The incidence of floorball injuries-A systematic review and meta-analysis.

OBJECTIVE: Floorball is a swift sport; players perform multiple quick turns during practices and games. The aim of this study was to examine the incidence of floorball injuries. In addition, we aimed to examine the differences in the incidences between sexes and anatomical locations. METHODS: The PubMed (National Library of Medicine), Web of Science (Clarivate), Scopus (Elsevier), and SPORTDiscus (EBSCO) databases were searched from inception to January 6th, 2023. A study was eligible for analysis if the number of injuries per exposure time was reported. The study protocol was prospectively registered in the PROSPERO database (CRD42023390659). RESULTS: The total pooled incidence of floorball injuries was 2.28 (confidence interval [CI] 1.27 to 4.10) injuries per 1000 h for all included studies. For females, the pooled incidence was 2.33 (CI 1.22 to 4.46) injuries per 1000 h, and for males, the incidence was 1.98 (CI 1.83 to 2.14) injuries per 1000-h. For adults, the pooled incidence was 3.11 (CI 1.58 to 6.12) injuries per 1000 h and for youths, the incidence was 1.40 (CI 0.50 to 3.94) injuries per 1000 h. CONCLUSIONS: The incidence of floorball injuries is high, especially among women. When considering the growing popularity of floorball, these pooled incidences serve as reference values for future injury prevention programs.

Randomized controlled trials reporting patient-reported outcomes with no significant differences between study groups are potentially susceptible to unjustified conclusions-a systematic review.

OBJECTIVES: Ceiling effect may lead to misleading conclusions when using patient-reported outcome measure (PROM) scores as an outcome. The aim of this study was to investigate the potential source of ceiling effect-related errors in randomized controlled trials (RCTs) reporting no differences in PROM scores between study groups. STUDY DESIGN AND SETTING: A systematic review of RCTs published in the top 10 orthopedic journals according to their impact factors was conducted, focusing on studies that reported no significant differences in outcomes between two study groups. All studies published during 2012-2022 that reported no differences in PROM outcomes and used parametric statistical approach were included. The aim was to investigate the potential source of ceiling effect-related errors-that is, when the ceiling effect suppresses the possible difference between the groups. The proportions of patients exceeding the PROM scales were simulated using the observed dispersion parameters based on the assumed normal distribution, and the differences in the proportions between the study groups were subsequently analyzed. RESULTS: After an initial screening of 2343 studies, 190 studies were included. The central 95% theoretical distribution of the scores exceeded the PROM scales in 140 (74%) of these studies. In 33 (17%) studies, the simulated patient proportions exceeding the scales indicated potential differences between the compared groups. CONCLUSION: It is common to have a mismatch between the chosen PROM instrument and the population being studied increasing the risk of an unjustified "no difference" conclusion due to a ceiling effect. Thus, a considerable ceiling effect should be considered a potential source of error.

The association between interpregnancy interval and gestational diabetes mellitus: A nationwide register-based study in Finland.

OBJECTIVE: Previous results on the association between interpregnancy interval (IPI) and gestational diabetes mellitus (GDM) have been contradictory. Hence, the aim of this study was to examine the association between IPI and GDM using high-quality nationwide register data. METHODS: All women with first and second pregnancies during our study period from the National Medical Birth Register during 2004-2018 were considered. A logistic regression model was used to assess the association between the length of the IPI and development of the GDM in the second pregnancy. Women were divided into three groups based on the length of the IPI: short IPI (0-11 months), normal IPI (12-47 months), and long IPI (48+ months). Adjusted odds ratios (aOR) with 95% CI were compared between the groups. RESULTS: A total of 47 078 women were included in the study. We found no evidence of difference when women with short IPI were compared with women with normal IPI (aOR 0.99, 95% CI 0.93-1.05). Women with long IPI had increased odds for the development of GDM when compared with women with normal IPI (aOR 1.28, 95% CI 1.19-1.38). In the logistic regression model for continuous IPI, the total odds for the development of GDM increased as the IPI increased (aOR 1.05 per year, 95% CI 1.03-1.06). CONCLUSION: The odds for the development of GDM increased as the IPI increased. This study's results serve as a clarion call for proactive measures in GDM prevention. Moreover, they advocate for intensified investigation into the underlying factors contributing to GDM among women with extended IPI. It is imperative that these insights inform both clinical practice and further research agendas, as we strive to safeguard maternal health and well-being.

Clinical Outcomes After Revision Hip Arthroplasty due to Prosthetic Joint Infection-A Single-Center Study of 369 Hips at a High-Volume Center With a Minimum of One Year Follow-Up.

BACKGROUND: Prosthetic joint infection (PJI) treatment decisions are traditionally based on treatment algorithms. There is, however, a lack of evidence to support the choice of these treatment algorithms. Therefore, we aimed to assess the one-year survival after PJI revision and compared different surgical strategies in a single-center setting. METHODS: Revisions of the hip due to PJI performed at our institution between January 2008 and September 2021 with at least one-year of follow-up were identified. In total, 134 debridement, antibiotics, and implant retentions (DAIRs), 114 one-stage revisions, and 121 two-stage revisions were performed. Infections were classified as early, acute hematogenous, and chronic. Survival was calculated using the Kaplan-Meier method and cumulative incidence function. Predictors of outcomes were examined with Fine-Gray regressions and Cox proportional hazards regressions. Subdistribution hazard ratios and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. RESULTS: At one-year follow-up, 26.6% (CI 22.2 to 31.2%) of the patients had undergone reoperation and 7.9% (CI 5.4 to 10.9%) had died. The risk for reoperation was highest after DAIR (36.6%, CI 28.5 to 44.7%) and lowest after one-stage revision (20.2%, CI 13.4 to 28%). Within the early infections, the one-stage revision almost halved the risk of reoperation (HR 0.51, CI 0.31 to 0.84) with no added mortality risk (HR 1.05, CI 0.5 to 2.2), when compared to DAIR. CONCLUSION: By utilizing 1-stage revision over DAIR in early infections, it might be possible to improve the prognosis by decreasing the risk of reoperation without increasing mortality. However, as the patient selection is undeniably difficult, more research is warranted.

KLIC Score Does Not Predict Failure After Early Prosthetic Joint Infection: An External Validation With 153 Knees and 130 Hips.

BACKGROUND: A preoperative risk score, the KLIC score (chronic renal failure [K], liver cirrhosis [L], indication of the index surgery [I], cemented prosthesis [C], and C-reactive protein >115 mg/L), has been developed to predict the risk of treatment failure after early prosthetic joint infection (PJI). This study aimed to validate the KLIC score for the debridement, antibiotics, and implant retention (DAIR) procedure and one-stage revisions in a Northern European cohort. METHODS: Revisions due to early PJI of the hip or knee between January 1, 2008, and September 12, 2021, were identified retrospectively. The primary outcome was early failure, which was considered when the patient needed an unscheduled surgery, the patient died, or the patient was prescribed long-term suppressive antibiotics. To examine the association between KLIC score and failure risk, univariable logistic regression with area under the curve (AUC) was used. In addition, models were calibrated to assess prognostic ability and clinical utility was examined with decision-curve analyses. RESULTS: An increase in KLIC score had a moderate predictive value for early failure after DAIR (odds ratio [OR] 1.45; confidence interval [CI] 1.13 to 1.90). For one-stage revision, it was only slightly predictive of failure (OR 1.20; CI 0.93 to 1.56). After 60 days, the AUC for DAIR was 0.63 (CI 0.55 to 0.72) and 0.56 (CI 0.46 to 0.66) for one-stage revisions, indicating poor discriminative ability. The decision-curve analyses revealed that the model did not offer a remarkable net benefit across a range of threshold probabilities. CONCLUSIONS: We demonstrated that the KLIC score is not a reliable predictor of early failure after early PJI in a Northern European cohort. Using the model to guide treatment decisions does not provide any additional clinical utility beyond the baseline strategies.

Prevalence of post-traumatic osteoarthritis after anterior cruciate ligament injury remains high despite advances in surgical techniques.

Aims: The aim of this study was to report the pooled prevalence of post-traumatic osteoarthritis (PTOA) and examine whether the risk of developing PTOA after anterior cruciate ligament (ACL) injury has decreased in recent decades. Methods: The PubMed and Web of Science databases were searched from 1 January 1980 to 11 May 2022. Patient series, observational studies, and clinical trials having reported the prevalence of radiologically confirmed PTOA after ACL injury, with at least a ten-year follow-up, were included. All studies were analyzed simultaneously, and separate analyses of the operative and nonoperative knees were performed. The prevalence of PTOA was calculated separately for each study, and pooled prevalence was reported with 95% confidence intervals (CIs) using either a fixed or random effects model. To examine the effect of the year of injury on the prevalence, a logit transformed meta-regression analysis was used with a maximum-likelihood estimator. Results from meta-regression analyses were reported with the unstandardized coefficient (ß). Results: The pooled prevalence of PTOA was 37.9% (95% CI 32.1 to 44) for operatively treated ACL injuries with a median follow-up of 14.6 years (interquartile range (IQR) 10.6 to 16.7). For nonoperatively treated ACL injuries, the prevalence was 40.5% (95% CI 28.9 to 53.3), with a median of follow-up of 15 years (IQR 11.7 to 20.0). The association between the year of operation and the prevalence of PTOA was weak and imprecise and not related to the choice of treatment (operative ß -0.038 (95% CI -0.076 to 0.000) and nonoperative ß -0.011 (95% CI -0.101 to 0.079)). Conclusion: The initial injury, irrespective of management, has, by the balance of probability, resulted in PTOA within 20 years. In addition, the prevalence of PTOA has only slightly decreased during past decades. Therefore, further research is warranted to develop strategies to prevent the development of PTOA after ACL injuries.

Association of Nighttime Speed Limits and Electric Scooter-Related Injuries.

This cohort study investigates whether nighttime speed restrictions are associated with the incidence of electric scooter­related injuries in Finland.

Previous traumatic brain injury is associated with an increased odds for gestational diabetes: a nationwide register-based cohort study in finland.

AIMS: Despite recent findings that traumatic brain injury (TBI) is a possible risk factor for type 2 diabetes (DM2) and that a strong association exists between gestational diabetes (GDM) and the risk for the development of DM2, no previous studies have investigated the effects of TBI on the risk for the development of GDM. Therefore, this study aims to determine the possible association between a previous traumatic brain injury and later gestational diabetes. METHODS: In this retrospective register-based cohort study, data from the National Medical Birth Register were combined with data from the Care Register for Health Care. Women who had sustained a TBI before pregnancy were included in the patient group. Women who had sustained previous fractures of the upper extremity, pelvis, or lower extremity were included in the control group. A logistic regression model was used to assess the risk for the development of GDM during pregnancy. Adjusted odds ratios (aOR) with 95% confidence intervals between the groups were compared. The model was adjusted by prepregnancy body mass index (BMI) and maternal age during pregnancy, the use of in vitro fertilization (IVF), maternal smoking status, and multiple pregnancies. The risk for the development of GDM during different periods following the injury (0-3 years, 3-6 years, 6-9 years, and 9+ years) was calculated. RESULTS: In total, a 75 g 2-h oral glucose tolerance test (OGTT) was performed on 6802 pregnancies of women who had sustained a TBI and on 11 717 pregnancies of women who sustained fractures of the upper extremity, pelvis, or lower extremity. Of these, 1889 (27.8%) pregnancies were diagnosed with GDM in the patient group and 3117 (26.6%) in the control group. The total odds for GDM were higher after TBI compared to the other traumas (aOR 1.14, CI 1.06-1.22). The odds were highest at 9 + years after the injury (aOR 1.22, CI 1.07-1.39). CONCLUSION: The total odds for the development of GDM after TBI were higher when compared to the control group. Based on our findings, more research on this topic is warranted. Moreover, a history of TBI should be considered a possible risk factor for the development of GDM.

Trends in Revision Knee Arthroplasty for Prosthetic Joint Infection: A Single-Center Study of 384 Knees at a High-Volume Center Between 2008 and 2021.

BACKGROUND: Prosthetic joint infection (PJI) is one of the most devastating complications after total knee arthroplasty (TKA), and comorbidities increase the risk. We examined whether a temporal change has occurred in the demographics, especially regarding comorbidities, of patients who have PJI and were treated at our institution over a 13-year study period. In addition, we assessed the surgical methods used and the microbiology of the PJIs. METHODS: Revisions (n = 384, 377 patients) due to PJI of the knee performed at our institution between 2008 and September 2021 were identified. All included PJIs fulfilled the 2013 International Consensus Meeting diagnostic criteria. The surgeries were categorized into one of the following categories: debridement, antibiotics, and retention (DAIR), 1-stage revision, and 2-stage revision. Infections were classified as early, acute hematogenous, and chronic. RESULTS: No changes in the median age of the patients nor comorbidity burden were observed during the study period. However, the proportion of 2-stage revisions decreased remarkably from 57.6% in 2008 to 2009 to 6.3% in 2020 to 2021. A DAIR was the most used treatment strategy, but the proportion of 1-stage revisions increased the most. In 2008 to 2009, 12.1% of the revisions were 1-stage, but in 2020 to 2021, the proportion was 43.8%. The most common pathogen was Staphylococcus aureus (27.8%). CONCLUSION: The comorbidity burden remained at the same level with no trends. A DAIR was the most used strategy, but the proportion of 1-stage revisions rose to almost the same level. The incidence of PJI varied between the years, but remained relatively low.

Delivery mode and fetal outcome in attempted vaginal deliveries after previous cesarean section: a nationwide register-based cohort study in Finland.

PURPOSE: Even though the risks and advantages of repeat Cesarean sections (CSs) and vaginal births after cesarean section (VBACs) are well studied, there is a scarcity of information on the effects of previous CS on maternal and fetal outcomes during subsequent deliveries. The aim of this study is to evaluate delivery mode and fetal outcomes in a trial of labor after cesarean section (TOLAC). METHODS: In this nationwide retrospective cohort study, data from the National Medical Birth Register (MBR) were used to evaluate the outcomes of TOLACs. TOLACs were compared to the outcomes of the trial of labor after previous successful vaginal delivery. A multivariable logistic regression model was used to assess the primary outcomes (delivery mode, neonatal intensive care unit, and perinatal/neonatal mortality). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were used for comparison. RESULTS: A total of 29 352 (77.0%) women attempted vaginal delivery in the TOLAC group. In the control group, 169 377 (97.2%) women attempted vaginal delivery. The adjusted odds for urgent CS (aOR 13.05, CI 12.59-13.65) and emergency CS (aOR 3.65, CI 3.26-4.08) were notably higher in the TOLAC group when compared to the control group. The odds for neonatal intensive care unit treatment (aOR 2.05, CI 1.98-2.14), perinatal mortality (aOR 2.15, CI 1.79-2.57), and neonatal mortality (aOR 1.75, CI 1.20-2.49) were higher in the TOLAC group. CONCLUSIONS: The odds for emergency CS were higher among women who underwent TOLAC. The odds for neonatal intensive care and perinatal mortality were also higher, and further research is needed to identify those expecting women who are better suited for TOLAC to minimize the risk for a neonate. The results of this study should be acknowledged by the mother and the clinician when considering the possibility of vaginal births after cesarean section.

The rates of vaginal births after cesarean section have increased during the last decades: a nationwide register-based cohort study in Finland.

PURPOSE: Epidemiological studies assessing the effects of previous cesarean section (CS) on subsequent delivery mode using large nationwide study populations. This study aims to calculate the incidence rates of trial of labors after cesarean section (TOLACs) and evaluate the annual rates of vaginal births after cesarean section (VBAC) during the last decades in Finland. METHODS: Data from the National Medical Birth Register (MBR) were used to evaluate incidence rates of VABC in the Finnish population (1998-2018). All nulliparous women having their first and second pregnancy during our study period, and with the mode of delivery identified in both of these pregnancies were included in this study. Absolute annual numbers and incidence rates for TOLACs, elective CS, and VBAC were calculated. RESULTS: The absolute number of TOLACs had an increasing trend during our study period, increasing up to 2118 TOLACs in 2016. The incidence rates for elective CS after the first CS had a decreasing trend, decreasing from 45% in 1999, to 28% in 2018. The absolute number of VBACs had an increasing trend during our study period, peaking in 2016 (1466 VBACs). The rates for VBAC remained relatively constant, ranging between 38 and 52%, but a slightly increasing trend at the end of the study period was seen. CONCLUSION: Despite the increasing annual total number of deliveries with CS in the first pregnancy, the absolute numbers and rates for VBACs have increased towards the end of the study period in Finland. The epidemiology of TOLACs and VBACs should be better studied around the world, as with the rapidly increasing rate of CSs, these events are becoming more common challenges in health care.

Multifetal gestations after traumatic brain injury: a nationwide register-based cohort study in Finland.

BACKGROUND: There is a paucity of information regarding the association between traumatic brain injuries (TBIs) and subsequent multifetal gestations. Since TBIs are known to negatively affect the neuroendocrine system, we hypothesized that the functions of the whole reproductive system might be disturbed as a result. The aim of this study is to determine the association between previous TBIs and the risk of multifetal gestations using nationwide registers. METHODS: In this retrospective register-based cohort study, data from the National Medical Birth Register (MBR) were combined with data from the Care Register for Health Care. All fertile-aged women (15-49 years) who had sustained a TBI before pregnancy were included in the patient group. Women with prior fractures of the upper extremity, pelvis, and lower extremity were included in the control group. A logistic regression model was used to assess the risk for multifetal gestation after TBI. Odds ratios (ORs) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs) between the groups were compared. The model was adjusted by maternal age and maternal BMI during pregnancy and previous births. The risk for multifetal gestations were evaluated during different periods following the injury (0-3 years, 3-6 years, 6-9 years, and 9 + years). RESULTS: A total of 14 153 pregnancies occurred after the mother had sustained a TBI, and 23 216 pregnancies occurred after the mother had sustained fractures of the upper extremity, pelvis, or lower extremity. Of these, 201 (1.4%) women had multifetal gestations after TBI and 331 (1.4%) women had multifetal gestations after fractures of the upper extremity, pelvis, or lower extremity. Interestingly, the total odds of multifetal gestations were not higher after TBI when compared to fractures of the upper extremity, pelvis, and lower extremity (aOR 1.04, CI 0.86-1.24). The odds were highest at 6-9 years (aOR 1.54, 1.03-2.29) and lowest at 0-3 years (aOR 0.84, CI 0.59-1.18). CONCLUSION: The risk for multifetal gestations after TBIs was not higher than after the other traumas included in this study. Our results provide good baseline information on the effects of TBIs on the risk for multifetal gestations, but further research is required on this topic.

Quality of surgical patient-reported outcome measure validation studies is often deficient: a systematic review.

OBJECTIVES: To examine the methodological basis behind the conclusions of patient-reported outcome measure (PROM) validation studies. STUDY DESIGN AND SETTING: A systematic review was performed on surgical studies evaluating the measurement properties of a PROM between June 1 and December 31, 2021. The quality of the validity subfield evaluation in the studies was assessed according to the consensus-based standards for the selection of health measurement instruments checklist. Nine validity subfields were assessed. RESULTS: The median sample size of the 87 included studies was 125 (interquartile range: 99-226), and 22 of the studies (25%) had an insufficient sample size according to the consensus-based standards for the selection of health measurement instruments checklist. For the nine validity subfields, the mean number of correctly assessed subfields was 3.6 (standard deviation: 1.5). In 68 of the studies (78%), the conclusion determined the PROM to be valid. In these studies, the mean number of evaluated validity subfields was 3.8 (standard deviation: 1.4). None of the studies reported that the PROM was not valid. CONCLUSION: The empirical basis of the conclusions drawn in studies investigating the measurement properties of a PROM is often deficient. PROM studies were often performed with insufficient sample sizes and focused on only a few validity subfields, calling into question the deterministic conclusions that a PROM is valid.

Traumatic brain injury during pregnancy is associated with increased rate of cesarean section: a nationwide multi-register study in Finland.

OBJECTIVE: The literature on the incidence of traumatic brain injury (TBI) during pregnancy is lacking. Furthermore, only studies with small sample size have analyzed the impact of TBI during pregnancy to maternal and fetal outcomes. Thus, we aim to report the incidence of TBIs during pregnancy and study the pregnancy outcomes using nationwide high-quality registers. METHODS: This nationwide retrospective register-based matched cohort study utilized two national registers. All fertile-aged (15-49 years) women with a TBI hospitalization period during pregnancy were retrieved the Care Register for Health Care. Data were then linked with the data from the National Medical Birth Register (MBR). Propensity score matching was conducted according to maternal age during pregnancy, previous cesarean section (CS), maternal smoking status, maternal body mass index, and maternal gestational diabetes. The matching was conducted using the nearest neighbor methods with a caliber width if 0.15, and with a ratio 1:3 (patients/references). Adverse maternal and fetal outcomes were compared between patient group and reference group using Chi-squared tests. RESULTS: A total of 392 women having a TBI during pregnancy were found. The control group consisted of 722,497 women without TBI during pregnancy. Of the TBIs occurring during pregnancy, the most common types of TBIs were concussion (S06.0) (n = 359, 91.6%), diffuse traumatic brain injury (S06.2) (n = 11, 2.8%), traumatic subdural hemorrhage (n = 7, 1.8%), and unspecified intracranial injury S06.9 (n = 6, 1.5%). The incidence rates of pregnancies with a TBI have remained similar during pregnancy in Finland, peaking at 0.8 per 1000 pregnancies in 2016. The Chi-squared test showed higher rate for CS among women with TBI than for their matched references (21.4% vs. 15.5%, p = .008). Especially, women with TBI during 3rd trimester had higher rate for CS (29.0 vs. 15.0%, p = .016). CONCLUSIONS: The main findings of this study were that the incidence rates for TBI during pregnancy have remained similar during our study period (2004-2018). TBI during pregnancy, even a mild one, is associated with an increased rate for CS. Especially, TBI during the 3rd trimester was associated with high rate for CS, but the etiology behind this remains unknown. In addition, we found no evidence of difference in fetal outcomes, such as preterm birth, low birth weight, or need for intensive care unit. Future studies should focus on the indications for elective CS, and reasons for unplanned CS among women with TBI during pregnancy, as these could possibly provide important information on the effects of TBI on the course of childbirth.

Previous induced abortion or miscarriage is associated with increased odds for gestational diabetes: a nationwide register-based cohort study in Finland.

AIMS: The aim of this study was to investigate the association between previous induced abortion or miscarriage and the development of gestational diabetes mellitus (GDM) using high-quality register data. METHODS: In this retrospective nationwide register-based cohort study, data from the national medical birth register (MBR) were used to evaluate the association between a history of miscarriage or induced abortion and GDM. We included all first pregnancies ending in delivery in which the oral glucose tolerance test was performed between 2004 and 2018. A logistic regression model was used to assess the development of GDM in the first pregnancy ending in delivery. Adjusted odds ratios (aOR) with 95% confidence intervals (Cis) were compared between groups. RESULTS: In total, 15,873 nulliparous women with a history of induced abortions, 22,337 with a history of miscarriages and 3594 with a history of both were found. The reference group consisted of 138,869 women without a history of induced abortions or miscarriages. Women with a history of induced abortions (24.7%, aOR 1.15 [CI 1.11-1.20]), a history of miscarriages (24.8%, aOR 1.14 [CI 1.10-1.18]) and a history of both (27.7% aOR 1.18 [CI 1.09-1.28]) had higher odds for the development of GDM when compared to the reference group (20.8%). The odds for GDM increased along with the increasing number of previous induced abortions and miscarriages. CONCLUSION: Women with a history of induced abortions or miscarriages had higher odds for GDM in their first pregnancy leading to birth. Knowledge of this association will be helpful in the prevention and screening of GDM.

Trends in Revision Hip Arthroplasty for Prosthetic Joint Infection: A Single-Center Study of 423 Hips at a High-Volume Center Between 2008 and 2021.

BACKGROUND: Prosthetic joint infection (PJI) is one of the most devastating complications after total hip arthroplasty (THA), and comorbidities increase the risk. We examined whether there was a temporal change in the demographics, especially regarding comorbidities, of patients who have PJIs and were treated over a 13-year study period at a high-volume academic joint arthroplasty center. In addition, the surgical methods used and the microbiology of the PJIs were assessed. METHODS: Revisions (n = 423, 418 patients) due to PJI of the hip performed at our institution between 2008 and September 2021 were identified. All included PJIs fulfilled the 2013 International Consensus Meeting diagnostic criteria. The surgeries were categorized into one of the following categories: debridement, antibiotics, and implant retention, 1-stage revision, and 2-stage revision. Infections were classified as early, acute hematogenous, and chronic infections. RESULTS: There was no change in the median age of the patients, but the proportion of ASA-class 4 patients increased from 10.5% to 20%. The incidence of early infections increased from 0.11 per 100 primary THAs in 2008 to 1.09 in 2021. The incidence of 1-stage revisions increased the most, rising from 0.10 per 100 primary THAs in 2010 to 0.91 per 100 primary THAs in 2021. Furthermore, the proportion of infections caused by Staphylococcus aureus increased from 26.3% in 2008 to 2009 to 40% in 2020 to 2021. CONCLUSION: The comorbidity burden of PJI patients increased during the study period. This increase may present a treatment challenge, as comorbidities are known to have a negative effect on PJI treatment outcomes.

Obesity increases the odds of multiple pregnancies: A nationwide register-based cohort study in Finland.

OBJECTIVE: To investigate the effects of increased pre-pregnancy body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) on the risk of having spontaneous multiple pregnancies using a nationwide register-based study sample. METHODS: Data from the National Medical Birth Register (MBR) (2004-2018) were used to evaluate the effects of a higher pre-pregnancy BMI on the risk of multiple pregnancies. Lower and higher pre-pregnancy BMI classes, using the WHO classification, were compared with a normal weight class. A logistic regression model was used to assess the primary outcomes. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) between the groups were compared. The model was adjusted by maternal age, maternal height, and maternal smoking status. RESULTS: The odds of multiple pregnancies were higher among women in the overweight group (aOR 1.07, 95% CI 1.02-1.12), obesity class I group (aOR 1.11, 95% CI 1.04-1.18), and obesity class II group (aOR 1.15, 95% CI 1.03-1.28) compared with women in the non-overweight BMI class. Women in the underweight group had lower odds for multiple pregnancies (aOR 0.82, 95% CI 0.73-0.93). CONCLUSION: The odds of multiple pregnancies slightly increase with pre-pregnancy obesity, and this should be acknowledged as a minor risk factor for multiple pregnancies.

Trends in the epidemiology of fear of childbirth and association with intended mode of delivery: A nationwide register-based cohort study in Finland.

INTRODUCTION: Fear of childbirth (FOC) is a common obstetrical challenge that affects the health of women. The epidemiology of FOC has not been studied in Finland for the last decade. The aim of this study was to analyze the epidemiology and risk factors for FOC and to evaluate the association between FOC and the rate of elective cesarean section (CS) as an intended mode of delivery. MATERIAL AND METHODS: Data from the National Medical Birth Register were used to evaluate the epidemiology of FOC and to determine the main risk factors for FOC in Finland between 2004 and 2018. Nulliparous and multiparous women were analyzed separately. Logistic regression model was used to determine the main risk factors for FOC. Multivariable logistic regression model was used to assess the intended mode of delivery in those pregnancies with diagnosed maternal FOC. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were calculated. RESULTS: A total of 1 million pregnancies were included. The annual rate of pregnancies with maternal FOC increased from 1.5% (CI: 1.4-1.6) in 2004 to 9.1% (CI: 8.7-9.3) in 2018 for all women. For nulliparous women, the rate increased from 1.1% (CI: 1.0-1.3) in 2004 to 7.1% (CI: 6.7-7.5) in 2018, and from 1.8% (CI: 1.7-2.0) in 2004 to 10.3% (10.0-10.7) in 2018 for multiparous women. The strongest risk factors for maternal FOC were higher maternal age and gestational diabetes. For multiparous women, the strongest risk factors were gestational diabetes and previous CS. The total odds for elective CS were notably higher among women with FOC (aOR 8.63, CI: 8.39-8.88). CONCLUSIONS: The incidence of maternal FOC rose six-fold during our study period. However, the numbers of elective CS among women with this diagnosis, which had earlier risen in parallel, leveled off in 2014.

Birth rate among women with fear of childbirth: a nationwide register-based cohort study in Finland.

PURPOSE: The association between fear of childbirth (FOC) and subsequent birth rate is not well studied. The aim of this study is to evaluate the birth rate, and risk for second pregnancy ending in delivery among women with FOC compared to women without FOC in their first pregnancy. METHODS: Data from the National Medical Birth Register were used to evaluate the birth rate after the first pregnancy in women with FOC. Cox regression model was used to evaluate the risk for the second pregnancy ending in delivery in women with FOC compared to reference individuals without FOC. The results were interpreted with adjusted hazard ratios (aHRs) and 95% confidence intervals (CI). RESULTS: In total, 375,619 women were included in this study. Of these, 9660 (2.6%) had FOC in the first pregnancy (exposed group), and 365,959 (97.4%) had no FOC (non-exposed group). In the exposed group, 3600 (37.3%) women had second pregnancy ending in delivery during the study period, and 206,347 (56.4%) had the second pregnancy ending in delivery in the non-exposed group. The risk for the second pregnancy ending in delivery was lower among women with FOC (aHR 0.61, CI 0.59-0.63). CONCLUSIONS: FOC complicates pregnancy and delivery and is strongly associated with lower likelihood to get pregnant again. Therefore, more research should be focused on the optimal prevention of FOC using a standardized procedure of care and treatment for women with FOC.

Factors associated with fear of childbirth in a subsequent pregnancy: a nationwide case-control analysis in Finland.

BACKGROUND: Fear of childbirth can develop due to the concerns or adverse maternal or foetal outcomes experienced in a previous pregnancy. The aim of this study was to examine the main risk factors associated with the development of fear of childbirth during subsequent pregnancies and deliveries. METHODS: In this case-control study, data from the National Medical Birth Register were used to evaluate the events in previous pregnancies that were potential risk factors for fear of childbirth in subsequent pregnancies. The first and second pregnancies of women registered during our study period (2004-2018) were included. The exposure variable was delivery mode, obstetric challenge or adverse neonatal outcomes during the first pregnancy. The outcome was the development of FOC during the second pregnancy. Adjusted odds ratios with 95% CIs were used for comparison. RESULTS: A total of 13 064 pregnancies were included in the case group and 195 351 in the control group. Previous emergency caesarean section was the strongest risk factor for the development of FOC in the second pregnancy (adjusted odds ratio 5.27, CIs 4.83-5.75). In addition, unplanned CS (adjusted odds ratio 3.93, CIs 3.77-4.10) and vacuum delivery (adjusted odds ratio 1.69, CIs 1.61-1.77) also increased the odds of fear of childbirth. Of the obstetric complications, third- or fourth-degree tear of the perineum was the strongest risk factor (adjusted odds ratio 2.99, CIs 2.69-3.31), followed by shoulder dystocia (adjusted odds ratio 2.82, CIs 2.16-3.62). Neonatal mortality also increased the odds for the development of FOC (adjusted odds ratio 2.17, CIs 1.77-2.64). CONCLUSION: The main risk factors for the development of fear of childbirth in the second pregnancy were previous fear of childbirth, unplanned CS, vacuum delivery, perineal tear or shoulder dystocia. The results of this study can be used in a clinical setting to improve the prevention of fear of childbirth.