Uuden yksityistielain vaikutukset tiekuntien toimintaan

Tiivistelmä. Tässä kandidaatintyössä tutkittiin uuden yksityistielain vaikutuksia tiekuntien toimintaan. Uusi yksityistielaki astui voimaan tammikuussa 2019 korvaten vanhan vuodelta 1963 olleen yksityistielain. Lakiuudistuksen myötä tiekuntien toimintaa jouduttiin muuttamaan joiltain osin. Uuden yksityistielain vaikutuksia tiekuntien toimintaan selvitettiin kirjallisuustutkimuksena vertaamalla uutta yksityistielakia vanhaan yksityistielakiin. Lisäksi muutoksia tutkittiin suorittamalla media-analyysi yksityistielakiin liittyvästä uutisoinnista ja kirjoituksista eri medioissa sekä haastattelemalla uuden yksityistielain kohderyhmään kuuluvia henkilöitä. Tämän tutkimuksen maantieteellisenä rajauksena oli Pohjois-Suomi. Suoritettujen kirjallisuustutkimuksen, media-analyysin ja haastattelujen perusteella uuden yksityistielain merkittävimmiksi vaikutuksiksi tunnistettiin muuttunut riitatilanteiden käsittelyprosessi sekä tiekuntien vastuun lisääntyminen. Yksityistielakimuutoksen myötä kunnan ja valtion yksityisteille myöntämien avustusten muuttuneet myöntökriteerit ovat aiheuttaneet erittäin paljon keskustelua eri medioissa. Tutkimuksessa havaittiin uuden yksityistielain seurauksena lakkautettujen kuntien tielautakuntien olleen tarpeellisia yksityistieasioita käsitteleviä toimijoita ja saman tapaisille organisaatioille olevan tarvetta myös uuden lain astuttua voimaan. Tämän tutkimuksen maantieteellisenä rajauksena oli Pohjois-Suomi, eivätkä tulokset edusta koko valtakunnan tasoa. Koko valtakunnan kattavaa tutkimusta uuden yksityistielain vaikutuksista tiekuntien toimintaan ei ole vielä suoritettu. Tällainen tutkimus on tärkeä, jotta uuden yksityistielain mahdolliset, vielä tunnistamattomat epäkohdat saataisiin selvitettyä. Tämän tutkimuksen tulokset voivat toimia lähtötietoina koko valtakunnan kattavan tutkimuksen toteuttamisessa

Risk of sudden cardiac death associated with QRS, QTc, and JTc intervals in the general population

BACKGROUND QRS duration and corrected QT (QTc) interval have been associated with sudden cardiac death (SCD), but no data are available on the significance of repolarization component (JTc interval) of the QTc interval as an independent risk marker in the general population. OBJECTIVE In this study, we sought to quantify the risk of SCD associated with QRS, QTc, and JTc intervals. METHODS This study was conducted using data from 3 population cohorts from different eras, comprising a total of 20,058 individuals. The follow-up period was limited to 10 years and age at baseline to 30-61 years. QRS duration and QT interval (Bazett's) were measured from standard 12-lead electrocardiograms at baseline. JTc interval was defined as QTc interval - QRS duration. Cox proportional hazards models that controlled for confounding clinical factors identified at baseline were used to estimate the relative risk of SCD. RESULTS During a mean period of 9.7 years, 207 SCDs occurred (1.1 per 1000 person-years). QRS duration was associated with a significantly increased risk of SCD in each cohort (pooled hazard ratio [HR] 1.030 per 1-ms increase; 95% confidence interval [CI] 1.017-1.043). The QTc interval had borderline to significant associations with SCD and varied among cohorts (pooled HR 1.007; 95% CI 1.001-1.012). JTc interval as a continuous variable was not associated with SCD (pooled HR 1.001; 95% CI 0.996-1.007). CONCLUSION Prolonged QRS durations and QTc intervals are associated with an increased risk of SCD. However, when the QTc interval is deconstructed into QRS and JTc intervals, the repolarization component (JTc) appears to have no independent prognostic value.Peer reviewe

Risk of sudden cardiac death associated with QRS, QTc, and JTc intervals in the general population

BackgroundQRS duration and corrected QT (QTc) interval have been associated with sudden cardiac death (SCD), but no data are available on the significance of repolarization component (JTc interval) of the QTc interval as an independent risk marker in the general population.ObjectiveIn this study, we sought to quantify the risk of SCD associated with QRS, QTc, and JTc intervals.MethodsThis study was conducted using data from 3 population cohorts from different eras, comprising a total of 20,058 individuals. The follow-up period was limited to 10 years and age at baseline to 30–61 years. QRS duration and QT interval (Bazett’s) were measured from standard 12-lead electrocardiograms at baseline. JTc interval was defined as QTc interval – QRS duration. Cox proportional hazards models that controlled for confounding clinical factors identified at baseline were used to estimate the relative risk of SCD.ResultsDuring a mean period of 9.7 years, 207 SCDs occurred (1.1 per 1000 person-years). QRS duration was associated with a significantly increased risk of SCD in each cohort (pooled hazard ratio [HR] 1.030 per 1-ms increase; 95% confidence interval [CI] 1.017–1.043). The QTc interval had borderline to significant associations with SCD and varied among cohorts (pooled HR 1.007; 95% CI 1.001–1.012). JTc interval as a continuous variable was not associated with SCD (pooled HR 1.001; 95% CI 0.996–1.007).ConclusionProlonged QRS durations and QTc intervals are associated with an increased risk of SCD. However, when the QTc interval is deconstructed into QRS and JTc intervals, the repolarization component (JTc) appears to have no independent prognostic value.</p

Impact of age and sex on the long-term prognosis associated with early repolarization in the general population

Abstract Background: Early repolarization (ER) has been linked to the risk of sudden cardiac death (SCD) in the general population, although controversy remains regarding risks across various subgroups. Objective: The purpose of this study was to investigate whether age and sex influence the prognostic significance of ER. Methods: We evaluated the 12-lead electrocardiograms of 6631 Finnish general population subjects age ≥30 years (mean age 50.1 ± 13.9 years; 44.5% men) for the presence of ER (J-point elevation ≥0.1 mV in ≥2 inferior/lateral leads) and followed them for 24.4 ± 10.3 years. We analyzed the association between ER and the risk of SCD, cardiac death, and all-cause mortality in subgroups according to age (&lt;50 or ≥50 years) and sex. Results: ER was present in 367 of the 3305 subjects age &lt;50 years and in 426 of 3326 subjects ≥50 years. ER was not associated with any of the endpoints in the entire study population. After adjusting for clinical factors, ER was associated with SCD (hazard ratio [HR] 1.88; 95% confidence interval [CI] 1.16–3.07) in subjects &lt;50 but not in older subjects (interaction between ER and age group, P = .048). In the younger subgroup, women with ER had a high risk of SCD (HR 4.11; 95% CI 1.41–12.03), whereas among men ER was not associated with SCD. Finally, ER was not associated with cardiac mortality or all-cause mortality in either age group. Conclusion: ER is associated with SCD in subjects younger than 50 years, particularly in women, but not in subjects 50 years and older

Prevalence and prognostic significance of negative U-waves in a 12-lead electrocardiogram in the general population

Abstract Negative U-waves are a relatively rare finding in an electrocardiogram (ECG), but are often associated with cardiac disease. The prognostic significance of negative U-waves in the general population is unknown. We evaluated 12-lead ECGs of 6,518 adults (45% male, mean age 50.9 ± 13.8 years) for the presence of U-waves, and followed the subjects for 24.5 ± 10.3 years. Primary end points were all-cause mortality, cardiac mortality, and sudden cardiac death; secondary end point was hospitalization due to cardiac causes. Negative U-waves (amplitude ≥0.05 mV) were present in 231 subjects (3.5%), minor negative (amplitude &lt;0.05 mV) or discordant U-waves in 1,004 subjects (15.4%), normal positive U-waves in 3,950 (60.6%) subjects, and no U-waves were observed in 603 subjects (9.3%). In 730 subjects (11.2%), U-waves were unassessable. When adjusted for age and gender, negative U-waves were associated with all end points (p &lt;0.01). In an analysis adjusted for multiple demographic and clinical factors, in men, negative U-waves were associated with increased risk of all-cause mortality (hazard ratio [HR] 1.60; 95% confidence interval [CI] 1.26 to 2.03; p &lt;0.001), cardiac mortality (HR 1.74; 95% CI 1.26 to 2.39; p = 0.001), and cardiac hospitalization (HR 1.67; 95% CI 1.27 to 2.18; p &lt;0.001), but not with sudden cardiac death, whereas women did not show a significant association to any of the end points (p &gt;0.30). In conclusion, negative U-waves are associated with adverse events in the general population. In men, this association is independent of cardiovascular risk factors

Experiences in digitizing and digitally measuring a paper-based ECG archive

Abstract Background: No established method for digitizing and digital measuring of paper electrocardiograms (ECG) exists. We describe a paper ECG digitizing and digital measuring process, and report comparability to manual measurements. Methods: A paper ECG was recorded from 7203 health survey participants in 1978–1980. With specific software, the ECGs were digitized (ECG Trace Tool), and measured digitally (EASE). A sub-sample of 100 ECGs was selected for manual measurements. Results: The measurement methods showed good agreement. The mean global (EASE)-(manual) differences were 1.4 ms (95% CI 0.5–2.2) for PR interval, −1.0 ms (95% CI −1.5–[−0.5]) for QRS duration, and 11.6 ms (95% CI 10.5–12.7) for QT interval. The mean inter-method amplitude differences of RampV5, RampV6, SampV1, TampII and TampV5 ranged from −0.03 mV to 0.01 mV. Conclusions: The presented paper-to-digital conversion and digital measurement process is an accurate and reliable method, enabling efficient storing and analysis of paper ECGs

Risk factors associated with atrioventricular block

Abstract Importance: Pacemaker implantations as a treatment for atrioventricular (AV) block are increasing worldwide. Prevention strategies for AV block are lacking because modifiable risk factors have not yet been identified. Objective: To identify risk factors for AV block in community-dwelling individuals. Design, Setting, and Participants: In this population-based cohort study, data from the Mini-Finland Health Survey, conducted from January 1, 1978, to December 31, 1980, were used to examine demographics, comorbidities, habits, and laboratory and electrocardiographic (ECG) measurements as potential risk factors for incident AV block. Data were ascertained during follow-up from January 1, 1987, through December 31, 2011, using a nationwide registry. A total of 6146 community-dwelling individuals were included in the analysis performed from January 15 through April 3, 2018. Main Outcomes and Measures: Incidence of AV block (hospitalization for second- or third-degree AV block). Results: Among the 6146 participants (3449 [56.1%] women; mean [SD] age, 49.2 [12.9] years), 529 (8.6%) had ECG evidence of conduction disease and 58 (0.9%) experienced a hospitalization with AV block. Older age (hazard ratio [HR] per 5-year increment, 1.34; 95% CI, 1.16–1.54; P &lt; 0.001), male sex (HR, 2.04; 95% CI, 1.19–3.45; P = 0.01), a history of myocardial infarction (HR, 3.54; 95% CI, 1.33–9.42; P = 0.01), and a history of congestive heart failure (HR, 3.33; 95% CI, 1.10–10.09; P = 0.03) were each independently associated with AV block. Two modifiable risk factors were also independently associated with AV block. Every 10–mm Hg increase in systolic blood pressure was associated with a 22% higher risk (HR, 1.22; 95% CI, 1.10–1.34; P = 0.005), and every 20-mg/dL increase in fasting glucose level was associated with a 22% higher risk (HR, 1.22; 95% CI, 1.08–1.35; P = 0.001). Both risk factors remained statistically significant (HR for systolic blood pressure, 1.26 [95% CI, 1.06–1.49; P = 0.007]; HR for glucose level, 1.22 [95% CI, 1.04–1.43; P = 0.01]) after adjustment for major adverse coronary events during the follow-up period. In population-attributable risk assessment, an estimated 47% (95% CI, 8%–67%) of AV blocks may have been avoided if all participants exhibited ideal blood pressure and 11% (95% CI, 2%–21%) may have been avoided if all had a normal fasting glucose level. Conclusions and Relevance: In this analysis of data from a population-based cohort study, suboptimal blood pressure and fasting glucose level were associated with AV block. These results suggest that a large proportion of AV blocks are assocated with these risk factors, even after adjusting for other major adverse coronary events

Prognostic significance of flat T-waves in the lateral leads in general population

Abstract Background: Negative T-waves are associated with sudden cardiac death (SCD) risk in the general population. Whether flat T-waves also predict SCD is not known. The aim of the study was to examine the clinical characteristics and risk of SCD in general population subjects with flat T-waves. Methods: We examined the electrocardiograms of 6750 Finnish general population adults aged ≥30 years and classified the subjects into 3 groups: 1) negative T-waves with an amplitude ≥0.1 mV in ≥2 of the leads I, II, aVL, V4–V6, 2) negative or positive low amplitude T-waves with an amplitude &lt;0.1 mV and the ratio of T-wave and R-wave &lt;10% in ≥2 of the leads I, II, aVL, V4–V6, and 3) normal positive T-waves (not meeting the aforesaid criteria). The association between T-wave classification and SCD was assessed during a 10-year follow-up. Results: A total of 215 (3.2%) subjects had negative T-waves, 856 (12.7%) flat T-waves, and 5679 (84.1%) normal T-waves. Flat T-wave subjects were older and had more often cardiovascular morbidities compared to normal T-wave subjects, while negative T-wave subjects were the oldest and had most often cardiovascular morbidities. After adjusting for multiple factors, both flat T-waves (hazard ratio [HR] 1.81; 95% confidence interval [CI] 1.13–2.91) and negative T-waves (HR 3.27; 95% CI 1.85–5.78) associated with SCD. Conclusions: Cardiovascular risk factors and disease are common among subjects with flat T-waves, but these minor T-wave abnormalities are also independently associated with increased SCD risk

Electrocardiographic risk markers of cardiac death:gender differences in the general population

Abstract Background: Cardiac death is one of the leading causes of death and sudden cardiac death (SCD) is estimated to cause approximately 50% of cardiac deaths. Men have a higher cardiac mortality than women. Consequently, the mechanisms and risk markers of cardiac mortality are not as well defined in women as they are in men. Aim: The aim of the study was to assess the prognostic value and possible gender differences of SCD risk markers of standard 12-lead electrocardiogram in three large general population samples. Methods: The standard 12-lead electrocardiographic (ECG) markers were analyzed from three different Finnish general population samples including total of 20,310 subjects (49.9% women, mean age 44.8 ± 8.7 years). The primary endpoint was cardiac death, and SCD and all-cause mortality were secondary endpoints. The interaction effect between women and men was assessed for each ECG variable. Results: During the follow-up (7.7 ± 1.2 years), a total of 883 deaths occurred (24.5% women, p &lt; 0.001). There were 296 cardiac deaths (13.9% women, p &lt; 0.001) and 149 SCDs (14.8% women, p &lt; 0.001). Among those who had died due to cardiac cause, women had more often a normal electrocardiogram compared to men (39.0 vs. 27.5%, p = 0.132). After adjustments with common cardiovascular risk factors and the population sample, the following ECG variables predicted the primary endpoint in men: left ventricular hypertrophy (LVH) with strain pattern (p &lt; 0.001), QRS duration &gt; 110 ms (p &lt; 0.001), inferior or lateral T-wave inversion (p &lt; 0.001) and inferolateral early repolarization (p = 0.033). In women none of the variables remained significant predictors of cardiac death in multivariable analysis, but LVH, QTc ≥ 490 ms and T-wave inversions predicted SCD (p &lt; 0.047 and 0.033, respectively). In the interaction analysis, LVH (HR: 2.4; 95% CI: 1.2–4.9; p = 0.014) was stronger predictor of primary endpoint in women than in men. Conclusion: Several standard ECG variables provide independent information on the risk of cardiac mortality in men but not in women. LVH and T-wave inversions predict SCD also in women

Poor R-wave progression as a predictor of sudden cardiac death in the general population and subjects with coronary artery disease

Abstract Background: Poor R-wave progression (PRWP) is a common clinical finding on the standard 12-lead electrocardiogram (ECG), but its prognostic significance is unclear. Objective: The purpose of this study was to examine the prognosis associated with PRWP in terms of sudden cardiac death (SCD), cardiac death, and all-cause mortality in general population subjects with and without coronary artery disease (CAD). Methods: Data and 12-lead ECGs were collected from a Finnish general population health examination survey conducted during 1978–1980 with follow-up until 2011. The study population consisted of 6854 subjects. Main end points were SCD, cardiac death, and all-cause mortality. PRWP was defined as R-wave amplitude ≤ 0.3 mV in lead V₃ and R-wave amplitude in lead V₂ ≤ R-wave amplitude in lead V₃. Results: PRWP occurred in 213 subjects (3.1%). During the follow-up period of 24.3 ± 10.4 years, 3723 subjects (54.3%) died. PRWP was associated with older age, higher prevalence of heart failure and CAD, and β-blocker medication. In multivariate analyses, PRWP was associated with SCD (hazard ratio [HR] 2.13; 95% confidence interval [CI] 1.34–3.39), cardiac death (HR 1.75; 95% CI 1.35–2.15), and all-cause mortality (HR 1.29; 95% CI 1.08–1.54). In the subgroup with CAD, PRWP had a stronger association with cardiac mortality (HR 1.71; 95% CI 1.19–2.46) than in the subgroup without CAD, while the association with SCD was significant only in the subgroup with CAD (HR 2.62; 95% CI 1.38–4.98). Conclusions: PRWP was associated with adverse prognosis in the general population and with SCD in subjects with CAD