Pirkanmaa Hospital District

Regular use of inhaled corticosteroids (ICS) is a cornerstone of asthma treatment. Adherence to ICS has been suggested to be poor and be associated with poor asthma control and exacerbations. To evaluate adherence to ICS and its relation to asthma symptom control and exacerbations in adult patients with asthma using ICS regularly. Altogether, 411 Finnish adult asthmatics who reported using regular/daily ICS were included. Comprehensive prescription and dispensation data from national records were obtained. Adherence (%) to ICS was calculated individually [(dispensed ICS µg /prescribed ICS µg) x100] during the follow-up time. Asthma control was assessed by the Asthma Control Test (ACT). Exacerbations were assessed over the previous 12 months by a questionnaire. Median prescribed daily ICS dose was 1000 (IQR 750–1500) µg and median dispensed dose was 784 (IQR 489–1008) µg equivalent to beclomethasone dry-powder inhaler, yielding a median adherence of 76.0 (53.2–98.8) % during the follow-up. Regarding asthma exacerbations during the previous year, 66.7% of the responders had temporarily increased their asthma medication, 32.7% had a course of oral corticosteroid, 22.7% had unscheduled health care visit and 2.5% were hospitalised for asthma. Poor adherence was not associated with any of these event types. There was no correlation between adherence to ICS and ACT scores (Pearson Correlation coefficient r = 0.011, p = 0.822). Adherence to ICS treatment among asthmatics in Finland is high, and poor asthma control or asthma exacerbations are not related to poor adherence. Rather, exacerbating asthma patients seem to have better adherence to ICS.

Some patients with cutaneous squamous cell carcinoma (cSCC) may suffer from multiple tumors but little is known of the patient- or tumor-related factors associated with multiple cSCCs. To investigate the proportion of patients having more than 1 cSCC tumor and to explore whether there are factors that associate with multiple cSCC tumors. Histopathological diagnoses of "cSCC" from patients treated in Pirkanmaa, Finland, between 2006 and 2020, were obtained from the pathology database to identify patients with cSCC and to obtain the number of all diagnosed cSCC tumors. Clinical records were reviewed to collect information on the patients and their tumors. A total of 1421 patients with 1988 cSCC tumors were identified. One-fifth of the patients (n = 285) had multiple cSCC tumors during the study period. A multivariable-adjusted model showed the patients with multiple cSCCs to be more often men and to have actinic keratosis, Bowen's disease, and basal cell carcinomas (BCCs) more frequently than the patients with a single cSCC. The median time between the index and the second cSCC was 13 (interquartile range 2-34) months and the second tumor appeared at the same location as the index tumor in 71% of the cases. An invasion depth of more than 2 mm was associated with multiple tumors. Multiple tumors appeared in 20% of the patients with cSCC, and were more common among those with previous or simultaneous premalignant skin lesions and BCCs.

Breast cancer is the second most common cancer worldwide, with HER2-positive disease being an aggressive subtype. Trastuzumab emtansine (T-DM1) has been the gold standard for second-line treatment in HER2-positive metastatic breast cancer since 2012. However, the high cost of cancer treatments presents a significant economic burden. Many oncology drugs, including T-DM1, are dosed on the basis of patient weight, leading to drug wastage due to single-dose vials. The aim of the study was to determine whether manual dose rounding down can reduce drug wastage and costs. This retrospective study included patients treated with T-DM1 from January 2015 to December 2022 at the Tampere University Hospital in Finland. Data were collected from chemotherapy and pharmacy software. Drug wastage and cost savings were analyzed. A total of 1797 T-DM1 doses were used over the 8-year study period. The proportion of T-DM1 doses suitable for rounding was on average 67%. Oncologists reduced 31,268 mg of drug waste (74% of total waste) by rounding doses down to the nearest vial size. During the study period, dose rounding resulted in savings of 1,307,659€ (14% of total costs). An additional 609,028€ could have been saved if all possible doses had been rounded down. Manual dose rounding of T-DM1 by oncologists considerably reduced drug wastage and costs. Implementing an automated dose rounding system in the chemotherapy management software would further reduce costs. These findings highlight the importance of innovative healthcare solutions to address the high costs of cancer treatments.

Frontal T-wave axis (TA) and QRS-T angle (QRSTA) are automated ECG measures that reflect depolarisation-repolarisation abnormalities-and have been linked to mortality. We tested whether increasing deviation in TA/QRSTA predicts adjudicated sudden cardiac death (SCD) events in patients undergoing coronary angiography-elective (chronic coronary syndrome) and acute (acute coronary syndrome)-and whether signals differ when ECGs are recorded post-acute. Retrospective consecutive cohort at Tampere University Hospital, 2007-2018. Exposures were automatically measured frontal TA and QRSTA (Marquette 12SL). Primary endpoint was SCD event (true SCD, resuscitated SCA or implantable cardioverter defibrillator-terminated VF/very fast ventricular tachycardia) adjudicated to guideline definitions, with Fine-Gray competing-risk models adjusted for clinical covariates. Follow-up through 31 December 2022. We analysed 18 828 patients (elective n=10 303; acute n=8525; median follow-up 9.0 and 7.8 years). In the elective cohort, SCD hazard increased monotonically with TA/QRSTA deviation; severely abnormal TA (<-75° or >165°) HR 4.06 (95% CI 2.94 to 5.61) and severely abnormal QRSTA (≥151°) HR 3.16 (2.35-4.24). Associations persisted after excluding left ventricular ejection fraction (LVEF) ≤35%. In the acute cohort, effects were smaller and non-monotonic (severely abnormal TA HR 2.01 (1.42-2.86); QRSTA HR 1.73 (1.24-2.39)). In a sensitivity cohort with ECGs 30-365 days postangiography (acute 30, n=5529), the TA-SCD association resembled the elective setting (severely abnormal TA HR 2.69 (1.70-4.24)); QRSTA was not significant. Severity of frontal TA deviation is a robust, graded marker of SCD risk in angiography patients, strongest in elective and postacute settings; QRSTA is supportive but weaker. These automated, low-cost metrics could augment SCD risk stratification beyond LVEF, warranting external validation and clinical utility testing.

BackgroundProximal humeral fractures (PHFs) are common injuries, but their management has remained controversial. Recent high-level evidence from randomized clinical trials has shown that for many PHFs, surgical treatment is not superior to non-surgical treatment. Our primary aim was to conduct a multi-nation assessment of temporal trends and changes in surgical treatment of isolated PHF in Denmark, England, and Sweden. A secondary aim was to estimate the incidence of serious adverse events (SAEs) within 30 days (and death within 90 days) of primary surgery.MethodsThis population-based cohort study presents routinely collected data from Danish, English, and Swedish patient registries and electronic health records from 1998 to 2018. All adult patients with isolated PHFs combined with predefined surgical procedure codes were included. Age- and sex-specific incidence rates (IRs) of surgery and each surgical procedure per calendar year were calculated. Kaplan–Meier plots displayed patient survival for the study period. Incidence proportions of SAEs within 30 days (and death within 90 days) of surgery were computed.ResultsA total of 54,077 primary surgical procedures, performed in 53,852 patients with isolated PHF, were included. Denmark and Sweden had the highest IR of surgery, with Denmark peaking at 17.4/100,000 person-years in 2011 and Sweden peaking at 18/100,000 person-years in 2013, while England peaked at 5/100,000 person-years in 2010. From 2004, plate fixation was the leading surgical procedure in Denmark and Sweden, while arthroplasty was the most frequent in England. The IR of surgery in Denmark and Sweden was 8–10 times higher for women aged 80 years than that observed in England. The 30-day incidence of SAEs varied between countries, ranging from 0.03% to 3.51%.ConclusionsVariations in surgical practice for isolated PHF exist between Denmark, England, and Sweden, with differences in overall IRs of surgery and preferred procedures. A complex interplay between hospitals, surgeons, healthcare systems, and evidence-based factors is likely to explain such variations. However, in all three countries, the IR of surgery, particularly for the use of locking plates, demonstrated a decline from 2013, coinciding with high-quality trials and meta-analyses suggesting that evidence-based factors are becoming more prominent in orthopaedic treatment decisions.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-025-04414-2.

BackgroundThe increased prevalence of atopic diseases may be due to lifestyle changes affecting our exposure to microbes. We investigated the association between infections, fever, and atopic diseases in a large international birth cohort setting.Methods3842 children at genetic risk for type 1 diabetes were followed prospectively for the first 10 years for the occurrence of infections and atopic diseases within The Environmental Determinants of Diabetes in the Young (TEDDY) study. A time‐discrete survival analysis was carried out to evaluate the association of self‐reported febrile and non‐febrile infections (respiratory, gastrointestinal, other, fever alone) and the risk of subsequent atopic eczema, allergic rhinitis, asthma, and allergies.ResultsThe rate of respiratory infections was positively associated with the subsequent risk of asthma (HR 1.30, 95% CI 1.25–1.35, p < .001). Febrile respiratory infections increased the risk of asthma more than non‐febrile ones (febrile respiratory infection HR 1.50, 95% CI 1.42–1.59, p < .001; non‐febrile respiratory infection HR 1.24, 95% CI 1.18–1.30, p < .001). In contrast, fever decreased the positive association of infections with the risk of other atopic diseases. Episodes of fever as the only reported symptom had a negative association particularly with the risk of atopic eczema (HR 0.53, 95% CI 0.39–0.71, p < .001).ConclusionsIn a longitudinal cohort study, fever shows a clear impact on how infections associate with subsequent atopic diseases. Understanding the modifying role of fever on risk offers new possibilities to explore the mechanisms that mediate the effect of infections in the atopic process.

The primary aim of this study was to investigate how the Clinical Frailty Scale (CFS) associates with survival of patients with diabetes after lower extremity amputation (LEA). This retrospective cohort study included patients with diabetes undergoing nontraumatic LEA at Tampere University Hospital during 2007-2020. Kaplan-Meier and Cox regression analyses were performed to evaluate the effect of CFS on overall survival (OS), amputation-free survival (AFS) and leg salvage (LS). A total of 1043 patients with mean age 71.0years were included. Compared to patients with low CFS (1, 2), scores 3-4 and 5-9 were associated with reduced OS (HR 1.821, p<0.001; HR 4.585, p<0.001), AFS (HR 1.575, p<0.001; HR 4.031, p<0.001) and LS (HR 1.435, p=0.049; HR 2.478, p<0.001). The multivariable Cox regression analysis showed that CFS remained a significant predictor of OS, AFS and LS. This study demonstrates a high prevalence of frailty among patients with diabetes undergoing LEA, suggesting that frailty assessment should be integrated into clinical decision-making for this patient population. The CFS score appears to be a promising tool for evaluating patients facing amputation to enhance survival rates.

Atrial fibrillation(AF) may be linked to increased sudden cardiac death (SCD) risk, but patients with AF are often neglected in studies on ECG risk factors for SCD. We aimed to clarify the long-term SCD incidence in AF among patients undergoing coronary angiography. SCD incidence was retrospectively assessed between 2007 and 2018 in patients with suspected or known coronary artery disease referred for elective angiography and in patients with acute coronary syndrome (ACS). Follow-up extended until 31 December 2022. SCD (defined per American Heart Association/American College of Cardiology/Heart Rhythm Society/European Society of Cardiology guidelines) and SCD-equivalent events occurring during follow-up were identified through in-depth review of medical records, including accounts of circumstances leading to deaths. History of AF was identified through review of medical records, while AF at baseline and during follow-up was detected using the GE HealthCare Marquette 12SL algorithm. 9622 ACS and 11 799 elective patients were included, with 955 SCD events during follow-up. The 10-year SCD incidence among patients with AF was 7.7% in ACS and 6.4% in elective patients, compared with 4.5% and 3.2% in those without AF. In competing risk models adjusted for baseline risk factors including left ventricular ejection fraction, AF was associated with SCD (ACS: subdistribution hazard 1.33 (95% CI 1.05 to 1.67); elective: 1.37 (95% CI 1.10 to 1.71)), but this was no longer evident in the elective cohort after adjusting for incident heart failure hospitalisations, which AF preceded in 57.5% by an average of 1.4 years. Overall, 33% of SCD cases occurred in patients with known AF (paroxysmal, persistent or permanent), and 21% of SCD victims had AF on their last ECG. A significant proportion of SCDs occur in patients with AF, but the risk appears mediated by heart failure hospitalisations rather than AF itself.

BackgroundSleep problems are common in psychotic disorders and are associated with worse quality of life and disease prognosis. Genome-wide association studies (GWAS) have revealed genetic influences for schizophrenia and sleep, but polygenic scores (PGSs) for sleep traits have not been evaluated systematically in patients with psychotic disorders.MethodsThis study investigated the associations between PGSs for sleep traits (insomnia, PGSINS; sleep duration, PGSSD; short sleep duration, PGSSS; long sleep duration; PGSLS), diurnal preference (eveningness, PGSME), and schizophrenia (PGSSZ) with clinical features of psychotic disorders in the Finnish SUPER study comprising 8,232 patients with psychotic disorders. The measures included self-reported sleep and well-being, cognitive assessments, clozapine use, and functional outcomes. Using FinnGen data of 356,077 individuals, we analyzed the distributions of PGSs in psychotic and bipolar disorders and the general population.ResultsPGSINS associated with more sleep problems and worse well-being (e.g. worse health-related quality of life [β = −0.07, CI = −0.09, −0.05, p < .001]). High PGSSZ is associated with better sleep quality, worse clinical outcomes, and performance in cognitive tests (e.g. more errors in paired-associated learning [β = 0.07, CI = 0.04, 0.09, p < .001]). PGSINS was higher in affective psychotic and bipolar disorders, while PGSSD and PGSME were higher in schizophrenia as compared with individuals with no psychiatric disorders.ConclusionGenetic risks for sleep and diurnal preference vary between non-affective psychosis, affective psychosis, and the general population. The findings in this study emphasize the heterogeneity in genetic etiology of the objective features of disease severity and the more subjective measures related to well-being and self-reported measures of sleep.

Background: The success of adipose stromal/stem cell (ASC)-based therapies may depend on donor characteristics such as body mass index (BMI). A high BMI may negatively impact the therapeutic potential of ASCs, but the effects of weight loss on ASC-mediated immunoregulation have not been extensively studied. Methods: ASCs were obtained from donors with obesity (obASCs) undergoing bariatric surgery and from the same donors after weight loss (wlASCs). Plasma samples, adipose tissue histology, and ASC characteristics, such as mitochondrial respiration and inflammatory factors, were studied before and after weight loss. The immunomodulatory capacity of ob/wlASCs was evaluated in cocultures with prepolarized and preactivated proinflammatory (M1) and anti-inflammatory (M2) macrophages by determining macrophage surface markers, gene expression, and cytokine secretion. Results: Weight loss significantly decreased plasma leptin levels and increased adiponectin levels. After weight loss, crown-like structures (CLSs) were undetectable, and the adipocyte size decreased. Weight loss significantly improved mitochondrial respiration in ASCs and resulted in a notable increase in their proliferative capacity. The proinflammatory marker genes tumor necrosis factor alpha (TNF-α), chemokine ligand 5 (CCL5), and cyclooxygenase-2 (COX2), as well as the proinflammatory cytokine interleukin 12p70 (IL-12p70), were significantly downregulated, while the anti-inflammatory gene tumor necrosis factor-inducible gene 6 (TSG6) was also significantly downregulated in ASC monocultures after weight loss. Following weight loss, ASCs exhibited increased proinflammatory properties when cocultured with macrophages, characterized by the downregulation of anti-inflammatory factors, along with the upregulation of several proinflammatory factors, compared with the effects of macrophage monocultures. Conversely, wlASCs demonstrated improved immunosuppressive functions in coculture with macrophages, as indicated by the upregulation of TSG6 gene expression and interleukin 4 (IL-4) secretion. Conclusions: Weight loss improved donors' metabolic health and partially recovered ASCs' anti-inflammatory gene expression and cytokine secretion profiles in monocultures. However, it was inadequate to fully restore the immunosuppressive functions of ASCs in cocultures with macrophages. Therefore, not only donor BMI but also weight loss history, among other donor characteristics, might be considered for optimal ASC-based therapy.