Change in medical practice over time? A register based study of regional trends in hysterectomy in Finland in 2001-2018.

BACKGROUND: A persistent research finding in Finland and elsewhere has been variation in medical practices both between and within countries. Variation seems to exist especially if medical decision making involves discretion and the best treatment cannot be identified unambiguously. This is true for hysterectomy when performed for benign causes. The aim of the current study was to investigate regional trends in hysterectomy in Finland and the potential convergence of rates over time. METHODS: We used hospital discharge register data on hysterectomies performed, diagnoses, age, and region of residence to examine hospital discharges for women undergoing hysterectomy in 2001-2018 among total female population aged 25 years or older in Finland. We examined hysterectomy rates among biannual cohorts by indication, calculated age-standardised rates and used multilevel models to analyse potential convergence over time. RESULTS: Altogether 131,695 hysterectomies were performed in Finland 2001-2018. We found a decreasing trend, with the age-adjusted overall hysterectomy rate decreasing from 553/100,000 person years in 2001-2002 to 289/100,000 py in 2017-2018. Large but converging regional differences were found. The correlations between hospital district intercepts and slopes in time ranged from - 0.71 to - 0.97 (p < 0.001) suggesting diminishing variation. CONCLUSIONS: Our findings demonstrate that change in hysterectomy practices and more uniformity across regions are achievable goals. Regional variation still exists suggesting differences in medical practices.

Nutritional status, energy, protein, and micronutrient intake of older service house residents.

OBJECTIVES: To examine the nutritional status and energy, protein, and micronutrient intake of aged residents living in service houses and to compare how they meet official recommendations. DESIGN: Cross-sectional study. PARTICIPANTS: Service house residents (n = 375) in the metropolitan region of Helsinki, Finland. MEASUREMENTS: The nutritional status of residents was assessed with the Mini Nutritional Assessment. Residents' energy, protein, and nutrient intake were calculated from 1-day food diaries and compared with the nutrition recommendations. RESULTS: The mean age of participants was 83 years; 82% were females. According to the Mini Nutritional Assessment, 65% were at risk for malnutrition and 21% were malnourished. Energy, protein, and nutrient intake varied greatly among residents. Inadequate energy, protein, and micronutrient intake was common among the oldest residents. Of the whole group, 46% received less than 1570 kcal/d of energy and 47% received less than 60 g/d of protein. Their intake of fiber, vitamin E, vitamin D, and folic acid was especially low. The percentages of residents receiving less than the recommended intake of these nutrients were 98%, 98%, 38%, and 86%, respectively. CONCLUSIONS: Taking into account the large number of aged residents suffering from malnutrition or being at risk for malnutrition, low energy, protein, and micronutrient intake was very common. Assessment-based nutritional care should be a significant part in supporting frail older people in service houses.

Bread fortified with cholecalciferol increases the serum 25-hydroxyvitamin D concentration in women as effectively as a cholecalciferol supplement.

Fortification of foods is a feasible way of preventing low vitamin D status. Bread could be a suitable vehicle for fortification because it is a common part of diets worldwide. The bioavailability of cholecalciferol from bread is not known. We studied cholecalciferol stability, the concentration of the added cholecalciferol, the dispersion of cholecalciferol in bread, and the bioavailability of cholecalciferol from fortified bread. Three batches of fortified low-fiber wheat and high-fiber rye breads were baked; from each batch, 3 samples of dough and bread were analyzed for their cholecalciferol content. In a single-blind bioavailability study, 41 healthy women, 25-45 y old, with mean serum 25-hydroxyvitamin D concentration 29 nmol/L (range 12-45 nmol/L), were randomly assigned to 4 study groups. Each group consumed fortified wheat bread, fortified rye bread, regular wheat bread (control), or regular wheat bread and a cholecalciferol supplement (vitamin D control) daily for 3 wk. The daily dose of vitamin D was 10 mug in all groups except the control group. The vitamin dispersed evenly in the breads and was stable. Both fortified breads increased serum 25-hydroxyvitamin D concentration as effectively as the cholecalciferol supplement. Supplementation or fortification did not affect serum intact parathyroid hormone concentration or urinary calcium excretion. In conclusion, fortified bread is a safe and feasible way to improve vitamin D nutrition.