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This article discusses the current situation of human resource management (HRM) in Finnish health care and charts the views of nurse directors (ward sisters and clinical nurse managers, n = 47) on the digital portfolio as a tool of HRM. The study is part of an evaluation research project; this article reports on the findings from nurse directors' perspective. The data were collected from three organizations in eastern Finland: a University Hospital, a Central Hospital and a Social and Health Centre. The nurse directors indicated a need for information on their staff's skills and competencies, but the area on which they had most information was on staff's formal education. They did not have access to systematic tools and methods for monitoring the continuous education of staff members. The digital portfolio can be used as a tool for HRM in health care, although the nurse directors did not realize it could provide a tool for sharing expertise through the units or wards. [ABSTRACT FROM AUTHOR]

Background: Nursing has been invisible in most of the international and national healthcare information systems and databases; also in Finland. The use of nursing minimum data set could be one solution to this problem. It is an information system that collects, stores, processes, retrieves, displays and communicates timely information about nursing practice needed for a variety of users and purposes. Objectives: To test the cultural applicability of the Belgian Nursing Minimum Data Set (BeNMDS) to Finnish nursing. Methods: The study design was methodological. It included testing of the validity, reliability and sensitivity of the BeNMDS. Content validity was tested using content analysis of the Finnish nursing doctorate dissertations, Katie Eriksson's publications of her Nursing Process Model and focus-group interviews of the healthcare administrators. Reliability, construct validity and sensitivity were tested using the data collected with the BeNMDS-tool from patients' nursing notes in Finnish Hospitals. Findings: The validity, reliability and sensitivity of the BeNMDS in Finland were mainly good. The study showed, however, that the interventions to describe the patient's spiritual well-being, were missing and the psycho-social care interventions were insufficient in the data set. Conclusion: The Finnish version of the BeNMDS has been shown to be valid, reliable and sensitive and applicable to describe nursing practice in Finland. Should the interventions to describe patient's spiritual and psycho-social well-being be included in the data set, Finnish nursing will have a valuable tool available to make nursing visible for the healthcare information systems and databases. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, Internet and social media became important and fast sources of health information, leading to overabundance of both valid and invalid information. Digital health literacy (DHL) is a core competency for navigating web- and social media based COVID-19 information. This study is part of the global COVID-HL survey assessing DHL among university students. Methods: Six universities from Eastern, Northern, Southern, and Western Finland participated in an online survey in May 2020. Five subscales from the DHL Instrument (DHLI), adapted to the context of the COVID-19 pandemic, were used. The data were analyzed using univariate and bivariate analyses. Results: Mean age of the students (N = 3771) was 28 y. (females n = 2720). Students had searched information from the Internet for themselves and others (85,2%). Females had searched more than male, and the probability of searches increased with age. Majority of students (90,4%) considered information easy to find and 83,2% of students found it easy to use the information in decisions related to their health, males easier than female or diverse gender. The greatest difficulty was in assessing the reliability of information (24,0%). The sources for information seeking often were news sites, search engines, and websites of public bodies (64,8%, 50,5% and 44,1%, respectively). The topics that were most searched were spread of the coronavirus (90,1%), its symptoms (88,0%) and restrictions (87,7%). 86,3% of students considered the verified information very important. Conclusions: Finnish students were rather confident in their DHL skills. However, almost every fourth had difficulties in assessing the reliability of the information, a key competence of DHL in the context of overabundance of information. This suggests that DHL, especially the competence of critically evaluate health related information, need to be strengthen among university students in Finland across different study subjects. [ABSTRACT FROM AUTHOR]

The aim of this study was to measure attitudes to health care prioritization in various Finnish population groups. Three study groups were established: 1) the general public (n=4260); 2) politicians (n=1427); and 3) medical and social work professionals (n=1055). The following background data were obtained: sex, year of birth, marital status, number of children, education, profession, personal income, self-perceived health, and how subjects viewed their own future and whether they were satisfied with their lives. Information on activities involving prioritization of health service was elicited by presenting a list of 16 health care activities. Respondents evaluated these activities as 1) more important than average, 2) of average importance, or 3) less important than average (indicated as numbers 1-3). The response rate was 59.3%, and 57.2% (n=3858) of the original sample was accepted for analysis. The politicians and professionals showed almost identical attitudes. All groups prioritized treatment of life-threatening diseases among children. The general public prioritized high-tech surgery more highly than professionals or politicians. Alternative medicine and cosmetic surgery were the two least important activities. All groups agreed about prioritization of serious diseases among children, care of dying patients, prevention, surgery which helps people to perform their everyday tasks, and home care for the disabled elderly. Professionals and politicians prioritized mental health more highly than the population. The general public prioritized intensive care for premature babies with a low birth weight (less than 800 g). Professionals prioritized family planning more highly than politicians and the population. The results resemble those obtained in Britain, indicating that attitudes towards priorities in health are similar between Britain and Finland, and that the respondents' professions determine attitudes more strongly than does cultural background. [ABSTRACT FROM AUTHOR]

Aims: Rural-urban disparities have been reported in the outcomes of cardiovascular diseases. We assessed whether rural-urban or other geographical disparities exist in the risk of ischemic stroke (IS) and death in patients with atrial fibrillation (AF) in Finland., Methods: The registry-based FinACAF cohort study covers all patients with AF from all levels of care in Finland from 2007 to 2018. Patients were divided into rural-urban categories and into hospital districts (HDs) based on their municipality of residence., Results: We identified 222,051 patients (50.1% female; mean age 72.8 years; mean follow-up 3.9 years) with new-onset AF, of whom 15,567 (7.0%) patients suffered IS and 72,565 (32.7%) died during follow-up. The crude IS rate was similar between rural and urban areas, whereas the mortality rate was lower in urban areas (incidence rate ratios (IRRs) with 95% confidence intervals (CIs) 0.97 (0.93-1.00) and 0.92 (0.91-0.93), respectively). However, after adjustments, urban residence was associated with slightly higher IS and mortality rates (IRRs with 95% CIs 1.05 (1.01-1.08) and 1.06 (1.04-1.07), respectively). The highest crude IS rate was in the East Savo HD and the lowest in Åland, whereas the highest crude mortality rate was in the Länsi-Pohja HD and the lowest in the North Ostrobothnia HD (IRRs with 95% CIs compared to Helsinki and Uusimaa HD for IS 1.46 (1.28-1.67) and 0.79 (0.62-1.01), and mortality 1.24 (1.16-1.32) and 0.97 (0.93-1.00), respectively., Conclusions: Rural-urban differences in prognosis of AF in Finland appear minimal, whereas considerable disparities exist between HDs ., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Konsta Teppo: research grants from The Finnish Foundation for Cardiovascular Research, Aarne and Aili Turunen Foundation. Jussi Jaakkola: none. Olli Halminen: none. Janne Kinnunen: none. Jukka Putaala: speaker: Bayer, Boehringer-Ingelheim, BMS-Pfizer, Abbott; advisory board member: Portola, Novo Nordisk, Herantis Pharma; visiting editor: Terve Media; stock ownership: Vital Signum. Pirjo Mustonen: consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer-Ingelheim, MSD Finland. Jari Haukka: consultant: Research Janssen R&D; speaker: Bayer Finland. Miika Linna: speaker: BMSPfizer-alliance, Bayer, Boehringer-Ingelheim. Juha Hartikainen: research grants from The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7; advisory board member: BMS-Pfizer-alliance, Novo Nordisk, Amgen; speaker: Cardiome, Bayer. KE Juhani Airaksinen: research grants from The Finnish Foundation for Cardiovascular Research; speaker: Bayer, Pfizer and Boehringer-Ingelheim; advisory board member: Bayer, Pfizer and AstraZeneca. Mika Lehto: consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, and MSD; speaker: BMS-Pfizer- alliance, Bayer, Boehringer-Ingelheim, MSD, Terve Media and Orion Pharma; research grants from Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim.

Background: Little is known how individual time-in-therapeutic-range (TTR) impacts the effectiveness and safety of warfarin therapy compared to direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF)., Objective: To compare the effectiveness and safety of standard dose DOACs to warfarin in patients with AF, while categorizing warfarin treated patients into quartiles based on their individual TTR., Materials and Methods: We conducted a nationwide study including all patients with new-onset AF between 2011 and 2018 in Finland. Hazard ratios (HR) were calculated using Cox regression analysis with the inverse probability of treatment weighted method to assess the risks of ischaemic stroke (IS), intracranial haemorrhage (ICH) and mortality for users of apixaban ( n  = 12,426), dabigatran ( n  = 4545), rivaroxaban ( n  = 12,950) and warfarin ( n  = 43,548)., Results: The median TTR for warfarin users was 72%. Compared to the second best TTR quartile (reference), the risk of IS was higher in the two poorest TTR quartiles, and lower in the best TTR quartile and on rivaroxaban [2.35 (95% confidence interval, 1.85-2.85), 1.44 (1.18-1.75), 0.60 (0.47-0.77) and 0.72 (0.56-0.92)]. These differences were non-significant for apixaban and dabigatran. HR of ICH was 6.38 (4.88-8.35) and 1.87 (1.41-2.49) in the two poorest TTR groups, 1.44 (1.02-1.93) on rivaroxaban, and 0.58 (0.40-0.85) in the best TTR group compared to the reference group. Mortality was higher in the two poorest TTR groups and lowest in the best TTR group., Conclusions: The outcome was unsatisfactory in the two lowest TTR quartiles - in half of the patients treated with warfarin. The differences between the high TTR groups and standard dose DOACs were absent or modest.

Aims: Guidelines on the management of atrial fibrillation (AF) have evolved significantly during the past two decades, but the concurrent developments in real-life management and prognosis of AF are unknown. We assessed trends in the treatment and outcomes of patients with incident AF between 2007 and 2017., Methods and Results: The registry-based nationwide FinACAF (Finnish AntiCoagulation in Atrial Fibrillation) cohort covers all patients with AF in Finland from all levels of care. We determined the proportion of patients who were treated with oral anticoagulants (OACs) or rhythm control therapies, experienced an ischaemic stroke or bleeding event requiring hospitalization, or died within 1-year follow-up after AF diagnosis. We identified 206 909 patients (mean age 72.6 years) with incident AF. During the study period, use of OACs increased from 43.6 to 76.3%, and the increase was most evident in patients with at least moderate stroke risk. One-year mortality decreased from 13.3 to 10.6%, and the ischaemic stroke rate from 5.3 to 2.2%. The prognosis especially improved in patients over 75 years of age. Concurrently, a small increase in major bleeding events was observed. Use of catheter ablation increased continuously over the study period, but use of other rhythm-control therapies decreased after 2013., Conclusion: Stroke prevention with OACs in patients with incident AF improved considerably from 2007 to 2017 in Finland. This development was accompanied by decreasing 1-year mortality and the reduction of the ischaemic stroke rate by more than half, particularly among elderly patients, whereas there was only slight increase in severe bleeding events., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)

This study investigates the effects of productivity, energy consumption, foreign direct investments, and urbanization on carbon dioxide emissions (CO 2 ) in Finland during 2000-2020 using an autoregressive distributed lag (ARDL) model. The results show that (i) there is evidence of cointegration among variables; (ii) energy consumption has a positive effect on CO 2 emissions in the long run; (iii) labor productivity and urbanization have a negative effect on CO 2 emissions in the long run; (iv) foreign direct investments are not a significant explainer of CO 2 emissions. The results are discussed with some policy implications and suggested future research., (© 2023. The Author(s).)

Aims: Socioeconomic disparities have been reported in the outcomes of patients with atrial fibrillation (AF). We assessed the hypothesis that AF patients with higher income or educational level are more frequently initiated with oral anticoagulant (OAC) therapy for stroke prevention., Methods: The nationwide registry-based Finnish AntiCoagulation in Atrial Fibrillation cohort covers all patients with AF from all levels of care in Finland. Patients were divided into income quartiles according to their highest annual income during 2004-2018 and into three categories based on educational attainment. The outcome was the first redeemed OAC prescription., Results: We identified 239 222 patients (mean age 72.7 ± 13.2 years, 49.8% female) with incident AF during 2007-2018. Higher income was associated with higher OAC initiation rate: compared to the lowest income quartile the adjusted SHRs (95% CI) for OAC initiation were 1.09 (1.07-1.10), 1.13 (1.11-1.14) and 1.13 (1.12-1.15) in the second, third and fourth income quartiles, respectively. Patients in the highest educational category had a slightly lower OAC initiation rate than patients in the lowest educational category (adjusted SHR 0.92 [95% CI 0.90-0.93]). Income-related disparities were larger and education-related disparities only marginal among patients at high risk of ischemic stroke. The socioeconomic disparities in OAC initiation within 1-year follow-up decreased from 2007 to 2018. The adoption of direct OACs as the initial anticoagulant was faster among patients with higher income or educational levels., Conclusion: These findings highlight potential missed opportunities in stroke prevention, especially among AF patients with low income, whereas the education-related disparities in OAC initiation appear controversial., (© 2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)

Objective: Atrial fibrillation (AF) is a worldwide healthcare challenge owing to population ageing. In this study, we assessed the current trends in the incidence and prevalence of AF for the first time in an unselected, nationwide population., Methods: In the Finnish Anticoagulation in Atrial Fibrillation study, we gathered comprehensive data including all primary, secondary and tertiary healthcare visits and drug reimbursement from national healthcare registers to identify all patients with incident AF between 2004 and 2018 in Finland. Incident AF was defined as new-onset AF occurring after 2007. Time trends for the incidence and prevalence of AF were calculated and stratified by sex and age., Results: A total of 411 387 patients with AF diagnosis were documented in Finland during 2004-2018. In 2018, the incidence and prevalence of AF in the total Finnish population were 469/100 000 and 4.1%, respectively. The incidence of new-onset AF in the adult population (≥20 years) increased from 471/100 000 in 2007 to 604/100 000 in 2018, but the age-adjusted incidence remained stable. The prevalence of AF increased in the adult population from 2.5% to 5.2%, and was higher in men than in women (5.9% vs 4.6%, p<0.001). The incidence and prevalence of AF increased with age and were 3194/100 000 and 23.4% in patients older than 75 years., Conclusions: Based on comprehensive nationwide data including primary care, we observed an increasing incidence and prevalence of AF over time. This increase was strongly age-dependent with the age-standardised incidence remaining stable during 2007-2018., Trial Registration Number: NCT04645537., Competing Interests: Competing interests: MLe: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim. JHau: Consultant: Research Janssen R&D; Speaker: Bayer Finland. AA: Research grants: Finnish Foundation for Cardiovascular Research; Speaker: Abbott, Johnson&Johnson, Sanofi, Bayer, Boehringer Ingelheim. JP: Consultant: Boehringer-Ingelheim, Bayer, BMS-Pfizer, Abbott/St. Jude Medical, Vital Signum, Nokia Technologies, Bittium, BcB Medical, Herantis Pharma, Medixine, and Portola. Speaker: Boehringer-Ingelheim, Bayer, BMS-Pfizer, and Terve Media; Research grants: BMS-Pfizer, Abbott/St. Jude Medical, Business Finland, and Amgen. MLi: Speaker: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim. PM: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. JHar: Research grants: The Finnish Foundation for Cardiovascular Research, Advisory Board Member: BMS-Pfizer-alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. JKEA: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards:Bayer, Pfizer and AstraZeneca., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: Little is known about rural-urban differences in the treatment and outcomes in patients with atrial fibrillation (AF). We aimed to assess whether the initiation of oral anticoagulant (OAC) therapy in patients with AF differs between those with rural and urban residence., Methods: The registry-based FinACAF cohort covers all patients with AF from all levels of care in Finland. Patients were divided into rural and urban categories and into urbanization degree tertiles based on their municipality of residence at the time of AF diagnosis. The outcome was the first redeemed OAC prescription., Results: We identified 222 419 patients (50.1% female; mean age 72.8 (SD 13.2) years) with incident AF during 2007-2018. Urban residence was associated with a lower rate of OAC therapy initiation (adjusted subdistribution hazard ratio (SHR) (95% CI) 0.96 (0.95-0.97)). Correspondingly, an inverse graded dose-response relationship was observed between higher urbanization degree tertile and OAC initiation rate (highest tertile compared to lowest: adjusted SHR (95% CI) 0.94 (0.93-0.95)). The adoption of direct oral anticoagulants for stroke prevention was faster among patients with urban residence., Conclusion: This nationwide cohort study documented that urban residence is associated with a slightly lower rate of OAC therapy initiation in patients with incident AF, but faster adoption of direct oral anticoagulant use., Competing Interests: Conflict of Interest Disclosures: Konsta Teppo: none. Jussi Jaakkola: none. Ville Langén: none. Fausto Biancari: none Olli Halminen: none. Jukka Putaala: Dr. Putaala reports personal fees from Boehringer-Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS-Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum, personal fees from Abbott, outside the submitted work. Pirjo Mustonen: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. Jari Haukka: Consultant: Research Janssen R&D; Speaker: Bayer Finland. Miika Linna: Speaker: BMSPfizer-alliance, Bayer, Boehringer-Ingelheim. Juha Hartikainen: Research grants: The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7. Advisory Board Member: BMS-Pfizer-alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. K.E. Juhani Airaksinen: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. Mika Lehto: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim.

Background: Rural-urban disparities have been reported in the access, utilization, and quality of healthcare. We aimed to assess whether use of antiarrhythmic therapies (AATs) in patients with atrial fibrillation (AF) differs between those with rural and urban residence. Methods: The registry-based FinACAF cohort covers all patients with AF from all levels of care in Finland. Patients were divided into rural and urban categories and into urbanization degree tertiles based on their municipality of residence at the time of AF diagnosis. The primary outcome was the use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. Results: We identified 177,529 patients (49.9% female, mean age 73.0 (SD13.0) years) with incident AF during 2010-2018. Except for AADs, the differences in AAT use were nonsignificant when patients were stratified according to the rural-urban classification system (urban vs. rural adjusted incidence rate ratios (aIRRs) with 95% CIs for any AAT 1.01 (0.99-1.03), AADs 1.11 (1.07-1.15), cardioversion 1.01 (0.98-1.03), catheter ablation 1.05 (0.98-1.12)). However, slightly higher use of all rhythm control modalities was observed in the highest urbanization degree tertile when compared to the lowest tertile (aIRRs with 95% Cis for any AAT 1.06 (1.03-1.08), AADs 1.18 (1.14-1.23), cardioversion 1.05 (1.02-1.08), catheter ablation 1.10 (1.02-1.19)). Conclusions: This nationwide retrospective cohort study observed that urban residence is associated with higher use of AADs in patients with incident AF. Otherwise, the observed disparities were only marginal, suggesting that in the use of rhythm control therapies, no large rural-urban inequity exists in Finland.

Objective: We assessed the hypothesis that mental health conditions (MHCs) are associated with higher risk of bleeding in patients with atrial fibrillation (AF)., Methods: The registry-based FinACAF study covers all patients with AF diagnosed during 2007-2018 in Finland. MHCs of interest were depression, bipolar disorder, anxiety disorder, schizophrenia, and any MHC. The outcomes were first-ever gastrointestinal, intracranial, and any bleeding event., Results: We identified 205,019 patients (50.9% female; mean age 72.3 [standard deviation 13.4] years) with incident AF without prior bleeding, and the prevalence of any MHC was 6.1%. Any MHC, depression, and anxiety disorder were associated with the risk of any bleeding (adjusted hazard ratios (HRs) 1.19 [1.12-1.27], 1.21 [1.13-1.30], and 1.21 [1.08-1.35], respectively). Additionally, any MHC and depression were associated with the risk of gastrointestinal and intracranial bleeding and anxiety disorder with gastrointestinal bleeding. Bipolar disorder and schizophrenia were not associated with risk of bleeding. Use of oral anticoagulants was associated with the risk of any bleeding (adjusted HR 1.24 [95% CI 1.21-1.28)]), and this association was similar in patients with and without MHCs. Serotonin reuptake inhibitors were not associated with bleeding risk., Conclusions: MHCs are associated with a higher risk of bleeding in patients with AF., Competing Interests: Declaration of Competing Interest Konsta Teppo: none. Jussi Jaakkola: none. Fausto Biancari: none Olli Halminen: none. Jukka Putaala: Dr. Putaala reports personal fees from Boehringer-Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS-Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum, personal fees from Abbott, outside the submitted work. Pirjo Mustonen: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. Miika Linna: Speaker: BMSPfizer-alliance, Bayer, Boehringer-Ingelheim. Juha Hartikainen: Research grants: The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7. Advisory Board Member: BMS-Pfizer-alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. K.E. Juhani Airaksinen: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. Mika Lehto: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Low socioeconomic status has been associated with poor outcomes in patients with atrial fibrillation (AF). However, little is known about socioeconomic disparities in adherence to stroke prevention with direct oral anticoagulants (DOACs). We assessed the hypothesis that AF patients with higher income or educational levels have better adherence to DOACs in terms of treatment implementation and persistence. The used nationwide registry-based FinACAF cohort covers all patients with incident AF starting DOACs in Finland during 2011-2018. The implementation analyses included 74 222 (mean age 72.7 ± 10.5 years, 50.8% female) patients, and persistence analyses included 67 503 (mean age 75.3 ± 8.9 years, 53.6% female) patients with indication for permanent anticoagulation (CHA 2 DS 2 -VASc score >1 in men and >2 in women). Patients were divided into income quartiles and into three categories based on their educational attainment. Therapy implementation was measured using the medication possession ratio (MPR), and patients with MPR ≥0.90 were defined adherent. Persistence was measured as the incidence of therapy discontinuation, defined as the first 135-day period without DOAC purchases after drug initiation. Patients with higher income or education were consistently more likely adherent to DOACs in the implementation phase (comparing the highest income or educational category to the lowest: adjusted odds ratios 1.18 (1.12-1.25) and 1.21 (1.15-1.27), respectively). No association with income or educational levels was observed on the incidence of therapy discontinuation. In conclusion, we observed that income and educational levels both have independent positive association on the implementation of DOAC therapy but no association on therapy persistence in patients with AF., (© 2022 The Authors. Pharmacology Research & Perspectives published by John Wiley & Sons Ltd, British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics.)

Atrial fibrillation (AF) is a major cause of ischemic stroke and the number of AF patients is increasing. Thus, up-to-date multifaceted data about the characteristics of AF patients, their treatments, and outcomes are urgently needed. The Finnish anticoagulation in atrial fibrillation (FinACAF) study has collected comprehensive data on all Finnish AF patients from 1st January 2004 to 31st December 2018. The aim of this paper is to describe the study rationale, the process of integrating data from the applied resources and to define the study cohort. Using national unique personal identification number, individual patient data is linked from nationwide health care registries (primary, secondary, and tertiary care), drug purchases, education, and socio-economic status as well as places of domicile, incomes, and taxes. Six regional laboratory databases (~ 282,000, 77% of the patients) are also included. The study cohort comprises of a total of 411,000 patients. Since the introduction of the national primary care register in 2012, 9% of all AF patients were identified outside hospital care registers. The prevalence of AF in Finland-4.1% of whole population-is for the first time now established. The FinACAF study allows a unique possibility to investigate the epidemiology and socio-medico-economic impact of AF as well as the cost effectiveness of different AF management strategies in a completely unselected, nationwide population. This article provides the rationale and design of the study together with a summary of the characteristics of the cohort., (© 2022. The Author(s).)

Background: Mental health problems in childhood and adolescence result in high costs to society. Despite the relevance of these problems, there are still relatively few economic evaluations of this domain, in particular the evaluation of the costs of treatment-resistant minors., Aim of the Study: The study is aimed to evaluate the costs of mental services use of 52 treatment-resistant minors at the Intensive Psychiatric Care Unit of the Niuvanniemi Hospital, in Kupio, Finland, and the costs of the mental health services used by these patients before their referral to this unit., Methods: The data were collected from case history files of minors (N 2dd = 2dd 52) who were directed to the intensive psychiatric care unit between 2004 and 2007. The data included information of the use of earlier specialised medical psychiatric care. The study evaluated the cost of daily bed charges for treatment-resistant minors., Results: The mean duration of the intensive psychiatric care unit treatment was twelve months. The average cost was 367,150/patient. Fifty-one per cent of the minors were discharged to less intensive mental health services after the intensive psychiatric care., Conclusions: The costs of intensive psychiatric treatment are currently high. Benefits may be achieved over time. Further research should monitor and analyse the benefit of such expensive treatment on the outcomes of treatment-resistant patients over time, an investment in the minors' future, that ultimately benefits society.

The importance of core competencies (CC) and their relationship to core interventions in clinical practice guidelines on schizophrenia (CPGS), and the abilities to master these competencies were studied among registered nurses (RN) and practical mental nurses (PMN) in a forensic psychiatric setting. Data were collected from RNs, PMNs, and managers of all five forensic psychiatric facilities in Finland. The research material was obtained by using a 360-degree feedback method. The response rate was 68% (N = 428). The differences between the nurse groups were statistically significant (p ≤ 0.05) regarding the importance of and ability to master the following CCs: (1) pharmacotherapy, (2) knowledge in forensic psychiatry and violent behavior, (3) the treatment of violent patients, (4) processing patient's and own emotion, and (5) need-adapted treatment of the patient. Overall, RNs exceeded PMNs in mastering the CCs, however the principles of the CPGS were not achieved within the current resources in Finland. In summary, RNs, rather than PMNs, should be recruited for work in forensic psychiatric nursing, although a considerable amount of specific training would still be required to achieve competence. Implications of our research indicate that all nurses working in this area need to receive further education in forensic psychiatry and in forensic psychiatric nursing., (© 2011 International Association of Forensic Nurses.)

Aim: This paper reports a study examining whether nurses' work overload is associated with increased sick leave and quantifying the loss of working days from work overload., Background: The RAFAELA patient classification system indicates nursing care intensity in relation to an optimum and is one of the few validated monitoring instruments of patient-associated workload among nurses. However, it is not clear whether work overload is a risk factor for increased sickness absenteeism, an important occupational problem in health care., Method: An observational cohort study was carried out with 877 nurses, 31 wards and five Finnish hospitals. Patient-associated workload scores from the RAFAELA system were based on a 6-month monitoring period in 2004. Records of 12-month self certified (1-3 days) and medically certified (>3 days) periods of sick leave in the same year were obtained from employers' registers., Findings: The mean workload was 9% (sd = 8%) above the optimum. There was a linear trend between increasing workload and increasing sick leave (P < or = 0.006). Among nurses with workload > or =30% above the optimum the rate of self certified periods of sick leave was 1.44 (95% CI 1.13-1.83) times higher than among those with an optimum workload. The corresponding rate ratio for medically certified sick leave was 1.49 (1.10-2.03). These excess rates of sickness absence resulted in 12 extra sick leave days per person-year., Conclusion: Measuring nurses' workload may be an important part of strategic human resource management of nurses to reduce sick leave among nurses.

Background: When developing Information and Communication Technology (ICT), such as services for the decision-making process, skilled health care professionals with their comprehensive knowledge of patients/clients are essential contributors to the project. Careful evaluation is needed to assess the effectiveness of project management as well as to analyze the commitment of the personnel to goal attainment., Objective: In the course of the development of integrated maternity care services, the commitment of project participants (n=48) was evaluated. What factors enhanced or impaired their commitment to the project work?, Methods: Questionnaire (n=80, response rate 60%) with quantitative analysis as well as open-ended questions with qualitative content analysis., Results: Positive commitment was related to a confidential and open atmosphere during the project. The utilization of personal skills and experience was appreciated. Differences in the working principles and cultures between the participating organizations complicated fluent collaboration. To encourage commitment, a lot of attention should be paid to internal communication as well as the effective realization of project tasks., Conclusion: The strength of the project was the highly innovative and confidential atmosphere. The well-established project goals, the highly inspired project team, and the effective co-operation between the project manager and the core group helped to deepen overall commitment in the project.

Objective: The aim of this study was to investigate the association between adverse physical disorders and violent/non-violent criminal behaviour., Design: The study material consisted of the large, prospectively followed, unselected and genetically homogeneous Northern Finland 1966 Birth Cohort, the Finnish Hospital Discharge Registers and the National Crime Register (n=10934)., Main Results: The results of the logistic regression analyses showed that male offenders had statistically significantly more injuries (adj. OR=1.81, 95% CI=1.51-2.17), when compared with males without a criminal history. Violent male offenders exhibited greater morbidity to the diseases of the respiratory system (adj. OR=1.64, 95% CI=1.03-2.60) when compared with non-violent criminals. Female offenders suffered more commonly from poisonings (adj. OR=3.84, 95% CI=1.69-8.72), injuries (adj. OR=2.79, 95% CI=1.67-4.66), infections (adj. OR=1.87, 95% CI=1.16-2.99) and indefinite symptoms (adj. OR=2.02, 95% CI=1.20-3.40) than non-offending females., Conclusions: At epidemiological level, criminal behaviour seems to be associated especially with an increased risk of injuries for both sexes. The observed increase of the diseases of the respiratory system among violent but not among non-violent males calls for further investigations.

The aim of this study was to investigate the acceptability of 14 prioritization criteria from nurses', doctors', local politicians' and the general public's perspective. Respondents (nurses, n = 682, doctors, n = 837 politicians, n = 1,133 and the general public, n = 1,178) received a questionnaire with 16 imaginary patient cases, each containing 2-3 different prioritization criteria. The subjects were asked to indicate how important it was for them that the treatments in the presented patient cases be subsidized by the community. All respondents preferred treatments for poor people and children. With the exception of the doctors, the three other study groups also prioritized elderly patients. Treatment for institutionalised patients, those with self-induced disease, diseases with both poor and good prognosis, and mild disease were given low priorities. Priority setting in health care should be regarded as a continuous process because of changes in attitudes. However, the best method for surveying opinions and ethical principles concerning prioritization has not yet been discovered.

In the hospital district of Helsinki and Uusimaa, 32 municipalities with one or more health centres provide primary care to their residents. Legal and organizational barriers between primary care and hospital care impede the continuity of patient care. Integrating primary and secondary care with the aid of information technology may facilitate a virtual electronic patient record, in which the viewing of images and other patient data is possible regardless of the organization that produced them. For example, in one trial, diabetic patients sent their home blood glucose measurements by modem to their health centre. Preliminary observations suggest that they could increase their glucose testing largely because they were able to transmit the results to the database and receive teleconsultations. Also, a picture archiving and communication system (PACS) has been in operation in two clinics of the Helsinki University Central Hospital for over two years and seven hospitals had become filmless by the end of 2001. A regional PACS is planned to be completed by the year 2004.

A 3-year PACS project was started in 1997 and completed in 1999 with filmless radiology and surgery. An efficient network for transferring images provides the infrastructure for integration of different distributed imaging systems and enables efficient handling of all patient-related information on one display station. Because of the need for high-speed communications and the massive amount of image data transferred in radiology, ATM (25, 155 Mbit/s) was chosen to be the main technology used. Both hardware and software redundancy of the system have been carefully planned. The size of the Dicom image library utilizing MO discs is currently 1.2 TB with 300 GB RAID capacity. For the increasing amount of teleradiologic consultations, a special Dicom gateway is planned. It allows a centralized and resilient handling and routing of received images around the hospital. Hospital-wide PACS has already improved the speed and quality of patient care by providing instant access to diagnostic information at multiple locations simultaneously. The benefits of PACS are considered from the viewpoint of the entire hospital: PACS offers a method for efficiently transporting patient-related images and reports to the referring physicians.

Background: It has earlier been suggested that one-third of violent offenders are recorded in psychiatric case registers. Our aim was to study whether violent and non-violent offenders differ with respect to admissions to any health care inpatient service due to psychiatric disorders., Methods: We used a genetically homogeneous, general population database from the Northern Finland 1966 Birth Cohort, together with the Finnish Hospital Discharge Register and national crime registers., Results: We found that one-third of violent and one-fourth of non-violent male offenders had at least one hospital admission due to a psychiatric disorder before the age of 32. Sixty-five violent criminals - 1.2% of all cohort males (n = 5636) - accounted for 14.4% of all psychiatric treatment days. The admission rates among both violent and non-violent male offenders were significantly higher when compared with males with no criminal history. Among violent males, only half (55.5%) of the inpatient hospital days due to psychiatric disorders occurred in psychiatric hospitals. The corresponding percentages for non-violent criminals and non-criminals were 64.9% and 74.1%, respectively. Among the violent offenders, one-third of hospital inpatient days occurred in university hospitals or central hospitals, and only 1.9% of them occurred in a comprehensive community care system., Conclusions: Violent offenders' admission rates due to a psychiatric diagnosis are high, and they are frequently treated at an inappropriate health care level.

The aim of this postal questionnaire study was to measure attitudes to health care prioritisation criteria among the Finnish general public (n = 1156), politicians (n = 1096), doctors (n = 803) and nurses (n = 667), altogether 3722 subjects. The questionnaire consisted of questions on background data, a list of seven alternative prioritisation methods and a list of 11 possible criteria for health care prioritisation. The most acceptable prioritisation methods were increased treatment fees and restricting expensive treatments and examinations. Only a few supported administrative prioritisation decisions. One third of the general public indicated that they did not accept any limitations in health care, whereas only 5% of doctors agreed with them. More doctors accepted prioritisation methods than respondents in other groups. Patient is a child, patient is an elderly person, severity of the disease and prognosis of the disease were the most accepted prioritisation criteria. Politicians and the general public also accepted self-induced nature of disease and patient's wealth as prioritisation crieteria. Logistic regression analysis of the general public respondents demonstrated that male gender, higher education and higher personal income were associated with acceptance of most prioritisation criteria. Similarly, older age of the respondent was associated with acceptance of self-induced nature of disease and patient's wealth as prioritisation criteria.

The genetic contribution to common forms of osteoarthritis (OA) is well established but poorly understood. We performed a genome scan, using 302 markers for loci predisposing to distal interphalangeal joint (DIP) OA. To minimize genetic heterogeneity in our study sample, we identified siblings with a severe, radiologically defined phenotype from the nationwide registers of Finland. In the initial genome scan, linkage analysis in 27 sibships gave a pairwise LOD score (Z) >1.00 with nine of the screening markers. In the second stage, additional markers and family members were genotyped in these chromosomal regions. On 2q12-q13, IL1R1 resulted in Z=2.34 at recombination fraction (theta) 0, allowing a dominant mode of inheritance. Association analysis of markers D2S2264, IL1R1, D2S373, and D2S1789 jointly provided some evidence for a shared haplotype among the affected individuals (P value of.012). Also, multipoint nonparametric linkage analysis yielded a P value of.0001 near the locus IL1R1 and P=.0007 approximately 20 cM telomeric near marker D2S1399, which, in two-point analysis, gave Z=1.48 (straight theta=. 02). This chromosomal region on 2q harbors the interleukin 1 gene cluster and, thus, represents a good candidate region for inflammatory and autoimmune disorders. Three additional chromosomal regions-4q26-q27, 7p15-p21, and Xcen-also provided some evidence for linkage, and further analyses would be justified to clarify their potential involvement in the genetic predisposition to DIP OA.

The aim of this study was to examine attitudes to prioritization in health care among the general public, politicians, doctors and nurses. The focus in this paper is on the types of services from a perspective that is 'policy analytical'. This study forms part of the wider 'Prioritization in Health Care Project' carried out at the University of Kuopio exploring patient treatment level prioritizations. Data were collected by a postal questionnaire in 1995. Four groups were established for the study: (1) a general public sample of 2000 subjects, (2) a random sample of 1000 nurses, (3) a random sample of 1500 medical doctors and (4) a sample of 2200 politicians involved in social and health care administration. Respondents were asked to make value choices between specialized and primary health care services in a real budget situation. One of the most salient findings in this study was that attitudes towards priorities are context-dependent. Certain differences were observed between the groups studied. The attitudes of the general public and nurses were quite similar, while similar views were shared by politicians and doctors. The attitudes of the respondents reflect well what has actually happened in Finnish health care, with the exception of psychiatric services which have undergone drastic cuts.

The aim of this postal questionnaire study was to measure attitudes to cuts and increased fees in health care in various Finnish population groups. Four groups were identified; a population sample of 2000 subjects, aged 18-70 y; a random sample of 1500 medical doctors of working age; a random sample of 1000 nurses of working age; and a sample of 2200 politicians involved in health and social care administration, mostly at the municipal level (altogether 6700 subjects). The main questionnaire included, among other things, the following questions: (1) Which of 18 specified medical activities at the primary health care level could be cut without causing severe harm to the population? (2) For which of 13 specified medical activities should clients pay at least 50% of the real cost? All the groups indicated the greatest willingness to cut expenditure on health education, occupational health services, hygiene inspection, substance abuse care, rehabilitation services for war veterans, and family planning. All the groups were least willing to make cuts in home care for disabled and elderly people, maternity services and clinics for under-fives. Most respondents in all groups felt that the activities for which clients should pay at least 50% of the cost were visits to physicians, occupational health services and dental services, whereas clinics for under-five and home care for disabled and elderly persons should be kept free of charge. As a conclusion, primary health care and prevention of diseases for small children, mothers, the elderly and disabled persons, were prioritised by all the groups.

Objectives: The aim of this study was to investigate differences in attitudes concerning prioritisation in health care held by doctors, nurses, local politicians and the general public., Methods: Four groups were established: a population sample of 2000 subjects, aged 18-70 years; a random sample of 1500 doctors of working age; a random sample of 1000 nurses of working age; and a sample of 2200 politicians involved in health and social care administration, mostly at the municipal level (altogether 6700 subjects). The main questionnaire contained, among other things, a list of 12 statements concerning ethical decisions regarding prioritisation in health care. Respondents were asked to indicate their level of agreement with each statement., Results: Most respondents in all the groups felt able to express an opinion on the statements. Despite considerable professional and cultural differences between groups, the views were generally similar. On the whole, respondents supported liberal policies in which the community took responsibility for subsidising health care. When differences between groups occurred, it was usually the doctors who held discordant views. Doctors were less inclined to consider a patient's economic status as a determinant of priority for treatment than the other three groups. Both doctors and nurses were less punitive towards patients with self-induced diseases. And doctors and politicians were more likely to feel further cuts in health care expenditure were possible than was true for nurses and the public., Conclusions: While considerable uniformity of opinion exists on ethical issues of prioritisation between the principal interested parties, the views of doctors differ substantially on some matters. If prioritisation was left entirely to doctors, health care provision would not reflect the views of other groups in some important ways.

The quality of health care is largely discussed issue among health care professionals in Finland. The purpose of this article is to point out some relations between the quality of nursing and the economical costs. The theme is mostly ignored in the published articles and books about quality of nursing and health care. In the previous studies of quality of nursing four main approaches have been introduced 1) practical approach, 2) professionalism, 3) client orientation and 4) research orientation. An important weakness in the approaches is that they are carried out from a point of view of a single profession at the time. Really multiprofessional projects are the exception. Additionally, economic costs have not been included in nursing quality concept or evaluation criterion. The need for quality in any health services is urgent, including nursing. That is because of decreasing resources and changing market oriented steering mechanisms in the Finnish health care system. In this situation the quality of nursing may arise as one important competition factor in the organizations and the units. The costs of poor quality of nursing are not well recognized among professionals. Collaboration between different professionals is a key issue to solve these kind of problems. We need more research about the relations between economic factors and quality of nursing and other health services.

The aim of this article is to examine, by means of an empirical study, the: a) relationship between formal and cultural structures; b) similarities and differences between professional subcultures (medical, nursing and managerial); and, c) the effects of the social assumptions of the work teams on development activities in one large primary health care organization. The results show that different professional groups have created quite different sets of social values, norms and assumptions, which have significant consequences, both for patients care and organizational performance.