Detecting epinephrine auto-injector shortages in Finland 2016-2022: Log-data analysis of online information seeking.

INTRODUCTION: Medicine shortages prevail as a worldwide problem causing life-threatening situations for adults and children. Epinephrine auto-injectors are used for serious allergic reactions called anaphylaxis, and alternative auto-injectors are not always available in pharmacies. Healthcare professionals in Finland use the dedicated internet source, Physician's Database (PD), when seeking medical information in practice, while Health Library (HL) provides health information for citizens (S1 Data). The objectives were to assess whether (1) professionals' searches for epinephrine auto-injectors and (2) citizens' anaphylaxis article openings relate to epinephrine shortages in Finland. METHODS: Monthly log data on epinephrine auto-injectors (EpiPen®, Jext®, Emerade®) from PD and on openings of anaphylaxis articles from HL were collected during 2016-2022. Professionals' searches of seven auto-injectors and citizens' openings of four anaphylaxis articles were compared to information on epinephrine shortages reported by Finnish Medicines Agency. Professionals' auto-injector prescriptions provided by Social Insurance Institution were also assessed. RESULTS: Total searches in EpiPen® (N = 111,740), Jext® (N = 25,631), and Emerade® (N = 18,329) could be analyzed during 2016-2022. EpiPen® only could visually show seasonal patterns during summertime, peaking vigorously in the summer of 2018 when the major EpiPen® shortage appeared worldwide. Anaphylaxis articles equaled 2,030,855 openings altogether. Openings of one anaphylaxis article ("Bites and Stings") peaked during summertime, while another article ("Anaphylactic Reaction") peaked only once (three-fold increase) at the end of 2020 when COVID-19 vaccinations started, and auto-injector prescriptions were lowest. Fifty EpiPen®, one Jext®, and twelve Emerade® shortages were reported. Almost a two-fold increase in peaks of auto-injector prescriptions was found during summertime. CONCLUSION: This study shows that (1) epinephrine shortages related to professionals' searching for auto-injectors, and (2) citizens' information seeking on anaphylaxis related to summertime and shortages with lesser prescriptions. Therefore, the dedicated internet databases aimed at professionals and citizens could be used as additional information sources to detect anaphylactic reactions and auto-injector shortages.

Online searches of children's oseltamivir in public primary and specialized care: Detecting influenza outbreaks in Finland using dedicated databases for health care professionals.

INTRODUCTION: Health care professionals working in primary and specialized care typically search for medical information from Internet sources. In Finland, Physician's Databases are online portals aimed at professionals seeking medical information. As dosage errors may occur when prescribing medication to children, professionals' need for reliable medical information has increased in public health care centers and hospitals. Influenza continues to be a public health threat, with young children at risk of developing severe illness and easily transmitting the virus. Oseltamivir is used to treat children with influenza. The objective of this study was to compare searches for children's oseltamivir and influenza diagnoses in primary and specialized care, and to determine if the searches could aid detection of influenza outbreaks. METHODS: We compared searches in Physician's Databases for children's oral suspension of oseltamivir (6 mg/mL) for influenza diagnoses of children under 7 years and laboratory findings of influenza A and B from the National Infectious Disease Register. Searches and diagnoses were assessed in primary and specialized care across Finland by season from 2012-2016. The Moving Epidemic Method (MEM) calculated seasonal starts and ends, and paired differences in the mean compared two indicators. Correlation was tested to compare seasons. RESULTS: We found that searches and diagnoses in primary and specialized care showed visually similar patterns annually. The MEM-calculated starting weeks in searches appeared mainly in the same week. Oseltamivir searches in primary care preceded diagnoses by -1.0 weeks (95% CI: -3.0, -0.3; p = 0.132) with very high correlation (τ = 0.913). Specialized care oseltamivir searches and diagnoses correlated moderately (τ = 0.667). CONCLUSION: Health care professionals' searches for children's oseltamivir in online databases linked with the registers of children's influenza diagnoses in primary and specialized care. Therefore, database searches should be considered as supplementary information in disease surveillance when detecting influenza epidemics.

Analyzing Citizens' and Health Care Professionals' Searches for Smell/Taste Disorders and Coronavirus in Finland During the COVID-19 Pandemic: Infodemiological Approach Using Database Logs.

BACKGROUND: The COVID-19 pandemic has prevailed over a year, and log and register data on coronavirus have been utilized to establish models for detecting the pandemic. However, many sources contain unreliable health information on COVID-19 and its symptoms, and platforms cannot characterize the users performing searches. Prior studies have assessed symptom searches from general search engines (Google/Google Trends). Little is known about how modeling log data on smell/taste disorders and coronavirus from the dedicated internet databases used by citizens and health care professionals (HCPs) could enhance disease surveillance. Our material and method provide a novel approach to analyze web-based information seeking to detect infectious disease outbreaks. OBJECTIVE: The aim of this study was (1) to assess whether citizens' and professionals' searches for smell/taste disorders and coronavirus relate to epidemiological data on COVID-19 cases, and (2) to test our negative binomial regression modeling (ie, whether the inclusion of the case count could improve the model). METHODS: We collected weekly log data on searches related to COVID-19 (smell/taste disorders, coronavirus) between December 30, 2019, and November 30, 2020 (49 weeks). Two major medical internet databases in Finland were used: Health Library (HL), a free portal aimed at citizens, and Physician's Database (PD), a database widely used among HCPs. Log data from databases were combined with register data on the numbers of COVID-19 cases reported in the Finnish National Infectious Diseases Register. We used negative binomial regression modeling to assess whether the case numbers could explain some of the dynamics of searches when plotting database logs. RESULTS: We found that coronavirus searches drastically increased in HL (0 to 744,113) and PD (4 to 5375) prior to the first wave of COVID-19 cases between December 2019 and March 2020. Searches for smell disorders in HL doubled from the end of December 2019 to the end of March 2020 (2148 to 4195), and searches for taste disorders in HL increased from mid-May to the end of November (0 to 1980). Case numbers were significantly associated with smell disorders (P<.001) and taste disorders (P<.001) in HL, and with coronavirus searches (P<.001) in PD. We could not identify any other associations between case numbers and searches in either database. CONCLUSIONS: Novel infodemiological approaches could be used in analyzing database logs. Modeling log data from web-based sources was seen to improve the model only occasionally. However, search behaviors among citizens and professionals could be used as a supplementary source of information for infectious disease surveillance. Further research is needed to apply statistical models to log data of the dedicated medical databases.

Psychotropic medication use among personality disordered young adults. A follow-up study among former adolescent psychiatric inpatients.

OBJECTIVE: To analyze the use of prescribed psychotropic medication in subjects with personality disorder (PD) diagnosed in early adulthood. METHODS: The study population consisted of former adolescent psychiatric inpatients (N=508). 63 had a diagnosis of PD, including with borderline PD (BPD) (N=38) and other PD (OPD) (N=25). DSM IV-based psychiatric diagnoses in adolescence were based on the Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL). The information on in-or outpatient hospital treatments until the end of 2016 were extracted from the National Care Register for Health Care. Lifetime data on purchases of physician-prescribed psychotropic medications was obtained from the Social Insurance Institution of Finland. RESULTS: 98.4% (N=62) of subjects with PD had purchased at least one type of psychotropic medication during the follow-up period. The use of non-opioid analgesics and antipyretics was over twice as common among subjects with BPD than subjects with OPD (57.9% vs.28.0%, p=0.020). Anxiolytic use was 1.5 times more common among subjects with BPD than subjects with OPD (65.8% vs. 40.0%, p=0.044) CONCLUSIONS: Psychotropic medication use was common among subjects with PD. The use of non-opioid analgesics, antipyretics and anxiolytics was more common among subjects with BPD.

Healthcare professionals' queries on oseltamivir and influenza in Finland 2011-2016-Can we detect influenza epidemics with specific online searches?

BACKGROUND: Healthcare professionals (HCPs) search medical information during their clinical work using Internet sources. In Finland, Physician's Databases (PD) serve as an Internet medical portal aimed at HCPs. Influenza epidemics appear seasonal outbreaks causing public health concern. Oseltamivir can be used to treat influenza. Little is known about HCPs' queries on oseltamivir and influenza from dedicated online medical portals and whether queries could be used as an additional source of information for disease surveillance when detecting influenza epidemics. METHODS: We compared HCPs' queries on oseltamivir and influenza from PD to influenza diagnoses from the primary healthcare register in Finland 2011-2016. The Moving Epidemic Method (MEM) calculated the starts of influenza epidemics. Laboratory reports of influenza A and influenza B were assessed. Paired differences compared queries, diagnoses, and laboratory reports by using starting weeks. Kendall's correlation test assessed the season-to-season similarity. RESULTS: We found that PD and the primary healthcare register showed visually similar patterns annually. Paired differences in the mean showed that influenza epidemics based on queries on oseltamivir started earlier than epidemics based on diagnoses by -0.80 weeks (95% CI: -1.0, 0.0) with high correlation (τ = 0.943). Queries on influenza preceded queries on oseltamivir by -0.80 weeks (95% CI: -1.2, 0.0) and diagnoses by -1.60 weeks (95% CI: -1.8, -1.0). CONCLUSIONS: HCPs' queries on oseltamivir and influenza from Internet medical databases correlated with register diagnoses of influenza. Therefore, they should be considered as a supplementary source of information for disease surveillance when detecting influenza epidemics.