Publications by authors named "Reijo Sund"

142 Publications

Mortality among patients with low-grade follicular lymphoma: A binational retrospective analysis.

Cancer 2022 Apr 13. Epub 2022 Apr 13.

University of Eastern Finland, Kuopio, Finland.

Background: The life expectancy of patients with follicular lymphoma (FL) has improved considerably since the introduction of rituximab. This study examined the proportion of deaths from progressive lymphoma and the impact of FL on survival compared with that in the general population.

Methods: Altogether, 749 patients with grades 1 and 2 FL in 9 institutions between 1997 and 2016 were enrolled. Competing risk models were used to estimate the cumulative incidences of deaths from progressive lymphoma and from other reasons. Excess mortality was analyzed with respect to the corresponding background populations standardized for age and sex using the excess mortality model based on the penalized spline approach.

Results: The median follow-up duration was 69 months (range, 0-226 months). The estimated 10-year overall, disease-specific, and net survival rates were 72.4%, 86.6%, and 86.4%, respectively. The cumulative incidence of deaths from progressive lymphoma was slightly smaller than that of other causes in the study population (estimated 10-year cumulative incidences: 12.3% [95% CI, 9.6%-15.3%] and 15.4% [95% CI, 12.2%-18.8%], respectively). Excess mortality was observed for up to 10 years after diagnosis, and it slightly increased with time.

Conclusions: Deaths from progressive lymphoma are nearly as common as deaths from other causes in FL patients during the rituximab era. Despite the improvements in survival, there was evidence of excess mortality resulting from FL for at least 10 years after diagnosis.
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http://dx.doi.org/10.1002/cncr.34221DOI Listing
April 2022

Hospital treatment costs associated with incident complications in patients with type 2 diabetes-real-world study based on electronic patient information systems.

BMC Health Serv Res 2022 Apr 9;22(1):469. Epub 2022 Apr 9.

School of Pharmacy, University of Eastern Finland, Kuopio, Finland.

Background: Type 2 diabetes (T2D) and its complications cause a significant public health and economic challenge. To enable the optimal resource allocation across different prevention and treatment policies for the management of T2D-related complications, detailed cost estimates related to the complications of T2D are needed. Therefore, the objective of the study was to provide reliable and sufficiently detailed real-world estimates of costs associated with different T2D complications in a Finnish university hospital setting.

Methods: A cohort of T2D patients living in the catchment area of a university hospital during 2012 and 2016 was identified from the comprehensive national FinDM diabetes database for longitudinal assessment of T2D associated complication treatment costs. Data on patient-level events were extracted from the FinDM data and complemented with all accountable services and related detailed costing data gathered from the university hospital's electronic patient information systems by using unique personal identity codes. Patients were screened for their first diagnoses of complications using the same national quality registry definitions as in the FinDM database. Multivariable gamma regression model with a log link function was applied to study the association between baseline factors and complication costs. In addition, an interactive online tool was developed to create predicted costs for complication costs with selected baseline factors.

Results: A total of 27 255 prevalent and incident patients with T2D were identified from the national FinDM register. Finally, a total of 16 148 complication episodes for 7 895 patients were included in the cost analyses. The mean estimated one-year hospital treatment costs of T2D-related complication varied from 6 184 to 24 507 euros per complication. Regression analyses showed that coexisting conditions are significantly associated with initial and recurrent complication costs.

Conclusions: The study shows updated Finnish cost estimates and their main cost drivers for T2D-related complications treated in the university hospital setting. The results of our study highlight the significance of guideline implementation, effective preventive treatments for T2D, as well as the importance of treatment adherence to avoid these costly complications.
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http://dx.doi.org/10.1186/s12913-022-07895-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8994912PMC
April 2022

Using multiple imputation and intervention-based scenarios to project the mobility of older adults.

BMC Geriatr 2022 Apr 9;22(1):311. Epub 2022 Apr 9.

Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271, Helsinki, Finland.

Background: Projections of the development of mobility limitations of older adults are needed for evidence-based policy making. The aim of this study was to generate projections of mobility limitations among older people in the United States, England, and Finland.

Methods: We applied multiple imputation modelling with bootstrapping to generate projections of stair climbing and walking limitations until 2026. A physical activity intervention producing a beneficial effect on self-reported activities of daily living measures was identified in a comprehensive literature search and incorporated in the scenarios used in the projections. We utilised the harmonised longitudinal survey data from the Ageing Trajectories of Health - Longitudinal Opportunities and Synergies (ATHLOS) project (N = 24,982).

Results: Based on the scenarios from 2012 to 2026, the prevalence of walking limitations will decrease from 9.4 to 6.4%. A physical activity intervention would decrease the prevalence of stair climbing limitations compared with no intervention from 28.9 to 18.9% between 2012 and 2026.

Conclusions: A physical activity intervention implemented on older population seems to have a positive effect on maintaining mobility in the future. Our method provides an interesting option for generating projections by incorporating intervention-based scenarios.
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http://dx.doi.org/10.1186/s12877-022-03008-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8994920PMC
April 2022

The effect of COVID-19 lockdown on the incidence of emergency department visits due to injuries and the most typical fractures in 4 Finnish hospitals.

Acta Orthop 2022 03 7;93:360-366. Epub 2022 Mar 7.

University of Eastern Finland, School of Medicine, Kuopio; Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio; Kuopio University Hospital, Kuopio.

Background And Purpose: COVID-19 lockdowns have affected personal mobility and behavior worldwide. This study compared the number of emergency department (ED) visits due to injuries and typical low-energy fractures in Finland during the COVID-19 lockdown period in spring 2020 to the reference period in 2019.

Patients And Methods: The data was collected retrospectively from the electronic patient records of 4 hospitals covering 1/5 of the Finnish population. We included the patients who were admitted to a hospital ED due to any injury during the lockdown period (March 18-May 31, 2020) and the reference period (March 18-May 31, 2019). We compared the differences between the average daily ED admissions in the 2 years using the zero-inflated Poisson regression model.

Results: The overall number of ED visits due to injuries decreased by 16% (mean 134/day vs. 113/day, 95% CI -18 to -13). The number of ED visits due to wrist fractures decreased among women aged over 50 years by 40% (CI -59 to -9). Among women, the number of ED visits due to ankle fractures decreased by 32% (CI -52 to -5). The number of ED visits due to fractures of the upper end of the humerus decreased by 52% (CI -71 to -22) among women. The number of ED visits due to hip fractures increased by 2% (CI -16 to 24).

Interpretation: Restrictions in personal mobility decreased the number of ED visits due to injuries during the pandemic. The effect can mainly be seen as a decreased number of the most typical low-energy fractures among women. In contrast, lockdown restrictions had no effect on the number of hip fractures.
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http://dx.doi.org/10.2340/17453674.2022.2252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8902588PMC
March 2022

Evaluation of the impact of changes in the autopsy rate on mortality trend of pulmonary embolism, Finland, 1996-2017.

Blood Coagul Fibrinolysis 2022 Feb 11. Epub 2022 Feb 11.

Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki Institute of Clinical Medicine, University of Eastern Finland, Kuopio Department of Development, Turku University Hospital, Turku, Finland.

Pulmonary embolism is listed as a cause of death in fewer and fewer cases in the twenty-first century. Autopsies reveal undiagnosed pulmonary embolism at a significant rate, but fewer and fewer autopsies are being performed. It could be that deaths from pulmonary embolism are not decreasing, but are increasingly missed because of decreasing autopsy rate. Population-based registry data of all individuals with pulmonary embolism related death from the Finnish death certificate archive from 1996 to 2017 were collected. The pulmonary embolism mortality trend was analysed with linear regression and the association of pulmonary embolism mortality with the number of autopsies was also assessed. Deaths with pulmonary embolism as immediate, underlying and contributory cause of death were not only included, but also analysed separately. In addition, the estimated pulmonary embolism mortality when presumptively missed pulmonary embolisms are taken into account is presented. During 1996-2017, the pulmonary embolism related mortality rate decreased 28% from 25 : 100 000 to 18 : 100 000, if all pulmonary embolism deaths were analysed, and 51% from 21 : 100 000 to 11 : 100 000 if contributory pulmonary embolism deaths were excluded. From 1996 to 2009, autopsy rate in the population remained unchanged, but declined thereafter. In 1996, autopsy rate was 31.1% (15 319/49 167) and in 2017 20.1% (10 830/53 923). Our results suggest that there has been real improvement in the prevention of death from pulmonary embolism in Finland in the twenty-first century. However, due to the decreasing autopsy rate, the pulmonary embolism mortality trend after 2010 should be interpreted more carefully.
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http://dx.doi.org/10.1097/MBC.0000000000001127DOI Listing
February 2022

Ankle fractures in Finland: 118,929 operatively treated between 1987 and 2019.

Acta Orthop 2022 02 11;93:327-333. Epub 2022 Feb 11.

Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio; University Hospital, Kuopio, Finland.

Background And Purpose: Ankle fractures are one of the most common fractures requiring operative treatment. They occur most commonly in postmenopausal women and younger men and recent studies suggest that the incidence of ankle fractures is increasing. In this registry study, we analyze inpatient data of operatively treated ankle fractures during a period of 33 years from our comprehensive nationwide register data.

Patients And Methods: The data on operatively treated ankle fracture patients between January 1, 1987 and December 31, 2019 was collected from the Finnish National Hospital Discharge Register and analyzed.

Results: 118,929 ankle fractures were treated operatively. These included lateral malleolar fractures (33%), bior trimalleolar fractures (51%), medial malleolar fractures (7%), and other fractures (9%). Mean age was 53 (SD 17) years for women and 43 (16) for men. The average annual incidence rate was 69 per 100,000 person-years. Over the past 3 decades incidence has leveled off for women and has started to decline for men. However, the incidence is increasing in the elderly women group (over 70 years of age). In the over 50 age group, comorbidities have increased over the years, being more common in men than in women. The incidence of ankle fractures was higher during the winter months (November-March).

Interpretation: The number of operatively treated ankle fractures has leveled off during the last 33 years. However, nowadays we operate on more difficult fractures in elderly patients with comorbidities.
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http://dx.doi.org/10.2340/17453674.2022.2071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8833737PMC
February 2022

Association between severe lumbar disc degeneration and self-reported occupational physical loading.

J Occup Health 2022 Jan;64(1):e12316

Kuopio musculoskeletal research unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland.

Objectives: Occupational physical loading has been reported to be associated with intervertebral disc degeneration. However, previous literature reports inconsistent results for different vertebral levels. The aim of our study was to investigate the association between lumbar disc degeneration (LDD) at different vertebral levels and the self-reported physical loading of occupation.

Methods: The study population consisted of 1,022 postmenopausal women and was based on the prospective Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort. The severity of LDD was graded from T2-weighted MRI images using the five-grade Pfirrmann classification. Five intervertebral levels (L1-L2 to L5-S1) were studied (total 5110 discs). The self-rated occupational physical loading contained four groups: sedentary, light, moderate, and heavy.

Results: The heavy occupational physical loading group had higher odds for severe LDD at the L5-S1 vertebral level (OR 1.86, 95% CI: 1.19-2.92, p = .006) in comparison with the sedentary work group. A clear trend of increasing disc degeneration with heavier occupational loading was also observed at the L5-S1 level. Age, smoking, and higher body mass index (BMI) were associated with more severe LDD. Leisure-time physical activity at the age of 11-17 years was associated with less severe LDD. Controlling for confounding factors did not alter the results.

Conclusions: There appears to be an association between occupational physical loading and severe disc degeneration at the lower lumbar spine in postmenopausal women. Individuals in occupations with heavy physical loading may have an increased risk for work-related disability due to more severe disc degeneration.
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http://dx.doi.org/10.1002/1348-9585.12316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8793002PMC
January 2022

Blood pressure changes during the first 24 hours of life and the association with the persistence of a patent ductus arteriosus and occurrence of intraventricular haemorrhage.

PLoS One 2021 30;16(11):e0260377. Epub 2021 Nov 30.

New Children's Hospital, Pediatric Research Center, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.

Very low birthweight (VLBW) infants are at risk of intraventricular haemorrhage (IVH) and delayed closure of ductus arteriosus. We investigated mean arterially recorded blood pressure (MAP) changes during the first day of life in VLBW infants as potential risk factors for a patent ductus arteriosus (PDA) and IVH. This retrospective cohort study exploring MAP changes during adaption and risk factors for a PDA and IVH comprised 844 VLBW infants admitted to the Helsinki University Children's Hospital during 2005-2013. For each infant, we investigated 600 time-points of MAP recorded 4-24 hours after birth. Based on blood pressure patterns revealed by a data-driven method, we divided the infants into two groups. Group 1 (n = 327, mean birthweight = 1019 g, mean gestational age = 28 + 1/7 weeks) consisted of infants whose mean MAP was lower at 18-24 hours than at 4-10 hours after birth. Group 2 (n = 517, mean birthweight = 1070 g, mean gestational age = 28 + 5/7 weeks) included infants with a higher mean MAP at 18-24 hours than at 4-10 hours after birth. We used the group assignments, MAP, gestational age at birth, relative size for gestational age, surfactant administration, inotrope usage, invasive ventilation, presence of respiratory distress syndrome or sepsis, fluid intake, and administration of antenatal steroids to predict the occurrence of IVH and use of pharmacological or surgical therapy for a PDA before 42 weeks of gestational age. Infants whose mean MAP is lower at 18-24 hours than at 4-10 hours after birth are more likely to undergo surgical ligation of a PDA (odds ratio = 2.1; CI 1.14-3.89; p = 0.018) and to suffer from IVH (odds ratio = 1.83; CI 1.23-2.72; p = 0.003).
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260377PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8631614PMC
January 2022

Length of Nutritional Transition Associates Negatively with Postnatal Growth in Very Low Birthweight Infants.

Nutrients 2021 Nov 6;13(11). Epub 2021 Nov 6.

Pediatric Research Center, New Children's Hospital, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland.

Very low birthweight (VLBW, <1500 g) infants may be predisposed to undernutrition during the nutritional transition phase from parenteral to enteral nutrition. We studied the associations among the length of the transition phase, postnatal macronutrient intake, and growth from birth to term equivalent age in VLBW infants. This retrospective cohort study included 248 VLBW infants born before 32 weeks of gestation and admitted to the Children's Hospital, Helsinki, Finland during 2005-2013. Daily nutrient intakes were obtained from computerized medication administration records. The length of the transition phase correlated negatively with cumulative energy, protein, fat, and carbohydrate intake at 28 days of age. It also associated negatively with weight and head circumference growth from birth to term equivalent age. For infants with a long transition phase (over 12 d), the estimates (95% CI) for weight and head circumference z-score change from birth to term equivalent age were -0.3 (-0.56, -0.04) and -0.44 (-0.81, -0.07), respectively, in comparison to those with a short transition phase (ad 7 d). For VLBW infants, rapid transition to full enteral feeding might be beneficial. However, if enteral nutrition cannot be advanced, well-planned parenteral nutrition during the transition phase is necessary to promote adequate growth.
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http://dx.doi.org/10.3390/nu13113961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8622897PMC
November 2021

Physical capacity, subjective health, and life satisfaction in older women: a 10-year follow-up study.

BMC Geriatr 2021 11 23;21(1):658. Epub 2021 Nov 23.

Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Mediteknia Building, P.O. Box 1627, 70211, Kuopio, Finland.

Background: Physical capacity and subjective wellbeing are important for healthy aging. Our aim was to study how objective/subjective physical capacity and subjective health relate to life satisfaction, in a 10-year follow-up of aging women.

Methods: The participants (n = 1485, mean age 67.4 years) consisted of community-dwelling older women living in Kuopio, Finland. Grip strength and one-legged stance test time were used as objective, and self-rated mobility (SRM) as subjective physical capacity measures. Self-rated health (SRH) and SRM were assessed with one-item scales and life satisfaction with a 4-item scale. Correlation and linear regression were used to analyze these relationships and correlation network analysis to visualize them. Age and BMI were included in the analysis as adjusting factors.

Results: All the study variables were significantly correlated with baseline and follow-up life satisfaction, except BMI, which was only associated with life satisfaction at follow-up. On both occasions, SRH and SRM were the two strongest correlates of life satisfaction, but their mutual correlation was still higher. In linear regression analyses, SRH was positively associated with both baseline and follow-up life satisfaction, but physical capacity measures became non-significant after including SRH and SRM in the model. In the partial correlation network analyses, SRH and SRM were the most central nodes, connecting every other variable.

Conclusions: Self-reports on health, mobility, and life satisfaction are closely intertwined and provide easily accessible health information among aging women, but the impacts of objective physical capacity measures warrant further longitudinal studies in respect to subjective wellbeing among aging people.
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http://dx.doi.org/10.1186/s12877-021-02605-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8609741PMC
November 2021

Maternal Smoking During Pregnancy and Offspring Head Growth in Comparison to Height and Weight Growth Up to 6 Years of Age: A Longitudinal Study.

Clin Epidemiol 2021 12;13:959-970. Epub 2021 Oct 12.

School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.

Background: Maternal smoking during pregnancy causes fetal growth retardation. Thereafter, it has been associated with excessive childhood weight gain and decreased linear growth in the offspring. However, it is not known whether head circumference (HC), the surrogate of brain size in childhood, is altered after intrauterine tobacco exposure. We assessed the association of maternal smoking during pregnancy with offspring HC growth up to age 6 years in comparison with length/height growth and weight gain.

Methods: We combined data from Medical Birth Register and longitudinal growth data from primary care of 43,632 children (born 2004-2017). Linear mixed effects models were used for modeling, adjusting for potential perinatal and socioeconomic confounders.

Results: At birth, maternal smoking during pregnancy was associated with a mean deficit of 0.19 standard deviation score (SDS) (95% CI: -0.25, -0.12) in HC, -0.38 SDS (95% CI: -0.43, -0.32) in length, and -0.08 SDS (95% CI:-0.14, -0.02) in weight-for-length. HC in smokers' children failed to catch up to that of non-smokers' children. Height of smokers' infants reached that of non-smokers' infants by 12 months but declined thereafter. Weight-for-height of smokers' infants exceeded the level of non-smokers' infants at 3 months and remained significantly elevated thereafter. HC in the offspring of mothers who quit smoking in the first trimester was not deficient, but their weight-for-height was elevated.

Conclusion: HC of smokers' children is still deficient at age 6 years. Since most of the head growth occurs during the first 2 years of life, the defect may be permanent. In smokers' children, weight gain was excessive up to 6 years and height was deficient at 6 years consistent with previous literature. Efforts should be made to encourage pregnant women to quit smoking in the beginning of the pregnancy.
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http://dx.doi.org/10.2147/CLEP.S327766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8520481PMC
October 2021

Characteristics of Long-Term Femoral Neck Bone Loss in Postmenopausal Women: A 25-Year Follow-Up.

J Bone Miner Res 2022 02 19;37(2):173-178. Epub 2021 Oct 19.

Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland.

The aim of this study was to monitor long-term changes in bone mineral density (BMD) after menopause and factors affecting BMD. The study population consisted of a random sample of 3222 women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study, of which 62.1% were postmenopausal at the beginning of the study. This group of women underwent dual-energy X-ray absorptiometry (DXA) measurements at the femoral neck every 5 years from baseline (in 1989) up to 25-year follow-up. They also responded to risk-factor questionnaires at 5-year intervals. During the 25-year follow-up, the baseline cohort decreased to 686 women. The women were divided into quartiles based on their baseline BMD. Self-reported hormone replacement therapy (HRT) and corticosteroid use were divided into ever users and never users. Morbidity was assessed as the total number of self-reported diseases and BMD-affecting diseases. The mean 25-year BMD change was found to be -10.1%, p < 0.001. Higher baseline BMD was associated with higher bone loss rate; the reduction in the highest quartile BMD was 11.1% and in the lowest quartile 7.4% (p = 0.0031). Lower baseline body mass index (BMI) and a greater increase in BMI were found to protect against postmenopausal bone loss (p < 0.001). The lowest bone loss quartile included 15.2% more HRT users than the highest bone loss quartile (p = 0.004). The number of diseases/bone-affecting diseases, use of vitamin D/calcium supplementation, use of corticosteroids, smoking or alcohol use had no statistical significance for annual bone loss rate. This study presents hitherto the longest (25-year) BMD follow-up in postmenopausal women. The linear femoral neck bone loss of 10% was less than previously assumed. A 5-year BMD change appeared to predict long-term bone loss in postmenopausal women. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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http://dx.doi.org/10.1002/jbmr.4444DOI Listing
February 2022

Quality of care and patient safety at healthcare institutions in Oman: quantitative study of the perspectives of patients and healthcare professionals.

BMC Health Serv Res 2021 Oct 16;21(1):1109. Epub 2021 Oct 16.

Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.

Background: Oman's healthcare system has rapidly transformed in recent years. A recent Report of Quality and Patient Safety has nevertheless highlighted decreasing levels of patient safety and quality culture among healthcare professionals. This indicates the need to assess the quality of care and patient safety from the perspectives of both patients and healthcare professionals.

Objectives: This study aimed to examine (1) patients' and healthcare professionals' perspectives on overall quality of care and patient safety standards at two tertiary hospitals in Oman and (2) which demographic characteristics are related to the overall quality of care and patient safety.

Methods: A cross-sectional study design was employed. Data were collected by two items: overall quality of care and patient safety, incorporated in the Revised Humane Caring Scale, and Healthcare Professional Core Competency Instrument. Questionnaires were distributed to (1) patients (n = 600) and (2) healthcare professionals (nurses and physicians) (n = 246) in three departments (medical, surgical and obstetrics and gynaecology) at two tertiary hospitals in Oman towards the end of 2018 and the beginning of 2019. Descriptive statistics and binary logistic regression were used for data analysis.

Results: A total of 367 patients and 140 healthcare professionals completed the questionnaires, representing response rates of 61.2% and 56.9%, respectively. Overall, quality of care and patient safety were perceived as high, with the healthcare professionals rating quality of care (M = 4.36; SD = 0.720) and patient safety (M = 4.39; SD = 0.675) slightly higher than the patients did (M = 4.23; SD = 0.706), (M = 4.22; SD = 0.709). The findings indicated an association between hospital variables and overall quality of care (OR = 0.095; 95% CI = 0.016-0.551; p = 0.009) and patient safety (OR = 0.153; 95% CI = 0.027-0.854; p = 0.032) among healthcare professionals. Additionally, an association between the admission/work area and participants' perspectives on the quality of care (patients, OR = 0.257; 95% CI = 0.072-0.916; p = 0.036; professionals, OR = 0.093; 95% CI = 0.009-0.959; p = 0.046) was found.

Conclusions: The perspectives of both patients and healthcare professionals showed that they viewed both quality of care and patient safety as excellent, with slight differences, indicating a high level of patient satisfaction and competent healthcare delivery professionals. Such perspectives can provide meaningful and complementary insights on improving the overall standards of healthcare delivery systems.
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http://dx.doi.org/10.1186/s12913-021-07152-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8520619PMC
October 2021

Urban RCT participants were healthier than non-participants or rural women.

J Clin Epidemiol 2021 12 3;140:44-55. Epub 2021 Sep 3.

Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland.

Objective: To investigate sociodemographic characteristics and physical and mental health indicators between participants and nonparticipants of a large-scale 2-year exercise RCT including noninvited women living in nearby rural area in Finland.

Study Design And Setting: From a previous OSTPRE study cohort, 914 women (aged 72-84) participated in Kuopio Fall Prevention Study in 2016-2019. The participants were compared to non-participants (n = 4,536) and noninvited OSTPRE women (n = 7,119) living outside the urban recruitment area.

Results: Participants were younger (P< 0.001) with higher education (P< 0.001) and had more often regular hobbies (P< 0.001) and physical exercising (P< 0.001) than nonparticipants or noninvited. They reported better functional capability (P< 0.001), mental (P< 0.001) and subjective health (P< 0.001), lower number of medications (P< 0.001), less fear of falls (P< 0.001), but more frequent falls (P= 0.002) and more often musculoskeletal diseases (P= 0.006).  Participants also showed better functional capacity in the clinical measurements. In register analysis, urban-rural differences in the prevalence of diseases were detected.

Conclusion: In population-based exercise interventions, participants are more likely to be better off in respect to physical and mental wellbeing, functional capability and sociodemographic status. Recruiting participants only from cities increases unavoidable selection bias due to urban-rural differences which should be noticed when interpreting and generalizing RCT results.

Trial Registration Number: ClinicalTrials.gov identifier NCT02665169.
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http://dx.doi.org/10.1016/j.jclinepi.2021.08.032DOI Listing
December 2021

The association between treated psychiatric and neurodevelopmental disorders and out-of-home care among Finnish children born in 1997.

Eur Child Adolesc Psychiatry 2021 Jun 8. Epub 2021 Jun 8.

Research Centre for Child Psychiatry and INVEST Research Flagship, University of Turku, Turku, Finland.

Comprehensive overviews of the use of psychiatric services among children and adolescents placed in out-of-home care (OHC) by child welfare authorities are scarce. We examine specialized service use for psychiatric and neurodevelopmental disorders among children and adolescents in a total population involving children in OHC. We used the longitudinal administrative data of a complete Finnish birth cohort 1997 (N = 57,174). We estimated risk ratios (RRs) for a range of diagnosed psychiatric and neurodevelopmental disorders among children in OHC. We also estimated RRs for OHC among those with diagnosed disorders. We used descriptive methods to explore the timing of first entry into OHC relative to the first diagnosis. Among children in OHC, 61.9% were diagnosed with any psychiatric or neurodevelopmental disorder, compared with 18.0% among those never in OHC (RR: 3.7; 95% CI 3.6-3.8). The most common diagnosed disorders among children in OHC were depression and anxiety disorders, neurodevelopmental disorders, and oppositional defiant disorder/conduct disorder (ODD/CD). Among all children with any diagnosis, 18.1% experienced OHC, compared with 2.5% among those without a diagnosis (RR: 7.4; 95% CI 6.9-7.9). Of those diagnosed with self-harm and suicidality, ODD/CD, substance-related disorders, and psychotic and bipolar disorders, 43.5-61.2% experienced OHC. Of the children in OHC receiving psychiatric services, half were diagnosed before first placement in OHC. The majority of children with experience in OHC were diagnosed with psychiatric or neurodevelopmental disorders. They comprised a significant proportion of individuals treated for severe and complex psychiatric disorders and self-harm.
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http://dx.doi.org/10.1007/s00787-021-01819-1DOI Listing
June 2021

Association of antidiabetic medication and statins with survival from ductal and lobular breast carcinoma in women with type 2 diabetes.

Sci Rep 2021 05 17;11(1):10445. Epub 2021 May 17.

Department of Oncology and Radiotherapy, Cancer Center Tampere, Tampere University Hospital, Tampere, Finland.

We investigated the survival of female patients with pre-existing type 2 diabetes (T2D) diagnosed with invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) of breast, in relation to the use of metformin, other antidiabetic medication (ADM) and statins. The study cohort consisted of 3,165 women (2,604 with IDC and 561 with ILC). The cumulative mortality from breast cancer (BC) and from other causes was calculated using the Aalen-Johansen estimator. The cause-specific mortality rates were analysed by Cox models, and adjusted hazard ratios (HRs) were estimated for the use of different medications. No evidence of an association of metformin use with BC mortality was observed in either IDC (HR 0.92, 95% confidence interval [CI] 0.64-1.31) or ILC (HR 0.68, 95% CI 0.32-1.46) patients, when compared to other oral ADMs. The mortality from other causes was found to be lower amongst the IDC patients using metformin (HR 0.64, 95% CI 0.45-0.89), but amongst ILC patients the evidence was inconclusive (HR 1.22, 95% CI 0.64-2.32). Statin use was consistently associated with reduced mortality from BC in IDC patients (HR 0.77, 95% CI 0.62-0.96) and ILC patients (HR 0.59, 95% CI 0.37-0.96), and also mortality from other causes in IDC patients (HR 0.81, 95% CI 0.67-0.96) and in ILC patients (HR 0.66, 95% CI 0.43-1.01). We found no sufficient evidence for the possible effects of metformin and statins on the prognosis of BC being different in the two histological subtypes.
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http://dx.doi.org/10.1038/s41598-021-88488-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129135PMC
May 2021

Detecting pathological features and predicting fracture risk from dual-energy X-ray absorptiometry images using deep learning.

Bone Rep 2021 Jun 24;14:101070. Epub 2021 Apr 24.

Department of Applied Physics, University of Eastern Finland, POB1627, 70211 Kuopio, Finland.

Dual-energy X-ray absorptiometry (DXA) is the gold standard imaging method for diagnosing osteoporosis in clinical practice. The DXA images are commonly used to estimate a numerical value for bone mineral density (BMD), which decreases in osteoporosis. Low BMD is a known risk factor for osteoporotic fractures. In this study, we used deep learning to identify lumbar scoliosis and structural abnormalities that potentially affect BMD but are often neglected in lumbar spine DXA analysis. In addition, we tested the approach's ability to predict fractures using only DXA images. A dataset of 2949 images gathered by Kuopio Osteoporosis Risk Factor and Prevention Study was used to train a convolutional neural network (CNN) for classification. The model was able to classify scoliosis with an AUC of 0.96 and structural abnormalities causing unreliable BMD measurement with an AUC of 0.91. It predicted fractures occurring within 5 years from the lumbar spine DXA scan with an AUC of 0.63, meeting the predictive performance of combined BMD measurements from the lumbar spine and hip. In an independent test set of 574 clinical patients, AUC for lumbar scoliosis was 0.93 and AUC for unreliable BMD measurements was 0.94. In each classification task, neural network visualizations indicated the model's predictive strategy. We conclude that deep learning could complement the well established DXA method for osteoporosis diagnostics by analyzing incidental findings and image reliability, and improve its predictive ability in the future.
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http://dx.doi.org/10.1016/j.bonr.2021.101070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102403PMC
June 2021

Physical capability after total joint arthroplasty: long-term population-based follow-up study of 6,462 women.

Acta Orthop 2021 Oct 12;92(5):551-556. Epub 2021 May 12.

Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland.

Background and purpose - There is lack of knowledge concerning patient-reported long-time outcome after arthroplasty. Therefore, we investigated patient self-reported physical capabilities (PC) and subjective well-being (SW) up to 20 years after total hip (THA) or knee (TKA) arthroplasty.Subjects and methods - The self-reports from postal questionnaires for study checkpoints (baseline, 10-year follow-up, 20-year follow-up) were provided by the Kuopio OSTPRE study including only women aged 52-62 years (n = 6,462). The Finnish Arthroplasty Register and Care Register for Health Care provided data on arthroplasties in the OSTPRE population. The results of women with THA/TKA were compared with women without arthroplasty (control group).Results - In subjects with THA performed before the 10-year follow-up, the proportion of good PC was initially decreased by 0.6 percentage points (pp) at the 10-year follow-up and later by 19 pp at the 20-year follow-up. After TKA, the proportion of subjects with good PC decreased by 4.1 pp (10-year follow-up) and 27 pp (20-year follow-up), respectively. The proportion of controls reporting good PC decreased by 1.4 pp at the 10-year follow-up and 14 pp at the 20-year follow-up compared with the baseline. After THA, the proportion of subjects with good SW stayed on the same level at 10-year follow-up and decreased by 2.3 pp at 20-year follow-up. After TKA, the proportion of good SW increased by 9.0 pp (10-year follow-up) and decreased by 14 pp (20-year follow-up). The proportion of controls reporting good SW increased by 4.0 pp (10-year follow-up) and decreased by 8.8 pp (20-year follow-up).Interpretation - THA and TKA maintain PC and SW. The overall PC and SW are lower in women with arthroplasty, in comparison with controls without arthroplasty. THA seems to outperform TKA in maintaining PC.
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http://dx.doi.org/10.1080/17453674.2021.1922039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519522PMC
October 2021

Correction to: Cardiovascular and musculoskeletal health disorders associate with greater decreases in physical capability in older women.

BMC Musculoskelet Disord 2021 Apr 12;22(1):349. Epub 2021 Apr 12.

Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland.

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http://dx.doi.org/10.1186/s12891-021-04219-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042917PMC
April 2021

Retrospective Population-Based Cohort Study of Incidence, Complications, and Survival of 202 Operatively Treated Periprosthetic Femoral Fractures.

J Arthroplasty 2021 07 1;36(7):2591-2596. Epub 2021 Mar 1.

Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland; Kuopio Musculoskeletal Research Unit, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.

Background: The aim of this study is to investigate the population and primary total hip arthroplasty (THA)-based incidences, fracture types, complications, and survival of operatively treated periprosthetic femoral fracture (PFF).

Methods: This retrospective study reviewed 202 cases of operatively treated PFFs in a study period from January 2004 to December 2016. The Vancouver classification was used to classify PFFs.

Results: The incidence of PFF related to 1000 primary THAs per year was 2.7 (standard deviation 1.0, range 0.9-4.5) at a defined hospital district area during the study period. The mean population-based incidence of operatively treated PFFs raised from 1.6 to 4.5 per 100,000 person-years during the study period. The B1-type fracture was the most common fracture type in 71 of 202 (35%) of these PFFs. The cumulative incidence of re-revision was 10.9% at 1 year and 15.6% at 15 years (95% confidence interval [CI] 10.9-21.0). The cumulative incidence for other major complications was 6.4% at 1 year and 9.9% at 15 years (95% CI 5.9-15.0). The cumulative incidence of death after PFF was 7.4% at 1 year and 56.3% at 15 years (95% CI 41.3-68.8) during the follow-up time from January 1, 2004 to December 31, 2019.

Conclusion: This country-specific study showed a 3-fold increasing trend in the incidence of operatively treated PFFs from 2004 to 2016 per 1000 THAs. The Vancouver type B1 fracture was the most common type. A high number of complications were associated with PFFs and 7.4% of the patients had died within 1 year after PFF surgery.
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http://dx.doi.org/10.1016/j.arth.2021.02.060DOI Listing
July 2021

What works? The association of organisational structure, reforms and interventions on efficiency in treating hip fractures.

Soc Sci Med 2021 04 24;274:113611. Epub 2020 Dec 24.

Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.

Many studies indicate huge regional and hospital-level differences in health care performance. In order to increase health system efficiency, it is important to know the reasons behind the differences and analyse the effects of those factors that can be affected by health policy. The aim of this study is to evaluate and compare various organisational factors and health policy interventions in the performance of the care of hip fracture patients in Finland. We analysed the relationship between organisational factors (hospital volume, regional concentration of treatments) and performance. The focus is also on the effects of two macro-level organisational changes (integration of production of all health and social services in one provider) and two micro-level interventions (integrated patient pathway interventions, aiming to discharge patients as soon as possible). Our results indicate that macro-level integration of the production or financing of health and social services, bigger hospital volumes, and the concentration of the acute phase of care in fewer hospitals within hospital districts were not consistently related to efficiency in the care of hip fracture patients. Instead, efficiency can be increased using micro-level interventions aiming to coordinate patient pathways at the patient group level.
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http://dx.doi.org/10.1016/j.socscimed.2020.113611DOI Listing
April 2021

Cardiovascular and musculoskeletal health disorders associate with greater decreases in physical capability in older women.

BMC Musculoskelet Disord 2021 Feb 16;22(1):192. Epub 2021 Feb 16.

Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland.

Background: Good physical capability is an important part of healthy biological ageing. Several factors influencing physical capability have previously been reported. Long-term reports on physical capability and the onset of clinical disorders and chronic diseases are lacking. Decrease in physical capacity has been shown to increase mortality. This study focuses on the prevalence of chronic diseases. The primary objective of the study was to reveal the association between physical capability and morbidity. Secondary objectives included the validity of self-reported physical capability and the association between baseline physical capability and mortality.

Methods: The OSTPRE (Kuopio Osteoporosis Risk Factor and Prevention Study) prospective cohort involved all women aged 47-56 years residing in the Kuopio Province, Finland in 1989. Follow-up questionnaires were mailed at five-year intervals. Physical capability questions were first presented in 1994. From these women, we included only completely physically capable subjects at our baseline, in 1994. Physical capability was evaluated with five scale self-reports at baseline and in 2014 as follows: completely physically capable, able to walk but not run, can walk up to 1000 m, can walk up to 100 m and temporarily severely incapable. The prevalences of selected chronic diseases, with a minimum prevalence of 10% in 2014, were compared with the change in self-reported physical capability. Additionally, associations between long-term mortality and baseline physical capability of the whole 1994 study population sample were examined with logistic regression. The correlation of self-reported physical capability with functional tests was studied cross-sectionally at the baseline for a random subsample.

Results: Our study population consisted of 6219 Finnish women with a mean baseline age of 57.0 years. Self-reported physical capability showed statistically significant correlation with functional tests. Cardiovascular diseases and musculoskeletal disorders show the greatest correlation with decrease of physical capability. Prevalence of hypertension increased from 48.7% in the full physical capability group to 74.5% in the "able to walk up to 100 metres" group (p < 0.001). Rheumatoid arthritis showed a similar increase from 2.1 to 7.4% between these groups. Higher baseline body mass index (BMI) decreases long-term capability (P < 0.001). Women reporting full physical capability at baseline had a mortality rate of 15.1%, in comparison to 48.5% in women within the "able to walk up to 100 m" group (p = 0.357). Mortality increased steadily with worsening baseline physical capability.

Conclusions: The results of this study show that chronic diseases, particularly cardiovascular and musculoskeletal disorders, correlate with faster degradation of physical capability in the elderly. Similar results are shown for increase in BMI. We also demonstrate that the risk of mortality over a 20-year period is higher in individuals with poor baseline physical capability.
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http://dx.doi.org/10.1186/s12891-021-04056-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888167PMC
February 2021

Association of Metformin, Other Antidiabetic Medications, and Statins With Incidence of Colon Cancer in Patients With Type 2 Diabetes.

Clin Colorectal Cancer 2021 06 16;20(2):e113-e119. Epub 2020 Nov 16.

Department of Oncology and Radiotherapy, Tampere University Hospital, Tampere, Finland; Cancer Centre Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.

Background: Metformin and statins may have anticancer effects, with plausible cellular mechanisms. However, the association of these agents with the risk of colorectal cancer is unclear.

Patients And Methods: This was a retrospective cohort study on a large population (N = 316,317) of patients with type 2 diabetes. Data were obtained from the Diabetes in Finland database (FinDM). In a full cohort analysis, hazard ratios (HRs) with their 95% confidence intervals (CIs) for ever use versus never use were estimated using a multiple Poisson regression model. A nested case-control design within the cohort was used to examine the association of colon cancer (CC) with the defined daily dose of medication. The data were analyzed by conditional logistic regression. The analyses were adjusted for the patient's age, sex, and duration of diabetes.

Results: In total, 1351 CC cases were diagnosed during 1996-2011. The results revealed insufficient evidence for an association between metformin (HR, 1.01; 95% CI, 0.90-1.14), other oral antidiabetic medications (HR, 1.05; 95% CI, 0.93-1.19), insulin (HR, 1.02; 95% CI, 0.86-1.22), or statins (HR, 0.94; 95% CI, 0.84-1.05) and the incidence of CC in the full cohort analysis. The results from the case-control study were similar, with no consistent trend in the incidence of CC according to the cumulative dose of metformin or the other studied medications.

Conclusion: This study found insufficient evidence for an association between metformin, insulin, other oral type 2 diabetes medications, or statins and the incidence of CC.
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http://dx.doi.org/10.1016/j.clcc.2020.11.003DOI Listing
June 2021

Incidence of and Characteristics Associated With Long-term Benzodiazepine Use in Finland.

JAMA Netw Open 2020 10 1;3(10):e2019029. Epub 2020 Oct 1.

Turku University Hospital, Department of Psychiatry, University of Turku, Turku, Finland.

Importance: The proportion of patients who develop long-term benzodiazepine use remains controversial, as do the length of time before long-term use develops and the factors associated with long-term use.

Objective: To investigate the incidence of long-term benzodiazepine and related drug (BZDR) use and factors associated with the development of long-term use implementing a follow-up design with new BZDR users.

Design, Setting, And Participants: This population-based cohort study used a nationwide cohort of 129 732 new BZDR users in Finland. New users of BZDRs aged 18 years or older were identified from the prescription register maintained by the Social Insurance Institution of Finland as individuals who initiated BZDR use during 2006 and had not used BZDRs from 2004 to 2005. The follow-up continued until death, long-term hospitalization, a gap of 2 years in BZDR use, or December 31, 2015. The population was analyzed according to age at treatment initiation, categorized into younger (<65 years) and older (≥65 years) subcohorts. Analyses were conducted from May 2019 to February 2020.

Exposures: Use of BZDRs, modeled from register-based data using the PRE2DUP (from prescriptions to drug use periods) method.

Main Outcomes And Measures: Long-term BZDR use, defined as continuous use of 180 days or longer, and factors associated with long-term vs short-term use, compared using Cox proportional hazards models.

Results: Among the 129 732 incident BZDR users, the mean (SD) age was 52.6 (17.7) years, and 78 017 (60.1%) individuals were women. During the follow-up period, 51 099 BZDR users (39.4%) became long-term users. Long-term treatment was more common in the older subcohort (19 103 individuals [54.5%]) than the younger subcohort (31 996 individuals [33.8%]). At 6 months, 28 586 individuals (22.0%) had become long-term users: 11 805 (33.7%) in the older subcohort and 16 781 (17.7%) in the younger subcohort. The largest proportions of initiators who became long-term users were those persons who initiated treatment with nitrazepam (76.4%; 95% CI, 73.6%-79.1%), temazepam (63.9%; 95% CI, 62.9%-65.0%), lorazepam (62.4%; 95% CI, 59.7%-65.1%), or clonazepam (57.5%; 95% CI, 55.9%-59.2%). Factors associated with the development of long-term use included male sex, older age, receipt of social benefits, psychiatric comorbidities, and substance abuse.

Conclusions And Relevance: The findings of this population-based cohort study conducted in Finland suggest that the incidence of subsequent long-term BZDR use in individuals who initiate use of BZDRs is high, especially among older persons, and that the specific BZDR used initially is associated with the development of long-term BZDR use and should be carefully considered when prescribing BZDRs. The observed factors that appear to be associated with development of long-term BZDR use also should be considered in clinical decision-making when starting and monitoring BZDR treatment.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.19029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596584PMC
October 2020

Following total hip arthroplasty: femoral head component diameter of 32 mm or larger is associated with lower risk of dislocation in patients with a prior lumbar fusion.

Bone Joint J 2020 Aug;102-B(8):1003-1009

Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.

Aims: There is evidence that prior lumbar fusion increases the risk of dislocation and revision after total hip arthroplasty (THA). The relationship between prior lumbar fusion and the effect of femoral head diameter on THA dislocation has not been investigated. We examined the relationship between prior lumbar fusion or discectomy and the risk of dislocation or revision after THA. We also examined the effect of femoral head component diameter on the risk of dislocation or revision.

Methods: Data used in this study were compiled from several Finnish national health registers, including the Finnish Arthroplasty Register (FAR) which was the primary source for prosthesis-related data. Other registers used in this study included the Finnish Health Care Register (HILMO), the Social Insurance Institutions (SII) registers, and Statistics Finland. The study was conducted as a prospective retrospective cohort study. Cox proportional hazards regression and Kaplan-Meier survival analysis were used for analysis.

Results: Prior lumbar fusion surgery was associated with increased risk of prosthetic dislocation (hazard ratio (HR) = 2.393, p < 0.001) and revision (HR = 1.528, p < 0.001). Head components larger than 28 mm were associated with lower dislocation rates compared to the 28 mm head (32 mm: HR = 0.712, p < 0.001; 36 mm: HR = 0.700, p < 0.001; 38 mm: HR = 0.808, p < 0.140; and 40 mm: HR = 0.421, p < 0.001). Heads of 38 mm (HR = 1.288, p < 0.001) and 40 mm (HR = 1.367, p < 0.001) had increased risk of revision compared to the 28 mm head.

Conclusion: Lumbar fusion surgery was associated with higher rate of hip prosthesis dislocation and higher risk of revision surgery. Femoral head component of 32 mm (or larger) associates with lower risk of dislocation in patients with previous lumbar fusion. Cite this article: 2020;102-B(8):1003-1009.
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http://dx.doi.org/10.1302/0301-620X.102B8.BJJ-2019-1037.R1DOI Listing
August 2020

Genetic and environmental variation in educational attainment: an individual-based analysis of 28 twin cohorts.

Sci Rep 2020 07 29;10(1):12681. Epub 2020 Jul 29.

Washington State Twin Registry, Washington State University - Health Sciences Spokane, Spokane, WA, USA.

We investigated the heritability of educational attainment and how it differed between birth cohorts and cultural-geographic regions. A classical twin design was applied to pooled data from 28 cohorts representing 16 countries and including 193,518 twins with information on educational attainment at 25 years of age or older. Genetic factors explained the major part of individual differences in educational attainment (heritability: a = 0.43; 0.41-0.44), but also environmental variation shared by co-twins was substantial (c = 0.31; 0.30-0.33). The proportions of educational variation explained by genetic and shared environmental factors did not differ between Europe, North America and Australia, and East Asia. When restricted to twins 30 years or older to confirm finalized education, the heritability was higher in the older cohorts born in 1900-1949 (a = 0.44; 0.41-0.46) than in the later cohorts born in 1950-1989 (a = 0.38; 0.36-0.40), with a corresponding lower influence of common environmental factors (c = 0.31; 0.29-0.33 and c = 0.34; 0.32-0.36, respectively). In conclusion, both genetic and environmental factors shared by co-twins have an important influence on individual differences in educational attainment. The effect of genetic factors on educational attainment has decreased from the cohorts born before to those born after the 1950s.
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http://dx.doi.org/10.1038/s41598-020-69526-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391756PMC
July 2020

Toe pressure should be part of a vascular surgeon's first-line investigation in the assessment of lower extremity artery disease and cardiovascular risk of a patient.

J Vasc Surg 2021 02 23;73(2):641-649.e3. Epub 2020 Jul 23.

Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Electronic address:

Objective: Toe pressure (TP) is an accurate indicator of the peripheral vascular status of a patient and thus cardiovascular risk, with less susceptibility to errors than ankle-brachial index (ABI). This study aimed to analyze how ABI and TP measurements associate with overall survival and cardiovascular death and to analyze the TP of patients with ABI of 0.9 to 1.3.

Methods: The first ABI and TP measurements of a consecutive 6784 patients treated at the Helsinki University Hospital vascular surgery clinic between 1990 and 2009 were analyzed. Helsinki University Vascular Registry and the national Cause of Death Registry provided the data.

Results: The poorest survival was in patients with ABI >1.3 (10-year survival, 15.3%; hazard ratio, 2.2; 95% confidence interval, 1.9-2.6; P < .0001; reference group, ABI 0.9-1.3), followed by the patients with TP <30 mm Hg (10-year survival, 19.6%; hazard ratio, 2.0; 95% confidence interval, 1.7-2.2; P < .0001; reference group, TP ≥80 mm Hg). The best 10-year survival was in patients with TP ≥80 mm Hg (43.9%). Of the 642 patients with normal ABI (0.9-1.3), 18.7% had a TP <50 mm Hg. The highest cardiovascular death rate (64.6%) was in the patients with TP <30 mm Hg, and it was significantly lower than for the patients with TP >50 mm Hg.

Conclusions: Low TP is associated significantly with survival and cardiovascular mortality. Patients with a normal ABI may have lower extremity artery disease (LEAD) and a considerable risk for a cardiovascular event. If only the ABI is measured in addition to clinical examination, a substantial proportion of patients may be left without LEAD diagnosis or adequate treatment of cardiovascular risk factors. Thus, especially if ABI is normal, LEAD is excluded only if TPs are also measured and are normal.
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http://dx.doi.org/10.1016/j.jvs.2020.06.104DOI Listing
February 2021

Trends in operative ankle ligament surgery in Finland between 1986 and 2018.

Foot Ankle Surg 2021 Apr 18;27(3):252-255. Epub 2020 Jun 18.

Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio University Hospital, Yliopistoranta 1, 70210 Kuopio, Finland.

Background: Ankle sprains are common musculoskeletal injuries. Until the 1990s, ankle ligament injuries were often treated operatively. The aim of this registry study was to determine how the change in treatment practice has affected the number of acute and elective ankle ligament surgeries in Finland.

Material: The data of ankle ligament injury patients operated between 1 January 1986 and 31 December 2018 was collected from the Finnish National Hospital Discharge Register.

Results: A total of 33,770 ankle ligament injuries were repaired. The incidence of acute ankle ligament injury repair surgery has decreased nearly 80% over the last three decades. No increase in the number of late-stage ankle ligament injury repairs was found.

Conclusion: The number of acute and elective ankle ligament surgeries has remained low in the 2000s. This suggests that the occurrence of clinical instability after ankle sprains has not increased, even though acute-phase treatment has become conservative.
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http://dx.doi.org/10.1016/j.fas.2020.06.008DOI Listing
April 2021

Survival after breast cancer in women with type 2 diabetes using antidiabetic medication and statins: a retrospective cohort study.

Acta Oncol 2020 Sep 1;59(9):1110-1117. Epub 2020 Jun 1.

Research Unit of Mathematical Sciences, University of Oulu, Oulu, Finland.

We assessed survival of breast cancer in women with type 2 diabetes (T2D) treated with metformin, other types of antidiabetic medication (ADM) and statins. The study cohort consisted of women with T2D and diagnosed with breast cancer in Finland in 1998─2011. Mortality rates from breast cancer and other causes were analysed by Cox models, and adjusted hazard ratios (HRs) with 95% confidence intervals (Cls) were estimated in relation to the use of different types of medication. The final cohort consisted of 3,533 women. No clear evidence was found for breast cancer mortality being different in metformin users (HR 0.86, 95% Cl 0.63-1.17), but their other-cause mortality appeared to be lower (HR 0.73, 95% Cl 0.55-0.97) in comparison with women using other types of oral ADM. Other-cause mortality was higher among insulin users (HR 1.45, 95% Cl 1.16-1.80) compared with users of other oral ADMs, other than metformin. Prediagnostic statin use was observed to be associated with decreased mortality from both breast cancer (HR 0.76, 95% Cl 0.63-0.92) and other causes (HR 0.75, 95% Cl 0.64-0.87). We did not find any association between ADM use and disease-specific mortality among women with T2D diagnosed with breast cancer. However, interestingly, prediagnostic statin use was observed to predict reduced mortality from breast cancer and other causes. We hypothesise that treating treatment practices of T2D or hypercholesterolaemia of breast cancer patients might affect overall prognosis of women diagnosed with breast cancer and T2D.
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http://dx.doi.org/10.1080/0284186X.2020.1769858DOI Listing
September 2020

Genetic and environmental influences on human height from infancy through adulthood at different levels of parental education.

Sci Rep 2020 05 14;10(1):7974. Epub 2020 May 14.

Department of Epidemiology, School of Public Health, Seoul National University, Seoul, 08826, Korea.

Genetic factors explain a major proportion of human height variation, but differences in mean stature have also been found between socio-economic categories suggesting a possible effect of environment. By utilizing a classical twin design which allows decomposing the variation of height into genetic and environmental components, we tested the hypothesis that environmental variation in height is greater in offspring of lower educated parents. Twin data from 29 cohorts including 65,978 complete twin pairs with information on height at ages 1 to 69 years and on parental education were pooled allowing the analyses at different ages and in three geographic-cultural regions (Europe, North America and Australia, and East Asia). Parental education mostly showed a positive association with offspring height, with significant associations in mid-childhood and from adolescence onwards. In variance decomposition modeling, the genetic and environmental variance components of height did not show a consistent relation to parental education. A random-effects meta-regression analysis of the aggregate-level data showed a trend towards greater shared environmental variation of height in low parental education families. In conclusion, in our very large dataset from twin cohorts around the globe, these results provide only weak evidence for the study hypothesis.
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http://dx.doi.org/10.1038/s41598-020-64883-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224277PMC
May 2020
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