Variations in older people's use of general practitioner consultations and the relationship with mortality rate in Vantaa, Finland in 2003-2014

Objective: It is generally expected that the growth of the older population will lead to an increase in the use of health care services. The aim was to examine the changes in the number of visits made to general practitioners (GP) by the older age groups, and whether such changes were associated with changes in mortality rates. Design and setting: A register-based observational study in a Finnish city where a significant increase in the older population took place from 2003 to 2014. The number of GP visits made by the older population was calculated, the visits per person per year in two-year series, together with respective mortality rates. Subjects: The study population consisted of inhabitants aged 65 years and older (65+) in Vantaa that visited a GP in primary health care. Main outcome measures: The number of GP visits per person per year in the whole older population during the study years. Results: In 2009-2010, there was a sudden drop in GP visits per person in the younger (65-74 years) age groups examined. In the population aged 85+, use of GP visits remained at a fairly constant level. The mortality rate decreased until the year 2008. After that, the positive trend ended and the mortality rate plateaued. Conclusions: Simultaneously with the decline in GP visits per person in the older population, the mortality rate leveled off from its positive trend in 2009-2010. Factors identified being associated with the number of GP consultations were organizational changes in primary health care, economic recession causing retrenchment, and even vaccinations during the swine flu epidemic.Peer reviewe

Return of Nimat?—Wild Reindeer as an Indicator of Evenki Biocultural Systems

This paper reviews oral histories and established scientific materials regarding wild reindeer (Rangifer tarandus spp.) in the Southern Sakha-Yakutia, in the Neriungri district and surrounding highlands, river valleys and taiga forest ecosystems. Wild reindeer is seen as an ecological and cultural keystone species through which environmental and social changes can be understood and interpreted. Oral histories of Evenki regarding wild reindeer have been documented in the community of Iyengra between 2005 and 2020. During this 15-year-co-researchership the Southern Sakha-Yakutian area has undergone rapid industrial development affecting the forest and aquatic ecosystems. The wild reindeer lost habitats and dwindles in numbers. We demonstrate that the loss of the wild reindeer is not only a loss of biodiversity, but also of cultural and linguistic diversity as well as food security. Our interpretative and analytical frame is that of emplacement. Socio-ecological systems have the potential and capacity to reconnect and re-establish themselves in post-extractive landscapes, if three main conditions are met. These conditions for successful emplacement include (1) surviving natural core areas, (2) links to cultural landscape knowledge and (3) an agency to renew endemic links