Prediction of Asthma Hospitalizations for the Common Cold Using Google Trends: Infodemiology Study.

BACKGROUND: In contrast to air pollution and pollen exposure, data on the occurrence of the common cold are difficult to incorporate in models predicting asthma hospitalizations. OBJECTIVE: This study aims to assess whether web-based searches on common cold would correlate with and help to predict asthma hospitalizations. METHODS: We analyzed all hospitalizations with a main diagnosis of asthma occurring in 5 different countries (Portugal, Spain, Finland, Norway, and Brazil) for a period of approximately 5 years (January 1, 2012-December 17, 2016). Data on web-based searches on common cold were retrieved from Google Trends (GT) using the pseudo-influenza syndrome topic and local language search terms for common cold for the same countries and periods. We applied time series analysis methods to estimate the correlation between GT and hospitalization data. In addition, we built autoregressive models to forecast the weekly number of asthma hospitalizations for a period of 1 year (June 2015-June 2016) based on admissions and GT data from the 3 previous years. RESULTS: In time series analyses, GT data on common cold displayed strong correlations with asthma hospitalizations occurring in Portugal (correlation coefficients ranging from 0.63 to 0.73), Spain (ρ=0.82-0.84), and Brazil (ρ=0.77-0.83) and moderate correlations with those occurring in Norway (ρ=0.32-0.35) and Finland (ρ=0.44-0.47). Similar patterns were observed in the correlation between forecasted and observed asthma hospitalizations from June 2015 to June 2016, with the number of forecasted hospitalizations differing on average between 12% (Spain) and 33% (Norway) from observed hospitalizations. CONCLUSIONS: Common cold-related web-based searches display moderate-to-strong correlations with asthma hospitalizations and may be useful in forecasting them.

Digital Divide in Perceived Benefits of Online Health Care and Social Welfare Services: National Cross-Sectional Survey Study.

BACKGROUND: The number of online services in health care is increasing rapidly in developed countries. Users are expected to take a more skilled and active role in taking care of their health and prevention of ill health. This induces risks that users (especially those who need the services the most) will drop out of digital services, resulting in a digital divide or exclusion. To ensure wide and equal use of online services, all users must experience them as beneficial. OBJECTIVE: This study aimed to examine associations of (1) demographics (age, gender, and degree of urbanization), (2) self-rated health, (3) socioeconomic position (education, experienced financial hardship, labor market position, and living alone), (4) social participation (voting, satisfaction with relationships, and keeping in touch with friends and family members), and (5) access, skills, and extent of use of information and communication technologies (ICT) with perceived benefits of online health care and social welfare services. Associations were examined separately for perceived health, economic, and collaboration benefits. METHODS: We used a large random sample representative of the Finnish population including 4495 (56.77% women) respondents aged between 20 and 97 years. Analyses of covariance were used to examine the associations of independent variables with perceived benefits. RESULTS: Access to online services, ICT skills, and extent of use were associated with all examined benefits of online services. ICT skills seemed to be the most important factor. Poor self-rated health was also consistently associated with lower levels of perceived benefits. Similarly, those who were keeping in touch with their friends and relatives at least once a week perceived online services more often beneficial in all the examined dimensions. Those who had experienced financial hardship perceived fewer health and economic benefits than others. Those who were satisfied with their relationships reported higher levels of health and collaboration benefits compared with their counterparts. Also age, education, and degree of urbanization had some statistically significant associations with benefits but they seemed to be at least partly explained by differences in access, skills, and extent of use of online services. CONCLUSIONS: According to our results, providing health care services online has the potential to reinforce existing social and health inequalities. Our findings suggest that access to online services, skills to use them, and extent of use play crucial roles in perceiving them as beneficial. Moreover, there is a risk of digital exclusion among those who are socioeconomically disadvantaged, in poor health, or socially isolated. In times when health and social services are increasingly offered online, this digital divide may predispose people with high needs for services to exclusion from them.

[Introduction of Kanta services between 2010 and 2014]. / Kanta-palvelujen käyttöönotto vuosina 2010-2014.

National Kanta Services are at the deployment stage. The use of electronic prescription has become established and will be mandatory in 2017. Public health care organizations send data to the national Patient Data Repository in a large scale, and private health care is carrying out preparations in order to implement and start using the service. As part of Patient Data Repository services, a national Patient Data Management service has been accessible to citizens since 2010 and will be extended in 2015. Patient Data Management service patient summary for health care professionals is in development and will be implemented in 2016-2018. A user interface service My Kanta pages has been accessible to citizens since May 2010. A user interface for health care professionals (Kelain) to access Kanta Services is in development. Social welfare data repository will be developed as part of the national Kanta Services.

Use of My Kanta in Finland 2010-2022.

In Finland, descriptive performance indicators point towards increasing and sustained use of the national Kanta Services among adults from May 2010 to December 2022. Adult users have accessed the web-based My Kanta, sent electronic prescription renewal requests to healthcare organizations, and caregivers and parents have acted on behalf of their children. Furthermore, adult users have recorded consents, consent restrictions, organ donation testaments and living wills. In this register study, 11% of the young person cohorts (<18-year-olds) and over 90% of the working age cohorts had used the My Kanta portal in 2021, whereas 74% of the 66-75-year-olds and 44% of the at least 76-year-olds.

Implementation, Adoption and Use of the Kanta Services in Finland 2010-2022.

Nationwide implementation and adoption of the Prescription Centre and the Patient Data Repository services required 5.5 years since May 2010 in Finland. The Clinical Adoption Meta-Model (CAMM) was applied in the post-deployment assessment of the Kanta Services in its four dimensions (availability, use, behavior, clinical outcomes) over time. The CAMM results on the national level in this study suggest 'Adoption with Benefits' as the most appropriate CAMM archetype.

Over 89% Adoption Rate of the Nationwide Online Patient Portal in Finland.

Among 1,650 persons in an internet panel survey in October 2020 in Finland, over 89% reported use of the nationwide My Kanta online patient portal. Only 1.5% of the respondents did not know the service. Compared with non-users, among My Kanta users there were more females, less living in countryside, household net income was higher, and more reported independent use of online services. My Kanta use increased by poorly self-rated health status, increasing number of reported prescribed medicines, long-term diseases and physician visits during the six previous months.

Electronic Health Records on the Top of Medical Device Incident Reports.

Medical Device incident reporting is a legal obligation for professional users in Finland. We analyzed all medical device incident reports recorded into the national incident repository from January 2014 to August 2021. Almost 30% of the total of 5,897 recorded incidents were caused by top ten devices, of which electronic health records were the most common (332 incidents). High number of incidents caused by electronic health records arouses safety concerns. A further analysis is required to explore the causes of findings.

Medical Device Incident Reports by Professional Users in Finland 2014-2021.

Medical Device incident reporting is a legal obligation for professional users in Finland. We analyzed all medical device incident reports recorded into the national incident repository from January 2014 to August 2021. Among the total 5,897 records, annual numbers of incident reports varied between 463 and 1,190. Approximately 80% of the medical device incident reports were near misses, 18.7% were person injuries and 1.3% deaths. The number of annual medical device incident reports between hospital districts varied more than expected when related to the population of catchment area. There was a tendency towards lesser reports per population from smaller hospital districts. In conclusion, medical device incident reporting activity of the professional user varied both annually and geographically. A high number of incidents caused person injuries or even death, which arouses safety concerns. A further analysis is required to explore the causes behind our findings.

COVID-19 in Finland: Vaccination strategy as part of the wider governing of the pandemic.

Objectives: To analyze the vaccination strategy as part of wider public governing of the COVID-19 pandemic in Finland. Methods: The study provides a synthesis of vaccination strategy and health policy measures, as well as economic challenges, in the COVID-19 pandemic in Finland. The analysis is based on the systematic collection and reviewing of documents and reports. The review was complemented with relevant pandemic and vaccination monitoring data from Finland. Results: The vaccination strategy approved by the Finnish Government in December 2020 prioritised various risk groups and health and social care professionals attending to COVID-19 patients. The Government has purchased COVID-19 vaccines through the EU joint procurement programme. Vaccinations were organised by municipalities and offered free of charge. The Government recommends universal vaccinations, including foreign residents and undocumented migrants. In 2021, the Government adopted a revised COVID-19 hybrid strategy, which aimed to dismantle wide restrictions as a means to control the epidemic. Despite high vaccination coverage, the Omicron variant became widespread in the population. The economic consequences of the pandemic have been less severe than expected. Conclusions: In the approach to manage the pandemic, the vaccination strategy has a central role. Finland has probably benefitted from the EU joint vaccine procurement programme. The rapid launch of the vaccinations was supported by the existing vaccination capacity in municipalities. High vaccine coverage was seen as a key in opening society. Although a relatively high vaccination rate was not able to stop the spread of Omicron in late 2021, it has efficiently curbed serious cases and kept the death rate low.

The Factors Associated With Nonuse of and Dissatisfaction With the National Patient Portal in Finland in the Era of COVID-19: Population-Based Cross-sectional Survey.

BACKGROUND: In the abnormal circumstances caused by the COVID-19 pandemic, patient portals have supported patient empowerment and engagement by providing patients with access to their health care documents and medical information. However, the potential benefits of patient portals cannot be utilized unless the patients accept and use the services. Disparities in the use of patient portals may exacerbate the already existing inequalities in health care access and health outcomes, possibly increasing the digital inequality in societies. OBJECTIVE: The aim of this study is to examine the factors associated with nonuse of and dissatisfaction with the Finnish nationwide patient portal My Kanta Pages among the users of health care services during the COVID-19 outbreak. Several factors related to sociodemographic characteristics, health, and the use of health care services; experiences of guidance concerning electronic services; and digital skills and attitudes were evaluated. METHODS: A national population survey was sent using stratified sampling to 13,200 Finnish residents who had reached the age of 20 years. Data were collected from September 2020 to February 2021 during the COVID-19 pandemic. Respondents who had used health care services and the internet for transactions or for searching for information in the past 12 months were included in the analyses. Bivariate logistic regression analyses were used to examine the adjusted associations of respondent characteristics with the nonuse of My Kanta Pages and dissatisfaction with the service. The inverse probability weighting (IPW) method was applied in all statistical analyses to correct for bias. RESULTS: In total, 3919 (64.9%) of 6034 respondents were included in the study. Most respondents (3330/3919, 85.0%) used My Kanta Pages, and 2841 (85.3%) of them were satisfied. Nonusers (589/3919, 15%) were a minority among all respondents, and only 489 (14.7%) of the 3330 users were dissatisfied with the service. Especially patients without a long-term illness (odds ratio [OR] 2.14, 95% CI 1.48-3.10), those who were not referred to electronic health care services by a professional (OR 2.51, 95% CI 1.70-3.71), and those in need of guidance using online social and health care services (OR 2.26, 95% CI 1.41-3.65) were more likely nonusers of the patient portal. Perceptions of poor health (OR 2.10, 95% CI 1.51-2.93) and security concerns (OR 1.87, 95% CI 1.33-2.62) were associated with dissatisfaction with the service. CONCLUSIONS: Patients without long-term illnesses, those not referred to electronic health care services, and those in need of guidance on the use of online social and health care services seemed to be more likely nonusers of the Finnish nationwide patient portal. Moreover, poor health and security concerns appeared to be associated with dissatisfaction with the service. Interventions to promote referral to electronic health care services by professionals are needed. Attention should be targeted to information security of the service and promotion of the public's confidence in the protection of their confidential data.

Impact of a Conformité Européenne (CE) Certification-Marked Medical Software Sensor on COVID-19 Pandemic Progression Prediction: Register-Based Study Using Machine Learning Methods.

BACKGROUND: To address the current COVID-19 and any future pandemic, we need robust, real-time, and population-scale collection and analysis of data. Rapid and comprehensive knowledge on the trends in reported symptoms in populations provides an earlier window into the progression of viral spread, and helps to predict the needs and timing of professional health care. OBJECTIVE: The objective of this study was to use a Conformité Européenne (CE)-marked medical online symptom checker service, Omaolo, and validate the data against the national demand for COVID-19-related care to predict the pandemic progression in Finland. METHODS: Our data comprised real-time Omaolo COVID-19 symptom checker responses (414,477 in total) and daily admission counts in nationwide inpatient and outpatient registers provided by the Finnish Institute for Health and Welfare from March 16 to June 15, 2020 (the first wave of the pandemic in Finland). The symptom checker responses provide self-triage information input to a medically qualified algorithm that produces a personalized probability of having COVID-19, and provides graded recommendations for further actions. We trained linear regression and extreme gradient boosting (XGBoost) models together with F-score and mutual information feature preselectors to predict the admissions once a week, 1 week in advance. RESULTS: Our models reached a mean absolute percentage error between 24.2% and 36.4% in predicting the national daily patient admissions. The best result was achieved by combining both Omaolo and historical patient admission counts. Our best predictor was linear regression with mutual information as the feature preselector. CONCLUSIONS: Accurate short-term predictions of COVID-19 patient admissions can be made, and both symptom check questionnaires and daily admissions data contribute to the accuracy of the predictions. Thus, symptom checkers can be used to estimate the progression of the pandemic, which can be considered when predicting the health care burden in a future pandemic.

Use and Users of the Web-Based Omaolo Covid-19 Symptom Self-Assesment Tool in Finland Since March 16, 2020.

In Finland, it is possible to quickly produce medical symptom self-assessment tools within the existing infrastructure. The Finnish Omaolo Covid-19 web-based symptom self-assessment tool (symptom checker) was launched on March 16, 2020 after a 6-day development period. By using the web-based Omaolo Covid-19 symptom checker during the second wave of the epidemic, some 1.72 million questionnaires were recorded, out of which 1.55 million from symptomatic persons. Some 15% of the responses (245,500) were directed to seek emergency medical care based on the online screening by respondent response profiles.

Bass Models for EHR, RIS and PACS Diffusion in Finland and Germany.

Building on Rogers' Diffusion of Innovation Theory, Bass models describe the diffusion processes distinguishing between innovation (p) and imitation (q). This study aimed at modelling the uptake of RIS, PACS and EHR systems in Germany and Finland. The Bass models revealed a quick and almost identical uptake process across all three systems for Finland. In contrast, the Bass models mirrored a slower uptake in Germany. Consequently, the Finnish "imitation" coefficients were larger than the German ones. While in Germany almost free market forces were driving the adoption through imitation but without tail wind from policy, the adoption process in Finland was centrally governed. This suggests that the diffusion process in Finland reflected a well-managed roll-out of the systems rather than imitation behaviour. Thus, in order for Bass model coefficients to be understood properly, additional contextual information is required.

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.

Confidence in biopreparedness authorities among Finnish conscripts.

A large sample of Finnish military conscripts of the armored brigade were questioned on the extent to which they trusted the information given biopreparedness authorities (such as the police, military, health care, and public health institutions) and how confident they were in the authority's ability to protect the public during a potential infectious disease outbreak, from either natural or deliberate causes. Participants answered a written questionnaire during their initial health inspection in July 2007. From a total of 1,000 conscripts, 953 male conscripts returned the questionnaire. The mean sum scores for confidence in the information given to biopreparedness authorities and the media on natural and bioterrorism-related outbreaks (range = 0-30) were 20.14 (SD = 7.79) and 20.12 (SD = 7.69), respectively. Mean sum scores for the respondents' confidence in the ability of the biopreparedness authorities to protect the public during natural and bioterrorism-related outbreaks (range 0-25) were 16.04 (SD = 5.78) and 16.17 (SD = 5.89). Most respondents indicated that during a natural outbreak, they would have confidence in information provided by a health care institution such as central hospitals and primary health care centers, whereas in the case of bioterrorism, the respondents indicated that they would have confidence in the defense forces and central hospitals.

Decreasing Number of Medication Prescriptions After e-Prescriptions Became Mandatory and Their Valid Period Was Extended: A Big Bang Policy Change in Finland in 2017.

We measured the first time the number of prescriptions in Finland by using a centralized national shared repository of e-prescriptions and their dispensing data. This was made possible by introducing two policy interventions that were effective since 1 January 2017: mandatory e-prescribing and extension of a prescription's valid period from 12 months to two years. The trend in recording e-prescriptions started decreasing since the 'big bang', but pharmacy dispensations were not affected, as followed up to September 2019. It is possible to monitor the effects of health policy interventions by utilizing national e-health data systems, especially at the occurrence of a natural experiment.

COVID-19 pandemic in Finland - Preliminary analysis on health system response and economic consequences.

OBJECTIVES: The objective of this study was to describe and analyze the impact of the coronavirus disease COVID-19 on health policy, social- and health system, and economic and financing system to prevent, treat, contain and monitor the virus in Finland. METHODS: This study provides early outcomes of health policy measures, social- and health system capacity as well as economic challenges in COVID-19 pandemic in Finland. This paper is based available documents and reports of different ministries and social, health and economic authorities collected online. This was complemented by other relevant pandemic data from Finland. RESULTS: The impact of COVID-19 pandemic on the Finnish society has been unpredictable although it has not been as extensive and massive than in many other countries. As the situation evolved the Government took strict measures to stop the spread of the virus (e.g. Emergency Powers Act). Available information shows that the economic consequences will be drastic also in Finland, albeit perhaps less dramatic than in large industrial economies. CONCLUSIONS: Finland has transferred gradually to a "hybrid strategy", referring to a move from extensive restrictive measures to enhanced management of the epidemic. However, health system must be prepared for prospective setback. It is possible, that COVID-19 pandemic has accelerated the development of digital health services and telemedicine in Finnish healthcare system.

The socio-demographic patterning of sexual risk behaviour: a survey of young men in Finland and Estonia.

BACKGROUND: Sexually transmitted infections (STIs) among the youth are an increasing challenge for public health in Europe. This study provided estimates of men's (18-25 years) sexual risk behaviour and self-reported STIs and their socio-demographic patterning in Finland and Estonia; two countries that are geographically close, but have very different STI epidemics. METHOD: Nationally representative cross-sectional population surveys with comparable survey questions were used. Data from self-administered questionnaires for 1765 men aged 18-25 years in Finland (85% of the age cohort was included in the sampling frame, 95% of the sample responded) and 748 in Estonia, with a response rate of 43% respectively, were analysed. Socio-demographic patterning of multiple partners, condom use and self-reported STIs are presented was studied using multiple logistic regression analysis. RESULTS: The main findings focus on associations found within each country. In Finland, higher age, low education and to a lesser extent relationship with a non-steady partner increased the likelihood of reporting multiple lifetime-partners, while in Estonia only higher age and low education revealed this effect. In relation to unprotected intercourse, in Finland, higher age, low education and relationship status with a steady partner increased the likelihood of reporting unprotected intercourse. In Estonia, the same was observed only for relationship status. In Finland the likelihood of self-reported STIs increased by older age and lower education and decreased by being with a non-steady partner, while in Estonia, a non-significant increase in self-reported STIs was observed only in the older age group. CONCLUSION: A clear socio-demographic patterning for sexual behaviour and self-reported STIs was revealed in Finland, but a less consistent trend was seen in Estonia. The findings of this study suggest that prevention strategies should focus in Finland on less educated singles and in Estonia on young men generally.

Sexual behaviour and lifestyles of young men in Finland, 1998-2005. Cross-sectional survey of military conscripts.

OBJECTIVE: To reveal sexual risk behaviour over time and to explore the associations of sexual risk behaviour, HIV-testing and socio-demographic and lifestyle characteristics, including alcohol and drug use among young men. METHODS: Cross-sectional, structured health and lifestyle survey carried out during the beginning of the mandatory military service. Data were collected from 10,446 randomized conscripts in 1998-2005, with a response rate of 95%. RESULTS: There was a minor increase in the prevalence of those reporting early sexual intercourse and multiple lifetime partners between 1998 and 2005 (age adjusted odds ratios [ORs] 0.68 [95% confidence interval (CI) 0.54-0.87] and 0.83 [0.70-0.99]), and a minor decrease in multiple partners over the past 12 months or engaging in high risk sex between 2000 and 2005 (ORs: 1.20 [95% CI: 1.08-1.41] and 1.45 [1.13-1.86]). No significant differences were observed in non-condom use and HIV-testing over the study period. Alcohol consumption had an independent, strong dose-contingent relationship with sexual risk behaviour. Illegal drug use showed a trend for similar but weaker association with risky sex as alcohol use. CONCLUSIONS: This study shows minor change in the risk indicators over time, yet the prevalence of sexually transmitted infections has risen. More in-depth research to identify groups with risky sexual behaviour and multiple risk factors related to sex, alcohol and drugs is a matter of public health importance.