Changes in SARS-CoV-2 seroprevalence and population immunity in Finland, 2020-2022.

Studying the prevalence of SARS-CoV-2 specific antibodies (seroprevalence) allows for assessing the impact of epidemic containment measures and vaccinations and estimating the number of infections regardless of viral testing. We assessed antibody-mediated immunity to SARS-CoV-2 induced by infections and vaccinations from April 2020 to December 2022 in Finland by measuring serum IgG to SARS-CoV-2 nucleoprotein (N-IgG) and spike glycoprotein from randomly selected 18-85-year-old subjects (n = 9794). N-IgG seroprevalence remained at <7% until the last quartile (Q) of 2021. After the emergence of the Omicron variant, N-IgG seroprevalence increased rapidly and was 31% in Q1/2022 and 54% in Q4/2022. Seroprevalence was highest in the youngest age groups from Q2/2022 onwards. We did not observe regional differences in seroprevalence in 2022. We estimated that 51% of the Finnish 18-85-year-old population had antibody-mediated hybrid immunity induced by a combination of vaccinations and infections by the end of 2022. In conclusion, major shifts in the COVID-19 pandemic and resulting population immunity could be observed by serological testing.

Incidence of SARS-CoV-2 Infection and Factors Associated With Complete COVID-19 Vaccine Uptake Among Migrant Origin Persons in Finland.

Objective: We examined incidence of SARS-CoV-2 infection, COVID-19 vaccine uptake and factors associated with complete COVID-19 vaccine uptake among persons of migrant origin in Finland. Methods: Data on laboratory-confirmed SARS-CoV-2 infection and COVID-19 vaccine doses between March 2020 and November 2021 were linked to FinMonik register sample (n = 13,223) and MigCOVID (n = 3,668) survey data using unique personal identifier. Logistic regression was the main method of analyses. Results: Among FinMonik sample, complete COVID-19 vaccine uptake was lower among persons of Russia/former Soviet Union, Estonia, and rest of Africa and higher among persons of Southeast Asia, rest of Asia, and the Middle East/North Africa than among persons originating from Europe/North America/Oceania. Male sex, younger age, migration age (<18 years) and shorter length of residence were associated with lower vaccine uptake among FinMonik sample, whereas younger age, being economically inactive, poorer language skills, experiences of discrimination and psychological distress were associated with lower vaccine uptake among MigCOVID sub-sample. Conclusion: Our Findings point to a further need of tailored and targeted communication and community outreach strategies to increase vaccine uptake among persons of migrant origin.

The COVID-19 pandemic and the timing of government response: A comparison of four Nordic countries March-June 2020.

OBJECTIVES: The aim is to compare Sweden, Denmark, Finland and Norway regarding government response to the COVID-19 pandemic in mid-March-June 2020 using the Oxford Government Response Tracker. STUDY DESIGN: Descriptive longitudinal ecological study. METHODS: Descriptive analysis of time series data. RESULTS: Sweden displayed a far lower response index in March. By late April indexes were similar. In May-June, response indexes were lower in Finland and Norway than in Sweden. The average response index in mid-March-June was similar in Sweden, Finland and Norway. CONCLUSIONS: The government response in the four countries indicates that timing of response was essential. Sweden's slow and weak initial government response in March-April was followed by less loosening of government response in May-June compared with, especially, Finland and Norway, which resulted in similar average government response in mid-March-June for the three countries. As a comparison, COVID-19 mortality per capita was 10 times higher in Sweden than in Finland and Norway, and five times higher than in Denmark during the same period.

Socioeconomic disparities in adolescent anxiety and depression in Finland have not increased during the COVID-19 pandemic.

AIMS: The purpose of this research was to assess whether socioeconomic disparities in adolescent depression and anxiety in Finland increased among middle adolescents during the COVID-19 pandemic. METHODS: Repeated cross-sectional surveys (the School Health Promotion Study) from spring 2019 and spring 2021 were compared. The respondents were 87,283 eighth and ninth graders (14-16-year-olds) in 2019 and 91,560 in 2021, corresponding respectively to 73% and 75% of the age groups. Depression was measured by Patient Health Questionnaire-2 (PHQ-2), and anxiety with GAD-7, and adverse socioeconomic background using low parental education, not living with both parents, and family's poor financial situation. Associations of socioeconomic adversities with depression and generalised anxiety, and the effect of COVID-19 (2021 vs 2019), were analysed using logistic regression. RESULTS: Depression and anxiety were more common in both sexes the more sociodemographic adversities there were in the adolescent's background. However, increases in the prevalence of anxiety and depression from pre- to in-pandemic time did not differ with accumulating sociodemographic adversities. CONCLUSIONS: Depression and anxiety increased in prevalence among Finnish adolescents during the pandemic. Sociodemographic disparities in depression and anxiety show no increase. Emotional symptoms are nevertheless more common in adolescents from lower socioeconomic status families.

Face mask recommendations in schools did not impact COVID-19 incidence among 10-12-year-olds in Finland - joinpoint regression analysis.

BACKGROUND: In autumn 2021 in Finland, a recommendation to use face masks was implemented nationwide in schools for pupils ages 12 years and above. While national guidelines were in form of recommendations, cities implemented mandatory masking in schools. Some cities extended this mandate for younger pupils as well. Our aim was to compare COVID-19 incidence among 10-12-year-olds between cities with different recommendations on the use of face masks in schools. METHODS: COVID-19 case numbers, defined as positive laboratory verified SARS-CoV-2 test results, were obtained from the National Infectious Disease Registry (NIDR) of the Finnish Institute for Health and Welfare. Helsinki, Turku and Tampere were selected for comparison since the baseline COVID-19 incidence in the cities had been similar in August and September 2021. Helsinki and Tampere implemented the national recommendation on face mask use at schools, while Turku extended this to include those 10 years old and above, starting from the beginning of semester in early August. Age groups of 7-9-year-olds, 10-12-year-olds and 30-49-year-olds were included in the statistical analysis and moving averages of 14-day incidences per 100 000 inhabitants were used as a dependent variable. Joinpoint regression was used to estimate average percent changes (APC) and average daily percent changes (ADPC) in the 14-day incidences. Differences in the ADPC values between the cities were compared in one-month periods. We also calculated cumulative incidences from the beginning of August to the end of November in the cities by age group. RESULTS: In August, the ADPC was highest in Turku (3.9) and lowest in Tampere (2.0), while in September, the ADPC was highest in Turku (-0.3) and lowest in Helsinki (-3.2) among 10-12-year-olds. In October, the ADPC was highest in Helsinki (2.1) and lowest in Turku (-0.2) and in November, the ADPC was highest in Turku (4.1) and lowest in Tampere (-0.5) among 10-12-year-olds. We also calculated cumulative incidences from the beginning of August to the end of November in the cities by age groups of 7-9 years, 10-12 years, and 30-49 years. The cumulative incidence was highest in Turku in all age groups and lowest in Tampere. CONCLUSIONS: According to our analysis, no additional effect was gained from mandating face masks, based on comparisons between the cities and between the age groups of the unvaccinated children (10-12 years versus 7-9 years).

Care workers' positive health during the COVID-19 pandemic: Psychometric properties of the Finnish version of the Salutogenic Health Indicator Scale and an 18-month follow-up.

BACKGROUND: There is a need to shift from biomedical and pathogenic approaches to salutogenic approach. OBJECTIVE: To validate the Finnish version of the SHIS by testing its psychometric properties in care workers and to assess the SHIS score over time. METHODS: We first conducted a survey in 2020 (T1) and tested the psychometric properties of SHIS among care workers. We repeated the survey in spring 2022 (T2) among the same subjects. We analyzed the changes in SHIS, self-rated health (SRH), work ability (WAS), sickness absence and occupational calling between T1 and T2. Thereafter, we compared changes between health care sectors' and the other sectors' care workers. RESULTS: The results showed an increase in positive health measured with the SHIS and the occupational calling, a decrease in the SRH, and an increase in the number of sickness-related absences among all the care workers between T1 and T2. There was no change in their WAS. The health care workers had a lower SHIS than the other sectors' care workers in both T1 and T2, but the increase in their SHIS was parallel to that of the other workers. CONCLUSION: SHIS is a useful and reliable measure of positive health and can be used in studies when determining subjective health instead of, or in addition to, diagnoses. It was able to detect the health changes caused by the COVID-19 pandemic. SHIS is capable of capturing the underlying salutogenic approach of health promotive resources.

SARS-CoV-2 and type 1 diabetes in children in Finland: an observational study.

BACKGROUND: Some epidemiological studies have suggested an increase in incidence of type 1 diabetes during the COVID-19 pandemic, however the mechanism(s) behind such an increase have yet to be identified. In this study we aimed to evaluate the possible role of the SARS-CoV-2 virus in the reported increase in the rate of type 1 diabetes. METHODS: In this observational cohort study using data from the Finnish Pediatric Diabetes Register (FPDR), we assessed the incidence of type 1 diabetes (number of children with newly diagnosed type 1 diabetes per 100 000 person-years during the pandemic and the reference period) during the first 18 months of the COVID-19 pandemic in children in Finland younger than 15 years old compared with a reference period which included three corresponding pre-pandemic periods also obtained from the FPDR. Children with confirmed monogenic diabetes were excluded. We also compared the phenotype and HLA genotype of the disease between these two cohorts, and analysed the proportion of newly diagnosed people with type 1 diabetes testing positive for SARS-CoV-2 antibodies. FINDINGS: 785 children and adolescents in Finland were diagnosed with type 1 diabetes from March 1, 2020, to Aug 31, 2021. In the reference period, which comprised three similar 18-month terms (from March 1, 2014, to Aug 31, 2015; March 1, 2016, to Aug 31, 2017; and March 1, 2018, to Aug 31, 2019) 2096 children and adolescents were diagnosed. The incidence of type 1 diabetes was 61·0 per 100 000 person-years (95% CI 56·8-65·4) among children younger than 15 years old during the pandemic, which was significantly higher than during the reference period (52·3 per 100 000 person-years; 50·1-54·6). The incidence rate ratio adjusted for age and sex for the COVID-19 pandemic was 1·16 (1·06-1·25; p=0·0006) when compared with the reference period. The children diagnosed during the COVID-19 pandemic had more often diabetic ketoacidosis (p<0·001), had a higher HbA1c (p<0·001), and tested more frequently positive for glutamic acid debarboxylase antibodies at diagnosis (p<0·001) than those diagnosed before the pandemic. There were no significant differences in the distribution of HLA genotypes between the two periods. Only five of those diagnosed during the pandemic (0·9%) of 583 tested positive for infection-induced SARS-CoV-2 antibodies. INTERPRETATION: Children and adolescents diagnosed with type 1 diabetes during the pandemic had a more severe disease at diagnosis. The observed increase in type 1 diabetes incidence during the first 18 months could be a consequence of lockdown and physical distancing rather than a direct effect of SARS-CoV-2 infection. FUNDING: Helsinki University Hospital Research Funds, EU Horizon 2020 (Versatile emerging infectious disease observatory project), Academy of Finland, Sigrid Jusélius Foundation, Jane & Aatos Erkko Foundation, and Medicinska understödsföreningen Liv och Hälsa. TRANSLATIONS: For the Finnish and Swedish translations of the abstract see Supplementary Materials section.

Generalized anxiety among Finnish youth from 2013 to 2021-Trend and the impact of COVID-19.

BACKGROUND: Alarming levels of emotional symptoms among youth were reported during the COVID-19 pandemic. Studies assessing these figures against the pre-pandemic developments are rare. We examined the trend of generalized anxiety (GA) in adolescents in the 2010s and the effect of the COVID-19 pandemic against this trend. METHODS: Data from the Finnish School Health Promotion study with 750,000 participants aged 13-20 between 2013 and 2021 was analyzed using GAD-7 to measure self-reported GA (cut-off ≥10). Inquiries were made about remote learning arrangements. Effects of time and COVID-19 were analyzed with logistic regression. RESULTS: Among females, an increasing trend in GA between 2013 and 2019 was found (OR per year 1.05), and the prevalence increased from 15.5 % to 19.7 %. Among males, the trend was decreasing (OR = 0.98), with prevalence from 6.0 % to 5.5 %. Increase in GA from 2019 to 2021 was stronger in females (19.7 % to 30.2 %) than males (5.5 % to 7.8 %), while the effect of COVID-19 on GA was equally strong (OR = 1.59 vs. OR = 1.60) against the pre-pandemic trends. Remote learning was associated with elevated levels of GA, especially among those with unmet needs for learning support. LIMITATIONS: The design of repeated cross-sectional surveys doesn't allow analyses of within individual changes. CONCLUSIONS: Given the pre-pandemic trends of GA, the COVID-19 effect on it appeared equal in both sexes. The increasing pre-pandemic trend among adolescent females and the strong effect of COVID-19 on GA among both sexes warrants constant monitoring of mental health of the youth in the aftermath of the COVID-19 pandemic.

In the Shadow of COVID-19: The Well-Being and Rights of People Living with Dementia in Finland During the Pandemic.

BACKGROUND: Exceptional circumstances such as the COVID-19 pandemic increase the risk for vulnerability among people living with dementia. OBJECTIVE: This article discusses the well-being and rights of people living with dementia in Finland during the pandemic and analyses the legal framework covering the restrictions of their rights during that period. METHODS: The empirical research comprises a survey of persons with dementia (n = 31) and their family members (n = 168). The participants completed a total of 13 survey items involving questions about their well-being during the pandemic, restrictions on freedom, access to services, information on pandemic regulations and guidelines as well as possible problems with authorities. The survey included both multiple choice and open-ended questions. RESULTS: According to people with dementia and their family members, by spring 2021, the pandemic had reduced meaningful activities available to people living with dementia in Finland and decreased the number of meetings between them and other people. Many reported a decline in their physical and/or mental well-being or greater difficulty or delays in accessing social and health services. Over a third of respondents found that the right to meet people was restricted among people with dementia, and almost half of the respondents took the view that their freedom of movement was restricted. There were also major shortcomings in terms of information on restrictions. CONCLUSION: The results highlight the importance of bearing in mind the negative effects that restrictions on mobility, meeting other people and meaningful activities can have on the well-being of people living with dementia. This should be considered, for example, when reforming legislation.

Birth rate among women with fear of childbirth: a nationwide register-based cohort study in Finland.

PURPOSE: The association between fear of childbirth (FOC) and subsequent birth rate is not well studied. The aim of this study is to evaluate the birth rate, and risk for second pregnancy ending in delivery among women with FOC compared to women without FOC in their first pregnancy. METHODS: Data from the National Medical Birth Register were used to evaluate the birth rate after the first pregnancy in women with FOC. Cox regression model was used to evaluate the risk for the second pregnancy ending in delivery in women with FOC compared to reference individuals without FOC. The results were interpreted with adjusted hazard ratios (aHRs) and 95% confidence intervals (CI). RESULTS: In total, 375,619 women were included in this study. Of these, 9660 (2.6%) had FOC in the first pregnancy (exposed group), and 365,959 (97.4%) had no FOC (non-exposed group). In the exposed group, 3600 (37.3%) women had second pregnancy ending in delivery during the study period, and 206,347 (56.4%) had the second pregnancy ending in delivery in the non-exposed group. The risk for the second pregnancy ending in delivery was lower among women with FOC (aHR 0.61, CI 0.59-0.63). CONCLUSIONS: FOC complicates pregnancy and delivery and is strongly associated with lower likelihood to get pregnant again. Therefore, more research should be focused on the optimal prevention of FOC using a standardized procedure of care and treatment for women with FOC.

Association of sociodemographic characteristics with self-perceived access to COVID-19 information and adherence to preventive measures among migrant origin and general populations in Finland: a cross-sectional study.

OBJECTIVES: This study examines how access to COVID-19 information and adherence to preventive measures varies by sociodemographic characteristics, and whether the associations differ among the migrant origin and the general Finnish population. Additionally, the association of perceived access to information with adherence to preventive measures is examined. DESIGN: Cross-sectional, population-based random sample. BACKGROUND: Equity in access to information is crucial for securing individual well-being and successful management of a crisis at population level. SETTING: Persons who have a residence permit in Finland. PARTICIPANTS: Migrant origin population constituted of persons aged 21-66 years born abroad, who took part in the Impact of the Coronavirus on the Wellbeing of the Foreign Born Population (MigCOVID) Survey conducted from October 2020 to February 2021 (n=3611). Participants in the FinHealth 2017 Follow-up Survey conducted within the same time frame, representing the general Finnish population, constituted the reference group (n=3490). OUTCOME MEASURES: Self-perceived access to COVID-19 information, adherence to preventive measures. RESULTS: Self-perceived access to information and adherence to preventive measures was overall high both among the migrant origin and the general population. Perceived adequate access to information was associated with living in Finland for 12 years or longer (OR 1.94, 95% CI 1.05-3.57) and excellent Finnish/Swedish language skills (OR 2.71, 95% CI 1.62-4.53) among the migrant origin population and with higher education (OR 3.56, 95% CI 1.49-8.55 for tertiary and OR 2.87, 95% CI 1.25-6.59 for secondary) among the general population. The association between examined sociodemographic characteristics with adherence to preventive measures varied by study group. CONCLUSIONS: Findings on the association of perceived access to information with language proficiency in official languages highlight the need for rapid multilingual and simple language crisis communications. Findings also suggest that crisis communications and measures designed to influence health behaviours at population level may not be directly transferable if the aim is to influence health behaviours also among ethnically and culturally diverse populations.

Using HbA1c measurements and the Finnish Diabetes Risk Score to identify undiagnosed individuals and those at risk of diabetes in primary care.

BACKGROUND: Prevalence of prediabetes and type 2 diabetes mellitus (T2DM) is increasing worldwide. The objective of this study was to determine the proportion of people in Northern Iceland with prediabetes, at risk of developing T2DM or with manifest undiagnosed T2DM, as this information is lacking in Iceland. METHODS: A cross-sectional study. Clients of the three largest primary health care centres in the Health Care Institution of North Iceland (HSN) were invited to participate if fulfilling the following inclusion criteria: a) aged between 18 and 75 years, b) not diagnosed with diabetes, c) speaking and understanding Icelandic or English fluently and d) living in the included service area. Data collection took place via face-to-face interviews between 1 March 2020 and 15 May 2021. Participation included answering the Finnish Diabetes Risk Score (FINDRISC), measuring the HbA1c levels and background information. RESULTS: Of the 220 participants, 65.9% were women. The mean age was 52.1 years (SD ± 14.1) and FINDRISC scores were as follows: 47.3% scored ≤8 points, 37.2% scored between 9 and 14 points, and 15.5% scored between 15 and 26 points. The mean HbA1c levels in mmol/mol, were 35.5 (SD ± 3.9) for men and 34.4 (SD ± 3.4) for women, ranging from 24 to 47. Body mass index ≥30 kg/m2 was found in 32% of men and 35.9% of women. Prevalence of prediabetes in this cohort was 13.2%. None of the participants had undiagnosed T2DM. Best sensitivity and specificity for finding prediabetes was by using cut-off points of ≥11 on FINDRISC, which gave a ROC curve of 0.814. CONCLUSIONS: The FINDRISC is a non-invasive and easily applied screening instrument for prediabetes. Used in advance of other more expensive and invasive testing, it can enable earlier intervention by assisting decision making, health promotion actions and prevention of the disease burden within primary health care. TRIAL REGISTRATION: This study is a pre-phase of the registered study "Effectiveness of Nurse-coordinated Follow up Program in Primary Care for People at risk of T2DM" at www. CLINICALTRIALS: gov (NCT01688359). Registered 30 December 2020.

Power and politics in a pandemic: Insights from Finnish health system leaders during COVID-19.

Power and politics are both critical concepts to engage with in health systems and policy research, as they impact actions, processes, and outcomes at all levels in health systems. Building on the conceptualization of health systems as social systems, we investigate how power and politics manifested in the Finnish health system during COVID-19, posing the following research question: in what ways did health system leaders and experts experience issues of power and politics during COVID-19, and how did power and politics impact health system governance? We completed online interviews with health system leaders and experts (n = 53) at the local, regional, and national level in Finland from March 2021 to February 2022. The analysis followed an iterative thematic analysis process in which the data guided the codebook. The results demonstrate that power and politics affected health system governance in Finland during COVID-19 in a multitude of ways. These can be summarized through the themes of credit and blame, frame contestation, and transparency and trust. Overall, political leaders at the national level were heavily involved in the governance of COVID-19 in Finland, which was perceived as having both negative and positive impacts. The politicization of the pandemic took health officials and civil servants by surprise, and events during the first year of COVID-19 in Finland reflect recurring vertical and horizontal power dynamics between local, regional, and national actors. The paper contributes to the growing call for power-focused health systems and policy research. The results suggest that analyses of pandemic governance and lessons learned are likely to leave out critical factors if left absent of an explicit analysis of power and politics, and that such analyses are needed to ensure accountability in health systems.

COVID-19 Anxiety and Wellbeing at Work in Finland during 2020-2022: A 5-Wave Longitudinal Survey Study.

The COVID-19 pandemic impacted workers globally during 2020-2022 and it has had major psychological implications for workers' wellbeing. This longitudinal study analyzed risk and protective factors predicting COVID-19 anxiety among workers in Finland. Longitudinal national sample of Finnish workers (n = 685) participated in a five-wave study conducted in 2020-2022, covering multiple waves of the COVID-19 pandemic and its aftermath. Our outcome measure was COVID-19 anxiety. Predictors were psychological distress, work exhaustion, technostress, and loneliness. Models also controlled for self-regulation; social support at work and remote working; and socio-demographic background factors. Both within-person and between-person effects were analyzed using multilevel hybrid regression models. COVID-19 anxiety varied between time points which is explained by changes in circumstances during the pandemic. Highest anxiety was expressed in the middle of the Delta variant surge and lockdown in spring 2021. Within-person changes in psychological distress, work exhaustion, technostress, self-regulation, and perceived loneliness were all associated with COVID-19 anxiety. Between-person results showed that distressed, exhausted, technostressed, and lonely workers expressed more anxiety than others. Remote workers reported higher anxiety over time than others. Those who had reported high self-regulation reported lower anxiety than others. Female gender and younger age were associated with higher anxiety. COVID-19 anxiety continues to be an important phenomenon with a magnitude of consequences on people and numerous industries. This study showed that general mental health and work stressors predict COVID-19 anxiety. Promoting social support and workers' self-regulation skills can be beneficial for overcoming anxiety during and after the pandemic.

Changes in symptom burden from 2019 to 2021 amongst community-dwelling older adults in Finland.

BACKGROUND: Symptom burden causes suffering amongst older adults and is associated with healthcare visits and prognosis. AIMS: We evaluated the prevalence of 10 symptoms and changes in symptom burden amongst home-dwelling older adults in 2019 and 2021 using Finnish cohort data. We analysed factors associated with symptom burden increase during follow-up. METHODS: Altogether 1,637 people aged 75+ participated in the Helsinki Ageing Study postal survey in 2019, where they reported the presence of 10 common symptoms over the past 2 weeks. Of them, 785 participated in a follow-up in 2021, where the same symptoms were queried. We compared the prevalence of various symptoms and symptom burden scores in the 2-year interval and evaluated factors associated with increased symptom burden during this time. RESULTS: Of participants, 33% reported at least one daily symptom in 2019 versus 44% in 2021. Symptom burden increased by a mean ratio of 1.29 between 2019 and 2021. The most common symptoms were joint pain, back pain, urinary incontinence and fatigue. The prevalence of four symptoms increased between 2019 and 2021: joint pain, urinary incontinence, dizziness and shortness of breath. Higher age, reduced functional capacity and comorbidities were associated with higher odds of symptom burden increase during follow-up. Psychological well-being (PWB) was strongly associated with lower odds of symptom burden increase in the logistic regression model. CONCLUSIONS: Symptom burden increased in our cohort aged 75+ between 2019 and 2021 before and during the COVID-19 pandemic. PWB was associated with lower odds of acquiring additional symptoms over time.

Efficacy and effectiveness of case isolation and quarantine during a growing phase of the COVID-19 epidemic in Finland.

Based on data collected as part of the contact tracing activity of the City of Helsinki Epidemiological Operations Unit, we evaluated the efficacy and effectiveness of isolating SARS-CoV-2 cases and quarantining their exposed contacts during a mildly growing phase of the COVID-19 epidemic in Finland in autumn 2020. Based on the observed symptom-to-symptom intervals in 1016 pairs of primary and secondary cases, we estimated that without case isolation or quarantine 40[Formula: see text] (90[Formula: see text] credible interval, CI 25-59) of transmission would have occurred on the day of or after symptom onset. One third of SARS-CoV-2 cases (N = 1521) had initially been quarantined, with a self-reported time until isolation (quarantine) of 0.8 days before symptom onset. This delay translates into an efficacy of 50[Formula: see text] (90[Formula: see text] CI 40-63) of averting secondary infections per quarantined case. Due to later isolation (mean 2.6 days after symptoms), the efficacy was smaller (24[Formula: see text]; 90[Formula: see text] CI 12-41) in those two third of the cases (N = 3101) whose isolation was prompted by their symptoms, i.e. without being previously quarantined. At the population level, we evaluated the effectiveness of case isolation and quarantine on the growth rate of the COVID-19 epidemic in the autumn of 2020. Under a wide range of underlying assumptions, the rate would have been at least 2 times higher without case isolation and quarantine. The numbers needed to isolate or quarantine to prevent one secondary case were 2 and 20, respectively.

Tobacco use and risk of COVID-19 infection in the Finnish general population.

Empirical evidence, primarily based on hospital-based or voluntary samples, suggests that current smokers have a lower risk of COVID-19 infection than never smokers. In this study, we used nationally representative data to examine the association between tobacco use and the risk of having a confirmed COVID-19 case. We explored several forms of tobacco use, contributing to separate the role of nicotine from smoking. We used data from 44,199 participants from three pooled national health surveys in Finland (FinSote 2018-2020). The primary outcome was a confirmed COVID-19 case. We examined current smoking, moist smokeless tobacco (snus), e-cigarettes with and without nicotine and nicotine replacement therapy products. Current daily smokers had a relative risk of 1.12 of a confirmed COVID-19 case (95% CI 0.65; 1.94) in fully adjusted models compared with never smokers. Current snus use was associated with a 68% higher risk of a confirmed COVID-19 case (RR 1.68, 95% CI 1.02; 2.75) than never users. We did not find conclusive evidence of associations between e-cigarettes with and without nicotine and nicotine replacement therapy products and the risk of confirmed COVID-19 cases. Our findings suggest that nicotine might not have a protective role in the risk of COVID-19 as previously hypothesized.

Impact of Selected Meteorological Factors on COVID-19 Incidence in Southern Finland during 2020-2021.

We modelled the impact of selected meteorological factors on the daily number of new cases of the coronavirus disease 2019 (COVID-19) at the Hospital District of Helsinki and Uusimaa in southern Finland from August 2020 until May 2021. We applied a DLNM (distributed lag non-linear model) with and without various environmental and non-environmental confounding factors. The relationship between the daily mean temperature or absolute humidity and COVID-19 morbidity shows a non-linear dependency, with increased incidence of COVID-19 at low temperatures between 0 to -10 °C or at low absolute humidity (AH) values below 6 g/m3. However, the outcomes need to be interpreted with caution, because the associations found may be valid only for the study period in 2020-2021. Longer study periods are needed to investigate whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a seasonal pattern similar such as influenza and other viral respiratory infections. The influence of other non-environmental factors such as various mitigation measures are important to consider in future studies. Knowledge about associations between meteorological factors and COVID-19 can be useful information for policy makers and the education and health sector to predict and prepare for epidemic waves in the coming winters.

Temporal changes in health-related lifestyle during the COVID-19 epidemic in Finland - a series of cross-sectional surveys.

BACKGROUND: Public health recommendations and governmental restrictions during the COVID-19 epidemic have affect everyday life. This study aimed to examine temporal changes in health-related lifestyle and the accumulation of positive and negative changes in the key lifestyle factors (vegetable consumption, leisure-time physical activity, sleeping, alcohol consumption, smoking) in the same individuals among Finnish adults during the epidemic. METHODS: This study was based on a series of cross-sectional surveys conducted between April 2020 and June 2021 to investigate antibody levels for the new coronavirus in the population. In each survey, a random sample of adults (18 to 69 years) from five university hospital regions were invited. A total of 5655 (response rate 32%) responded to the questionnaire including questions on lifestyle changes during epidemic. RESULTS: On average one-sixth of respondents (17%) reported at least two negative changes in the key lifestyle factors during the study period. An increase in snacking and sleep problems and decrease in leisure-time physical activity and active commuting to work were the most common of individual negative changes. The proportion of negative changes in physical activity increased as the epidemic drags on. In contrast, on average every seventh of the respondents (14%) reported at least two positive lifestyle changes in the key lifestyle factors. The most common individual positive changes were increased consumption of fruit, berries and vegetables and decreased consumption of alcohol. More negative changes were reported on average, when both negative and positive changes in the key lifestyle factors were summed. The most negative changes were reported in the late 2020. CONCLUSION: The results of the present study suggest that the lifestyle changes during the COVID-19 epidemic have been diverse being on average more commonly unfavorable than favorable for health. The deteriorated epidemic situation in the late 2020 and, on the other hand, prolonged epidemic predisposed to negative lifestyle changes. Further studies are important to examine whether these changes are maintained over time and to identify the factors that contribute to changes and their accumulation in the same individuals. Health promotion actions are needed to prevent the long-term effects of the epidemic on health and welfare.