Prioritizing Elective Surgery During the COVID-19 Pandemic Has Caused Age-Related Inequality : a Multicenter Study

The concern has been that this prioritization has resulted in age-related inequality between patients, with the older population suffering the most. The aim of this multicenter study was to examine the differences in incidence and waiting times of elective surgeries by age during the SARS-CoV-2 coronavirus disease (COVID-19) pandemic in Finland. Data on elective surgery (88 716 operations) were gathered from three Finnish public hospitals for the years 2017-2020. Surgery incidence and waiting times stratified by age groups (younger than 18, 18 to 49, 50 to 69, and 70 or older) were examined, and the year 2020 was compared to the reference years 2017-2019. The mean annual, monthly, and weekly waiting times were calculated with 95% confidence intervals (CI). The first COVID-19 wave decreased surgery incidence most prominently in patients younger than 18 (incidence rate ratio [IRR] 0.64, CI 0.60-0.68) and 70 or older (IRR 0.68, CI 0.66-0.70). After the first wave, the incidence increased in patients aged 50 to 69 and 70 or older by 22% and 29%, respectively. Among patients younger than 18, the incidence in 2020 was 15% lower. In patients younger than 18, waiting times were at mean of 43% longer in June to December compared to the reference years. In patients aged 18 to 49, 50 to 69, and 70 or older, waiting times increased in May but recovered to normal level during fall 2020. COVID-19 decreased the incidence of surgery and led to increased waiting times. Clearing of the treatment backlog started with older patients which resulted in prolonged waiting times among pediatric patients.publishedVersionPeer reviewe

Effects of reindeer grazing and forestry on ground lichens in Finnish Lapland.

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Antithrombotic management after aortic valve replacement with biological prosthesis : a meta-analysis

Background: We aimed to summarise the existing knowledge regarding antithrombotic medications following surgical aortic valve replacement (SAVR) using a biological valve prosthesis. Methods: We performed a meta-analysis of studies that reported the results of using antithrombotic medication to prevent thromboembolic events after SAVR using a biological aortic valve prosthesis and recorded the outcomes 12 months after surgery. Since no randomised controlled trials were identified, observational studies were included. The analyses were conducted separately for periods of 0–12 months and 3–12 months after surgery. A random effects model was used to calculate pooled outcome event rates and 95% confidence intervals (CIs). Results: The search yielded eight eligible observational studies covering 6727 patients overall. The lowest 0- to 12-month mortality was observed in patients with anticoagulation (2.0%, 95% CI 0.4–9.7%) and anticoagulation combined with antiplatelet therapy (2.2%, 95% CI 0.9–5.5%), and the highest was in patients without antithrombotic medication (7.3%, 95% CI 3.6–14.2%). Three months after surgery, mortality was lower in anticoagulant patients (0.5%, 95% CI 0.1–2.6%) than in antiplatelet patients (3.0%, 95% CI 1.2–7.4%) and those without antithrombotics (3.5%, 95% CI 1.3–9.3%). There was no eligible evidence of differences in stroke rates observed among medication strategies. At 0- to 12-month follow-up, all antithrombotic treatment regimens resulted in an increased bleeding rate (antiplatelet 4.2%, 95% CI 2.9–6.1%; anticoagulation 7.5%, 95% CI 3.8–14.4%; anticoagulation combined with antiplatelet therapy 8.3%, 95% CI 5.7–11.8%) compared to no antithrombotic medication (1.1%, 95% CI 0.4–3.4%). At 3- to 12-month follow-up, there was up to an eight-fold increase in the bleeding rate in patients with anticoagulation combined with antiplatelet therapy when compared to those with no antithrombotic medication. Overall, the evidence certainty was ranked as very low. Conclusion: Although this meta-analysis reveals that anticoagulation therapy has a beneficial tendency in terms of mortality at 1 year after biological SAVR and suggests potential advantages in continuing anticoagulation beyond 3 months, it is limited by very low evidence certainty. The imperative for cautious interpretation and the urgent need for more robust randomised research underscore the complexity of determining optimal antithrombotic strategies in this patient population.Peer reviewe

Poron laidunnuksen ja metsätalouden vaikutukset maajäkäliin

TutkimusselosteSeloste artikkelista: Akujärvi, A., Hallikainen, V., Hyppönen, M., Mattila, E., Mikkola, K. & Rautio, P. 2014. Effects of reindeer grazing and forestry on ground lichens in Finnish Lapland. Silva Fennica 48(3), article id 1153

Primary care visits due to mental health problems and use of psychotropic medication during the COVID-19 pandemic in Finnish adolescents and young adults

Background: Social restrictions due to COVID-19 have impacted the everyday life of adolescents and young adults, with increased levels of stress and anxiety being reported. Therefore, we report primary care visits due to mental health problems and the use of psychotropic medication in Finland. Methods: We conducted a nationwide register-based study and included primary care visits with mental health problems (F*-class ICD-10 diagnosis) for patients aged 15–24 years. We calculated incidence for visits and used incidence rate ratios (IRR) for comparisons. Psychotropic medication purchases for patients aged 13–24 years were included. Annual psychotropic medication user prevalence per 1000 was calculated and prevalence rate ratios (PRR) with 95% confidence intervals (CI) were used for comparisons. The years 2020 and 2021 were compared to the pre-pandemic reference year 2019. Results: A total of 396534 visits to primary care due to mental health problems were included. Annual visit incidences per 1000 were 151.7 in 2019, 193.6 in 2020, and 306.7 in 2021, indicating a 28% (IRR 1.28, CI 1.27–1.29) increase from 2019 to 2020 and a 102% (IRR 2.02, CI:2.01–2.04) increase from 2019 to 2021. Highest reported increases in 2020 were sleeping disorders (IRR 1.79, CI 1.72–1.87) and anxiety disorders (IRR 1.39, CI 1.37–1.42). Prevalence of antidepressant use increased by 25% (PRR 1.25, CI 1.23–1.26) in 2021. An increase was also seen in the use of antipsychotics (+ 19%, PRR 1.19. CI 1.16–1.21). Conclusions: The COVID-19 pandemic increased the need for mental health services and medication among Finnish adolescents and young adults. Our health care system needs the capacity to manage the increased number of visits, and we must be better prepared for future crises.publishedVersionPeer reviewe

Kaksoisenergiatietokonetomografia - lisäarvoa päivystyskuvantamiseen?

Kaksoisenergiatietokonetomografia (KETT) on menetelmä, jossa tietokonetomografian (TT) tarkkuuteen havaita ja luokitella poikkeavia löydöksiä pystytään edelleen vaikuttamaan tehostamalla kudoserottelua. KETT:llä voidaan myös vähentää artefakteja tai kohinaa ja materiaalien erottelukyvyn perusteella esimerkiksi suoraan kuvantaa jodin kertymistä kudoksiin. KETT-sovelluksia on jo monipuolisesti, myös päivystyskuvantamiseen. Virtuaaliset natiivisarjat mahdollistavat sädeannoksen tutkimuskohtaisen vähentämisen. Samaan suuntaan vaikuttaa mahdollisten jatkotutkimusten väheneminen, kun diagnostiikka tarkentuu

Incidence of Electric Scooter-Associated Injuries in Finland From 2019 to 2021

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Trends in Emergency Department Visits and Surgeries due to Traumatic Brain Injury During the COVID-19 Pandemic in Finland

We aim to evaluate the changes in the incidence of TBI, trauma craniotomies, and craniectomies during the COVID-19 pandemic in Finland. This retrospective register study was conducted at three Finnish hospitals. We retrieved the numbers of emergency department (ED) visits, inpatient admissions, and trauma craniotomies and craniectomies due to TBI in the adult population from 2017 to 2020.We calculated the incidences per 100 000 inhabitants and compared the year 2020 to the reference years (2017–2019) by incidence rate ratios (IRR) with 95% confidence intervals. The incidence of TBI-related ED visits during the study period compared to the reference years started to decrease in March 2020 (IRR 0.86, CI: 0.73–1.02), and the lowest incidence was seen in April 2020 (IRR 0.83, CI: 0.68–1.01). The incidence of ED visits showed a second decrease in December (IRR 0.80, CI: 0.67–0.96). The incidence of concussion decreased during the national lockdown in March (IRR 0.80, CI 0.66–0.97). The incidence of ED visits due to TBI decreased after the declaration of national lockdown in spring 2020 and showed a second decrease during regional restrictions in December. In addition, the incidence of neurosurgically treated TBI decreased during restaurant restrictions in the spring.Peer reviewe

Daylight savings time transition and the incidence of femur fractures in the older population : a nationwide registry-based study

Background. Daylight Savings Time (DST) transition is known to cause sleep disruption, and thus may increase the incidence of injuries and accidents during the week following the transition. The aim of this study was to assess the incidence of femur fractures after DST transition. Methods. We conducted retrospective population-based register study. All Finnish patients 70 years or older who were admitted to hospital due to femur fracture between 1997 and 2020 were gathered from the Finnish National Hospital Discharge Register. Negative binomial regression with 95% confidence intervals (CI) was used to evaluate the incidence of femur fractures after DST transition. Results. The data included a total of 112,658 femur fractures during the study period between 1997 and 2020, with an annual mean (SD) of 4,694 (206) fractures. The incidence of femur fractures decreased at the beginning of the study period from 968 to 688 per 100,000 person-years between 1997 and 2007. The weekly mean of femur fractures remained lower during the summer (from 130 to 150 per 100,000 person-weeks) than in winter (from 160 to 180 per 100,000 person-weeks). Incidence rate ratio for the Monday following DST transition was 1.10 (CI [0.98–1.24]) in spring and 1.10 (CI [0.97–1.24]) in fall, and for the whole week 1.07 (CI [1.01–1.14]) in spring and 0.97 (CI [0.83–1.13]) in fall. Conclusion. We found weak evidence that the incidence of femur fractures increases after DST transition in the spring.publishedVersionPeer reviewe

Monivammapotilaiden tietojen tarkkuus (accuracy) ja kattavuus (coverage) HILMO-rekisterissä : vertailu Helsingin Traumarekisteritietoihin ja potilasasiakirjoihin

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