Register-based studies on psychotic disorders should pay attention to exclusion criteria and to the definition of treatment onset