Experiences from patients in mental healthcare accessing their electronic health records: results from a cross-national survey in Estonia, Finland, Norway, and Sweden.

BACKGROUND: Patients' online record access (ORA) enables patients to read and use their health data through online digital solutions. One such solution, patient-accessible electronic health records (PAEHRs) have been implemented in Estonia, Finland, Norway, and Sweden. While accumulated research has pointed to many potential benefits of ORA, its application in mental healthcare (MHC) continues to be contested. The present study aimed to describe MHC users' overall experiences with national PAEHR services. METHODS: The study analysed the MHC-part of the NORDeHEALTH 2022 Patient Survey, a large-scale multi-country survey. The survey consisted of 45 questions, including demographic variables and questions related to users' experiences with ORA. We focused on the questions concerning positive experiences (benefits), negative experiences (errors, omissions, offence), and breaches of security and privacy. Participants were included in this analysis if they reported receiving mental healthcare within the past two years. Descriptive statistics were used to summarise data, and percentages were calculated on available data. RESULTS: 6,157 respondents were included. In line with previous research, almost half (45%) reported very positive experiences with ORA. A majority in each country also reported improved trust (at least 69%) and communication (at least 71%) with healthcare providers. One-third (29.5%) reported very negative experiences with ORA. In total, half of the respondents (47.9%) found errors and a third (35.5%) found omissions in their medical documentation. One-third (34.8%) of all respondents also reported being offended by the content. When errors or omissions were identified, about half (46.5%) reported that they took no action. There seems to be differences in how patients experience errors, omissions, and missing information between the countries. A small proportion reported instances where family or others demanded access to their records (3.1%), and about one in ten (10.7%) noted that unauthorised individuals had seen their health information. CONCLUSIONS: Overall, MHC patients reported more positive experiences than negative, but a large portion of respondents reported problems with the content of the PAEHR. Further research on best practice in implementation of ORA in MHC is therefore needed, to ensure that all patients may reap the benefits while limiting potential negative consequences.

No Major Differences in Recovery After Hip Fracture Between Home-Dwelling Female and Male Patients.

BACKGROUND: Studies comparing recovery of men and women after hip fracture have reported conflicting results, some reporting worse recovery in male patients, while others found no differences between genders. METHODS: Recovery was compared in 105 male and 433 female patients with hip fractures and in age-matched groups of patients 50 years or older, who were home-dwelling and received similar rehabilitation. Residential status, walking ability, hip pain and activities of daily living function were recorded at admission and 4 and 12 months postoperatively, along with mortality and re-operations. RESULTS: No differences were observed between men and women 4 and 12 months postoperatively regarding residential status (p = 0.181 vs p = 0.883), mortality rates (p = 0.232 vs p = 0.880) or total activities of daily living scores (p = 0.546 vs p = 0.435). Walking ability was better among male patients prefracture (p < 0.001) and 4 and 12 months after fracture (p < 0.001, p = 0.031, respectively). In age-matched pair analysis, no differences were found regarding mortality, residential status, walking ability, or ADL score. Cox regression analysis identified mortality risk factors as being age, prefracture ADL score, American Society of Anesthesiologists score 4-5 and place of rehabilitation. Sex was not mortality risk factor. INTERPRETATION: Home-dwelling male and female patients had similar courses of recovery from hip fracture, although there were singular differences in specific activities of daily living functions and postoperative pain. There were no differences in mortality, even when prefracture characteristics were considered. Mortality was higher among older patients and who had high American Society of Anesthesiologists scores and low prefracture activities of daily living scores.

Genetic heterogeneity underlying variation in a locally adaptive clinal trait in Pinus sylvestris revealed by a Bayesian multipopulation analysis.

Local adaptation is a common feature of plant and animal populations. Adaptive phenotypic traits are genetically differentiated along environmental gradients, but the genetic basis of such adaptation is still poorly known. Genetic association studies of local adaptation combine data over populations. Correcting for population structure in these studies can be problematic since both selection and neutral demographic events can create similar allele frequency differences between populations. Correcting for demography with traditional methods may lead to eliminating some true associations. We developed a new Bayesian approach for identifying the loci underlying an adaptive trait in a multipopulation situation in the presence of possible double confounding due to population stratification and adaptation. With this method we studied the genetic basis of timing of bud set, a surrogate trait for timing of yearly growth cessation that confers local adaptation to the populations of Scots pine (Pinus sylvestris). Population means of timing of bud set were highly correlated with latitude. Most effects at individual loci were small. Interestingly, we found genetic heterogeneity (that is, different sets of loci associated with the trait) between the northern and central European parts of the cline. We also found indications of stronger stabilizing selection toward the northern part of the range. The harsh northern conditions may impose greater selective pressure on timing of growth cessation, and the relative importance of different environmental cues used for tracking the seasons might differ depending on latitude of origin.

Effects of sympatholytic therapy on postmenopausal symptoms in hypertensive postmenopausal women.

OBJECTIVE: The short-term effects of two sympatholytic antihypertensive drug treatments, ß-blocking agent atenolol and imidazoline receptor-1 agonist moxonidine, on postmenopausal symptoms and their relationship to antihypertensive and insulin sensitivity effect were studied. DESIGN: This was a double-blind, prospectively randomized study in a multicenter, multinational setting in 112 hypertensive, overweight, postmenopausal women without hormone therapy. METHODS: Treatment was either with moxonidine, 0.6 mg/day, or with atenolol, 50 mg/day, for 8 weeks. The main outcome measures were blood pressure, insulin sensitivity by Matsuda sensitivity index and postmenopausal symptoms (hot flushes, palpitations, insomnia, irritability, depression and general impression of the symptoms (GIS) through a questionnaire. RESULTS: Both atenolol and moxonidine caused a significant reduction in diastolic blood pressure of 9.5 mmHg and 6.2 mmHg, respectively. The severity of hot flushes and palpitations were reduced significantly in both treatment groups. Relief from hot flushes was recorded in 43% of women taking atenolol and in 27% (not significant between the groups) of moxonidine-treated patients. Palpitations were relieved in 41% and 25% (not significant between the groups) of the women in the atenolol- and moxonidine-treated groups, respectively. In the atenolol group, insomnia and GIS were reduced significantly, with relief of symptoms occurring in 33% and 27% of the patients. A change in irritability was seen in blood pressure responders during the treatment in the atenolol group. There was no correlation between improvement of insulin sensitivity and relief of postmenopausal symptoms. CONCLUSIONS: In this study, two sympatholytic antihypertensives, atenolol and moxonidine, provided relief from hot flushes and palpitations, and atenolol additionally helped with insomnia and improved GIS.

Wireless infrared thermometer in the follow-up of finger temperatures.

After replantation surgery it is helpful to use temperature monitoring in order to detect vascular problems early. One of the methods currently employed is to use a thermometer with a wired probe attached to the tissue being monitored. An infrared wireless thermometer, commonly used in industry, measures temperatures of surfaces without actually touching them. The purpose of this study was to evaluate the efficacy of infrared wireless thermometer technology for monitoring finger temperature. Finger temperatures of 38 volunteers were measured using the infrared wireless thermometer. A traditional wired thermometer was used as control. The measurements of both thermometers were similar when the temperature was 31.5 degrees and over, with no statistical differences (mean difference 0.06 degrees , P=0.521). At lower temperatures, however, the wireless infrared thermometer showed slightly lower temperature values (mean difference 1.01 degrees , P<0.001). There was no difference between the finger temperatures of smokers and non-smokers. There is potential for the wireless infrared thermometer to be used as an easier alternative to the traditional wired thermometer in monitoring temperatures of revascularised or replanted parts including digital replants. Further clinical studies would be warranted.

Biocompatibility of sol-gel-derived titania-silica coated intramedullary NiTi nails.

We investigated bone response to sol-gel-derived titania-silica coated functional intramedullary NiTi nails that applied a continuous bending force. Nails 26 mm in length, either straight or with a radius of curvature of 28 or 15 mm, were implanted in the cooled martensite form from a proximal to distal direction into the medullary cavity of the right femur in 40 Sprague-Dawley rats. Body temperature restored the austenite form, causing the curved implants to generate a bending force on the bone. The femurs were examined after 24 weeks. Bone length measurements did not reveal any bowing or shortening of the bone in the experimental groups. The results from histomorphometry demonstrated that the stronger bending force, together with sol-gel surface treatment, resulted in more bone deposition around the implant and the formation of significantly less fibrous tissue. Straight intramedullary nails, even those with a titania-silica coating, were poorly attached when compared to the implants with a curved austenite structure.

Effects of sympatholytic therapy on insulin sensitivity indices in hypertensive postmenopausal women.

Cardiovascular risk factors are often ineffectively controlled in hypertensive postmenopausal women, and moreover, some antihypertensive drugs may increase particular risk factors such as insulin resistance. In a multicenter, multinational (Finland, Sweden, Lithuania), double-blind, prospectively randomized study hypertensive obese postmenopausal women without hormone therapy (n = 98) were randomly assigned to receive treatment with either the centrally acting agent moxonidine, 0.6 mg/day, or with the peripherally acting atenolol, 50 mg/day, for 8 weeks. In addition to blood pressure measurements, insulin sensitivity was estimated by the quantitative insulin sensitivity check index (QUICKI) and by the insulin sensitivity index (ISI-Matsuda). Subgroup analysis in insulin-resistant women (fasting P-insulin > or = 10 mU/l) and blood pressure responders (diastolic blood pressure < or = 90 mmHg and/or reduction of blood pressure > or = 10 mmHg) were also carried out. Both atenolol and moxonidine led to a significant reduction in diastolic blood pressure of 9.5 mmHg and 6.2 mmHg, respectively. Among insulin-resistant women, an increase in the insulin sensitivity assessed by ISI was improved with moxonidine treatment (p = 0.025). A decrease in insulin sensitivity assessed by QUICKI was observed with atenolol treatment in women with fasting insulin level < 10 mU/l. In patients, in whom blood pressure was reduced, an improvement in insulin sensitivity (ISI) was associated with moxonidine treatment (p = 0.019), but not with atenolol treatment. The centrally acting sympatholytic agent moxonidine did reduce blood pressure somewhat less than atenolol, but it was associated with an improved metabolic profile in terms of decreased insulin resistance both in insulin-resistant postmenopausal women and in women with a significant blood pressure response.

Incidence of regurgitation and pulmonary aspiration of gastric contents in survivors from out-of-hospital cardiac arrest.

BACKGROUND: The regurgitation of gastric contents and subsequent pulmonary aspiration remain serious adverse events in cardiac arrest and cardiopulmonary resuscitation. The aim of this study was to determine the association between clinical signs of regurgitation and radiological findings consistent with aspiration in resuscitated out-of-hospital cardiac arrest (OHCA) patients admitted to hospital. METHODS: The incidence of regurgitation was studied in 182 successfully resuscitated OHCA patients. The inclusion criterion was the restoration of spontaneous circulation after OHCA not caused by trauma or drug overdose. RESULTS: The incidence of regurgitation was 20%. Regurgitation was associated with radiological findings consistent with aspiration with a high specificity (81%) and a low sensitivity (46%). CONCLUSIONS: Although there was a strong association between clinical regurgitation and radiological findings consistent with aspiration, our data suggest that regurgitation is not invariably followed by radiological findings compatible with aspiration. Radiological findings consistent with aspiration are relatively infrequent without preceding signs of regurgitation in resuscitated patients.

Bystander mouth-to-mouth ventilation and regurgitation during cardiopulmonary resuscitation.

OBJECTIVES: To determine whether there is an association between bystander mouth-to-mouth ventilation and regurgitation in prehospital cardiac arrest patients. DESIGN: Prospectively conducted observational study. SETTING: Data were collected from patients treated by the emergency medical service (EMS) systems in three middle-sized or large Finnish urban communities, the Tampere District EMS and the physician-staffed Helicopter EMSs in the Helsinki and Turku areas in southern Finland. SUBJECTS: The study population consisted of 529 consecutive prehospital cardiac arrest patients with attempted resuscitation. Exclusion criteria were cardiac arrest due to trauma or drug overdose. MAIN OUTCOME MEASURES: Regurgitation in prehospital cardiac arrest patients documented by EMS personnel on the scene. RESULTS: Regurgitation occurred in a fourth of patients. Bystander cardiopulmonary resuscitation (CPR) with mouth-to-mouth ventilation was associated with a significantly increased risk of regurgitation compared with no CPR (P < 0.013) and CPR without ventilations (P < 0.01). CONCLUSIONS: The mode and role of bystander CPR in cardiac arrest needs to be further evaluated.

Recovery of muscle strength after late repair of distal biceps brachii tendon.

BACKGROUND AND AIMS: Ruptures of the distal part of the biceps brachii tendon are rare. The diagnosis is often delayed and only late repair can be considered. In this study, the recovery of muscle strength after late repair of the distal biceps brachii tendon was evaluated. MATERIALS AND METHODS: Sixteen patients with a ruptured distal biceps brachii tendon were analysed. The mean delay from the primary trauma to the operation was 35 weeks. The tendon was anatomically re-attached with bone anchors. In three cases a tendon graft was needed. The operated arms were immobilised postoperatively for four weeks, after which mobilisation was allowed. Maximal static flexion and supination strength was measured after an average follow-up time of 124 weeks by using a computer-based isokinetic dynamometer. RESULTS: Patient satisfaction and overall muscle strength recovery were very good. Compared to the non-operated side, average flexion strength recovery was 90% and corresponding recovery of supination strength 78%. Weakness on supination remained in the cases where a tendon graft was used. One patient needed a re-operation for a re-rupture. There were three cases of transient paresthesia of the cutaneous nerve. All patients resumed their previous work. CONCLUSION: Late anatomical repair of the biceps brachii tendon restores very good flexion and moderate supination strength. This operation should always be considered when the primary diagnosis is delayed.

Composite implant of native bovine bone morphogenetic protein (BMP) and biocoral in the treatment of scaphoid nonunions--a preliminary study.

BACKGROUND AND AIMS: Bone morphogenetic protein (BMP) has been shown to induce bone formation and union in long bone defects and nonunions. We report a preliminary study of a composite implant consisting of a biocoral frame, carrier collagen and bovine BMP in the treatment of scaphoid nonunions. MATERIAL AND METHODS: Two proximal and eight waist area scaphoid nonunions were treated using BMP/coral implant combined with either the Matti-Russe procedure (2 cases) or an interpositional bone graft fixed with screws or compression fixation pins (8 cases). In two cases only a one piece BMP/coral implant was used as an interpositional graft and in other cases interpositional autograft was used with granular BMP/coral implant placed between the fragments and the graft. RESULTS AND CONCLUSIONS: Only two wrists resulted in complete union. These preliminary results suggest that composite implant of BMP, as used in the present study, may not solve the problems encountered in the treatment of scaphoid nonunions. Poor vascular conditions in scaphoid may not provide enough mandatory osteogenic cells for BMP to function properly. In avascular conditions coral does not resorb edequately and implants may also work as a sequester between the bone graft and the scaphoid bone and therefore actually inhibit the healing process.

Comparison of the bone modeling effects caused by curved and straight nickel-titanium intramedullary nails.

Nitinol (NiTi) shape memory metal alloy makes it possible to prepare functional implants. A curved intramedullary NiTi nail has been shown to cause bending of the bone, bone thickening, increase in cortical area, and reduction in bone longitudinal growth. The purpose of the present study was to find out whether these changes are caused by the bending force of the curved nail or by the intramedullary nailing itself. Pre-shaped intramedullary NiTi nails were implanted in the cooled martensitic form into the medullary cavity of the right femur in 12 rats, where they started to restore their austenitic form, causing a bending force. Straight nails were used as controls in another 12 rats. After 12 weeks, the operated femurs were compared with their non-operated contralateral counterparts and the differences were compared between the groups. Anteroposterior radiographs demonstrated bone bowing only in the curved nail group. Retardation of longitudinal growth was observed in both groups, showing that the growth effect seems to be due to the intramedullary nailing itself. Increase in bone cross-sectional area and cortical thickness were found in both groups. However, this increase was more evident with the curved nail, indicating that the bending force of the functional nail seems to induce these changes.

Self-reported health, illness, and self-care among finnish physicians: a national survey.

BACKGROUND: Physicians' health problems have been discussed mainly in relation to substance abuse and psychiatric disorders. In this study, the prevalence of common chronic diseases and their treatment were determined. OBJECTIVE: To find differences in self-reported health status, amount of sick leave, and the use of health services among physicians according to sex and specialty. Data were also compared with those of the total employed population. DESIGN AND SETTING: Cross-sectional postal questionnaire survey in Finland. PARTICIPANTS AND METHODS: A random sample of licensed physicians younger than 66 years (n = 4477) was randomly selected from the register of the Finnish Medical Association. A total of 3313 physicians (74%) responded. MAIN OUTCOME MEASURES: Perceived health, prevalence of diseases, self-treatment of diseases, amount of sick leave, and medical consultations. RESULTS: Female physicians assessed their health as being better than other female employees and had used health services and had been on sick leave more often than their male colleagues. Male physicians assessed their health as being equal to that of other men. Both female and male physicians had fewer sick leave than other employees. However, physicians-especially men-reported many common chronic illnesses as often or more often than other employees. Physicians had consulted other medical professionals less often than other employees, and they primarily self-treated their illnesses. Of the specialties, psychiatrists had used health services and had been on sick leave more often than other physicians. CONCLUSION: This study indicates that the usual form of care of physicians' diseases is self-treatment and "working through" illnesses. Arch Fam Med. 2000;9:1079-1085

Evaluation of undergraduate medical education in Finnish community-oriented and traditional medical faculties: a 10-year follow-up.

OBJECTIVES: This study focused on Finnish physicians' views of their undergraduate medical education. Differences between traditional and community-oriented medical faculties were examined and changes which had taken place during a 10-year follow-up period were also assessed. METHODS: The study was based on data retrieved from a postal survey made among Finnish physicians in 1998. The study population consisted of all doctors who graduated between 1987 and 1996 (n=4926); those born on odd-numbered days were selected for this study (n=2492). A postal questionnaire and two reminders were sent to those selected, and 1822 questionnaires were returned, giving a response rate of 73.1%. RESULTS: Physicians who graduated from the community-oriented faculties were more satisfied with their undergraduate medical education when compared with their colleagues graduating from traditional faculties. There were some differences between the universities with respect to education for hospital work. The teaching of primary health care, however, was clearly more effective in community-oriented faculties. The proportion of graduates who were satisfied with their primary care education was over 70% in community-oriented faculties, whereas in the traditional faculties it was only 35-45%. CONCLUSIONS: According to graduates, the community-oriented medical school curriculum better meets the needs of practising physicians than that in traditional faculties. In curriculum reforms, more emphasis should be placed on comprehensive medical education, which includes both primary and secondary health care.

Becoming a doctor--was it the wrong career choice?

The aim of the study was to investigate the social background of physicians, the reasons that influenced doctors to enter medicine, and the association between those reasons and satisfaction in career choice of young Finnish doctors. An extensive postal questionnaire was mailed to a random sample of 2632 young Finnish doctors in 1988 and to 2332 doctors in 1993. We found out that majority of the respondents reported that interest in people, a wide range of job opportunities, the fact that medicine is a highly-appreciated profession, and success at school had influenced their decision to enter medicine quite a lot or very much. In 1988, 8% and in 1993, 7% of the respondents reported that interest in people had not influenced their career choice at all or only slightly. More women than men were influenced quite a lot or very much by factors like interest in people, success at school and vocation, meaning the lifelong calling to physicians' profession. A total of 22% of respondents would not enter medicine again. Vocation, interest in people and wide range of job opportunities were significantly more rarely mentioned as an important career choice motive by these respondents. It seems that interest in human beings and vocation are important to would-be doctors, and also help them to get along in the physicians' profession. Medical schools should develop their curricula towards more humanistic medicine in order to maintain their students' interest in people.

Semantic distance and single cue use in category search.

Perceptual classification may be based either on the physical features of target and background items or on the semantic attributes of the presented items. In this paper we used enumeration tasks to study the role of semantic features in a categorial classification task. This means that subjects were asked to count the number of target words in a display belonging to one semantic category among a number of background items of other categories. Our goal was to study the decision logic in category search by manipulating target background conditions and the semantic distance between target and background classes. In the first experiment we found that the larger the semantic distance between targets and background words, the easier it was to find the targets. In the second experiment we found a "pop-out" effect, in which subjects could use and benefit from a single distinctive semantic feature, "part-likeness", in categorial classification. The results of the two experiments imply that the categorization decision logic is basically the same in physical and semantic perceptual classification.

Where should special attention be paid in undergraduate medical education? Two surveys among Finnish physicians.

The study focuses on Finnish doctors' views of their undergraduate medical education. In 1988, a study (Junior Physician 88 Study) involving all the doctors registered during the years 1977-1986 in Finland (n = 5208) was carried out. A questionnaire was sent to a random sample of 2632 doctors, and after two mailings 1745 questionnaires (66.3%) were returned. A total of 1334 gave at least one answer to the question: 'Where should special attention be paid in undergraduate medical education?' Five years later, in 1993, another study (Physician 93 Study) involving all medical doctors registered in Finland during the years 1982-1991 (n = 4671) was carried out. The same questionnaire was sent to a random sample of 2332 doctors, and after two reminders 1818 questionnaires (78.0%) were returned, and 1228 doctors also answered the open-ended question. Content analysis was used to analyse the answers qualitatively and quantitatively. About 90% of the answers could be classified into two main categories: practical skills and evaluation of subjects. The most common proposal for the improvement of undergraduate medical education was that the practical skills needed in general practice should be taught. More education in administration and health economics was also desired. Respondents said that preclinical and clinical studies should be more closely integrated. In answers to the open question, the course in public health was strongly criticized for being too theoretical. Learning of the core knowledge for medical practice was considered essential.

More women enter medicine: young doctors' family origin and career choice.

This study is part of the Finnish Junior Physicians 88 Study, the purpose of which was to shed light on the life situation, career choice and future plans of young doctors and their views on medical education. The survey population included all the medical doctors registered during the years 1977-1986 in Finland (n = 5208). A postal questionnaire was sent to a sample of 2632 doctors born on odd-numbered days. After a reminder letter, 1745 questionnaires (66%) were returned. Forty-nine per cent of the respondents were women. Typically both men and women doctors had a father who was an upper-level white-collar worker and a mother who was a housewife. More men than women had a father who was a doctor or other health professional. More women than men mentioned that a lifelong calling (42% vs 30%), success at school (58% vs 47%) and an interest in helping people (78% vs 71%) had considerable influence on their decision to become a doctor. Men more often than women emphasized the medical profession being regarded as a highly paid (56% vs 47%) and a high status profession (64% vs 56%) and also that a family member was a doctor (15% vs 11%).

Medical education and the corresponding professional needs of young doctors: the Finnish Junior Physician 88 study.

The Universities of Kuopio and Tampere in collaboration with the Ministry of Social Affairs and Health and Finnish Medical Association carried out the 'Junior Physician 88' study in 1988, the purpose of which was to shed further light on the life situation and future plans of young doctors and their views concerning undergraduate and postgraduate medical education. The study concerned all the doctors registered during the years 1977-1986 in Finland (n = 5208). After randomization, a postal questionnaire was sent to one half (n = 2631) of these doctors. After the first reminder letter, 1745 questionnaires (66.3%) were returned. According to the views of the respondents undergraduate hospital teaching was adequate but the teaching of practice in health centres, school health care, team-work, health care of the elderly, home health care, rehabilitation, environmental health care and administration did not meet the professional needs of doctors. All doctors were satisfied with the hospital teaching in their undergraduate curriculum. However, only the doctors who graduated from the two modern universities in Kuopio and Tampere were satisfied with their undergraduate health centre teaching.