id	PY	author	title	abstract
1	2021	Roxburgh A;Sam B;Kriikku P;Mounteney J;Castanera A;Dias M;Giraudon I	Trends In Mdma-Related Mortality Across Four Countries	Aims to determine trends in 3,4 methylenedioxymethamphetamine (mdma)-related death rates across australia, finland, portugal and turkey and to analyse the toxicology and causes of death across countries. Design analysis of mdma-related deaths extracted from a national coronial database in australia (2001-19) and national forensic toxicology databases in finland (2001-17), portugal (2008-19) and turkey (2007-17). Presentation of mdma use and seizure data (market indicators). Setting australia, finland, portugal and turkey. Cases all deaths in which mdma was considered by the forensic pathologist to be contributory to death. Measurements information collected on cause and circumstances of death, demographics and toxicology. Findings a total of 1400 mdma-related deaths were identified in turkey, 507 in australia, 100 in finland and 45 in portugal. The median age ranged from 24 to 27.5 years, and males represented between 81 and 94% of the deaths across countries. Standardized mortality rates significantly increased across all four countries from 2011 to 2017 during a period of increased purity and availability of mdma. The underlying cause of death was predominantly due to drug toxicity in australia (n = 309, 61%), finland (n = 70, 70%) and turkey (n = 840, 60%) and other causes in portugal (n = 25, 56%). Minorities of all deaths across the countries were due to mdma toxicity alone (13-25%). These deaths had a significantly higher blood mdma concentration than multiple drug toxicity deaths in australia, finland and turkey. Drugs other than mdma commonly detected were stimulants (including cocaine, amphetamine and methamphetamine) (australia 52% and finland 61%) and alcohol (australia 46% and portugal 49%). In addition to mdma toxicity, benzodiazepines (81%) and opioids (64%) were commonly identified in these deaths in finland. In comparison, synthetic cannabinoids (15%) and cannabis (33%) were present in a minority of deaths in turkey. Conclusions deaths related to 3,4 methylenedioxymethamphetamine (mdma) increased in australia, finland, portugal and turkey between 2011 and 2017. Findings show mdma toxicity alone can be fatal, but multiple drug toxicity remains more prevalent.
2	2019	Cunningham Ja;Koski-Jannes A	The Last 10 Years: Any Changes In Perceptions Of The Seriousness Of Alcohol, Cannabis, And Substance Use In Canada?	Background: over the last decade, there have been a number of changes in the canadian landscape - the deconstruction of alcohol policy in some provinces, the legalization of cannabis, increased availability of gambling options, and the increase in opioid use and its associated problems. Have there been concomitant changes in societal images of addictions? Methods: a general population survey on societal images of addictions was conducted in multiple countries in 2008 - finland, sweden, canada (canadian sample size: n = 864; 40% response rate), and part of russia (st petersburg). We repeated the same survey in 2018 in canada (n = 813; response rate = 23%). The survey assessed perceptions of the seriousness of different issues to society - including items about alcohol, tobacco, marijuana, gambling, misuse of medical drugs, and drugs like amphetamine, cocaine, or heroin - among other items (e.g., pollution, violent crime, prostitution). Results: there were increases in perceptions of the seriousness of misuse of medical drugs (p = .001), of illicit drugs (p = .005), ratings of the seriousness of cannabis use (p = .02), and a decrease in ratings of gambling as a social problem (p = .04). Ratings of the seriousness of alcohol and tobacco as social problems did not display significant changes over time (p > .05). Conclusions: there has been some variation in societal perceptions of the seriousness of different addictions. Increases in perceptions of the seriousness of misusing medical drugs and the use of illicit drugs may reflect increases in societal concerns about opioid use and its associated problems. Despite substantial changes in alcohol control policies, the legalization of cannabis, and the increased availability of options for gambling, there appears to be very little associated change in societal perceptions regarding these addictive behaviours.
3	2022	Faltberg N;Partanen M;Lintonen T;Mishina K;Niemela S	Buprenorphine-Naloxone Abuse Among Participants In The Needle Exchange Programme. A Finnish Time-Trend Study From 2008 To 2018	Background: since the early 2000's, buprenorphine has been the most used street opioid in finland. Buprenorphine-naloxone combination drug was originally introduced due to its lower abuse potential when injected compared to monobuprenorphine. Currently, buprenorphine-naloxone combination drug is the most used drug in finnish opioid agonist treatment. To date, the studies reporting buprenorphine-naloxone abuse and associated factors are scarce. Aim: the purpose of this time-trend study was to examine the prevalence, possible changes and associated factors of buprenorphine-naloxone abuse compared to monobuprenorphine abuse among finnish i.v.-users. Methods: participants were people who inject drugs (pwid) attending a needle exchange programme in turku, finland. Information on user profile was collected anonymously via questionnaires at four time-points (2008, 2011, 2014, 2018). These questionnaires examined participants substance abuse during the last six months (2008, 2011, 2014), or 30 days (2018) together with socio-demographic factors. Results: among survey participants, both monobuprenorphine (bup) and buprenorphine-naloxone (bnx) abuse were common during the 10-year study period: 86%/66% in 2008, 85%/81% in 2011, 75%/80% in 2014, and 80%/72% in 2018. Compared to bup abusers, lower education level (or 2.4, 95%ci 1.2-5.0), attending opioid agonist treatment (or 4.0, 95%ci 1.2-13.5), needle sharing (or 3.2, 95%ci 1.5-6.8), amphetamine abuse (or 3.0, 95%ci 1.4-6.6) and methadone abuse (or 5.6 95%ci 1.6-19.2) associated with bnx abuse. Conclusions: the prevalence of buprenorphine-naloxone abuse among pwid is high in south-western finland. Buprenorphine-naloxone abuse seems to relate with more disadvantaged drug use profile compared to monobuprenorphine abuse, and this phenomenon should be addressed in future studies. Harm reduction strategies should be aimed for opioid abusers with buprenorphine-naloxone abuse.
4	2016	Kankaanpaa A;Ariniemi K;Heinonen M;Kuoppasalmi K;Gunnar T	Current Trends In Finnish Drug Abuse: Wastewater Based Epidemiology Combined With Other National Indicators	No single measure is able to provide a complete picture of population-or community-level drug abuse and its current trends. Therefore, a multi-indicator approach is needed. The aim of this study was to combine wastewater-based epidemiology (wbe) with data from other national indicators, namely driving under the influence of drugs (duid) statistics, drug seizures, and drug use surveys. Furthermore, drug market size estimates and a comparison of confiscated drugs to drugs actually consumed by users were performed using the wbe approach. Samples for wastewater analysis were collected during one-week sampling periods in 2012, 2014 and 2015, with a maximum of 14 cities participating. The samples were analysed with a validated ultra-high-performance liquid chromatography-mass spectrometric (uhplc-ms/ms) methodology for various common drugs of abuse. The results were then compared with data from other national indicators available. Joint interpretation of the data shows that the use of amphetamine and mdma has increased in finland from 2012 to 2014. A similar trend was also observed for cocaine, although its use remains at a very low level compared to many other european countries. Heroin was practically absent from the finnish drug market during the study period. The retail market for the most common stimulant drugs were estimated to have been worth eur 70 million for amphetamine and around eur 10 million for both methamphetamine and cocaine, in 2014 in finland. (C) 2016 elsevier b.v. All rights reserved.
5	2021	Raitasalo K;Karjalainen K;Ollila H;Ruokolainen O;Hakkarainen P	Smoke In The Air - Associations Between Experimentation With Cannabis And The Use Of Tobacco And Nicotine Products Among 15-16-Year-Old School Students	Background: cannabis is the most popular illicit drug among adolescents in developed countries, including finland. The aim of this study was to estimate 1) how cannabis experimentation among finnish adolescents changed between 2003 and 2019, and 2) whether the associations between cannabis experiments and factors related to it, especially the use of tobacco and nicotine products, changed during the same time period. Methods: the analyses are based on the european school survey project on alcohol and other drugs data, collected from finnish adolescents aged 15 to 16 in 2003, 2007, 2011, 2015, and 2019 (n = 20,630). Results: experimentation with cannabis among finnish adolescents has increased since the beginning of our follow-up. At the same time, alcohol use and smoking have decreased markedly, and attitudes toward cannabis use have become more relaxed. The association between smoking and cannabis experimentation has become weaker over time. However, the use of tobacco and nicotine products, especially polytobacco, is still a strong risk factor for experimentation with cannabis. The higher the number of tobacco or nicotine products used, the higher the probability for cannabis experimentation. Conclusions: experimentation with cannabis has previously been concentrated predominantly on adolescents who smoke, but recently non-smokers are increasingly trying cannabis. It is possible that alternative ways of using cannabis may have increased its use. Despite the strict cannabis policy in finland, its use has increased, which may be an indication that youth cultures and images of different substances play a significant role in adolescents experimenting with cannabis.
6	2021	Kudre D;Vorobjov S;Ringmets I;Parna K	Adolescent Alcohol Use In Estonia Compared With Latvia, Lithuania, Finland And Sweden: Results From Cross-Sectional Surveys, 2003-2015	Objectives the aims of the study were (1) to describe trends in the prevalence of monthly alcohol use from 2003 to 2015 and (2) to analyse the associations between alcohol use and family-related and school-related factors, risk behaviours and perceived alcohol availability in estonia compared with latvia, lithuania, finland and sweden. Methods the study used nationally representative data of 15-16-year-old adolescents from the european school survey project on alcohol and other drugs. Data from estonia, latvia, lithuania, finland and sweden collected in 2003, 2007, 2011 and 2015 were utilised (n=57 779). The prevalence of monthly alcohol use including light and strong alcohol use was calculated for each study year. A chi(2) test for trend was used to evaluate statistically significant changes in alcohol use over the study period. A multilevel logistic regression analysis was used for assessing the association between alcohol use and explanatory factors. Marginal ors with 95% cis for each country were calculated. Results monthly alcohol use decreased significantly among boys and girls in all countries from 2003 to 2015. In 2015, the prevalence of monthly alcohol use among boys was 36.1% in estonia, 44.3% in latvia, 32.4% in lithuania, 32.3% in finland and 22.4% in sweden. Among girls, it was 39.1%, 45.9%, 35.6%, 31.8% and 29.1%, respectively. In all countries, higher odds of monthly alcohol use were observed among adolescents who skipped school, smoked cigarettes, used cannabis, perceived alcohol to be easy to access and had parents who did not know always/often about their child's whereabouts on saturday nights. Compared with estonia, associations between alcohol use and explanatory factors were similar in latvia and lithuania but different in finland and sweden. Conclusion results of cross-national comparison of alcohol use and explanatory factors could be effectively used to further decrease alcohol use among adolescents.
7	2019	Moeller K	Sisters Are Never Alike? Drug Control Intensity In The Nordic Countries	Background: the nordic countries - denmark, finland, norway, and sweden - have traditionally had different approaches to drug control policies. From the late 1980s to the early 1990s, sweden and norway were the most restrictive countries. Prior research has described how nordic control policies became more repressive after this, but no research has examined this claim using the intensity of implementation as a measure. Methods: this study uses data collated by the emcdda to examine drug control intensity from 2000 to 2016. The four countries are compared on three measures: seizure numbers relative to total population, seizures numbers by type of drug relative to population, and cannabis seizures relative to the number of annual cannabis users. Standard bivariate tests for statistical significance are used to compare control intensity over time and between countries. Results: compared to an earlier period from the late 1980s to the early 1990s, denmark maintained the level of drug seizures to population from 2000 to 2016. Finland increased intensity by 176 percent but remained at the lowest level in the region. Norway increased by 18 percent and is currently the country with the highest enforcement intensity. Sweden reduced overall intensity by 57 percent, which decreases the level for the region by 22 percent. Sixty to seventy percent of all seizures in every country was for cannabis. Accounting for cannabis prevalence rates changes the ranking of enforcement intensity in the countries. Conclusion: drug control intensity in the nordic countries has harmonized over time. The disparity between the extremes of low control intensity in finland and high intensity in sweden has been reduced. Denmark is still comparatively lenient to users when considering high cannabis prevalence rates and norway has taken the position as the strictest country on all control intensity measures.
8	2017	Karjalainen K;Kuussaari K;Kataja K;Tigerstedt C;Hakkarainen P	Measuring Concurrent Polydrug Use In General Populations: A Critical Assessment	Background/aims: polydrug use is a complicated phenomenon that is measured in a wide variety of different ways. Using finland as an example, we aimed to demonstrate how the prevalence and prevalence trends of concurrent polydrug use (cpu) varied in the general population based on the different measurements used. Methods: population-based drug surveys conducted every 4 years during 19982014 were used. Cpu was measured with different measurements: strict, medial and loose definition of cpu, which were based on different combinations of alcohol, illicit drugs, pharmaceutical drugs and cigarettes used during the last 12 months/30 days. Logistic regression was used to estimate the p values for assessing trends. Results: depending on the measurements used, the prevalence of cpu in 2014 varied between 2.0 and 18.7%. Different definitions also produced contradictory trends of cpu: there was a modest increase in prevalence if it was measured with a medial (p < 0.001) or strict (p = 0.054) definition, but when measured with the loose definition (only measure that included smoking), there was a decrease in prevalence (p < 0.001). Conclusions: the prevalence of cpu varies greatly depending on the measurement used, as does the course of the prevalence trends. The concept of simultaneous polydrug use may capture the phenomenon better compared to the concept of cpu. (C) 2017 s. Karger ag, basel
9	2021	El Ansari W;Salam A	Multi-Substance Use Behaviors: Prevalence And Correlates Of Alcohol, Tobacco And Other Drug (Atod) Use Among University Students In Finland	Virtually no studies appraised the co-use of alcohol, tobacco, and other drug (atod) among finn undergraduates. We assessed the associations between sociodemographic, health, academic, policy, and lifestyle characteristics (independent variables); and individual, multiple and increasing atod use (dependent variables) using regression analyses. Data were collected by online questionnaire at the university of turku, finland (1177 students). Roughly 22% of the sample smoked, 21% ever used illicit drug/s, 41% were high frequency drinkers, and 31.4%, 16.3%, and 6.7% reported 1, 2, or 3 atod behaviors respectively. Individual atod use was significantly positively associated with the use of the other two substances [adjusted odds ratio (adj or range 1.893-3.311)]. Multiple atod use was negatively associated with being single (p = 0.021) or agreeing with total smoking or alcohol ban policy on campus (p < 0.0001 for each); but positively associated with not living with parents (p = 0.004). Increasing atod behaviors were significantly less likely among those agreeing with total smoking or alcohol ban policy on campus (p range 0.024 to <0.0001). Demographics significant to either individual, multiple, or increasing atod use included males, being single, not living with their parents during semesters, and to some extent, religiosity. Age, depressive symptoms, perceived stress, self-rated health, health awareness, income sufficiency, and academic variables were not associated with individual, multiple, or increasing atod use. Education and prevention efforts need to reinforce abstinence from atod, highlight their harmful outcomes, and target risk groups highlighted above. University strategies should be part of the wider country-wide successful atod control policies.
10	2020	Lintonen T;Ahtinen S;Konu A	Alcoholic Beverage Preferences Among Teenagers In Finland Before And After The 2018 Alcohol Law Change	Aims: the alcohol law change in finland in the beginning of 2018 was forecast to shift alcohol sales from alcohol monopoly stores to grocery stores. The trend of declining adolescent alcohol use was predicted to end. This study aimed to provide a more detailed view on under-age drinking change through analysing alcoholic beverage use preferences among 14 and 16 year olds in finland from 2017 to 2019. Methods: nationally representative surveys of adolescent health behaviours in finland from 2017 (n = 2451) and 2019 (n = 2119) among 14 and 16 year olds were analysed using cross-tabulations and logistic regression modelling. Beverage data were coded from an open-ended question concerning the latest drinking occasion. Results: the proportion of 14 and 16-year-old girls reporting drinking alcohol was 41% in 2017 and 45% in 2019. The corresponding proportions among boys were 39% in 2017 and 43% in 2019. The share of alcohol consumed in the form of beer, alcopops and cider increased among girls from 55% to 75%, but the apparent increase among boys from 69% to 76% was not statistically significant. The only beverage type category that increased in popularity from the year 2017 to 2019 was alcopops. Conclusions: the law change bringing strong alcopops, beer and cider into grocery stores increased their consumption - especially among the under-aged. Comprehensive measures including taxation, restrictions on advertising and sales affecting the population total consumption are also likely to remain the keys to reducing alcohol consumption among adolescents. In addition, effective age-limit control and sanctions against neglecting age-restriction enforcement are needed.
11	2019	Bosetti C;Santucci C;Radrezza S;Erthal J;Berterame S;Corli O	Trends In The Consumption Of Opioids For The Treatment Of Severe Pain In Europe, 1990-2016	Background over the last decades, consumption of opioids for the treatment of pain increased steadily in the united states, australia, and a few european countries. To date, no study has analysed time trends in opioid consumption across europe. Methods we analysed data provided by international narcotics control boards on the consumption of fentanyl, oxycodone, morphine, hydromorphone and pethidine in 40 european countries over the last decade. Trends in total opioid consumption from 1990 to 2016 in 22 selected european countries, the european union (eu) as a whole, and, for comparison purpose, the united states, were analysed using the joinpoint regression analysis. Results in 2014-2016, opioid use was >10,000 defined daily doses for statistical purposes (s-ddd) per 1,000,000 inhabitants die in western/northern countries, whereas it was ddd in southern/eastern ones. In most european countries, opioid consumption increased to a great extent between 2004-2006 and 2014-2016; it rose from 6,477 to 8,967 s-ddd (+38.4%) in the eu, and from 14,598 to 16,491 s-ddd (+13%) in the united states. The increase in opioid use was steady since the early to mid-1990s in most european countries and it slowed down after the mid- to late 2000s. In denmark, finland, france, ireland, switzerland, poland and the eu, opioid use levelled off or declined over most recent years. Conclusions consumption of opioid analgesics sharply increased in most of european countries since the early to mid-1990s. This notwithstanding, in the mid-2010s there was still a more than 10-fold difference between the highest consumption in western/northern countries and the lowest one in southern/eastern countries. Significance: this study provides an updated and comprehensive analysis of time trends and geographic variations in opioid consumption use across european countries over the last three decades.
12	2022	Keto J;Heiskanen T;Hamunen K;Kalliomaki Ml;Linna M	Opioid Trends In Finland: A Register-Based Nationwide Follow-Up Study	The opioid epidemic in the u.s has gotten payers, prescribers, and policymakers alike interested in trends in opioid use. Despite no recognized opioid crisis in europe, several countries have reported an increase in opioid-related deaths, which has further prompted discussion on the need of monitoring of opioid prescriptions. This study was conducted to offer information on opioid use during the escalation of the u.s. Opioid epidemic in finland, a nordic country with universal tax-based health care. This is a nationwide retrospective register-based cohort study on all individuals in finland who were dispensed opioids in 2009-2017 (n of unique patients = 1,761,584). By using the unique personal identification code assigned to every finnish resident, we linked data from nationwide registers on dispensed drugs, medical history, and socio-demographic parameters. We report a wide set of patient demographics, dispensing trends for all opioid anatomical therapeutic chemical (atc) classes, and reasons for opioid initiation based on diagnostic coding for the most recent health care visit. For a cohort of incident opioid users with a four-year wash-out period (n = 1 370 057), we also present opioid use patterns in a three-year follow-up: the likelihood of becoming a persistent user or escalating from weak to strong opioids. A steady 7% of the finnish population were dispensed opioids annually in 2009-2017. The mean annual quantity of dispensed opioids per opioid patient increased between 2009 and 2017 by 33%, reaching 2 583 oral morphine equivalent mg (omeq)/patient/year in 2017. The median quantity of dispensed opioids was lower: 315 omeq/year/patient. Depending on the opioid atc class, there were either increasing or decreasing numbers of patients who had been dispensed said opioid class, and also in the mean quantity. The most common reason for opioid initiation was post-surgical pain (20%), followed by musculoskeletal pain (15%), injury (8.3%), and non-postsurgical dental pain (6.2%). 94% of new opioid initiators started with a weak opioid, i.e. Codeine or tramadol. 85% of the patients who had been dispensed a weak opioid were not dispensed an opioid subsequently 3-6 months after the first one, and 95% of them had not escalated to a strong opioid in a 3-year follow-up. The number of patients dispensed opioids in finland did not change during the escalation of the opioid epidemic in the u.s., but there were changes in the quantity of opioids dispensed per patient. Opioid therapy was typically initiated with weak opioid, the initial dispensed prescription was relatively small, and escalation to strong opioids was rare. A considerable share of patients had been prescribed opioids for chronic non-cancer pain - a type of pain where the risk-benefit ratio of opioids is controversial.
13	2021	Hamalainen L;Lahti E	Argumentation In Anonymous Online Discussions About Decriminalising Cannabis Use	Aims: in october 2019, a citizens' initiative to decriminalise cannabis use started a large debate about drug policy in finland. This study examines online discussions about the initiative to supplement the current knowledge about citizens' drug opinions. The focus is especially on argumentation techniques that are used to support or object to the decriminalisation. Design: methodologically, the study is based on discourse studies, new rhetoric, and argumentation analysis. The data of 1,092 messages were collected from a popular finnish anonymous discussion forum ylilauta. Results: online discussions about the legal status of cannabis are highly polarised. Decriminalisation is often both supported and resisted in a strong and affective manner, and even hate speech is not rare in the data. Statements made by both discussion parties often lack any argumentation or are based on fallacies, especially ad hominem arguments. Some discussants refer to scientific studies and expert statements, even though such references are usually inaccurate. Cannabis is compared to alcohol more often than to other illegal drugs. Conclusions: the emotional responses and inadequate argumentation might be partially explained by the general nature of online discussions and the culture of the investigated website, but also by the powerful stigma related to illegal drugs and insufficient knowledge on the subject. A future objective is to create a societal atmosphere where the complex question of the legal status of cannabis could be discussed more neutrally and rationally.
14	2017	Adam C;Raschzok A	Cannabis Policy And The Uptake Of Treatment For Cannabis-Related Problems	Introduction and aimswe examine public health effects of steps towards more permissive cannabis policies introduced in belgium, finland, france and portugal between 1999 and 2004. Public health effects are captured in terms of cannabis-induced treatment uptake as reported by the european monitoring centre for drugs and drug addiction. Design and methodswe use a quasi-experimental difference-in-differences design drawing on observational data. Resultswhile the number of clients with primary cannabis problems per reporting treatment unit has generally increased, this increase does not seem to be substantially stronger in the countries that introduced more permissive cannabis policies. Discussion and conclusionsthe specific reforms carried out in the group of reforming countries can thus not be shown to have had adverse effects on public health in terms of treatment uptake.
15	2022	Karjalainen K;Gunnar T;Hakkarainen P;Kankaanpaa A;Ronka S	Analysis Of Illicit Stimulant Use Triangulating Wastewater, General Population Survey And Web Survey Data	Background: we analysed illicit stimulant use in finland by comparing three separate datasets collected at the same time. Methods: the data used were wastewater analysis (2014 and 2018), population-based drug surveys (2014 and 2018) and european web survey on drugs (2018, finnish data). Proportions, prevalence levels and trends of stimulant use as well as their consumption were measured. Factors associated with stimulant use were assessed for past-year stimulant or amphetamine use as an outcome measure in regression analyses. Results: both population-based drug survey and wastewater data showed that stimulant use has increased in finland between 2014 and 2018. Disadvantaged socio-demographic background and other substance use were associated with past-year stimulant use, with no geographical variation in finland. The socio-demographics of those reporting amphetamine use differed between population-based drug survey and web survey. In the web survey, infrequent and occasional users of amphetamine were quite alike, whereas frequent users were more likely to be unemployed or use injection as the route of administration. Conclusion: analysis of three different data revealed findings that would have been missed and conclusions that could not have been made by using only one dataset. Putting findings from different methods into dialogue raises new questions and opens new interpretations. This analysis emphasises the importance of the prevention of frequent use and associated harm, as well as the impact of versatile drug treatment and harm reduction services on it.
16	2019	Sama Tb;Hiilamo H	Alcohol Industry Strategies To Influence The Reform Of The Finnish Alcohol Law	Aim: the aim of this study was to investigate the strategies used by the alcohol industry to influence the reform of the alcohol act in finland during the preparation phase between 2016 and 2017. The study answers the following research question: what strategies were used by the alcohol industry to change the original purpose of the reform on alcohol in finland? Method: primary data were collected through 16 expert interviews with experts who had participated in the preparation of the alcohol reform in finland, while secondary data were collected from prior literature, journal articles and google databases. Results: the results identified three main political strategies used by the alcohol industry to influence the reform of the law on alcohol in finland during the preparation phase between 2016 and 2017: "information", under which the alcohol industry lobbied politicians in parliament through members of parliament of the national coalition party due to the close ties between the two; "constituency building", under which the alcohol industry formed alliances with interest groups in the grocery-retail business in finland, to advocate for liberalisation of the law, as well as the use of social media - specifically twitter - to lobby the public; and lastly, "policy substitution" to promote self-regulation. Conclusions: the results suggest that the involvement of the alcohol industry in political decision-making following finland's eu membership has given the industry legitimacy and new opportunities to influence alcohol policy, while limiting policies to protect the public from alcohol-related harms. The results may be useful to alcohol policy-makers.
17	2017	Pena S;Makela P;Valdivia G;Helakorpi S;Markkula N;Margozzini P;Koskinen S	Socioeconomic Inequalities In Alcohol Consumption In Chile And Finland	Background: reasons for socioeconomic inequalities in alcohol harm are not sufficiently understood. One explanation relates to differential exposure to alcohol by socioeconomic status (ses). The present study investigated socioeconomic inequalities in alcohol use in two countries with high alcohol consumption and alcohol harm. Methods: data from nationally representative surveys in 2009-2010 in chile and in 2008-2011 in finland were used. Surveys comprised 3477 participants in chile and 9994 in finland aged 30-64 years. Outcome measures included abstinence, weekly consumption of pure alcohol, heavy volume drinking and heavy episodic drinking (hed). We employed a novel method in alcohol research, the concentration index, to measure socioeconomic inequalities. Results: alcohol abstinence showed a strong association with lower ses in chile and finland. These were largely driven by inequalities among women in chile and older subgroups in finland. In both countries, women aged 45-64 of higher ses showed higher weekly consumption of pure alcohol and heavy volume drinking. Heavy volume drinking among chilean women aged 45-64 showed the highest inequality, favouring higher ses. Hed was equally distributed among ses groups in chile; in finland hed disproportionally affected lower ses groups. Conclusions: lower ses was associated with higher abstinence rates in both countries and heavy episodic drinking in finland. Heavy volume drinking was more prevalent in middle-aged women of high ses. The results identified groups for targeted interventions, including middle-aged higher ses women, who traditionally have not been specifically targeted. The concentration index could be a useful measure of inequalities in alcohol use. (C) 2017 elsevier b.v. All rights reserved.
18	2016	Hakkarainen P	Vaporizing The Pot World - Easy, Healthy, And Cool	Purpose - the purpose of this paper is to study vaporizers - especially the vape pen - as a new technology in cannabis use. Until now, almost all information on the use of vaporizers or e-cigarettes for cannabis consumption has come from the internet, the popular press, and accounts by users, but not from the scientific literature. More research is needed. Design/methodology/approach - since scientific studies of the phenomenon are virtually non-existent, the author will also base his study on sociological reflections upon internet sites and articles published both in subcultural and mainstream media. The author will document a national estimate of the prevalence of vaping based on a recent population survey in finland. Findings - vaping is an emerging trend in cannabis culture internationally. It has been seen as a healthier route of administration than traditional ways of smoking cannabis. Other images, created especially with the help of advanced high-tech machinery and stylish and fashionable designs for the vape pen, are aiming at being cool and easy to use. In finland, 6 percent of cannabis users make regular use of a vaporizer, and around a quarter of users use one occasionally. A vape pen or e-cigarette was regularly used by 2.6 percent and occasionally by 9.1 percent of cannabis users. Originality/value - the trend of increasing vaping and the use of new devices has not been properly recognized among researchers. The paper presents some original results from a national population survey.
19	2022	Hamina A;Muller Ae;Clausen T;Skurtveit S;Hesse M;Tjagvad C;Thylstrup B;Odsbu I;Zoega H;Jonsdottir Hl;Taipale H	Prescription Opioids Among Older Adults: Ten Years Of Data Across Five Countries	Background opioid use has increased globally in the recent decade. Although pain remains a significant problem among older adults, susceptibility to opioid-related harms highlights the importance of careful opioid therapy monitoring on individual and societal levels. We aimed to describe the trends of prescription opioid utilisation among residents aged >= 65 in all nordic countries during 2009-2018. Methods we conducted cross-sectional measurements of opioid utilisation in 2009-2018 from nationwide registers of dispensed drugs in denmark, finland, iceland, norway, and sweden. The measures included annual opioid prevalence, defined daily doses (ddds) per 1000 inhabitants per day (dids), and morphine milligram equivalents (mmes) per user per day. Results from 2009 to 2018, an average of 808,584 of adults aged >= 65 used opioids yearly in all five countries; an average annual prevalence of 17.0%. During this time period, the prevalence decreased in denmark, norway, and sweden due to declining codeine and/or tramadol use. Iceland had the highest opioid prevalence in 2009 (30.2%), increasing to 31.7% in 2018. In the same period, dids decreased in all five countries, and ranged from 28.3 in finland to 58.5 in denmark in 2009, and from 23.0 in finland to 54.6 in iceland in 2018. Mmes/user/day ranged from 4.4 in iceland to 19.6 in denmark in 2009, and from 4.6 in iceland to 18.8 in denmark in 2018. In finland, norway, and sweden, mmes/user/day increased from 2009 to 2018, mainly due to increasing oxycodone utilisation. Conclusions the stable or decreasing opioid utilisation prevalence among a majority of older adults across the nordic countries coincides with an increase in treatment intensity in 2009-2018. We found large cross-national differences despite similarities across the countries' cultures and healthcare systems. For the aged population, national efforts should be placed on improving pain management and monitoring future trends of especially oxycodone utilisation.
20	2021	Raitasalo K;Kraus L;Bye Ek;Karlsson P;Tigerstedt C;Torronen J;Raninen J	Similar Countries, Similar Factors? Studying The Decline Of Heavy Episodic Drinking In Adolescents In Finland, Norway And Sweden	Aim to (i) examine several factors associated with trends in heavy episodic drinking (hed) in finland, norway and sweden, (ii) investigate similarities in these associations across the countries and (iii) analyse the contribution of these factors to the trend in hed and the differences across the countries. Design and setting observational study using five waves of the european school survey project on alcohol and other drugs (espad) from finland, norway and sweden between 1999 and 2015. Participants a total of 18 128 male and 19 121 female 15- to 16-year-old students. Measurements monthly hed, perceived access to alcohol, truancy, parental control, leisure time activities and daily smoking. The cochran-armitage test was used to examine linear time trends in hed. Logit regression models using the karlson-holm-breen (khb) method were fitted for each country separately, including all the independent variables together with time and adjusted for family status, parental education and gender. Findings in finland, norway and sweden, perceived access to alcohol, truancy and daily smoking decreased significantly between 1999 and 2015 whereas risk perceptions, parental control and participation in sports increased in the same period. The confounding percentage of all the independent variables related to the trend in hed was 48.8%, 68.9% and 36.7% for finland, norway and sweden, respectively. Decline in daily smoking (p < 0.001) and perceived access to alcohol (p < 0.001) were positively and increase in parental control (p < 0.001) negatively associated with the decline in hed in all three countries. Changes in truancy, going out with friends, and engaging in sports and other hobbies had little or no impact on the decline in hed or displayed no consistent results across the countries. Conclusions the decline in adolescent heavy episodic drinking in finland, norway and sweden between 1999 and 2015 appears to be associated with a decline in adolescent daily smoking and perceived access to alcohol and an increase in parental control.
21	2020	Pitkanen T;Kaskela T;Levola J	Mortality Of Treatment-Seeking Men And Women With Alcohol, Opioid Or Other Substance Use Disorders - A Register-Based Follow-Up Study	Background: alcohol (aud), opioid (oud) and other substance use disorders (sud) are associated with an increased risk of premature death. The aim of this register-based follow-up study was to compare the risk of death between individuals who had sought treatment for auds, ouds and other suds in finland. Design, setting, participants: data included 10,888 individuals who had sought help from three clinics at some point between 1990 and 2009. Treatment data were linked to national register data concerning education, hospitalizations and death by the year 2018. Measurements: individuals were categorized into four groups: only alcohol (aud-only), all ouds (oud-all), other or multiple suds (sud-other) and outpatients without substance-related diagnoses or hospitalizations (sunas); in mortality analyses, those who had started in opioid substitution treatment (ost) were analyzed separately. Cox regression analyses were used to calculate the risk of death by the year 2018 or up to 15 years after seeking treatment. Results: among the 10,888 treatment-seeking individuals the cumulative mortality rates during 1-, 5- and 15-year follow-up were 2.5% (n = 271), 10.9% (n = 1191) and 28.4% (n = 3096), respectively. The mean age at death varied according to substance of use (55.0 years for aud-only, 35.8 oud-all, 45.8 su-d-other and 55.6 su-nas). The patients who had started in ost had a lower risk of death compared to the other groups, as did the sunas group that likely included individuals with a less severe course of auds/suds. There were no differences between the aud-only, oud-other and sud-other groups for the risk of death during the 15-year follow-up period when gender and year of birth were included as covariates. Conclusions: the mortality rates were very high; however, most of the deaths occurred several years after seeking treatment. The lower mortality amongst the patients who had initiated ost solidifies previous knowledge on the benefits of ost and efforts should be made to improve access to treatment. These results show that treatment plays a role in lowering the risk of death among individuals with auds/suds.
22	2020	Norstrom T;Ramstedt M	The Link Between Alcohol Sales And Alcohol-Related Harm In Finland, 1995-2016	Objective: a key assumption in finnish alcohol policy is that the officially registered alcohol consumption (i.e., alcohol sales) is closely related to alcohol-related harm. During the last two decades, a sizable part of total alcohol consumption, however, comprises unrecorded consumption, which may potentially make alcohol sales less powerful as a predictor of alcohol-related harm. This article thus aims to estimate the relationship between alcohol sales and alcohol-related harm on the basis of more recent finnish time-series data. Method: data on alcohol sales (liters of 100% alcohol/capita age 15 years and older) were obtained from the national institute for health and welfare in finland. As indicators of harm, we used police-reported assaults and three forms of mortality: alcohol-specific mortality, accidents, and suicide. Quarterly data on mortality and alcohol sales spanned the period 1995-2016, and data on police-reported offenses covered the period 1990-2016. Data were analyzed by sarima (seasonal autoregressive integrated moving average) modeling. Results: a positive and significant association between alcohol sales and all harm indicators was found. A 1-l increase in alcohol sales per capita was associated with a 20% increase in alcohol-specific mortality, a 12% increase in assaults, and a 5%-6% increase in accidents and suicide. These estimates are in line with earlier findings estimated on data for the period when unrecorded alcohol consumption was less common in finland. Conclusions: the results provide support for a continued strong relationship between alcohol sales and alcohol-related harm in finland. Policy measures aimed at lowering alcohol sales were supported from these results.
23	2018	Raitasalo K;Simonen J;Tigerstedt C;Makela P;Tapanainen H	What Is Going On In Underage Drinking? Reflections On Finnish European School Survey Project On Alcohol And Other Drugs Data 1999-2015	Introduction and aimsas alcohol use has decreased among finnish adolescents, we aim to assess: (i) time trends in alcohol use, heavy episodic drinking (hed) and potential explanatory variables among adolescents; (ii) the relationship between trends of explanatory variables and trends in alcohol use and hed; and (iii) which of the explanatory variables can account for the temporal change in alcohol use and hed. Design and methodsthe analyses are based on european school survey project on alcohol and other drugs data collected from 15- to 16-year-old finnish adolescents in 1999, 2003, 2007, 2011 and 2015. Resultsthe decline in alcohol use and hed among underage youth in finland is associated with at least three factors: (i) obtaining alcohol has become more difficult; (ii) parents know better than before where their children spend their friday nights; and (iii) the risk attached to going out with friends on drinking has decreased. Discussion and conclusionsformal policy measures and adults' attitudes have probably affected the availability of alcohol for adolescents, and thus they partly explain the decline in youth drinking. This decline coincides with the introduction of new digital technologies, new forms of interaction within families and peer groups, and more conscientious teenagers. All these changes are not necessarily causes of the decline but are part of a similar broader change in adolescents' lives.
24	2019	Norstrom T;Makela P	The Connection Between Per Capita Alcohol Consumption And Alcohol-Specific Mortality Accounting For Unrecorded Alcohol Consumption: The Case Of Finland 1975-2015	Introduction and aims unrecorded alcohol consumption has increased strongly in finland after 1995 when the country joined the european union. This development may have rendered alcohol sales less trustworthy as a proxy for population drinking, and less powerful as predictor of alcohol-related harm. The study aims to test this contention by analyzing the association between recorded and unrecorded alcohol consumption on the one hand, and alcohol-specific mortality on the other. Design and methods we analysed age-standardised rates of alcohol-specific deaths for the working-age (15-64 years) population. For alcohol consumption, we used (i) alcohol sales in litres of 100% alcohol per capita, and (ii) estimated unrecorded consumption in litres of 100% alcohol per capita. The data spanned the period 1975-2015. As the data were cointegrated, the relations between mortality and the alcohol indicators were estimated through time-series analysis of the raw data. Results a one litre increase in alcohol sales was associated with an increase in alcohol-specific deaths of 7.590 deaths per 100 000; the corresponding figure for unrecorded consumption was 9.112 deaths per 100 000. Both estimates were statistically significant (p < 0.001), but the difference between them was not significant (p = 0.293). Although recoded consumption captured the main feature of the trends in alcohol-specific mortality, it accounted for only half of its marked increase in 1975-2007, while unrecorded consumption explained the remaining part. Discussion and conclusions our study confirms previous findings that recorded alcohol consumption is an important determinant of alcohol-specific mortality in finland. A more novel insight is the importance of unrecorded consumption in this context.
25	2020	Knaappila N;Marttunen M;Frojd S;Lindberg N;Kaltiala R	Changes In Cannabis Use According To Socioeconomic Status Among Finnish Adolescents From 2000 To 2015	Background: despite reduced sanctions and more permissive attitudes toward cannabis use in the usa and europe, the prevalences of adolescent cannabis use have remained rather stable in the twenty-first century. However, whether trends in adolescent cannabis use differ between socioeconomic groups is not known. The aim of this study was to examine trends in cannabis use according to socioeconomic status among finnish adolescents from 2000 to 2015. Methods: a population-based school survey was conducted biennially among 14-16-year-old finns between 2000 and 2015 (n = 761,278). Distributions for any and frequent cannabis use over time according to socioeconomic adversities were calculated using crosstabs and chi-square test. Associations between any and frequent cannabis use, time, and socioeconomic adversities were studied using binomial logistic regression results shown by odds ratios with 95% confidence intervals. Results: at the overall level, the prevalences of lifetime and frequent cannabis use varied only slightly between 2000 and 2015. Cannabis use was associated with socioeconomic adversities (parental unemployment in the past year, low parental education, and not living with both parents). The differences in any and frequent cannabis use between socioeconomic groups increased significantly over the study period. Conclusions: although the overall changes in the prevalence of adolescent cannabis use were modest, cannabis use increased markedly among adolescents with the most socioeconomic adversities. Socioeconomic adversities should be considered in the prevention of adolescent cannabis use.
26	2020	Saarela J;Kolk M	Alcohol-Related Mortality By Ethnic Origin Of Natives: A Prospective Cohort Study Based On Multigenerational Population Register Data From Finland And Sweden	Objectives the aim was to assess alcohol-related mortality of persons with mixed and uniform ethnic origins in two national contexts. Setting data were from the multigenerational population registers of the total population of finland and sweden observed from 1971 to 2017. Study persons were men and women of ethnic finnish and swedish background, born in their country of residence. Participants persons were born between 1953 and 1999. In finland, ethnic origin was assessed through own, mother's and father's finnish or swedish ethnolinguistic affiliation. Data on sweden included persons born in sweden, with mother and father born in sweden or finland. A total of 2 997 867 and 4 148 794 persons were included in the finnish and swedish data, respectively. The total number of alcohol-related deaths by main cause was 13 204 and 3336. Cox regressions were used to examine associations. Outcome measures for the period 1971-2017, we studied alcohol as the main cause of death. For the period 1996-2017, we observed if alcohol was the main or contributing cause of death. Parallel analyses were performed for all-cause mortality. Results for men in finland, the hazard rate of alcohol-related mortality of swedish speakers with uniform swedish background was 0.44 (95% ci: 0.38 to 0.52) that of finnish speakers with uniform finnish background. The corresponding hazard rate for women was 0.40 (95% ci: 0.28 to 0.55). In sweden, the hazard rate of men with both parents born in sweden was 0.40 (95% ci: 0.32 to 0.49) that of men with both parents born in finland. The corresponding hazard rate for women was 0.50 (95% ci: 0.31 to 0.79). In both countries, persons with mixed background had an alcohol-related mortality rate between that of persons with uniform finnish and swedish background. Conclusion the consistent pattern across countries necessitates increased policy attention towards offspring disadvantaged via parental ethnicity to minimise harmful consequences of alcohol consumption across and within ethnic groups.
27	2018	Wieczorek L;Sieroslawski J;Dabrowska K	Changes In Use And Availability Of Cannabis Among Adolescents Over Last Two Decades. Situation In Poland And Selected European Countries	Introduction: the aim of the article is to analyse prevalence of use and availability of cannabis (marijuana and hashish) by adolescents in the last 20 years in poland and compare the results with those obtained in selected european countries (czech republic, france, finland and ukraine). Material and methods: data from the espad study were used. Trends analyses include data from measurements obtained in 1995, 1999, 2003, 2007, 2011 and 2015. Results: over the last 20 years a threefold increase in prevalence of cannabis use among adolescents is observed in poland. Regarding experimental use, this is the highest increase in prevalence compared to reference countries. During the last two decades the perceived availability of marijuana and hashish has doubled in poland. In 2015, availability was assessed at a similar level as in france. Recently, in all countries there has been a decrease noticed in the percentage of respondents claiming that the availability of cannabis is easy. In czech republic this trend was noted even earlier since 2007. Discussion: changes in polish drug policy in the last 20 years can be treated as restrictive, aimed at limiting of use. However, the prevalence of cannabis use among adolescents has increased. On the other hand, in the czech republic, where liberal legislative changes were implemented in 2010, a decrease in the prevalence of use has been observed since 2007. Conclusions: legal instruments regulating the supply and demand of drugs may have less impact on shaping the prevalence than psychosocial factors identified at the individual user level, such as knowledge on places where you can easily get substances or drug use by friends and significant others.
28	2019	Tarkiainen L;Rehnberg J;Martikainen P;Fritzell J	Income Trajectories Prior To Alcohol-Attributable Death In Finland And Sweden	Background and aims mortality from alcohol-attributable causes is patterned by income. We study the income trajectories 17-19 years prior to death in order to determine: (1) whether income levels and trajectories differ between those who die of alcohol-attributable causes, survivors with similar socio-demographic characteristics, all survivors and those dying of other causes; (2) whether the income trajectories of these groups differ by education; and (3) whether there are differences in income trajectories between finland and sweden-two countries with differing levels of alcohol-attributable mortality but similar welfare-provision systems. Design retrospective cohort study using individual-level longitudinal register data including information on income, cause of death and socio-economic status. Setting finland and sweden. Participants the subjects comprised an 11% sample of the finnish population in 2006-07 and the total population of sweden aged 45-64 years in 2007-08. Measurements median household income trajectories by educational group were calculated by cause of death and population alive during the respective years. Additionally, propensity score matching was used to match the surviving population to those dying from alcohol-attributable causes with regard to socio-demographic characteristics. Findings the median income 17-19 years prior to death from alcohol-attributable causes was 92% (finland) and 91% (sweden) of survivor income: 1 year prior to death, the respective figures were 47% and 57%. The trajectories differed substantially. Those dying of alcohol-attributable causes had lower and decreasing incomes for substantially longer periods than survivors and people dying from other causes. These differences were more modest among the highly educated individuals. The baseline socio-demographic characteristics of those dying of alcohol causes did not explain the different trajectories. Conclusions in finland and sweden, income appears to decline substantially before alcohol-attributable death. Highly educated individuals may be able to buffer the negative effects of extensive alcohol use on their income level. Income trajectories are similar in finland and sweden, despite marked differences in the level of alcohol-attributable mortality.
29	2021	Hauser W;Buchser E;Finn D;Dom G;Fors E;Heiskanen T;Jarlbaek L;Knaggs Rd;Kosek E;Krcevski-Skvarc N;Pakkonen K;Perrot S;Trouvin Ap;Morlion B	Is Europe Also Facing An Opioid Crisis?-A Survey Of European Pain Federation Chapters	Background there is considerable public interest in whether europe is facing an opioid crisis comparable to the one in the united states and the contribution of opioid prescriptions for pain to a potential opioid crisis. Methods a task force of the european pain federation (efic) conducted a survey with its national chapter representatives on trends of opioid prescriptions and of drug-related emergency departments and substance use disorder treatment admissions and of deaths as proxies of opioid-related harms over the last 20 years. Results data from 25 european countries were received. In most european countries opioid prescriptions increased from 2004 to 2016. The levels of opioid consumption and their increase differed between countries. Some eastern european countries still have a low opioid consumption. Opioids are mainly prescribed for acute pain and chronic noncancer pain in some western and northern european countries. There was a parallel increase in opioid prescriptions and some proxies of opioid-related harms in france, finland and the netherlands, but not in germany, spain and norway. In united kingdom, opioid overdose deaths, but not opioid prescriptions increased between 2016 and 2018. There are no robust data available on whether prescribed opioids for pain patients contributed to opioid-related harms. Conclusions there are marked differences between european countries in trends of opioid prescribing and of proxies for opioid-related harms. Europe as a whole is not facing an opioid crisis. Discussions on the potential harms of opioids should not obstruct their prescription for cancer pain and palliative care. Significance europe as a whole is not facing an opioid crisis. Some eastern european countries have limited access to opioid medicines. Discussions on the potential harms of opioid medicines for noncancer pain should not obstruct opioid therapy for cancer therapy and palliative care.
30	2016	Agardh Ee;Danielsson Ak;Ramstedt M;Holm Al;Diderichsen F;Juel K;Vollset Se;Knudsen Ak;Kinge Jm;White R;Skirbekk V;Makela P;Forouzanfar Mh;Coates Mm;Casey Dc;Naghavi M;Allebeck P	Alcohol-Attributed Disease Burden In Four Nordic Countries: A Comparison Using The Global Burden Of Disease, Injuries And Risk Factors 2013 Study	Aims(1) to compare alcohol-attributed disease burden in four nordic countries 1990-2013, by overall disability-adjusted life years (dalys) and separated by premature mortality [years of life lost (yll)] and health loss to non-fatal conditions [years lived with disability (yld)]; (2) to examine whether changes in alcohol consumption informs alcohol-attributed disease burden; and (3) to compare the distribution of disease burden separated by causes. Designa comparative risk assessment approach. Settingsweden, norway, denmark and finland. Participantsmale and female populations of each country. Measurementsage-standardized dalys, ylls and ylds per 100 000 with 95% uncertainty intervals (uis). Findingsin finland, with the highest burden over the study period, overall alcohol-attributed dalys were 1616 per 100000 in 2013, while in norway, with the lowest burden, corresponding estimates were 634. Dalys in denmark were 1246 and in sweden 788. In denmark and finland, changes in consumption generally corresponded to changes in disease burden, but not to the same extent in sweden and norway. All countries had a similar disease pattern and the majority of dalys were due to ylls (62-76%), mainly from alcohol use disorder, cirrhosis, transport injuries, self-harm and violence. Ylds from alcohol use disorder accounted for 41% and 49% of dalys in denmark and finland compared to 63 and 64% in norway and sweden 2013, respectively. Conclusionsfinland and denmark has a higher alcohol-attributed disease burden than sweden and norway in the period 1990-2013. Changes in consumption levels in general corresponded to changes in harm in finland and denmark, but not in sweden and norway for some years. All countries followed a similar pattern. The majority of disability-adjusted life years were due to premature mortality. Alcohol use disorder by non-fatal conditions accounted for a higher proportion of disability-adjusted life years in norway and sweden, compared with finland and denmark.
31	2017	Hamina A;Taipale H;Tanskanen A;Tolppanen Am;Karttunen N;Pylkkanen L;Tiihonen J;Hartikainen S	Long-Term Use Of Opioids For Nonmalignant Pain Among Community-Dwelling Persons With And Without Alzheimer Disease In Finland: A Nationwide Register-Based Study	Persons with alzheimer disease (ad) commonly present with chronic nonmalignant pain, but long-term use of opioids among this population has not been studied previously. Our aim was to investigate the prevalence of long-term (>= 180 days) use of opioids for nonmalignant pain and associated factors among community-dwelling persons with ad and to compare the prevalence with a matched cohort without ad. The medication use and alzheimer's disease (medalz) cohort was used for this study, comprising all community- dwelling persons diagnosed with ad in finland during 2005 to 2011 and their matched comparison persons without ad. After exclusion of persons with active cancer treatment, 62,074 persons with and 62,074 persons without ad were included in this study. Data were collected from nationwide registers. Opioids were used by 13,111 persons with and by 16,659 without ad. Overall long-term opioid use was more common among persons without ad (8.7%) than among persons with ad (7.2%, p, 0.0001). However, among opioid users, prevalence of long-term opioid use was slightly higher among persons with ad than among those without ad (34.2% vs 32.3%, respectively, p = 0.0004). Long-term use of transdermal opioids was more than 2-fold among opioid users with ad (13.2%) compared with users without ad (5.5%). Factors associated with long-term opioid use included ad, age >= 80 years, female sex, rheumatoid arthritis, osteoporosis, low socioeconomic position, history of substance abuse, and long- term benzodiazepine use. Prevalence of long- term opioid use was somewhat similar among both groups. Among persons with ad, longterm opioid use was strongly associated with transdermal opioids.
32	2022	Moustgaard H;Tarkiainen L;Ostergren O;Korhonen K;Zangarini N;Costa G;Martikainen P	The Contribution Of Alcohol-Related Deaths To The Life-Expectancy Gap Between People With And Without Depression - A Cross-Country Comparison	Background: alcohol-related deaths may be among the most important reasons for the shorter life expectancy of people with depression, yet no study has quantified their contribution. We quantify the contribution of alcoholrelated deaths to the life-expectancy gap in depression in four european countries with differing levels of alcoholrelated mortality.methods: we used cohort data linking population registers with health-care and death records from denmark, finland, sweden and turin, italy, in 1993-2007 (210,412,097 person years, 3046,754 deaths). We identified psychiatric inpatients with depression from hospital discharge registers in denmark, finland, and sweden and outpatients with antidepressant prescriptions from prescription registers in finland and turin. We assessed alcohol-related and non-alcohol-related deaths using both underlying and contributory causes of death, stratified by sex, age and depression status. We quantified the contribution of alcohol-related deaths by cause-of-death decomposition of the life-expectancy gap at age 25 between people with and without depression.results: the gap in life expectancy was 13.1-18.6 years between people with and without inpatient treatment for depression and 6.7-9.1 years between those with and without antidepressant treatment. The contribution of alcohol-related deaths to the life-expectancy gap was larger in denmark (33.6%) and finland (18.1-30.5%) - i.e., countries with high overall alcohol-related mortality - than in sweden (11.9%) and turin (3.2%), and larger among men in all countries. The life-expectancy gap due to other than alcohol-related deaths varied little across countries.conclusions: alcohol contributes heavily to the lower life expectancy in depression particularly among men and in countries with high overall alcohol-related mortality.
33	2018	Trias-Llimos S;Martikainen P;Makela P;Janssen F	Comparison Of Different Approaches For Estimating Age-Specific Alcohol-Attributable Mortality: The Cases Of France And Finland	Background accurate estimates of the impact of alcohol on overall and age-specific mortality are crucial for formulating health policies. However, different approaches to estimating alcohol-attributable mortality provide different results, and a detailed comparison of age-specific estimates is missing. Methods using data on cause of death, alcohol consumption, and relative risks of mortality at different consumption levels, we compare eight estimates of sex- and age-specific alcohol-attributable mortality in france (2010) and finland (2013): five estimates using cause-of-death approaches (with one accounting for contributory causes), and three estimates using attributable fraction (af) approaches. Results af-related approaches and the approach based on alcohol-related underlying and contributory causes of death provided estimates of alcohol-attributable mortality that were twice as high as the estimates found using underlying cause-of-death approaches in both countries and sexes. The differences across the methods were greatest among older age groups an inverse u-shape in age-specific alcohol-attributable mortality (peaking at around age 65) was observed for cause-of-death approaches, with this shape being more pronounced in finland. Af-related approaches resulted in different estimates at older ages: i.e., mortality was found to increase with age in france; whereas in finland mortality estimates depended on the underlying assumptions regarding the effects of alcohol consumption on cardiovascular mortality. Conclusions while the most detailed approaches (i.e., the af-related approach and the approach that includes underlying and contributory causes) are theoretically able to provide more accurate estimates of alcohol-attributable mortality, they especially the af approaches- depend heavily on data availability and quality. To enhance the reliability of alcohol-attributable mortality estimates, data quality for older age groups needs to be improved.
34	2017	Nelson Jp;Mcnall Ad	What Happens To Drinking When Alcohol Policy Changes? A Review Of Five Natural Experiments For Alcohol Taxes, Prices, And Availability	Natural experiments are an important alternative to observational and econometric studies. This paper provides a review of results from empirical studies of alcohol policy interventions in five countries: denmark, finland, hong kong, sweden, and switzerland. Major policy changes were removal of quotas on travelers' tax-free imports and reductions in alcohol taxes. A total of 29 primary articles are reviewed, which contain 35 sets of results for alcohol consumption by various subpopulations and time periods. For each country, the review summarizes and examines: (1) history of tax/quota policy interventions and price changes; (2) graphical trends for alcohol consumption and liver disease mortality; and (3) empirical results for policy effects on alcohol consumption and drinking patterns. We also compare cross-country results for three select outcomes-binge drinking, alcohol consumption by youth and young adults, and heavy consumption by older adults. Overall, we find a lack of consistent results for consumption both within- and across-countries, with a general finding that alcohol tax interventions had selective, rather than broad, impacts on subpopulations and drinking patterns. Policy implications of these findings are discussed.
35	2021	Stickley A;Baburin A;Jasilionis D;Krumins J;Martikainen P;Kondo N;Leinsalu M	Economic Cycles And Inequalities In Alcohol-Related Mortality In The Baltic Countries And Finland In 2000-2015: A Register-Based Study	Aim to estimate whether large macroeconomic fluctuations in the 2000s affected inequalities in alcohol-related mortality in the baltic countries and finland. Design longitudinal register-based follow-up study. Setting estonia, latvia, lithuania and finland. Participants general population in the 35-74 age group. Measurements socioeconomic status was measured by the highest achieved educational level and was categorised using the international standard classification of education 2011 as low (included categories 0-2), middle (3-4), and high (5-8). Educational inequalities in alcohol-related mortality in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 were examined using census-linked longitudinal mortality data. We estimated age-standardised mortality rates and the relative and slope index of inequality. Findings alcohol-related mortality increased in all countries in 2004-2007 except among estonian women and decreased/remained the same from 2008 onward except among latvian men. By 2012-2015 alcohol-related mortality was still higher than in 2000-2003 in finland, latvia and lithuania (women only). Relative inequalities increased across the study period in all countries (significantly in lithuania and latvia). The 2004-2007 increase in relative inequalities was mostly driven by a larger mortality increase among the low educated, whereas in 2008-2011 and in 2012-2015 inequalities often increased because of a larger relative mortality decline among the high educated. However, these period changes in relative inequalities and between educational groups were often not statistically significant. Absolute inequalities were larger in 2012-2015 versus 2000-2003 in all countries except estonia (decrease). Conclusion in the baltic countries and finland, alcohol-related mortality tended to increase faster among the low educated during a period of economic expansion (2004-2007) and decrease more among the high educated during a period of economic recession (2008-2011).
36	2020	Muilu P;Rantalaiho V;Kautiainen H;Virta Lj;Puolakka K	Opioid Use Among Patients With Early Inflammatory Arthritides Compared To The General Population	Objective. To assess to what extent the worldwide opioid epidemic affects finnish patients with early inflammatory arthritis (ia). Methods. From the nationwide register maintained by the social insurance institution of finland, we collected all incident adult patients with newly onset seropositive and seronegative rheumatoid arthritis (ra+ and ra-) and undifferentiated arthritis (ua) between 2010 and 2014. For each case, 3 general population (gp) controls were matched according to age, sex, and place of residence. Drug purchases between 2009 and 2015 were evaluated 1 year before and after the index date (date of ia diagnosis), further dividing this time into 3-month periods. Results. A total of 12,115 patients (66% women) were identified. At least 1 opioid purchase was done by 23-27% of the patients 1 year before and 15-20% one year after the index date. Relative risk (rr) of opioid purchases compared to gp was highest during the last 3-month time period before the index date [rr 2.81 (95% ci 2.55-3.09), 3.06 (2.68-3.49), and 4.04 (3.51-4.65) for ra+, ra-, and ua, respectively] but decreased after the index date [rr 1.38 (1.23-1.58), 1.91 (1.63-2.24), and 2.51 (2.15-2.93)]. Up to 4% of the patients were longterm users both before and after the diagnosis. Conclusion. During 2009-15 in finland, opioid use peaked just before the diagnosis of ia but decreased rapidly after that, suggesting effective disease control, especially in seropositive ra. Further, opioids were used to treat arthritis pain of patients with incident ra and ua less often than previously reported from other countries.
37	2019	Tanghe M;Van Den Noortgate N;Pivodic L;Deliens L;Onwuteaka-Philipsen B;Szczerbinska K;Finne-Soveri H;Collingridge-Moore D;Gambassi G;Van Den Block L;Piers R	Opioid, Antipsychotic And Hypnotic Use In End Of Life In Long-Term Care Facilities In Six European Countries: Results Of Pace	Opioids, antipsychotics and hypnotics are recommended for comfort care in dying. We studied their prescription during the last 3 days in residents deceased in the long-term care facility (ltcf). In a retrospective, cross-sectional survey in belgium, england, finland, italy, the netherlands and poland, ltcfs, selected by proportional stratified random sampling, reported all deaths over the previous 3 months. The nurse most involved in the residents care reviewed the chart for opioid, antipsychotic and hypnotic prescription, cause of death and comorbidities. Multivariable logistic regression was performed to adjust for resident characteristics. Response rate was 81.6%. We included 1079 deceased residents in 322 lctfs. Opioid prescription ranged from 18.5% (95% ci: 13.025.8) of residents in poland to 77.9% (95% ci: 69.584.5) in the netherlands, antipsychotic prescription from 4.8% (95% ci: 2.49.1) in finland to 22.4% (95% ci: 14.732.4) in italy, hypnotic prescription from 7.8% (95% ci: 4.612.8) in finland to 47.9% (95% ci: 38.557.3) in the netherlands. Differences in opioid, antipsychotic and hypnotic prescription between countries remained significant (p < 0.001) when controlling for age, gender, length of stay, cognitive status, cause of death in multilevel, multivariable analyses. Dying from cancer showed higher odds for receiving opioids (or 3.51; p < 0.001) and hypnotics (or 2.10; p = 0.010). Opioid, antipsychotic and hypnotic prescription in the dying phase differed significantly between six european countries. Further research should determine the appropriateness of their prescription and refine guidelines especially for ltcf residents dying of non-cancer diseases.
38	2016	Retamal Cp;Markkula N;Pena S	Mental Health In Chile And Finland. Challenges And Lessons	This article analyses and compares the epidemiology of mental disorders and relevant public policies in chile and finland. In chile, a specific mental health law is still lacking. While both countries highlight the role of primary care, finland places more emphasis on participation and recovery of service users. Comprehensive mental health policies from finland, such as a successful suicide prevention program, are presented. Both countries have similar prevalence of mental disorders, high alcohol consumption and high suicide rates. In chile, the percentage of total disease burden due to psychiatric disorders is 13% and in finland 14%. However, the resources to address these issues are very different. Finland spends 4.5% of its health budget on mental health, while in chile the percentage is 2.2%. This results in differences in human resources and service provision. Finland has five times more psychiatric outpatient visits, four times more psychiatrists, triple antidepressant use and twice more clinical guidelines for different psychiatric conditions. In conclusion, both countries have similar challenges but differing realities. This may help to identify gaps and potential solutions for public health challenges in chile. Finland's experience demonstrates the importance of political will and long-term vision in the construction of mental health policies.
39	2021	Bockerman P;Haapanen M;Hakulinen C;Vainiomaki J	Prescription Opioid Use And Employment: A Nationwide Finnish Register Study	Background: the secular decline in labor market participation and the concurrent increase in opioid use in many developed countries have sparked a policy debate on the possible connection between these two trends. We examined whether the use of prescription opioids was connected to labor market outcomes relating to partici-pation, employment and unemployment among the finnish population. Methods: the working-age population (aged 19-64 years) living in finland during the period 1995-2016 was used in the analyses (consisting of 67 903 701 person-year observations). Lagged values of prescription opioid use per capita were used as the exposure. Instrumental variables (iv) estimation method was used to identify causal effects, where opioid use per capita for the elderly (65-95-year-old) was used as an instrument for the opioid use per capita for the working-age population of the same gender, education and region. Results: increased opioid use led to worse labor market outcomes in the long run, with the effect size of 16 % and 20 %, compared to the standard deviation of the employment and participation rates. On the contrary, in the short run, increased opioid use had positive employment effects. Conclusions: policymakers should take the contradictory short-and long-term effects into account while considering regulation and monitoring of opioid use. Regulating and monitoring long-term prescription opioids is crucial for reducing their negative labor market consequences.
40	2020	Karlsson T;Makela P;Tigerstedt C;Keskimaki I	The Road To The Alcohol Act 2018 In Finland: A Conflict Between Public Health Objectives And Neoliberal Goals	Finnish alcohol policy has aimed for decades years to mitigate alcohol-related harm by using high taxation and restrictions on the physical availability of alcohol. The state monopoly on the retail of alcohol has played a central role in reducing the availability of alcohol. In 2011, preparations began for a comprehensive reform of the alcohol act 1994. Over time, the issue became highly politicised, lobbied and divisive. It took intense work of two consecutive governments to finalise the reform. The new alcohol act came into force in 2018. It expanded the rights of grocery stores to sell alcohol and reduced the administrative burden for on-premise sales. As a result, the state monopoly on the retail of alcohol was weakened, but it still has an important impact on the physical availability of alcohol. The finnish public health community expected an increase in alcohol sales following the reform because of greater alcohol availability and expected price reductions related to greater competition of sales in grocery stores. However, prices decreased less than expected in 2018, partly due to a simultaneous increase in alcohol taxes. It is difficult to evaluate the impact of the reform at this early stage. However, after the reform, the 10-year (2008-2017) downward trend in the total per capita alcohol consumption was discontinued despite the tax increase. According to preliminary analyses, the change in the law may have slightly increased recorded alcohol sales but the effect was not statistically significant. (C) 2019 elsevier b.v.
41	2016	Nelson Jp;Mcnall Ad	Alcohol Prices, Taxes, And Alcohol-Related Harms: A Critical Review Of Natural Experiments In Alcohol Policy For Nine Countries	Objective: evidence for alcohol-price policy relies heavily on aggregate econometric studies for the united states. Prior reviews of prices and alcohol-related harms include only a few studies based on natural experiments. This study provides a comprehensive review of natural experiments for a wide variety of harms from studies published during 2003 to 2015. We examine policy changes that importantly affected alcohol taxes and prices, and related changes in availability. Methods: forty-five studies met inclusion criteria, covering nine countries: australia, denmark, finland, hong kong, iceland, russia, sweden, switzerland, and united states. Some studies cover more than one harm or country, and there are 69 outcomes for review. Summaries are provided for five outcome groups: alcohol-related mortality and hospitalizations; assaults and other crime; drink-driving; intoxication; and survey-indexes for dependency. The review notes both positive/mixed results and negative/null results. Results: findings indicate that changes in taxes and prices have selective effects on harms. Mortality outcomes are positive for liver disease and older persons, especially in finland and russia. Mostly null results for assaults and drink-driving are found for five countries. Intoxication results for nordic countries are mixed for selective subpopulations. Results for survey indexes are mixed, with no strong pattern of outcomes within or across countries. Conclusion: prior reviews stress taxes as a comprehensive and cost-effective intervention for addressing alcohol-related harms. A review of natural experiments indicates the confidence placed on this measure is too high, and natural experiments in alcohol policy had selective effects on various subpopulations. (C) 2016 elsevier ireland ltd. All rights reserved.
42	2022	Jarroch R;Tajik B;Tuomainen Tp;Kauhanen J	Economic Recession And The Long Term Risk Of Psychiatric Disorders And Alcohol Related Diseases-A Cohort Study From Eastern Finland	Backgroundlong-term development of psychiatric disorders and alcohol-related diseases after economic recessions is insufficiently studied. We investigated the overall impact of the economic recession between 1991 and 1994 in finland on the long-term incidence of psychiatric and alcohol-related diseases. Methodsa population-based sample of 1,774 women and men aged 53-73 years were examined between 1998 and 2001 from the kuopio ischemic heart disease risk factor study (kihd). Participants completed comprehensive questionnaires on the possible impact of the 1990s recession in finland on their lives. They were followed-up until 2018. Cox proportional hazards regression was used to estimate hazard ratios (hr) of new incident psychiatric and alcohol-related disorders during the 20-years follow-up after linkage to the national hospital registry. Logistic regression was used to estimate odds ratios (or) of psychiatric disorders at baseline. Resultsat baseline, 93 participants had psychiatric disorders. During 20-years follow-up, 138 new psychiatric disorders and 45 alcohol-related diseases were developed. The covariate-adjusted risk of psychiatric disorders was over twice higher among men who experienced recession-induced hardships compared to those who did not (hr = 2.20, 95%ci = 1.04-4.70, p = 0.04). The risk of alcohol-related diseases was more than four times higher among men with hardships (hr = 4.44, 95%ci = 1.04-18.90, p = 0.04). No such associations were observed among women. No association was observed between recession-induced hardships and having psychiatric disorders at baseline in both genders (multivariate-adjusted p = 0.63 for women, multivariate-adjusted p = 0.36 for men). Conclusionlong-term risk of psychiatric disorders and alcohol-related diseases was increased after the 1990s economic recession in finland, but only among middle-age and older men.
43	2016	Ojanpera I;Kriikku P;Vuori E	Fatal Toxicity Index Of Medicinal Drugs Based On A Comprehensive Toxicology Database	The fatal toxicity index (fti) is the absolute number of fatal poisonings caused by a particular drug divided by its consumption figure. Consequently, it is a useful measure in evaluating toxicity of the drug and its relevance in fatal poisonings. In this study, we assessed the fti of medicinal drugs in 3 years (2005, 2009, and 2013) in finland. As the measure of drug consumption, we used the number of defined daily doses (ddd) per population in each year. There were 70 medicinal drugs in finland for which the mean fti expressed as the number of deaths per million ddd over the three study years was higher or equal to 0.1. The anatomical therapeutic chemical (atc) classification system was used for the classification of the active ingredients of medicinal drugs according to the organ or system which they act on. Of these 70 drugs, 55 drugs (78.6 %) acted on the nervous system (denoted by atc code n), 11 (15.7 %) on the cardiovascular system (c), three (4.3 %) on the alimentary tract and metabolism (a), and one (1.4 %) on the musculoskeletal system (m). The nervous system drugs consisted of 20 psycholeptics, (atc code n05), 20 psychoanaleptics (n06), eight analgesics (n02), six antiepileptics (n03), and one other nervous system drug (n07). The highest individual ftis were associated with the opioids methadone, dextropropoxyphene, oxycodone, tramadol, and morphine; the antipsychotics levomepromazine and chlorprothixene; and the antidepressants doxepin, amitriptyline, trimipramine, and bupropion. Buprenorphine was not included in the study, because most of the fatal buprenorphine poisonings were due to smuggled tablets. A clearly increasing trend in fti was observed with pregabalin and possibly with bupropion, both drugs emerging as abused substances.
44	2021	Agardh Ee;Allebeck P;Flodin P;Wennberg P;Ramstedt M;Knudsen Ak;Overland S;Kinge Jm;Tollanes Mc;Eikemo Ta;Skogen Jc;Makela P;Gissler M;Juel K;Iburg Km;Mcgrath Jj;Naghavi M;Vollset Se;Gakidou E;Danielsson Ak	Alcohol-Attributed Disease Burden In Four Nordic Countries Between 2000 And 2017: Are The Gender Gaps Narrowing? A Comparison Using The Global Burden Of Disease, Injury And Risk Factor 2017 Study	Introduction and aims the gender difference in alcohol use seems to have narrowed in the nordic countries, but it is not clear to what extent this may have affected differences in levels of harm. We compared gender differences in all-cause and cause-specific alcohol-attributed disease burden, as measured by disability-adjusted life-years (daly), in four nordic countries in 2000-2017, to find out if gender gaps in dalys had narrowed. Design and methods alcohol-attributed disease burden by dalys per 100 000 population with 95% uncertainty intervals were extracted from the global burden of disease database. Results in 2017, all-cause dalys in males varied between 2531 in finland and 976 in norway, and in females between 620 in denmark and 270 in norway. Finland had the largest gender differences and norway the smallest, closely followed by sweden. During 2000-2017, absolute gender differences in all-cause dalys declined by 31% in denmark, 26% in finland, 19% in sweden and 18% in norway. In finland, this was driven by a larger relative decline in males than females; in norway, it was due to increased burden in females. In denmark, the burden in females declined slightly more than in males, in relative terms, while in sweden the relative decline was similar in males and females. Discussion and conclusions the gender gaps in harm narrowed to a different extent in the nordic countries, with the differences driven by different conditions. Findings are informative about how inequality, policy and sociocultural differences affect levels of harm by gender.
45	2020	Tigerstedt C;Agahi N;Bye E;Ekholm O;Harkonen J;Jensen Hr;Lau Cj;Makela P;Moan Is;Parikka S;Raninen J;Vilkko A;Bloomfield K	Comparing Older People's Drinking Habits In Four Nordic Countries: Summary Of The Thematic Issue	Aim: the present article summarises status and trends in the 21st century in older people's (60-79 years) drinking behaviour in denmark, finland, norway and sweden and concludes this thematic issue. Each country provided a detailed report analysing four indicators of alcohol use: the prevalence of alcohol consumers, the prevalence of frequent use, typical amounts of use, and the prevalence of heavy episodic drinking (hed). The specific aim of this article is to compare the results of the country reports. Findings: older people's drinking became more common first in denmark in the 1970s and then in the other countries by the 1980s. Since 2000 the picture is mixed. Denmark showed decreases in drinking frequency, typically consumed amounts and hed, while in sweden upward trends were dominant regarding prevalence of consumers and frequency of drinking as well as hed. Finland and norway displayed both stable indicators except for drinking frequency and proportion of women consumers where trends increased. In all four countries, the gender gap diminished with regard to prevalence and frequency of drinking, but remained stable in regard to consuming large amounts. In norway the share of alcohol consumers among women aged 60-69 years exceeded the share among men. During the late 2010s, denmark had the highest prevalence of alcohol consumers as well as the highest proportion drinking at a higher frequency. Next in ranking was finland, followed by sweden and norway. This overall rank ordering was observed for both men and women. Conclusion: as the populations aged 60 years and older in the nordic countries continue to grow, explanations for the drivers and consequences of changes in older people's drinking will become an increasingly relevant topic for future research. Importantly, people aged 80 years and older should also be included as an integral part of that research.
46	2022	Savonen J;Hakkarainen P;Karjalainen K	The Perceived Risk Of Illicit Drug Use And Views On Drug Policy In The General Population	This article analyzes the riskiness attached to illicit drug use by means of a social representations framework. The implications of these social representations are further studied through their associations with views on drug policy: restrictive control and harm reduction measures. The data for the study is from a finnish drug survey (n = 3229). Latent class analysis (lca) and multinomial logistic regression analysis were used to analyze the data. Four representational profiles of perceived risk were identified: high-risk (70% of respondents), cannabis ok (15%), experimenting ok (10%), and low-risk (2%). All illicit drug use was considered as a moderate or high risk in the high-risk profile. Cannabis was considered less risky than other substances in the cannabis ok profile and experimenting was a less risky way of use in the experimenting ok profile. Most people in the low-risk profile considered the risks related to illicit drug use as nonexistent or minor. These representational profiles were also connected to opinions on drug policy: those who saw the most risks with use tended to support restrictive control measures, while those who considered illicit drug use to be less risky were more accepting toward harm reduction measures.
47	2020	Tigerstedt C;Harkonen J;Makela P;Lintonen T;Karlsson T;Warpenius K	Change And Continuity In Finnish Drinking In The 21st Century	Aim: alcohol consumption and policy in finland have undergone a variety of changes in the two last decades. In several cases, trends in both consumption and policy have shifted direction when moving from the first decade of the 21st century to the second one. The aim of the overview is to summarise the trends. Data: the overview draws on results primarily from the cross-sectional finnish drinking habits survey (fdhs) in 2000, 2008 and 2016, and also from the whole series including altogether seven separate data collections carried out every eight years from 1968 to 2016 and mainly covering finns aged 15-69 years. Response rates show a falling trend (78% in 2000, 74% in 2008 and 60% in 2016). The overview also makes use of data collected within the european school survey project on alcohol and other drugs (espad) and, for the elderly, the national finsote study carried out by the finnish institute for health and welfare (thl). Results: after an all-time high of 12.7 litres of pure alcohol per capita 15 years and over in 2007, total consumption of alcohol had decreased by 21% by the year 2019. Underage drinking has decreased ever since the millennium shift. Older people's drinking has continued increasing or levelled out. Along with reduced total consumption, heavy episodic drinking (hed) has also decreased, but the differences between manual and white-collar workers in hed have continued to grow. Drinking alcoholic beverages with meals has also declined since 2008. Liberal and restrictive alcohol policy measures have alternated. Conclusions: finnish drinking culture seems to change at a slow pace; several typical drinking habits have remained unchanged.
48	2016	Warpenius K;Holmila M;Raitasalo K	Compliance With The Legal Age Limits For Alcohol, Tobacco And Gambling -A Comparative Study On Test Purchasing In Retail Outlets	Aim: to assess whether retail outlets comply with the minimum legal age of 18 for the purchase of alcohol and tobacco and for gambling on slot machines in finland. Methods: a test-purchase research in 117 retail outlets selling alcohol, tobacco and supplying slot machines in two towns. Five-hundred fifty-seven purchase attempts were made for alcohol (n=173), tobacco (n=177) and gambling on slot machines (n=170) in private outlets and 37 attempts in government alcohol retail monopoly outlets. The differences in denial rates and factors of potential significance for denials were tested using logistic regression. Findings: the denial rate for gambling on slot machines was 4%. The odds that an alcohol or a tobacco purchase was denied were 25- and 20-fold, respectively, compared to gambling. The odds of denial of an alcohol purchase were 12-fold in alcohol monopoly stores compared to private outlets. Conclusion: the low compliance with the age limit for gambling is a challenge in a gambling policy system where slot machines are decentralized in private retail outlets and are widely available. The high denial rate in government alcohol retail monopoly outlets indicates that monopoly outlets are more capable of enforcing legal age limits effectively compared to private outlets.
49	2020	Kriikku P;Ojanpera I	Significant Decrease In The Rate Of Fatal Alcohol Poisonings In Finland Validated By Blood Alcohol Concentration Statistics	Background: alcohol may cause death directly by acute poisoning, as well as induce illnesses or accidents that lead to death. Our research question was whether the current decreasing trend in acute fatal alcohol poisonings in finland is a real phenomenon or an artefact caused by possible changes in the process of determining the cause of death. Methods: all cases in the national post-mortem toxicology database in which the underlying cause of death was acute alcohol poisoning in 1987-2018 were investigated in terms of blood alcohol concentration (bac), age and gender. The number of acute alcohol poisonings was compared to the number of deaths from alcohol induced illness in the post-mortem toxicology database. Results: a total of 12 126 acute alcohol poisoning cases were retrieved. Between 2004 and 2017 the number of acute alcohol poisonings decreased 60.1 %. At the same time the number of alcohol induced illnesses in the study material remained stable or decreased marginally. The median bac in all acute alcohol poisonings was 3.2 g/kg. The annual median bac values showed a small but significant decrease over the study period. The proportion of women in acute alcohol poisonings increased significantly over the study period, from 17.1%-22.3%. Women were on average 2.5 years older than men. Conclusions: on grounds of the bac statistics and supporting evidence, we conclude that the significant decrease in the number of fatal alcohol poisonings is true and likely reflects changes in the overall consumption of alcohol.
50	2019	Gedeon C;Sandell M;Birkemose I;Kakko J;Runarsdottir V;Simojoki K;Clausen T;Nyberg F;Littlewood R;Alho H	Standards For Opioid Use Disorder Care: An Assessment Of Nordic Approaches	Aims: outcomes in opioid use disorder (oud) in nordic countries have improved with integrated treatment and harm-reduction programmes. Approaches and the standard of care are different across the region. Evidence of treatment needs and current approaches are defined from evidence to inform development of a common standard. Method: evidence of population sizes and treatment approach collected. Common standards for care (harm reduction, pharmacotherapy, psychology/social therapy) defined for each country. Results: evidence defines number in treatment; potential population needing treatment not defined for all countries. Populations sizes, treatment access (ratio in treatment programme compared to total country population) defined: sweden 4,000 in oud care (access ratio 40); finland 3,000 (55); norway 8,000 (154); denmark 7,500 (132). Approach to treatment similar: integrated treatment programmes standard. Care provided by specialists in outpatient clinics/primary care; secondary care/inpatient services are available. Harm reduction is limited in sweden but available and more accessible elsewhere. Treatment entry criteria: access relatively unlimited in norway and denmark, more limited in finland and sweden. Standards of care defined: easy access to high-quality services, individual planning, care not limited by time, management of relapse, education for patients, continuous engagement, holistic approach including management of comorbidities, needle equipment programmes without limit, treatment in prisons as community. Conclusion: there are opportunities to improve oud care in the nordics. Policy makers and clinicians can advance oud care and share common success factors. Collaborative work across the nordic countries is valuable. Further research in clinical practice development can yield important results for the benefit of patients with oud.
51	2017	Lintonen T;Nevalainen J	Has The Role Of Personal Income In Alcohol Drinking Among Teenagers Changed Between 1983 And 2013: A Series Of Nationally Representative Surveys In Finland	Objective: affordability is known to be a key determinant of alcohol consumption, possibly even more important in adolescence. Relating adolescent drinking pattern developments over a period of time to trends in adolescent income can yield information on the significance of parental control of adolescent income. Design: biannual repeated cross-sectional surveys. Setting: nationally representative samples. Participants: 14-year-old adolescents in the period 1983-2013 in finland (n=33 771). Results: adolescents' alcohol drinking pattern was significantly associated with their disposable income. The or for monthly drunkenness versus abstinence was 6.6 (95% ci 5.0 to 8.8) among girls and 9.0 (6.3 to 13.0) among boys in the highest income group compared with the lowest. However, the association between income and drinking pattern weakened considerably during the 30-year period. Conclusions: disposable income has been a significant predictor of adolescent alcohol drinking in the past 30 years. However, in the recent years, the amount of disposable money has decreased in importance.
52	2022	Rossow I;Bye Ek;Moan Is	The Declining Trend In Adolescent Drinking: Do Volume And Drinking Pattern Go Hand In Hand?	Traditionally, adolescent drinking cultures differed between nordic and mediterranean countries; the former being characterised by low volume and relatively frequent heavy episodic drinking (hed). Across these drinking cultures, we examined the associations between alcohol volume and hed with respect to (i) secular trends at the country level and (ii) individual-level associations over time. The data stem from the european school survey project on alcohol and other drugs (espad) conducted among 15-16-year-olds in finland, iceland, norway, sweden, france and italy, employing six cross-sectional surveys from 1999 to 2019 (n = 126,126). Both consumption volume and hed frequency decreased in all nordic countries and displayed a curvilinear trend in france and italy. In all countries, consumption volume and hed correlated highly over time at the country level. At the individual level, the correlation was positive but with a varying magnitude over time and between countries. In 1999/2003, the alcohol volume-hed correlation was significantly higher in the nordic compared to the mediterranean countries but became significantly weaker in finland, norway and sweden and remained stable in france, iceland and italy during the period. In conclusion, while trends in consumption volume and drinking patterns went hand in hand at the aggregate level, the association at the individual level weakened over time in several nordic countries, along with the substantial decline in adolescent drinking since 2000.
53	2021	Ochaba R;Baska T;Baskova M	Alcohol Use And Its Affordability In Adolescents In Slovakia Between 2010 And 2018: Girls Are Less Adherent To Policy Measures	Background: the article analyzes selected indicators of alcohol use (weekly use, drunkenness within last month) and the ability of adolescents to buy alcohol in slovakia between 2010 and 2018. Methods: health behavior in school-aged children (hbsc) is a cross-sectional questionnaire study. A standardized uniform questionnaire was used to create a representative sample of 15-year-old adolescents. Two surveys carried out in slovakia in 2010 (n = 1568) and 2018 (n = 1298) were analyzed. Results: weekly alcohol use and drunkenness declined only in boys, not in girls. Affordability of alcohol (not being prevented from buying it) declined among weekly drinking boys (from 60.4 to 34.1%) but remained almost unchanged in girls from a higher socioeconomic group compared to those from a lower one (57.9% vs. 30.6% in 2018). Conclusions: affordability of alcohol in boys decreased with a decline in alcohol use, corresponding with implemented legislative measures. However, it remained unchanged in girls from a higher socioeconomic group.
54	2017	Smith Ea;Mcdaniel Pa;Hiilamo H;Malone Re	Policy Coherence, Integration, And Proportionality In Tobacco Control: Should Tobacco Sales Be Limited To Government Outlets?	Multiple factors, including marijuana decriminalization/legalization, tobacco endgame discourse, and alcohol industry pressures, suggest that the retail regulatory environment for psychoactive or addictive substances is a dynamic one in which new options may be considered. In most countries, the regulation of tobacco, marijuana, and alcohol is neither coherent, nor integrated, nor proportional to the potential harms caused by these substances. We review the possible consequences of restricting tobacco sales to outlets run by government-operated alcohol retail monopolies, as well as the likely obstacles to such a policy. Such a move would allow governments more options for regulating tobacco sales, and increase coherence, integration, and proportionality of substance regulation. It might also serve as an incremental step toward an endgame goal of eliminating sales of commercial combustible tobacco.
55	2016	Budhiraja M;Landberg J	Socioeconomic Disparities In Alcohol-Related Mortality In Sweden, 1991-2006: A Register-Based Follow-Up Study	To examine whether apparent stability of overall alcohol-related mortality in sweden during a period when traditionally strict alcohol policies went through a series of liberalizations and overall alcohol mortality remained stable, concealed a heterogeneity across socioeconomic groups (defined by educational level); and whether an increase occurred in the contribution of alcohol-related mortality to overall mortality differentials. Drawing on cause of death data linked to census records for the period 1991-2006, we computed annual age-standardized and sex-specific rates of alcohol-related mortality for groups with low, intermediate and high education. Alcohol-related mortality was considerably higher in lower educational groups for both men and women. For men, the trends in alcohol-related mortality were roughly stable for all education groups, and there were no signs of increasing inequalities by education. For women, alcohol-related mortality increased significantly for the low-education group whereas the two higher education groups showed no significant time trends, thus resulting in a widened educational gap in alcohol mortality for women. Alcohol's contribution to the overall mortality differentials declined for men and was basically unchanged for women. The findings provide only partial support to the hypothesis that the liberalizations of swedish alcohol policy have been followed by a general increase in socioeconomic disparities in alcohol-related mortality.
56	2022	Belfrage H;Lankinen E;Kylanpaa L;Louhimo J	Acute Pancreatitis In Helsinki In 2016-2018: Incidence, Etiology And Risk Factors-Analysis Of 1378 Acute Pancreatitis Episodes In A Finnish Normal Population	Objectives updated population-based studies on acute pancreatitis (ap) in finland are lacking. Our aim was to evaluate the current data for ap in helsinki. Materials and methods we performed an electronic health care records (ehrs) search on ap patients treated at helsinki university hospital between the years 2016 - 2018. Incidence was calculated, etiological and potential risk factors, as well as severity of ap were documented and analyzed. Results between 2016 and 2018 we found 1378 ap episodes on 1084 patients, 35% of the patients had several ap episodes, i.e., recurrent ap (rap). The domicile-adjusted incidence was 42.2/100 000. 47% of the patients had alcohol etiology (59% men, 27% women) and 23% had biliary etiology, 21% were idiopathic and 2.9% were post-ercp pancreatitis. 13.1% of the patients had passed at the end of september 2021. 45% of the patients were currently smoking, 11% were ex-smokers, and the highest percentage of smokers was in the group of alcohol-caused ap with 74% ever-smokers. Biliary ap had the highest amount of overweight patients. 24% of the patients used anticoagulation (ac) medication, and the percentage was significantly higher with idiopathic ap (48%). Rap, female sex and normal bmi associated with a mild form of ap. Conclusions incidence of ap and the percentage of alcohol etiology are lower than earlier reported for finland although still higher than in other nordic countries. Smoking and the use of ac medication associate with ap.
57	2018	Aaltonen N;Chydenius M;Kokkinen L	"First, Do No Harm": Have The Health Impacts Of Government Bills On Tax Legislation Been Assessed In Finland?	As taxation is one of the key public policy domains influencing population health, and as there is a legal, strategic, and programmatic basis for health impact assessment (hia) in finland, we analyzed all 235 government bills on tax legislation over the years 2007-2014 to see whether the health impacts of the tax bills had been assessed. We found that health impacts had been assessed for 13 bills, bills dealing with tobacco, alcohol, confectionery, and energy legislation and that four of these impact assessments included impacts on health inequalities between social classes. Based on our theoretical classification, the health impacts of 40 other tax bills should have been evaluated.
58	2016	Lehikoinen M;Arffman M;Manderbacka K;Elovainio M;Keskimaki I	Comparative Observational Study Of Mortality Amenable By Health Policy And Care Between Rural And Urban Finland: No Excess Segregation Of Mortality In The Capital Despite Its Increasing Residential Differentiation	Background: large cities are often claimed to display more distinct geographical and socioeconomic health inequalities than other areas due to increasing residential differentiation. Our aim was to assess whether geographical inequalities in mortality within the capital (city of helsinki) both exceeded that in other types of geographical areas in finland, and whether those differences were dependent on socioeconomic inequalities. Methods: we analysed the inequality of distribution separately for overall, ischemic heart disease and alcohol-related mortality, and mortality amenable (am) to health care interventions in 1992-2008 in three types of geographical areas in finland: city of helsinki, other large cities, and small towns and rural areas. Mortality data were acquired as secondary data from the causes of death statistics from statistics finland. The assessment of changing geographical differences over time, that is geographical inequalities, was performed using gini coefficients. As some of these differences might arise from socioeconomic factors, we assessed socioeconomic differences with concentration indices in parallel to an analysis of geographical differences. To conclude the analysis, we compared the changes over time of these inequalities between the three geographical areas. Results: while mortality rates mainly decreased, alcohol-related mortality in the lowest income quintile increased. Statistically significant differences over time were found in all mortality groups, varying between geographical areas. Socioeconomic differences existed in all mortality groups and geographical areas. In the study period, geographical differences in mortality remained relatively stable but income differences increased substantially. For instance, the values of concentration indices for am changed by 54 % in men (p < 0.027) and by 62 % in women (p < 0.016). Only slight differences existed in the time trends of gini or in the concentration indices between the geographical areas. Conclusions: no geographical or income-related differences in the distribution of mortality existed between helsinki and other urban or rural areas of finland. This suggests that the effect of increasing residential differentiation in the capital may have been mitigated by the policies of positive discrimination and social mixing. One of the main reasons for the increase in health inequalities was growth of alcohol-related mortality, especially among those with the lowest incomes.
59	2021	Sama Tb;Konttinen I;Hiilamo H	Alcohol Industry Arguments For Liberalizing Alcohol Policy In Finland: Analysis Of Twitter Data	Objective: the aim of this study was to investigate the arguments used by the alcohol industry and actors aligning with it as a lobbying strategy on twitter to influence the reform of the finnish alcohol law during its preparation phase between 2014 and 2017, when the original purpose of the law reform was changed from reducing alcohol-related harm to liberalizing alcohol policy. Method: primary data were collected on twitter between 2014 and 2017 from six alcohol industry actors (n = 1,085 tweets). The twitter data were analyzed by coding using microsoft excel and by content and thematic analyses using a modified version of the european centre for monitoring alcohol marketing's (2011) seven key messages of the alcohol industry. Results: the findings identified three main arguments used on twitter by the alcohol industry and actors aligning with it, namely: (1) application of liberal alcohol policies generates more revenue, (2) liberties should be generally prioritized above bureaucracy and control, and (3) education about responsibility is the best solution to alcohol-related problems. Conclusions: social media applications such as twitter offer the alcohol industry unlimited opportunities for promoting its traditional public relations arguments.
60	2017	Smith Mc	Questioning Similarities: Prohibition In The United States And Finland	Only two republics have ever adopted national alcohol prohibition in peacetime, and they did so at almost exactly the same time. For these reasons and others, historians of temperance have considered prohibition in finland and the united states to be essentially similar. In fact, despite originating at the same time, the two are quite dissimilar. American prohibition came out of protestant revivalism and a capitalist desire for worker efficiency. By the late nineteenth century two powerful temperance organizations, the women's christian temperance union and the anti saloon league, had emerged to lead the movement for domestic prohibition and to evangelize for prohibition abroad. Prohibition in finland came out of the movement to achieve a cultural and political nationalism. Temperance was part of the turku academics' attempt to create a virtuous unified peasantry and working class. The working class, in particular, used the temperance movement to organize their movements. While the united states and finland were the only two republics to undertake national prohibition, the us largely ignored the finnish experiment. They praised it in the early 1920s only to emphasize its later failures as a way of trying to obscure their own inability to achieve a viable policy.
61	2018	Liu Y;Lintonen T;Tynjala J;Villberg J;Valimaa R;Ojala K;Kannas L	Socioeconomic Differences In The Use Of Alcohol And Drunkenness In Adolescents: Trends In The Health Behaviour In School-Aged Children Study In Finland 1990-2014	Aims: the aims of this study were to explore time-based trends of socioeconomic differences in alcohol use and drunkenness in finnish adolescents from 1990 to 2014 and to investigate the significance of two indicators in detecting socioeconomic differences in alcohol use and drunkenness. Methods: data were retrieved from seven surveys conducted as part of the health behaviour in school-aged children (hbsc) study in finland from 1990 to 2014. The alcohol use and drunkenness of 15-year-old students, as well as socioeconomic status, including educational aspiration and perceived family wealth, were assessed via a self-report questionnaire. Logistic regression models were used to investigate the relationships between alcohol use, drunkenness and indicators of socioeconomic status. Results: the study showed that the alcohol use and drunkenness of finnish 15-year-old adolescents have decreased since the late 1990s. However, the level of decrease is not consistent among different socioeconomic groups and socioeconomic differences in drinking behaviour between two educational aspiration groups have persisted over two decades. Girls from the groups with low perceived family wealth were more likely to be frequently drunk in the time period 2006-2014. Conclusions: this study suggests that students with low educational aspiration should be the target population for interventions aiming at reducing the alcohol use and drunkenness of finnish adolescents. In future interventions aimed at reducing heavier drinking, adolescents (especially girls) from less wealthy families should be the first priority. Further studies on trends in socioeconomic differences in alcohol use and drunkenness in adolescence should be conducted using different indicators of socioeconomic status and other social context factors should also be taken into account.
62	2021	Rovira P;Kilian C;Neufeld M;Rumgay H;Soerjomataram I;Ferreira-Borges C;Shield Kd;Sornpaisarn B;Rehm J	Fewer Cancer Cases In 4 Countries Of The Who European Region In 2018 Through Increased Alcohol Excise Taxation: A Modelling Study	Introduction: prevention of cancer has been identified as a major public health priority for europe, and alcohol is a leading risk factor for various types of cancer. This contribution estimates the number of cancer cases that could have potentially been averted in 2018 in 4 european countries if an increase in alcohol excise taxation had been applied. Methods: current country and beverage-specific excise taxation of 4 member states of the who european region (germany, italy, kazakhstan, and sweden) was used as a baseline, and the potential impacts of increases of 20, 50, and 100% to current excise duties were modelled. A sensitivity analysis was performed, replacing the current tax rates in the 4 countries by those levied in finland. The resulting increase in tax was assumed to be fully incorporated into the consumer price, and beverage-specific price elasticities of demand were obtained from meta-analyses, assuming less elasticity for heavy drinkers. Model estimates were applied to cancer incidence rates for the year 2018. Results: in the 4 countries, >35,000 cancer cases in 2018 were caused by alcohol consumption, with the highest rate of alcohol-attributable cancers recorded in germany and the lowest in sweden. An increase in excise duties on alcohol would have significantly reduced these numbers, with between 3 and 7% of all alcohol-attributable cancer cases being averted if taxation had been increased by 100%. If the 4 countries were to adopt an excise taxation level equivalent to the one currently imposed in finland, an even higher proportion of alcohol-attributable cancers could be avoided, with germany alone experiencing 1,600 fewer cancer cases in 1 year. Discussion/conclusion: increasing excise duties can markedly reduce cancer incidence in european countries.
63	2018	Kalsi J;Selander T;Tervo T	Alcohol Policy And Fatal Alcohol-Related Crashes In Finland 2000-2016	Objective: the purpose of this study was to explore the relationship between annual alcohol consumption per capita/alcohol price index and the number of alcohol-related fatal motor vehicle accidents (afmvas). We were particularly interested in whether a tax reduction in 2004 increased the number of alcohol-related accidents.method: the data consisted of all fatal motor vehicle accidents (fmvas) during the years 2000-2016 obtained from a database maintained by the finnish crash data institute (oti). The data included all fatally injured drivers. We compared the oti data to official statistics on annual alcohol consumption and the alcohol price index.results: there were 3,447 fatally injured drivers, of which 25% (n = 869) were intoxicated (blood alcohol concentration [bac] 0.05%). After the reduction of the alcohol tax in 2004, the alcohol consumption rose 12.4% from 2003 to 2005 and afmvas rose 38%. There was a strong correlation (r = 0.7000, p < .018) between the recorded consumption of alcohol and the number of afmvas. There was a strong negative correlation between afmvas and the combined (retail + restaurant sales) alcohol price index (r = -0.7863, p = .0005). A linear mixed-effects model showed that a 1-l increase in total alcohol consumption per capita per year increases afmvas by 10.6 and a one-unit increase in the price index decreases afmvas by 1.8 per year.conclusions: the correlation between alcohol consumption and alcohol-related crashes should be considered when making political decisions regarding alcohol price and availability. Any further liberalization of the alcohol policy would likely lead to an increase in alcohol-related fatal motor vehicle accidents. Similar consequences are likely to occur with drugs. Alcohol price policy is an effective way to improve road safety, but other measures taken to prevent fmvas also seem to reduce the prevalence of afmvas.
64	2016	Tarkiainen L;Martikainen P;Laaksonen M	The Contribution Of Education, Social Class And Economic Activity To The Income-Mortality Association In Alcohol-Related And Other Mortality In Finland In 1988-2012	Aimsfirst, to quantify trends in the contribution of alcohol-related mortality to mortality disparity in finland by income quintiles. Secondly, to estimate the degree to which education, social class and economic activity explain the income-mortality association in alcohol-related and other mortality in four periods within 1988-2012. Designregister-based longitudinal study using an 11% random sample of finnish residents linked to socio-economic and mortality data in 1988-2012 augmented with an 80% sample of all deaths during 1988-2007. Mortality rates and discrete time survival regression models were used to assess the income-mortality association following adjustment for covariates in 6-year periods after baseline years of 1988, 1994, 2001, and 2007. Settingfinland. Participantsindividuals aged 35-64years at baselines. For the four study periods for men/women, the final data set comprised, respectively, 26360/12825, 22561/11423, 20342/11319 and 2651/1514 deaths attributable to other causes and 7517/1217, 8199/1450, 9807/2116, 1431/318 deaths attributable to alcohol-related causes. Measurementsalcohol-related deaths were analysed with household income, education, social class and economic activity as covariates. Findingsthe income disparity in mortality originated increasingly from alcohol-related causes of death, in the lowest quintile the contribution increasing from 28 to 49% among men and from 11 to 28% among women between periods 1988-93 and 2007-12. Among men, socio-economic characteristics attenuated the excess mortality during each study period in the lowest income quintile by 51-62% in alcohol-related and other causes. Among women, in the lowest quintile the attenuation was 47-76% in other causes, but there was a decreasing tendency in the proportion explained by the covariates in alcohol-related mortality. Conclusionsthe income disparity in mortality among working-age finns originates increasingly from alcohol-related causes of death. Roughly half the excess mortality in the lowest income quintile during 2007-12 is explained by the covariates of household income, education, social class and economic activity.
65	2019	Virtanen S;Kaprio J;Viken R;Rose Rj;Latvala A	Birth Cohort Effects On The Quantity And Heritability Of Alcohol Consumption In Adulthood: A Finnish Longitudinal Twin Study	Aims to estimate birth cohort effects on alcohol consumption and abstinence in finland and to test differences between birth cohorts in genetic and environmental sources of variation in finnish adult alcohol use. Design the older finnish twin cohort longitudinal survey study 1975-2011. Setting finland. Participants a total of 26 121 same-sex twins aged 18-95 years (full twin pairs at baseline n = 11 608). Measurements outcome variables were the quantity of alcohol consumption (g/month) and abstinence (drinking zero g/month). Predictor variables were 10-year birth cohort categories and socio-demographic covariates. In quantitative genetic models, two larger cohorts (born 1901-20 and 1945-57) were compared. Findings multi-level models in both sexes indicated higher levels of alcohol consumption in more recent birth cohorts and lower levels in earlier cohorts, compared with twins born 1921-30 (all p < 0.003). Similarly, compared with twins born 1921-30, abstaining was more common in earlier and less common in more recent cohorts (all p < 0.05), with the exception of men born 1911-20. Birth cohort differences in the genetic and environmental variance components in alcohol consumption were found: heritability was 21% [95% confidence interval (ci) = 0-56%] in the earlier-born cohort of women [mean age 62.8, standard deviation (sd) = 5.3] and 51% (95% ci = 36-56%) in a more recent cohort (mean age 60.2, sd = 3.7) at the age of 54-74. For men, heritability was 39% (95% ci = 27-45%) in both cohorts. In alcohol abstinence, environmental influences shared between co-twins explained a large proportion of variation in the earlier-born cohort (43%, 95% ci = 23-63%), whereas non-shared environmental (54%, 95% ci = 39-72%) and additive genetic influences (40%, 95% ci = 13-61%) were more important among more recent cohorts of men and women. Conclusion the contribution of genetic and environmental variability to variability in alcohol consumption in the finnish population appears to vary by birth cohort.
66	2019	Roitto Hm;Kautiainen H;Aalto Ul;Ohman H;Laurila J;Pitkala Kh	Fourteen-Year Trends In The Use Of Psychotropic Medications, Opioids, And Other Sedatives Among Institutionalized Older People In Helsinki, Finland	Objectives: the use of psychotropic drugs in long-term care (ltc) is very common, despite their known adverse effects. The prevalence of opioid use is growing among older adults. This study aimed to investigate trends in the prevalence of psychotropics, opioids, and sedative load in a ltc setting over a 14-year period. We also explored the interaction of psychotropic and opioid use according to residents' dementia status in nursing home (nh) and assisted living facility (alf) settings. Design: four cross-sectional studies. Setting: institutional settings in helsinki, finland. Participants: older residents in nhs in 2003 (n = 1987), 2011 (n = 1576), and 2017 (n = 791) and in alfs in 2007 (n = 1377), 2011 (n = 1586), and 2017 (n = 1624). Measures: comparable assessments were conducted among ltc residents at 4 time points over 14 years. The prevalence of regular psychotropics, opioids, and other sedatives and data on demographics and diagnoses were collected from medical records. Results: disabilities and severity of dementia increased in both settings over time. The prevalence of all psychotropics decreased significantly in nhs (from 81% in 2003 to 61% in 2017), whereas in alfs there was no similar linear trend (65% in 2007 and 64% in 2017). There was a significant increase in the prevalence of opioids in both settings (30% in nhs and 22% in afls in 2017). Residents with dementia used less psychotropics and opioids than those without dementia in both settings and at each time point. Conclusions/implications: nhs show a favorable trend in psychotropic drug use, but the rates of psychotropic use remain high in both nhs and alfs. In addition, the rates of opioid use have almost tripled, leading to a high sedative load among ltc residents. Clinicians should carefully consider the risk-to-benefit ratio when prescribing in ltc. (C) 2018 amda - the society for post-acute and long-term care medicine.
67	2017	Poikolainen K;Alanko T	Population Alcohol Consumption As A Predictor Of Alcohol-Specific Deaths: A Time-Series Analysis Of Aggregate Data	Aims: the study examines whether the number of alcohol-specific deaths can be predicted by population total and/or beverage-specific alcohol consumption and if, how precisely. The data are annual series of spirits, wine, beer and total consumption and alcohol-specific deaths in finland in the years 1969-2015. Methods: we specify a auto regressive distributed lags model with cointegrated variables, to be used in prediction. In our model, the number of alcohol-specific deaths is the response variable, and log of spirits consumption and log of non-spirits consumption, are the explanatory variables. The response variable has one added annual lag and the explanatory variables have both four annual added lags in the model. Results: in our data alcohol-specific deaths, log of spirits and log of non-spirits consumption are significantly cointegrated. The precision of the estimated model is good. The prediction results include prediction of the 2008 downturn in alcohol deaths, using the data from the years 1969-2004, forecasting the as yet unknown 2016 alcohol deaths on the basis of known values of alcohol consumption up to 2016, and forecasts of future (2017-2020) alcohol deaths from 2016 on. Forecasted effects of a proposed finnish alcohol policy change, leading to six percent total consumption increase, are estimated. Conclusions: the number of alcohol-specific deaths can be predicted with an appropriate time-series regression model on the basis of population consumption. It is important to consider also beverage type because of the improved predictive power. The model is useful in an evaluation of proposed alcohol policy changes.
68	2017	Trias-Llimos S;Bijlsma Mj;Janssen F	The Role Of Birth Cohorts In Long-Term Trends In Liver Cirrhosis Mortality Across Eight European Countries	Background and aims understanding why inequalities in alcohol-related mortality trends by sex and country exist is essential for developing health policies. Birth cohort effects, indicative of differences by generation in drinking, have rarely been studied. This study estimated the relative contributions of birth cohorts to liver cirrhosis mortality trends and compared sex-and country-specific cohort patterns across eight european countries. Design time-series analysis of population-level mortality data. Setting austria, finland, hungary, italy, the netherlands, poland, spain and sweden; 1950-2011. Participants national populations aged 15-94 years. Measurements we modelled country-and sex-specific liver cirrhosis mortality (from national vital registers) adjusting for age, period and birth cohort. Findings birth cohorts (adjusted for age and period) made statistically significant contributions to liver cirrhosismortality in all countries and for both sexes (p < 0.001), and more so among women (average contribution to deviance reduction of 38.8%) than among men (17.4%). The observed cohort patterns were statistically different between all but two country pairs (p < 0.001). Sex differences existed overall (p < 0.001), but not in the majority of countries (p > 0.999). Visual inspection of birth cohort patterns reveals birth cohorts at higher risk of liver cirrhosis mortality. Conclusions the inclusion of the birth cohort dimension improves the understanding of alcohol-attributable mortality trends in europe. Birth cohorts at higher risk of liver cirrhosis mortality were born during 1935-49 in sweden and finland, around 1950 in austria and the netherlands and 1960 or later in hungary, italy, poland and spain.
69	2021	Mainio A;Kuusisto L;Hakko H;Riipinen P	Antipsychotics As A Method Of Suicide: Population Based Follow-Up Study Of Suicide In Northern Finland	Aim this study examined the trend and role of antipsychotics as a method of self-poisoning suicide. Materials and methods the basic data covered 483 poisoning suicides, occurring between the years 1988 and 2011, in northern finland, of which 178 (115 men, 63 women) were completed using antipsychotics. Results during the 23-year follow-up period, second-generation antipsychotics (sgas) overtook first-generation antipsychotics (fgas) as a suicide method. Female victims, compared to males, had more commonly used quetiapine (17.5% vs. 6.1%, p = .016), while suicides using promazine were more common in males compared to females (36.5% vs. 22.2%, p = .049). People with unipolar depression had more frequently used sgas (40.0%) or a combination of sgas and fgas (12.5%) than fgas (19.2%) (p = .019) in their suicides. Conclusion the use of sgas in suicides is becoming increasingly common, which calls for further studies.
70	2018	Bujalski M;Hellman M;Moskalewicz J;Beccaria F;Rolando S	Depoliticising Addiction: Who Gets To Speak In European Press Reporting, 1991-2011?	Aims: the article presents an analysis of sources of information employed in mainstream print media reporting on addiction problems in finland, italy and poland in the 1990s and 2000s. Method: a quantitative content analysis of frequency of different sources employed in articles in daily newspapers from finland (n = 258), italy (n = 296), and poland (n = 212) from the years 1991, 1998 and 2011. Semantic units were coded in atlas.ti. The societal spheres represented were identified using a common coding scheme broadly inspired by boltanski and thevenot's typology of polities of worth. Transformations were identified in line with van leeuwen's framework for trends in discourse salience over time. Results: the study highlights different patterns of coverage of addictions in the three countries. Over time, increased salience is given to the individuals affected by addictions and experts who represent biomedical sciences. This process occurred with varying intensity and expressiveness in all countries under study. Conclusions: social and political sources were employed to less extent over time. The media focus seemed to shift to the affected individuals and scientific expertise. This confirms results from previous studies on a general move towards individualisation and an increased focus on more personal and technical aspects of addiction problems in the mass media.
71	2017	Noel Jk;Babor Tf;Robaina K;Feulner M;Vendrame A;Monteiro M	Alcohol Marketing In The Americas And Spain During The 2014 Fifa World Cup Tournament	Background and aims to identify the nature of visual alcohol references in alcohol advertisements during televised broadcasts of the 2014 fifa world cup tournament matches and to evaluate cross-national differences according to alcohol marketing policy restrictiveness. Design content analysis using the delphi method and identification of in-game sponsorships. Setting television broadcasts of the 2014 fifa world cup in argentina, brazil, canada, finland, france, mexico, spain and the united states. Cases eighty-seven alcohol advertisements; 20 matches. Measurements quantitative rating scales, combined with the delphi rating technique, were used to determine compliance of the alcohol advertisements with the international alliance for responsible drinking's (iard) guiding principles. Recordings of five matches from four countries were also used to identify the number of in-and out-of-game alcohol brand appearances. Findings a total of 86.2% of all unique alcohol advertisements contained at least one violation of iard's guiding principles, with violation rates ranging from 72.7% (mexico) to 100% (brazil). Countries with the least restrictive marketing policies had a higher prevalence of violations in guidelines designed to protect minors. There were 2.76 in-game alcohol brand appearances and 0.83 out-of-game alcohol brand appearances per minute. Brand appearances did not differ across countries or according to a country's marketing policy restrictiveness. Conclusions self-regulation and statutory policies were ineffective at limiting alcohol advertising during the 2014 fifa world cup tournament television broadcasts. Most advertisements contained content that violated the self-regulation codes, and there were high levels of within broadcast brand appearances.
72	2019	Angus C;Holmes J;Meier Ps	Comparing Alcohol Taxation Throughout The European Union	Background and aims the world health organization recommends increasing alcohol taxes as a 'best-buy' approach to reducing alcohol consumption and improving population health. Alcohol may be taxed based on sales value, product volume or alcohol content; however, duty structures and rates vary, both among countries and between beverage types. From a public health perspective, the best duty structure links taxation level to alcohol content, keeps pace with inflation and avoids substantial disparities between different beverage types. This data note compares current alcohol duty structures and levels throughout the 28 european union (eu) member states and how these vary by alcohol content, and also considers implications for public health. Design and setting descriptive analysis using administrative data, european union, july 2018. Measurements beverage-specific alcohol duty rates per uk alcohol unit (8 g ethanol) in pounds sterling at a range of different alcoholic strengths. Findings only 50% of member states levy any duty on wine and several levy duty on spirits and beer at or close to the eu minimum level. There is at least a 10-fold difference in the effective duty rate per unit between the highest- and lowest-duty countries for each beverage type. Duty rates for beer and spirits stay constant with strength in the majority of countries, while rates for wine and cider generally fall as strength increases. Duty rates are generally higher for spirits than other beverage types and are generally lowest in eastern europe and highest in finland, sweden, ireland and the united kingdom. Conclusions different european union countries enact very different alcohol taxation policies, despite a partially restrictive legal framework. There is only limited evidence that alcohol duties are designed to minimize public health harms by ensuring that drinks containing more alcohol are taxed at higher rates. Instead, tax rates appear to reflect national alcohol production and consumption patterns.
73	2020	Pallari E;Soukup T;Kyriacou A;Lewison G	Assessing The European Impact Of Alcohol Misuse And Illicit Drug Dependence Research: Clinical Practice Guidelines And Evidence-Base Policy	Background despite alcohol and illicit drug dependence being one of the most common diagnoses in europe, there is heterogeneity of research evidence used in policy and practice. Objective we sought to (1) evaluate european research outputs on alcohol misuse and drug addiction in 2002-2018 in the web of science, (2) compare these with their burden of disease and (3) determine their impact in several ways. Methods a bibliometric research was undertaken including an assessment of the citation counts, the influence of research on members of national health advisory committees, and their contribution to the evidence base of clinical practice guidelines (cpgs). Findings there were 3201 analysed references cited in 28 cpgs across 11 european countries on alcohol misuse and illicit drug abuse. Research conducted in the usa dominated both sets of cpgs, while many european countries were overcited relative to their research presence. The illicit drug research appeared to be adequate relative to the evidence of harm in europe. However, alcohol misuse research appeared grossly inadequate to the harm it causes by a factor of 20. Conclusions the volume of research on illicit drug addiction is commensurate to the european burden, whereas alcohol misuse is far below what is needed to curb a significant source of harm. Clinical implications the research asymmetries call for attention to the causes of the problem. Development of research-based solutions to a serious social harm is needed, including minimum pricing and collaborative work to harmonise efforts on disease management and treatment practices across european countries.
74	2016	Bloomfield K;Karlsson T;Grittner U	How Do Drinking Cultures Change? - Or Do They?: A Provisional Model Based On Evidence Of Transitions In Denmark	Denmark, along with other industrialised nations, has experienced recent declines in alcohol consumption and other changes to its drinking culture. The point of departure for this study stems from growing evidence of changes in the danish drinking culture. We have thus proposed a model to describe a society's drinking culture and have then applied it to the danish case. We examine trends for several components of the model and focus roughly on a 10-year period from 2003 to 2013. The components include longitudinal survey data on consumption and alcohol-related harm, registry data on morbidity and mortality, alcohol taxes and prices, physical availability, consumer purchasing power, demographic and structural changes, drinking norms and attitudes, alcohol advertising, as well as health education and promotion efforts. Although unable to conduct formal tests of drinking culture change, a review of our assembled data points in the direction of declining or stagnating consumption and increasing restrictiveness in attitudes, policies and regulations, thus suggesting the start of a shift in drinking practises and perceptions in denmark. Such changes may also apply to other industrialised countries. Future research should examine longer periods, refine the model and its components, and if possible, conduct formal tests of change.
75	2017	Torikka A;Kaltiala-Heino R;Luukkaala T;Rimpela A	Trends In Alcohol Use Among Adolescents From 2000 To 2011: The Role Of Socioeconomic Status And Depression	Aims: to assess temporal trends of adolescent alcohol use in finland from 2000 to 2011, according to socio-economic status and depression. Methods: classroom self-administered questionnaires concerning health, health behaviours and school experiences were administered biennially from 2000-2001 to 2010-2011 to nationwide samples of 14-to 16-year-olds (n = 618,084). Alcohol use was measured as the frequencies of drinking and drunkenness. Socioeconomic status was measured using parental education and unemployment. Depression was measured using a finnish modification of the beck depression inventory. Cross-tabulations and a logistic regression analysis were applied. Results: over the study period, rates of frequent drinking and frequent drunkenness decreased among both boys and girls. Low levels of parental education and unemployment as well as adolescent depression increased the likelihoods of frequent drinking and drunkenness. Unlike the general decreasing trend observed for alcohol use, the likelihoods of frequent drinking and drunkenness increased among adolescents who were depressed and had unemployed parents with low levels of education. The prevalence of frequent drunkenness was 75.8% among the boys in this group during 2008-2011, whereas the corresponding prevalence was 2.3% for boys without depression and with highly educated, employed parents. The corresponding figures for girls were 41.7% and 1.4%, respectively. Conclusions: the overall decreasing trend in frequent alcohol use was not observed among socioeconomically deprived adolescents with depression. Thus, alcohol prevention programmes should treat these youth as special targets.
76	2017	Wilson Ml;Tenovuo O;Mattila Vm;Gisler M;Celedonia Kl;Impinen A;Saarijarvi S	Pediatric Tbi In Finland: An Examination Of Hospital Discharges (1998-2012)	Background: traumatic brain injury constitutes a persistent health problem among pediatric populations worldwide and is often referred to as a silent epidemic. There remains a paucity of scientific exploration with regard to understanding the ecological risk profiles of well-defined populations. In finland, the healthcare system covers all hospitals, provides uniform access to care and has a universal surveillance system that allows for epidemiological examination of a wide variety of health issues. The present study aims to clarify the incidence, type and geographical presentation of pediatric tbi in finland. Methods: we utilized the national hospital discharge register (nhdr) to prospectively identify all new cases of tbi among persons aged 18 years or younger between 1998 and 2012. Incidence rates were computed as average annual rates per 100,000 person years (py). Results: during the study period 1998-2012, 21,457 children and adolescents were hospitalized for tbi. The cumulative incidence rate for the entire period was 99/100,000. Males were approximatively 1.5 times more likely to have sustained a tbi and had consistently higher rates during each year under study. Concussions were the most common form of tbi (92.9/100,000 person years), with diffuse brain injuries being the second most common (8.7/100,000 py). Diagnostic trends differed markedly with southern finland experiencing the lowest rates of tbi when adjusted for population size. Conclusions: tbi are serious and potentially disabling conditions. The elevated levels of pediatric tbi in finland warrant increased attention. (C) 2016 european paediatric neurology society. Published by elsevier ltd. All rights reserved.
77	2017	Kujansuu A;Rautiainen S;Hakko H;Kanamuller J;Sihvola N;Riipinen P	Drivers' Psychiatric Disorders And Fatal Motor Vehicle Accidents In Finland	Relatively little is known about fatal motor vehicle accidents (fmva) involving drivers with psychiatric disorders. In this study of all drivers killed in fmvas in finland between 1990 and 2011, we aimed to study drivers' death rate trends in fmvas, with special focus on drivers with a history of psychiatric disorders. Prevalence of drivers' hospital treated psychiatric disorders, and characteristics of drivers with psychiatric disorders were also studied. For the purpose of this study, three national registers were accessed. Drivers' hospital treated psychiatric disorders were screened in a five-year period prior to death. Drivers with (n = 425) and without (n = 3856) psychiatric disorders were compared, female and male drivers separately. The main outcome measure was any psychiatric disorder in drivers within the five-year timescale. Socio-demographic factors, use of intoxicants and medication at the time of death, recent adverse life events, and drivers' physical and emotional states were used as covariates in the statistical analyses. During the study period, death rates increased for females with psychiatric disorders, and decreased for females without psychiatric disorders. Death rates for males with psychiatric disorders decreased between the years 1990-2000 and 2007-2011, and increased between the years 2000-2007. Death rates decreased over the whole study period in males without psychiatric disorders. Alcohol related disorders and affective disorders were the most prevalent hospital treated psychiatric disorders among drivers involved in fmvas. Use of medications at the time of death, and committing suicide in traffic both associated with being a driver with psychiatric disorders involved in fmvas for both genders. As fmvas involving drivers with psychiatric disorders have increased, a more focused and detailed evaluation of the driving performance of drivers with psychiatric disorders is recommended. These evaluations should also be extended to drivers with non-psychotic disorders. (C) 2016 elsevier ltd. All rights reserved.
78	2020	Kivisto Je;Karjalainen J;Huhtala H;Protudjer Jlp	The Use Of Short-Acting Beta-2 Adrenergic Receptor Agonists For Asthma Increased Among Finnish And Swedish Children From 2006 To 2017	Aim paediatric asthma hospitalisation has decreased in finland, but has remained stable in sweden. The reasons for these intercountry differences are unclear. The aim of this study was to explore the trend of dispensed asthma medication, including inhaled corticosteroids (ics), among paediatric populations in the two countries. Methods we explored trends in dispensed asthma medication among paediatric populations aged 0-19 in finland and sweden from 2006 to 2017. The finnish statistics on reimbursements for prescription medicines and the swedish prescribed drug register provided data on all dispensed asthma prescriptions. Results during the study period, the prevalence of dispensed ics in paediatric populations was fairly stable in finland and sweden. Among children aged 0-4, ics were 1.5 times more commonly dispensed in sweden than in finland. The prevalence of children dispensed short-acting beta-2 adrenergic receptor agonists (saba) increased in both countries, but rose more in finland (51%) than in sweden (27%). Conclusion inhaled corticosteroids were more commonly dispensed for children aged 0-4 in sweden than in finland during the study period. This study showed an increasing prevalence of children dispensed saba in finland and sweden, particularly in finland. Differences and trends in asthma medication may effect asthma hospitalisation and asthma deaths.
79	2017	Aspara J;Tikkanen H	Why Do Public Policy-Makers Ignore Marketing And Consumer Research? A Case Study Of Policy-Making For Alcohol Advertising	Public policy-makers have been noted to sometimes ignore marketing/consumer research, even when the policy issue clearly pertains to consumption markets. We embark to identify factors that may explain policy-makers' limited attention to marketing/consumer research, especially in cases related to consumer affairs that may have public health implications. Empirically, we focus on policy-making around the advertising of alcohol products. Having been involved in this policy-making process in finland, we elucidate the case through an introspective narrative. We find that the factors explaining policy-makers' limited attention to marketing/consumer research range from the decision-making characteristics of policy-makers, through inconsistent definitions for key terminology, to the fear of over-generalizing certain theories of marketing/consumer research. Regarding the latter, a key issue in the present case was that public policy-makers were unconvinced about the generic marketing theory stating that in mature markets, advertising will not increase the total consumption demand of a product category.
80	2022	Hallberg S;Rolfson O;Karppinen J;Schiottz-Christensen B;Stubhaug A;Fischer Mr;Gerdle B;Grip Et;Gustavsson A;Robinson Rl;Varenhorst C;Schepman P	Burden Of Disease And Management Of Osteoarthritis And Chronic Low Back Pain: Healthcare Utilization And Sick Leave In Sweden, Norway, Finland And Denmark (Biscuits): Study Design And Patient Characteristics Of A Real World Data Study	Objectives: osteoarthritis (oa) and chronic low back pain (clbp) are common musculoskeletal disorders with substantial patient and societal burden. Nordic administrative registers offer a unique opportunity to study the impact of these conditions in the real-world setting. The burden of disease and management of osteoarthritis and chronic low back pain: health care utilization and sick leave in sweden, norway, finland and denmark (biscuits) study was designed to study disease prevalence and the societal and economic burden in broad oa and clbp populations. Methods: patients in sweden, norway, finland and denmark with diagnoses of oa or clbp (low back pain record plus >= 2 pain relief prescriptions to indicate chronicity) were identified in specialty care, in primary care (sweden and finland) and in a quality-of-care register (sweden). Matched controls were identified for the specialty care cohort. Longitudinal data were extracted on prevalence, treatment patterns, patient-reported outcomes, social and economic burden. Results: almost 1.4 million patients with oa and 0.4 million with clbp were identified in specialty care, corresponding to a prevalence in the nordic countries of 6.3 and 1.9%, respectively. The prevalence increased to 11-14% for oa and almost 6% for clbp when adding patients identified in primary care. Oa patients had a higher elixhauser comorbidity index (0.66 vs. 0.46) and were using opioids (44.7 vs. 10.2%) or long-term nonsteroidal anti-inflammatory drug (nsaids) (20.9 vs. 4.5%) more than four times as often as compared to controls. The differences were even larger for clbp patients compared to their controls (comorbidity index 0.89 vs. 0.39, opioid use 77.7 vs. 9.4%, and long-term nsaid use 37.2 vs. 4.8%). Conclusions: the biscuits study offers an unprecedented, longitudinal healthcare data source to quantify the real-world burden of more than 1.8 million patients with oa or clbp across four countries. In subsequent papers we aim to explore among others additional outcomes and subgroups of patients, primarily those patients who may benefit most from better healthcare management.
81	2017	Karjalainen K;Lintonen T;Hakkarainen P	Illicit Drug Use Is Increasing Among Non-Medical Users Of Prescription Drugs-Results From Population-Based Surveys 2002-2014	Background: non-medical use of prescription drugs (nmupd) is known to be associated with illicit drug use, but less is known about how illicit drug use has changed in nmupd. We examined (1) the changes in illicit drug use among finnish non-medical users of prescription drugs during the 2000s and (2) whether the trends of illicit drug use differ by non-medical use of prescription drugs in the general population. Methods: data were derived from population-based (aged 15-69) drug surveys conducted in finland in 2002, 2006, 2010 and 2014. The response rates varied between 63% and 48%. Nmupd during the last year was measured (n = 252). Past-year illicit drug use among non-medical users of prescription drugs and the reference population not reporting nmupd (n = 10,967) was compared. Logistic regression was used to estimate the p-values for trends. Results: illicit drug use has increased notably among finnish non-medical users of prescription drugs (from 21% to 70%, p for trend < 0.001). This was not explained by the respondents' gender, age, employment status or alcohol use. Among the reference population, illicit drug use also increased statistically significantly, but much more moderately (from 2.5% to 5.4%). The difference between the trends was confirmed by an interaction test (p = 0.022). Conclusions: nmupd seems to be increasingly merging with illicit drug use. This indicates an increasing prevalence of polydrug use among non-medical users of prescription drugs, which may bring about more severe harms and worse health outcomes for users and more challenges in regard to treatment.
82	2021	Neuberger M	Tobacco, Nicotine And Health	Recent studies have explored improvements in smoking prevention and cessation to reduce smoking prevalence, however, in europe, only finland has already set a date to become nicotine free. Studies reporting on central, eastern and southern europe have mostly focused on combustible cigarettes up to now. In young people, correlations were found between traditional smoking, the "vaping" of e-cigarettes, experimentation with alcohol intoxication, and the use of illicit drugs. Prevention and cessation should include strategies against active and passive exposures to new nicotine products. This is a prerequisite for a successful public health policy and a future end-game against the business interests of the tobacco industry and its allies.
83	2016	Thesleff T;Niskakangas T;Luoto Tm;Ohman J;Ronkainen A	Fatal Cervical Spine Injuries: A Finnish Nationwide Register-Based Epidemiologic Study On Data From 1987 To 2010	Background context: the number of cervical spine injuries (csis) is increasing. Cervical spine injuries are associated with high morbidity and mortality. Identifying those who are at risk for csi-related death can help develop national and international interventions and policies to reduce mortality. Purpose: this study aimed to determine the trends in the incidence and the characteristics of fatal csis in finland over a 24-year study period from 1987 to 2010. Study design/setting: a large nationwide, retrospective, register-based study was carried out. Patient sample: the population-based sample was collected from death certificates issued in finland between 1987 and 2010. The death certificates were obtained from the official cause-of-death register, coordinated by statistics finland, which covers all deaths occurring in finland. Outcome measures: sociodemographics and injury-and death-related data were used for outcome measures. Methods: all death certificates issued in finland (1987-2010) containing a csi as the cause of death were carefully reviewed. Results: a total of 2,041 fatal csis were identified. These constituted 0.17% of all deaths in finland within the study period. The average annual incidence of fatal csis was 16.5 per million (range: 12.5-21.2). The majority of the victims were male (72.9%) and had concurrent spinal cord injury (83.0%). Traffic accidents (40.1%) and falls (45.0%) were the most common injury mechanisms. Almost one-third (29.8%) of the deaths were alcohol-related. Among the young victims (<60 years) with upper csi (c0-c2), the majority (91.8%) died within 24 hours post-injury. One-third of elderly victims' (>= 60 years) csi-related deaths occurred after 1 week post-injury and were mostly (74.2%) caused by respiratory and circulatory system diseases. Within the 24-year period, the incidence of fatal csis (+2/million), as well as the average age of sustaining a fatal csi (+13.5 years), increased markedly. Fall-induced accidents among elderly males were the most prominently increasing subpopulation of fatal csi victims. Conclusions: in recent decades, fatal csi incidence (death certificate-based) has increased, being 18.6 per million in finland in 2010. Victims of fatal csis tend to be older than in the past, and for a substantial number of males, low-energy falls lead to cervical trauma and death. (C) 2015 elsevier inc. All rights reserved.
84	2021	Taipale H;Puranen A;Mittendorfer-Rutz E;Tiihonen J;Tanskanen A;Cervenka S;Lahteenvuo M	Antipsychotic Use Among Persons With Schizophrenia In Sweden And Finland, Trends And Differences	Objectives to compare the differences in prevalence of antipsychotic and adjunctive pharmacotherapy use among individuals with schizophrenia between sweden and finland during 2006-2016. Methods nationwide register-based data were utilized for constructing two separate cohorts: all persons in finland with a diagnosis of schizophrenia treated in inpatient care during 1972-2014, and persons in sweden aged 16-64 with recorded diagnoses of schizophrenia in inpatient or specialized outpatient care, sickness absence or disability pension during 2005-2013. The prevalence of use was assessed as a point prevalence on 31 october each year 2006-2016, based on drug use periods modelled with the pre2dup method. In 2016, the finnish cohort included 37,780 persons and swedish cohort 25,433 persons. Results the most commonly used antipsychotic in 2016 was oral olanzapine in both countries (22.7% [95% ci 21.6-22.4] in finland, 20.9% [20.4-21.4] in sweden), followed by clozapine which was more frequently used in finland (22.0%, 21.6-22.4) than in sweden (14.8%, 14.4-15.3). Long-acting injectable (lai) use was almost two times more likely in sweden (21.6%, 95% ci 21.1-22.1) than in finland (12.8%, 12.5-13.1), a difference which was due to more common use of fg-lais in sweden. A four-fold difference was observed in z-drugs use (19.9% in sweden versus 5.0% in finland). Conclusion potential explanations for the observed discrepancies include differences in national treatment guidelines, methods of data collection, patient characteristics and/or attitudes towards treatment among both patients and physicians.
85	2020	Pechholdova M;Jasilionis D	Contrasts In Alcohol-Related Mortality In Czechia And Lithuania: Analysis Of Time Trends And Educational Differences	Introduction and aims.globally, czechia and lithuania are among the top-ranking countries in terms of high alcohol consumption. This study highlights notable contrasts in temporal trends in alcohol-related mortality and identifies country-specific patterns in educational differences.design and methods.the study uses harmonised cause-of-death series from the human cause of death database. Mortality disparities by education were assessed using census-linked mortality data. Directly standardised death rates were used to estimate levels of national and group-specific mortality. Relative and absolute mortality differences by education were assessed by range-type measures (poisson regression mortality ratios and rate differences) and gini-type measures.results.between 1994-1995 and 2016, the absolute difference between czechia and lithuania in terms of alcohol-related age-standardised death rates (per 1 000 000) decreased from 450 for males and 130 for females to 76 in males and 11 in females. In both countries, alcohol-related mortality was markedly higher among persons of lower education levels. Lithuanian males experienced the highest absolute inequalities measured by rate difference between the low and high educated (740 per million), while lithuanian females showed the most pronounced relative inequalities (6.70-fold difference between low and high educated). The corresponding figures were less than half for czechia.discussion and conclusions.reducing educational disparities in alcohol-related mortality within both countries would have a substantial impact on overall levels. Policies aimed at targeting the lowest priced and illegal alcohols and reducing levels of harmful drinking should be a priority, especially in lithuania.
86	2020	Raisamo S;Kinnunen Jm;Pere L;Lindfors P;Rimpela A	Adolescent Gambling, Gambling Expenditure And Gambling-Related Harms In Finland, 2011-2017	Existing literature on recent trends in adolescent gambling is scarce. The rapidly changing landscape of gambling, together with the generally applied legal age limits, calls for the continuous monitoring of gambling also among the adolescent population. In finland, the legal gambling age is 18. We examined changes in adolescents' gambling, gambling expenditure and gambling-related harms from 2011 to 2017. Comparable cross-sectional biennial survey data were collected in 2011, 2013, 2015 and 2017 among 12-18-year-olds (n = 18,857). The main measures were self-reported six-month gambling, average weekly gambling expenditure (euro) and harms due to gambling. Data were analyzed using cross-tabulations, chi(2)-tests and linear regression analysis. A significant decline in gambling among minors (aged 12-16-year-olds) was found (beta = - 0.253), while no significant changes were observed among 18-year-olds (who are not targeted by the law). The mean gambling expenditure also declined from 2011 to 2017. Adolescent gamblers experienced significantly less (p = .003) gambling-related harms in 2017 (7.4%) compared to 2011 (13.5%). Adolescent gambling and its related negative consequences have become less prevalent in finland between 2011 and 2017. Further monitoring is necessary to ascertain whether the positive direction will continue. Also, empirical analyses providing evidence of reasons for the observed trend are warranted.
87	2017	Mendis S	Global Progress In Prevention Of Cardiovascular Disease	Although there is measurable global progress in prevention of cardiovascular disease (cvd), it has been highly uneven and inadequate, particularly in low- and middle-income countries. Voluntary global targets have helped to galvanize attention, resources and accountability on tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity which are the major behavioural drivers of cvd. Many obstacles and challenges continue to impede the progress of cardiovascular prevention. The inclusion of noncommunicable diseases (ncds) in the sustainable development agenda as a specific target, offers an unprecedented opportunity to further advance the global progress of cardiovascular prevention. In order to seize this opportunity, a paradigm shift is required in the way key challenges to cardiovascular prevention are addressed. Such an approach must provide leadership for intersectoral policy coherence, identify effective means of tackling commercial determinants of behavioural risk factors, use rights based arguments, enhance public engagement and ensure accountability.
88	2019	Simonen J;Torronen J;Tigerstedt C;Scheffels J;Moan Is;Karlsson N	Do Teenagers' And Parents' Alcohol-Related Views Meet? - Analysing Focus Group Data From Finland And Norway	Aims: this study analyses how finnish and norwegian teenagers and parents of teenagers perceive the appropriateness, desirability or harmfulness of different drinking situations. The focus is on whether teenagers and parents perceive the situations similarly or differently. Methods: our data consist of focus group interviews from finland and norway with teenagers aged 14-17 years (n = 8 groups, n = 44 participants) and parents (n = 8 groups, n = 38). Three pictures portraying different drinking situations were presented to the participants, who were asked to describe (1) what kind of situation the picture depicts, (2) whether the way of drinking in the picture was acceptable or not and (3) whether they identified with the situation or not. Findings: our analysis showed that teenagers and parents defined the situations similarly and applied rather similar criteria when assessing the appropriateness of drinking. The most important criteria related to the amount and the way of drinking, and whether or not children were present in the situation. Regarding the identification with the situations, teenagers seemed to have somewhat stricter attitudes towards intoxication than adults, which can be perceived as a sign of an ongoing trend of decreasing youth drinking. Conclusions: overall, our analysis suggests that the alcohol worlds of parents and teenagers resembled each other, supporting the notion that the generational gap between parents and teenagers is diminishing.
89	2018	Lumme S;Manderbacka K;Karvonen S;Keskimaki I	Trends Of Socioeconomic Equality In Mortality Amenable To Healthcare And Health Policy In 1992-2013 In Finland: A Population-Based Register Study	Objective to study trends in socioeconomic equality in mortality amenable to healthcare and health policy interventions. Design a population-based register study. Setting nationwide data on mortality from the causes of death statistics for the years 1992-2013. Participants all deaths of finnish inhabitants aged 25-74. Outcome measures yearly age-standardised rates of mortality amenable to healthcare interventions, alcohol-related mortality, ischaemic heart disease mortality and mortality due to all the other causes by income. Concentration index (c) was used to evaluate the magnitude and changes in income group differences. Results significant socioeconomic inequalities favouring the better-off were observed in each mortality category among younger (25-64) and older (65-74) age groups. Inequality was highest in alcohol-related mortality, c was -0.58 (95% ci -0.62 to -0.54) among younger men in 2008 and -0.62 (-0.72 to -0.53) among younger women in 2013. Socioeconomic inequality increased significantly during the study period except for alcohol-related mortality among older women. Conclusions the increase in socioeconomic inequality in mortality amenable to healthcare and health policy interventions between 1992 and 2013 suggests that either the means or the implementation of the health policies have been inadequate.
90	2020	Lunetta P;Haikonen K	Land Motor Vehicle-Related Fatal Drowning In Finland: A Nation-Wide Population-Based Survey	Objective: who mortality statistics overlook land motor-vehicle accident (lmva)-related drowning. The aim of the study was to provide an overview of the prevalence and trends of fatal lmva-related drowning in finland, plus the main crash settings, victims' demographic characteristics, and contributing factors leading to such deaths. Methods: a descriptive, retrospective, population-based study of drowning deaths associated with lmva among finnish residents of all ages, 1971-2013. Lmva-related drownings and applicable variables were extracted from the statistics finland (sf) mortality database by cross-analysis of icd injury- and external cause-of-death codes. Results: during the study period, 538 lmvas leading to drowning occurred among finnish residents (2.5/1 000 000/year; 4.9% of all unintentional drownings, 3.7% of all lmva). Three main settings, ones responsible for over 95% of lmva-related drownings, were recognized: traffic vehicle accidents involving a passenger car; non-traffic vehicle accident involving a snowmobile; and non-traffic accidents involving agricultural, industrial, or construction vehicles. Alcohol use was a contributing factor for death in > 40% of the victims, whereas severe injuries were reported in less than 6%. Conclusion: because transport safety is crucial to prevent any vehicle entering the water, placing lmva-related drowning in the category of transport accidents is warranted. Once the vehicle becomes submersed, however, prevention measures to avoid death by drowning remains decisive.
91	2020	Tigerstedt C;Harkonen J;Makela P;Parikka S;Vilkko A	Drinking Patterns Among Finns Aged 60 Years And Over From The 1990s Onwards	Aim: to analyse prevalence and trends in older people's (60+) alcohol use in finland in 1993-2018. Data and method: data on people aged 65+ were obtained from the health behaviour and health among the finnish elderly study (hbhfe) for the years 1993-2011 and from its successor the national finsote survey for the years 2013-2018. Data for 60-64-year-olds and for the reference group (20-59-year-olds) were obtained from the health behaviour and health among the finnish adult population (hbhfa) study for the years 1993-2011 and from the finsote study for the years 2013-2018. Four measures were chosen to describe prevalence and trends in drinking patterns in five-year age groups among men and women aged 60+: prevalence of current drinking, prevalence of frequent drinking, typical amounts of drinking and prevalence of heavy episodic drinking (hed). Results: regarding prevalence of current drinking and frequent drinking, older women have been catching up with men, but older men still consume larger amounts of alcohol per occasion. The long-lasting increase in the prevalence of current drinkers continued in most older female age groups into the 2010s, settled in most older male and some female age groups, and shifted downwards in the oldest male age groups. In most older male and female age groups, the increasing trend in frequent drinking continued to the present. Data on typical amounts consumed and hed were only available for 2013-2018. In that period those measures remained rather stable. Conclusion: more detailed research on drinking patterns among people aged 60+ years is needed for two reasons: older people's drinking is a new cultural phenomenon and alcohol-related social and health harms are increasing in older age groups.
92	2019	Nivukoski U;Bloigu A;Bloigu R;Aalto M;Laatikainen T;Niemela O	Liver Enzymes In Alcohol Consumers With Or Without Binge Drinking	Background: while alcohol use is linked with a wide variety of health problems, the question of whether differences in drinking patterns could yield different outcomes has remained unclear. Patients and methods: we measured liver enzymes (alt, ggt) from alcohol consumers with or without binge drinking from a population-based sample in finland, where binge-type drinking is common. Data on alcohol use, diet, body weight, lifestyle (smoking, coffee consumption, physical activity), and health status were collected from 19225 subjects (9492 men, 9733 women), aged 25-74 years. The participants were subsequently classified to subgroups, both according to the frequencies of binge drinking and the amounts of regular alcohol intake (low-, medium-, and high-risk drinking). Results: the quantity of regular alcohol use was roughly linearly related with ggt and alt activities. Anova analyses of the trends according to the frequency of binge drinking showed a significant ggt increase in both men (p < 0.0005) and women (p < 0.0005), and a significant increase of alt in men (p < 0.0005). In those with low-risk overall consumption, markedly higher ggt (p < 0.0005) and alt (p < 0.0005) occurred in those with binge drinking more than once a month, compared with those with no such occasions. Binge drinking occurring <= 1/month also resulted in higher ggt (p < 0.0005) and alt (p < 0.05) activities. Conclusions: these results emphasize possible adverse consequences of binge drinking on hepatic function even in those with low-risk overall consumption. The pattern of drinking should be more systematically implicated in clinical recommendations for drinking reduction. (C) 2019 elsevier inc. All rights reserved.
93	2019	Faltmarch S;Perttila I;Tuomi U;Kautiainen H;Gissler M;Pennanen P;Eriksson Jg;Laine Mk	Use Of Opioids During Pregnancy And Effects Of Pregnancy Outcomes	Purpose to evaluate the use of opioids in pregnant primiparous women and study the effect of opioid use on maternal and offspring delivery outcomes. Methods the study cohort (n = 6231) consists of all primiparous women with a finnish background who delivered a singleton between 2009 and 2015 in the city of vantaa, finland. Data on births, maternal characteristics, pregnancy outcomes, and purchases of prescription drugs were obtained from national health registers. Results of the primiparous women, 5.1% used opioids during pregnancy. Of these, 95.9% used codeine. No differences were observed in purchases of opioids between the different trimesters but more women purchased opioids as pregnancy progressed (.002). Users of opioids more often also purchased other prescription drugs compared with non-users of opioids, 89% versus 58% (p < .001); age, smoking, education, and body mass index adjusted odds ratio 5.66 (95% confidence interval 3.96 to 8.09). Caesarean sections were more common in users of opioids than in non-users, 28.3% versus 21.9% (.007). Before the age of 7 days, the offspring of users of opioids more often needed respirator treatment compared with the offspring of non-users, 3.1% versus 1.6% (.044). Conclusions one out of 20 pregnant women used opioids. Use of opioids during pregnancy was associated with the risk for deliveries by caesarean sections and need for respiratory treatment among the offspring during the first week of life. Further safety evaluations are needed.
94	2016	Haapasalo-Pesu Km;Karukivi M;Saarijarvi S	The Growing Trend Of Prescribing Antipsychotics For Young People In Finland, 2000 To 2010	Background: according to previous reports from many countries (e.g., the united states, germany, the united kingdom), the use of antipsychotic drugs has increased among young people. Antipsychotics have also increasingly been prescribed for non-psychotic disorders. Objective: the purpose of this study was to estimate the rate at which antipsychotics were prescribed for young people in the age groups of 10 to 14 years, 15 to 19 years, and 20 to 24 years in finland in the years 2000, 2005, and 2010. Methods: this was a nationwide register study using data from the databases of statistics finland and the finnish national prescription register. Statistics finland's databases provided background information, including the total number of young people and the finnish national prescription register keeps record of all drug orders reimbursed by the social insurance institution of finland. Results: the prescription of antipsychotics grew 6.8-, 4.6-, and 2.6-fold over the study period for these three age groups, respectively. For the youngest age group, use was more common among males than females in all three periods studied. During the course of the study period, the use of antipsychotics became more common among females: in 2010, antipsychotics were more commonly used among females than males in both the 15- to 19-year-old age group and the 20- to 24-year-old age group. The younger the patient, the higher the probability that the indication for medication was a non-psychotic disorder. Conclusions: in finland, the trends involved in the prescription of antipsychotic medications resemble those seen in many western countries. Therefore, it is important that the safety and effectiveness of these pharmaceuticals be investigated among young people as well.
95	2022	Livingston M;Callinan S;Vashishtha R;Yuen Ws;Dietze P	Tracking The Decline In Australian Adolescent Drinking Into Adulthood	Background and aims adolescent drinking in australia (and many other countries) has declined substantially since the early 2000s. This study aimed to test whether these declines have been maintained into adulthood and whether they are consistent across sub-groups defined by sex and socio-economic status. Design quasi-cohorts were constructed from seven repeated waves of cross-sectional household survey data (2001-2019). Setting australia. Participants a total of 20 733 respondents age between 14 and 24 (male: 9492; female: 11 241). Measurements participants were grouped into five cohorts based on their birth year (from 1979-1983 to 1999-2003). Three measures of drinking were assessed: any past-year consumption (yes/no), past-year regular risky drinking (12 or more drinking episodes of >40 g of pure alcohol, yes/no) and total volume of alcohol consumed in the past year (in australian standard drinks, 10 g of alcohol). Socio-economic status was measured based on neighbourhood of residence. Findings drinking declines were consistent across socio-economic groups on all measures and trends were broadly similar for women and men. More recent birth cohorts had significantly lower levels of drinking across all three measures (odds ratios between 0.31 and 0.70 for drinking and risky drinking, coefficients between -0.28 and -0.80 for drinking volume). There were significant interactions between birth cohort and age for past-year drinking and past-year regular risky drinking, with cohort differences diminishing as age increased. Conclusions lighter drinking adolescent cohorts appear to partly 'catch up' to previous cohorts by early adulthood, but maintain lower levels of drinking and risky drinking up to the age of 24. These ongoing reductions in drinking are spread evenly across socio-economic groups.
96	2021	Oksanen A;Oksa R;Savela N;Celuch M;Savolainen I	Drinking And Social Media Use Among Workers During Covid-19 Pandemic Restrictions: Five-Wave Longitudinal Study	Background: the covid-19 pandemic restricted everyday life during 2020-2021 for many people worldwide. It also affected alcohol consumption patterns and leisure activities, including the use of social media. Objective: the aim of this study was to analyze whether social media use predicts increased risky drinking over time and during the covid-19 pandemic restrictions in particular. Methods: this 5-wave longitudinal survey study, based on a nationwide sample of workers, was conducted in finland in 2019-2021. A total of 840 respondents (male: 473/840, 56.31%; age range 18-64 years; mean age 43.90, sd 11.14 years) participated in all 5 waves of the study. The outcome variable was risky drinking, measured using the 3-item alcohol use disorders identification test (audit-c). Multilevel linear hybrid modeling enabled the investigation of both within-person and between-person effects. Predictors included social media use and communication, involvement in social media identity bubbles, psychological distress, and remote working. Controls included sociodemographic factors and the big five personality traits. Results: increased involvement in social media identity bubbles was associated with an increase in risky drinking behavior. Of all social media platforms examined, online dating app use was associated with riskier use of alcohol over time during the covid-19 crisis. Daily social media communication with colleagues about nonwork topics was associated with risky drinking. Female gender, younger age, university education, nonindustrial occupational field, conscientiousness, agreeableness, and neuroticism were associated with lower levels of risky drinking. Conclusions: social media use during a pandemic carries some risks for alcohol consumption. Involvement in social media identity bubbles and online dating are risk factors for excessive drinking during the covid-19 pandemic.
97	2016	Lumme S;Pirkola S;Manderbacka K;Keskimaki I	Excess Mortality In Patients With Severe Mental Disorders In 1996-2010 In Finland	Unselected population-based nationwide studies on the excess mortality of individuals with severe mental disorders are scarce with regard to several important causes of death. Using comprehensive register data, we set out to examine excess mortality and its trends among patients with severe mental disorders compared to the total population. Patients aged 2574 and hospitalised with severe mental disorders in 1990-2010 in finland were identified using the national hospital discharge register and linked individually to population register data on mortality and demographics. We studied mortality in the period 1996-2010 among patients with psychotic disorders, psychoactive substance use disorders, and mood disorders by several causes of death. In addition to all-cause mortality, we examined mortality amenable to health care interventions, ischaemic heart disease mortality, disease mortality, and alcohol-related mortality. Patients with severe mental disorders had a clearly higher mortality rate than the total population throughout the study period regardless of cause of death, with the exception of alcohol-related mortality among male patients with psychotic disorders without comorbidity with substance use disorders. The all-cause mortality rate ratio of patients with psychotic disorders compared to the total population was 3.48 (95% confidence interval 2.98-4.06) among men and 3.75 (95% ci 3.08-4.55) among women in the period 2008-10. The corresponding rate ratio of patients with psychoactive substance use disorders was 5.33 (95% ci 4.87-5.82) among men and 7.54 (95% ci 6.30-9.03) among women. Overall, the mortality of the total population and patients with severe mental disorders decreased between 1996 and 2010. However, the mortality rate ratio of patients with psychotic disorders and patients with psychoactive substance use disorders compared to the total population increased in general during the study period. Exceptions were alcohol-related mortality among patients with psychoactive substance use disorders and female patients with psychotic disorders, as well as amenable mortality among male patients with psychotic disorders. The mortality rate ratio of persons with mood disorders compared to the total population decreased. The markedly high mortality amenable to health care intervention among patients with severe mental disorders found in our study suggests indirectly that they may receive poorer quality somatic care. The results highlight the challenges in co-ordinating mental and somatic health services.
98	2019	Paalanen L;Harkanen T;Tolonen H	Protocol Of A Research Project Projections Of The Burden Of Disease And Disability In Finland - Health Policy Prospects' Using Cross-Sectional Health Surveys And Register-Based Follow-Up	Introduction with the rapid ageing of the population in europe, reliable estimates of the future development of the disease and disability burden as well as healthy life years in the older sections of the population are crucial. Meanwhile, the future prospects of the health and functional ability of the working-aged population are critical. The aims of the projections of the burden of disease and disability in finland health policy prospects research project are to provide information about the long-term consequences of health-related behaviours of the population and to project the potential improvement of the burden of disease and disability based on realistic scenarios about the development of risk behaviours in the total population and its subgroups. Methods and analysis the analyses will be based on data from representative cross-sectional and longitudinal health examination surveys (hess) conducted between 1972 to 2017 in finland, and register data from several national administrative registers. Included hess (finrisk surveys from 1972 to 2012, mini-finland survey from 1978 to 1980, the health 2000/2011 surveys and the finhealth 2017 study) provide abundant information about biological and behavioural risk factors and the health and morbidity of the population. The modifiable risk factors used as predictors include hypertension, hyperlipidaemia, obesity, diabetes, physical inactivity, smoking, alcohol use and unfavourable diet. The main outcomes are ischaemic heart disease, cerebrovascular diseases, lung cancer, chronic obstructive pulmonary disease, alzheimer's disease and diabetes. Within the project, novel projection techniques of data-driven bayesian hierarchical models to provide robust and comparable estimates will be developed. Ethics and dissemination the prevailing legislation and regulations have been followed for all surveys. Surveys since 1997 have been approved by the respective ethics committees covering the scope of this project. A written informed consent was obtained from participants since 1997. The outputs of the project will include 8 to 10 scientific papers in peer-reviewed journals.
99	2019	Mikhail A;Tanoli O;Legare G;Dube Pa;Habel Y;Lesage A;Low Ncp;Lamarres S;Singh S;Rahme E	Over-The-Counter Drugs And Other Substances Used In Attempted Suicide Presented To Emergency Departments In Montreal, Canada A Cross-Sectional Study	Background: over-the-counter (otc) analgesics are frequently used in suicide attempts. Accessibility, toxicity, and unsupervised acquisition of large amounts may be facilitators. Aims: to identify patient characteristics associated with otc drug use as a suicide attempt method among adults. "Method: a cross-sectional study was conducted using chart review of all individuals who presented to the emergency department (ed) of two adult general hospitals following a suicide attempt during 2009-2010 in montreal, canada. Results: among the 369 suicide attempters identified, 181 used overdosing, 47% of whom used otc drugs. In logistic regression, women and those with medical comorbidity were more likely to use overdosing, while those with substance use disorders were less likely to do so. Among those who overdosed, women were more likely to use otc drugs, while those who were caucasian, had children, comorbidities, diagnoses with substance use disorders, and made attempts in the fall were less likely to do so. Substances most frequently used were: acetaminophen among otc drugs (30%); antidepressants (37%), anxiolytics (30%), opioids (10%), and anticonvulsants (9%) among prescription drugs; and cocaine (10%) among recreational drugs. Limitations: reasons for the suicide method choice were not available. Conclusion: otc drugs, in particular acetaminophen, are frequently used in suicide attempts. Accessibility to these drugs may be an important contributor.
100	2017	Reitan T;Callinan S	Changes In Smoking Rates Among Pregnant Women And The General Female Population In Australia, Finland, Norway, And Sweden	Introduction: smoking rates have dropped substantially in most developed countries in recent decades. This general trend has, however, not always been evident among women-particularly younger women. Smoking habits do, however, often change in connection with pregnancy and the aim of this study is to determine whether smoking during pregnancy follows general trends in smoking rates in the general female population in four countries with active anti-tobacco policies and decreasing population smoking rates. Methods: changes in rates of persistent smoking, that is, smoking in late pregnancy or daily smoking among all women of childbearing age were described according to age groups. Data were retrieved from the australian household drug surveys during 2000-2013 and from registries and surveys in finland, norway, and sweden between 1995 and 2014. Results: in general, persistent smoking has decreased and late-pregnancy smoking rates are lower than daily smoking rates among all women. However, younger women are more likely to be persistent smokers regardless of pregnancy status. In norway and finland, persistent smoking was most common among young pregnant women and in sweden there was an increased polarization between age groups. In australia, a steady decrease in smoking rates appears to have stalled in younger pregnant women. Conclusion: although smoking has declined substantially in recent decades, there are groups lagging behind this general trend. Young pregnant women are of particular concern in this respect. The possibility that these findings reflect the changing characteristics of younger pregnant women is discussed. Implications: this study puts recent trends in maternal smoking into a broader context by relating developments to changes in smoking rates among women in general. By using similar data from four countries we were able to follow changes in smoking rates "within" groups of women within the four countries without being limited by methodological problems related to cross-country or inter-group comparisons. We were above all able to show that aggregate data disclose the strong age gradient in maternal smoking habits.
101	2018	Safreed-Harmon K;Hetherington Kl;Aleman S;Alho H;Dalgard O;Frisch T;Gottfredsson M;Weis N;Lazarus Jv	Policy Responses To Hepatitis C In The Nordic Countries: Gaps And Discrepant Reporting In The Hep-Nordic Study	Background and aims in the nordic countries (denmark, finland, iceland, norway, sweden), the prevalence of chronic hepatitis c virus (hcv) infection is relatively low in the general population, but is much higher among people who inject drugs (pwid). We conducted an exploratory study to investigate the extent to which these countries have policies supporting key elements of the public health response that is necessary to achieve the global goal of eliminating hcv as a public health threat. Methods fourteen stakeholders representing government agencies, medical societies, and civil society organisations (csos) in the nordic countries completed a cross-sectional online survey that included 21 policy questions related to national coordination, prevention, testing, linkage to care, and treatment. We summarised the findings in a descriptive analysis, and noted discrepant responses from stakeholders within the same country. Results stakeholders reported that three of the five study countries have national viral hepatitis strategies, while only iceland has a national hcv elimination goal. The availability of harm reduction services varies, with opioid substitution therapy provided for the general population throughout all countries, but not needle and syringe programmes. No country has access to anonymous hcv testing in all parts of the country. National hcv treatment guidelines are available in all countries except finland, and all countries provide publicly funded direct-acting antiviral treatment. Disagreement regarding policies was observed across countries, and csos were the stakeholder group that most frequently answered survey questions incorrectly. Conclusion the nordic region as a whole has not consistently expressed its commitment to tackling hcv, despite the existence of large hcv epidemics among pwid in these countries. Stakeholder alignment and an established elimination goal with an accompanying strategy and implementation plan should be recognised as the basis for coordinated national public health efforts to achieve hcv elimination in the nordic region and elsewhere.
102	2021	Santos Jv;Gorasso V;Souza J;Wyper Gma;Grant I;Pinheiro V;Viana J;Ricciardi W;Haagsma Ja;Devleesschauwer B;Plass D;Freitas A	Risk Factors And Their Contribution To Population Health In The European Union (Eu-28) Countries In 2007 And 2017	Background: the global burden of disease (gbd) study has generated a wealth of data on death and disability outcomes in europe. It is important to identify the disease burden that is attributable to risk factors and, therefore, amenable to interventions. This paper reports the burden attributable to risk factors, in deaths and disability-adjusted life years (dalys), in the 28 european union (eu) countries, comparing exposure to risks between them, from 2007 to 2017. Methods: retrospective descriptive study, using secondary data from the gbd 2017 results tool. For the eu-28 and each country, attributable (all-cause) age-standardized death and daly rates, and summary exposure values are reported. Results: in 2017, behavioural and metabolic risk factors showed a higher attributable burden compared with environmental risks, with tobacco, dietary risks and high systolic blood pressure standing out. While tobacco and air quality improved significantly between 2007 and 2017 in both exposure and attributable burden, others such as childhood maltreatment, drug use or alcohol use did not. Despite significant heterogeneity between eu countries, the eu-28 burden attributable to risk factors decreased in this period. Conclusion: accompanying the improvement of population health in the eu-28, a comparable trend is visible for attributable burden due to risk factors. Besides opportunities for mutual learning across countries with different disease/risk factors patterns, good practices (i.e. Tobacco control in sweden, air pollution mitigation in finland) might be followed. On the opposite side, some concerning cases must be highlighted (i.e. Tobacco in bulgaria, latvia and estonia or drug use in czech republic).
103	2022	Sipila Jot;Kalviainen R	Adult Onset Epilepsy Incidence In Finland Over 34 Years: A Nationwide Registry Study	Background and purpose the incidence of epilepsy is decreasing among the working-aged in high-income countries, but previous studies have reported conflicting results in finland. Methods a nationwide population-based cross-sectional analysis was made of annual epilepsy drug reimbursement rights frequency data from the social insurance institution of finland, the national authority, between 1986 and 2019. All persons at least 20 years of age living in finland during the study period were included. Results based on the analysis of 77,939 new reimbursement rights, crude incidence was 57.4/100,000 (95% confidence interval [ci] = 57.0-57.8) person-years, and age-standardized (to the european standard population 2013) incidence was 51.6/100,000 person-years. Both crude (r = 0.62, p = 0.00009) and standardized (r = 0.65, p = 0.00003) incidence increased over time. Incidence increased in both men (from 66.4 to 71.6/100,000, r = 0.51, p = 0.002) and women (from 51.5 to 55.3/100,000, r = 0.68, p < 0.00001). The mean male to female incidence rate ratio was 1.28 (95% ci = 1.26-1.30, range = 1.15-1.41), but decreased during the study period (r = -0.47, p = 0.006). Incidence decreased in those 20-59 years old but increased in all older age groups. This development was similar between sexes. Conclusions the incidence of adult onset epilepsy in finland increased in people older than 60 years and decreased in the 20-59-year age group during the study period. These trends were similar between sexes. Therefore, etiological epilepsy trends in the elderly need to be studied further to plan public health measures to prevent epilepsy in this age group.
104	2022	Latvala T;Lintonen T;Luopa P;Raisamo S	Gambling Among Finnish 14-16-Year-Old Adolescents Before (2008-2009), During (2010-2011), And After (2013-2017) Setting The Legal Age Limit Of 18 For Gambling And The Role Of Socio-Economic Status	Legislation prohibiting minors from engaging in gambling is a gambling policy measure set to protect adolescents from the harmful effects of gambling. The finnish gambling system is based on a state monopoly, regulated by the lotteries act. After an amendment to the lotteries act, the new minimum legal gambling age was raised to 18 years old between 2010 and 2011. The main purpose of this study was to discover how the amendment to the act altered adolescents' gambling (14-16-year-olds) and to examine whether the amendment decreased socio-economic differences. Adolescents gambling was studied before (2008-2009), during (2010-2011), and after (2013-2017) the age limit of gambling was raised in finland. The study based on five waves (2008-2009, 2010-2011, 2013, 2015, 2017) of the national repeated cross-sectional school health promotion study. Cross-tabulations where gambling was studied by study year and socio-economic status (ses) were formulated, and the statistical differences were studied by using chi(2)-tests. Percentage change in gambling frequency was also examined by study year and ses. Study years were analyzed separately to model the weekly gambling via logistic regression models. Adolescent gambling significantly decreased over time. It appears that raising the legal gambling age had a permanent effect on under-aged gambling. However, differences in gambling by adolescents' family's ses increased during the study period, indicating widening inequalities in gambling among adolescents. Diminishing inequalities in adolescent gambling is likely to require both societal action and consensus on adolescent gambling being a significant social and public health concern.
105	2016	Gromyko Aa;Plevako Ns	On The Sweden's And Finland's Optional Membership In Nato	In the past two years, the sweden's and finland's membership of nato has been extensively discussed. The issue has become one of the priorities in the political agenda in both countries, along with immigration. According to swedish and finnish political analysts, that is reasoned by response to the russian foreign policy activities, particularly in the northern region. At the same time, there are significant differences in substance and form of these debates in each of these nordic states.
106	2018	Mononen N;Jarvinen R;Hameen-Anttila K;Airaksinen M;Bonhomme C;Kleme J;Pohjanoksa-Mantyla M	A National Approach To Medicines Information Research: A Systematic Review	Background: the finnish medicines agency fimea published the first national medicines information (mi) strategy in 2012. For the purpose of implementing the mi strategy into practice by the national mi network, a comprehensive inventory of mi research in finland was needed. Objective: to systematically review literature on mi research conducted in finland by analyzing and classifying the studies, and identifying the gaps in mi research. Methods: medline, scopus and medic databases were searched for peer-reviewed mi publications by using key word screening criteria. The search and extraction process followed prisma guidelines and covered the period from january 2000 to june 2016. Included studies were content analyzed according to mi practices identified, trends over time in research methodology and theory. Results: included publications (n = 126) applied a variety of research methods, most often cross-sectional surveys (n = 51, 40% of all studies), but more than half of the studies were qualitative (n = 68, 54%). Twelve were intervention studies of which 6 were randomized and had a control group. Studies were categorized into: patient counseling in different settings (n = 45); mi sources and needs of medicine users (n = 25); healthcare professionals' (hcps) competence in patient counseling and pharmacotherapy (n = 25); mi sources and needs of hcps (n = 23); mi education and literacy (n = 13); and mi policies and strategies (n = 3). Most of the studies were descriptive, and only 6 studies applied a theory. Conclusions: regardless of some methodological pitfalls, mi research conducted in finland since 2000 provides multifaceted understanding of mi practices and their development needs. Research should shift towards larger research lines having a stronger theory base and study designs to deepen the understanding of mi practices and behaviors, and effectiveness of mi in different healthcare settings. Future research should cover also the use of electronic mi sources and services which apply modern information technology to clinical decision making and medication reviews, national mi policy, mi literacy, mi needs of hcps and consumers.
107	2019	Sipila Jot;Soilu-Hanninen M;Rautava P;Kyto V	Progressive Multifocal Leukoencephalopathy In Finland: A Cross-Sectional Registry Study	Objectiveto investigate if progressive multifocal leucoencephalopathy (pml) incidence has increased in finland like in the neighbouring sweden.methodsnational administrative registries were searched for all pml admissions aged 16years or more in 2004-2014 on all neurological and internal medicine wards in finland. The mortality data of the patients was extracted from the national causes of death registry. National level data on annual predisposing drug use was obtained from the national pharmaceutical authority.resultswe identified 35 pml cases (57% male) with a peak in 2010-2011 that amounted to 49% of all cases. The annual incidence for the entire study period was 0.072/100,000 person-years (95% ci 0.050-0.10) with no temporal trend (p=0.18). Mean age was 57years (22-88years) with no sex difference (p=0.42). Neoplasms (60%), hiv infection (17%) and systemic connective tissue disorders (ctd, 14%) were the most common predisposing conditions. Ms was recorded in three cases (9%). The national level use of drugs that predispose to pml increased during the study period, with the exceptions of alemtuzumab and fludarabine. Overall survival was 85% at 90 days, 79% at 1year, and 66% at 5years. Survival was worst in patients with malignancy and best in patients with ctd.conclusionspml most often occurs in patients with malignancies and patients with hiv or ctd cover a third. Pml incidence in finland is lower than in sweden and shows no temporal trend despite increasing use of predisposing drugs. Mortality after pml varies according to the predisposing condition.
108	2020	Hupli A	Cognitive Enhancement With Licit And Illicit Stimulants In The Netherlands And Finland: What Is The Evidence?	Purpose european studies have shown lower prevalence rates of prescription stimulant use for cognitive enhancement, especially among student populations, compared to north america. This difference requires more cross-country research of the various factors involved. To find out whether other parts of the globe are witnessing similar increases in extra-medical stimulant use, and how this might relate to cognitive enhancement, requires empirical study of local contexts. This paper aims to argue that the academic and public discussion on cognitive enhancement should consider the specific country context of drug policy and research and rethink which drugs are included under the term cognitive enhancement drugs. Design/methodology/approach this paper offers a general review and a sociological country comparison between the netherlands and finland, focusing not only on prescription stimulants used to treat attention deficit hyperactivity disorder but also illicit amphetamines among young adults and methylphenidate use among dutch and finnish participants of the global drug survey. This paper emphasises sociocultural perspectives and the importance of context in cognitive enhancement in general as the line between therapeutic and enhancement use can often be blurred. Data is drawn from global, european and national sources, including the international narcotics control board, european monitoring centre for drugs and drug addiction and global drug survey. Findings there are hardly any national empirical studies done on cognitive enhancement drug use in finland. On the other hand, there have been studies in the netherlands showcasing that the use of prescription stimulants and other drugs for enhancement purposes is something that is happening among young people, albeit yet in a relatively small scale. Illicit and licit stimulant use and drug policy action in relation to cognitive enhancement drugs in the two countries varies, emphasising the importance of country context. Originality/value given that cross-country research is scarce, this general review provides one of the first glimpses into cognitive enhancement drug use by comparing the country context and research in finland, where the phenomenon has not been studied, with the netherlands, where the topic has received more research and public attention. Further research areas are suggested.
109	2017	Roberts Se;Morrison-Rees S;John A;Williams Jg;Brown Th;Samuel Dg	The Incidence And Aetiology Of Acute Pancreatitis Across Europe	Background: acute pancreatitis is increasingly one of the most important acute gastrointestinal conditions throughout much of the world, although incidence and aetiology varies across countries and regions. This study investigated regional and national patterns in the incidence and aetiology of acute pancreatitis, demographic patterns in incidence and trends over time in incidence across europe. Methods: a structured review of acute pancreatitis incidence and aetiology from studies of hospitalised patient case series, cohort studies or other population based studies from 1989 to 2015 and a review of trends in incidence from 1970 to 2015 across all 51 european states. Results: the incidence of acute pancreatitis was reported from 17 countries across europe and ranged from 4.6 to 100 per 100 000 population. Incidence was usually highest in eastern or northern europe, although reported rates often varied according to case ascertainment criteria. Of 20 studies that reported on trends in incidence, all but three show percentage increases over time (overall median increase = 3.4% per annum; range = -0.4%-73%). The highest ratios of gallstone to alcohol aetiologies were identified in southern europe (greece, turkey, italy and croatia) with lowest ratios mainly in eastern europe (latvia, finland, romania, hungary, russia and lithuania). Conclusions: the incidence of acute pancreatitis varies across europe. Gallstone is the dominant aetiology in southern europe and alcohol in eastern europe with intermediate ratios in northern and western europe. Acute pancreatitis continues to increase throughout most of europe. (C) 2017 published by elsevier b. V. On behalf of iap and epc.
110	2016	Hemminki E	Research Ethics Committees In The Regulation Of Clinical Research: Comparison Of Finland To England, Canada, And The United States	Background: the aim of this paper is to compare common features and variation in the work of research ethics committees (recs) in finland to three other countries - england, canada, the united states of america (usa) - in the late 2000s. Methods: several approaches and data sources were used, including semi-or unstructured interviews of experts, documents, previous reports, presentations in meetings and observations. A theoretical framework was created and data from various sources synthesized. Results: in finland, recs were regulated by a medical research law, whereas in the other countries many related laws and rules guided recs; drug trials had specific additional rules. In england and the usa, there was a rec control body. In all countries, members were voluntary and included lay-persons, and payment arrangements varied. Patient protection was the main ethics criteria, but other criteria (research advancement, availability of results, payments, detailed fulfilment of legislation) varied. In all countries, recs had been given administrative duties. Variations by country included the mandate, practical arrangements, handling of multi-site research, explicitness of proportionate handlings, judging scientific quality, time-limits for decisions, following of projects, role in institute protection, handling conflicts of interests, handling of projects without informed consent, and quality assurance research. The division of work between rec members and secretariats varied in checking of formalities. In england, quality assurance of rec work was thorough, fairly thorough in the usa, and not performed in finland. Conclusions: the work of recs in the four countries varied notably. Various deficiencies in the system require action, for which international comparison can provide useful insights.
111	2021	Rajamaki Tj;Moilanen T;Puolakka Pa;Hietaharju A;Jamsen E	Is The Preoperative Use Of Antidepressants And Benzodiazepines Associated With Opioid And Other Analgesic Use After Hip And Knee Arthroplasty?	Background mental health disorders can occur in patients with pain conditions, and there have been reports of an increased risk of persistent pain after tha and tka among patients who have psychological distress. Persistent pain may result in the prolonged consumption of opioids and other analgesics, which may expose patients to adverse drug events and narcotic habituation or addiction. However, the degree to which preoperative use of antidepressants or benzodiazepines is associated with prolonged analgesic use after surgery is not well quantified. Question/purposes (1) is the preoperative use of antidepressants or benzodiazepine medications associated with a greater postoperative use of opioids, nsaids, or acetaminophen? (2) is the proportion of patients still using opioid analgesics 1 year after arthroplasty higher among patients who were taking antidepressants or benzodiazepine medications before surgery, after controlling for relevant confounding variables? (3) does analgesic drug use decrease after surgery in patients with a history of antidepressant or benzodiazepine use? (4) does the proportion of patients using antidepressants or benzodiazepines change after joint arthroplasty compared with before? Methods of the 10,138 patients who underwent hip arthroplasty and the 9930 patients who underwent knee arthroplasty at coxa hospital for joint replacement, tampere, finland, between 2002 and 2013, those who had primary joint arthroplasty for primary osteoarthritis (64% [6502 of 10,138] of patients with hip surgery and 82% [8099 of 9930] who had knee surgery) were considered potentially eligible. After exclusion of another 8% (845 of 10,138) and 13% (1308 of 9930) of patients because they had revision or another joint arthroplasty within 2 years of the index surgery, 56% (5657 of 10,138) of patients with hip arthroplasty and 68% (6791 of 9930) of patients with knee arthroplasty were included in this retrospective registry study. Patients who filled prescriptions for antidepressants or benzodiazepines were identified from a nationwide drug prescription register, and information on the filled prescriptions for opioids (mild and strong), nsaids, and acetaminophen were extracted from the same database. For the analyses, subgroups were created according to the status of benzodiazepine and antidepressant use during the 6 months before surgery. First, the proportions of patients who used opioids and any analgesics (that is, opioids, nsaids, or acetaminophen) were calculated. Then, multivariable logistic regression adjusted with age, gender, joint, charlson comorbidity index, bmi, laterality (unilateral/same-day bilateral), and preoperative analgesic use was performed to calculate odds ratios for any analgesic use and opioid use 1 year postoperatively. Additionally, the proportion of patients who used antidepressants and benzodiazepines was calculated for 2 years before and 2 years after surgery. Results at 1 year postoperatively, patients with a history of antidepressant or benzodiazepine use were more likely to fill prescriptions for any analgesics than were patients without a history of antidepressant or benzodiazepine use (adjusted odds ratios 1.9 [95% confidence interval 1.6 to 2.2]; p < 0.001 and 1.8 [95% ci 1.6 to 2.0]; p < 0.001, respectively). Similarly, patients with a history of antidepressant or benzodiazepine use were more likely to fill prescriptions for opioids than patients without a history of antidepressant or benzodiazepine use (adjusted ors 2.1 [95% ci 1.7 to 2.7]; p < 0.001 and 2.0 [95% ci 1.6 to 2.4]; p < 0. 001, respectively). Nevertheless, the proportion of patients who filled any analgesic prescription was smaller 1 year after surgery than preoperatively in patients with a history of antidepressant (42% [439 of 1038] versus 55% [568 of 1038]; p < 0.001) and/or benzodiazepine use (40% [801 of 2008] versus 55% [1098 of 2008]; p < 0.001). The proportion of patients who used antidepressants and/or benzodiazepines was essentially stable during the observation period. Conclusion surgeons should be aware of the increased risk of prolonged opioid and other analgesic use after surgery among patients who were on preoperative antidepressant and/or benzodiazepine therapy, and they should have candid discussions with patients referred for elective joint arthroplasty about this possibility. Further studies are needed to identify the most effective methods to reduce prolonged postoperative opioid use among these patients.
112	2020	Kuussaari K;Karjalainen K;Niemela S	Mental Health Problems Among Clients With Substance Use Problems: A Nationwide Time-Trend Study	Purpose mental health and substance use disorders are notable contributors to the global total burden of disease. On a population level, co-occurring mental health and substance use problems are estimated to account for 2-4%. In clinical samples, estimate is even higher. The aim of this study was to examine changes in recognized mental health problems (mhps) and in the substance use profiles among clients with substance use problems in finland. Methods data concerning individuals with substance use entering finnish social and health care services during 1 day were collected nationwide at three time-points in 2007, 2011, and 2015. Cross-tabulations and logistic regression were used for statistical analysis. Results co-occurring mhps and substance use problems were common: 56-60% of the clients with substance use problems were reported to have had mhps between the years 2007 and 2015. The proportion of mhps remained rather stable among them. Substance use profiles have changed: the proportion of illicit drug use among those who had mhps has increased in health care services, social services, and substance use problem services. Conclusion co-occurring substance use and mhps among clients with substance use problems are common, and substance use profile is shifting from using alcohol only towards illicit drug use. This may even bring along more challenges for the treatment system and should be considered in future service planning.
113	2020	Lohse M	Sharing National Security Information In Finland	Safeguarding finland's national security is a collaborative function of the intelligence authorities and their clients and partners. This collaboration requires a sharing of national security information within the intelligence community, and with other public authorities - both domestic and foreign - as well as with enterprises and corporations. The first objective of this article is to distinguish norms regulating the sharing of national security information from the intelligence and data processing legislation, and to organise this legal substance into three categories: disclosure of information in (1) national co-operation, (2) international co-operation, and for (3) crime prevention. The second objective is to identify areas of development in each of these three categories and accordingly suggest law and policy recommendations for the future.
114	2017	Peltonen R;Ho Jy;Elo It;Martikainen P	Contribution Of Smoking-Attributable Mortality To Life Expectancy Differences By Marital Status Among Finnish Men And Women, 1971-2010	Background smoking is known to vary by marital status, but little is known about its contribution to marital status differences in longevity. We examined the changing contribution of smoking to mortality differences between married and never married, divorced or widowed finnish men and women aged 50 years and above in 1971-2010. Data and methods the data sets cover all persons permanently living in finland in the census years 1970, 1975 through 2000 and 2005 with a five-year mortality follow-up. Smoking-attributable mortality was estimated using an indirect method that uses lung cancer mortality as an indicator for the impact of smoking on mortality from all other causes. Results life expectancy differences between the married and the other marital status groups increased rapidly over the 40-year study period because of the particularly rapid decline in mortality among married individuals. In 1971-1975 37-48% of life expectancy differences between married and divorced or widowed men were attributable to smoking, and this contribution declined to 11-18% by 2006-2010. Among women, in 1971-1975 up to 16% of life expectancy differences by marital status were due to smoking, and the contribution of smoking increased over time to 10-29% in 2006-2010. Conclusions in recent decades smoking has left large but decreasing imprints on marital status differences in longevity between married and previously married men, and small but increasing imprints on these differences among women. Over time the contribution of other factors, such as increasing material disadvantage or alcohol use, may have increased.
115	2022	Hemminki K;Tichanek F;Forsti A;Hemminki O;Liska V;Hemminki A	Long-Term Incidence In Hepatocellular Carcinoma And Intrahepatic Bile Duct Cancer In Denmark, Finland, Norway And Sweden, Role Of Thorotrast?	We analyzed long-term incidence trends in liver cancer (including hepatocellular carcinoma and intrahepatic cholangiocarcinoma) with an aim to interpret the changes in terms of known risk factors and hypothesize that historical exposure to thorotrast, a radiographic contrast medium emitting alpha particles, has changed population rates. The nordcan database was used to collect cancer registry data from denmark (dk), finland (fi), norway (no) and sweden (se), which we used from 1953 (dk, fi and no) and 1960 (se) through 2019. Thorotrast, which caused a 100-fold risk of liver cancer was used in dk and se, and probably also in fi between 1930 and 1950, but not in no. The incidence trend for liver cancer showed a broad maximum at around 1980, most prominent and statistically significant in se and dk men and women, and in all countries, a steadily increasing trend towards the end of follow-up. Incidence for no was lower than for the other countries and the rates showed no peaking at around 1980. Birth cohort analysis identified a transient risk which could be dated to a period between 1930 and 1950 in countries other than no. Considering a lag time between thorotrast use and liver cancer appearance, the large incidence peak around 1980 in dk and de was probably contributed by thorotrast but considering the ecological nature of the findings, the association should be considered cautiously as hypothesis generating. The late increase in liver cancer risk is most likely lifestyle related and largely preventable.
116	2022	Luurila K;Kangasniemi M;Hult M;Haggman-Laitila A	Nurses' Substance Use Disorder In Disciplinary Procedures: A Retrospective Document Analysis	Aim and objectives to describe nurses with substance use disorder (sud) in authority disciplinary actions. Background nurses with sud risk patient safety. Research evidence on the identification of nurses' sud and related management procedures is currently sparse. Design retrospective document analysis of decisions related to sud in nurses' disciplinary actions. Method decisions on nurses (n = 171) made by the finnish national supervisory authority for welfare and health in finland during 2007-2016 were used as data. An electronic extraction sheet was developed for data collection including variables (n = 34), of which 18 were analysed in this study with descriptive statistical methods and chi-squared statistics. The study reported in accordance with the strobe checklist for cross-sectional studies. Results the mean age of the nurses was 43 years (sd 8.7). The most mentioned reasons for notifications leading to disciplinary actions were substance abuse with working while intoxicated and drug theft. The most mentioned intoxicants used were medicines and alcohol. On average, the first disciplinary decision was given at 6.4 months (sd 3.9) and the final decision was given at 17.9 months (sd 13.1). The most common decision was restriction of the right to practice. Conclusion the results supported findings from previous decades and different continents, showing similar trends are prevalent globally and continue today. In future studies, countries' registers of nurses with sud could be used to clarify the profile of nurses and develop appropriate procedures. Qualitative studies could be conducted to investigate to shed light on concealment of the phenomenon. Relevance to clinical practice there is a need for early identification, intervention and referral to treatment as well as effective protocols for reducing nurses' risks of disciplinary actions related to sud. It is important to be aware of the signs and symptoms of sud and training for this is needed.
117	2020	Taipale H;Sarkila H;Tanskanen A;Kurko T;Taiminen T;Tiihonen J;Sund R;Tuulio-Henriksson A;Saastamoinen L;Hietala J	Incidence Of And Characteristics Associated With Long-Term Benzodiazepine Use In Finland	This cohort study uses national longitudinal data from the social insurance institution of finland to investigate the incidence of long-term use of benzodiazepines and related drugs among new users and factors associated with development of long-term use. Importance the proportion of patients who develop long-term benzodiazepine use remains controversial, as do the length of time before long-term use develops and the factors associated with long-term use. Objective to investigate the incidence of long-term benzodiazepine and related drug (bzdr) use and factors associated with the development of long-term use implementing a follow-up design with new bzdr users. Design, setting, and participants this population-based cohort study used a nationwide cohort of 129x202f;732 new bzdr users in finland. New users of bzdrs aged 18 years or older were identified from the prescription register maintained by the social insurance institution of finland as individuals who initiated bzdr use during 2006 and had not used bzdrs from 2004 to 2005. The follow-up continued until death, long-term hospitalization, a gap of 2 years in bzdr use, or december 31, 2015. The population was analyzed according to age at treatment initiation, categorized into younger (<65 years) and older (>= 65 years) subcohorts. Analyses were conducted from may 2019 to february 2020. Exposures use of bzdrs, modeled from register-based data using the pre2dup (from prescriptions to drug use periods) method. Main outcomes and measures long-term bzdr use, defined as continuous use of 180 days or longer, and factors associated with long-term vs short-term use, compared using cox proportional hazards models. Results among the 129x202f;732 incident bzdr users, the mean (sd) age was 52.6 (17.7) years, and 78x202f;017 (60.1%) individuals were women. During the follow-up period, 51x202f;099 bzdr users (39.4%) became long-term users. Long-term treatment was more common in the older subcohort (19x202f;103 individuals [54.5%]) than the younger subcohort (31x202f;996 individuals [33.8%]). At 6 months, 28x202f;586 individuals (22.0%) had become long-term users: 11x202f;805 (33.7%) in the older subcohort and 16x202f;781 (17.7%) in the younger subcohort. The largest proportions of initiators who became long-term users were those persons who initiated treatment with nitrazepam (76.4%; 95% ci, 73.6%-79.1%), temazepam (63.9%; 95% ci, 62.9%-65.0%), lorazepam (62.4%; 95% ci, 59.7%-65.1%), or clonazepam (57.5%; 95% ci, 55.9%-59.2%). Factors associated with the development of long-term use included male sex, older age, receipt of social benefits, psychiatric comorbidities, and substance abuse. Conclusions and relevance the findings of this population-based cohort study conducted in finland suggest that the incidence of subsequent long-term bzdr use in individuals who initiate use of bzdrs is high, especially among older persons, and that the specific bzdr used initially is associated with the development of long-term bzdr use and should be carefully considered when prescribing bzdrs. The observed factors that appear to be associated with development of long-term bzdr use also should be considered in clinical decision-making when starting and monitoring bzdr treatment. Questions what is the incidence of long-term use of benzodiazepines and related drugs (bzdrs) in persons who start new bzdr treatment, and what factors are associated with the development of long-term use? Findings in a cohort study of 129x202f;732 new bzdr users in finland, 34% of working-aged persons and 55% of older persons developed long-term use. Higher rates of long-term use were associated with specific drugs, namely, nitrazepam, temazepam, lorazepam, and clonazepam. Meaning despite guidelines and recommendations, bzdrs are still prescribed frequently for long-term treatment, especially in older persons, and the initial choice of a specific bzdr is associated with development of long-term bzdr use.
118	2018	Pirttisalo Al;Sipila Jot;Soilu-Hanninen M;Rautava P;Kyto V	Adult Hospital Admissions Associated With Multiple Sclerosis In Finland In 2004-2014	Introduction: treatment of multiple sclerosis (ms) has developed significantly and several new immunotherapeutic drugs have become available in finland since 2004. We studied whether this is associated with changes in hospital admission frequencies and healthcare costs and whether admission rates due to infection have increased. Methods: the national care register for health care was searched for all discharges from neurological, medical, surgical, neurosurgical and intensive care units with ms as a primary diagnosis or an auxiliary diagnosis for primary infection diagnosis in 2004-2014. Only patients >= 16 years of age were included. Results: we identified 12,276 hospital admissions for 4296 individuals. The number of admissions declined by 4.6% annually (p = .0024) in both genders. Proportion of admissions with an infection as the primary diagnosis increased but no change in their frequency was found. They were longer than admissions with ms as the primary diagnosis and were associated with increased in-hospital mortality. The annual aggregate cost of hospital admissions declined by 51% during the study period. Conclusions: this study shows that hospital admission rates and costs related to ms hospital admissions have markedly declined from 2004 to 2014 in finland, which coincides with an increase in the use of disease-modifying therapies.
119	2018	Somersalo A;Paloneva J;Lonnroos E;Heinanen M;Koponen H;Kiviranta I	Sixfold Post-Fracture Mortality In 16-To 30-Year-Old Patients-Suicides, Homicides, And Intoxications Among Leading Causes Of Death	Background and aims: the death of any young individual is associated with the loss of many potentially fulfilling years of life. It has been suggested that the relative mortality of fracture patients may be higher in younger age groups than in older cohorts. We determined the mortality and causes of death in a cohort of 16- to 30-year-old patients that had been hospitalized for fractures. Material and methods: we collected data using criteria based on the diagnosis code (international statistical classification of diseases and related health problems, 10th revision), surgical procedure code (nordic medico-statistical committee), and seven additional characteristics of patients admitted to the trauma ward at the central finland hospital between 2002 and 2008. Patients were then followed to ascertain their mortality status until the end of 2012. Standardized mortality ratios were calculated and causes of death were determined by combining our registry data with data provided by statistics finland. Results: during the study, 199 women and 525 men aged 16-30 years had sustained fractures. None of these patients died during the primary hospital stay. At the end of follow-up (mean duration 7.4 years), 6 women and 23 men had died. The standardized mortality ratio for all patients was 6.2 (95% confidence interval: 4.3-8.9). Suicides and intoxications comprised over half, and motor vehicle accidents and homicides comprised nearly a third of the post-fracture deaths. Conclusion: we found a concerning increase in mortality among young adults that had been hospitalized due to a fracture compared to the general population that had been standardized by age, sex, and calendar-period. Leading causes of death were suicides and intoxications or motor vehicle accidents and homicides, which may be indicative of depressive disorders or impulse control disorders, respectively. Identification of the underlying psychosocial problems may provide an opportunity for preventive interventions.
120	2016	Majuri P	Ground Source Heat Pumps And Environmental Policy - The Finnish Practitioner's Point Of View	Since the 1970s energy crises, and increasingly in recent years, ground source heat pumps have attracted large interest as an instrument for energy conservation. Rapid growth of the industry has raised questions about the environmental benefits and costs of heat pumps. Governments have designed policies to both promote and regulate the industry. This study concentrates on the development of the ground source heat pump industry in finland, and on national policies and regulations concerning the industry. The focus is on practitioners' responses to heat pump legislation, a topic so far overlooked by researchers, but also the users' perspective is considered. The study is based on interviews and questionnaire responses from heat pump professionals, heat pump statistics, and literature. Six sectors of legislation and environmental policy are considered: the regulation of ozone depleting substances and greenhouse gases in refrigerants, qualification requirements imposed on the ground source heat pump industry, the permission procedure for ground loop heat exchangers, legislation on groundwater protection, requirements and incentives for heat pump efficiency and labelling, and public funding and subsidies for the industry. The results show that policies have an important role in the development of the industry, and that quality aspects deserve more attention in policies regarding e.g. Gshp training and planning permissions. (C) 2016 elsevier ltd. All rights reserved.
121	2017	Tallberg P;Heiskanen As;Niemisto J;Hall Poj;Lehtoranta J	Are Benthic Fluxes Important For The Availability Of Si In The Gulf Of Finland?	We estimated the efflux of dissolved silicon (dsi) from sediments in the gulf of finland and compared it to sedimentation fluxes, burial of si and existing data on si loading and stocks, reassessing the reliability of existing si budgets. Benthic fluxes of dsi measured in situ and in vitro were several times higher than estimates from diffusion calculations. The spatial variability in the open gulf of finland was relatively small, while both very high and low fluxes were measured from coastal areas. Fluxes were highest in late summer and lowest in early spring. In our re-assessed budget we present a new lower estimate for si burial in the sediments, ca. 6 gmol a(-1) and show that more than half of the sedimentation flux of si is released back into the water column. Changes in the efficiency of internal dsi recycling may thus affect the prevalence of siliceous phytoplankton within the ecosystem, and the diatom spring bloom may be regulated by the functioning of this internal recycling pump. We also show that the seasonal variation in benthic dsi fluxes and dissolved phosphate fluxes is similar, and that a tentative connection between hypolxia and high dsi efflux exists. (C) 2017 elsevier b.v. All rights reserved.
122	2018	Gloukhovtsev A;Schouten Jw;Mattila P	Toward A General Theory Of Regulatory Arbitrage: A Marketing Systems Perspective	Businesses and consumers frequently exploit differences in laws and policies across jurisdictions to circumvent local laws, regulations, or restrictions. This practice, known as regulatory arbitrage, can have negative consequences for both business and social welfare. Although previous research examines regulatory arbitrage in specific contexts such as financial markets and the pharmaceutical industry, a general framework remains missing. Drawing on marketing systems theory, this study proposes a conceptualization that reflects the necessary conditions for regulatory arbitrage to occur across a variety of contexts. It also derives a typology of strategies to prevent and eliminate regulatory arbitrage. Using the context of alcohol policy in finland as an illustrative example, the study applies the conceptualization to examine a situation where regulatory arbitrage has repeatedly threatened local policy. The findings illustrate how the broader perspective offered by marketing systems theory can help to more accurately predict whether businesses and consumers will pursue regulatory arbitrage in a given situation, and to select appropriate strategies for preventing and eliminating regulatory arbitrage in situations where it has negative consequences.
123	2022	Pirhonen E;Haapea M;Rautio N;Nordstrom T;Turpeinen M;Laatikainen O;Koponen H;Silvan J;Miettunen J;Jaaskelainen E	Characteristics And Predictors Of Off-Label Use Of Antipsychotics In General Population Sample	Objective increasing number of people have been prescribed antipsychotics (aps) off-label in recent decades. This study aimed to identify the characteristics and predictors of receiving prescription of antipsychotics off-label. Methods the study sample was part of the northern finland birth cohort 1966 (n = 7071). Data included questionnaires and national register data. Information on prescribed medications was extracted from the national register. The sample was divided into three groups: persons who had been prescribed aps off-label (n = 137), individuals with non-psychotic mental disorders without aps off label (n = 1478) and individuals who had been diagnosed with psychosis or bipolar disorder and who had been prescribed aps (n = 151). We compared sociodemographic, lifestyle and clinical characteristics between the off-label and the comparison groups using logistic regression. Results the most common diagnoses in the off-label group were depression (n = 96, 70.1%) and anxiety (n = 55, 40.1%). Compared with individuals with non-psychotic mental disorders who were not prescribed aps off-label, individuals with prescribed off-label aps had a lower level of education, lower socioeconomic status, were less often married, had a higher level of somatic and psychiatric morbidity, were more often smokers and more often had a substance abuse disorder and heavy alcohol consumption. When comparing the off-label group to individuals with psychosis or bipolar disorder who used aps, there were less differences, though individuals with psychosis or bipolar disorder had more markers of morbidity and a lower level of education. Conclusion individuals who had been prescribed aps off label had a higher level of mental and somatic morbidity and poorer socioeconomic status than individuals with non-psychotic mental disorders who did not use aps.
124	2022	Patinen P;Tanner T;Honkanen J;Tjaderhane L;Pakkila J;Anttonen V;Kamppi A	General- And Oral-Health-Related Predisposing Factors For Interrupting Military Service In The Finnish Defence Forces	Introduction finland's security policy relies heavily on its own independent national defense, which is based on conscription. In 2011, 26,492 conscripts started their military service in finland. Of these, 1,706 interrupted their military service and 191 changed to civilian service. Conscripts who interrupt their service seem to have an increased tendency to smoking, alcohol consumption, and taking snuff, which previous studies suggest to have strong associations with the need for restorative dental treatment and with lower socioeconomic status. The aim of this study was to compare the general and oral health habits between finnish conscripts who interrupt their service and those who completed their military service and to find out what general- and oral-health-related factors could be used in predicting interruption of service. Methods the study population consisted of 13,819 conscripts taking an oral examination during the service. Of these, 8,449 answered a computer-based anamnestic questionnaire and 264 interrupted their service. Predisposing factors on the anamnestic questionnaire for interrupting military service were evaluated by using a binary logistic regression model. The statistically significant factors were selected to form a sum variable which finally consisted of seven predisposing questions. Odds ratio (or) values and 95% confidence intervals were calculated for each question and for the sum variable. Predictive accuracy was assessed by area under the receiver-operating curve. Results the most obvious predisposing factor among those who interrupted their service compared to the reference group was lack of weekly physical exercise (or = 5.80). The risk for interruption of military service was 68.6 times higher in cases where a subject exhibited six predisposing factors out of seven compared to those who had none. Conclusion as a conclusion, a set of statistically chosen anamnestic questions could help identify conscripts who have an increased risk of interruption of military service in addition to a risk of dental problems.
125	2021	Rebane K;Aalto K;Haanpaa M;Puolakka K;Virta Lj;Kautiainen H;Pohjankoski H	Initiating Disease-Modifying Anti-Rheumatic Drugs Rapidly Reduces Purchases Of Analgesic Drugs In Juvenile Idiopathic Arthritis	Objective to describe the use of analgesics 12 months before and after initiation of the first disease-modifying anti-rheumatic drug (dmard) in children with juvenile idiopathic arthritis (jia). Method a register-based study linked three nationwide registers in finland: the register on reimbursement for prescription medicines, the drug purchase register (both maintained by the finnish social insurance institution), and the finnish population register. The study ran from 1 january 2010 to 31 december 2014. It included 1481 patients aged < 16 years with diagnosed jia and 4511 matched controls. Index day was the date when reimbursement for jia medication was approved and treatment was initiated. The study period included 12 months pre- and post-index date, and purchases of prescription drugs were assessed for 3 month periods. Results non-steroidal anti-inflammatory drugs (nsaids) were purchased for 60% of the patients. Compared to controls, nsaid purchases for jia patients were at their highest during the last 3 months before the index day [relative rate (rr) 21.2, 95% confidence interval (ci) 17.1-26.2], and they decreased steeply over the 10-12 months post-index (rr 4.0, 95% ci 3.1-5.0). Similar trends were seen with paracetamol and opioid purchases, but only 2% of patients purchased opioids during the 12 months pre-index and 1% during the 12 months post-index. Methotrexate was the most commonly used dmard (91.9%), biologic dmards were used by 2.8% and glucocorticoids by 24.8% in the 3 months after the index day. Conclusion initiation of dmards rapidly reduces the need for analgesics in patients with jia.
126	2021	Mertens Aej;Kunst Ae;Lorant V;Alves J;Rimpela A;Clancy L;Kuipers Mag	Smoking Cessation Among Adolescents In Europe: The Role Of School Policy And Programmes	Introduction: european estimates of adolescent smoking cessation are lacking and studies on the role of schools in quit behaviour are scarce. We aimed to describe smoking cessation attempts and success among adolescents in europe and explored the association with school policy and programmes. Methods: we used cross-sectional data from the 2013 and 2016-2017 surveys of the european silne and silne -r projects. We included 4,509 12-19-year-old current or ex-smokers in 67 secondary schools in seven countries (belgium, germany, finland, ireland, italy, the netherlands, and portugal). School staff reported strength of smoke-free school policies (sfsps), proportion of grades in which anti-tobacco education was offered, and whether the school offered any form of cessation support programme. Multilevel logistic regression analysis determined school-level variation and the association of school-level and individual-level variables with self-reported and self-defined quit attempts and quit success. Results: over three quarters (77.3%) of students reported a quit attempt and half of them (50.1%) reported quit success. Prevalence rates of quit success and quit attempts, showed relatively small variations between schools within countries. Associations of smoke-free school policy, tobacco educational programmes and cessation programmes with quit attempts and quit success could not be demonstrated with statistical significance. Quit attempts and quit success were inversely associated with alcohol use, parental smoking, and friend smoking. Conclusion: this study demonstrates that adolescence is an important time to encourage quitting and to support quit attempts. We did not find evidence for a contribution of school policies and programmes to quit behaviour of adolescent smokers.
127	2016	Chatenoud L;Garavello W;Pagan E;Bertuccio P;Gallus S;La Vecchia C;Negri E;Bosetti C	Laryngeal Cancer Mortality Trends In European Countries	After a steady increase between the 1950s and the 1970s, laryngeal cancer mortality has been levelling off since the early 1980s in men from most western and southern european countries and since the early 1990s in central and eastern europe. To update trends in laryngeal cancer mortality, we analyzed data provided by the world health organization over the last two decades for 34 european countries and the european union (eu) as a whole. For major european countries, we also identified significant changes in trends between 1980 and 2012 using joinpoint regression analysis. Male mortality in the eu was approximately constant between 1980 and 1991 (annual percent change, apc=-0.5%) and declined by 3.3% per year in 1991-2012. Eu age-standardized (world population) rates were 4.7/100,000 in 1990-91 and 2.5/100,000 in 2010-2011. Rates declined in most european countries, particularly over the last two decades. In 2010-11, the highest male rates were in hungary, the republic of moldova, and romania (over 6/100,000), and the lowest ones in finland, norway, sweden, and switzerland (below 1/100,000). In eu women, mortality was stable around 0.29/100,000 between 1980 and 1994 and slightly decreased thereafter (apc=-1.3%; 0.23/100,000 in 2000-01). We also considered male incidence trends for nine european countries or cancer registration areas. In most of them, declines were observed over recent decades. Laryngeal cancer mortality thus showed favourable trends over the last few decades in most europe, following favourable changes in tobacco and, mostly for mediterranean countries, alcohol consumption.
128	2018	Virta Lj;Kalviainen R;Villikka K;Keranen T	Declining Trend In Valproate Use In Finland Among Females Of Childbearing Age In 2012-2016-A Nationwide Registry-Based Outpatient Study	Background and purposedocumented teratogenic effects of valproate (vpa) prompted restrictions of its use in females of childbearing age in 2014. We investigated possible annual changes in the outpatient use of vpa in finland during 2008-2016 with a special focus on women. Methodswe identified all outpatients with vpa purchases between 2008 and 2016 categorizing users due to epilepsy, bipolar disorder or miscellaneous indications. Temporal trends in the annual prevalence rates of vpa use were estimated using poisson regression analyses. Resultsbetween 2012 and 2016, the prevalence of vpa use among women aged 15-44years decreased by 19%, from 50/10000 to 40/10000 (prevalence rate ratio, 0.81; 95% confidence intervals, 0.77-0.91; p< 0.001). The use of vpa due to epilepsy decreased significantly in females aged 15-24 and 25-34years and that due to bipolar disorders decreased significantly in females aged 25-34 and 35-44years. The use of vpa in the miscellaneous indication group decreased by 32% after 2014 in females aged 15-44years and, most strikingly, by 56% among those aged 15-25years. In women with epilepsy, the use of vpa increased among those over the age of 44years. Conclusionsthe rates of female vpa users with childbearing potential have decreased in all three major indication groups in finland during recent years, especially after the european medicines agency restrictions were published in 2014. However, it still remains open to question as to whether the practice of vpa use follows current guidelines. A special concern is the relatively high prevalence of off-label use of vpa in fertile-aged females.
129	2022	Koskinen Ai;Hemminki O;Forsti A;Hemminki K	Incidence And Survival In Oral And Pharyngeal Cancers In Finland And Sweden Through Half Century	Background cancers of the oral cavity and pharynx encompass a heterogeneous group of cancers for which known risk factors include smoking, alcohol consumption and human papilloma virus (hpv) infection but their influence is site-specific with hpv mainly influencing oropharyngeal cancer. Their incidence and survival rates are not well known over extended periods of time. Patients/methods data were obtained for finnish (fi) and swedish (se) patients from the nordcan database recently updated through 2019. Age-adjusted incidence trends (fi from 1953, se from 1960) and relative survival rates for years 1970 through 2019 were calculated. Results we observed a prominent increase in oral and oropharyngeal cancers in fi and se men and women but the trend for oral cancer was interrupted for se men in 1985 and possibly also for fi and se women in 2015. The trend changes in male and female oral cancer was confirmed in data for denmark and norway. Relative survival for these cancers has improved overall but they differed for one cluster of oral, oropharyngeal and nasopharyngeal cancers with 60-70% 5-year survival in the last period and hypopharyngeal cancer with 25% male survival. In all these cancers, survival for old patients was unfavorable. Discussion/conclusion we hypothesize that reduction in smoking prevalence helped to stop the increase in oral cancer especially in men. As the prevalence of smoking is decreasing, hpv is becoming a dominant risk factor, particularly for the increasing oropharyngeal cancer. Prevention needs to emphasize sexual hygiene and hpv vaccination.
130	2022	Pyorala E;Sepponen K;Lauhio A;Saastamoinen L	Outpatient Antibiotic Use And Costs In Adults: A Nationwide Register-Based Study In Finland 2008-2019	The objective of this study was to describe the prevalence of outpatient use and costs for systemic antibacterials by age and sex among adults in finland from 2008-2019. Data from the finnish statistical database kelasto, containing information concerning all reimbursed medicines for 18+-year-olds during 2008-2019, were analyzed. In addition to the decreased (26%) use of systemic antibiotics, decreased use was observed in all antibiotic categories, notably including several wide-spectrum antibiotics. The use of quinolones decreased by 49% and of tetracyclines by 39%. The 10 most frequently used antibiotics covered 89% of all adult antibiotic prescriptions. Antibiotic use also decreased in every age group during the study period. Although the overall yearly costs of outpatient antibiotics during the 10-year study period decreased from eur 36.4 million to eur 30.7 million, the cost per prescription increased slightly. In conclusion, according to the findings of this study, concerning adults and the results of our previous study concerning children and adolescents (2008-2016), there has been a decreasing trend of outpatient antibacterial use among the whole finnish outpatient population over the duration of nearly one decade. However, during the same time period, there has been a specific increasing trend for the gram-negative amr threat regarding e. Coli resistance. Therefore, based on our important findings in finland, methods other than the restriction of antibiotic use, such as new anti-infective innovations, including antibacterials, are needed as soon as possible to tackle this major global health threat-a silent pandemic.
131	2022	Luukkanen Sv;Tolonen Hm;Airaksinen M;Saarukka Lsm	The Price And Market Share Evolution Of The Original Biologics And Their Biosimilars In Finland	Background biological drugs are generally expensive and produce a continuously growing share of drug costs. Yet they are essential in the treatment of many chronic diseases. Biosimilars, clinically equivalent to biological originator products, are expected to restrain drug costs in the biological market. Objective this study aimed to examine the impact of the biosimilar market entry on the prices of the reference products in outpatient care in finland, investigate the impact of biosimilar market entries on price competition among biological medicinal products, and examine how the prices and market shares of outpatient biosimilars have developed in finland during 2009-2020. Methods this retrospective register study applied data from iqvia covering national community pharmacy wholesale data between 1 january, 2009, and 31 august, 2020, for somatropin, epoetin, filgrastim, follitropin, insulin glargine, insulin lispro, etanercept, pegfilgrastim, adalimumab, teriparatide, and enoxaparin biosimilars and their reference products, in addition to two relevant insulin products. We determined the monthly wholesale amounts in defined daily doses and wholesale weighted average prices (excluding value-added tax) per defined daily dose for each product. We analyzed the evolution of the price and market shares. We performed a linear segmented regression analysis to examine the impact of the market entry of biosimilars on the prices of reference products. Results the prices of the reference products mainly decreased after the biosimilar entered the market. If the reference product price was not reduced, it was no longer reimbursable after evaluation under the health insurance act, leading to marginal market shares. The changes in the prices of biosimilars were not as remarkable as the changes in the prices of reference products after the biosimilar market entry. For most active substances, biosimilar prices were stable or decreased. The utilization of biosimilars varied widely between different active substances at the end of the observation period. Conclusions changes in pricing policy and the public reimbursement scheme related to the market entry of biosimilars were the main reasons for the decrease in the prices of reference products. Therefore, biosimilars did not generate genuine price competition between biological products. In many of the drug groups examined, the market shares of biosimilars have growth potential in the future.
132	2022	Unlu A;Tammi T;Hakkarainen P	Stakeholders' Problematisation Of Drug Consumption Rooms: A Case Study Of The Policy Initiative In Helsinki	Drug consumption rooms are one of the harm reduction interventions to handle complex social problems. The helsinki city initiative puts drug consumption room (dcr) on a government agenda in finland, which has also triggered a broader discussion. This study presents how stakeholders problematise and what solutions they propose for dcrs. The research is based on in-depth interviews of 23 stakeholders and the theoretical perspective of bacchi's approach - 'what's the problem represented to be?' (Wpr). The results show that while stakeholders' solutions resemble each other on the core dcr functions, the variations are found mainly in the introduction of extended services, policy development strategy, types of drug allowance in dcrs, and drug testing options. Stigmatisation of pwuds still leads the harm reduction services to be considered from a moral framework. Stakeholders tend to take their positions according to strategic considerations related to electoral politics, expedience and the symbolic role of policies.
133	2021	Kontula Ksk;Skogberg K;Ollgren J;Jarvinen A;Lyytikainen O	Population-Based Study Of Bloodstream Infection Incidence And Mortality Rates, Finland, 2004-2018	We evaluated the incidence, outcomes, and causative agents of bloodstream infections (bsi) in finland during 2004-2018 by using data from the national registries. We identified a total of 173,715 bsis; annual incidence increased from 150 to 309 cases/100,000 population. Bsi incidence rose most sharply among persons >= 80 years of age. The 1-month case-fatality rate decreased from 13.0% to 12.6%, but the 1-month all-cause mortality rate rose from 20 to 39 deaths/100,000 population. Bsis caused by escherichia coli increased from 26% to 30% of all bsis. Bsis caused by multidrug-resistant microbes rose from 0.4% to 2.8%, mostly caused by extended-spectrum beta-lactamase-producing e. Coli. We observed an increase in community-acquired bsis, from 67% to 78%. The proportion of patients with severe underlying conditions rose from 14% to 23%. Additional public health and healthcare prevention efforts are needed to curb the increasing trend in community-acquired bsis and antimicrobial drug-resistant e. Coli.
134	2020	Lane A;Murphy N;Donohoe A;Regan C	A Healthy Sports Club Initiative In Action In Ireland	Objective: the gaelic athletic association (gaa) is part of the cultural fabric of irish society with a club in almost every community nationwide. The aim of this project was to carry out a pilot evaluation of the gaa healthy club project (hcp), which is a unique effort by a national governing body to include health as part of the core business of the organisation at grass roots level. Design: a pre-post intervention group only design was used across 18 clubs recruited to a pilot phase of the project. Setting: gaa grassroots sports clubs across ireland. Methods: twelve healthy club officers completed a self-evaluation survey of their club at two time points to indicate the health promotion orientation of their club and the extent of health promotion activity in the club. Results: data showed improvements in the health promotion orientation of clubs, from moderate to high health promoting overall and particular increases in policy and practice scores. This is likely due to the widespread appointment of healthy club officers and the delivery of health-related initiatives in clubs. Conclusion: the impact of the project, while not demonstrable as an intervention effect at this stage, was real for the clubs involved. The gaa hcp is a novel way of carrying out health promotion in ireland, serving as a meeting point between the 'push of health' and 'pull of the sports club'.
135	2022	Unlu A;Tammi T;Hakkarainen P	Policy Windows For Drug Consumption Rooms In Finland	Background: use of drug consumption rooms is a novel harm reduction approach to reach marginalised and isolated people who used drugs, under the high risk of overdose deaths and infectious diseases. The aim of this article was to evaluate the policy opportunities and barriers of the helsinki city initiative for establishing the first drug consumption room (dcr) in finland from the multiple streams framework. Method: a qualitative interview research method is used to evaluate the perspectives of stakeholders. By including 23 participants, we analysed the political, social and policy level advantages and disadvantages of the current initiative. Findings: our results show that the cost of dcrs, the covid-19 burdens on public resources, the requirement of legislative change, public unawareness, potential policy failure of dcrs, and its impacts on electoral votes constitute the main policy barriers. On the other hand, an increase in drug-related deaths, economic benefits of dcr for society, its effects on street safety and public order, being a local initiative, prospectus change in national drug strategy plans and motivation to catch up with eu standards were underlined as policy opportunities. Four issues, leadership, moral perspective, social change and generational differences, act as mediating factors, which are fluctuated according to public opinions and political environment. Conclusion: by applying the multiple streams framework, our results show that experts' dcr problematisation is still beyond the public and political interest, which needs additional effort around problem identification and prioritisation. Besides public unawareness, the covid-19 situation seems to be postponing policy progress since the primary attention and available funds have already been dedicated to public health. Already having a local initiative and an upcoming drug strategy plan might be good formal leverage, but unexpected events might also trigger discussions.
136	2016	Haikonen K;Lillsunde Pm;Lunetta P;Kokki E	Economic Burden Of Fire-Related Deaths In Finland, 2000-2010: Indirect Costs Using A Human Capital Approach	Background: the aim of this study was to examine the indirect economic burden of fire-related deaths in finland in the period 2000-2010. Methods: the human capital (hc) approach was the main method used to estimate productivity losses due to fire-related deaths. Additionally, potential years of life lost (pyll) due to deaths were reported. Results: a total of 1090 fire-related deaths occurred in the period 2000-2010 within a population of some 5.4 million. The majority were male (76% vs 24%), with a mean age of 52 (ci: 51.0-53.2) years for males and 57 (ci: 54.6-59.6) for females; 24% (ci: 21.1-26.2%) of victims were over the retirement age. Most of the victims died of combustion gas poisoning (65%, ci: 61.8-67.6%), followed by burns (33%, ci: 30.6-36.3%). Alcohol was often involved and victims were often socially disadvantaged, with socioeconomic features significantly deviating from those of the general population. Annual pyll ranged from 2094 (ci: 1861-2326) to 3299 (ci: 3008-3594), with an annual average pyll of 2763 (ci: 2675-2851). Pyll per death fell in the study period from 34.3 (2000, ci: 31.0-37.7) to 24.6 (2010, ci: 21.8-27.6). The reduction is attributable to a decreasing fraction of young victims and an increase in average ages. Conclusions: total productivity loss in the period 2000-2010 was c. A. Eur 342 million (ci: 330-354 million), giving an annual average of eur 31.1 million (ci: 30.0-32.2 million), with the mean for a victim being eur 0.315 million (ci: 0.30-0.33 million). The economic burden of deaths is considerable and this study remedies the lack of academic knowledge about the burden of fire-related deaths. (C) 2015 elsevier ltd and isbi. All rights reserved.
137	2021	Katuwal S;Jousilahti P;Pukkala E	Causes Of Death Among Women With Breast Cancer: A Follow-Up Study Of 50 481 Women With Breast Cancer In Finland	Our study aims to assess mortality from causes other than breast cancer among women with breast cancer with focus on indications of joint aetiology. Data on female breast cancer patients were obtained from the finnish cancer registry and their underlying causes of death in 54 categories from the statistics finland. Standardised mortality ratios (smr) and their 95% confidence intervals (cis) were calculated for 50 481 patients diagnosed between 1971 and 2000 and followed until december 2012, stratified by histology, age at diagnosis and time since diagnosis. The expected numbers of deaths were based on respective mortality rates among the finnish general population. Hazard ratio (hr) was estimated from poisson regression model to compare risks of cause of death by histology. 41% of 30 841 deaths were due to causes other than breast cancer. Significant excess mortality was observed for stomach cancer (smr 1.43, 95% ci 1.26-1.62), circulatory system diseases (smr 1.17, 95% ci 1.14-1.20) and suicide (smr 1.51, 95% ci 1.28-1.78). In an age-adjusted analysis, significantly higher relative risk of stomach cancer mortality was observed for lobular vs ductal subtype (hr 2.00, 95% ci 1.32-3.02). Significantly increased smrs were observed for cancers of respiratory organs among premenopausal women, and for other respiratory system diseases, dementia and alzheimer disease among postmenopausal women. We conclude that female breast cancer patients are at increased risk of death from causes other than the breast cancer diagnosis including circulatory and respiratory system diseases and cancer of stomach, ovary and respiratory systems. The excess mortality because of different causes varies based on menopausal status and histology. There might be shared aetiological factors between the diagnosis of breast cancer and the causes of death among these patients.
138	2020	Hamina A;Tanskanen A;Tiihonen J;Taipale H	Medication Use And Health Care Utilization After A Cost-Sharing Increase In Schizophrenia A Nationwide Analysis	Background: increases in prescription drug cost-sharing may decrease adherence to treatment among persons with schizophrenia and lead to discontinuation of use and an increased risk of hospitalization. Objective: the objective of this study was to investigate the impact of new deductible and increased drug copayments implemented on antipsychotic and other drug purchases and on rates of hospitalizations and primary care contacts among persons with schizophrenia in finland. Research design: interrupted time series analysis. Subjects: all persons with schizophrenia in finland who were alive at the beginning of 2015 (n=41,017). Measures: we measured the rates of antipsychotic, other psychotropic and cardiometabolic drug purchasers, hospitalizations, and primary care contacts during 2015 and 2016 with data collected from several nationwide health care registers. Results: during 2016, the proportion of antipsychotic purchasers decreased by -0.26 percentage points per month [95% confidence interval (ci): -0.47 to -0.05] compared with 2015. The trend of other psychotropic purchasers decreased to -0.13 percentage points per month in 2016 (95% ci: -0.22 to -0.04) compared with 2015 and cardiometabolic drug purchases to -0.17 percentage points per month (95% ci: -0.29 to -0.05) compared with 2015. The decreasing trend of psychiatric hospitalizations in 2015 halted in 2016. There were no other significant differences in health care utilization. Conclusions: in our nationwide time-series analysis, we observed decreases in the slopes of antipsychotic and other drug purchases of persons with schizophrenia after prescription drug cost-sharing increase implementation on january 1, 2016. Policymakers need to be aware of the unintended consequences of increasing cost-sharing among people with severe mental disorders.
139	2019	Parviainen S;Saastamoinen L;Lauhio A;Sepponen K	Outpatient Antibacterial Use And Costs In Children And Adolescents: A Nationwide Register-Based Study In Finland, 2008-16	Objectives: to describe the prevalence of outpatient use and the costs of systemic antibacterials among children and adolescents in finland during 2008-16 and to examine patterns of use by age and gender. Methods: data were retrieved from the finnish statistical database kelasto, based on the finnish prescription registry. Data included information on dispensed reimbursed prescriptions of antibacterials for systemic use in children aged 0-17 years during 2008-16. The prevalence of antibacterial prescriptions per 1000 children and costs per prescription were calculated. Results: the overall prevalence of antibacterial prescriptions decreased in the study period and was highest in 2010 (with 708 prescriptions per 1000 children) and lowest in 2016 (with 374 prescriptions per 1000 children). Children aged 1-2 years had the highest prevalence of antibacterial prescriptions. Furthermore, boys had slightly higher prevalences than girls. The 10 most commonly used antibacterial agents covered similar to 97% of all prescriptions and broad-spectrum penicillins were the most commonly used antibacterials. The total costs of antibacterials decreased during the study period, but the costs per prescription increased. Conclusions: this study showed a decreasing trend in the prescribing of antibacterial drugs, regardless of age or gender. Increasing awareness of antimicrobial resistance, reimbursement status changes and pneumococcal and influenza vaccinations are possible reasons for this. Some of the antibacterial oral solutions lost their reimbursement status, but their consumption did not decrease any faster than the consumption of the substances with continuous reimbursability. It is likely that removing the reimbursement status of antibacterials has placed an extra cost burden on families and increased costs per prescription.
140	2020	Heintjes Em;Bezemer Id;Prieto-Alhambra D;Smits E;Booth Hp;Dedman D;He Y;Hoti F;Vehkala M;De Vogel S;Robinson Nj;Appenteng K;Penning-Van Beest Fja	Evaluating The Effectiveness Of An Additional Risk Minimization Measure To Reduce The Risk Of Prescribing Mirabegron To Patients With Severe Uncontrolled Hypertension In Four European Countries	Background: mirabegron, indicated for the treatment of overactive bladder, is contraindicated in patients with severe uncontrolled hypertension (systolic blood pressure >= 180 mm hg and/or diastolic blood pressure >= 110 mm hg). In september 2015, a direct healthcare professional communication (dhpc) letter was disseminated as an additional risk minimisation measure. Purpose: to assess the effectiveness of the dhpc in reducing the proportions of patients with severe or non-severe uncontrolled hypertension at mirabegron initiation. Methods: an observational multi-database cohort study was undertaken using routinely collected healthcare data (december 2012-december 2016) from the pharmo database network (netherlands), sidiap database (spain), cprd (united kingdom, uk) and national healthcare registers and electronic medical records from finland. Dhpc effectiveness was evaluated using interrupted time series analyses comparing trends and changes in monthly proportions of severe or non-severe uncontrolled hypertensive mirabegron initiations relative to the timing of the dhpc dissemination. Results: the study population comprised 52,078 patients. Prior to dhpc dissemination, across the four databases, 0.3-1.3% had severe uncontrolled hypertension. Estimated absolute changes (eac) in proportions of severe uncontrolled hypertension post-dhpc indicated a tendency towards a lower proportion in the netherlands (eac -0.36%, p=0.053), unchanged proportions in spain and the uk and a higher proportion in finland (eac + 0.73%, p=0.016). For non-severe uncontrolled hypertension ( 13-16% pre-dhpc), post-dhpc proportions tended to be lower in the netherlands (eac -2.02%, p=0.038) and spain (eac -1.04%, p=0.071), and unchanged in the uk and finland. Conclusion: severe uncontrolled hypertension prior to mirabegron initiation was uncommon in these four european countries even before dhpc dissemination. This suggests that other risk minimisation communications (prior to the dhpc dissemination) had worked adequately with respect to minimising mirabegron use among patients with severe uncontrolled hypertension. No strong and consistent evidence of further risk minimisation after the dhpc dissemination was observed in this study.
141	2020	Vora P;Pietila A;Peltonen M;Brobert G;Salomaa V	Thirty-Year Incidence And Mortality Trends In Upper And Lower Gastrointestinal Bleeding In Finland	Question what are the incidence and mortality rates and trends in major upper and lower gastrointestinal bleeding (gib) in finland from 1987 to 2016? Findings in this cohort study of 39054 finnish survey participants, the age-standardized incidence rate of major upper gib was lower than the rate of lower gib. Mortality rate and case fatality were higher in participants with upper gib compared with lower gib. Meaning results of this study suggest that the outcome for gib did not seem to improve over the years and that the incidence, recurrence, and mortality data can inform efforts to improve care and prevent rebleeding or death for patients with major gib. Importance epidemiological data on lower gastrointestinal bleeding (gib) in the general population are sparse. Objective to describe the incidence, recurrence, mortality, and case fatality rates of major upper gib and lower gib in the general population of finland between 1987 and 2016. Design, setting, and participants this prospective cohort study used data from the 1987 to the 2012 cycles of the national finrisk study, a health examination survey that was conducted every 5 years in finland. Survey participants were adults aged 25 to 74 years who were recruited from a population register by random sampling; those with a history of hospitalization for gib were excluded. Participants were followed up from survey enrollment to onset of gib that led to hospitalization, death from any cause, or study end (december 31, 2016). Follow-up was performed through linkage with national electronic health registers. Data were analyzed from february 1, 2019, to january 31, 2020. Main outcomes and measures incidence, recurrence, mortality, and case fatality rates for all, upper, lower, and unspecified gib. Outcome measures were stratified by sex and age group. Results among the 39054 participants included in the study, 494 (1.3%) experienced upper gib (321 men [65.0%]; mean [sd] age, 52.8 [12.1] years) and 645 (1.7%) had lower gib (371 men [57.5%]; mean [sd] age, 54.0 [11.7] years). The age-standardized incidence rate was 0.94 per 1000 person-years (95% ci, 0.85-1.04) for upper gib and 1.26 per 1000 person-years (95% ci, 1.15-1.38) for lower gib; the incidence was higher in men than in women. Between 1987 and 2016 the incidence rate of upper gib remained mostly stable, ranging from 0.40 to 0.66 per 1000 person-years, whereas constant increases occurred in the incidence of lower gib until the rate stabilized. The proportion of recurrent gib events showed an increasing trend from 1987 to 2016. The upper gib-specific mortality was higher (0.07 per 1000 person-years; 95% ci, 0.04-0.09) than the lower gib-specific mortality (0.01 per 1000 person-years; 95% ci, 0.001-0.03). Case fatality was high for those with upper gib (7.0%; 95% ci, 4.7-10.1) compared with those with lower gib (0.4%; 95% ci, 0.1-1.3). Case fatality remained stable over the years but was higher in men (between 5% and 10%) than women (<2%) with gib. Conclusions and relevance this study found that the overall incidence rate of upper gib was lower than the incidence of lower gib, but the recurrence, mortality, and 28-day case fatality were higher in participants with upper gib. These data can serve as a reference when putting into context the rates of drug-associated gib and can inform efforts to improve gib care and outcome and to prevent rebleeding or death for patients with major gib. This cohort study examines 30-year incidence and mortality trends in upper and lower gastrointestinal bleeding using nationwide health examination survey data from adults in different regions in finland.
142	2019	Sipila Jot;Soilu-Hanninen M;Rautava P;Kyto V	Hospital Admission And Prevalence Trends Of Adult Myasthenia Gravis In Finland In 2004-2014: A Retrospective National Registry Study	Hospital admission trends in myasthenia gravis are largely unknown, so they were here investigated in finland between 2004 and 2014 using national mandatory registry data. There were 2989 hospital admissions (59.7% for women) for 861 individuals (median 2 admissions/individual) the annual number of admissions (p = .56), the age of admitted patients (p = .24) or length of stay (p = .20) showed no change during the study period. The proportion of infections as the primary diagnosis increased from 4.5% to 10.4% (p = .0056). These admissions lasted longer than admissions with a non-infectious primary diagnosis (median 6 vs. 4 days, p < .0001). In hospital mortality rate was 1.0%, predicted by age over 65 (hr 8.8; p = .0034) and infection as the primary diagnosis (hr 6.9; p < .0001). Annual frequencies of thymectomies (p = .66) or plasmaphereses (p = .12) remained unchanged. Myasthenia drug reimbursement data suggested increasing mg prevalence during the study period (p < .00001). Considering that the annual hospitalisation frequency remained stable, this would suggest decreased need of hospitalisations per patient. The importance of infections as causes of myasthenia hospitalisations merits further study.
143	2022	Nevalainen N;Luoto Tm;Iverson Gl;Mattila Vm;Huttunen Tt	Craniotomies Following Acute Traumatic Brain Injury In Finland-A National Study Between 1997 And 2018	Background a number of patients who sustain a traumatic brain injury (tbi) require surgical intervention due to acute intracranial bleeding. The aim of this retrospective study was to assess the national trends of acute craniotomies following tbi in the finnish adult population. Methods the data were collected retrospectively from the finnish care register for health care (1997-2018). The study cohort covered all first-time registered craniotomies following tbi in patients aged 18 years or older. A total of 7627 patients (median age =59 years, men =72%) were identified. Results the total annual incidence of acute trauma craniotomies decreased by 33%, from 8.6/100,000 in 1997 to 5.7/100,000 in 2018. The decrease was seen in both genders and all age groups, as well as all operation subgroups (subdural hematoma, sdh; epidural hematoma, edh; intracerebral hematoma, ich). The greatest incidence rate of 15.4/100,000 was found in patients 70 years or older requiring an acute trauma craniotomy. The majority of surgeries were due to an acute sdh and the patients were more often men. The difference between genders decreased with age (18-39 years =84% men, 40-69 =78% men, 70 + years =55% men). The median age of the patients increased from 58 to 65 years during the 22-year study period. Conclusions the number of trauma craniotomies is gradually decreasing; nonetheless, the incidence of tbi-related craniotomies remains high among geriatric patients. Further studies are needed to determine the indications and derive evidence-based guidelines for the neurosurgical care of older adults with tbis to meet the challenges of the growing elderly population.
144	2022	Ojagbemi A;Estrada E;De La Torre-Luque A;Moreno-Agostino D;Lara E;Caballero Ff;Bello T;Olaya B;Haro Jm;Gureje O;Ayuso-Mateos Jl	Late-Life Disability Trajectories In Yoruba Nigerians And The Spanish Population: A State Space Model In Continuous Time	Objectives we compared the trajectory of activities of daily living (adl) in a nationally representative sample of older nigerians with their spanish peers and identified factors to explain country-specific growth models. Methods data from two household multistage probability samples were used, comprising older adults from spain (n = 2,011) and nigeria (n = 1,704). All participants underwent assessment for adl. Risk factors including sex, household income, urbanicity, years of education, depression, alcohol consumption and smoking were assessed using validated methods. State-space model in continuous time (ssm-ct) methods were used for trajectory comparison. Results compared with nigerians (mu(adl80)=0.44, se = 0.015, p < 0.001), spanish older adults had higher disability scores (mu(adl80)=1.23, se = 0.021, p < 0.001). In ssm-ct models, the rate of increase in disability was faster in nigerians (nigeria: beta = 0.061, p<.01; spain: beta = 0.028, p < 0.010). An increasing course of disability in the spanish sample was predicted by female sex, lower education and depression diagnosis. Conclusion the rate of increase in disability was faster in older nigerians living in an economically disadvantaged context.
145	2021	Airaksinen M;Toivo T;Jokinen L;Savela E;Parkkamaki S;Sandler C;Kalliomaki H;Dimitrow M	Policy And Vision For Community Pharmacies In Finland: A Roadmap Towards Enhanced Integration And Reduced Costs	Finland's community pharmacy system provides an example of a privately-owned regulated system being proactively developed by the profession and its stakeholders. Community pharmacists have a legal duty to promote safe and rational medicine use in outpatient care. The development of professionally oriented practice has been nationally coordinated since the 1990s with the support of a national steering group consisting of professional bodies, authorities, pharmacy schools and continuing education centers. The primary focus has been in patient counseling services and public health programs. The services have extended towards prospective medication risk management applying evidence-based tools, databases and digitalization. Research has been essential in informing progress by indicating high-risk patients, medications, practices and processes needing improvement. Despite the commitment of the profession and pharmacy owners, large-scale implementation of services has been challenging because of lack of remuneration, the pharmacy income still consisting primarily of sale of prescription and nonprescription medicines. Policy documents by the ministry of social affairs and health have supported the extension of the community pharmacists' role beyond traditional dispensing to promote rational pharmacotherapy. The current roadmap by the ministry of social affairs and health emphasizes ensuring adequate regional availability and accessibility of medicines, regardless of the future pharmacy system. It also emphasizes the importance of strong regulation on pharmacy business operations and sale of medicines to ensure medication safety. At the same time, the roadmap requires that the regulation must enable implementation of new patient-oriented services and procedures, and further promote digitalization in service provision. Competition and balance of funding should be enhanced, e.g., through price competition, but the risk of pharmaceutical market concentration should be managed. The regulation should also consider influence of the new social and health care system on drug delivery. Year 2021 will be crucial for making long-term political decisions on the future direction of tasks and finances of finnish community pharmacies in this framework. Government-funded studies are underway to guide decision making. Ongoing covid-19 crisis has demonstrated the readiness of finnish community pharmacies to adapt fast to meet the changing societal needs.
146	2020	Parviainen T;Helenius J	Trade Imports Increasingly Contribute To Plant Nutrient Inputs: Case Of The Finnish Food System 1996-2014	In finland, while total agricultural production has remained relatively constant, nutrient input from industrial mineral fertilizers has declined over the past 20 years, which has been the target of environmental policies due to eutrophication risks. From 1996 to 2014, the use of nitrogen (n) declined by 18%, phosphorus (p) by 49%, and potassium (k) by 49%. However, at the same time, the international agricultural products trade has increased dramatically by mass (58%), and finland has increased imports of food and feed products, such as, protein feeds, vegetables, and fruits. We analyzed the nutrient contents of foreign trade from 1996 to 2014 by using a substance flow analysis. We discovered that, when comparing nutrients contained in trade to the use of fertilizers, the trade of food and feed accounts for more than one-third (40%) of the fertilizer input to the finnish food system. In 2014, 53 gg of n, 8 gg of p, and 15 gg of k were imported due to trade, equating to 35%, 70%, and 45%, respectively, compared to the use of fertilizers in the food system. Declines in fertilizer inputs to crop production are partially offset by flows of plant nutrients from feed imports. In formulating agri-environmental policies targeting nutrient loading, more attention should be paid to national imports-export balances and, especially, to the spatial distribution of flows in feed trade.
147	2022	Salminen J;Maatta K;Haimi H;Maidell M;Karjalainen A;Noro K;Koskiaho J;Tikkanen S;Pohjola J	Water-Smart Circular Economy-Conceptualisation, Transitional Policy Instruments And Stakeholder Perception	The circular economy (ce) is a concept that has gained considerable global attention during the past decade amongst private and public sector actors, politicians and policymakers, citizens and media, and scientific communities. Water and water-related ecosystems, despite their vital role in practically all human activities, have been largely missing from conceptualisations and scientific definitions of the ce. Therefore, this paper presents a definition and concept for a water-smart ce that incorporates water and water-related ecosystems. A water-smart ce would (i) reduce losses of water, energy and valuable substances, (ii) improve water efficiency and productivity, (iii) reuse treated wastewater, and (iv) better protect and lessen pressure upon water-related (both aquatic and groundwater) ecosystems. The paper also touches upon the potential risks of the ce to water-related ecosystems. Policy instruments that could be used to promote a transition towards a water-smart ce in finland - the setting of the present study - and beyond were also sought. Additionally, actors who provide and/or use water-smart ce solutions were interviewed to shed light on their perceptions about the drivers of, barriers to and potential policy instruments for promoting a transition towards a water-smart ce. Based on the analyses of policy instruments and stakeholder interviews, a mixed use of economic, regulatory and informative instruments is suggested to support the desired transition towards a water-smart ce in finland and elsewhere.
148	2019	Kronstrom K;Tiiri E;Jokiranta-Olkoniemi E;Kaljonen A;Sourander A	Suicidality Among Child And Adolescent Psychiatric Inpatients: Time Trend Study Comparing 2000 And 2011	Child and adolescent inpatient treatment has faced major changes since the year 2000, including shorter inpatient stays and a greater use of psychotropic drugs. This study explored changes and correlates of suicidal threats and suicide acts among inpatients, by comparing finnish cross-sectional surveys from 2000 to 2011. A questionnaire that explored the background, diagnosis and treatment characteristics of inpatients was sent to all child and psychiatric wards in finland. The data collection was carried out on specified days in 2000 and 2011. We received comprehensive data on 504 patients from 64/69 (93%) wards in 2000 and on 412 patients from 75/79 (95%) wards in 2011. The spectrum of suicidal behaviour scale was used to explore suicidality. The prevalence of suicidality did not change in this nationwide study: suicidal threat rates were 38% in 2000 and 37% in 2011, and suicide attempts in both years were 11%. The prevalence of suicidal acts was higher among girls and teenagers, while low general functioning, defined as children's global assessment scale scores of under 30, was associated with both suicidal threats and acts. Violent acts were associated with both suicidal threats and acts in 2000, but not in 2011. Despite changes in treatment practices and shorter inpatient stays, the prevalence of suicidality in child and adolescent inpatient treatment remained unchanged in finland in 2000 and 2011.
149	2019	Luo Gf;Zhang Yt;Guo P;Ji Hl;Xiao Yj;Li K	Global Patterns And Trends In Pancreatic Cancer Incidence Age, Period, And Birth Cohort Analysis	Objectives: we aim to provide a global geographical picture of pancreatic cancer incidence and temporal trends from 1973 to 2015 for 41 countries. Methods: joinpoint regression and age-period-cohort model was used. Results: in 2012, the highest age-adjusted rate was in central and eastern europe for males and north america for females. Most regions showed sex disparities. During the recent 10 years, increasing trends were observed in north america, western europe, and oceania. The greatest increase occurred in france. For recent birth cohorts, cohort-specific increases in risk were pronounced in australia, austria, brazil, canada, costa rica, denmark, estonia, france, israel, latvia, norway, philippines, republic of korea, singapore, spain, sweden, the netherlands, united states, and us white male populations and in australia, austria, brazil, bulgaria, canada, china, czech republic, finland, france, italy, japan, lithuania, norway, republic of korea, singapore, spain, the netherlands, united kingdom, united states, and us white female populations. Conclusions: in contrast to the favorable effect of the decrease in smoking prevalence, other factors, including the increased prevalence of obesity and diabetes and increased physical inactivity, increased intake of red or processed meat and inadequate intake of fruits and vegetables are likely to have an unfavorable role in pancreatic cancer incidence worldwide.
150	2018	Terranova C;Zen M;Maguolo N;Cirillo T;Montisci M	Underage Victims And Perpetrators Of Murder In Italy: 2007-2015	From the epidemiological and criminological points of view, murders committed by minors, including both victims and perpetrators, differ from those observed in adults. Analysis of trends and characteristics of murders at national level could provide useful information to assess the phenomenon and address political and social choices aiming at preventing violence involving children and adolescents. This study focuses on the trends of murders in italy during the period 2007-2015 and compares the data with those for other age groups. Data on murders regarding trends, gender, age and ethnic group from the italian institute of statistics were analysed by chi-square with odds ratio and linear regression. Results show that, after standardization, murders involving minors as victims and perpetrators were less frequent with respect to data observed in all age groups. Trend analysis showed that murders involving minors remained stable in the period considered, but the stability of the rate of murders of minors was in contrast with reduced rates in other age groups. Among minors, males aged 14-17 are at higher risk of being the perpetrators and victims of homicide. The rate of perpetrators and victims among foreign-born minors was higher than that among the native-born. Further studies are needed to determine risk factors associated with these results and to propose preventive strategies through appropriate policies and interventions.
151	2022	Knop J;Martikainen P;Remes H;Tarkiainen L	Income Differences In Partial Life Expectancy Between Ages 35 And 64 From 1988 To 2017: The Contribution Of Living Arrangements	Background socioeconomic differences in mortality among the working-age population have increased in several high-income countries. The aim of this study was to assess whether changes in the living arrangement composition of income groups have contributed to changing income differences in life expectancy during the past 30 years. Methods we used finnish register data covering the total population to calculate partial life expectancies between ages 35 and 64 by income quartile in 1988-2017. The contribution of living arrangements to these differences was assessed by direct standardization. Decomposition methods were used to determine the extent of life expectancy differences due to external (accidental, violent and alcohol-related) causes of death. Results the life expectancy gap between the highest and lowest income quartile increased until 2003-07, but decreased thereafter. The contribution of living arrangements to these differences remained mostly stable: 36-39% among men and 15-23% among women. Those living without children consistently showed the greatest life expectancy differences by income. External causes of death significantly contributed to income differences in life expectancy. Conclusions the living arrangement composition of income groups explained part of the differences in life expectancy, but not their changes. Our results on the contribution of external causes of death imply that both the persistent income gradient in mortality as well as the mortality disparities by living arrangements are at least partially related to similar selection or causal mechanisms.
152	2022	Purola P;Kaarniranta K;Ojamo M;Gissler M;Uusitalo H	Visual Impairment Due To Age-Related Macular Degeneration During 40 Years In Finland And The Impact Of Novel Therapies	Purpose to evaluate the changes in visual impairment (vi) due to age-related macular degeneration (amd) during the past 40 years and the impact of novel therapies at population level. Methods in this nationwide register-based study, we assessed the incidence, prevalence, severity, and onset age of vi due to amd based on the finnish register of visual impairment data from 1980 to 2019. Our data included 30 016 visually impaired persons with amd as the main diagnosis for vi. The number of persons treated with intravitreal injections in finland was obtained from hospital data kept by the finnish institute for health and welfare. Results between the 1980s and the 2010s, the incidence of reported vi doubled; however, this increase has stagnated in the 2010s. Since 2012, the prevalence of reported vi has decreased. The number of patients treated with intravitreal injections showed a 40-fold increase during 2005-2019. The severity of reported vi has decreased whereas the mean age at the onset of reported vi has increased during the 40 years. The age-adjusted incidence and prevalence of reported vi were significantly higher in females in comparison to males in all decades. Conclusion increase in the incidence and prevalence of vi due to amd in the past decades has stagnated and shifted to older age in the 2010s when therapies for exudative class became commonly available. Furthermore, the prognosis of vi has improved during the past 40 years. These positive trends are likely contributable to improved diagnostic tools, earlier diagnoses, and new therapy options.
153	2016	Malmi H;Kautiainen H;Virta Lj;Farkkila Ma	Increased Short- And Long-Term Mortality In 8146 Hospitalised Peptic Ulcer Patients	Background incidence and complications of peptic ulcer disease (pud) have declined, but mortality from peptic ulcer bleeding has remained unchanged. The few recent studies on mortality associated with both uncomplicated and complicated patients with peptic ulcer disease provide contradictory results. Aims to evaluate short-and long-term mortality, and the main causes of death in peptic ulcer disease. Methods in this retrospective epidemiologic cohort study, register data on 8146 adult patients hospitalised with peptic ulcer disease during 2000-2008 were collected in the capital region of finland. All were followed in the national cause of death register until the end of 2009. The data were linked with the nationwide drug purchase register of the finnish social insurance institution. Results mean follow-up time was 4.9 years. Overall mortality was substantially increased, standardised mortality ratio 2.53 (95% ci: 2.44-2.63); 3.7% died within 30 days, and 11.8% within 1 year. At 6 months, the survival of patients with perforated or bleeding ulcer was lower compared to those with uncomplicated ulcer; hazard ratios were 2.06 (1.68-2.04) and 1.32 (1.11-1.58), respectively. For perforated duodenal ulcers, both the short-and long-term survival was significantly impaired in women. The main causes of mortality at 1 year were malignancies and cardiovascular diseases. Previous use of statins was associated with significant reduction in all-cause mortality. Conclusions one-year mortality in patients hospitalised with peptic ulcer disease remained high with no change. This peptic ulcer disease cohort had a clearly decreased survival rate up to 10 years, especially among women with a perforated duodenal ulcer, most likely explained by poorer survival due to underlying comorbidity.
154	2016	Esbjornsson J;Mild M;Audelin A;Fonager J;Skar H;Jorgensen Lb;Liitsola K;Bjorkman P;Bratt G;Gisslen M;Sonnerborg A;Nielsen C;Medstrand P;Albert J	Hiv-1 Transmission Between Msm And Heterosexuals, And Increasing Proportions Of Circulating Recombinant Forms In The Nordic Countries	Increased knowledge about hiv-1 transmission dynamics in different transmission groups and geographical regions is fundamental for assessing and designing prevention efforts against hiv-1 spread. Since the first reported cases of hiv infection during the early 1980s, the hiv-1 epidemic in the nordic countries has been dominated by hiv-1 subtype b and msm transmission. Hiv-1 pol sequences and clinical data of 51 per cent of all newly diagnosed hiv-1 infections in sweden, denmark, and finland in the period 2000-2012 (n = 3,802) were analysed together with a large reference sequence dataset (n = 4,537) by trend analysis and phylogenetics. Analysis of the eight dominating subtypes and crfs in the nordic countries (a, b, c, d, g, crf01_ae, crf02_ag, and crf06_cpx) showed that the subtype b proportion decreased while the crf proportion increased over the study period. A majority (57 per cent) of the nordic sequences formed transmission clusters, with evidence of mixing both geographically and between transmission groups. Detailed analyses showed multiple occasions of transmissions from msm to heterosexuals and that active transmission clusters more often involved single than multiple nordic countries. The strongest geographical link was between denmark and sweden. Finally, denmark had a larger proportion of heterosexual domestic spread of hiv-1 subtype b (75 per cent) compared with sweden (49 per cent) and finland (57 per cent). We describe different hiv-1 transmission patterns between countries and transmission groups in a large geographical region. Our results may have implications for public health interventions in targeting hiv-1 transmission networks and identifying where to introduce such interventions.
155	2020	Pohjankoski H;Kautiainen H;Lauri Jv;Puolakka K;Rantalaiho V	Trends Towards More Active Introduction Of Drug Therapy, Emphasizing Methotrexate And Biologic Agents, For Juvenile Idiopathic Arthritis	To evaluate the drug treatment trends in patients with incident juvenile idiopathic arthritis (jia) in 2006-2014. In finland, patients are entitled to a special reimbursement for medication if their condition meets certain criteria. We gathered all reimbursement decisions with the icd-10 diagnosis of m08 for patients under 16 years of age from a nationwide register maintained by kela, the social institution of finland. A total of 2439 incident cases of jia were identified. We surveyed their reimbursable drugs purchased for the first time for jia upon a doctor's prescription in 3-year cohorts (2006-2008, 2009-2011, 2012-2014). Changes of drug treatment for jia became more active during our study years. Between 2006-2008 and 2011-2014, the introduction of methotrexate (mtx) for the first time within the first 3 months increased from 73% (2006-2008) to 90% (2011-2014) of the patients, irr (incidence rate ratio) was 1.23 (95% ci 1.10-1.37). The use of parenteral mtx increased even more; irr was 1.97 (95% ci 1.61-2.41). During the first 2 years of their disease, 18% of the first cohort received subcutaneous biologic agents, while the corresponding proportion in the last cohort was 31%. Biologic agents were more likely to be introduced for patients with early (3 months) mtx administration than for patients without early mtx introduction; hr (hazard ratio) 2.19 (95% ci 1.63-2.93). During the follow-up, mtx administration became more prevalent for the treatment of jia soon after diagnosis, mostly because of the increase in the use of parenteral mtx.
156	2017	Aaltonen Kj;Joensuu Jt;Pirila L;Kauppi M;Uutela T;Varjolahti-Lehtinen T;Yli-Kerttula T;Isomaki P;Nordstrom D;Sokka T	Drug Survival On Tumour Necrosis Factor Inhibitors In Patients With Rheumatoid Arthritis In Finland	Objective: a systematic review found that an average of 27% of rheumatoid arthritis (ra) patients using tumour necrosis factor (tnf) inhibitors discontinue their treatment within 1year. The aim of this study was to assess drug survival on tnf inhibitors among patients with ra.methods: patients were identified from the national register for biologic treatment in finland (rob-fin), which is a longitudinal cohort study established to monitor the effectiveness and safety of biologic drugs in rheumatic diseases. Inclusion was limited to tnf-inhibitor treatments started as the patient's first, second, or third biologic treatment between 2004 and 2014. Follow-up was truncated at 36months. The results of a time-dependent cox proportional hazards model were reported as adjusted hazard ratios (hrs) with 95% confidence intervals (cis).Results: of the 4200 tnf-inhibitor treatment periods identified from rob-fin, 3443 periods from 2687 patients met the inclusion criteria. Twenty-seven per cent of the patients discontinued their treatment within 12months. Infliximab (hr 1.8, 95% ci 1.3-2.5) and certolizumab pegol (hr 1.7, 95% ci 1.2-2.3) had lower drug survival compared to golimumab. A similar trend was seen with adalimumab (hr 1.2, 95% ci 0.90-1.7) and etanercept (hr 1.2, 95% ci 0.87-1.6). Concomitant use of methotrexate (mtx) was associated with improved drug survival (hr 0.76, 95% ci 0.64-0.90) in comparison with tnf-inhibitor monotherapy.conclusions: golimumab was better in terms of drug survival than infliximab or certolizumab pegol and at least as good as adalimumab and etanercept. Concomitant use of mtx improved drug survival on tnf inhibitors.
157	2021	Wong F;Hung H;Dryfhout-Clark H;Aas W;Bohlin-Nizzetto P;Breivik K;Mastromonaco Mn;Lunden Eb;Olafsdottir K;Sigurdsson A;Vorkamp K;Bossi R;Skov H;Hakola H;Barresi E;Sverko E;Fellin P;Li H;Vlasenko A;Zapevalov M;Samsonov D;Wilson S	Time Trends Of Persistent Organic Pollutants (Pops) And Chemicals Of Emerging Arctic Concern (Ceac) In Arctic Air From 25 Years Of Monitoring	The long-term time trends of atmospheric pollutants at eight arctic monitoring stations are reported. The work was conducted under the arctic monitoring and assessment programme (amap) of the arctic council. The monitoring stations were: alert, canada; zeppelin, svalbard; storhofoi, iceland; pallas, finland; andoya, norway; villum research station, greenland; tiksi and amderma, russia. Persistent organic pollutants (pops) such as a- and.-hexachlorocyclohexane (hch), polychlorinated biphenyls (pcbs), a-endosulfan, chlordane, dichlorodiphenyltrichloroethane (ddt) and polybrominated diphenyl ethers (pbdes) showed declining trends in air at all stations. However, hexachlorobenzene (hcb), one of the initial twelve pops listed in the stockholm convention in 2004, showed either increasing or non-changing trends at the stations. Many pops demonstrated seasonality but the patterns were not consistent among the chemicals and stations. Some chemicals showed winter minimum and summer maximum concentrations at one station but not another, and vice versa. The ratios of chlordane isomers and ddt species showed that they were aged residues. Time trends of perfluorooctanoic acid (pfoa) and perfluorooctane sulfonic acid (pfos) were showing decreasing concentrations at alert, zeppelin and andoya. The chemicals of emerging arctic concern (ceac) were either showing stable or increasing trends. These include methoxychlor, perfluorohexane sulfonic acid (pfhxs), 6:2 fluorotelomer alcohol, and c9-c11 perfluorocarboxylic acids (pfcas). We have demonstrated the importance of monitoring ceac before they are being regulated because model calculations to predict their transport mechanisms and fate cannot be made due to the lack of emission inventories. We shouldmaintain long-term monitoring programmes with consistent data quality in order to evaluate the effectiveness of chemical control efforts taken by countries worldwide. Crown copyright (c) 2021 published by elsevier b.v. This is an open access article under the cc by-nc-nd license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
158	2021	Rissanen E;Heikkinen S;Seppa K;Ryynanen H;Eriksson Jg;Harkanen T;Jousilahti P;Knekt P;Koskinen S;Mannisto S;Rahkonen O;Rissanen H;Malila N;Laaksonen Ma;Pitkaniemi J	Incidence Trends And Risk Factors Of Lung Cancer In Never Smokers: Pooled Analyses Of Seven Cohorts	The trends in incidence of lung cancer in never smokers are unclear as well as the significance of risk factors. We studied time trends in the incidence and risk factors of lung cancer in never smokers in finland in a large, pooled cohort. We pooled data from seven finnish health cohorts from the period between 1972 and 2015 with 106 193 never smokers. The harmonised risk factors included education, alcohol consumption, physical activity, height and bmi. We retrieved incident lung cancers from the nation-wide finnish cancer registry. We estimated average annual percent change (aapc) and the effects of risk factors on cause-specific hazard ratios (hrs) of lung cancer using poisson regression. We detected 47 lung cancers in never smoking men (n = 31 859) and 155 in never smoking women (n = 74 334). The aapc of lung cancer incidence was -3.30% (95% confidence interval [ci]: -5.68% to -0.88%, p = .009) in never smoking men and 0.00% (95% ci: -1.57% to 1.60%, p = .996) in never smoking women. Of the five studied risk factors only greater height in women had a statistically significant increased risk of lung cancer (multivariate hr = 1.84, 95%ci: 1.08 to 3.12). It is plausible that tobacco control measures focused on working places have reduced passive smoking among men more than among women, which could explain the declining trend in lung cancer incidence in never smoker men but not in never smoker women. As tobacco control measures have not been targeted to domestic environments, it is likely that women's exposure to passive smoking has continued longer.
159	2016	Daneshmand R;Kurl S;Tuomainen Tp;Virtanen Jk	Associations Of Serum N-3 And N-6 Polyunsaturated Fatty Acids With Plasma Natriuretic Peptides	Background/objectives: the n-3 and n-6 polyunsaturated fatty acids (pufas) have been associated with lower risk of cardiovascular disease (cvd), but little is known about their association with natriuretic peptides (nps), a marker for cvd risk. The aim of this study was to investigate the association of serum n-3 and n-6 pufas with nps. Subjects/methods: a cross-sectional analysis of the association between serum n-3 and n-6 pufas with plasma n-terminal atrial (nt-proanp) and brain (nt-probnp) nps in a population-based sample of 985 men aged 46-65 years from eastern finland. Results: after adjustment for age and examination year, only serum n-6 pufa arachidonic acid (ara) was inversely associated with nt-proanp (p-trend across quartiles = 0.02), but further adjustments for conventional risk factors (body mass index, smoking, alcohol intake, systolic blood pressure, low-density lipoprotein cholesterol and history of cvd) attenuated the association (p-trend = 0.10). The associations with the other pufas were not statistically significant. Among the pufas, only serum n-3 pufa docosapentaenoic acid (dpa; p-trend=0.03) and ara (p-trend = 0.02) had inverse associations with nt-probnp after adjustment for age and examination years. The associations were again attenuated after further adjustments but remained statistically significant for dpa (p-trend=0.05). Our results also suggested that the inverse associations may be more evident among those using beta-blockers. Conclusions: our study suggests little overall impact of serum n-3 or n-6 pufas on plasma nps.
160	2021	Ranta P;Kinnunen I;Jouhi L;Vahlberg T;Back Ljj;Halme E;Koivunen P;Autio T;Pukkila M;Irjala H	Long-Term Quality Of Life After Treatment Of Oropharyngeal Squamous Cell Carcinoma	Objectives to analyze the long-term quality of life (qol) among oropharyngeal squamous cell carcinoma (opscc) survivors. Study design retrospective chart analysis and patient response to european organization for research and treatment of cancer quality of life questionnaire, core module (eortc qlq-c30), head and neck module (eortc qlq-h&n35), and m.d. Anderson dysphagia inventory (mdadi) survey questionnaires. Methods all survivors of opscc diagnosed and treated between 2000 and 2009 in finland were included. There were 263 survivors (44.2% of all curatively treated patients), of which a total of 164 participated in this study (62.4%). Median follow-up was 11.79 years (range = 8.59-18.53 years, interquartile range [iqr] = 4.64 years). The mean age of the participants was 67.9 years (standard deviation = 8.0 years) at qol follow-up. Results most survivors reported a good qol. The eortc qlq-c30 global health status median was 75.00 (iqr = 31.25). The single modality treatment group had significantly better qol outcomes than the combined treatment group. Nonsmokers and previous smokers had significantly better qol outcomes than patients who smoked at the time of diagnosis. A history of heavy alcohol use resulted in significantly worse qol outcomes. The p16-positive cancer patients had significantly better qol outcomes than p16-negative patients. Percutaneous endoscopic gastrostomy (peg) tube-dependent patients reported a significantly worse qol than patients without a peg tube. Conclusions long-term qol in opscc survivors is generally good. In line with previous literature, single modality treatment was superior to combined treatment in long-term qol outcomes, and it should be pursued whenever possible. Level of evidence 4laryngoscope, 2020
161	2016	Lappi-Seppala T	Nordic Sentencing	Broad harmony and much commonality characterize the basic principles and core priorities of the sentencing systems of the four larger nordic countries, notwithstanding rich diversity in details. Since 1960, there have been three distinctive phases in criminal justice policy and associated law reforms. A liberal period of "human and rational penal policy" from the late 1960s to early 1990s reformulated principles of penological thinking and resulted, among other things, in a radical reduction in the use of imprisonment in finland. A second phase beginning in the mid-1990s, the "punitive turn-nordic style," with sweden playing the central role, included a gradual politicization of criminal justice policy and intensification in penal control especially in relation to drugs, violence, and sexual offenses. Political and police trends in the 2000s have been somewhat contradictory but include success in controlling the use of imprisonment and expanding the use of community penalties. Imprisonment rates rose slightly in the late 1990s but since 2005 have been either stable or declining. There is rich diversity in details among the nordic countries but also broad harmony in basic principles and priorities.
162	2017	Juriloo A;Pesonen L;Lauerma H	Knocking On Prison's Door: A 10-Fold Rise In The Number Of Psychotic Prisoners In Finland During The Years 2005-2016	Background: as in many european countries, finnish psychiatric services experienced a rapid process of deinstitutionalization in the 1990s. In recent decades, the decrease in numbers of psychiatric hospital beds has in several countries been found to be linked with increasing criminality among severely mentally ill individuals. It has been concluded that deinstitutionalization could be the main reason for this development.aim: to investigate whether the prevalence of severely mentally ill persons to prison is a growing trend also in finland.methods: we searched for the annual data in electronic case files of all prisoners about the icd-10 diagnostic group of the most severe psychotic disorders. We also searched for the comorbid substance use disorders. Psychotic disorders due to substance abuse only were excluded from this study.results: during the years 2005-2016, a rapid 10-fold increase in psychotic disorders has occurred in finnish prisons. In 2016, 185 prisoners (5.9% of all finnish prisoners) were diagnosed as having a psychotic disorder that was not induced by substance abuse. The causes of this dramatic change are unclear. Comorbid substance abuse disorders were detected in only 39.5% of these prisoners and therefore substance abuse can only partly explain the increasing criminality of the severely mentally ill persons. 80.5% of psychotic disorders were diagnosed in psychiatric hospital for prisoners and 19.5% in prison policlinic services.conclusion: trans-institutionalization has become a serious challenge for the finnish criminal justice and mental health systems. Further studies are needed to detect the causes of this change. More specialized services for severely mentally ill persons are needed both in the community psychiatry and also inside the prison services.
163	2022	Richards Gc;Aronson Jk;Mackenna B;Goldacre B;Hobbs Fdr;Heneghan C	Sales Of Over-The-Counter Products Containing Codeine In 31 Countries, 2013-2019: A Retrospective Observational Study	Introduction opioid prescribing trends have been investigated in many countries. However, the patterns of over-the-counter purchases of opioids without a prescription, such as codeine combinations, are mostly unknown. Objective we aimed to assess national sales and expenditure trends of over-the-counter codeine-containing products purchased in countries with available data over 6 years. Methods we conducted a retrospective observational study using electronic point-of-sale data from the human data science company, iqvia, for countries that had such data, including argentina, belgium, brazil, bulgaria, canada, croatia, estonia, finland, france, germany, greece, ireland, italy, japan, latvia, lithuania, mexico, the netherlands, poland, portugal, romania, russia, serbia, slovakia, slovenia, south africa, spain, switzerland, thailand, the uk, and the usa. We calculated annual mean sales (dosage units/1000 population) and public expenditure ( pound/1000 population) for each country between april 2013 and march 2019 and adjusted for data coverage reported by iqvia. We quantified changes over time and the types of products sold. Results in total, 31.5 billion dosage units (adjusted: 42.8 billion dosage units) of codeine, costing 2.55 pound billion (adjusted: 3.68 pound billion), were sold over the counter in 31 countries between april 2013 and march 2019. Total adjusted sales increased by 11% (from 3911 dosage units/1000 population in 2013 to 4358 in 2019) and adjusted public expenditure increased by 72% (from 263 pound/1000 in 2013 to 451 pound/1000 in 2019). Sales were not equally distributed; south africa sold the most (36 mean dosage units/person), followed by ireland (30 mean dosage units/person), france (20 mean dosage units/person), the uk (17.2 mean dosage units/person), and latvia (16.8 mean dosage units/person). Types of products (n = 569) and formulations (n = 12) sold varied. Conclusion in many parts of the world, substantial numbers of people may be purchasing and consuming codeine in over-the-counter products. Clinicians should ask patients about their use of over-the-counter products, and public health measures are required to improve the collection of sales data and the safety of such products.
164	2018	Glintborg B;Lindstrom U;Aaltonen K;Kristianslund Ek;Gudbjornsson B;Chatzidionysiou K;Askling J;Nordstrom D;Hetland Ml;Di Giuseppe D;Dreyer L;Kristensen Le;Jorgensen Ts;Eklund K;Grondal G;Ernestam S;Joensuu J;Tormanen Mrk;Skydsgaard H;Hagfors J;Kvien Tk;Lie E;Fagerli K;Geirsson Aj;Jonsson H;Provan Sa;Krogh Ns;Jacobsson Lth	Biological Treatment In Ankylosing Spondylitis In The Nordic Countries During 2010-2016: A Collaboration Between Five Biological Registries	Objectives: large-scale observational cohorts may be used to study the effectiveness and rare side effects of biological disease-modifying anti-rheumatic drugs (bdmards) in ankylosing spondylitis (as), but may be hampered by differences in baseline characteristics and disease activity across countries. We aimed to explore the research infrastructure in the five nordic countries regarding bdmard treatment in as. Method: this observational cohort study was based on data from biological registries in denmark (danbio), sweden (srq/artis), finland (rob-fin), norway (nor-dmard), and iceland (icebio). Data were collected for the years 2010-2016. Registry coverage, registry inventory (patient characteristics, disease activity measures), and national guidelines for bdmard prescription in as were described per country. Incident (first line) and prevalent bdmard use per capita, country, and year were calculated. In as patients who started first line bdmards during 2010-2016 (n = 4392), baseline characteristics and disease activity measures were retrieved. Results: registry coverage of bdmard-treated patients ranged from 60% to 95%. All registries included extensive prospectively collected data at patient level. Guidelines regarding choice of first line drug and prescription patterns varied across countries. During the period 2010-2016 prevalent bdmard use increased (p < 0.001), whereas incident use tended to decrease (p for trend < 0.004), with large national variations (e.g. 2016 incidence: iceland 10.7/100 000, finland 1.7/100 000). Baseline characteristics were similar regarding c-reactive protein, but differed for other variables, including the bath ankylosing spondylitis disease activity index (basdai) (range 3.5-6.3) and ankylosing spondylitis disease activity score (asdas) (2.7-3.8) (both p < 0.0001). Conclusion: collaboration across the five nordic biological registries regarding bdmard use in as is feasible but national differences in coverage, prescription patterns, and patient characteristics must be taken into account depending on the scientific question.
165	2022	Ijas P	Trends In The Incidence And Risk Factors Of Pregnancy-Associated Stroke	Pregnancy is a female-specific risk factor for stroke. Although pregnancy-associated stroke (pas) is a rare event, pas leads to considerable maternal mortality and morbidity. It is estimated that 7.7-15% of all maternal deaths worldwide are caused by stroke and 30-50% of surviving women are left with persistent neurological deficits. During last decade, several studies have reported an increasing incidence of pas. The objective of this review is to summarize studies on time trends of pas in relation to trends in the prevalence of stroke risk factors in pregnant women. Seven retrospective national healthcare register-based cohort studies from the us, canada, uk, sweden, and finland were identified. Five studies from the us, canada, and finland reported an increasing trend of pas. Potential biases include more sensitive diagnostics and improved stroke awareness among pregnant women and professionals toward the end of the study period. However, the concurrent increase in the prevalence of several stroke risk factors among pregnant women, particularly advanced age, hypertensive disorders of pregnancy, diabetes, and obesity, indicate that the findings are likely robust and should be considered seriously. To reduce stroke in pregnancy, increased awareness among all medical specialties and pregnant women on the importance of risk-factor management during pregnancy and stroke symptoms is necessary. Important preventive measures include counseling for smoking cessation and substance abuse, treatment of hypertensive disorders of pregnancy, use of aspirin in women at high risk for developing preeclampsia, and antithrombotic medication and pregnancy surveillance for women with high-risk conditions. Epidemiological data from countries with a high risk-factor burden are largely missing. National and international registries and prospective studies are needed to increase knowledge on the mechanisms, risk factors, management, and future implications for the health of women who experience this rare but devastating complication of pregnancy.
166	2019	Tikkinen Kao;Rutanen J;Frances A;Perry Bl;Dennis Bb;Agarwal A;Maqbool A;Ebrahim S;Leinonen Js;Jarvinen Tln;Guyatt Gh	Public, Health Professional And Legislator Perspectives On The Concept Of Psychiatric Disease: A Population-Based Survey	Objective to assess which mental health-related states of being are perceived as diseases by psychiatrists, non-psychiatric physicians, nurses, parliament members and laypeople. Design and setting a population-based, mailed survey in finland. Participants respondents from a random sample of 3000 laypeople, 1500 physicians, 1500 nurses and all 200 members of the parliament (mps) of finland. Primary outcome measures respondents' perspectives on 20 mental health-related states of being as diseases, measuring the extent of agreement with the claim: '[this state of being] is a disease'. Results of the 6200 people approached, we received 3259 eligible responses (53%). Two conditions (schizophrenia and autism) were considered to be diseases by at least 75% and two states (grief and homosexuality) were considered not to be diseases by at least 75% in each group. A majority (at least 50% in each group) considered seven states as diseases (anorexia, attention deficit hyperactivity disorder, bulimia, depression, generalised anxiety disorder, panic disorder and personality disorder) and three not to be diseases (absence of sexual desire, premature ejaculation and transsexualism). In six states, there was a wide divergence of opinion (alcoholism, drug addiction, gambling addiction, insomnia, social anxiety disorder and work exhaustion). Psychiatrists were significantly more inclined to considering states of being as diseases relative to other groups, followed by non-psychiatric physicians, nurses, mps and laypeople. Conclusions respondents agreed that some conditions, such as schizophrenia and autism, are diseases and other states, such as grief and homosexuality, are not; for others, there was considerable disagreement. Psychiatrists are more inclined to consider mental health-related states of being as diseases compared with other physicians, who, in turn, are more inclined than other constituencies. Understanding notions of disease may underlie important debates in public policy and practice in areas of mental health and behaviour, and have implications for resource allocation and stigma.
167	2016	Polkki Pl;Vornanen Rh	Role And Success Of Finnish Early Childhood Education And Care In Supporting Child Welfare Clients: Perspectives From Parents And Professionals	Day care in finland comprising care, education and teaching-called educare or the ecec model-can be used as an open care (community care) support measure for children whose development is at risk. The general aim of the study was to investigate whether the needs of child welfare client children and their parents are fulfilled in day care services from the perspective of parents and professionals. The questions were: (1) how are the individual needs of child protection client children met in day care? (2) in what way does day care support the parenting of child welfare client parents? (3) what kind of enabling and hindering factors, processes and mechanisms are there for good outcomes from day care for children and parents? The study uses both quantitative and qualitative approaches. The methods used were a questionnaire for parents (n = 42), group-level documentary materials from day care and social services officers about the problems faced by client children and parents, and interviews with ecec and child welfare staff (n = 28). Parents experienced many problems, including exhaustion, poor mental health, substance abuse and parenting problems. Twenty percent of the children had individual support needs. The parents were very satisfied with the ecec service their children were receiving and the parenting support provided. The ecec professionals highlighted many positive changes in children in day care and they were also able to support parenting. The enabling and hindering factors for good outcomes were connected with the attitudes and problems of the clients, administrative processes within sectors, and cooperation between ecec and child welfare staff. Ecec services can considerably increase the safety and well-being of child welfare client children and support their parents in their upbringing. The role and cooperation of ecec and child welfare staff need clarification.
168	2019	Mononen N;Airaksinen Msa;Hameen-Anttila K;Helakorpi S;Pohjanoksa-Mantyla M	Trends In The Receipt Of Medicines Information Among Finnish Adults In 1999-2014: A Nationwide Repeated Cross-Sectional Survey	Objective the aim of this study was to examine long-term trends in the receipt of medicines information (mi) among adult medicine users from 1999 to 2014. Design repeated cross-sectional postal survey from the years 1999,2002,2005 and 2008-2014. Setting each study year, a new nationally representative sample of 5000 finns aged 15-64 years was drawn from the population register centre of finland. Participants the range of annual respondents varied from 2545 to 3371 and response rates from 53% to 67%. Of the total responses (n=29465), 64% were from medicine users (n=18 862, ranging by year from 58% to 68%). Outcome measures receipt of information on medicines in use within 12 months prior to the survey from a given list of consumer mi sources available in finland. Results physicians, community pharmacists and package leaflets were the most common mi sources throughout the study period. Receipt of mi increased most from the internet (from 1% in 1999 to 16% in 2014), while decreased most from physicians (62% to 47%) and package leaflets (44% to 34%), and remained stable from community pharmacists (46% to 45%) and nurses (14% to 14%). In 1999, of the medicine users 4% did not report receipt of mi from any of the sources listed in the survey, while this proportion had remarkably increased to 28% in 2014. Conclusions healthcare professionals and package leaflets had still a dominating importance in 2014 despite the growing number of mi sources over time, but still a minority of adult medicine users reported receiving mi via the internet in 2014. Worrying is that the proportion of adult medicine users who did not receive mi from any of the sources became seven fold during the study period.
169	2020	Halavaara M;Martelius T;Anttila Vj;Jarvinen A	Three Separate Clinical Entities Of Infective Endocarditis -A Population-Based Study From Southern Finland 2013-2017	Background. Health care-associated infective endocarditis (haie) and intravenous drug use-related ie (iduie) have emerged as major groups in infective endocarditis (ie). We studied their role and clinical picture in a population-based survey. Methods. A population-based retrospective study including all adult patients diagnosed with definite or possible ie in southern finland in 2013-2017. Ie episodes were classified according to the mode of acquisition into 3 groups: community-acquired ie (caie), haie, and iduie. Results. Total of 313 episodes arising from 291 patients were included. Incidence of ie was 6.48/100 000 person-years. Caie accounted for 38%, haie 31%, and iduie 31% of ie episodes. Patients in the iduie group were younger, and they more frequently had right-sided ie (56.7% vs 5.0%; p < .001) and s. Aureus as etiology (74.2% vs 17.6%; p < .001) compared with the caie group. In-hospital (15.1% vs 9.3%; p = .200) and cumulative 1-year case fatality rates (18.5% vs 17.5%; p = .855) were similar in caie and iduie. Patients with haie had more comorbidities, prosthetic valve involvement (29.9% vs 10.9%; p = .001), enterococcal etiology (20.6% vs 5.9%; p = .002), and higher in-hospital (27.8% vs 15.1%; p = .024) and cumulative 1-year case fatality rates (43.3% vs 18.5%; p < .001) than patients with caie. Staphylococcus aureus caused one-fifth of ie episodes in both groups. Conclusions. Our study indicates that in areas where injection drug use is common iduie should be regarded as a major risk group for ie, along with haie, and not seen as part of caie. Three different risk groups, caie, haie, and iduie, with variable characteristics and outcome should be recognized in ie.
170	2020	Kuusisto K;Lintonen T	Factors Predicting Satisfaction In Outpatient Substance Abuse Treatment: A Prospective Follow-Up Study	Background while treatment satisfaction has been associated with better outcomes in substance abuse treatment, there is an obvious need for a more profound understanding of what predicts client's satisfaction with treatment. This study elucidates factors relevant to treatment outcome measured at follow-up in terms of satisfaction with the treatment received. Methods the research was implemented as a multisite study in outpatient clinics (n = 7) in southern and western finland. Data consists of therapists (n = 33) and their clients (n = 327). Each consenting client beginning a treatment period was accepted as a research subject and all therapists at the clinics in question participated. The study was conducted as part of the clinic's normal activity. Clients were allocated to therapists according to a randomization list drawn up in advance. Apart from the randomisation and the completion of questionnaires, it did not interfere with the progress of treatment. Follow-up lasted 6 months. Multiple classification analysis (mca) was used through combinations of variables organized by content, e.g. Client demographics, previous substance use, therapist's characteristics and client's expectations. The analyses were based in part on conventional statistical testing (t -test, chi(2)-test, anova). Results among 37 independent variables few were statistically significant in the final model. The results suggest that high treatment expectations at baseline are a strong predictor of satisfaction at follow-up. Also, previous substance use predicted treatment satisfaction; people using multiple substances were less satisfied than those taking only one substance. Stronger predictors reduced the statistical significance of those independent variables that were statistically significant in the first analyses. Therefore, therapist's role in recovery and readiness to change should be also seen as antecedents to treatment satisfaction. Conclusions it seems that treatment expectations are fulfilled among those participating in follow-up. Yet many are lost during treatment and by follow-up. Service users have experiential knowledge that differs from professionals' and policymakers' knowledge. It is clinically relevant to understand what factors affect client's satisfaction. Hence, it is possible to identify the population whose treatment should receive the most attention, how the client's experience, their commitment to treatment, and treatment effectiveness could be improved.
171	2021	Pyykonen M;Linna M;Tykkylainen M;Delmelle E;Laatikainen T	Patient-Specific And Healthcare Real-World Costs Of Atrial Fibrillation In Individuals Treated With Direct Oral Anticoagulant Agents Or Warfarin	Background anticoagulant therapies are used to prevent atrial fibrillation-related strokes, with warfarin and direct oral anticoagulant (doac) the most common. In this study, we incorporate direct health care costs, drug costs, travel costs, and lost working and leisure time costs to estimate the total costs of the two therapies. Methods this retrospective study used individual-level patient data from 4000 atrial fibrillation (af) patients from north karelia, finland. Real-world data on healthcare use was obtained from the regional patient information system and data on reimbursed travel costs from the database of the social insurance institution of finland. The costs of the therapies were estimated between june 2017 and may 2018. Using a geographical information system (gis), we estimated travel time and costs for each journey related to anticoagulant therapies. We ultimately applied therapy and travel costs to a cost model to reflect real-world expenditures. Results the costs of anticoagulant therapies were calculated from the standpoint of patient and the healthcare service when considering all costs from af-related healthcare visits, including major complications arising from atrial fibrillation. On average, the annual cost per patient for healthcare in the form of public expenditure was higher when using doac therapy than warfarin therapy (average cost = euro 927 vs. Euro 805). Additionally, the average annual cost for patients was also higher with doac therapy (average cost = euro 406.5 vs. Euro 296.7). In warfarin therapy, patients had considerable more travel and time costs due the different implementation practices of therapies. Conclusion the results indicated that doac therapy had higher costs over warfarin from the perspectives of the patient and healthcare service in the study area on average. Currently, the cost of the doac drug is the largest determinator of total therapy costs from both perspectives. Despite slightly higher costs, the patients on doac therapy experienced less af-related complications during the study period.
172	2016	Anttila P;Brorstrom-Lunden E;Hansson K;Hakola H;Vestenius M	Assessment Of The Spatial And Temporal Distribution Of Persistent Organic Pollutants (Pops) In The Nordic Atmosphere	Long-term atmospheric monitoring data (1994-2011) of persistent organic pollutants (pops) were assembled from a rural site in southern sweden, rao, and a remote, sub-arctic site in finland, pallas. The concentration levels, congener profiles, seasonal and temporal trends, and projections were evaluated in order to assess the status of pops in the scandinavian atmosphere. Our data include atmospheric concentrations of polycyclic aromatic hydrocarbons (pahs), polychlorinated biphenyls (pcbs) and organo-chlorine pesticides (ocps), altogether comprising a selection of 27 different compounds. The atmospheric pop levels were generally higher in the south, closer to the sources (primary emissions) of the pollutants. The levels of low-chlorinated pcbs and chlordanes were equal at the two sites, and one of the studied pops, alpha-hch, showed higher levels in the north than in the south. Declining temporal trends in the atmospheric concentrations for the legacy pops - pcbs (2-4% per year), hchs (6-7% per year), chlordanes (3-4% per year) and dtts (2-5% per year) - were identified both along sweden's west coast and in the sub-arctic area of northern finland. Most of pahs did not show any significant long-term trends. The future projections for pop concentrations suggest that in scandinavia, low-chlorinated pcbs and p,p'-dde will remain in the atmospheric compartment the longest (beyond 2030). Hch's and pcb180 will be depleted from the nordic atmosphere first, before 2020, whereas chlordanes and rest of the pcbs will be depleted between the years 2020 and 2025. Pcbs tend to deplete sooner and chlordanes later from the sub-arctic compared to the south of sweden. This study demonstrates that the international bans on legacy pops have successfully reduced the concentrations of these particular substances in the nordic atmosphere. However, the most long-lived compounds may continue in the atmospheric cycle for another couple of decades. (C) 2016 elsevier ltd. All rights reserved.
173	2019	Aho H;Konu A;Koivisto Am;Joronen K	Relationship Among School Connectedness, Smoking Policy, And Smoking Behavior In Finnish Vocational Schools	Objective: we examined school connectedness as a significant predictor of adolescent wellbeing. Methods: we analyzed data for 34,776 adolescents who took part in the school health promotion study in finland. We used a multinomial regression model to assess the associations among adolescent smoking, school connectedness, and anti-smoking policies. Results: a lower level of perceived teacher support, disliking school, and more than 2 days of skipping school increased the odds of smoking behavior among vocational students. In addition, school staff smoking and close monitoring of student smoking were associated with increased smoking among students. Conclusions: our results suggest that it is possible to reduce the odds of smoking by enhancing school connectedness and by enforcing anti-smoking school policies.
174	2018	Coomber R;Moyle L;Belackov V;Decorte T;Hakkarainen P;Hathaway A;Laidler Kj;Lenton S;Murphy S;Scott J;Stefunkova M;Van De Ven K;Vlaemynck M;Werse B	The Burgeoning Recognition And Accommodation Of The Social Supply Of Drugs In International Criminal Justice Systems: An Eleven-Nation Comparative Overview	Background: it is now commonly accepted that there exists a form of drug supply, that involves the non-commercial supply of drugs to friends and acquaintances for little or no profit, which is qualitatively different from profit motivated 'drug dealing proper'. 'Social supply', as it has become known, has a strong conceptual footprint in the united kingdom, shaped by empirical research, policy discussion and its accommodation in legal frameworks. Though scholarship has emerged in a number of contexts outside the uk, the extent to which social supply has developed as an internationally recognised concept in criminal justice contexts is still unclear. Methods: drawing on an established international social supply research network across eleven nations, this paper provides the first assessment of social supply as an internationally relevant concept. Data derives from individual and team research stemming from australia, belgium, canada, czech republic, finland, germany, hong kong, the netherlands, england and wales, and the united states, supported by expert reflection on research evidence and analysis of sentencing and media reporting in each context. In situ social supply experts addressed a common set of questions regarding the nature of social supply for their particular context including: an overview of social supply research activity, reflection on the extent that differentiation is accommodated in drug supply sentencing frameworks; evaluating the extent to which social supply is recognised in legal discourse and in sentencing practices and more broadly by e.g. Criminal justice professionals in the public sphere. A thematic analysis of these scripts was undertaken and emergent themes were developed. Whilst having an absence of local research, new zealand is also included in the analysis as there exists a genuine discursive presence of social supply in the drug control and sentencing policy contexts in that country. Results: findings suggest that while social supply has been found to exist as a real and distinct behaviour, its acceptance and application in criminal justice systems ranges from explicit through to implicit. In the absence of dedicated guiding frameworks, strong use is made of discretion and mitigating circumstances in attempts to acknowledge supply differentiation. In some jurisdictions, there is no accommodation of social supply, and while aggravating factors can be applied to differentiate more serious offences, social suppliers remain subject to arbitrary deterrent sentencing apparatus. Conclusion: due to the shifting sands of politics, mood, or geographical disparity, reliance on judicial discretion and the use of mitigating circumstances to implement commensurate sentences for social suppliers is no longer sufficient. Further research is required to strengthen the conceptual presence of social supply in policy and practice as a behaviour that extends beyond cannabis and is relevant to users of all drugs. Research informed guidelines and/or specific sentencing provisions for social suppliers would provide fewer possibilities for inconsistency and promote more proportionate outcomes for this fast-growing group.
175	2018	Sassi S;Hakko H;Raty E;Riipinen P	Light Motor Vehicle Collisions With Heavy Vehicles - Psychosocial And Health Related Risk Factors Of Drivers Being At-Fault For Collisions	Background: fatal head-on collisions between passenger cars and trucks are sometimes thought as self-inflicted death of the passenger car drivers. Methods: a total of 378 finnish drivers of light motor vehicles (lmv) died in collisions with heavy vehicles between the years 2002-2011. These male and female drivers, who were considered as being at fault, and whose collisions with heavy vehicles occurred in the oncoming vehicle's lane, were explored in relation to information on their socio-demographics, physical and mental health condition and driving-related factors. Results: cause of death of at-fault lmv drivers, as defined in medico-legal examination, was most commonly accidental (51%), followed by suicide (32%), undetermined intent (17%) and acute illness (0.3%). Ten-year time trend in rates of lmv drivers has remained stable (annual percentage change, apc = 0.03; p = 0.983), the annual proportion varying between 14%-21%. However, a statistically significantly increasing time trend was observed in fatal accidents due to suicides (apc = 5.31, p = 0.028). Generally, at-fault lmv drivers were characterized as having mental health problems susceptibility to risk (44%), personal relationship problems (33%), long-term physical illness (68%) or medication (35%) or driving under influence of alcohol (24%). Male lmv drivers, compared to women, were more commonly unmarried, farm/wood/industrial workers and drove alone and without a planned destination. Female lmv drivers were, more commonly than men, widowed, third degree students, skilled workers, had long term mental illnesses/disturbances, drove with family member(s) and their fatal accidents occurred in winter. Conclusion: the findings give support to the recommendation that suicidal ideation must be considered when assessing fitness-to-drive. (C) 2018 elsevier b.v. All rights reserved.
176	2022	Van Breen Ja;Liem Mca	Clustering Of Homicide With Other Adverse Health Outcomes In The Netherlands	In this project we examine whether homicide 'clusters together' with other adverse health outcomes in the netherlands, focusing on child mortality, suicide, sexual risk behavior, and substance abuse. We expect moderate-to-strong correlations between homicide and the other adverse health phenomena (hypothesis 1). Further, we expect that these correlations will be reduced when social disorganization is controlled for (hy-pothesis 2).The study used population-level data between the years 1996 and 2019, for each of the 40 local regions of the netherlands. We applied a multilevel correlation procedure to evaluate correlations between homicide and the other adverse health outcomes. Correlations between homicide and the other adverse health outcomes were modest. That is, we found only limited evidence for clustering between homicide and the other adverse health outcomes. The patterns of clustering that did occur, suggested that social disorganization in the region promotes risk-taking behaviors in the population, which ultimately increases rates of homicide, abuse of illegal drugs and births to adolescent parents.project materials, syntax and supplementary information can be found on the open science framework at htt ps://osf.io/jd5yu/.
177	2018	Hughes Ce;Barratt Mj;Ferris Ja;Maier Lj;Winstock Ar	Drug-Related Police Encounters Across The Globe: How Do They Compare?	Background: drug law enforcement subsumes the majority of drug policy expenditure across the globe. Fuelled by knowledge that much of this investment is ineffective or counter-productive there have been increasing calls for cross-national comparisons to identify where policing approaches differ and what types of approaches may be more effective. Yet, to date cross-national comparison of drug law enforcement has proven a methodologically hazardous affair. Using a new drug policing module added to the 2017 global drug survey, this study seeks to provide the first cross-national comparison of the incidence, nature and intensity of illicit drug-related police encounters amongst people who use drugs. Methods: the global drug survey was administered in late 2016. Across 26 countries including australia, germany, italy, mexico, switzerland, the uk and the usa a total of 45,942 people who had recently used drugs completed the drug policing module. Key variables assessed included the incidence and frequency of drug related police encounters in the last 12 months that involved: a) being stopped and searched; b) encountering a drug detection dog; c) being given a caution or warning; d) being charged and arrested; and e) paying a bribe. Multi-level models were used to control for pre-existing national differences in drug use prevalence and non-drug specific policing (including the total number of police personnel in each country). Results: drug-related police encounters were most commonly reported in italy and scotland. Conversely, police encounters were most likely to lead to arrest in norway, finland and sweden. The type and locations of encounters further differed across countries, with for example stop and search most reported in greece and colombia, and encounters with drug detection dogs most reported in scotland, italy, uk and australia. Multilevel models showed that the incidence of reported policing encounters continued to differ significantly across countries after controlling for pre-existing national differences in drug use prevalence and policing, and that drug policing encounters were 4 to 14 times more common in some nations than others. Conclusion: the findings unearth significant cross-national differences in the incidence and nature of drug-related policing of people who use drugs. This suggests that there may be opportunities for countries to learn from each other about how and why they differ, and the potential benefits of switching to lower intensity modes of drug policing.
178	2021	Toma A;Crisan O	Regulations On Green Pharmacy In European Countries - A Comparative Study	Green pharmacy is a policy of protecting the environment from the risk of contamination with medicines. The aim of the paper was to compare relevant regulations from european countries in order to find solutions for such a policy in romania. Official texts from five countries were analysed using methods of legal interpretation and the comparative method. Each country has specific regulations, but the responsibility of each stakeholder is different, from regulating, to collecting or funding. In finland, expired medicines are collected by pharmacies and municipalities, which fund their disposal. In france, spain and hungary, expired medicines are collected by pharmacies, but the pharmaceutical industry is responsible for managing and funding the waste disposal. In romania, only pharmacies and drugstores are responsible for collecting and disposing expired medicines from patients. Regulations on sharing the responsibility among all types of pharmaceutical enterprises are needed in order to develop a green pharmacy policy in romania.
179	2019	Salonsalmi A;Pietilainen O;Lahelma E;Rahkonen O	Childhood Adversities, Parental Education And Disability Retirement Among Finnish Municipal Employees	Background there is increasing evidence that childhood socioeconomic position and childhood adversities influence adult health. However, the potential contribution of these factors to disability retirement is poorly understood. This study aimed to examine the associations between childhood adversities, parental education and disability retirement. Methods data on parental education and childhood adversities were derived from the helsinki health study baseline survey, conducted in 2000-02 among 40- to 60-year old employees of the city of helsinki, finland. Data on disability retirement and their diagnoses were obtained from the finnish centre of pensions and followed until the end of 2016. The analyses included 5992 employees. The associations of parental education and childhood adversities with disability retirement due to any cause, musculoskeletal diseases and mental disorders were analysed using cox regression analysis. Results low parental education was associated with an increased risk of disability retirement due to any cause (maternal education: hr 1.74, 95% ci 1.16-2.62; paternal education: 1.86, 1.38-2.51) and due to musculoskeletal diseases (maternal education: 4.44, 1.66-11.92; paternal education: 3.81, 2.02-7.17). However, adjustment for own education mainly abolished the associations. Economic difficulties in the childhood family, parental alcohol problems and having been bullied at school or by peers increased the risk of disability retirement due to all studied diagnostic groups, whereas parental death or divorce had no effect. Childhood illness (1.53, 1.20-1.95) and parental mental illness (1.68, 1.28-2.20) were associated with disability retirement due to any cause and due to mental disorders (1.65, 1.05-2.59; 3.60, 2.46-5.26). The associations between childhood adversities and disability retirement remained after adjustment for own education, whereas working conditions, and weight and health behaviours somewhat attenuated the associations. Conclusions parental education and childhood adversities contributed to disability retirement even in midlife. Policy actions investing in children's well-being might promote work ability in midlife.
180	2020	Mcglinchey A;Sinioja T;Lamichhane S;Sen P;Bodin J;Siljander H;Dickens Am;Geng Dw;Carlsson C;Duberg D;Ilonen J;Virtanen Sm;Dirven H;Berntsen Hf;Zimmer K;Nygaard Uc;Oresic M;Knip M;Hyotylainen T	Prenatal Exposure To Perfluoroalkyl Substances Modulates Neonatal Serum Phospholipids, Increasing Risk Of Type 1 Diabetes	In the last decade, increasing incidence of type 1 diabetes (t1d) stabilized in finland, a phenomenon that coincides with tighter regulation of perfluoroalkyl substances (pfas). Here, we quantified pfas to examine their effects, during pregnancy, on lipid and immune-related markers of t1d risk in children. In a mother-infant cohort (264 dyads), high pfas exposure during pregnancy associated with decreased cord serum phospholipids and progression to t1d-associated islet autoantibodies in the offspring. This pfas-lipid association appears exacerbated by increased human leukocyte antigen-conferred risk of t1d in infants. Exposure to a single pfas compound or a mixture of organic pollutants in non-obese diabetic mice resulted in a lipid profile characterized by a similar decrease in phospholipids, a marked increase of lithocholic acid, and accelerated insulitis. Our findings suggest that pfas exposure during pregnancy contributes to risk and pathogenesis of t1d in offspring.
181	2017	Ray B;Richardson Nj	Traumatic Brain Injury And Recidivism Among Returning Inmates	In recent years, there has been a surge in research that examines the relationship between traumatic brain injury (tbi) and involvement in the criminal justice system. However, the bulk of this research has been largely retrospective and descriptive, comparing rates of tbi in the offending population with the rates of tbi in the general population. Although findings from these studies indicate a higher prevalence of tbi in the offending population, virtually no studies have examined whether those with tbi are more likely to recidivate. To address this gap, the present study examined rearrest post release from prison among a cohort sample of indiana inmates who were screened using the ohio state university traumatic brain injury identification (osu-tbi-id) instrument. Findings indicate that, net of control variables, those with tbi were more likely to recidivate sooner than those without tbi. Policy implications and directions for future research are discussed.
182	2022	Lopez-Ballesteros A;Delaney A;Quirke J;Stout Jc;Saunders M;Carolan Jc;White B;Stanley Da	Assessing Availability Of European Plant Protection Product Data: An Example Evaluating Basic Area Treated	Besides the benefits of plant protection products (ppps) for agricultural production, there is an increasing acknowledgement of the associated potential environmental risks. Here, we examine the feasibility of summarizing the extent of ppp usage at the country level, using ireland as a case study, as well as at the european level. We used the area over which ppps are applied (basic area) as an example variable that is relevant to initially assess the geographic extent of environmental risk. In irish agricultural systems, which are primarily grass-based, herbicides fluroxypyr and glyphosate are the most widely applied active substances (ass) in terms of basic area, followed by the fungicides chlorothalonil and prothioconazole that are closely associated with arable crops. Although all eu countries are subject to regulation (ec) no 1185/2009, which sets the obligation of ppp usage data reporting at the national level, we only found usable data that met our criteria for estonia, germany, finland, and spain (4 of 30 countries reviewed). Overall, the most widely applied fungicide and herbicide in terms of basic area were prothioconazole (20%, 7% and 5% of national cultivated areas of germany, estonia and ireland) and glyphosate (11%, 8% and 5% of national cultivated areas of spain, estonia and ireland) respectively, although evaluations using application frequency may result in the observation of different trends. Several recommendations are proposed to tackle current data gaps and deficiencies in accessibility and usability of pesticide usage data across the eu in order to better inform environmental risk assessment and promote evidence-based policymaking.
183	2021	Shakeri A;Konstantelos N;Chu C;Antoniou T;Feld J;Suda Kj;Tadrous M	Global Utilization Trends Of Direct Acting Antivirals (Daas) During The Covid-19 Pandemic: A Time Series Analysis	The 2019 novel coronavirus (covid-19) pandemic has placed a significant strain on hepatitis programs and interventions (screening, diagnosis, and treatment) at a critical moment in the context of hepatitis c virus (hcv) elimination. We sought to quantify changes in direct acting antiviral (daa) utilization among different countries during the pandemic. We conducted a cross-sectional time series analysis between 1 september 2018 and 31 august 2020, using the iqvia midas database, which contains daa purchase data for 54 countries. We examined the percent change in daa units dispensed (e.g., pills and capsules) from march to august 2019 to the same period of time in 2020 across the 54 countries. Interrupted time-series analysis was used to examine the impact of covid-19 on monthly rates of daa utilization across each of the major developed economies (g7 nations). Overall, 46 of 54 (85%) jurisdictions experienced a decline in daa utilization during the pandemic, with an average of -43% (range: -1% in finland to -93% in brazil). All high hcv prevalence (hcv prevalence > 2%) countries in the database experienced a decline in utilization, average -49% (range: -17% in kazakhstan to -90% in egypt). Across the g7 nations, we also observed a decreased trend in daa utilization during the early months of the pandemic, with significant declines (p < 0.01) for canada, germany, the united kingdom, and the united states of america. The global response to covid-19 led to a large decrease in daa utilization globally. Deliberate efforts to counteract the impact of covid-19 on treatment delivery are needed to support the goal of hcv elimination.
184	2019	Semenkov In;Koroleva Tv	International Environmental Legislation On The Content Of Chemical Elements In Soils: Guidelines And Schemes	We analyzed the original and most developed environmental legislation of the netherlands, germany, the united states, and canada, as well as the systems of finland, the czech republic, china, the republic of south africa, australia, and new zealand, which have a number of specific features in terms of the content of chemical elements in soils. We summarized environmental legislation principles and actions in cases of exceeding soil quality standards. Comparing methodologically close legislations, the specificity of calculation of a soil quality standard should be taken into account. The standards for the content of chemical elements are differentiated depending on the properties of soils in russia, germany, china, and the czech republic; land use is taken into account in canada, germany, the republic of south africa, china (only for agricultural land), australia, new zealand, and the united states. Synergism of negative effects on organisms in case of polyelemental contamination is taken into account in the standards of russia for element pairs mn + v and hg + pb and in the standards of the united states for all substances.
185	2019	Yu Y;Katsoyiannis A;Bohlin-Nizzetto P;Brorstrom-Lunden E;Ma Jm;Zhao Y;Wu Zy;Tych W;Mindham D;Sverko E;Barresi E;Dryfhout-Clark H;Fellin P;Hung H	Polycyclic Aromatic Hydrocarbons Not Declining In Arctic Air Despite Global Emission Reduction	Two decades of atmospheric measurements of polycyclic aromatic hydrocarbons (pahs) were conducted at three arctic sites, i.e., alert, canada; zeppelin, svalbard; and pallas, finland. Pah concentrations decrease with increasing latitude in the order of pallas > zeppelin > alert. Forest fire was identified as an important contributing source. Three representative pahs, phenanthrene (phe), pyrene (pyr), and benzo[a]pyrene (bap) were selected for the assessment of their long-term trends. Significant decline of these pahs was not observed contradicting the expected decline due to pah emission reductions. A global 3-d transport model was employed to simulate the concentrations of these three pahs at the three sites. The model predicted that warming in the arctic would cause the air concentrations of phe and pyr to increase in the arctic atmosphere, while that of bap, which tends to be particle-bound, is less affected by temperature. The expected decline due to the reduction of global pah emissions is offset by the increment of volatilization caused by warming. This work shows that this phenomenon may affect the environmental occurrence of other anthropogenic substances, such as more volatile flame retardants and pesticides.
186	2016	Hyoty H	Viruses In Type 1 Diabetes	Environmental factors play an important role in the pathogenesis of type 1 diabetes and can determine if a genetically susceptible individual develops the disease. Increasing evidence suggest that among other exogenous agents certain virus infections can contribute to the beta-cell damaging process. Possible viral etiology of type 1 diabetes has been explored extensively but the final proof for causality is still lacking. Currently, the group of enteroviruses (evs) is considered as the strongest candidate. These viruses have been found in the pancreas of type 1 diabetic patients, and epidemiological studies have shown more ev infections in diabetic patients than in controls. Prospective studies, such as the type 1 diabetes prediction and prevention (dipp) study in finland, are of fundamental importance in the evaluation viral effects as they can cover all stages of the beta-cell damaging process, including those preceding the initiation of the process. Dipp study has carried out the most comprehensive virological analyses ever done in prospective cohorts. This article summarizes the findings from these analyses and discuss them in the context of the existing other knowledge and the prospects for intervention studies with ev vaccines or antiviral drugs.
187	2018	Wastesson Jw;Martikainen Je;Zoega H;Schmidt M;Karlstad O;Pottegard A	Trends In Use Of Paracetamol In The Nordic Countries	Paracetamol (acetaminophen) is one of the most commonly used analgesics in europe; however, both the safety and efficacy of paracetamol have recently been questioned. Little is known about cross-national differences in the sales of paracetamol. Using national wholesale statistics and nationwide prescription drug registers, we investigated trends in total and prescribed use of paracetamol in the nordic countries. The total sales of paracetamol (anatomical therapeutic chemical (atc) classification system code: n02be01) measured as defined daily doses (ddd) per 1000 inhabitants/day, and the sales by prescription (users per 1000 inhabitants/year), increased in the nordic countries from 2000 to 2015. The total sales were highest in denmark throughout the period, with 65 ddd per 1000 inhabitants/day and lowest in iceland with 30 ddd per 1000 inhabitants/day in 2015. The cross-national difference in total sales of paracetamol was smaller in 2015 than in 2000. The proportion of paracetamol (ddd per 1000 inhabitants/day) sold by prescription was also highest in denmark (78%), compared with 75% in finland, 69% in sweden, 61% in norway and 38% in iceland. Paracetamol by prescription was more common at older ages and among women. Total and prescribed sales of paracetamol have increased in all five nordic countries over time. Cross-national differences exist, with highest sales per capita in denmark throughout the period.
188	2017	Austin Ae;Van Den Heuvel C;Byard Rw	Differences In Local And National Database Recordings Of Deaths From Suicide	A search was undertaken at forensic science south australia (fssa) for all cases of suicide registered in south australia, australia, over a 10-year period from january 2003 to december 2012. More recent data was not accessioned as not all contemporary cases may have been completed or formally registered. The data were compared to corresponding numbers on two national registers: the national coronial information system (ncis) and the australian bureau of statistics (abs). A total of 2105 cases of suicide were registered at fssa, with a death rate of 13.3/100,000 population. Ncis data were available from 2003 to 2010, with 1542 suicides recorded (12.3/100,000 population). Abs data were available from 2003 to 2011, with 1366 deaths coded as suicides (12.4/100,000 population). Significant differences were found between local data on suicides and related data accrued nationally from the same population, with only 67.8% of local drug overdoses recorded on the ncis. Although this represents an australian-based study the conclusions have global applications. Thus, given the likely accuracy of local data, reliance on smaller, community-specific datasets in any country/jurisdiction may be of far greater use in analyzing and monitoring such complex cases.
189	2018	Nystad Tw;Fenstad Am;Furnes O;Fevang Bt	Predictors For Orthopaedic Surgery In Patients With Rheumatoid Arthritis: Results From A Retrospective Cohort Study Of 1010 Patients Diagnosed From 1972 To 2009 And Followed Up Until 2015	Objectives: to investigate how patient characteristics, time of diagnosis, and treatment affect the need for orthopaedic surgery in patients with rheumatoid arthritis (ra).Method: we reviewed the medical history of 1544 patients diagnosed with ra at haukeland university hospital in bergen, norway, from 1972 to 2009, of whom 1010 (mean age 57years, 69% women) were included in the present study. Relevant orthopaedic procedures were obtained from the norwegian arthoplasty register and the hospital's administrative patient records. In total, 693 procedures (joint synovectomies 22%, arthrodeses 21%, prostheses 41%, and forefoot procedures 12%) were performed in 315 patients. Survival analyses were completed to evaluate the impact of different factors such as age, gender, radiographic changes, and year of diagnosis, on the risk of undergoing surgery.results: patients diagnosed in 1972-1985 and 1986-1998 had a relative risk of undergoing surgery of 2.4 and 2.2 (p<0.001), respectively, compared to patients diagnosed in 1999-2009. Radiographic changes at diagnosis and female gender were also significant risk factors. Anti-rheumatic medication was significantly different in the three time periods.conclusion: patients with a diagnosis in the early years had a greatly increased risk of having orthopaedic surgery performed. This is probably due to the year of diagnosis being a proxy for the type and intensity of medical treatment.
190	2022	Martinho I;Rodrigues At;Guerreiro J;Rocha J;Sepodes B;Torre C	A Cross-Country Utilization Patterns Comparison Of High Expenditure Therapeutic Groups Between Portugal And Six European Countries: The Two Sides Of The Portuguese Coin	Background understanding variability in prescribing patterns through comparative drug utilization studies can contribute to improve an efficient, effective and safe use of medicines. Objectives to perform a cross-country comparison of consumption patterns of ambulatory high expenditure therapeutic groups between portugal and six european countries and simulate potential cost-saving scenarios through the adoption of the different prescribing patterns of studied countries. Methods cross-country comparison of 2019 drug consumption patterns between portugal, denmark, england, finland, the netherlands, norway, and spain. Analysis comprised antihypertensive drugs, glucose lowering drugs (gld), insulins, lipid lowering drugs (lld) and oral anticoagulants. Cost-saving analysis were performed using the portugal average annual cost/daily defined dose and the potential reduction in expenditure simulating other european countries consumption pattern scenarios. Results portugal had the lowest consumption uptake of metformin and the highest consumption of gld (30.1%) and lld (8.5% vs <3%) fixed-dose combinations. Annual cost-savings scenarios showed that portugal would have saved between 53 meuro and 305 meuro if it had the same prescribing patterns than norway or the netherlands, respectively. Conclusions different utilization patterns across countries were found. Although portugal has the lowest gross domestic product per capita among the countries studied, it had the highest uptake of newly and costly drugs.
191	2022	Hojlund M;Gudmundsson Ls;Andersen Jh;Saastamoinen Lk;Zoega H;Skurtveit So;Wastesson Jw;Hallas J;Pottegard A	Use Of Benzodiazepines And Benzodiazepine-Related Drugs In The Nordic Countries Between 2000 And 2020	Use of benzodiazepines (bz) and related drugs is subject to considerable debate due to problems with dependency and adverse events. We aimed to describe and compare their use across the nordic countries. Data on the use of clonazepam, bz-sedatives, bz-hypnotics, and benzodiazepine-related drugs (bzrd) in adults (>= 20 years) were obtained from nationwide registers in denmark, finland, iceland, norway, and sweden, 2000-2020. Main measures were therapeutic intensity (ti:ddd/1000 inhabitants [inhab.]/Day) and annual prevalence (users/1000 inhab./Year). Overall, ti of bz and related drugs decreased in all nordic countries from 2004 to 2020. However, there were considerable differences between countries in ti. In 2020, the ti of bz and related drugs ranged from 17 ddd/1000 inhab./Day in denmark to 93 ddd/1000 inhab./Day in iceland. Bzrd accounted for 55-78% of bz use in 2020, followed by bz sedatives at 20-44%, bz-hypnotics at <1-5%, and clonazepam at <1-2%. Annual prevalence of bz use increased with age in all countries, and the highest annual prevalence was observed among people >= 80 years. Overall, the use of bz and related drugs has decreased in all nordic countries from 2004 to 2020, however, with considerable differences in their use between countries. The highest prevalence was observed among the oldest age groups-despite warnings against their use in this population.
192	2020	Mehta N;Stenholm S;Mannisto S;Jousilahti P;Elo I	Excess Body Weight, Cigarette Smoking, And Type Ii Diabetes Incidence In The National Finrisk Studies	Purpose: we identify the individual and joint contributions of excess weight and cigarette smoking to national-level type ii diabetes (t2d) incidence and to educational and gender disparities therein filling an important gap in t2d epidemiology. Methods: based on the finrisk surveys conducted in 1997, 2002, and 2007 and linked to the finnish national drug reimbursement register through 2011, we used a regression-counterfactual approach to estimate the percentage of diagnosed drug-treated incident t2d cases attributable to excess body weight and cigarette smoking. Body mass index (bmi) and waist circumference were evaluated. Results: t2d incidence was 10.24 in men and 7.04 in women per 1000 person-years. Excess baseline bmi (>= 25.0 kg/m(2)) explained 69% and 63%, and smoking explained 9% and 14% of t2d incidence, in men and women, respectively. Most of the gender difference was explained by the risk factors. Approximately 90% in men and 98% in women of the higher t2d incidence among those in the lower versus upper third of the educational distribution was explained by excess bmi. The results were similar for waist circumference and lifetime maximum bmi. Conclusions: excess body weight is the main risk factor contributing to national-level t2d incidence and disparities by educational attainment and gender in a high-income population. (C) 2020 elsevier inc. All rights reserved.
193	2017	Hyseni L;Elliot-Green A;Lloyd-Williams F;Kypridemos C;O'flaherty M;Mcgill R;Orton L;Bromley H;Cappuccio Fp;Capewell S	Systematic Review Of Dietary Salt Reduction Policies: Evidence For An Effectiveness Hierarchy?	Background non-communicable disease (ncd) prevention strategies now prioritise four major risk factors: food, tobacco, alcohol and physical activity. Dietary salt intake remains much higher than recommended, increasing blood pressure, cardiovascular disease and stomach cancer. Substantial reductions in salt intake are therefore urgently needed. However, the debate continues about the most effective approaches. To inform future prevention programmes, we systematically reviewed the evidence on the effectiveness of possible salt reduction interventions. We further compared "downstream, agentic" approaches targeting individuals with "upstream, structural" policy-based population strategies. Methods we searched six electronic databases (cdsr, crd, medline, sci, scopus and the campbell library) using a pre-piloted search strategy focussing on the effectiveness of population interventions to reduce salt intake. Retrieved papers were independently screened, appraised and graded for quality by two researchers. To facilitate comparisons between the interventions, the extracted data were categorised using nine stages along the agentic/structural continuum, from "downstream" : dietary counselling (for individuals, worksites or communities), through media campaigns, nutrition labelling, voluntary and mandatory reformulation, to the most "upstream" regulatory and fiscal interventions, and comprehensive strategies involving multiple components. Results after screening 2,526 candidate papers, 70 were included in this systematic review (49 empirical studies and 21 modelling studies). Some papers described several interventions. Quality was variable. Multi-component strategies involving both upstream and downstream interventions, generally achieved the biggest reductions in salt consumption across an entire population, most notably 4g/day in finland and japan, 3g/day in turkey and 1.3g/day recently in the uk. Mandatory reformulation alone could achieve a reduction of approximately 1.45g/day (three separate studies), followed by voluntary reformulation (-0.8g/day), school interventions (-0.7g/day), short term dietary advice (-0.6g/day) and nutrition labelling (-0.4g/day), but each with a wide range. Tax and community based counselling could, each typically reduce salt intake by 0.3g/day, whilst even smaller population benefits were derived from health education media campaigns (-0.1g/day). Worksite interventions achieved an increase in intake (+0.5g/day), however, with a very wide range. Long term dietary advice could achieve a -2g/day reduction under optimal research trial conditions; however, smaller reductions might be anticipated in unselected individuals. Conclusions comprehensive strategies involving multiple components (reformulation, food labelling and media campaigns) and "upstream" population-wide policies such as mandatory reformulation generally appear to achieve larger reductions in population-wide salt consumption than "downstream", individually focussed interventions. This 'effectiveness hierarchy' might deserve greater emphasis in future ncd prevention strategies.
194	2021	Turunen S;Vaarasmaki M;Leinonen M;Gissler M;Mannisto T;Suvanto E	The Increased Trend Of Medical Treatment For Thyroid Diseases During Pregnancy: A 13-Year National Study	Objective: thyroid dysfunction affects up to 5-7% of all pregnancies. The rates of thyroid hormone use in nonpregnant population have substantially increased in recent years. The aim of this study was to assess possible changes in the use of levothyroxine substitution and antithyroid drugs over time in pregnant women. Methods: the study data consisted of all singleton pregnancies (n = 736,873) between 2004 and 2016 in finland collected from the finnish medical birth register. The prescription register and special refund entitlement register provided information on levothyroxine and antithyroid drug purchases. The annual rates of levothyroxine and antithyroid drug prescription redemptions were explored to estimate changes in exposure rates to thyroid medication from 2004 to 2016. Joinpoint regression analyses were performed to explore interannual variability in levothyroxine and antithyroid drug treatment. Results: there was more than a five-fold increase in levothyroxine use during the study period; in 2004, 1.1% of pregnant women had levothyroxine treatment, and by 2016, the prevalence increased to 6.2%. In addition, we observed a slight increase in antithyroid medication during pregnancy, but antithyroid drug use during pregnancy overall was very rare. In 2004, 0.05% of pregnant women used antithyroid drugs, and by 2016, this percentage had increased to 0.14%. Conclusions: our study shows that the rate of levothyroxine use in pregnancy has markedly increased. This suggests that tracing and screening relevant patients and awareness of thyroid disorders on pregnancy and their significance for the pregnancy outcome have increased and the threshold to treat thyroid disorders has declined.
195	2019	Klein Ey;Tseng Kk;Pant S;Laxminarayan R	Tracking Global Trends In The Effectiveness Of Antibiotic Therapy Using The Drug Resistance Index	Background evaluating trends in antibiotic resistance and communicating the results to a broad audience are important for dealing with this global threat. The drug resistance index (dri), which combines use and resistance into a single measure, was developed as an easy-to-understand measure of the effectiveness of antibiotic therapy. We demonstrate its utility in communicating differences in the effectiveness of antibiotic therapy across countries. Methods we calculated the dri for countries with data on antibiotic use and resistance for the disease-causing organisms considered by the who as priority pathogens: acinetobacter baumannii, escherichia coli, klebsiella pneumoniae, pseudomonas aeruginosa, staphylococcus aureus, enterococcus faecium and enterococcus faecalis. Additionally, we estimated pooled worldwide resistance rates for these pathogens. Results 41 countries had the requisite data and were included in the study. Resistance and use rates were highly variable across countries, but a. Baumannii resistance rates were uniformly higher, on average, than other organisms. High-income countries, particularly sweden, canada, norway, finland and denmark, had the lowest dris; the countries with the highest dris, and therefore the lowest effectiveness of antibiotic therapy, were all lowincome and middle-income countries. Conclusions the dri is a useful indicator of the problem of resistance. By combining data on antibiotic use with resistance, it captures a snapshot of how the antibiotics a country typically uses match their resistance profiles. This single measure of the effectiveness of antibiotic therapy provides a means of benchmarking against other countries and can, over time, indicate changes in drug effectiveness that can be easily communicated.
196	2021	Sahman M;Mugosa S;Rancic N	Utilization Of Mycophenolic Acid, Azathioprine, Tacrolimus, Cyclosporin, Sirolimus, And Everolimus: Multinational Study	Background: organ transplantations are difficult, complicated and very expensive interventions. In order to preserve the transplanted organs, it is necessary to provide medical care to the patients in terms of immunosuppression. According to the guidelines, the first-line therapy choices for achieving immunosuppression after transplantation are tacrolimus, cyclosporine, mycophenolic acid, azathioprine, sirolimus, everolimus and corticosteroids. The aim of our study was to examine the utilization of this drugs in montenegro and to compare the results with the ones from finland, croatia, and serbia. Methods: in our investigation we used anatomical therapeutic chemical/defined daily dose (atc/ddd) methodology. Prices per ddd of drugs are presented in euros (euro). Results: in all observed countries, there is a positive trend in the consumption of all 6 drugs during the analyzed period. The prices per ddd of these drugs generally show a negative trend. Tacrolimus and mycophenolic acid in montenegro recorded the largest reduction in the price per ddd. Price per one ddd of tacrolimus decreased from euro13.28 in 2009 to euro5.11 in 2019, thus by about 260%, and as regards mycophenolic acid, the price per one ddd decreased from euro9.59 in 2009 to euro 3.36 in 2019, thus by almost 300%. Conclusion: despite the reduction in the price per ddd, drugs that are used as immunosuppressants are showing increasing costs from year to year. Since these drugs are expensive, they participate in a significant percentage in the budget for medicines in each country.
197	2018	Da Silva Re;Amato Aa;Sousa Td;De Carvalho Mr;Novaes Mrcg	The Patient's Safety And Access To Experimental Drugs After The Termination Of Clinical Trials: Regulations And Trends	Participants' rights and safety must be guaranteed not only while a clinical trial is being conducted but also when a clinical trial finishes. The criteria for post-trial access to experimental drugs, however, are unclear in various countries. The objectives of this study were (i) to ascertain if there were regulations or guidelines related to patients' access to drugs after the end of clinical trials in the countries selected in the study and (ii) to analyze trends in post-trial access in countries classified by their level of economic development. This study is a retrospective review. The data are from the records of clinical trials from 2014 registered in the world health organization's international clinical trials registry platform (ictrp) database. Among the countries selected, provision of drugs post-trial is mandatory only in argentina, brazil, chile, finland, and peru. The plans for post-trial access tend to be more present in low- and middle-income and upper middle-income countries, in comparison with high-income countries. Studies involving vulnerable populations are 2.53 times more likely to have plans for post-trial access than studies which do not. The guaranteeing of post-trial access remains mandatory in few countries. Considering that individuals seen as vulnerable have been included in clinical trials without plans for post-trial access, stakeholders must discuss the need to develop regulations mandating the guaranteeing of post-trial access in specified situations.
198	2018	Soppi A;Heino P;Kurko T;Maljanen T;Saastamoinen L;Aaltonen K	Growth Of Diabetes Drug Expenditure Decomposed A Nationwide Analysis	Objectives: the aim of this study was to quantify different factors underlying the growth of diabetes drug expenditure in finland. Methods: data representing purchases of antidiabetic agents between 2003 and 2015 were extracted from a nationwide prescription register. By using fisher's ideal indexes, the per capita expenditure growth for both insulins and non-insulin antidiabetic agents was decomposed into six different determinants: purchase volume, purchase size, switches between therapeutic classes, switches within therapeutic classes, unit costs and switches to generic alternatives. Results: between 2003 and 2015, the per capita expenditure on insulins increased by (sic) 8.64 and on non-insulins by (sic)13.73. For insulins, holding other factors constant, change in the number of purchases represented a (sic)4.67 increase in expenditure, change in the size of purchases a (sic)4.33 increase and switches between therapeutic classes a (sic)4.07 increase. For non-insulins, change in the number of purchases represented a (sic)10.22 increase in expenditure and switches between therapeutic classes, a (sic)10.17 increase. Changes in purchase size increased the non-insulin per capita expenditure by (sic)1.48. For both insulins and non-insulins, changes in prices and product level switches had decreasing effects on expenditures. Conclusions: the main drivers of the growth in diabetes drug expenditure were volume growth and switches to newer and more expensive drugs. Price changes, however, had a decreasing effect on the overall diabetes drug expenditure. (C) 2018 elsevier b.v. All rights reserved.
199	2016	Saarinen Mm;Sillanpaa M;Schmidt D;Virta Lj	Long-Term Changes In The Incidence Of Childhood Epilepsy. A Population Study From Finland	Background: the incidence of childhood epilepsy has changed during the past decades, but it is unclear whether it increased or decreased. Methods: changes in drug-treated childhood epilepsy between 1968 and 2012 were evaluated using the finnish nationwide register of all children, aged <= 15 years, on antiepileptic drugs (aeds) prescribed for the treatment of epilepsy. The first registered entitlement to full-refundable aeds was used as a proxy for newly diagnosed epilepsy. Incidence densities were calculated as ratios of annual new cases per 100,000 person-years in each calendar year during 1968 to 2012. Results: the annual incidence density of newly treated childhood epilepsy increased from 35 in the 1960s to 87 per 100,000 person-years in the 1990s and decreased thereafter to 61 per 100,000 person-years. Since 1996, the incidence density decreased 1-2% per year in children aged <1, 1-5, or 6-10 years (all 95% confidence intervals within 0.3%-3%), while no substantial change was seen in older children. Conclusion: the incidence of drug-treated childhood epilepsy from the late 1960s to the early 1990s distinctly increased. The reasons for the increase are not fully understood but may include increasing ascertainment through improved diagnosis and a wider acceptance of aed treatment. Since the 1990s, a slight decline can be seen, probably reflecting the recent improvement in child health and safety. (C) 2016 elsevier inc. All rights reserved.
200	2017	Taipale H;Koponen M;Tanskanen A;Lavikainen P;Tolppanen Am;Sund R;Tiihonen J;Hartikainen S	Use Of Benzodiazepines And Related Drugs Is Associated With A Risk Of Stroke Among Persons With Alzheimer's Disease	The aim of our study was to investigate the risk of any, ischemic, and hemorrhagic stroke associated with incident benzodiazepine and related drug (bzdr) use among community-dwelling individuals with alzheimer's disease (ad). Data from the medalz cohort including all community-dwelling persons newly diagnosed with ad between 2005 and 2011 in finland were utilized. Incident bzdr users were identified with a 1-year washout period for previous use. Persons with a previous stroke were excluded, resulting in a final study sample of 45050 individuals. Incident any, ischemic, and hemorrhagic strokes were identified from the hospital discharge and causes of death registers. The risk of stroke between time on bzdrs was compared with nonuse time with cox proportional hazard models. During the follow-up, 21.9% (n=9879) of persons started bzdr use. Compared with nonuse, bzdr use was associated with an increased risk of any stroke [adjusted hazard ratio (ahr): 1.21; 95% confidence interval (ci): 1.04-1.40] and ischemic stroke (ahr: 1.21; 95% ci: 1.02-1.44), but the association between bzdr use and hemorrhagic stroke did not reach significance (ahr: 1.26; 95% ci: 0.91-1.74). Z-drug use was associated with a similar risk as benzodiazepine use. In conclusion, bzdr use was associated with an increased risk of stroke among older individuals with ad.
201	2020	Cohen Jm;Cesta Ce;Furu K;Einarsdottir K;Gissler M;Havard A;Hernandez-Diaz S;Huybrechts Kf;Kieler H;Leinonen Mk;Li J;Reutfors J;Schaffer A;Selmer R;Yu Yf;Zoega H;Karlstad O	Prevalence Trends And Individual Patterns Of Antiepileptic Drug Use In Pregnancy 2006-2016: A Study In The Five Nordic Countries, United States, And Australia	Purpose to describe recent international trends in antiepileptic drug (aed) use during pregnancy and individual patterns of use including discontinuation and switching. Methods we studied pregnancies from 2006 to 2016 within linked population-based registers for births and dispensed prescription drugs from denmark, finland, iceland, norway, sweden, and new south wales, australia and claims data for public and private insurance enrollees in the united states. We examined the prevalence of aed use: the proportion of pregnancies with >= 1 prescription filled from 3 months before pregnancy until birth, and individual patterns of use by trimester. Results prevalence of aed use in almost five million pregnancies was 15.3 per 1000 (n = 75 249) and varied from 6.4 in sweden to 34.5 per 1000 in the publicly-insured us population. Aed use increased in all countries in 2006-2012 ranging from an increase of 22% in australia to 104% in sweden, and continued to rise or stabilized in the countries in which more recent data were available. Lamotrigine, clonazepam, and valproate were the most commonly used aeds in the nordic countries, united states, and australia, respectively. Among aed users, 31% only filled a prescription in the 3 months before pregnancy. Most filled a prescription in the first trimester (59%) but few filled prescriptions in every trimester (22%). Conclusions use of aeds in pregnancy rose from 2006 to 2016. Trends and patterns of use of valproate and lamotrigine reflected the safety data available during this period. Many women discontinued aeds during pregnancy while some switched to another aed.
202	2020	Salonen Ph;Salonen Jh;Saila H;Helminen M;Linna M;Kauppi Mj	Decreasing Trend In The Incidence Of Serious Pneumonias In Finnish Children With Juvenile Idiopathic Arthritis	Objectives children with juvenile idiopathic arthritis (jia) may be predisposed to serious pneumonia due to modern disease-modifying anti-rheumatic treatment. In this nationwide retrospective study with clinical data, we describe the pneumonia episodes among children with jia. Methods patients under 18 years of age with jia and pneumonia during 1998-2014 were identified in the national hospital discharge register in finland. Each individual patient record was reviewed, and detailed data on patients with jia and pneumonia were retrieved, recorded, and analyzed. If the patient was hospitalized or received intravenous antibiotics, the pneumonia was considered serious. Results there were 157 episodes of pneumonia among 140 children with jia; 111 episodes (71%) were serious (80% in 1998-2006 and 66% in 2007-2014). The mean age of the patients was 9 years. Forty-eight percent had active jia and 46% had comorbidities. Disease-modifying anti-rheumatic drugs (dmard) were used at the time of 135 episodes (86%): methotrexate (mtx) by 62% and biologic dmards (bdmard) by 30%. There was no significant difference in the use of bdmards, mtx and glucocorticoids between the patient groups with serious and non-serious pneumonia episodes. During six of the episodes, intensive care was needed. Two patients (1.3%) died, the remaining ones recovered fully. Conclusions although the incidence of pneumonia and the use of immunosuppressive treatment among children with jia increased from 1998 to 2014, the proportion of serious pneumonias in these patients decreased. There was no significant difference in the use of anti-rheumatic medication between patients with serious and non-serious pneumonia.
203	2020	Pulkki J;Aaltonen M;Raitanen J;Rissanen P;Jylha M;Forma L	Purchases Of Medicines Among Community-Dwelling Older People: Comparing People In The Last 2 Years Of Life And Those Who Lived At Least 2 Years Longer	While it is known that those who are living their last years are frequent users of social and health services, research about medicines at the end of life is scarce. We examined whether the proportions of purchasers and the types of prescription medicines purchased during a 2-year period differed between community-dwelling old people who died (decedents) in 2002, 2006 or 2011 and old people who lived at least 2 years longer (survivors) in finland. We also examined how those differences changed over time. The study population was identified from nationwide registers and consisted of 174,097 community-dwelling people who were 70 years of age or older. Of these, 81,893 were decedents and 92,204 survivors. Data on purchases of medicines were gathered from the finnish prescription database. Along with descriptive analyses, binary logistic regression analysis was used to find the association between decedent status and the purchase of medicines in general and different categories of medicines in particular. Almost all community-dwelling decedents and survivors purchased medicines at least once during the 2-year period. Over time, the proportion of purchasers increased in both groups but especially among survivors, thereby reducing the differences between the groups. However, the probability of purchasing medicines in general and different categories of medicine in particular remained significantly higher for decedents than for survivors after adjustments. This study shows that purchases of medication are concentrated at the end of life, as is the use of social and health services. However, the differences between decedents and survivors diminish over time.
204	2021	Perhoniemi R;Tuulio-Henriksson A;Blomgren J;Laaksonen M	Consumption Of Psychotropic Drugs Among Disability Pension Applicants With Mental Disorders: Comparing Awarded And Rejected Applicants In Finland	Purpose psychotropic drug consumption as a proxy measure of mental health problems during a disability pension process has only been studied among awarded applicants. This study examined psychotropic drug purchase trajectories among awarded and rejected disability pension applicants. Analyses were conducted in different diagnostic and sociodemographic groups. Methods a representative 70% sample of finnish adults applying for disability pension due to a mental disorder in 2009-2011 (n = 18,087) was followed for 4 years in 3-month periods both before and after the pension decision. Register data on purchased drugs measured in defined daily doses (ddds), gender, age, occupational class, unemployment history, and diagnostic group were used. The ddd levels and trends were analyzed using growth curve models. Results psychotropic drug purchases increased before the pension decision and decreased gradually thereafter among both awarded and rejected applicants. The average ddd level was higher for rejected than awarded applicants before the decision but lower thereafter. The high pre-decision level for rejected applicants was explicit with a lower socioeconomic status. The pre-decision increase in ddds was steeper for awarded applicants. Changes in ddds before and after the decision were most prominent for depression, bipolar disorders, schizophrenia, and anxiety disorders. Conclusion awarded and rejected disability pension applicants differed partly in their trajectories of psychotropic drug consumption. For awarded applicants, the steep rise of consumption prior to the award possibly reflects worsening occupational capacity. Early high consumption for rejected applicants signals long running mental health problems and calls for earlier support.
205	2022	Leiviska T;Risteela S	Analysis Of Pharmaceuticals, Hormones And Bacterial Communities In A Municipal Wastewater Treatment Plant - Comparison Of Parallel Full-Scale Membrane Bioreactor And Activated Sludge Systems	In this study, the occurrence of pharmaceuticals, hormones and bacterial community structures was studied at a wastewater treatment plant in finland having two different parallel treatment lines: conventional activated sludge (cas) treatment with a sedimentation stage, and a membrane bioreactor (mbr). Influent and effluents were sampled seven times over a period of one year. The bacterial communities of the influent samples showed a high degree of similarity, except for the february sample which had substantially lower diversity. There was significant fluctuation in the species richness and diversity of the effluent samples, although both effluents showed a similar trend. A marked decrease in diversity was observed in effluents collected between august and november. The initiation of nitrogen removal as a result of an increase in temperature could explain the changes in microbial community structures. In overall terms, suspended solids, bacteria and total organic matter (cod and bod) were removed to a greater extent using the mbr, while higher tot-n, tot-p and nitrate removal rates were achieved using the cas treatment. Estrone (e1) concentrations were also consistently at a lower level in the mbr effluents (<0.1-0.68 ng/l) compared to the cas effluents (1.1-12 ng/l). Due to the high variation in the concentrations of pharmaceuticals, no clear superiority of either process could be demonstrated with certainty. The study highlights the importance of long-term sampling campaigns to detect variations effectively.
206	2020	Vuori Ma;Laukkanen Ja;Pietila A;Havulinna As;Kahonen M;Salomaa V;Niiranen Tj	The Validity Of Heart Failure Diagnoses In The Finnish Hospital Discharge Register	Background: contemporary validation studies of register-based heart failure diagnoses based on current guidelines and complete clinical data are lacking in finland and internationally. Our objective was to assess the positive and negative predictive values of heart failure diagnoses in a nationwide hospital discharge register. Methods: using finnish hospital discharge register data from 2013-2015, we obtained the medical records for 120 patients with a register-based diagnosis for heart failure (cases) and for 120 patients with a predisposing condition for heart failure, but without a heart failure diagnosis (controls). The medical records of all patients were assessed by a physician who categorized each individual as having heart failure (with reduced or preserved ejection fraction) or no heart failure, based on the definition of current european society of cardiology heart failure guidelines. Unclear cases were assessed by a panel of three physicians. This classification was considered as the clinical gold standard, against which the registers were assessed. Results: register-based heart failure diagnoses had a positive predictive value of 0.85 (95% ci 0.77-0.91) and a negative predictive value of 0.83 (95% ci 0.75-0.90). The positive predictive value decreased when we classified patients with transient heart failure (duration <6 months), dialysis/lung disease or heart failure with preserved ejection fraction as not having heart failure. Conclusions: heart failure diagnoses of the finnish hospital discharge register have good positive predictive value and negative predictive value, even when patients with pre-existing heart conditions are used as healthy controls. Our results suggest that heart failure diagnoses based on register data can be reliably used for research purposes.
207	2018	Vahaniemi A;Warwick-Smith K;Hatonen H;Valimaki M	A National Evaluation Of Community-Based Mental Health Strategies In Finland	Objective: high-quality mental health care requires written strategies to set a vision for the future, yet, there is limited systematic information available on the monitoring and evaluation of such strategies. The aim of this nationwide study is to evaluate local mental health strategies in community-based mental health services provided by municipalities. Design and setting: mental health strategy documents were gathered through an online search and an e-mail survey of the local authorities of all finnish mainland municipalities (n = 320). Participants: out of 320 municipalities, documents for 129 municipalities (63 documents) were included in the study. Intervention: the documents obtained (n = 63) were evaluated against the world health organization checklist for mental health strategies and policies. Main outcome measures: evaluation of the process, operations and content of the documents, against 31 indicators in the checklist. Results: out of 320 finnish municipalities, 40% (n = 129) had a mental health strategy document available and 33% (n = 104) had a document that was either in preparation or being updated. In these documents, priorities, targets and activities were clearly described. Nearly all (99%) of the documents suggested a commitment to preventative work, and 89% mentioned a dedication to developing community-based care. The key shortfalls identified were the lack of consideration of human rights (0%), the limited consideration of research (5%) and the lack of financial planning (28%) to successfully execute the plans. Of the documents obtained, 60% covered both mental health and substance abuse issues. Conclusions: this study contributes to the limited evidence base on health care strategy evaluations. Further research is needed to understand the potential impact of policy analysis.
208	2019	Muilu P;Rantalaiho V;Kautiainen H;Virta Lj;Eriksson Jg;Puolakka K	Increasing Incidence And Shifting Profile Of Idiopathic Inflammatory Rheumatic Diseases In Adults During This Millennium	To explore the trends in the incidence of idiopathic inflammatory rheumatic diseases (iirds) after the turn of the millennium. From a nationwide register maintained by the social insurance institution of finland, we collected all adult patients with iirds granted a new special reimbursement for anti-rheumatic drugs between 2000 and 2014. Temporal trends in the incidences of various iirds were estimated in three 5-year intervals. A total of 58,405 adult patients were identified. Between 2000-2004 and 2010-2014, the age-adjusted incidence rate of iirds increased from 114 to 116/100000 [incidence rate ratio (irr) 1.03 (95% ci 1.01 to 1.06)] in women and from 67 to 69/100,000 [irr 1.10 (95% ci 1.06-1.14)] in men. The incidence of seropositive rheumatoid arthritis (ra) remained stable while that of seronegative ra decreased. For other diagnoses, the incidences either increased (unspecified arthritis, psoriatic arthritis, spondyloarthritis), remained stable (reactive arthritis), or decreased (sle and the group of diseases with the icd-10 code m35). The gender difference in spondyloarthritis leveled as the incidence in women increased at a higher rate than in men. Mean age at iird diagnosis decreased among women. The total age-adjusted incidence of iirds has gradually increased, due to the increase in unspecified arthritis, psoriatic arthritis, and spondyloarthritis. This, in addition to the ascending number of individuals at risk in the population, translates into a growing burden to the health care system.
209	2021	Elfving P;Kariniemi S;Kautiainen H;Virta Lj;Kaipiainen-Seppanen O;Puolakka K	Mortality In Sle Patients Compared With Population Controls In Finland In Years 2000-2015	Objective to estimate the risk of mortality in the finnish incident sle cohort in a 16-year period compared with the general population. Methods adults with new-onset sle between 1 january 2000 and 31 december 2014 identified from the national drug reimbursement register and their individually matched controls from the population register centre were followed up until death or 31 december 2015. Data on deaths were retrieved from the national causes of death register. Comorbidities and education were obtained by linkage to the other national registries. Results a total of 1006 patients with incident sle and 3005 population controls were found (mean follow-up 8.6years). Of these, 98 sle patients subsequently died. Their 5 -, 10-, and 15-year survival rates were 95.0% (95% ci: 93.3, 96.2), 88.8% (86.2, 91.0), and 82.1% (77.6, 85.8), respectively. Crude hazard ratio (hr) was 1.61 (95% ci: 1.26, 2.06), adjusted for education level was almost the same 1.61 (95% ci: 1.26, 2.05). After adjustment for comorbidities and education at baseline, the difference in mortality disappeared: hr 1.14 (95% ci: 0.88, 1.48). The leading causes of death were cardiovascular diseases (cvds) (33%), malignancies (27%) and neurological diseases (10%). Subhazard ratio for cvd deaths was 1.28 (95% ci: 0.85, 1.93), adjusted for comorbidities and education 0.88 (95% ci: 0.56, 1.39). Conclusions these results suggest that the increased mortality in sle patients is highly associated with comorbidities present at diagnosis. This underlines the importance to screen and treat comorbidities and disease actively without delays.
210	2019	Lin Nh;Yang Hw;Su Yj;Chang Cw	Herb Induced Liver Injury After Using Herbal Medicine A Systemic Review And Case-Control Study	In taiwan, traditional herbal medication was included in taiwan's national health insurance (nhi) system since 1996 and in 9 out of 10 hospitals have developed their own departments of traditional medicine. This study aims to address the herb-induced liver injury (hili) after using herbal medicine on the relationship between age, gender, epidemiology, laboratory data, pathogenesis, mobility, and mortality. We searched the pubmed database with "hepatitis after herbal medicine" and "in human" till 2018 april and returned 163 articles in a systemic review manner. Two cases reports describing in-vitro liver injury were excluded. Reviews and articles without the detailed report, laboratory data and history were excluded from this study. In the end, there were 53 articles enrolled in this study. These enrolled literatures are from france (n=13), germany (n=12), switzerland (n=5) united states of america (n=4), korea (n=4), hong kong (n=4), greece (n=3), china (n=2), canada (n=1), italy (n=1), thailand (n=1), finland (n=1), taiwan (n=1), and japan (n=1). The data were analyzed with a commercial statistical software stata/se 12.0 program stata corporation, college station, tx, usa. Statistical chi(2) tests were performed and the significance was set at a p value of less than .05 (2-tailed). The ages are ranged from 15 to 78 years with the mean +/- sd (standard deviation) of 48.3 +/- 16.2 years old. The majority of cases are female (n=37). In elderly, man is more commonly seen than female in hili (37.5% vs 10.5%, p=.02). Female is vulnerable to cholestatic type of hili than male (21.1% vs 0.0%, p=.04). Of all the cases in hili, using pure substance are more commonly seen than mixed substance (p=.02). In gender, male patients have higher alanine aminotransferase (gpt) (iu/l) level in hili than female ones (1560 +/- 819 vs 1047 +/- 706, p=.03). In hili, the female is more commonly seen than male, but less than male in the elderly. The pure substance more often happens to hili than mixture substance. Female is predominant in the cholestatic type of hili. The major prevalence of hili is in europe rather than asia. Hili cases in europe is 2.75-fold than in asia. This could be due to fewer reports of the herb induced liver injury in asia compared to europe. Prevention of hili is the best policy, because it needs to take 78 +/- 59 days to recover.
211	2017	Virta Lj;Saarinen Mm;Kolho Kl	Inflammatory Bowel Disease Incidence Is On The Continuous Rise Among All Paediatric Patients Except For The Very Young: A Nationwide Registry-Based Study On 28-Year Follow-Up	Background and aims: the burden of inflammatory bowel disease [ibd] in health care is high. We conducted research on the temporal changes in the incidence of paediatric ibd [pibd] using nationwide registry-based data in finland. Methods: all pibd cases diagnosed at less than 20 years of age during 1987-2014 [in total, 5415 patients] were retrieved from a database documenting reimbursements for drug costs. Incidence rates were calculated by dividing the number of annual new pibd cases by the size of the paediatric population at risk during each calendar year. Temporal trends in the incidences of pibd and its subtypes, ulcerative colitis [uc] and crohn's disease [cd], were estimated using poisson regression analyses. Results: the mean annual incidence of pibd increased from 7/100 000 for the years 1987-1990 to 23/100 000 for the years 2011-2014. The average rate of increase was 4.1% (95% confidence interval [ci]: 3.6-4.5) per annum. In the period 2000-2014, the increase rate in the annual incidence of uc [3.8%; 95% ci: 2.7-5.0], was steeper than for cd [2.5%; 95% ci: 1.0-3.8]. The most pronounced increase occurred in uc among adolescents aged 16-19 years [4.8%; 95% ci: 2.9-6.7]. For children less than 10 years of age, the rate of change remained low. Approximately 0.17% of the birth cohort for the years 1999-2000 was diagnosed with pibd by the age of 14 years. Conclusion: the incidence of pibd is primarily increasing among adolescents, challenging the identification of the possible environmental triggers for the disease.
212	2022	Di Giuseppe D;Lindstrom U;Aaltonen K;Relas H;Provan S;Gudbjornsson B;Hetland Ml;Askling J;Kauppi M;Geirsson Aj;Chatzidionysiou K;Jorgensen Ts;Dreyer L;Michelsen B;Jacobsson L;Glintborg B	The Occurrence Of Multiple Treatment Switches In Axial Spondyloarthritis. Results From Five Nordic Rheumatology Registries	Objectives in axial spondyloarthritis (axspa), switching between multiple biologic or targeted synthetic (b/ts-) dmards might indicate difficult-to-treat disease. We aimed to explore the occurrence of multiple switching in routine care axspa patients using various definitions, and to identify associated clinical characteristics upon start of first b/tsdmard (baseline). Methods observational cohort study including patients with axspa starting a first-ever b/tsdmard 2009-2018 based on data from five biologic registries (denmark/sweden/finland/norway/iceland). Comorbidities and extra-articular manifestations were identified through linkage to national registries. Multi-switching was defined in overlapping categories according to b/tsdmard treatment history: treatment with >= 3, >= 4 or >= 5 b/tsdmards during follow-up. We explored the cumulative incidence of patients becoming multi-switchers with >= 3 b/tsdmards stratified by calendar-period (2009-2011, 2012-2013, 2014-2015, 2016-2018). In the subgroup of patients starting a first b/tsdmard 2009-2015, baseline characteristics associated with multi-switching (within 3 years' follow-up) were explored using multiple logistic regression analyses. Results among 8398 patients included, 6056 patients (63% male, median age 42 years) started a first b/tsdmard in 2009-2015, whereof proportions treated with >= 3, >= 4 or >= 5 b/tsdmards within 3 years' follow-up were 8%, 3% and 1%, respectively. Calendar-period did not affect the cumulative incidence of multi-switching. Baseline characteristics associated with multi-switching (>= 3 b/tsdmards) were female gender, shorter disease duration, higher patient global score, comorbidities and having psoriasis but not uveitis. Conclusion in this large nordic observational cohort of axspa patients, multiple switching was frequent with no apparent time-trend. Clinical associated factors included gender, but also previous comorbidities and extra-articular manifestations illustrating the ongoing challenge of treating this patient group.
213	2022	Ruokolainen O;Ollila H;Karjalainen K	Correlates Of E-Cigarette Use Before And After Comprehensive Regulatory Changes And E-Liquid Flavour Ban Among General Population	Introduction in 2016, the finnish tobacco act was revised to harmonise e-cigarette regulations with the eu tobacco products directive. Unlike before, the sale of nicotine-containing e-liquids was allowed while additional national regulations included, for example, a ban for other than unflavoured and tobacco-flavoured e-liquids. This study examines the correlates of e-cigarette use before and after the comprehensive regulatory change, and characteristics and correlates of flavoured e-cigarette use after the flavour ban in the general finnish population. Methods repeated cross-sectional population-based drug surveys for 15-69-year-olds in 2014 (n = 3485; 50% response rate) and in 2018 (n = 3229; 46%). Correlates of e-cigarette use were studied with logistic regression models. Results current e-cigarette use remained infrequent (approximately 2%) and the correlates of e-cigarette use varied only slightly between the study years. In 2018, of past-year e-cigarette users (n = 316), 43% used unflavoured e-liquids, 24% used tobacco and 43% used other flavours, fruits being the most common. In univariate models, demographic variables, smoking and e-cigarette use-related factors were associated with flavoured e-cigarette use. In multivariable models, those who used e-cigarettes to experiment used unflavoured e-cigarettes more likely than other than tobacco flavours (odds ratio 3.00, 95% confidence interval 1.15-7.82). Discussion and conclusions in finland, the regulated entry of nicotine-containing e-liquids to retail sales has not led to increased e-cigarette use in the general population. After the flavour ban, other than tobacco-flavoured e-cigarette use still occurs. The use of flavoured e-cigarettes is associated with reasons for e-cigarette use. Flavoured e-cigarette use and its correlates warrant further monitoring.
214	2022	Poranen J;Koistinaho A;Tanskanen A;Tiihonen J;Taipale H;Lahteenvuo M	Twenty-Year Medication Use Trends In First-Episode Bipolar Disorder	Objectives to study the medication use patterns in patients newly diagnosed with bipolar disorder (bd) in finland during the past 20 years. Methods all persons diagnosed with bd between 1996 and 2018, aged 16-65 years, with no previous bd diagnosis were identified from nationwide finnish registers (n = 26,395). The point prevalences of medication use were observed up until 5 years after the first diagnosis. Five sub-cohorts according to calendar year of first diagnosis were also formed and the prevalence of medication use was compared between sub-cohorts 3 months after diagnosis. Medication data were modeled with the pre2dup-method using dispensing data. Results the prevalence of overall medication use declined during the 5-year follow-up period in the total cohort. The highest prevalence of use was seen 3 months after diagnosis for the three main medication classes-antidepressants (40.8%), antipsychotics (30.8%) and mood stabilizers (29.2%). The prevalence of lithium use varied between 5.9% and 6.5% during the 5 years in the total cohort, and the lowest prevalence of use at 3 months was seen in sub-cohort diagnosed in 2016-2018 (4.1%) versus 12.1% in 1996-2000 sub-cohort. The prevalence of benzodiazepine use was between 12.4% and 13.5% and the prevalence of z-drugs was between 7.3% and 7.9% during the 5 years. The prevalence of long-acting injectable antipsychotic (lai) use was the highest in patients diagnosed in 2016-2018, although still only 0.8%. Conclusions (i) the use of antidepressants is too prevalent, (ii) the use of lithium is declining and needs to be increased, and (iii) lais are markedly underutilized as compared to their oral counterparts.
215	2016	Vogler S;Vitry A;Babar Zud	Cancer Drugs In 16 European Countries, Australia, And New Zealand: A Cross-Country Price Comparison Study	Background cancer drugs challenge health-care systems because of their high prices. No cross-country price comparison of cancer drugs for a large number of countries has been published. We aimed to survey the prices of cancer drugs in high-income countries (europe, australia, and new zealand). Methods based on comparability in terms of the economic situation and of the pharmaceutical system, we surveyed official list prices per unit at ex-factory price level of 31 originator cancer drugs in 16 european countries, australia, and new zealand as of june, 2013. Drug price data for the european countries were provided by the pharma price information (ppi) service; australian and new zealand drug price data were retrieved from the respective pharmaceutical schedules. Findings in austria, denmark, finland, germany, italy, norway, sweden, and the uk, price information was available for all or all but one drug surveyed whereas the availability of price data was restricted for some drugs in other countries, especially in new zealand and portugal. The difference of a drug price between the highest priced country and the lowest priced country varied between 28% and 388%. A few drugs had lower outliers, especially greek and uk prices, and upper outliers (particularly prices in switzerland, germany, and sweden). Overall, greek prices ranked at a low level, whereas sweden, switzerland, and germany showed price data in similarly high ranges. Interpretation our results showed variations in ex-factory prices of originator cancer drugs in the 18 surveyed countries. However, the surveyed prices do not include discounts negotiated by funding organisations because these discounts are confidential. Because pricing authorities can also only use these official undiscounted prices when they set prices through the common policy of external price referencing, they risk overpaying. Our findings provide an evidence base for policy makers to decide whether further policy measures related to drug prices are needed.
216	2022	Rinkinen Mo;Roitto Hm;Ohman Hr;Kautiainen Hj;Tilvis Rs;Strandberg Te;Pitkala Kh;Aalto Ul	Temporal Trends Over Two Decades In The Use Of Anticholinergic Drugs Among Older Community-Dwelling People In Helsinki, Finland	Background knowledge of the adverse effects of drugs with anticholinergic properties (daps) has increased in recent decades. However, research on the temporal trends of the clinical use of daps is still sparse. Objectives the aim of this study was to investigate the temporal trends of dap use over two decades in the older community-dwelling population and to explore the medication classes contributing to the use of daps. Methods the study involved random samples of >= 75-year-old community-dwelling helsinki citizens in 1999, 2009, and 2019 from the helsinki ageing study. A postal questionnaire inquired about their health, functioning, and medications. The medications were categorized as daps according to duran's list. In addition, we grouped daps into various medication groups. Results the prevalence and burden of daps on duran's list showed a decreasing trend over the years. In 1999 the prevalence was 20% and the burden 0.35, in 2009 they were 22% and 0.35, respectively, and in 2019 they were 16% and 0.23, respectively. There were no differences in how the 75- and 80-year-olds used daps compared with those aged 85 years and older. The proportion of typical antipsychotics, benzodiazepines, hypnotics, urinary antispasmodics, and asthma/chronic obstructive pulmonary disease medications decreased, whereas the proportion of atypical antipsychotics, antidepressants, strong opioids, and antihistamines increased. In particular the use of mirtazapine increased-to 3.9% in 2019. In 2019 the three most prevalent groups of daps were antidepressants (7.4%), opioids (2.7%), and antihistamines (2.4%). Conclusions the decrease in the use of daps on duran's list is a welcome change. Although the use of old, strong daps has decreased, new daps have simultaneously emerged. Physicians need continuous education in prescribing daps and more recent information on the use and effects of daps is needed in order to decrease their exposure among the rapidly growing older population.
217	2022	Kaila L;Ketola J;Toivonen M;Loukola O;Hakala K;Raiskio S;Hurme T;Jalli M	Pesticide Residues In Honeybee-Collected Pollen: Does The Eu Regulation Protect Honeybees From Pesticides?	Researchers globally identify pesticides as one of the main reasons for pollinator decline. In the european union (eu), extensive legislation is implemented to protect pollinators from harmful pesticide exposure. The aim of our study was to discover whether the pesticide residue levels in honeybee matrices, such as nectar and pollen, exceeded the chronic or acute toxicity levels when beehives were located next to fields treated with specific insecticides. The insecticides were used according to the eu legislation and its national implementation. The experiments were conducted in turnip rape, oilseed rape, and caraway fields in southern finland during the years 2019 and 2020. The pesticides used in the experiments contained the active substances lambda-cyhalothrin (2019), esfenvalerate (2020), and tau-fluvalinate (2020). However, the honeybee-collected pollen and nectar were analyzed for residues of more than 100 active substances. The results showed that the pesticide residue levels clearly remained under the oral acute toxicity for honeybees, although we found high levels of thiacloprid residues in the pollen collected in 2019. The pesticide residues in nectar were below loq values, which was most likely due to the rainy weather conditions together with the chosen sampling method. No statistically significant differences were observed between the insecticide-treated and untreated fields. In light of our research, the eu legislation protected honeybees from oral acute toxicity during the years 2019 and 2020. However, potential sublethal effects of thiacloprid and other pesticide compounds found in the collected pollen cannot be ruled out. In the future, constant monitoring of pesticide exposure of honeybees and wild pollinators should be established to ensure that pesticide legislation, and its implementation across the eu successfully protects pollinators and their services in agricultural environments.
218	2017	Hamina A;Taipale H;Tanskanen A;Tolppanen Am;Tiihonen J;Hartikainen S	Differences In Analgesic Use In Community-Dwelling Persons With And Without Alzheimer's Disease	Background: there are conflicting findings about analgesic use among persons with cognitive impairment compared to cognitively intact older persons. The objective of our study was to investigate the prevalence of analgesic use in community-dwelling persons with and without alzheimer's disease (ad), within six months after ad diagnosis and to find out factors associated with the use of analgesics and specific analgesic groups. Method: we utilized data from register based medalz (medication use and alzheimer's disease) cohort consisting of all community-dwelling persons diagnosed with ad during 2005-2011 in finland and their matched comparison persons without ad. Altogether, 67,215 persons with ad and one comparison person for each case were included. Drug use data were collected from the prescription register and comorbidities from special reimbursement and hospital discharge registers. Results: statistically significant (p < 0.001) yet mostly small differences were found for analgesics use: analgesics were used by 34.9% and 33.5% of persons with and without ad, respectively. Paracetamol was the most frequently used analgesic both among persons with (25.0%) and without ad (19.1%). Persons with ad used less frequently nsaids (nonsteroidal anti-inflammatory drugs) (13.2% vs. 17.3%) and mild opioids (5.0% vs. 7.1%), while the use of strong opioids was more common in comparison to persons without ad (1.3% vs. 1.1%, respectively). Analgesic users were more likely women, aged > 80 years, had asthma/ copd, cardiovascular disease, diabetes, cancer, hip fracture, osteoporosis, rheumatoid arthritis, and lower socioeconomic position. Conclusion: further studies are needed to evaluate the adequateness of pain relief in older persons with and without ad. Significance: persons with alzheimer's disease (ad) used more frequently paracetamol and less frequently nsaids and mild opioids. A decreasing trend of nsaid use was observed among persons with ad during the study period.
219	2020	Kulju T;Verner R;Dibue-Adjei M;Eronen A;Rainesalo S;Lehtimaki K;Haapasalo J;Peltola J	Circadian Distribution Of Autostimulations In Rvns Therapy In Patients With Refractory Focal Epilepsy	Background: responsive vagus nerve stimulation (rvns) utilizes an electrocardiograph (ecg)-based algorithm to detect rapid sympathetic activations associated with the onset of a seizure. Abrupt sympathetic activation may also be associated with nocturnal arousals between sleep cycles or transitioning from sleep to wakefulness, a period in which many patients with epilepsy experience seizures. Because of circadian changes in autonomic function, we hypothesized that the autostimulation feature might also behave in a circadian fashion. Objective: the aim of this study was to assess the circadian rhythmicity of autostimulations in rvns treatment in patients with drug-resistant epilepsy (dre). Materials and methods: we performed a retrospective follow-up study of 30 patients with dre treated with rvns including 17 new implantations and 13 battery replacements at a single center in finland. After initiation of autostimulation mode, the exact rvns stimulation parameters and the timestamps of all individual autostimulations delivered were registered. A clustered autostimulation was defined as any autostimulation that occurred within the duration of the therapeutic cycle during the therapy "off" time compared with both the previous autostimulation and the following autostimulation. Results: autostimulations and especially autostimulation clusters show a higher probability of occurring in the morning and less at night. This trend appeared to follow the circadian rhythm of cortisol concentration. Conclusions: early morning peaks of autostimulations at low thresholds may reflect awakening-induced activation of the cardiovascular system, which is associated with a shift towards the dominance of the sympathetic branch of the autonomic nervous system. Cortisol release occurs in parallel driven by wakening-induced activation of the hypothalamic-pituitary-adrenal axis, which is fine-tuned by direct sympathetic input to the adrenal gland. This is of interest considering the known sympathetic hyperactivity in patients with epilepsy. (C) 2020 elsevier inc. All rights reserved.
220	2022	Alibudbud R;Cleofas Jv	Global Utilization Of Online Information For Substance Use Disorder: An Infodemiological Study Of Google And Wikipedia From 2004 To 2022	Introduction the increasing number of people who use drugs (pwuds) can be attributed to the rising online sales of drugs and other related substances. Information on drugs and drug markets has also become easily accessible in web-search engines and social media. Aside from providing direct care, nurses have essential roles in preventing substance use disorder. These roles include health education, liaison, and researcher. Thus, nurses must examine and utilize the internet, where information and transactions related to these substances are increasing. Design/methods this study utilized an infodemiological design in exploring the worldwide information utilization for substance use disorder. Data were gathered from google trends and wikimedia pageview. The data included relative search volumes (rsv), top and rising related queries and topics, and wikipedia page views between 2004 and 2022. After describing the data, autoregressive integrated mean averaging (arima) models were used to predict future utilization of online information from google and wikipedia. Results google trends ranked 37 countries based on the search volumes for substance use disorder. Ethiopia, finland, the united states, kenya, and canada have the highest rsvs, while the lowest-ranked country is turkey, followed by mexico, spain, japan, and indonesia. Google searches for substance use disorder-related information increased by more than 900% between 2004 and 2022. In addition, wikipedia page views for substance use disorder-related information increased by almost 200% between 2015 and 2022. Based on the arima models, rsvs and page views are predicted to increase by about 150% and 120% by december 2025. Top and rising search-related topics and queries revealed that the public increasingly utilized online information to understand specific substances and the possible mental health comorbidities related to substance use disorders. Their recent concerns revolved around diagnostics, specific substances, and specific disorders. Conclusion the internet can be of paradoxical use in substance use disorder. It has been previously reported to be increasingly used in drug trades, contributing to the increasing prevalence of substance use disorder. Likewise, the present study's findings revealed that it is increasingly utilized for substance use disorder-related information. Thus, nurses and other healthcare professionals should ensure that online information regarding substance use disorders is accurate and up-to-date. Clinical relevance nurse informaticists can form and lead internet- and social-media-based health teams that perform national infodemiological investigations to assess online information. In doing so, they can inform, expand, and contextualize ehealth substance use education and strengthen the accessibility and delivery of substance use healthcare. In addition, public health nurses can collaborate to engage patients and communities in identifying harmful substance use disorder information online and creating culturally-appropriate messages that will correct misinformation and improve ehealth literacy, specifically in substance use disorder.
221	2016	Kero Ae;Madanat-Harjuoja Lm;Jarvela Ls;Malila N;Matomaki J;Lahteenmaki Pm	Cardiovascular Medication After Cancer At A Young Age In Finland: A Nationwide Registry Linkage Study	Despite improved survival rates, childhood and young adult (ya) cancer survivors face elevated risks for life-threatening morbidities, especially cardiovascular complications. Our nationwide finnish registry study investigated the purchases of cardiovascular medication from 1993 to 2011 in patients diagnosed with cancer aged below 35 years (n=8,197) between 1993 and 2004 compared to siblings (n=29,974) via linkage to the drug purchase registry. The cumulative incidence for purchasing cardiovascular medications was higher in childhood and ya cancer patients compared to siblings with a rising trend over time. After childhood cancer, the highest hazard ratio (hr) was found for purchasing anticoagulants (hr 19.8, 95% ci 8.5-45.9). The hrs for any cardiovascular medication (hr 7.2, 95% ci 5.1-10.1) and cardiac medication (hr 4.8, 95% ci 3.3-6.9) were markedly elevated after childhood cancer as well. Regarding ya cancer patients, the respective hrs were 2.5 (95% ci 2.0-3.2) for anticoagulants, hr 1.7 (95% ci 1.5-1.9) for any cardiovascular medication and hr 1.5 (95% ci 1.3-1.7) for cardiac medication. Among cancer patients, highest hrs for cardiovascular medication were observed after childhood acute lymphoblastic leukemia (all) and bone tumors (hr 10.2, 95% ci 6.8-15.5 and hr 7.4, 95% ci 4.0-13.7) and ya all and acute myeloid leukemia (hr 5.1, 95% ci 3.5-7.1 and hr 2.8, 95% ci 1.8-4.0). Our study demonstrated increased hrs for purchasing cardiovascular medication after early-onset cancer compared to siblings reflecting elevated cardiovascular morbidity. Thus, the implementation of long-term cardiovascular disease screening is imperative to prevent, detect and adequately treat cardiovascular late effects after cancer at a young age.
222	2021	Dada S;Ashworth Hc;Bewa Mj;Dhatt R	Words Matter: Political And Gender Analysis Of Speeches Made By Heads Of Government During The Covid-19 Pandemic	Background the covid-19 pandemic has put a spotlight on political leadership around the world. Differences in how leaders address the pandemic through public messages have practical implications for building trust and an effective response within a country. Methods we analysed the speeches made by 20 heads of government around the world (bangladesh, belgium, bolivia, brazil, dominican republic, finland, france, germany, india, indonesia, new zealand, niger, norway, russia, south africa, scotland, sint maarten, united kingdom, united states and taiwan) to highlight the differences between men and women leaders in discussing covid-19. We used an inductive analytical approach, coding speeches for specific themes based on language and content. Findings five primary themes emerged across a total of 122 speeches on covid-19, made by heads of government: economics and financial relief, social welfare and vulnerable populations, nationalism, responsibility and paternalism, and emotional appeals. While all leaders described the economic impact of the pandemic, women spoke more frequently about the impact on the individual scale. Women leaders were also more often found describing a wider range of social welfare services, including: mental health, substance abuse and domestic violence. Both men and women from lower-resource settings described detailed financial relief and social welfare support that would impact the majority of their populations. While 17 of the 20 leaders used war metaphors to describe covid-19 and the response, men largely used these with greater volume and frequency. Conclusion while this analysis does not attempt to answer whether men or women are more effective leaders in responding to the covid-19 pandemic, it does provide insight into the rhetorical tools and types of language used by different leaders during a national and international crisis. This analysis provides additional evidence on the differences in political leaders' messages and priorities to inspire citizens' adhesion to the social contract in the adoption of response and recovery measures. However, it does not consider the influence of contexts, such as the public audience, on leaders' strategic communication approaches.
223	2021	Toppila-Salmi S;Lemmetyinen R;Chanoine S;Karjalainen J;Pekkanen J;Bousquet J;Siroux V	Risk Factors For Severe Adult-Onset Asthma: A Multi-Factor Approach	Background the aim was to identify risk factors for severe adult-onset asthma. Methods we used data from a population-based sample (adult asthma in finland) of 1350 patients with adult-onset asthma (age range 31-93 years) from finnish national registers. Severe asthma was defined as self-reported severe asthma and asthma symptoms causing much harm and regular impairment and >= 1 oral corticosteroid course/year or regular oral corticosteroids or waking up in the night due to asthma symptoms/wheezing >= a few times/month. Sixteen covariates covering several domains (personal characteristics, education, lifestyle, early-life factors, asthma characteristics and multiple morbidities) were selected based on the literature and were studied in association with severe asthma using logistic regressions. Results the study population included 100 (7.4%) individuals with severe asthma. In a univariate analysis, severe asthma was associated with male sex, age, a low education level, no professional training, ever smoking, >= 2 siblings, >= 1 chronic comorbidity and non-steroidal anti-inflammatory drug (nsaid)-exacerbated respiratory disease (nerd) (p < 0.05), and trends for association (p < 0.2) were observed for severe childhood infection, the presence of chronic rhinosinusitis with nasal polyps, and being the 1st child. The 10 variables (being a 1st child was removed due to multicollinearity) were thus entered in a multivariate regression model, and severe asthma was significantly associated with male sex (or [95% ci] = 1.96 [1.16-3.30]), ever smoking (1.98 [1.11-3.52]), chronic comorbidities (2.68 [1.35-5.31]), nerd (3.29 [1.75-6.19]), and >= 2 siblings (2.51 [1.17-5.41]). There was a dose-response effect of the total sum of these five factors on severe asthma (or [95% ci] = 2.30 [1.81-2.93] for each one-unit increase in the score). Conclusions male sex, smoking, nerd, comorbidities, and >= 2 siblings were independent risk factors for self-reported severe asthma. The effects of these factors seem to be cumulative; each additional risk factor gradually increases the risk of severe asthma.
224	2017	Vogler S;Zimmermann N;Babar Zud	Price Comparison Of High-Cost Originator Medicines In European Countries	Background: in recent years, high-cost medicines have increasingly been challenging the public health budget in all countries including high-income economies. In this context, this study aims to survey, analyze and compare prices of medicines that likely contribute to high expenditure for the public payers in high-income countries.methods: we chose the following 16 european countries: austria, belgium, denmark, finland, france, germany, greece, hungary, ireland, italy, the netherlands, portugal, sweden, slovakia, spain and united kingdom. The ex-factory price data of 30 medicines in these countries were collected in national databases accessible through the pharmaceutical price information (ppi) service of gesundheit osterreich gmbh (austrian public health institute).Results: the ex-factory prices (median) per unit (e.g. Per tablet, vial) ranged from 10.67 cent (levodopa + decarboxylase inhibitor) to 17,000 euro (ipilimumab). A total of 53% of the medicines surveyed had a unit ex-factory price (median) above 200 euro. For two thirds of the medicines, price differences between the highest-priced country and lowest-priced country ranged between 25 and 100%; the remaining medicines, mainly low-priced medicines, had higher price differential, up to 251%. Medicines with unit prices of a few euros or less were medicines for the treatment of diseases in the nervous system (anti-depressants, medicines to treat parkinson and for the management of neuropathic pain), of obstructive airway diseases and cardio-vascular medicines (lipid modifying agents). High-priced medicines were particularly cancer medicines.conclusion: medicine prices of greece, hungary, slovakia and uk were frequently at the lower end, german and swedish, as well as danish and irish prices at the upper end. For high-priced medicines, actual paid prices are likely to be lower due to confidential discounts and similar funding arrangements between industry and public payers. Pricing authorities refer to the higher undiscounted prices when they use price data from other countries for their pricing decisions.
225	2022	Hofmarcher T;Lindgren P;Wilking N	Systemic Anti-Cancer Therapy Patterns In Advanced Non-Small Cell Lung Cancer In Europe	Background: systemic anti-cancer therapy (sact) is the recommended treatment modality in patients with advanced non-small cell lung cancer (ansclc) in clinical guidelines. Sact options in ansclc have multiplied in recent years with the introduction of immunotherapy and targeted therapy. This article presents findings from the first comparative analysis of sact patterns in europe.methods: sact rates in ansclc were estimated as the ratio between the number of patients treated with sact (chemotherapy, immunotherapy, targeted therapy) and the number of potentially eligible patients for sact in 11 countries (belgium, bulgaria, finland, hungary, ireland, netherlands, norway, poland, portugal, romania, uk) between 2014 and 2020. Treated patients were estimated by combining national sales volume data of cancer drugs and average drug use per patient based on clinical trials. Potentially eligible patients were estimated from national epidemiological data. Results: sact rates in ansclc differed greatly, ranging from around 30 % in hungary, poland, and the uk to almost 60 % in ireland, norway, and portugal in 2014. Sact rates seemed to increase over time in most countries, but differences were still large by 2020, ranging from around 40 % in the uk to 75 % or more in belgium, norway, and portugal. Even in countries with the highest sact rates, far from all patients seemed to receive guideline-recommended sact options, as underuse of immunotherapy and targeted therapy was common.conclusion: up to 35 % of eligible patients with ansclc receives no sact in certain europe countries, although improvements have been achieved over time. The use of immunotherapy and targeted therapy is suboptimal even in countries with high sact rates, indicating room to improve the quality of care and patient outcomes. Policy summary: measuring if and what kind of therapy cancer patients have access to is vital to assess quality of care. The care of ansclc patients seems to be suboptimal in europe, due to factors such as exclusion of patients with moderate performance status from sact, limited resources for diagnostic testing, long reimbursement timelines and slow adoption of new medicines in clinical practice.
226	2021	Bro T;Wickstrom K;Linden C	The Future Is Old - Patients With Topical Ocular Hypotensive Treatment In The Nordic Region Between 2008 And 2017 With Projections For 2040	Purpose the primary objective was to evaluate prescribing trends for topical ocular hypotensive treatment in the nordic region during the last decade and, by population projections, estimate the glaucoma burden in 2040. A secondary objective was to analyse national variations in prescription patterns across the nordic region. Methods a retrospective analysis of national pharmacy data between 2008 and 2017 on the dispensation of topical ocular hypotensive treatment in the nordic region was performed. Predictions of the glaucoma burden in 2040 were calculated from official population projections. Results the total number of patients with ocular hypotensive treatment in the nordic region increased from 346 000 to 418 000 (21%) between 2008 and 2017. The number of patients with ocular hypotensive treatment in the age group of 50 years and older increased from 3.6% to 3.9%. The daily defined dose (ddd) per patient and day during the study period increased from 1.22 to 1.26. Adjusted for beta-blocker combinations, the same value increased from 1.49 to 1.67. Across the nordic countries, finland had almost twice as many ddd per patient and day in 2017 (2.1) compared with iceland (1.1). Between 2008 and 2017, the annual treatment cost for ocular hypotensive treatment in the nordic region decreased from 96 million to 87 million euro (-9%). In 2040, the number of patients with ocular hypotensive treatment in the nordic region is estimated to 633 000 individuals (+51% compared with 2017). Conclusions the study revealed an increased use of glaucoma medications in the nordic region the last decade. This was mainly caused by an increased number of patients with ocular hypotensive treatment, but also because of a more intensive treatment. Marked national differences were detected. Due to the introduction of generic medications, the total cost for ocular hypotensive treatment did however decrease during the last decade. In 2040, the current number of individuals with ocular hypotensive treatment is estimated to have increased with an additional 50% due to a growing number of ageing individuals. This will lead to higher costs, not only for medications but also for diagnosing, monitoring and other aspects of glaucoma care.
227	2020	Aalto Ul;Roitto Hm;Finne-Soveri H;Kautiainen H;Pitkala Kh	Temporal Trends In The Use Of Anticholinergic Drugs Among Older People Living In Long-Term Care Facilities In Helsinki	Background the use of drugs with anticholinergic properties (daps) is common among older adults despite their known adverse effects, such as cognitive decline. Professionals should pay attention to daps, since evidence on their adverse effects has been accumulating during the last decade. However, to our knowledge previous studies exploring temporal trends in the use of daps are scarce. Objective the aim of this study was to assess temporal trends in the use of daps from 2003 to 2017 in long-term care facilities in helsinki. Methods four cross-sectional studies were conducted in 2003, 2007, 2011, and 2017. Participants included older people (>= 65 years) living in nursing homes (nhs) in 2003 (n = 1979), 2011 (n = 1568), and 2017 (n = 750), and in assisted living facilities (alfs) in 2007 (n = 1336), 2011 (n = 1556), and 2017 (n = 1673) in helsinki, finland. Data on demographics, medication use, and diagnoses were collected by structured questionnaires. The assessments were conducted as a point prevalence over 1 day. The use of daps and the total anticholinergic burden were defined by the anticholinergic risk scale (ars). Results in alfs, there has been an increasing trend in the use of daps over a 10-year period (41.2% in 2007 and 53.7% in 2017). In nhs, by contrast, the use of daps remained quite stable (52.3% in 2003 and 52.4% in 2017). The burden of daps measured by ars score decreased in nhs and remained stable in alfs. Marked changes occurred in the daps used; antidepressants, especially mirtazapine, increased in both settings, whereas the use of hydroxyzine and urinary antispasmodics nearly disappeared. The proportion of users of dap antipsychotics increased in alfs. Participants with dementia had a lower anticholinergic burden than those without dementia, in both settings. Conclusions despite increased knowledge of the harms of daps, they remain widely used. Physicians seem to be aware of the harms of daps among people with dementia, and some other favorable trends in prescribing were also observed. Clinicians should especially consider the indications behind the use of dap antidepressants and antipsychotics, and carefully weigh their potential benefits and harms.
228	2022	De Craemer M;Van Stappen V;Brondeel R;Iotova V;Chakarova N;Rurik I;Lindstrom J;Kivela J;Moreno La;Mavrogianni C;Manios Y;Cardon G	Self-Reported Lifestyle Behaviours In Families With An Increased Risk For Type 2 Diabetes Across Six European Countries: A Cross-Sectional Analysis From The Feel4diabetes-Study	Background a healthy lifestyle decreases the risk of developing type 2 diabetes mellitus. The current cross-sectional study aimed to describe self-reported lifestyle behaviours and compare them to current health guidelines in european feel4diabetes-families at risk for developing type 2 diabetes across six countries (belgium, finland, spain, greece, hungary and bulgaria). Methods parents and their children were recruited through primary schools located in low socio-economic status areas. Parents filled out the findrisc-questionnaire (eight items questioning age, body mass index, waist circumference, pa, daily consumption of fruit, berries or vegetables, history of antihypertensive drug treatment, history of high blood glucose and family history of diabetes), which was used for the risk assessment of the family. Sociodemographic factors and several lifestyle behaviours (physical activity, sedentary behaviour, water consumption, fruit and vegetable consumption, soft drink consumption, sweets consumption, snack consumption, breakfast consumption) of both adults and children were assessed by parental questionnaires. Multilevel regression analyses were conducted to investigate families' lifestyle behaviours, to compare these levels to health guidelines and to assess potential differences between the countries. Analyses were controlled for age, sex and socio-economic status. Results most feel4diabetes-families at risk (parents and their children) did not comply with the guidelines regarding healthy behaviours, set by the who, european or national authorities. Less than half of parents and children complied with the physical activity guidelines, less than 15% of them complied with the fruit and vegetable guideline, and only 40% of the children met the recommendations of five glasses of water per day. Clear differences in lifestyle behaviours in feel4diabetes-families at risk exist between the countries. Conclusions countries are highly recommended to invest in policy initiatives to counter unhealthy lifestyle behaviours in families at risk for type 2 diabetes development, taking into account country-specific needs. For future research it is of great importance to focus on families at risk in order to counter the development of type 2 diabetes and reduce health inequity.
229	2017	Murtola Tj;Peltomaa Ai;Talala K;Maattanen L;Taari K;Tammela Tlj;Auvinen A	Statin Use And Prostate Cancer Survival In The Finnish Randomized Study Of Screening For Prostate Cancer	Background: recent research has suggested that statins have an effect on prostate cancer prognosis. It is currently unclear how prostate cancer screening, tumor and patient characteristics, or treatment selection may affect this association. Objective: to evaluate the risk of prostate cancer death among statin users. To determine how disease and treatment characteristics affect the association. Design, setting, and participants: this is a population-based cohort study consisting of a general male population of finland participating in the finnish randomized study for prostate cancer screening. The cohort of consisted of 6537 prostate cancer cases diagnosed in the finnish randomized study of screening for prostate cancer population during 1996-2012. The cohort was linked to the national prescription database for information on the use of statins and other drugs. Intervention: statin use before and after prostate cancer diagnosis compared with nonuse. Outcome measurements and statistical analysis: hazard ratios (hrs) for the risk of prostate cancer death by amount, duration, and intensity of statin use. Cox proportional hazards regression with postdiagnostic statin use as a time-dependent variable. Results: during the median follow-up of 7.5 yr postdiagnosis 617 men died of prostate cancer. Statin use after diagnosis was associated with a decreased risk of prostate cancer death (hr 0.80; 95% confidence interval 0.65-0.98). A decreasing risk trend was observed by increasing intensity of usage (doses/year). The risk decrease was clearest in men managed with androgen deprivation therapy. Prediagnostic statin use was not associated with risk of prostate cancer death (hr 0.92; 95% confidence interval 0.75-1.12). Conclusions: decreased risk of prostate cancer death by statin use after diagnosis suggests that statins may delay or prevent prostate cancer progression. The risk decrease was significant only in men managed with androgen deprivation therapy, but statistical power was limited to estimate the association in men managed with surgery or radiotherapy. Patient summary: use of statins after prostate cancer diagnosis was associated with a decreased risk of prostate cancer death. The risk decrease was dose-dependent and observed especially among patients treated with hormone therapy. (C) 2016 european association of urology. Published by elsevier b.v. All rights reserved.
230	2022	Caman S;Sturup J;Howner K	Mental Disorders And Intimate Partner Femicide: Clinical Characteristics In Perpetrators Of Intimate Partner Femicide And Male-To-Male Homicide	Intimate partner violence against women is a global and persistent public health issue. An extreme manifestation of this problem is intimate partner femicide (ipf), the killing of a woman by a male partner. While declining trends of homicide rates have been observed over decades, rates of femicide and ipf have remained stable. Yet, ipf as a phenomenon has until recently been fairly invisible in europe, why research from the european countries on rates and characteristics of ipf has been relatively scarce. One area of research, particularly in need of further scrutiny, is to what degree perpetrators of ipf suffer from mental health conditions, and what the clinical features are. The objective of present study was to add to the existing literature by investigating prevalence and types of mental disorders in perpetrators of ipf, and to compare with male-to-male homicide (mmh) perpetrators. Our aim was also to examine life-time contact with psychiatric services, and, with missed opportunities in mind, contacts shortly preceding the homicide. With a retrospective design, this population-based study includes all solved cases of male-perpetrated homicides against intimate female partners (ipf) and other males (mmh) committed in sweden between january 2007 and december 2009. Primary and secondary psychiatric diagnoses based on icd, version 8, 9 or 10 from psychiatric inpatient as well as outpatient care have been retrieved. In order to identify mental disorders in perpetrators during commission of the homicidal offense, we also retrieved diagnoses from forensic psychiatric evaluations. Our results demonstrate that approximately one-third of the perpetrators, irrespective of homicide type, had been diagnosed with a mental disorder (excluding substance related disorders) at some point in life. Diagnosis of substance related disorders from psychiatric care was significantly more common in mmh perpetrators (37%) compared to ipf perpetrators (15%). Similarly low rates of major mental disorder were found in both groups (11%) when aggregating life-time diagnoses and diagnoses during commission of the crime. However, homicide-suicide in connection to the offense was relatively common in ipf perpetrators (20%). Thus, our study supports the notion that previous suicide attempts and suicide ideation are important indicators for predicting and possibly preventing ipf.
231	2021	Brodny J;Tutak M;Bindzar P	Assessing The Level Of Renewable Energy Development In The European Union Member States. A 10-Year Perspective	The global economic development is, to a great extent, dependent on access to large amounts of cheap energy sources. The growing social awareness of ecology and the enormous damage to the earth's ecosystem due to the production of energy from conventional sources have forced fundamental changes in the energy sector. Renewable energy is considered to be an opportunity for such changes. The current state of the art allows such changes to be made without restricting economic development. Therefore, activities related to the energy transition are being taken all over the world. The european union has definitely managed to achieve the most tangible effects in this regard. This article presents the findings of the research aimed at presenting the current state of renewable energy in the european union and analyzing the changes reported in this sector in the last decade. The research was carried out using a selected set of 11 indicators characterizing renewable energy in individual countries. These indicators were selected on the basis of literature review and own studies of the state of renewable energy and its development prospects. Based on these indicators, changes in the energy structure of individual european union countries between 2008-2018 were determined. The study is divided into two main stages. The principal components analysis (pca) was used for the first analysis. In turn, the technique for order preference by similarity to ideal solution (topsis) was adopted to assess the level of renewable energy development in the european union countries. Both these methods and the extended statistical analysis were applied to determine the state of renewable energy development in the european union countries in the studied period and to divide the member states into classes with different levels of development. The results of the study showed that the eu countries are characterized by significant differences in the development of res during the period in question. The unquestionable leaders in this respect are sweden, austria, finland, and latvia. Based on the findings, it is possible to evaluate the effects of activities related to renewable energy development and to prepare assumptions for future activities. Additionally, both the research and its findings broaden the knowledge of the directions of renewable energy development in individual european union countries. This is particularly important in the context of changes related to the need to reduce harmful substance emissions and the implementation of the european green deal idea.
232	2020	Varimo E;Saastamoinen Lk;Ratto H;Mogk H;Aronen Et	New Users Of Antipsychotics Among Children And Adolescents In 2008-2017: A Nationwide Register Study	Introduction recently, prescribing antipsychotics for children and adolescents has been increasing in many countries. These drugs are often prescribed off-label, although antipsychotics have been associated with adverse effects. We determined the recent incidence of antipsychotic use among children and adolescents in finland. Methods finnish national prescription register including all finnish inhabitants receiving reimbursement for pharmaceuticals was searched for subjects of 1 to 17 years of age who had started an antipsychotic drug between january 1, 2008, and december 31, 2017 (n = 26,353). Between 2008 and 2017, the range of number of finnish children and adolescents aged 1 to 17 years was 1.01 to 1.03 million/year. The incidence was calculated by dividing the number of new users by all age- and sex-matched finnish inhabitants in the year. Results between 2008 and 2017, the incidence of antipsychotic use among children and adolescents increased from 2.1 to 3.8 per 1000 individuals, respectively. In children aged 7 to 12 years, the incidence of antipsychotic use 1.4-folded (from 1.9 (95% ci: 1.8-2.0) to 2.7 (95% ci: 2.5-2.9) per 1000) with a cumulative increase of 0.2% per year (chi(2) = 51.0, p < 0.0001). In adolescents aged 13 to 17 years, the incidence 2.2-folded (from 4.3 (95% ci: 4.1-4.5) to 9.4 (95% ci: 9.1-9.8) per 1000) with a cumulative increase of 0.6% per year (chi(2) = 590.3, p < 0.0001). The increase in the incidence of use was steeper in girls (2.3-fold) than in boys (1.4-fold) (chi(2) = 85.6, p < 0.0001), especially between 2015 and 2017 (1.6-fold and 1.2-fold, respectively) (chi(2) = 151.7, p < 0.0001). The year 2011 was the turning point when the incidence in girls exceeded the incidence in boys, and the incidence of quetiapine use exceeded that of risperidone use. Conclusions the incidence of antipsychotic use increased between 2008 and 2017, especially in adolescent girls. The use of quetiapine increased, although it has few official indications in children and adolescents. Future studies should investigate the reasons for increasing use of antipsychotics, especially quetiapine, in children and adolescents.
233	2017	Teter Z;Sliwczynski A;Brzozowska M;Swierkowski M;Jacyna A;Pinkas J;Sierocka A;Marczak M;Danska-Bidzinska A;Bidzinski M;Wierzba W	The Assessment Of Overall Survival (Os) After Adjuvant Chemotherapy For Patients With Malignant Endometrial Cancer In Poland	Objectives: in 2013 malignant endometrial cancers have amounted to 7.3% of all cancers diagnosed among women in the report by the polish national cancer registry raw prevalence rate amounted to 28.7, whereas standardised prevalence rate 15.6 per 100 000 population. Among the causes of death, these cancers amounted to 3% and were ranked ninth on the list of the most common causes of oncologic mortality of women. In the year 2013 a total of 1243 women died of malignant endometrial cancers. A stable increase of malignant endometrial cancer incidence has been observed for 2 decades. Despite that fact, the increase of the mortality incidence is at a much lower level, which demonstrates the much higher effectiveness of the treatment of such cancers. The recording rate of the malignant endometrial cancer mortality amounts to 95%, so the presented absolute numbers are reliable. Examining the clinical stages of malignant endometrial cancers, we can establish that approx. 85% of them are diagnosed at stage i or ii according to the figo classification. Patients with advanced stages of cancer represent less than 15%. Material and methods: retrospective analysis of endometrial body cancer prevalence data for the entire population of poland, assessment of malignant endometrial cancer prevalence in the years 2008-2015 and overall survival probability in the population of patients undergoing adjuvant chemotherapy. Results: the number of patients with a diagnosed malignant endometrial cancer within the studied period in poland remains on a stable level (2008 - 30.6 thousand patients, 2015 - 40.2 thousand patients). Among all listed patients with the indication of c54 each year approx. 20% enters hospital treatment. System therapy with chemotherapy drugs was used in approx. 1-2% of patients treated in hospitals. The average age of the patients was 64.9 years, and the median age 65 years. The number of observations was 2085, including 1088 censored observations. The average survival for the sample under study was 30.67 month (sd = +/- 0.6); median survival time was 23.93 month. The number of censored observations was 1088 (52.16%). Probable survival of 1 year is achieved by 67.57% of patients, 2 years by 49.73%, 3 years by 40.68%, above 5 years 30.77%. Conclusions: the incidence of endometrial cancer in poland in the years 2008-2015 continues to grow at 5% upward trend (in europe 3.4-5.9). In poland in 2012, crude incidence rate for cancer of the uterus was 29.8 and did not differ significantly from the results in countries such as finland, slovakia, sweden, belgium and bulgaria. The overall survival after adjuvant chemotherapy for patients with malignant endometrial cancer in poland shows considerable differences depending on the region of the country.
234	2022	Carnovale C;Battini V;Gringeri M;Volonte M;Uboldi Mc;Chiarenza A;Passalacqua G	Open Access Safety Of Fexofenadine And Other Second- Generation Oral Antihistamines Before And After The Removal Of The Prescription Requirement In Italy And Other European Countries: A Real-World Evidence Study And Systematic Review	Background: the change from prescription to over-the-counter (otc) status of oral antihista-mines may raise concerns about drug safety due to the possibility of misuse/abuse. In most eu-ropean countries, oral antihistamines are available without prescription, whereas in italy, only <10-tablet packs are available otc. Objectives: to evaluate the safety profile of fexofenadine after otc switch in italy in a real-world setting, and to compare its safety profile to that of other european countries where larger pack sizes are available. To compare the safety of fexofenadine, cetirizine, and loratadine in italy. To examine safety/efficacy across europe with a systematic review.methods: this case-by-case analysis used the us food and drug administration (fda) adverse event reporting system (faers) to extract data of the adverse events (aes) related to fex-ofenadine, loratadine and cetirizine in italy january 2010-june 2020. The year 2016 was taken as the index date (removal of prescription requirement) for evaluation of the reporting trend of aes of fexofenadine in italy and make a comparison pre/post-otc switch. A comparison of aes with other european countries where fexofenadine is sold otc in large packs >20 tablets (belgium, portugal, switzerland, finland, hungary) was made. The rate at which an ae related to oral anti-histamines occurred was estimated by calculation of the reporting rate (number of cases/[defined daily dose/1000 inhabitants per day]) on the basis of iqvia sales data using the italian institute of statistics database. A systematic review of the literature was also performed.results: there were 3760 reports of aes with a suspected association with fexofenadine; of these, eight were reported from italy. There was a slightly increasing trend per year, in line with a general reporting trend of other drugs. In european countries where fexofenadine is available, the impact of otc switch on ae reporting activity was negligible: from 2016, the reporting rate increased slightly and then normalized at 3.01, an incidence value similar to that recorded before the otc switch (3.7 in 2015). Of 22 studies included in the systematic review, 18 (82%) positively evaluated the otc use of oral antihistamines, confirming an acceptable safety/tolerability profile.conclusion: there was no difference in number of aes reported for fexofenadine pre/post-otc switch, indicating a similar safety profile. Spontaneous reporting systems are a valuable source ofreal-world data and support the otc provision of oral antihistamines in europe and fexofenadine in italy, in addition to supporting the use of larger pack sizes in italy.
235	2017	Room R;Livingston M	The Distribution Of Customary Behavior In A Population: The Total Consumption Model And Alcohol Policy	NA
236	2016	Kauppi P;Jantunen J;Martikainen J;Makela M;Haahtela T	Consumption Of Asthma And Allergy Drugs In Finland	NA