Mika Helminen

Narrow-band TL-01 ultraviolet B phototherapy (TL-01) is generally considered a relatively safe treatment for skin diseases, although conflicting findings have also been reported. This study aimed to evaluate the association between TL-01 exposure and skin cancer risk using a nested case-control design within a Finnish cohort of 4,815 patients treated with TL-01 monotherapy, with subsequent 38 cases of basal cell carcinoma, 13 cases of cutaneous melanoma, and 9 cases of cutaneous squamous cell carcinoma. Four matched controls were selected for each skin cancer case. Personal TL-01 exposure data were obtained from hospital records. Conditional logistic regression was used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs). An increased risk for basal cell carcinoma was observed with higher TL-01 exposure (OR per 20 sessions 1.36, 95% CI 1.08–1.72), whereas no association was found for cutaneous melanoma or cutaneous squamous cell carcinoma. In a categorical analysis, with category of 1–29 TL-01 sessions as the reference, the risk of basal cell carcinoma was markedly elevated among patients who received ≥60 sessions (OR 4.16, 95% CI 1.49–11.6). Occupational outdoor work was considered a potential confounder, but it had no effect. Further studies with larger cohorts and longer follow-up are needed to confirm these findings.

Introduction: Induction of labor (IOL) rates have been increasing in high‐income countries. Although IOL aims to reduce maternal and neonatal morbidity, the benefits for many common indications remain uncertain. Because IOL may also have disadvantages and place a burden on the health‐care system, it is important to clarify the factors underlying the rising national IOL rates. Material and Methods: This descriptive study included all singleton births in cephalic presentation delivered at 37 ⁺⁰ gestational weeks or later between January 1, 2005, and December 31, 2023, in Finland. Data from the Finnish Medical Birth Register were used to examine temporal trends in maternal characteristics, gestational age at delivery, pregnancy complications, and other pregnancy‐related problems across three periods: 2005–2010, 2011–2016, and 2017–2023. Induced deliveries were analyzed separately. Risk ratios with 95% confidence intervals were calculated to describe changes over time, and odds ratios with 95% confidence intervals were estimated to assess associations between IOL and risk factors. Logistic regression models were adjusted for maternal age, body mass index (BMI), and parity. Results: The study sample included 880 478 births. The IOL rate doubled from 18% to 36%. In the IOL group, the most prevalent and increasingly common factors were maternal age ≥35 years, BMI ≥30 kg/m ² , and gestational diabetes. Prelabor rupture of membranes, fear of childbirth, and other pregnancy‐related problems—despite their lower overall proportions—showed the steepest increases. Similar but less pronounced trends were seen in the total study cohort. The odds of IOL remained stable across the study periods for maternal age ≥35 years, BMI ≥30 kg/m ² , gestational diabetes, prelabor rupture of membranes, fear of childbirth, and other pregnancy‐related problems; and all associations remained statistically significant after adjustment. The proportion of post‐term pregnancy decreased significantly in both the total study cohort and the IOL group. In the IOL group, gestational age at birth shifted from post‐term to late‐ and full term. Conclusions: The main contributors to the increasing IOL rate were the increased prevalence of advanced maternal age, obesity, and gestational diabetes. The increases in the prevalence of other IOL indications were less extensive.

Background: Anaemia is common among patients with traumatic brain injury (TBI), and it might contribute to the development of secondary brain injury. However, the impact of anaemia on outcome among TBI patients remains controversial. The aim of this study was to investigate the association between acute anaemia and short‐term neurological outcome and mortality among patients with moderate to severe TBI. Methods: The retrospective cohort study included all successive patients admitted to Tampere University Hospital's emergency department with moderate to severe TBI between August 2010 and July 2012. Information on patient demographics, trauma‐related characteristics and post‐traumatic care was collected, including all in‐hospital haemoglobin (Hb) values. Hb concentration below 100 g/L at any point during the hospitalisation was defined as severe anaemia. The main outcome variable was the Glasgow Outcome Scale (GOS) at hospital discharge, dichotomized as poor (GOS 1 to 3) and good (GOS 4 to 5) outcome. The secondary outcome variables were mortality rates at 3, 6 and 12 months after TBI. Results: A total of 145 patients with moderate to severe TBI met the inclusion criteria. Severe anaemia was detected in 45.5%. In univariate analyses, severe anaemia was associated with poor unfavourable functional outcome at hospital discharge (83.3% vs. 55.6%, p < 0.001), and higher 3‐month, 6‐month and 12‐month mortality rates (28.8% vs. 13.9%, p = 0.028; 30.3% vs. 16.5%, p = 0.048; 36.4% vs. 17.7%, p = 0.011, respectively). In multivariable analysis, severe anaemia was independently associated with unfavourable functional outcome (OR 4.06, 95% CI 1.54–10.72, p = 0.005), but not with higher long‐term mortality. Conclusion: Among patients with moderate to severe TBI, severe anaemia with an Hb level below 100 g/L during hospitalisation was independently associated with unfavourable functional outcome at hospital discharge. Editorial Comment: For cases with severe traumatic brain injury, managing oxygen carrying capacity is one important factor. In this single center cohort, severe anemia documented at any point in the hospitalization was associated with worse neurological outcome.

Objectives: To study the annual incidence, diagnostic methods used and clinical presentation of giant cell arteritis (GCA) over time in Finland. Methods: Newly diagnosed GCA patients from 2010 to 2020 were retrospectively identified from four healthcare districts in Finland. Medical records were reviewed and data on incidence, diagnostic methods, phenotype [cranial vs large vessel (LV)-GCA] and clinical presentation were analysed. Results: We identified 602 newly diagnosed GCA patients. The annual incidence was 9.0 cases/100 000 persons (95% CI 8.3, 9.7) ≥50 years of age and was significantly higher in the period 2016–2020 compared with the period 2010–2015 [11.3 (95% CI 10.1, 12.5) vs 7.0 (95% CI 6.2, 7.9), P < 0.001]. Imaging- or biopsy-confirmed diagnosis was recorded in 75% of GCA patients, while 25% had a clinical diagnosis. The proportion of imaging- or biopsy-confirmed diagnoses increased over time [64.7% (2010–2015) vs 82.2% (2016–2020)] while that of clinical diagnoses decreased. The use of imaging methods increased while the use of temporal artery biopsies decreased between the two time periods. LV-GCA was discovered more often in the period 2016–2020 when compared with 2010–2015 (34.0% vs 19.3% of patients). Conclusion: The incidence of GCA increased during the study period, as well as the proportion of imaging- or biopsy-confirmed diagnoses, probably due to more frequent use of advanced imaging methods. Additionally, patients with LV-GCA were more commonly identified.

Study design: Prospective cohort study. Objectives: To study the mortality rates of TSCI patients compared to matched controls and to examine possible TSCI-related mortality risk factors and causes of death. Setting: Oulu and Tampere University Hospital, Finland. Methods: All consecutive patients with a new TSCI were included in a prospective study (n = 344, 2012-16). All patients were followed until death or the end of 2019. Patients were compared to a control group formed by randomly choosing gender, age, municipality, and calendar time-matched controls (5 controls/TSCI patient). Standardized mortality ratios (SMR) were calculated using general population mortality rates. Mortality information was extracted from the Statistics of Finland (Helsinki, Finland). Results: TSCI patients had an increased mortality (SMR = 2.9) compared with the Finnish population. During the observation period, 26% of TSCI patients and 12% of the matched controls died. Of the TSCI patient deaths, 51% occurred within the first two years postinjury. Increased age, severity of TSCI (as per International SCI Core Data Set) and fall were related to mortality (p < 0.05). The two most common etiologies of death were: circulatory (30%), and pulmonary diseases (28%). Pneumonia was the single most frequent disease leading to death among TSCI patients. Conclusions: During the first years after injury, the mortality of the patients with TSCI is double compared to the controls. Most deaths occur within two years postinjury. Elderly patients with more severe fall-related injury have the highest mortality risk. Circulatory diseases and pulmonary diseases, especially pneumonia, are the foremost causes of death after TSCI.

Objectives of the article: Inflammatory bowel disease (IBD) nursing has been identified as a crucial component in the IBD service delivery. This article aims to provide a comprehensive overview of the state of IBD nursing care in Finland, and to identify areas that would benefit from further research. Materials and methods: Tertiary IBD outpatient clinics nationwide were invited to participate in a cross-sectional descriptive study conducted using an electronic survey. The quality of IBD nursing services was assessed using the Nursing Care Quality in IBD (NCQ-IBD) evaluation tool. Results: Of the 34 identified clinics, 27 participated (79.4%) in the study. The NCQ-IBD tool classifies the clinics in four categories, where A indicates the highest level of quality, and D the lowest. In this study, 26 clinics (96.3%) were classified at level C, and one clinic (3.7%) at level D. Nursing responsibilities in IBD management and informing the patients were at a high level of quality, whereas nursing research in IBD was at a low level. An IBD database (i.e. clinical IBD registry) was in use only in 10 clinics. Although training in the clinical aspects of IBD was readily available, there was a lack of training plans for IBD, and clinics seldom held an annual review of the IBD nursing activities and outcomes. There were very few clinics using structured indices and questionnaires, and only 16 clinics (59.3%) applied a written IBD protocol. Conclusion: In the Finnish IBD nursing service, as measured with the NCQ-IBD tool, several areas for future improvement were identified.

Background: Researchers and clinicians using common clinical assessments need to attend to the prevalence of missing data to ensure the validity of the information gathered. The Expanded Prostate Cancer Index Short Form (EPIC-26) is a commonly used measurement scale used for assessing patients’ quality of life, but the measure lacks comprehensive analysis on missing data. We aimed to explore the quantity of missing answers in EPIC-26 and to characterize patterns and possible explanations of missing data in the survey. Methods: The survey sample consisted of 625 Finnish prostate cancer patients who participated in a study with a 1-year follow-up with three measurement points (0, 6, and 12 months). Descriptive statistics were used to describe the study population and missingness level. A logistic regression was performed for each EPIC domain to study factors related to missingness during the follow-up. Results: Proportions of missing answers in EPIC-26 were low (3.1–3.9%) between survey rounds. As much as 37% of patients left at least one question unanswered during their follow-up. The hormonal domain produced the most missing answers. Questions about breast tenderness/enlargement (question 13.b.), hot flashes (question 13.a.), frequency of erections (question 10.), and ability to reach orgasm (question 8.b.) were most frequently left unanswered. Higher age, lower education level, no relationship, more severe cancer, lower function scores in some EPIC domains, lower treatment satisfaction or self-rated health were associated with missingness. Conclusions: Questions 13.b. and 13.a. might be considered female-specific symptoms, thus difficult to comprehend unless patients had already experienced side effects from androgen deprivation therapy. Questions 10. and 8.b. might be difficult to answer if the patient has been sexually inactive. To improve the measure’s validity, the questionnaire’s hormonal section requires additional explanation that the inquired symptoms are common treatment side effects of anti-androgen therapy; questions 8–10 require a not-applicable category for sexually inactive patients.

Parental empowerment has been related to their well-being and self-efficacy. Learning more about the signs describing child maltreatment risk are crucial for the welfare of children and families. The aim of this study was to assess the risk of child maltreatment (CM) and related worrying factors of parents and associations between the CM risk, worries and parental empowerment. The study is based on self-report surveys administered to parents in primary health care and hospital settings. The risk of CM and related worrying factors were measured by the Brief Child Abuse Potential Inventory (BCAP) from 453 parents. Family empowerment was measured by The Generic Family Empowerment Scale (G-FES). Parents expressed worries such as loneliness and distress (20%), feelings of persecution (9%), family conflict (17%), rigidity (21%) and financial insecurity (4%). The BCAP found 27 parents with increased risk. Parents with CM risk expressed more empowerment in connection to services for their child and family. It is crucial to discuss worries in child and family services before they raise the risk level. Tools such as the BCAP are useful in systematically identifying the child maltreatment risk and parental worries under discussion, offering possibilities for preventing child maltreatment and increasing well-being of children.