Sociodemographic indicators of birth rate in a low fertility country – A nationwide study of 310 Finnish municipalities covering > 5,000,000 inhabitants

Background and aims: Declining fertility is a key driver behind the rapid ageing of populations worldwide. Finland has experienced a 25% decline in fertility from 2010 to date and ranks low even on the European and Nordic scales. This study aimed to address the association between sociodemographic indicators and birth rate (i.e., live births relative to total population) in Finland. Methods: Open data on 310 Finnish municipalities were retrieved from the public database of Statistics Finland. Several sociodemographic subdimensions (population structure, education and income, location and living, divorces, car ownership rate, and crime rate), each converted to standard deviation units, were modelled against birth rate at the municipality level using generalized estimating equations. Results: In this dataset, average annual birth rate was 8.8 per 1000 individuals. Birth rate was positively associated with change in population size (rate ratio 1.06, 95% confidence interval 1.04—1.08), percentage of <15-year-olds (1.29, 1.22—1.36), percentage of individuals living in their birth municipality (1.05, 1.03—1.08), and percentage of foreign language speakers (1.02, 1.01—1.04). In contrast, birth rate was negatively associated with percentage of ≥65-year-olds (0.90, 0.85—0.96), percentage of unemployed individuals (0.98. 0.95—0.99), income (0.92, 0.88—0.95), and number of individuals living in the same household unit (0.94, 0.90—0.98). Conclusion: The present findings are expected to advance the allocation of resources to areas and subpopulations that have high or low birth rate, and thus contribute to the development of a more family-friendly society. Future studies are encouraged to evaluate the sociodemographic indicators of birth rate in other low fertility countries, and to address the individual-level mechanisms behind the municipality-level associations identified in this study.Peer reviewe

Urbanization level and medical adverse event deaths among US hospital inpatients over the period 2010-2019

Urban-rural disparity constitutes a major source of health inequity also in high-income countries. This study aimed to compare the distribution of deaths due to medical adverse events across urbanization levels among US hospital inpatients. An open dataset from the National Center for Health Statistics (NCHS) comprised all certified deaths of US inpatients over the period 2010-2019. The urbanization level of each decedent was determined in accordance with the 2013 NCHS Urban-Rural Classification Scheme (large metropolitan, medium or small metropolitan, or nonmetropolitan). The outcome was death due to a medical adverse event (ICD-10 codes Y40-Y84) proportional to total inpatient deaths. The data were standardized for sex, ethnicity, and age, and analyzed with linear mixed models. Of the 8 071 907 certified inpatient deaths during the study period, 21 444 (0.27%) were primarily attributed to medical adverse events. Decedents who resided in medium or small metropolitans and nonmetropolitans had approximately 0.5 units higher rate of adverse events per 1000 deaths (corresponding to a relative differece of 20%) when compared to decedents who resided in large metropolitans. Moreover, the urban-rural gradients showed an increasing trend towards the end of the study period, as the difference was found to increase at a rate of approximately 0.1 units per year (3%). There were no statistically significant differences between decedents from medium or small metropolitans and nonmetropolitans. The present findings highlight gradients in adverse event deaths between geographic areas, providing a basis for targeted preventive efforts. Future studies are invited to elucidate the underlying phenomena.Peer reviewe

Medical adverse events in the US 2018 mortality data

Although medical error has been estimated as the third leading cause of death in the US, the capability of current diagnostic coding systems and standard death certificates to capture these events has been criticized. This register-based study aimed to scrutinize medical adverse event deaths (i.e., deaths due to adverse events occurring within the healthcare practice, avoidable or unavoidable, including late complications and sequelae of such events) in the US National Vital Statistics 2018 mortality dataset. Individual-level data on underlying and multiple causes of death according to the tenth revision of the International Classification of Diseases (ICD-10) coding system were extracted together with the decedents’ sex, age, ethnicity and education level. Adverse event deaths were identified by ICD-10 codes Y40—Y84 and Y88. The dataset comprised a total of 2 846 305 certified deaths. An adverse event ICD-10 code was used as the underlying cause of death in 0.16% (n = 4620) of the cases, and appeared on the list of multiple causes in 1.13% (n = 32 226) of the cases. Adverse event deaths were more common among younger than elderly individuals, among those of black than white ethnicity, and among individuals with higher education level. The present data indirectly support previous evidence that a large number of adverse events remain underrecognized or misclassified. Future analyses are needed to reveal the root causes behind underreporting and address whether it occurs at random or in a systematic way.Peer reviewe

Educational Gradients Behind Medical Adverse Event Deaths in the US—A Time Series Analysis of Nationwide Mortality Data 2010–2019

Background: Deaths due to medical care appear common. Individuals with low socioeconomic position seem to be at a higher risk for sustaining a medical adverse event and premature death. This time series analysis aimed to assess educational gradients behind adverse event deaths in the US over the period 2010–2019. Methods: Publicly available mortality and census data were retrieved from official sources. The data included age, sex, educational attainment, and underlying cause of death. Adverse event deaths were identified by ICD-10 codes Y40—Y84 and Y88. Four education categories were created in accordance with the International Standard Classification of Education 2011 coding scheme [No high school or General Educational Development (GED); High school or GED; Some college; Bachelor's degeree or higher]. To capture also highly educated individuals, the analysis was delimited to ≥30-year-olds. Age-adjusted mortality rates (AMRs) were compared between education categories by means of mortality plots and linear mixed models. Results: A total of 25,897,334 certified deaths occurred among ≥30-year-olds during the study period. The underlying cause of death was an adverse event in a rarity of cases (0.12%, n = 31,997). Individuals with Bachelor's degeree or higher had the lowest adverse event AMRs (6.1–12.4 per million per year), followed by the Some college category (9.6–18.6), the High school or GED category (17.1–35.4), and finally the No high school or GED category (20.0–36.0). AMRs showed a gradual increase as education level decreased (p ≤ 0.001 against those with Bachelor's degeree or higher). Moreover, the temporal increase in adverse event AMRs was more pronounced among individuals with low than high education; the contrasts between categories were greatest toward the end of the study period. Conclusion: The findings of this study suggest that the widening socioeconomic gradients in mortality extend also to fatal adverse events. Future studies should aim to analyze whether access to care, severity of the condition at presentation, quality of care, and social determinants of health may drive the gradients.Peer reviewe

A recent two-fold increase in medical adverse event deaths among US inpatients

Inpatients have a particular risk of sustaining medical adverse events (MAEs). This analysis aimed to identify patterns of change in deaths due to MAEs among US inpatients. The analysis was based on nationwide cause-of-death data from 1999 to 2019. To adjust for secular trends in overall mortality, MAE deaths were examined proportional to total deaths. Statistical analysis was performed by means of joinpoint regression modeling. Over the analysis period, a total of 18,126,135 certified deaths occurred among inpatients. MAEs were used as the underlying cause of death in 43,899 cases (0.24%). MAE deaths showed a significant increase from mid-2010s onwards; the estimated increase in MAE deaths was up to 15.6% per year (95% confidence interval 11.3-20.1) from 2014 to 2019. Procedure-related events mainly drove the trend. As the present data are insufficient to substantiate and disentangle underlying factors, future analyses are warranted.Peer reviewe

Elinaikaisten tekijöiden yhteys keski-iän nikamakokoon:tarkastelussa elinaikainen liikunnallisuus sekä varhainen kasvu

Tiivistelmä. Osteoporoosi on maailmanlaajuinen terveysongelma, joka koskettaa merkittävää osaa väestöstä keski-iästä lähtien. Sille tyypillistä on luukudoksen lujuuden heikentyminen mikro- ja makrotason muutosten seurauksena, mistä johtuu erityisesti kasvanut traumaan liittymättömien matalaenergisten murtumien riski. Selkänikama on yleisin ja usein myös ensimmäinen tällaisen murtuman esiintymiskohta. Nikaman pienen koon tiedetään lisäävän sen murtumariskiä, mutta nikaman kokoa määrittäviä tekijöitä tunnetaan varsin rajallisesti. Tämän tutkimuskokonaisuuden tarkoituksena on ollut tutkia, miten (1) vapaa-ajan yleinen liikunnallisuus, (2) yksittäiset liikuntalajit ja luita kuormittava liikunta, (3) työn fyysiset ominaisuudet sekä (4) varhainen kasvu vaikuttavat keski-iän nikamakokoon. Tutkimusjoukon on muodostanut Pohjois-Suomen syntymäkohortti 1966:n osaotos, johon kuuluneiden lanneranka on magneettikuvattu osana 46-vuotistutkimusta vuosina 2012–2014 (n = 1 540). Elinaikaisen eli lähes 50-vuotisen seurantajakson aikana tutkittavien terveydentilasta sekä elintavoista on kertynyt runsaasti tietoa, jota tutkimuksessa on hyödynnetty. Liikunnallista aktiivisuutta on tiedusteltu 14, 31 ja 46 vuoden kohdalla, lajikohtaista harrastusaktiivisuutta 31 ja 46 vuoden kohdalla ja työn fyysisiä piirteitä niin ikään 31 ja 46 vuoden kohdalla. Tietoa fyysisestä kehityksestä pituuden ja painon suhteen on kerätty syntymästä lähtien. Tutkimusprojekti on onnistunut paljastamaan nikamakoon kannalta potentiaalisesti merkityksellisiä tekijöitä. Naisten elinikäisen vapaa-ajan liikunnallisuuden on havaittu olevan yhteydessä suurentuneeseen keski-iän nikamakokoon. Yhteys on havaittu paitsi yleisen liikunnallisuuden osalta, myös erityisesti luustoa tehokkaasti kuormittavia liikunta- ja urheilulajeja (pallopelit, juoksu) tarkasteltaessa. Miehillä ei ole havaittu yhteyttä liikunnan ja nikamakoon välillä, eikä työn fyysisyys ole näyttänyt olevan yhteydessä nikamakokoon kummallakaan sukupuolella. Nopean varhaislapsuuden painonnousun on havaittu olevan itsenäisesti yhteydessä suurempiin keski-iän nikamiin sekä miehillä että naisilla, kun taas lapsuuden ja nuoruuden ripeä pituuskasvu on heijastunut keski-iän nikamakokoon aikuispituuden kautta. Havaitut yksilöiden väliset erot nikamakoossa ovat maltillisia, mutta tutkimuksen tulosten valossa erityisesti naisten vapaa-ajan liikuntakäyttäytyminen näyttää olevan yhteydessä nikamakokoon ja sitä kautta murtumariskiin. Lisäksi jo varhaisen lapsuuden fyysisen kehityksen perusteella näyttää olevan mahdollista ennustaa keski-iän nikamakokoa ja siten myös nikamamurtuman riskiä kummankin sukupuolen osalta. Kyseessä on väitöskirjaksi tarkoitettu tutkimuskokonaisuus, joka on toteutettu Oulun yliopiston lääketieteellisessä tiedekunnassa vuosina 2015–2017. Poikkitieteellisen tutkimusprojektin ohjaajina ovat toimineet professori Jaakko Niinimäki (radiologia), professori Jaro Karppinen (fysiatria) sekä dosentti Juho-Antti Junno (antropologia). Projektin osatöitä on julkaistu vertaisarvioiduissa tieteellisissä julkaisuissa ja Oura on toiminut näissä ensimmäisenä kirjoittajana. Tekijänoikeudellisista syistä syventävien opintojen raporttina julkaistaan tämä lyhennelmä sekä viitteet toistaiseksi julkaistuihin osatöihin. Täydellinen tutkimusprojektin kuvaus on tarkoitus julkaista väitöskirjan muodossa myöhemmin

Deep learning in forensic shotgun pattern interpretation-A proof-of-concept study

Little is known about the potential of artificial intelligence in forensic shotgun pattern interpretation. As shooting distance is among the main factors behind shotgun patterning, this proof-of-concept study aimed to explore the potential of neural net architectures to correctly classify shotgun pattern images in terms of shooting distance. The study material comprised a total of 106 shotgun pattern images from two discrete shooting distances (n = 54 images from 10 m and n = 52 images from 17.5 m) recorded on blank white paper. The dataset was used to train, validate and test deep learning algorithms to correctly classify images in terms of shooting distance. The open source AIDeveloper software was used for the deep learning procedure. In this dataset, a TinyResNet-based algorithm reached the highest testing accuracy of 94%. Of the testing set, the algorithm classified all 10 m patterns correctly, and misclassified one 17.5 m pattern. On the basis of these preliminary data, it seems achievable to develop algorithms that would serve as a beneficial tool for forensic investigators when estimating shooting distances from shotgun patterns. In the future, studies with larger and more complex datasets are needed to develop robust and applicable algorithms for forensic shotgun pattern interpretation.Peer reviewe

Post-mortem computed tomography in forensic shooting distance estimation: a porcine cadaver study

Objectives Gunshot wounds are frequently studied using computed tomography (CT) to examine tissue damage. In this study, we aimed to test the potential of post-mortem CT (PMCT) in shooting distance estimation at distances 0–100 cm. We hypothesized that in addition to the wound channel, we could also potentially detect tissue damage caused by muzzle pressure on PMCT. Results A total of 59 gunshot wounds (23 contact shots, 21 close-range shots, 15 distant shots) were inflicted on eight piglet carcasses with a .22 Long Rifle handgun. PMCT scans were obtained using clinical equipment, and they were evaluated for wound characteristics by visual inspection and numeric measurements. In our data, contact shots could be clearly distinguished from close-range and distant shots by a hyperdense ring-shaped area surrounding the outermost part of the wound channel. Close-range and distant shot wounds did not have this feature and were difficult to distinguish from each other. The mean wound channel diameter ranged from 3.4 to 5.4 mm, being smallest in contact shots and largest in distant shots. These preliminary findings suggest that PMCT may aid the estimation of shooting distance. As this study only addressed low velocity gunshot wounds in carcasses, further studies are warranted.Peer reviewe

Unnatural-cause mortality patterns of Northern Finnish men and women diverge in adolescence – A 52-year follow-up

The Finnish population has a long life expectancy but ranks high in unnatural deaths on the European scale. Mortality has historical regional discrepancy in Finland, as Northern Finns are overrepresented in both natural and unnatural deaths. This study aimed to characterize the age- and sex-related trends in unnatural mortality among Northern Finns. Altogether 12 143 individuals, constituting >95% of births in Northern Finland in 1966, were followed up for a median of 52 years. The mortality patterns of this population were studied using death record data. Crude annual mortality rates were calculated and graphed for 10-year age strata (all-cause, natural-cause, and unnatural-cause mortality, as well as accident, suicide, and homicide mortality). Cox regression was used to analyze the sex discrepancy in mortality. A total of 874 deaths (7.2%) occurred during the follow-up period. Women had 47% and 73% lower risks of any death and unnatural death than men, respectively. From the second decade of life onwards, the unnatural mortality of men was 3–5 times that of women. Accident and suicide mortality rates of men were 2–13 and 2–3 times those of women, respectively. Homicides were rare among either sex. We conclude that Northern Finnish women have a substantially lower risk of all-cause mortality and unnatural mortality than men. To aid the development of preventive strategies, future studies should aim to identify the underlying factors behind unnatural mortality. Primarily, emphasis should be placed on the increased mortality of men from the second decade of life onwards.Peer reviewe

Post-mortem computed tomography in forensic shooting distance estimation: a porcine cadaver study

Objectives Gunshot wounds are frequently studied using computed tomography (CT) to examine tissue damage. In this study, we aimed to test the potential of post-mortem CT (PMCT) in shooting distance estimation at distances 0–100 cm. We hypothesized that in addition to the wound channel, we could also potentially detect tissue damage caused by muzzle pressure on PMCT. Results A total of 59 gunshot wounds (23 contact shots, 21 close-range shots, 15 distant shots) were inflicted on eight piglet carcasses with a .22 Long Rifle handgun. PMCT scans were obtained using clinical equipment, and they were evaluated for wound characteristics by visual inspection and numeric measurements. In our data, contact shots could be clearly distinguished from close-range and distant shots by a hyperdense ring-shaped area surrounding the outermost part of the wound channel. Close-range and distant shot wounds did not have this feature and were difficult to distinguish from each other. The mean wound channel diameter ranged from 3.4 to 5.4 mm, being smallest in contact shots and largest in distant shots. These preliminary findings suggest that PMCT may aid the estimation of shooting distance. As this study only addressed low velocity gunshot wounds in carcasses, further studies are warranted.Peer reviewe