Pregnancy period and early-life risk factors for inflammatory bowel disease: a Northern Finland birth cohort 1966 study.

BACKGROUND: The pathogenesis of inflammatory bowel disease (IBD) has not been fully elucidated. The aim of this study was to analyze the pregnancy period, perinatal period, and infancy period risk factors for IBD in a well-characterized birth cohort from Northern Finland. METHODS: The Northern Finland Birth Cohort 1966 (NFBC1966) population comprises mothers living in the two northernmost provinces of Finland, Oulu, and Lapland, with dates of delivery between Jan 1st and Dec 31st, 1966 (12 055 mothers, 12 058 live-born children, 96.3% of all births during 1966). IBD patients were identified using hospital registries (from 1966 to 2020) and Social Insurance Institution (SII) registry reimbursement data for IBD drugs (from 1978 to 2016). The data were analyzed by Fisher's exact test and logistic regression. RESULTS: In total, 6972 individuals provided informed consent for the use of combined SII and hospital registry data. Of those, 154 (2.1%) had IBD (113 [1.6%] had ulcerative colitis (UC), and 41 (0.6%) had Crohn's disease (CD)). According to multivariate analysis, maternal smoking > 10 cigarettes/day during pregnancy was associated with a nearly 6-fold increased risk of CD in the offspring (OR 5.78, 95% CI 1.70-17.3). Breastfeeding (OR = 0.18, 95% CI 0.08-0.44) and iron supplementation during the first year of life (OR = 0.43, 95% CI 0.21-0.89) were negatively associated with CD. CONCLUSIONS: Smoking during pregnancy was associated with the risk of CD while Breastfeeding and oral iron supplementation at infancy were negatively associated with the risk of CD later in life.

Healthcare resource utilization and associated costs among patients with migraine in Finland: A retrospective register-based study.

Migraine is a common chronic brain disorder, characterized by recurring and often disabling attacks of severe headache, with additional symptoms such as photophobia, phonophobia and nausea. Migraine affects especially the working age population. The objective of this retrospective observational register-based study was to analyze the use of healthcare services and associated costs in Finnish migraine patients. Study was based on aggregate data from January 1st, 2020, to December 31st, 2021, from the Finnish Institute for Health and Welfare's national registries. Patients were grouped into nine patient groups according to medication prescriptions and diagnoses. Healthcare resource utilization in specialty, primary, and occupational healthcare was assessed and analyzed separately for all-cause and migraine related healthcare contacts from a one-year period. The total number of patients was 175 711, and most (45%) of the patients belonged to a group that had used only one triptan. Migraine related total healthcare resource utilization was greater for patients that had used two or more triptans compared to those that had used only one. The patients with three or more preventive medications had the highest total migraine related healthcare resource utilization of the studied patient cohorts. Of the total annual healthcare costs 11.5% (50.6 million €) was associated to be migraine related costs. Total per patient per year healthcare costs were highest with patients that had used three or more preventive medications (5 626 €) and lowest in those with only one triptan (2 257 €). Our findings are in line with the recent European Headache Federation consensus statement regarding the unmet need in patients who have had inadequate response to two or more triptans. When assessing the patient access and cost-effectiveness of novel treatments for the treatment of migraine within different healthcare systems, a holistic analysis of the current disease burden along with potential gains for patients and healthcare service providers are essential information in guiding decision-making.

Sauna bathing and mortality risk: unraveling the interaction with systolic blood pressure in a cohort of Finnish men.

Objectives: This cohort study aimed to investigate the potential interplay between systolic blood pressure (SBP), frequency of sauna bathing (FSB), and all-cause mortality risk among Caucasian men. Design: A prospective study was conducted, involving 2575 men aged 42 to 61 years. Baseline assessments included resting blood pressure measurements and self-reported sauna bathing habits. SBP levels were categorized as normal (<140 mmHg) or high (≥140 mmHg), while FSB was classified as low (≤2 sessions/week) or high (3-7 sessions/week). Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox regression analysis, while adjusting for lifestyle factors, lipids, inflammation, and comorbidities. Results: Over a median follow-up of 27.8 years, 1,618 deaths were recorded. In the adjusted analysis, individuals with high SBP versus low SBP showed a 29% increased all-cause mortality risk (HR 1.29, 95% CI 1.16-1.43). Similarly, those with low FSB versus high FSB exhibited a 16% elevated mortality risk (HR 1.16, 95% CI 1.02-1.31). When considering combined effects, participants with high SBP-low FSB had a 47% higher mortality risk (HR 1.47, 95% CI 1.24-1.74) compared to those with normal SBP-high FSB. However, no significant association was observed between individuals with high SBP-high FSB and mortality risk (HR 1.24, 95% CI 0.98-1.57). There were potential additive and multiplicative interactions between SBP and sauna bathing concerning mortality risk. Conclusions: This study reveals a potential interplay between SBP, sauna bathing, and mortality risk in Finnish men. Frequent sauna bathing may mitigate the increased mortality risk associated with elevated SBP.

Patient perception of labor support behaviors provided by Finnish midwives.

BACKGROUND: Almost all births in Finland occur in hospitals, but the concept of labor support behavior is not well-known among Finnish midwives. OBJECTIVE: The primary aim was to increase perceived labor support as measured by BANSILQ. METHODS: This study was tailored to evaluate the impacts of short on-the-job training interventions for midwives (n=70) in labor support given to mothers. The training was conducted at one university hospital and and one regional hospital during 2012. The trainings were carried out twice at both hospitals to reach as many miwdwives as possible to participate. Two university hospitals-one regional and one central-were selected as controls. New mothers were asked to complete the Bryanton Adaptation of the Nursing Support in Labor Questionnaire (BANSILQ) in the postpartum wards at all the selected hospitals before the intervention (n=1500) and after the intervention (n=1500). The data were linked to the Finnish Medical Birth Register (MBR). As this is an in-job training intervention study and not a trial, it has not been registered in a trial registry. RESULTS: The response rate was 68% (n=1020) for the pre-intervention survey and 47% (n=704) for the post-intervention survey. At the regional-level intervention hospital, the mean length of the second stage of childbirth decreased significantly. A bonding time of at least three minutes was three times more likely at both intervention hospitals. Support for breastfeeding was twice as likely at the university-level hospital after the intervention. In all the study hospitals, mothers with less education were more likely to receive tangible and informal support than highly educated mothers. CONCLUSIONS: This short on-the-job intervention did not increase labor support provided by Finnish midwives in its entirety, and the effect on birth outcomes was minimal. However, support for breastfeeding increased, and some types of support were targeted at those who needed it most. To improve midwifery care, both training and sufficient resources are needed.

Impacts of Post Critical Incident Seminar on emergency service personnel: The critical incident-related experiences and psychological state.

INTRODUCTION: Post Critical Incident Seminar (PCIS) is an intervention originally developed by the Federal Bureau of Investigation (FBI) for supporting law enforcement officers who have faced critical incidents (CIs) at work. In Finland, police forces have arranged modified PCIS regularly since 2012, but the first PCIS for emergency service personnel was organized in 2020. PCIS consists of psychoeducation, peer support, and mental health professional support/Eye Movement Desensitization and Reprocessing (EMDR). Previous international studies of PCIS are scarce. Our research question was this: After 6 months, how do emergency service personnel who have participated in the PCIS describe the impacts of PCIS on experiences and psychological state evoked by the CI that was the reason to apply for it? METHODS: The data consisted of individual interviews 6 months after attending the PCIS. The number of participants in this study was 15 (94%). The data was analyzed qualitatively with inductive content analysis. RESULTS: The impacts of PCIS on incident-related experiences and state 6 months afterward were divided into five main categories: social changes, new perspectives and sensations, incident-related components, future-oriented processes, and new abilities and actions. CONCLUSIONS: PCIS can have multilevel impacts on the experiences and psychological state caused by a CI. These impacts are reflected, for example, in their inner experience, choices, emotions, actions, and relationships with others in different areas of life. As a result of PCIS, the emergency service personnel's relationship with CIs in the past and the ability to function in the future can change. Further study is needed to investigate the long-term impacts of the PCIS.

The relationship between sensory impairment and home care client's received care time-A cross-sectional study.

AIM: The aim of this study was to explore the relationship between sensory impairment and home care client's received care time. DESIGN: A cross-sectional multi-source study. METHODS: Data from a self-reported staff survey on care time allocation were merged with registry data from the Resident Assessment Instrument registry (n = 1477). The data were collected during 1 week from 17 home care units in Finland in October 2021. The relationship between sensory impairment and clients received care time was examined using linear regression analyses. RESULTS: The linear regression analyses showed that having vision impairment alone increased care time, while dual sensory impairment resulted in decreased received care time. Hearing impairment alone was not statistically significantly associated with care time. CONCLUSION: The holistic care need of home care clients with dual sensory impairment may not be adequate. To ensure equality and the individually tailored care of clients, further attention must be paid to clients with sensory impairments, especially those with dual sensory impairment. Furthermore, the competence of home care workers to encounter and communicate with clients with sensory impairment must be developed to support the holistic care. IMPLICATIONS FOR THE PATIENT CARE: The sensory impairments of home care clients must be identified in time and considered in care planning and encountering clients. IMPACT: As there is a risk that clients with dual sensory impairment are not able to fully express themselves, it is imperative that further attention is paid to clients with sensory impairments, to better understand and support this vulnerable group. Increased awareness and continuous education are needed to better identify and support home care clients with sensory impairment. REPORTING METHOD: The study adheres to the STROBE reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Associations of diet quality and food consumption with serum biomarkers for lipid and amino acid metabolism in Finnish children: the PANIC study.

PURPOSE: To investigate the associations of overall diet quality and dietary factors with serum biomarkers for lipid and amino acid metabolism in a general population of children. METHODS: We studied 194 girls and 209 boys aged 6-8 years participating in the Physical Activity and Nutrition in Children study. Food consumption was assessed by 4-day food records and diet quality was quantified by the Finnish Children Healthy Eating Index (FCHEI). Fasting serum fatty acids, amino acids, apolipoproteins, as well as lipoprotein particle sizes were analyzed with high-throughput nuclear magnetic resonance spectroscopy. Data were analyzed using linear regression adjusted for age, sex, and body fat percentage. RESULTS: FCHEI was directly associated with the ratio of polyunsaturated (PUFA) to saturated fatty acids (SFA) (PUFA/SFA), the ratio of PUFA to monounsaturated fatty acids (MUFA) (PUFA/MUFA), the ratio of PUFA to total fatty acids (FA) (PUFA%), the ratio of omega-3-fatty acids to total FA (omega-3 FA%), and inversely associated with the ratio of MUFA to total FA (MUFA%), alanine, glycine, histidine and very-low density lipoprotein (VLDL) particle size. Consumption of vegetable oils and vegetable-oil-based margarine (≥ 60% fat) was directly associated with PUFA/SFA, PUFA/MUFA, PUFA%, the ratio of omega-6 FA to total FA (omega-6 FA%), and inversely associated with SFA, MUFA, SFA to total FA (SFA%), MUFA%, alanine and VLDL particle size. Consumption of high-fiber grain products directly associated with PUFA/SFA, PUFA/MUFA, omega-3 FA%, omega-6 FA%, PUFA% and inversely associated with SFA and SFA%. Fish consumption directly related to omega-3 FA and omega-3 FA%. Consumption of sugary products was directly associated with histidine and VLDL particle size. Vegetable, fruit, and berry consumption had direct associations with VLDL particle size and the ratio of apolipoprotein B to apolipoprotein A1. Consumption of low fat (< 1%) milk was directly associated with phenylalanine. A higher consumption of high-fat (≥ 1%) milk was associated with lower serum MUFA/SFA and higher SFA%. Sausage consumption was directly related to SFA% and histidine. Red meat consumption was inversely associated with glycine. CONCLUSIONS: Better diet quality, higher in intake of dietary sources of unsaturated fat and fiber, and lower in sugary product intake were associated with more favorable levels of serum biomarkers for lipid and amino acid metabolism independent of adiposity. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01803776, registered March 3, 2013.

Natural radioactivity of residues from groundwater treatment facilities in Finland.

The accumulation of naturally occurring radionuclides in solid residues was investigated from groundwater treatment facilities (GTFs) in Finland. Natural radionuclides U-238, Ra-226, Pb-210 and Ra-228 were found in various precipitates, sludges and filters at concentrations exceeding the general clearance level of 1 kBq kg-1used for solid materials in the European directive 2013/59/Euratom. The accumulation of natural radionuclides in different solid residues was observed even when the activity concentrations in the untreated groundwater were relatively low, and when there was no measurable change in the concentrations between raw and treated groundwater within analytical uncertainties. Based on mass and activity balance considerations this is thought to be due to the large volumes of treated water per year. The exposure of workers to natural radiation from solid residues in the regular use of a groundwater facility was found not to be likely to exceed 0.3 mSv a-1if the activity concentrations are <10 kBq kg-1for U-238, Ra-226, Pb-210 and Ra-228. The worker exposure from solid residues is therefore likely to remain below the reference level of 1 mSv a-1, and indoor radon is more of a concern for the radiation protection of workers at GTFs. However, the natural radionuclide content in the different solid residues from groundwater treatment needs to be characterised properly to be able to ensure safety in the final use of the residues with respect to the potential exposure of the public.

Use of complementary and integrative health in Finland: a cross-sectional survey.

BACKGROUND: Population based studies have shown large differences in the estimated prevalence of complementary and integrative health (CIH) usage between studies. This is in part due to there being no golden standard definition for CIH. In Finland, an updated and internationally comparable study on the prevalence of CIH usage is needed. In the present study, a modified Finnish version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-QFI) was utilised to examine prevalence of use of different CIH modalities and their experienced helpfulness in the general Finnish population. METHODS: Respondents aged 16 and above were invited to take part in this descriptive cross-sectional study through an online panel in December 2022. The usage of CIH and the experienced helpfulness were calculated with SPSS (v28) as the proportion of users per each modality. The data were weighted based on gender, age and place of residence. RESULTS: A total of 3244 respondents completed the survey. CIH was used by 51.1% (95%CI: 49.4-52.8) of the respondents in the 12 months prior to the survey. Self-help practices were the most used category of CIH (28.8%; 95%CI: 27.3-30.4). The prevalence of usage of CIH natural remedies excluding vitamins and minerals was 27.0% (95%CI: 25.5-28.6). CIH providers were visited by 20.4% of the respondents (95%CI: 19.0-21.8). Getting help for a long-term illness or improvement of well-being were often mentioned as the most important reason for the use of different CIH modalities. CIH was generally used more by women compared to men. The large majority found the modalities they used helpful. CONCLUSIONS: The results increase current understanding on CIH usage in Finland. As the majority of users experience CIH as helpful, there is a need to study CIH in the context of public health policies. The estimates of CIH usage are highly dependent on what is considered as CIH, and this should be paid attention to in future studies.

The effect of vitamin D3 supplementation on atrial fibrillation in generally healthy men and women: The Finnish Vitamin D Trial.

Atrial fibrillation is a common cardiac arrhythmia with high morbidity risk. Observational studies suggest that vitamin D deficiency is associated with higher atrial fibrillation risk but there is limited evidence whether vitamin D supplementation could affect the risk. In these post hoc analyses from the Finnish Vitamin D Trial, we compared the incidence of atrial fibrillation with 5-year supplementation of vitamin D3 (1600 IU/d or 3200 IU/d) vs placebo. CLINICAL TRIAL REGISTRY NUMBER: ClinicalTrials.gov: NCT01463813, https://clinicaltrials.gov/ct2/show/NCT01463813.

Female doping: observations from a data lake study in the Hospital District of Helsinki and Uusimaa, Finland.

BACKGROUND: Doping is a well-recognized risk factor for several potentially severe health effects. Scientific literature concerning the need for medical treatment for such adversities is still sparse. This is especially true for women, due to lower doping use prevalence compared to men. Our study explored the nature of medical contacts and deviance in red blood cell parameters of female patients with doping use in Finnish specialized health care. METHODS: This was a retrospective register study. The study sample was gathered from the Hospital District of Helsinki and Uusimaa, Finland (HUS) Datalake. An exhaustive search for doping related terms was performed to find patients with doping use documentation within free-text patient records. Medical record data was supplemented with laboratory data and medical diagnoses covering a total observation time of two decades. Statistical analysis included Fisher's Exact Test and one-way ANOVA. RESULTS: We found 39 female patients with history of doping use and specialized health care contacts in the HUS-area between 2002-2020. At initial contact (i.e., the first documentation of doping use), the mean age of these patients was 33.6 years (min 18.1, max 63.5, SD 10.6). The most frequently used doping agents were anabolic androgenic steroids (AAS). The initial contacts were significantly more often acute in nature among patients with active doping use than among patients with only previous use (no use within one year; p = 0.002). Psychiatric and substance use disorder (SUD) morbidity was high (46.2% and 30.8%, respectively). Eight patients (20.5%) had received specialized health care for acute poisoning with alcohol or drugs, and nine (23.1%) for bacterial skin infections. Less than 45% of patients with active AAS use presented with off-range red blood cell parameters. CONCLUSIONS: Our findings suggest that female patients with a history of doping use encountered in specialized health care may exhibit high psychiatric and SUD related morbidity. Also, majority of patients with AAS use had red blood cell parameters within-range. Further studies are required to assess the generalizability of these findings to patients within primary health care services, and to determine the usefulness of hematological parameters as indicators of AAS use in female patients.

The Interplay between Systolic Blood Pressure, Sauna Bathing, and Cardiovascular Mortality in Middle-Aged and Older Finnish Men: A Cohort Study.

OBJECTIVES: Elevated systolic blood pressure (SBP) is associated with an increased risk of cardiovascular disease (CVD) mortality, whereas frequent sauna bathing reduces the risk. Whether frequent sauna bathing mitigates CVD mortality among adults with elevated SBP has not been previously investigated. DESIGN AND SETTING: We examined the interactions between SBP and frequency of sauna bathing (FSB) with the risk of CVD mortality in a cohort of Caucasian men. PARTICIPANTS: The Kuopio Ischaemic Heart Disease Study cohort comprising of 2,575 men aged 42-61 years at baseline was employed for this prospective study analysis. MEASUREMENTS: Resting blood pressure was measured using a standardized protocol and sauna bathing habits were assessed by a self-administered questionnaire. Systolic blood pressure was categorized as normal and high (<140 and ≥140 mmHg, respectively) and FSB as low and high (defined as ≤ 2 and 3-7 sessions/week, respectively). RESULTS: A total of 744 CVD deaths were recorded during a median follow-up of 27.8 yr. Comparing high vs normal SBP, the multivariable-adjusted HR (95% CI) for CVD mortality was 1.44 (1.23-1.68). Comparing low vs high FSB, the multivariable-adjusted HR (95% CI) for CVD mortality was 1.24 (1.03-1.51). The associations persisted following mutual adjustment for each exposure. Compared with men with normal SBP-high FSB, high SBP-low FSB was associated with an increased risk of CVD mortality 1.81 (1.39-2.36), with attenuated but persisting evidence of an association for men with high SBP and high FSB 1.52 (1.06-2.16). When SBP was categorized as normal and high (<130 and ≥130 mmHg, respectively), there was no evidence of an association for men with high SBP and high FSB 1.11 (0.77-1.61). CONCLUSION: There might be an interaction between SBP, sauna bathing and CVD mortality risk in middle-aged and older Caucasian males. Frequent sauna baths may offset the increased risk of CVD mortality in men with high-normal SBP but not elevated SBP.

Comorbidities and Medication Use in Finnish Patients with Psoriasis: A Population-Based Registry Study.

Therapeutic options for psoriasis vulgaris have changed during recent decades with the introduction of biologics. Few nationwide studies are available on psoriasis treatment patterns, and those from Finland predate the use of biologics. The aim of this retrospective, population-based registry study was to identify patients with psoriasis vulgaris and their treatment patterns in the secondary care setting in Finland. The study cohort included 41,456 adults with a diagnosis of psoriasis vulgaris in the public secondary healthcare setting from 2012 through 2018. Data on comorbidities, pharmacotherapy, and phototherapy were collected from nationwide healthcare and drug registries. Patients in the cohort had a wide range of comorbidities, with 14.9% having psoriatic arthritis. Treatment was based largely on topical and conventional systemic medications. Conventional medications were used by 28.9% of patients, and methotrexate was the most common option (20.9%). Biologics were used by 7.3% of patients, mostly as second- and third-line treatment. The use of conventional systemic medications, topical treatments, and phototherapy decreased after the initiation of biologics. This study of psoriasis vulgaris in Finland provides a framework for the development of future care practices.

In-hospital supplementation and subsequent breastfeeding practices in Finland: A cross-sectional population-level study.

BACKGROUND: The Baby-Friendly Hospital Initiative suggests that in-hospital supplementation should be avoided unless medically indicated. The supporting evidence is contradictory, as nonexperimental studies have shown an association between supplementation and decreased breastfeeding rates, whereas trials have failed to do so. The aim of this study was to investigate whether in-hospital supplementation is associated with exclusive breastfeeding to the age of 5 months and any breastfeeding to the age of 12 months in full-term, normal-weight singleton infants. METHODS: This is a secondary analysis of national-level, cross-sectional survey data. The data were collected in child health clinics in Finland. Families attending a regular health examination with a child aged 2 weeks to 12 months were eligible to participate. Full-term, normal-weight, singleton infants (n = 3025) were included in this study. Multivariate logistic regression was performed using in-hospital supplementation and socioeconomic characteristics as covariates and exclusive and any breastfeeding as outcomes. RESULTS: In total, 55.3% (n = 1631) of the infants received in-hospital supplementation. After controlling for socioeconomic factors, in-hospital supplementation was associated with decreased exclusive breastfeeding to the age of 5 months and with a decrease in any breastfeeding to the age of 7 months. CONCLUSIONS: Our findings suggest that noncontrolled supplementation, without a trial's rigorous procedures of care, is associated with decreased breastfeeding postdischarge. Both donor milk and infant formula use were associated with lower breastfeeding rates, although the association was stronger with formula use. In clinical settings, liberal, nonmedically indicated supplementation should be avoided.

Medicine use in people with intellectual disabilities: a Finnish nationwide register study.

BACKGROUND: People with intellectual disability (ID) are a vulnerable group in our society; many of them depend on other people for assistance in their everyday lives. Compared with the general population, people with ID have poorer general health and, therefore, need more healthcare services and use more medicines. The aim of this study is to define the population of all Finnish people with ID using administrative data and to compare their medicine use and expenditure on medicines to those of the age-matched and sex-matched controls. METHODS: People with ID and their age-matched and sex-matched controls (1:1) were extracted from nationwide healthcare and social allowance registers. Administrative register data on all prescription medicine purchases in 2019 were used to determine the prevalence of medicine use in both groups on a general level and by medicine categories. The differences in the prevalence of medicine use between the two groups were analysed using the logistic regression model. In addition, we studied the total expenditure on reimbursable medicine purchases covered by the National Health Insurance between people with ID and control group. RESULTS: The subpopulation of people with ID consisted 37 196 individuals, of whom 82.7% purchased prescription medicines in 2019. The corresponding share of individuals purchasing prescription medicines in the control group was 70.3%. The differences in the prevalence of medicine use between the two populations were highest in the younger age groups (0-6, 7-12 and 13-17). In the study population, 28.1% (OR = 12.28; 95% CI: 11.54-13.07) of the people used antipsychotics, making it the most used medicine category in people with ID. In the control group, 3.3% of people used antipsychotics. Compared with the control group, the use of antiepileptics, drugs for constipation, mineral supplements and anxiolytics was four to seven times higher among people with ID. Furthermore, the median expenditure on medicine use among people with ID was four times higher than in the control group. CONCLUSIONS: Compared with the control group, people with ID used more medicines, especially psychotropics, and their expenditure on medicine use was higher.

Sources of vitamin D and determinants of serum 25-hydroxyvitamin D in Finnish adolescents.

PURPOSE: To study the intake and sources of vitamin D and determinants of serum 25-hydroxyvitamin D (S-25(OH)D) in Finnish adolescents. METHODS: We studied 265 adolescents (117 girls) aged 15-17 years attending 8-year examinations of the PANIC Study, assessed diet using food records and other lifestyle factors by questionnaires, and analyzed S-25(OH)D by chemiluminescence immunoassay and determinants of S-25(OH)D using multivariate linear regression. RESULTS: Mean (standard deviation) of total vitamin D intake from food and supplements was 19.2 (13.1) µg/d, and that of dietary vitamin D intake was 9.9 (5.4) µg/d. Milk fortified with vitamin D was the main dietary source of vitamin D, providing 45% of daily intake. Altogether, 29% of the adolescents used no vitamin D supplements and 25% did not meet the recommended total vitamin D intake of 10 µg/d. Mean (standard deviation) of S-25(OH)D was 62.0 (18.8) nmol/l, and S-25(OH)D was < 50 nmol/l in 29.5% of the adolescents. Vitamin D intake from supplements was the main determinant of S-25(OH)D (ß = 0.465, p < 0.001), followed by consumption of milk products (ß = 0.251, p < 0.001), consumption of meat products (ß = 0.179, p = 0.002), travels to sunny countries (ß = 0.178, p = 0.002), and average daylight time (ß = 0.162, p = 0.004). CONCLUSION: Most of the adolescents had vitamin D intake at the recommended level, although a fourth did not meet the recommended total vitamin D intake of 10 µg/d and almost a third had S-25(OH)D < 50 nmol/l. More attention should be paid to the sufficient intake of vitamin D in adolescents who do not use vitamin D supplements or fortified milk products. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01803776, registered March 3, 2013.

Recognising older people's individual resources and home-care-specific tasks in home care in Finland: A document analysis of care and service plans.

BACKGROUND AND RATIONALE: Comprehensive care and service planning in home care is tailored to older people's individual needs and resources in order to support them living at home. However, little is known about how these individual resources and home-care-specific tasks are recognised in older people's care and service plans. AIMS: To describe the content of care and service plans in older people's home care with special attention to their individual resources and home-care-specific tasks. DESIGN: This was a document-based cross-sectional study with mixed-methods analysis, carried out in Eastern Finland during Spring 2018. METHODS: A document analysis using the deductive Finnish Care Classification (FinCC), and an inductively developed framework of older people's care and service plans (n = 71). The data were analysed with descriptive statistical methods. RESULTS: Altogether, 1718 notes were relevant to the FinCC main categories: 707 (41%) focused on older people's needs and 1011 (59%) on nursing interventions. We identified 1104 notes based on the 26 inductively developed main categories: the majority (n = 628, 57%) focused on individual resources and the remainder (n = 476, 43%) on home-care-specific tasks. Increasing age resulted in fewer notes on safety and sensory functions. There were fewer notes on resources related to sleeping and wakefulness after longer care and service periods. An increased number of home visits resulted in more documentation on tasks related to pharmaceutical issues, including repeat prescriptions. DISCUSSION: Individual resources for older people were documented, to some extent, in their care and service plans. It is necessary to review these alongside home-care-specific tasks that support older people's independence and safety at home. CONCLUSION: Individual resources need to be recognised in order to enable home-care professionals to provide tailored, high-quality home care services. Home-care-specific tasks should be supported by documentation with updated, sensitive home care classifications.

National registry-based data of adverse events in Finnish long-term professional homecare in 2009-2019.

AIMS AND OBJECTIVES: The aim of this study was to discover the nature of the adverse events in Finnish long-term professional homecare reported by professionals, and to identify the circumstances in which adverse events occur and their consequences. BACKGROUND: Adverse events are incidents causing unintended and unnecessary harm to older people at home. Safety is a basic human right and a fundamental prerequisite for independent living among older people at home. Few studies have focused on both long-term professional homecare environment and the safety of older people. DESIGN: The research was a descriptive registry-based study. METHODS: This study consisted of adverse events (N = 61248) in Finnish public long-term professional homecare (2009-2019). Data were described using frequencies and percentages. STROBE statement checklist was chosen for reporting the study process. RESULTS: By profession, practical nurses and registered nurses reported the most of adverse events (89.8%). These were either critical incidents (78.3%) or near misses (20.0%) and concerned medicine, injuries and accidents, information flow or management. Consequences for older people were usually rated from no-harm to moderate harm. For long-term professional homecare, image harm, extra financial costs, no-harm and prolonged care for older people were among the consequences. Personnel frequently observed the older people afterwards and informed older people of adverse events, yet some of actions were unknown. CONCLUSIONS: Many harmful adverse events are considered harmless for older people. Sometimes this can lead to unmet care needs or missed care. The degree of harm needs to be assessed in terms of physical, mental and social health with the HaiPro reporting system for homecare. RELEVANCE TO CLINICAL PRACTICE: An understanding and a comprehensive view of the situation and holistic assessment of care needs includes safety and safety risks to increase safety and feeling of safety for older people at home.

Medical and midwifery students need increased sexual medicine education to overcome barriers hindering bringing up sexual health issues - A national study of final-year medical and midwifery students in Finland.

OBJECTIVES: Physicians and midwives meet patients with sexual health issues regularly; however, they may have limited sexual medicine education. The study's aim was to evaluate the self-reported competence of medical and midwifery students to bring up sexual health issues with their patients and to assess the barriers that hinder these discussions. The need for additional education was also evaluated. STUDY DESIGN: A web-based questionnaire was sent to the last-year medical and midwifery students graduating between December 2018 and May 2019 in Finland. In total, 233 medical students and 131 midwifery students participated in the study. Three fields were evaluated: the self-reported competence in discussing sexual health issues and treating patients with these issues, the barriers to bringing up sexual problems, and the need for education in sexual medicine. RESULTS: The students self-reported better competence in discussing sexual health issues than in treating patients' sexual problems. For the medical students, the most important barriers hindering bringing up sexual health issues were lack of i) time (89.2 %), ii) experience with sexual medicine (88.1 %), and iii) knowledge (82.1 %). For the midwifery students, the most important barriers were i) lack of experience with sexual medicine (73.3 %), ii) fear of failing to respond to patients' sexual health issues (64.9 %), and iii) lack of knowledge (62.5 %). A higher percentage of the midwifery students (96.2 %) reported an interest in sexual medicine education compared to the medical students (55.4 %) (OR 13.89, 95 % CI 5.32-35.71, P <.001). Majority (76.5 %) of the medical students and almost half (45.0 %) of the midwifery students reported receiving too little sexual medicine education (OR 7.30, 95 % CI 4.00-13.33, P <.001). CONCLUSIONS: Both student groups reported several barriers hindering bringing up sexual health issues with their patients and expressed a need for more education, particularly the medical students.

"Local cooperation has been the cornerstone": facilitators and barriers to resilience in a decentralized health system during COVID-19 in Finland.

PURPOSE: The purpose of this study was to elucidate facilitators and barriers to health system resilience and resilient responses at local and regional levels during the first year of the COVID-19 pandemic in Finland. DESIGN/METHODOLOGY/APPROACH: The authors utilized a qualitative research approach and conducted semi-structured interviews (n = 32) with study participants representing five different regions in Finland. Study participants were recruited using purposive and snowball sampling. All study participants had been in management and civil servant positions during the first year of the pandemic, representing municipalities, municipalities' social and healthcare services, hospital districts and regional state administrative agencies. All interviews were completed remotely from April to December 2021 and the recordings transcribed verbatim. The authors coded the transcripts in ATLAS.ti 9.1 using directed content analysis. FINDINGS: The findings highlighted a wide range of localized responses to the pandemic in Finland. Facilitators to health system resilience included active networks of cooperation, crisis anticipation, transitioning into crisis leadership mode, learning how to incorporate new modes of operation, as well as relying on the competencies and motivation of health workforce. The authors found several barriers to health system resilience, including fragmented organization and management particularly in settings where integrated health care systems were not in place, insufficient preparedness to a prolonged crisis, lack of reliable information regarding COVID-19, not having plans in place for crisis communication, pandemic fatigue, and outflux of health workforce to other positions with better compensation and working conditions. ORIGINALITY/VALUE: Factors affecting health system resilience are often studied at the aggregate level of a nation. This study offers insights into what resilient responses look like from the perspective of local and regional actors in a decentralized health system. The results highlight that local capacities and context matter greatly for resilience. The authors call for more nuanced analyses on health systems and health system resilience at the sub-national level.