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Background Non-response in survey studies is a growing problem and, being usually selective, it leads to under- or overestimation of health outcomes in the follow-up. We followed both respondents and non-respondents by registry linkage to determine whether there is a risk of death, related to non-response at baseline. Methods Sample data of biennial surveys to 12-18-year-old Finns in 1979–1997 were linked with national death registry up to 2001. The number of respondents was 62 528 (79.6%) and non-respondents 16 081 (20.4%). The average follow-up was 11.1 years, totalling 876 400 person-years. The risk of death between non-respondents and respondents was estimated by hazard ratios (HR). Results The number of deaths per 100 000 person-years were 229 in non-respondents and 447 in respondents (HR 2.0, 95% CI: 1.5–2.6). The hazard ratios of death were for intoxication 3.2 (95% CI: 1.9–5.4), for disease 3.1 (95% CI: 2.2–4.1), for violence-related injury 2.0 (95% CI: 1.5–2.6) and for unintentional injury 1.8 (95% CI: 1.3–2.4) in non-respondents vs. respondents. The association between non-response and death increased with age at baseline, and the increase persisted after the age of 25. Conclusion Our study demonstrated significantly increased rates of death among adolescent non-respondents in a follow-up. The highest hazard ratios were seen in disease- and violence-related deaths. The death rate varied between respondents and non-respondents by death type. Increased rates of death persisted beyond the age of 25.
The concern has been that this prioritization has resulted in age-related inequality between patients, with the older population suffering the most. The aim of this multicenter study was to examine the differences in incidence and waiting times of elective surgeries by age during the SARS-CoV-2 coronavirus disease (COVID-19) pandemic in Finland. Data on elective surgery (88 716 operations) were gathered from three Finnish public hospitals for the years 2017-2020. Surgery incidence and waiting times stratified by age groups (younger than 18, 18 to 49, 50 to 69, and 70 or older) were examined, and the year 2020 was compared to the reference years 2017-2019. The mean annual, monthly, and weekly waiting times were calculated with 95% confidence intervals (CI). The first COVID-19 wave decreased surgery incidence most prominently in patients younger than 18 (incidence rate ratio [IRR] 0.64, CI 0.60-0.68) and 70 or older (IRR 0.68, CI 0.66-0.70). After the first wave, the incidence increased in patients aged 50 to 69 and 70 or older by 22% and 29%, respectively. Among patients younger than 18, the incidence in 2020 was 15% lower. In patients younger than 18, waiting times were at mean of 43% longer in June to December compared to the reference years. In patients aged 18 to 49, 50 to 69, and 70 or older, waiting times increased in May but recovered to normal level during fall 2020. COVID-19 decreased the incidence of surgery and led to increased waiting times. Clearing of the treatment backlog started with older patients which resulted in prolonged waiting times among pediatric patients.
Alcohol is a major risk factor for several types of injuries, and it is associated with almost all types and mechanisms of injury. The focus of the study was to evaluate alcohol use in severely injured trauma patients with New Injury Severity Score (NISS) of 16 or over, and to compare mortality, injury severity scores and mechanisms and patterns of injury between patients with positive and negative blood alcohol levels (BAL). Medical histories of all severely injured trauma patients (n = 347 patients) enrolled prospectively in Trauma Register of Tampere University Hospital (TAUH) between January 2016 to December 2017 were evaluated for alcohol/substance use, injury mechanism, mortality and length of stay in Intensive Care Unit (ICU). A total of 252 of 347 patients (72.6%) were tested for alcohol with either direct blood test (50.1%, 174/347), breathalyser (11.2%, 39/347), or both (11.2%, 39/347). After untested patients were excluded, 53.5% of adult patients (18–64 years), 20.5% of elderly patients (above 65 years) and 13.3% of paediatric patients (0–17 years) tested BAL positive. The mean measured BAL for the study population was 1.9 g/L. The incidence of injuries was elevated in the early evenings and the relative proportion of BAL positive patients was highest (67.7%) during the night. Injury severity scores (ISS or NISS) and length of stay in ICU were not adversely affected by alcohol use. Mortality was higher in patients with negative BAL (18.2% vs. 7.7%, p = 0.0019). Falls from stairs, and assaults were more common in patients with positive BAL (15.4% vs. 5.4% and 8.7% vs. 2.7%, p < 0.006, respectively). There were no notable differences in injury patterns between the two groups. Alcohol use among severely injured trauma patients is common. Injury mechanisms between patients with positive and negative BAL have differences, but alcohol use will not increase mortality or prolong length of stay in ICU. This study supports the previously reported findings that BAL is not a suitable marker to assess patient mortality in trauma setting.
Background: Social restrictions due to COVID-19 have impacted the everyday life of adolescents and young adults, with increased levels of stress and anxiety being reported. Therefore, we report primary care visits due to mental health problems and the use of psychotropic medication in Finland. Methods: We conducted a nationwide register-based study and included primary care visits with mental health problems (F*-class ICD-10 diagnosis) for patients aged 15–24 years. We calculated incidence for visits and used incidence rate ratios (IRR) for comparisons. Psychotropic medication purchases for patients aged 13–24 years were included. Annual psychotropic medication user prevalence per 1000 was calculated and prevalence rate ratios (PRR) with 95% confidence intervals (CI) were used for comparisons. The years 2020 and 2021 were compared to the pre-pandemic reference year 2019. Results: A total of 396534 visits to primary care due to mental health problems were included. Annual visit incidences per 1000 were 151.7 in 2019, 193.6 in 2020, and 306.7 in 2021, indicating a 28% (IRR 1.28, CI 1.27–1.29) increase from 2019 to 2020 and a 102% (IRR 2.02, CI:2.01–2.04) increase from 2019 to 2021. Highest reported increases in 2020 were sleeping disorders (IRR 1.79, CI 1.72–1.87) and anxiety disorders (IRR 1.39, CI 1.37–1.42). Prevalence of antidepressant use increased by 25% (PRR 1.25, CI 1.23–1.26) in 2021. An increase was also seen in the use of antipsychotics (+ 19%, PRR 1.19. CI 1.16–1.21). Conclusions: The COVID-19 pandemic increased the need for mental health services and medication among Finnish adolescents and young adults. Our health care system needs the capacity to manage the increased number of visits, and we must be better prepared for future crises.
Objective: To calculate the rates of labor analgesia among women with fear of childbirth (FOC) in multiparous and nulliparous women, because FOC might be associated with higher rates of labor analgesia. Methods: In this retrospective register-based cohort study, data from the National Medical Birth Register was used to evaluate the usage of labor analgesia in pregnancies with FOC, when compared with those without. The analgesia methods were stratified into neuraxial analgesia, pudendal, paracervical, nitrous oxide, other medical, other non-medical, and no analgesia. Results: A total of 19 285 pregnancies with diagnosed maternal FOC were found during our study period. The control group consisted of 757 997 pregnancies without diagnosed maternal FOC. Nulliparous women with diagnosed FOC had a higher rate of epidural analgesia (70.2% vs 67.1%), spinal analgesia (12.3% vs 7.6%), and pudendal block (17.6% vs 9.6%). Multiparous women with FOC had a notably higher rate for epidural analgesia (47.0% vs 29.0%). Conclusion: The main finding in this study was that women with diagnosed FOC had a higher rate of labor analgesia. The results of this study can be used by midwives, obstetricians, and anesthesiologists to provide optimal pain relief for mothers with FOC.
Background: Randomized controlled trials in orthopaedics are powered to mainly find large effect sizes. A possible discrepancy between the estimated and the real mean difference is a challenge for statistical inference based on p-values. We explored the justifications of the mean difference estimates used in power calculations. The assessment of distribution of observations in the primary outcome and the possibility of ceiling effects were also assessed. Methods: Systematic review of the randomized controlled trials with power calculations in eight clinical orthopaedic journals published between 2016 and 2019. Trials with one continuous primary outcome and 1:1 allocation were eligible. Rationales and references for the mean difference estimate were recorded from the Methods sections. The possibility of ceiling effect was addressed by the assessment of the weighted mean and standard deviation of the primary outcome and its elaboration in the Discussion section of each RCT where available. Results: 264 trials were included in this study. Of these, 108 (41 %) trials provided some rationale or reference for the mean difference estimate. The most common rationales or references for the estimate of mean difference were minimal clinical important difference (16 %), observational studies on the same subject (8 %) and the ‘clinical relevance’ of the authors (6 %). In a third of the trials, the weighted mean plus 1 standard deviation of the primary outcome reached over the best value in the patient-reported outcome measure scale, indicating the possibility of ceiling effect in the outcome. Conclusions: The chosen mean difference estimates in power calculations are rarely properly justified in orthopaedic trials. In general, trials with a patient-reported outcome measure as the primary outcome do not assess or report the possibility of the ceiling effect in the primary outcome or elaborate further in the Discussion section.
Objectives: The aim of this study is to calculate the trends in the use of labor analgesia in vaginal twin pregnancies at or after 37+0 weeks of gestation and evaluate the use of different labor analgesia in vaginal twin deliveries when compared to vaginal singleton pregnancies. Study design: Data from the National Medical Birth Register during the years 2004–2018 was used to evaluate the usage of labor analgesia in vaginal twin deliveries at or after 37+0 weeks of gestation when compared to a comparison group consisting of singleton deliveries at or after 37+0 weeks of gestation. These results are presented as adjusted risk ratios (aORs) with 95% confidence intervals (Cis). The model was adjusted by maternal age and gestational diabetes, year of the pregnancy, and labor induction. Results: A total of 3060 twin deliveries and 669 718 singleton deliveries (comparison group) were included in our study. The use of spinal analgesia in vaginal twin deliveries has shown a steadily growing trend increasing from 7.8% (95% Ci 4.8, 12.0) in 2004–24.8% (95% Ci 16.0, 33.0) in 2018. When compared to singleton deliveries, there was increased use of epidural analgesia (57.3% vs 46.1%, aOR 1.41; 95% Ci 1.31, 1.51), but lower use of spinal analgesia (12.3% vs 16.7%, aOR 0.66; 95% Ci 0.59, 0.73), another medical (7.9% vs 12.5%, aOR 0.55; 95% Ci 0.48, 0.63), and nonmedical analgesia (21.8% vs 30.2%, aOR 0.69, 95% Ci 0.63, 0.76) observed among women with twin pregnancies. Conclusions: The main finding of this study was that women with twin pregnancies had a higher rate of epidural analgesia than women with singleton pregnancies. The results of this study should be acknowledged by midwives, obstetricians, and anesthesiologists to provide optimal pain relief for mothers with twin pregnancies and encourage researchers to further research on this topic.
Objectives: The literature concerning the overall use of labor analgesia among women with trials of labor after cesarean section (TOLAC) is lacking. The primary aim of this study is to report the rate of different labor analgesia methods among women with TOLAC. The secondary aim was to compare the use of labor analgesia between women with the first TOLAC and control group consisting of nulliparous women. Study design. Data from the National Medical Birth Register was used to evaluate the usage of labor analgesia in TOLACs. The use of labor analgesia in the first TOLAC is compared to the pregnancies of nulliparous women. The analgesia methods were stratified into neuraxial analgesia, pudendal, paracervical, nitrous oxide, other medical, other non-medical, and no analgesia. These are analyzed as categorized dichotomy (yes or no) variables. Results: A total of 38 596 TOLACs as second pregnancy of the mother was found during our study period. The control group consisted of a total of 327 464 pregnancies of nulliparous women. Epidural analgesia (61.6% vs 67.1%), nitrous oxide (56.1% vs 62.0%), and non-medical analgesia (30.1% vs 35.0%) were less consumed among women with TOLAC. The rate of spinal analgesia was higher among women with TOLAC (10.1% vs 7.6%) when compared to the control group. However, when only vaginal deliveries were included, the rate of labor analgesia increased especially in the TOLAC group. Conclusions: The main finding of this study is that women with TOLAC had a generally lower rate of labor analgesia. However, the rate of spinal analgesia was higher among women with TOLAC when compared to the control group, however. The results of this study inform midwives, obstetricians, and anesthesiologists on current practices and how to improve the analgetic treatment in TOLAC.
There is a limited number of studies examining the influence of birth complications on the length of the subsequent interpregnancy interval (IPI). This study aimed to study the association between different pregnancy complications at first pregnancy and subsequent IPI. All women with their first and second pregnancies were gathered from the National Medical Birth Register for years 2004–2018. A logistic regression model was used to assess the association between the pregnancy complication (gestational hypertension, gestational diabetes (GDM), preterm birth, perinatal mortality, shoulder dystocia) in the first pregnancy and subsequent length of the IPI. IPIs with a length in the lower quartal were considered short IPIs, and length in the upper quartal as long IPIs. Adjusted odds ratios (aOR) with 95% CIs were compared between the groups. A total of 52,709 women with short IPI, 105,604 women with normal IPI, and 52,889 women with long IPI were included. Women with gestational hypertension had higher odds for long IPI (aOR 1.12, CI 1.06–1.19), GDM had higher odds for short IPI (aOR 1.09, CI 1.09–1.13), preterm delivery had higher odds for short and long IPI (aOR 1.12, CI 1.07–1.17 for both), and perinatal mortality had higher odds for short IPI (aOR 8.05, CI 6.97–9.32) and lower odds for long IPI (aOR 1.13, CI 0.93–1.38). Women with gestational hypertension and preterm birth had higher odds for long IPI, and women with diagnosed GDM and perinatal mortality had higher odds for short IPI. We found no evidence of a difference in the length of the IPI for women with shoulder dystocia. More research on the reasons behind the subsequent long and short IPI is warranted.
Hospital discharge data is routinely collected in Finland and it is an invaluable source of information when assessing injury epidemiology as well as treatment. The database can be used when planning injury prevention and redirecting resources of the health care system. Most recently our hospital discharge register has been used to assess the incidence of surgical treatment of common fractures. This study was aimed to evaluate the coverage and accuracy of the Finnish National Hospital Discharge Register (NHDR) focusing on hip fractures. In other words, patients hospitalized for a pertrochanteric hip fracture were used to assess the validity of the NHDR. Methods The validity of the NHDR was assessed by comparing the data in hospital discharge register with the original patient records and radiographs in three separate hospitals; Tampere University Hospital, Hatanpää City Hospital of Tampere, and the Central Hospital of Kanta-Häme. The study analysis included 741 patients hospitalized due to pertrochanteric hip fracture between 1st January 2008 and 31st December 2010. Results The diagnosis was correctly placed on 96% (95% CI: 94 to 97%) of the 741 patients when radiographs were used as golden standard. The procedural coding had coverage of 98% (95% CI: 96 to 98%) and an accuracy of 88% (95% CI: 85 to 90%). The coverage of the external cause for injury was found to be 95% (95% CI: 94 to 97%) with an accuracy of 90% (95% CI: 87 to 92%). Conclusions Our results show that the validity of the Finnish NHDR is excellent as determined by accuracy of diagnosis and both accuracy and coverage of procedural coding and external cause for injury. The database can be used to assess injury epidemiology and changes in surgical treatment protocols.
The aim of the present study was to assess associations between physician diagnosed unspecified low back pain (LBP) during compulsory military service and self-reported LBP and physical fitness measured on average four years after military service. From a total of 1155 persons who had been pass medical examination for military service and who had completed physically demanding military training between 1997 and 2007, 778 men participated in a refresher military training course and physical tests. In this study, the association between LBP during military service and LBP in later life in addition to the association between LBP and physical fitness were examined. A total of 219 out of 778 participants (28%) had visited a physician due to some musculoskeletal symptom (ICD-10 M-diagnosis) during their military service. Seventy-four participants (9.5%) had visited a physician due to unspecified LBP during their service, and 41 (5.3%) had temporarily been absent from duty due to LBP. At the follow-up examination, 122 (15.7%) had reported LBP during the past month. LBP during military service was associated with self-reported LBP in the follow-up (p = 0.004). Of those who had been absent from duty due to LBP during their military service, 13 (31.7%) reported LBP during the past month. In risk factor analysis, no initial health behaviour and physical performance variables were associated with baseline LBP in the follow-up. The main finding of the present study was that unspecified LBP during military service predicts LBP in later life. On the basis of previous literature, it is also known that LBP is a common symptom and thus, one cannot expect to be symptomless the entire life. Interestingly, none of the health behaviours nor the physical performance studied in the follow-up were associated with baseline LBP. It appears that individuals prone to LBP have symptoms during physically demanding military service and also later in their life.
Background: Prior reviews have not conducted statistical synthesis of injury incidence on artificial turf in football. To analyse and compare the incidence of injuries sustained playing football (soccer) on artificial turf compared to grass and other playing surfaces. Methods: This was a systematic review and meta-analysis. We searched PubMed, Scopus, SPORTDiscus, and Web of Science databases in October 2022 without filters. All observational studies (prospective or retrospective) that analysed injuries sustained playing football on artificial turf and which included a control group that played on grass or other surface were included. Studies were included if they reported the number of injuries and the exposure time for the playing surfaces. Risk of bias was assessed by Newcastle-Ottawa Scale. A random effects model was used to calculate the pooled incidence rate ratios (IRR) with 95% confidence intervals. Protocol was registered with PROSPERO on October 30th, 2022. Registration number: CRD42022371414. Findings: We screened 1447 studies, and evaluated 67 full reports, and finally included 22 studies. Risk of bias was a notable issue, as only 5 of the 22 studies adjusted their analysis for potential confounders. Men (11 studies: IRR 0.82, CI 0.72–0.94) and women (5 studies: IRR 0.83, CI 0.76–0.91) had lower injury incidence on artificial turf. Professional players had a lower incidence of injury (8 studies: IRR 0.79, CI 0.70–0.90) on artificial turf, whereas there was no evidence of differences in the incidence of injury in amateur players (8 studies: IRR 0.91, CI 0.77–1.09). The incidence of pelvis/thigh (10 studies: IRR 0.72, CI 0.57–0.90), and knee injuries (14 studies: IRR 0.77, CI 0.64–0.92) were lower on artificial turf. Interpretation: The overall incidence of football injuries is lower on artificial turf than on grass. Based on these findings, the risk of injury can't be used as an argument against artificial turf when considering the optimal playing surface for football. Funding: No specific funding was received for this study.
Objectives: Both high and low body mass index (BMI) is known to be associated with increased risk for osteoporotic fractures in the postmenopausal population. However, the association between BMI and risk for fracture in the fertile-aged (15–49 years) population is not well studied. We aim to examine how increased BMI affects the risk for fracture leading to hospitalization after delivery in fertile-aged women. Material and methods: In this nationwide registry-based study, data on all women aged 15–49 years with fractures leading to hospitalization were retrieved from the Care Register for Health Care for the years 2004–2018. The data were linked with data from the National Birth Register, where the BMI status is collected for each pregnancy. Cox regression was used to examine the effect of increased BMI on the risk for fracture within five years after delivery. Risks were analyzed separately for upper extremity, spine and pelvis, and lower extremity fractures. The results were interpreted with hazard ratios (HR), adjusted hazard ratios (aHR), and 95% confidence intervals (CI). Results: A total of 529 992 pregnant women with 3276 fractures leading to hospitalization within 5-year follow-up were included in this study. Of these, a total of 548 fractures required surgical treatment. Patients with BMI of 30 kg/m2 or more had a higher rate of fractures in the lower extremity (≥50%). In lower extremity fractures, risk for fracture increased with increasing BMI. The risk fracture was highest in the group with BMI of 35–40 kg/m2 (overall lower extremity aHR 2.43 95% CI 1.92–3.06; knee aHR 2.04, 95% CI 1.45–2.87; ankle aHR 3.01, 95% CI 2.16–4.20). Conclusions: Higher BMI was associated to the increased risk for lower extremity fractures, especially ankle fractures, within five years of delivery. Information gained from this study is important in the clinical setting, as patients can be informed of the negative effect of obesity on the post-delivery risk for fractures.
Background and purpose: To assess the incidence of vaginal birth -related rupture of the pubic symphysis in Finland from 1998 to 2018. Methods: A retrospective cohort study using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register. As participants we included all ≥ 22-week pregnancies of women aged between 15 and 49 years from January 1, 1998 to December 31, 2017. Pubic symphysis rupture was classified based on the ICD-10 code S33.4 and operations were gathered with pelvis-specific operation codes of the Nordic NOMESCO-classification. Incidence per 100 000 deliveries with 95% confidence intervals (CI) was calculated for symphysis rupture and surgery using Poisson’s exact test. Results: For a total 1 175 326 deliveries, a total of 9 pubic symphysis ruptures occurred during the intrapartum and puerperal periods. All ruptures occurred after vaginal delivery. Of these, 4 ruptures were treated operatively. The incidence of rupture for vaginal delivery was 0.9 per 100 000 deliveries (CI 0.1 to 1.0). No perinatal mortality was observed. Conclusions: Birth -related ruptures of the pubic symphysis are rate events and are mostly associated with vaginal delivery with most ruptures being treated conservatively.
Introduction The COVID-19 pandemic has reduced pediatric emergency department (ED) visits and surgeries. This study evaluates the incidence of pediatric trauma ED visits and surgeries in Finland during the first and second waves of the pandemic. Methods Three large Finnish hospitals, covering one-sixth of the Finnish pediatric population, participated. Data on all ED visits and trauma surgeries between January 2017 and December 2020 were collected from hospital discharge registers. Monthly incidences with 95% CI were calculated per 100 000 person-months by Poisson exact method and compared by incidence rate ratio (IRR). Results During the lockdown the incidence of head injuries (IRR 0.19, 95% CI 0.04 to 0.87), sprains (IRR 0.25, 95% CI 0.14 to 0.46), and fractures (IRR 0.36, 95% CI 0.25 to 0.51) decreased in the 13-17 years age group. In the 4-12 years age group a 55% decrease (IRR 0.45, 95% CI 0.22 to 0.96) in head injuries was observed. During the period of regional restrictions a subtle decrease in head injuries was seen in the 13-17 years age group (IRR 0.26, 95% CI 0.09 to 0.78). During the lockdown in March 2020 the incidence of fractures decreased in the oldest age group (13-17 years) (IRR 0.62, 95% CI 0.46 to 0.85), while a rebound in incidence was seen at the end of the lockdown period in June. Conclusion The nationwide lockdown and the cancellation of sports and other hobbies markedly decreased the injuries among children aged 13-17 years, while the decrease was lower among children aged 4-12 years. Cancellation of sports and hobbies did not affect patients under 4 years of age.
Lower body mass index (BMI) is associated with a higher risk for osteoporotic fractures in the postmenopausal population. However, in the fertile-aged population, the association between BMI and risk for fracture is not well studied. Our aim, therefore, is to investigate whether lower BMI (<18.5 kg/m2) affects the risk for fractures requiring hospitalization after delivery in fertile-aged women when compared to women of normal weight (18.5 ≤ BMI < 25 kg/m2). In this nationwide registry-based cohort study, all pregnancies were gathered from the National Medical Birth Register. The data were linked with data from the Care Register for Health Care, which includes information of all fractures leading to hospitalization or treated as outpatients for fertile-aged females (15–49 years), for the period 2004–2018. The annual rate of pregnancies with maternal pre-pregnancy underweight in a high-income country was calculated. Cox regression was used to calculate adjusted hazard ratios (aHR) of lower BMI for the risk for fracture within 5 years after delivery. The association between the risk of fracture and continuous BMI was assessed using logistic regression and presented with adjusted odds ratios (aORs) with 95% CIs. In total, 20,784 women were included in the underweight group and 344,753 in the normal weight group. Women in the underweight group had a lower overall risk for any fractures during the 5-year follow-up (aHR 0.75, CI 0.61–0.94). The odds for all fractures (aOR 1.07, CI 1.04–1.09 per BMI-unit upwards for all fractures) increased as pre-pregnancy BMI increased. Despite previous findings of a higher risk for fractures for underweight patients in the older population, the risk for fractures after pregnancy was lower among fertile-aged women with lower BMI.
Introduction: The regional variation in spine surgery rates has been shown to be large both within and between countries. This variation has been reported to be less in studies from countries with spine registers. The aim of this study was to describe the regional variation in lumbar spine surgery in Finland. Materials and methods: This is a retrospective register study. Data from the Finnish National Hospital Discharge Register (NHDR) were used to calculate and compare the rates of lumbar disc herniation (LDH), decompression, and fusion surgeries in five University Hospital catchment areas, covering the whole Finnish population, from January 1, 1997, through December 31, 2018. Results: A total of 138,119 lumbar spine operations (including LDH, decompression, and fusion surgery) were performed in Finland between 1997 and 2018. The regional differences in the rate of LDH surgery were over fourfold (18 vs. 85 per 100,000 person years), lumbar decompression surgery over threefold (41 vs. 129 per 100,000 person years), and lumbar fusion surgery over twofold (14 vs. 34 per 100,000 person years) in 2018. The mean age of the patients increased in all regions during the study period. Conclusions: In Finland, the regional variations in spine surgeries were vast. In a country with a publicly funded healthcare system, this finding was surprising. The recently created national spine register may serve to shed more light on the reasons for this regional variation.
Objective: This study was undertaken to examine how pediatric traumatic brain injury (pTBI) correlates with incidence of epilepsy at later ages in Finland. Methods: This nationwide retrospective register-based cohort study extended from 1998 to 2018. The study group consisted of 71 969 pediatric (<18 years old) patients hospitalized with TBI and a control group consisting of 64 856 pediatric patients with distal extremity fracture. Epilepsy diagnoses were gathered from the Finnish Social Insurance Institution. Kaplan–Meier and multivariable Cox regression models were conducted to analyze the probability of epilepsy with 95% confidence intervals (CIs). Results: Cumulative incidence rates (CIRs) for the first 2 years were.5% in the pTBI group and.1% in the control group. The corresponding rates after 15 years of follow-up were 1.5% in the pTBI group and.7% in the control group. Due to proportional hazard violations, the study population was split to the first 2 years and in subgroup analysis 4 years. During the first 2 years of surveillance, the hazard ratio (HR) for the pTBI group was 4.38 (95% CI = 3.39–5.66). However, between years 2 and 20, the HR for the pTBI group was 2.02 (95% CI = 1.71–2.38). A total of 337 patients (.47%) underwent neurosurgery, and 36 (10.7%) patients subsequently developed epilepsy. The CIR for the first year after TBI was 4.5% (95% CI = 2.3–6.7) in operatively managed patients and.3% (95% CI =.3–.4) in nonoperatively managed patients. Corresponding figures after 15 years were 12.0% (95% CI = 8.2–15.8) and 1.5% (95% CI = 1.4–1.6). During the first 4 years of surveillance, the HR for the operative pTBI group was 14.37 (95% CI = 9.29–20.80) and 3.67 (95% CI = 1.63–8.22) between years 4 and 20. Significance: pTBI exposes patients to a higher risk for posttraumatic epilepsy for many years after initial trauma. Children who undergo operative management for TBI have a high risk for epilepsy, and this risk was highest during the first 4 years after injury.
Background and purpose — Knee arthroscopy is commonly performed to treat degenerative knee disease symptoms and traumatic meniscal tears. We evaluated whether the recent high-quality randomized control trials not favoring arthroscopic surgery for degenerative knee disease affected the procedure incidence and trends in Finland and Sweden. Patients and methods — We conducted a bi-national registry-based study including all adult (aged ≥18 years) inpatient and outpatient arthroscopic surgeries performed for degenerative knee disease (osteoarthritis (OA) and degenerative meniscal tears) and traumatic meniscal tears in Finland between 1997 and 2012, and in Sweden between 2001 and 2012. Results — In Finland, the annual number of operations was 16,389 in 1997, reached 20,432 in 2007, and declined to 15,018 in 2012. In Sweden, the number of operations was 9,944 in 2001, reached 11,711 in 2008, and declined to 8,114 in 2012. The knee arthroscopy incidence for OA was 124 per 105 person-years in 2012 in Finland and it was 51 in Sweden. The incidence of knee arthroscopies for meniscal tears coded as traumatic steadily increased in Finland from 64 per 105 person-years in 1997 to 97 per 105 person-years in 2012, but not in Sweden. Interpretation — The incidence of arthroscopies for degenerative knee disease declined after 2008 in both countries. Remarkably, the incidence of arthroscopy for degenerative knee disease and traumatic meniscal tears is 2 to 4 times higher in Finland than in Sweden. Efficient implementation of new high-quality evidence in clinical practice could reduce the number of ineffective surgeries.
The purpose of this study was to investigate whether operative treatment for distal radial fracture reduces the length of sick leave and the costs of treatment. We identified 19,995 patients from a registry who received a state sick leave allowance between 2010 and 2019 owing to distal radial fractures. We compared these patients to a registry of operations and identified 4346 operated patients. Operated patients had a mean sick leave of 75 days, whereas non-operated patients had a sick leave of 63 days. In the operated group, the cost of sick leave was €7505 (UK£6419; US$8070), which was 34% higher than in the non-operated group. Over the analysed period, the duration of sick leave decreased. Although several studies have shown better early functional outcomes after operation, this does not seem to shorten sick leave. Level of evidence: III.
This retrospective cohort study assesses the incidences of major fractures and surgery in women during the puerperium and the lactation period in Finland between January 1, 1999, and December 31, 2018. Using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register, all women aged between 15 and 49 years with a fracture hospitalization within 12 months of delivery between 1999 and 2018 were included. During the study period, a total of 3140 fractures after delivery and 152,800 fractures of the female normal population of similar age were hospitalized. The incidence rate after delivery increased from 219/100,000 person-years during the first 4 months to 310 fractures/100,000 person-years during the latter 8 months of the first year after delivery. Altogether, 29% (n = 904/3140) of these fractures were treated operatively. The most common fractures were ankle and distal radius fractures, which made up one-third of all fractures. The incidence of pelvic fracture hospitalization was 15/100,000 person-years at 4 months after delivery, with an operation rate of 22%. Over half of all fractures occurred between 6 and 12 months after delivery (mean 6.6 months). The incidence of fracture hospitalization after delivery increased steadily during the puerperium and the lactation periods but remained lower than in the general population (age-adjusted incidence 554/100,000 person-years) with an incidence rate ratio of 0.51. However, a higher proportion of pelvic fractures were observed in the first months after delivery. Surgical rates were in line with the general population. Fractures of the wrist and ankle made up most of the fractures.
Introduction: The aim of this study was to assess the incidence of all major fractures and surgery during pregnancy and the outcomes of pregnancy in Finland between 1998 and 2017. Materials and methods: A retrospective cohort study using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register. As participants we included all women aged between 15 and 49 years from January 1, 1998 to December 31, 2017 and their ≥ 22-week pregnancies. Results: Of a total 629,911 pregnancies, 1813 pregnant women were hospitalized with a fracture diagnosis, yielding an incidence of 247 fractures/100,000 pregnancy-years. Of these, 24% (n = 513/2098) were treated operatively. The most common fractures were fractures of the tibia, ankle, and the forearm, which made up half of all fractures. The incidence of pelvic fractures was 6.8/100,000 pregnancy-years, with an operation rate of 14%. The stillbirth rate of all fracture patients was low at 0.6% (n = 10/1813), although this was 1.5-fold the overall stillbirth rate in Finland. Lumbosacral and comminuted spinopelvic fractures resulted in preterm delivery in 25% (n = 5/20) of parturients, with a stillbirth rate of 10% (n = 2/20). Conclusion: The incidence of fracture hospitalization during pregnancy is lower than in the general population, and fractures in this population are more often treated conservatively. A higher proportion of preterm deliveries and stillbirths occurred in women with lumbosacral and comminuted spinopelvic fractures. Maternal mortality and stillbirth rates remain low among women with fractures leading to hospitalization or surgery during pregnancy.
Background: After the COVID-19 pandemic started, critical care resources were expanded in Finland to manage a possible surge in patients requiring intensive care. The aim of this study was to evaluate the incidence of overall ICU admissions, patient diagnoses, characteristics, and length of stay during the pandemic. Methods: This retrospective hospital register-based study was conducted in two large and one mid-size Finnish public hospitals. The required data were collected from ICU patient information systems and all adult patients were included. Monthly and yearly incidences with 95% confidence intervals (CI) were counted per 100 000 persons-years by Poisson exact method and compared by incidence rate ratios (IRR). Results: A total of 4407 admissions to ICUs for any cause occurred during 2020. In 2021, this figure was 4931. During the reference years (2017–2019), the mean number of admissions to ICU was 4781. In 2020 and 2021, the proportion of patients requiring intensive care due to COVID-19 was only 3%. The incidence of all-cause ICU admissions decreased during the lockdown in 2020 when compared to the reference years. Before the start of the lockdown in February 2020, the IRR of all-cause ICU admissions was 1.02 (CI: 0.89 to 1.18). During the lockdown period, however, the IRR of all-cause ICU admissions decreased to 0.78 (CI: 0.67 to 0.90) in March. When the lockdown ended, the incidence rebounded to the same level as before the lockdown. However, in 2021, the incidence of ICU admissions remained at the same level when compared to the reference years. The most prominent changes occurred in the incidence of diseases of the nervous system, which includes epilepsy and seizures and transient cerebral ischemic attacks, in diseases of the respiratory system, and neoplasms. Conclusions: According to the findings of this study, the incidence of all-cause ICU admissions decreased after the lockdown was implemented in 2020. Furthermore, the percentage of patients requiring intensive care due to COVID-19 in Finland was only 3% in 2020 and 2021. These findings may serve to help in the planning and allocating of ICU resources during future pandemics.
AbstractWe aim to report the incidences of ED visits due to back pain, hospitalizations, and urgent spine surgeries during the first and second waves of COVID-19 in Finland. The number of emergency department visits and hospitalizations due to back pain as well as urgent spine surgeries in the adult population was collected from hospital discharge registers for the years 2017 through 2019 (reference years) and 2020.This study was conducted at three large Finnish hospitals. The monthly incidence with 95% confidence intervals (CI) of emergency department visits and hospitalizations due to back pain and spine surgeries in the three participating hospitals were calculated and compared by incidence rate ratios (IRR).Visits to ED due to back pain decreased during the pandemic. The incidence of ED visits due to back pain was similar in February (IRR 0.95, CI: 0.82-1.10), but a decrease was seen after lockdown began (March IRR 0.67, CI: 0.57-0.78; April IRR 0.65, CI: 0.56-0.76) compared to the reference years. A second decrease in visits was seen after regional restrictions were implemented in October (IRR 0.88, CI: 0.76-1.02). The most common diagnoses were non-specific back pain, lumbar disk herniation, and back contusion. Incidence of non-specific back pain decreased during the lockdown (March IRR 0.65, CI: 0.55-0.78) and regional restrictions (October IRR 0.83, CI: 0.70-0.98), whereas the rates of other diagnoses remained unchanged, and incidences of hospitalizations and urgent spine surgeries remained stable.A clear decrease in ED visits due to back pain was seen during the first and second waves of the pandemic. This decrease was mainly the result of patients with non-specific back pain avoiding visits to the ED. The incidence of specific back pain, hospitalizations, and urgent spine surgeries remained unchanged during the pandemic.
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.
Background and purpose — An increased incidence rate of acromioplasty has been reported; we analyzed data from the Finnish National Hospital Discharge Register. Patients and methods — During the 14-year study period (1998–2011), 68,877 acromioplasties without rotator cuff repair were performed on subjects aged 18 years or older. Results — The incidence of acromioplasty increased by 117% from 75 to 163 per 105 person years between 1998 and 2007. The highest incidence was observed in 2007, after which the incidence rate decreased by 20% to 131 per 105 person years in 2011. The incidence declined even more at non-profit public hospitals from 2007 to 2011. In contrast, it continued to rise at profit-based private orthopedic clinics. Interpretation — We propose that this change in clinical practice is due to accumulating high-quality scientific evidence that shows no difference in outcome between acromioplasty and nonsurgical interventions for rotator cuff disease with subacromial impingement syndrome. However, the exact cause of the declining incidence cannot be defined based solely on a registry study. Interestingly, this change was not observed at private clinics, where the number of operations increased steadily from 2007 to 2011.
Background and purpose - COVID-19 lockdowns have resulted in noteworthy changes in trauma admissions. We report and compare the incidence and characteristics of severe injuries (New Injury Severity Score [NISS] > 15) during the COVID-19 lockdown in Finland with earlier years. Methods - We retrospectively analyzed incidence rate, injury severity scores, injury patterns, and mechanisms of injury of all severely injured patients (NISS >15) in 4 Finnish hospitals (Tampere University Hospital, Kuopio University Hospital, Central Finland Hospital, Mikkeli Central Hospital) during the 11-week lockdown period (March 16-May 31, 2020) with comparison with a matching time period in earlier years (2016-2018). These 4 hospitals have a combined catchment area of 1,150,000 people or roughly one-fifth of the population of Finland. Results - The incidence rate of severe injuries during the lockdown period was 4.9/105 inhabitants (95% CI 3.7-6.4). The incidence rate of severe injuries during years 2016-2018 was 5.1/105 inhabitants (CI 3.9-6.5). We could not detect a significant incidence difference between the lockdown period and the 3 previous years (incidence rate difference -0.2 (CI -2.0 to 1.7). The proportion of traffic-related accidents was 55% during the lockdown period and 51% during previous years. There were no detectable differences in injury patterns. During the lockdown period, the mean age of patients was higher (53 years vs. 47 years, p = 0.03) and the rate of severely injured elderly patients (aged 70 or more) was higher (30% vs. 16%). Interpretation - Despite heavy social restrictions, the incidence of severe injuries during the lockdown period was similar to previous years. Notably, a decline in road use and traffic volumes did not reduce the number of severe traffic accidents. Although our data is compatible with a decrease of 2.0 to an increase of 1.7 severely injured patients per 105 inhabitants, we conclude that severely injured patients do not disappear even during pandemic and stabile hospital resources are needed to treat these patients.
Introduction: There are only few studies on the effects of pelvic or hip fractures on subsequent delivery outcomes. The aim for this study is to evaluate in a nationwide sample whether the rate of elective CS and emergency CS would decrease during the time after maternal hip and pelvic fracture. Material and Methods: In this nationwide registry-based study, data on all women aged 15–49 years with pelvic or hip fractures leading to hospitalization were retrieved from the Care Register for Health Care for the years 1998–2018. Wrist fractures were used as a control group. The data were linked with data from the National Birth Register, where each first pregnancy during the 14-year follow-up is collected. The delivery outcomes of these pregnancies were analyzed. The results were interpreted with odds ratios (OR), adjusted odds ratios (aOR), and 95 % confidence intervals (CI). Results: A total of 2878 women with pelvic fracture, 1330 women with hip fracture, and 29 580 with wrist fracture found in the Care Register for Health Care. Of these, a total of 586 (20.4 %) women gave birth during the following 14 years after pelvic fracture, 147 (11.0 %) women after hip fracture, and 5255 (17.7 %) women after wrist fracture. Women with pelvic fracture had higher odds for CS during each time period. The aOR for CS was 1.62 (CI 1.22–2.12) during first 5 years, 1.87 (CI 1.33–2.62) during years 5–10, and 1.97 (CI 1.11–3.41) during years 10–14. Women with hip fractures had notably higher odds for CS during first 5 years after fracture (aOR 1.64, CI 1.40–2.67). Conclusions: The results of this study advocate that vaginal delivery is generally possible rather quickly after hip or pelvic fracture. Unplanned CS after hip fractures was more common at the beginning, but the exact reason for this remains unknown and further research should be made on this topic.
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.
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.
We aim to evaluate the changes in the incidence of TBI, trauma craniotomies, and craniectomies during the COVID-19 pandemic in Finland. This retrospective register study was conducted at three Finnish hospitals. We retrieved the numbers of emergency department (ED) visits, inpatient admissions, and trauma craniotomies and craniectomies due to TBI in the adult population from 2017 to 2020.We calculated the incidences per 100 000 inhabitants and compared the year 2020 to the reference years (2017–2019) by incidence rate ratios (IRR) with 95% confidence intervals. The incidence of TBI-related ED visits during the study period compared to the reference years started to decrease in March 2020 (IRR 0.86, CI: 0.73–1.02), and the lowest incidence was seen in April 2020 (IRR 0.83, CI: 0.68–1.01). The incidence of ED visits showed a second decrease in December (IRR 0.80, CI: 0.67–0.96). The incidence of concussion decreased during the national lockdown in March (IRR 0.80, CI 0.66–0.97). The incidence of ED visits due to TBI decreased after the declaration of national lockdown in spring 2020 and showed a second decrease during regional restrictions in December. In addition, the incidence of neurosurgically treated TBI decreased during restaurant restrictions in the spring.
Background Studies of the relationship between sports activity and smoking among adolescents and young adults report contradictory results. We examined the association between sports activity (intensity and type of sport) and the current use of snus (Swedish snuff), cigarette smoking, and the combined use of cigarettes and snus (dual use) among young males in Finland. Methods Data were collected from 16,746 male conscripts who completed a survey during the first days of their conscription during the years 1999-2010 (median age 19 years, response rate 95%). Main outcome measures were self-reported daily/occasional use of snus, cigarette smoking, and dual use. The association between sports activity, type of sport, and several sociodemographic background variables was assessed using logistic regression analysis. Results Over the study period (1999-2010), the prevalence of cigarette smoking decreased from 42% to 34%, while snus use increased from 5% to 12%, and dual use increased from 7% to 13% (p < 0.001). Compared with no physical activity, regular competitive sports activity (defined as high-intensity sports activity) was positively associated with use of snus (odds ratio [OR] 10.2; 95% confidence interval [CI]: 7.8-13.5) and negatively with cigarette smoking (OR 0.2; 95% CI: 0.1-0.3). When stratified by type of sport in multivariate models, ice hockey was most strongly associated with snus use (OR 1.6; 95% CI: 1.4-1.9) and dual use (OR 2.0; 95% CI 1.8-2.3) compared with those not playing ice-hockey, followed by other team sports for snus use (OR 1.5; 95% CI: 1.3-1.8) and dual use (OR 1.8; 95% CI: 1.6-2.0) compared with those not participating in other team-sports. Conclusions Our results show a clear association between snus use and intensity and type of training. Team sports were associated with increased use of snus and dual use compared with no participation in team sports. These findings should be acknowledged when planning and implementing preventive strategies. Keywords: Young people/youth; Tobacco use; Snus; Smoking; Sports; Physical activity
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.
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.
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.
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.
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.
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.
Objective: Only a few small studies have assessed the effects of pelvic fractures on pregnancies, deliveries, and rates of cesarean sections. We aimed to evaluate the effect of pelvic fractures on subsequent pregnancy and delivery in Finland. Study design: In this retrospective register-based nationwide cohort study, data on all fertile-aged (aged 15–49) women with a pelvic fracture during our study period (1998–2018) were retrieved from the Care Register for Health Care. The data were subsequently combined with data from the National Medical Birth Register. Women with pelvic fracture before pregnancy were compared with a no-fracture group consisting of 621 141 women who had had 1 156 723 singleton deliveries without a preceding pelvic fracture. We used logistic regression to analyze preterm deliveries, cesarean sections, and neonatal health. Results are reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI). Results: A total of 2 878 women with a previous pelvic fracture were identified. Of these, 596 women had 1 024 singleton deliveries after pelvic fracture. In the no-fracture group, 621 141 women had 1 156 378 singleton deliveries. Compared to the no-fracture group, women with a previous pelvic fracture had higher rates of cesarean sections (22.6% vs 15.9%) (AOR 1.55 CI 1.32–1.80), higher rate of preterm deliveries (6.2% vs 4.6%) (1.32 CI 1.01–1.69), and a higher rate of neonates requiring intensive care unit treatment (13.5% vs 10.0%) (AOR 1.35 CI 1.13–1.62). Conclusion: Vaginal delivery was the primary mode of delivery despite the higher rate of cesarean section among women with a previous fracture of the pelvis. The rate for preterm deliveries and need for neonatal intensive care was also higher, but the clinical importance of these findings is unclear. Our results suggest that vaginal delivery after fractures of the pelvic circle is generally safe for both mother and neonate.
Introduction: The effect of lockdown on the incidence of fractures and severe injuries has been widely studied, whereas studies regarding muscle, tendon, and ligament injuries have not received as much attention. The aim of the study was to investigate the effect of the lockdown and later regional regulations due to the COVID pandemic on the incidence of muscle, tendon, and ligament injuries and related surgical procedures. Materials and methods: This study focuses on the working-age population in the catchment areas of three major Finnish hospitals. Patients were divided into three age groups 18–34, 35–50 and 51–65 years of age. Suitable injuries were retrieved from the data using appropriate ICD-10 codes and procedure codes. The monthly incidence rate ratio (IRR), with 95% confidence intervals (CI), were compared between the year 2020 and the reference years 2017–2019. Results: Upper and lower extremity injury ED visits decreased by 15.7 and 8.2%. For upper extremity injuries, a decrease in incidence was observed for all three age groups in March (IRR 0.52, CI 0.33–0.80), (IRR 0.53, CI 0.31–0.91), (IRR 0.60, CI 0.38–0.95), respectively. An increase in 18–34 years of age group was detected in June (IRR 1.49, CI 1.05–2.13). Lower extremity injuries decreased in 18–34 years of age group in March (IRR 0.62, CI 0.43–0.90) and April (IRR 0.60, CI 0.42–0.87). A decrease on the incidence of surgeries was observed in April for the 35–50 (IRR 0.53, CI 0.29–0.97) and 51–65 years of age groups (IRR 0.58, CI 0.34–0.98). Conclusions: The nationwide lockdown in spring 2020 led to a notable decrease in the incidence of emergency department visits and the surgical treatment of muscle, tendon, and ligament injuries in Finland.
Background. Daylight Savings Time (DST) transition is known to cause sleep disruption, and thus may increase the incidence of injuries and accidents during the week following the transition. The aim of this study was to assess the incidence of femur fractures after DST transition. Methods. We conducted retrospective population-based register study. All Finnish patients 70 years or older who were admitted to hospital due to femur fracture between 1997 and 2020 were gathered from the Finnish National Hospital Discharge Register. Negative binomial regression with 95% confidence intervals (CI) was used to evaluate the incidence of femur fractures after DST transition. Results. The data included a total of 112,658 femur fractures during the study period between 1997 and 2020, with an annual mean (SD) of 4,694 (206) fractures. The incidence of femur fractures decreased at the beginning of the study period from 968 to 688 per 100,000 person-years between 1997 and 2007. The weekly mean of femur fractures remained lower during the summer (from 130 to 150 per 100,000 person-weeks) than in winter (from 160 to 180 per 100,000 person-weeks). Incidence rate ratio for the Monday following DST transition was 1.10 (CI [0.98–1.24]) in spring and 1.10 (CI [0.97–1.24]) in fall, and for the whole week 1.07 (CI [1.01–1.14]) in spring and 0.97 (CI [0.83–1.13]) in fall. Conclusion. We found weak evidence that the incidence of femur fractures increases after DST transition in the spring.