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Background: Several studies have attributed decreasing case fatality rates (CFRs) of aneurysmal subarachnoid hemorrhage (aSAH) to the gradually increasing use of endovascular treatment without considering improvements in other outcome-affecting factors. To assess the independent effect of a treatment modality on CFRs, we investigated CFR changes in a high-volume center rapidly transitioning from surgical to endovascular operations as the first-line treatment for all aSAH patients except those with middle cerebral artery (MCA) aneurysms. Methods: We identified all surgically/endovascularly treated aSAH patients in Helsinki University Hospital (HUH) during 2012–2017. As the treatment shift occurred in 2015, we defined two treatment eras: surgical (2012–2014) and endovascular (2015–2017). We compared time-dependent changes in 1-year CFRs between non-MCA and MCA patients using a Poisson regression model. To analyze consistency in operation rates, we also identified sudden-death and conservatively treated aSAHs in the HUH catchment area via two externally validated registers. Results: Of all 665 hospitalized aSAH cases in the HUH catchment area, 557 (84%) received operative treatment; 367 (66%) underwent surgical and 190 (34%) endovascular operations. Between the treatment eras, endovascular treatment for non-MCA cases increased from 21 to 79%, whereas 99% of the MCA cases were treated surgically during the whole study-period. Among the operatively treated patients, the 1-year CFRs decreased similarly in patients with non-MCA (42%; from 14 to 8%; adjusted risk ratio (aRR) = 0.66 (95% CI 0.37–1.19)) and MCA aneurysms (42%; from 15 to 9%; aRR = 0.66 (0.16–1.60)). The proportion of operatively treated patients, their clinical condition on admission, and amount of bleeding on the first CT-scan remained unchanged over time. Conclusions: We found similar CFR decreases in aSAH groups with and without undergoing a fast transition from surgery to endovascular operations, providing real-world evidence on the small independent effect of endovascular treatment on the decreasing CFRs in high-volume centers. [ABSTRACT FROM AUTHOR]

Twin pregnancies are associated with higher risks of adverse maternal and neonatal outcomes compared to singleton pregnancies. This retrospective nationwide cohort study analyzed trends in twin pregnancy outcomes in Finland from 2008 to 2023 using data from the Finnish Medical Birth Register. Outcomes assessed included perinatal mortality, stillbirths, neonatal mortality, neonatal intensive care unit (NICU) admissions, and hospitalization rates at one week of age. A total of 23,588 twin births were included, with an overall stillbirth rate of 9.0 per 1000 and a perinatal mortality rate of 16.0 per 1000. Neonatal mortality rates declined significantly, with term twins showing a rate of 0.9 per 1000 and preterm twins 4.6 per 1000 in the latest years of 2022–2023. NICU admission rates remained stable for preterm twins but showed an increasing trend for term twins. The rate of hospitalized neonates at the age of seven days decreased over time. Conclusion: These trends align with improved antenatal care and Finland’s reputation for low neonatal mortality. However, increasing maternal age and obesity rates may contribute to rising NICU admissions in term twins. The study highlights the need for continuous monitoring of neonatal outcomes to ensure high standards of care in the context of declining fertility and delivery rates in Finland. What is Known: • Twin pregnancies are associated with higher risks of adverse maternal and neonatal outcomes compared to singleton pregnancies. • Finland has one of the lowest neonatal mortality rates globally. What is New: • Neonatal mortality rates declined significantly both in term and preterm twins from 2008 to 2023. • NICU admission rates remained stable for preterm twins but showed an increasing trend for term twins. [ABSTRACT FROM AUTHOR]

We aimed to analyze the effect of video laryngoscopy on intubation success, time to intubation, and adverse events in infants and neonates. A systematic review and meta-analysis was performed, for which a neonates (age less than 29 days) and infants (age less than 365 days) needing to be intubated were included. The main outcomes were first attempt success rate in the intubation, time to intubation, and adverse events. Evidence certainty was assessed according to GRADE. We included 13 studies. Seven studies with 897 patients focused on neonates, and the first attempt success rate was higher in the video laryngoscopy group (RR 1.18, CI: 1.03–1.36). Six studies included 1039 infants, and the success rate was higher in the video laryngoscopy group (RR 1.06, CI: 1.00–1.20). Time to intubation was assessed in 11 trials, and there was no difference between the groups (mean difference 1.2 s, CI − 2.2 s to + 4.6 s). Odds of desaturation (OR 0.62, CI 0.42–0.93) and nasal/oral trauma (OR 0.24, CI 0.07–0.85) were lower in the video laryngoscopy group. Evidence certainties varied between moderate and low. Conclusion: We found moderate certainty evidence that the use of video laryngoscopy improves first attempt success rates in neonate and infant intubations, while the time to intubation did not differ between video and direct laryngoscopy groups. Further studies are still needed to improve the first intubation success rates in neonates. What is known: • Video laryngoscopy has been shown to improve first-pass intubation success rates and reduce time to intubation in adults and older children. What is new: • Video laryngoscopy improved the first attempt intubation success rates both in neonates and in infants. • Video laryngoscopy did not increase the time to intubation, and it was associated with less adverse events than direct laryngoscopy. [ABSTRACT FROM AUTHOR]

We aimed to analyze the effect of video laryngoscopy on intubation success, time to intubation, and adverse events in infants and neonates. A systematic review and meta-analysis was performed, for which a neonates (age less than 29 days) and infants (age less than 365 days) needing to be intubated were included. The main outcomes were first attempt success rate in the intubation, time to intubation, and adverse events. Evidence certainty was assessed according to GRADE. We included 13 studies. Seven studies with 897 patients focused on neonates, and the first attempt success rate was higher in the video laryngoscopy group (RR 1.18, CI: 1.03–1.36). Six studies included 1039 infants, and the success rate was higher in the video laryngoscopy group (RR 1.06, CI: 1.00–1.20). Time to intubation was assessed in 11 trials, and there was no difference between the groups (mean difference 1.2 s, CI − 2.2 s to + 4.6 s). Odds of desaturation (OR 0.62, CI 0.42–0.93) and nasal/oral trauma (OR 0.24, CI 0.07–0.85) were lower in the video laryngoscopy group. Evidence certainties varied between moderate and low. Conclusion: We found moderate certainty evidence that the use of video laryngoscopy improves first attempt success rates in neonate and infant intubations, while the time to intubation did not differ between video and direct laryngoscopy groups. Further studies are still needed to improve the first intubation success rates in neonates. What is known: • Video laryngoscopy has been shown to improve first-pass intubation success rates and reduce time to intubation in adults and older children. What is new: • Video laryngoscopy improved the first attempt intubation success rates both in neonates and in infants. • Video laryngoscopy did not increase the time to intubation, and it was associated with less adverse events than direct laryngoscopy. [ABSTRACT FROM AUTHOR]

Aim: To characterise typical practices in conducting and reporting umbrella reviews in paediatrics. Methods: PubMed database was searched for umbrella reviews focusing on children (0–18 years) published from 1 January 2020 to 15 June 2024, regardless of the speciality. The included studies were assessed for reporting practices, result summarisation and critical appraisal methods. Results: Ninety‐nine eligible umbrella reviews were included, of which 49 focused on interventions and 50 focused on epidemiology. The median number of included reviews in the umbrella reviews was 18 (range = 3–302), and statistical synthesis was performed in 32 studies. The most frequently used tool for critical appraisal of the included reviews was the updated Assessing the Methodological Quality of Systematic Reviews (AMSTAR‐2) tool (n = 56); the original AMSTAR‐1 tool was used in seven reviews, and the Risk of Bias in Systematic Reviews tool was used in 12 reviews. Evidence certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework in 14 reviews and by the Ioannidis criteria in 18 reviews. Conclusion: Umbrella reviews have heterogeneous characteristics in terms of reporting practices. Greater adherence to guidelines on conducting and reporting umbrella reviews is needed, particularly for improving critical appraisal methods. [ABSTRACT FROM AUTHOR]

Albert Camus has been a central figure in world culture for much of the 20th century. His polyphonic work combines metaphysical, anthropological and political problems. In this work we dwell on the "images" that disturb the soul of the writer and that, therefore, structure all his work. The tender and lost look of his mother, the child who dies in the streets of Algiers, the wooden piano that enlivens the sad day in the concentration camp are just some of the scenes that go through the great work. Our thesis is that they not only modulate the sensitivity of the great writer, but also give structure and motivation to his fundamental philosophical categories: absurdity and rebellion. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) is a complex and often debilitating condition that significantly impacts the gastrointestinal system and the overall quality of life of those affected. IBS is characterized by a variety of distressing symptoms, including cramping, abdominal pain, and irregular bowel movements, underlined by an intricate interplay of immune system dysfunction in its pathology. Numerous studies highlight an increased cellular immune response, with elevated levels of proinflammatory cytokines, mucosal alterations due to immune imbalance, and visceral hypersensitivity. Notably, studies indicate increased levels of proinflammatory cytokines, immune imbalances that lead to mucosal changes, and heightened visceral sensitivity. The roles of effector and regulatory T cells are particularly intriguing, as their modification appears to amplify inflammation and may even contribute to autoimmune disorders. This overview of systematic reviews explores the connections between IBS and immune responses, with a focus on immune cell alterations and proliferation of lymphocytes and mast cells in affected individuals. Furthermore, we explore various aspects of IBS management, including its pharmacological approaches. A systematic search of PubMed and Web of Science yielded 676 articles, which were ultimately narrowed down to 9 key studies that met our inclusion criteria. These studies collectively underscore the activation of the immune system with the degranulation of the mast cells in patients with IBS, where the release of inflammatory mediators can compromise intestinal permeability, exacerbating symptoms further. Additionally, we examine the multifaceted management strategies for IBS, emphasizing the potential therapeutic benefits of dietary polyphenols as antioxidants. The present study aims to enhance our understanding of IBS and offer insights into more effective treatment strategies for this challenging condition. [ABSTRACT FROM AUTHOR]

Introduction: Randomization and blinding are generally important in randomized trials. In neonatology, blinding of ventilation strategies is unfeasible if not impossible and we hypothesized that its importance has been overestimated, while the peculiarities of the neonatal patient and the specific outcomes have not been considered. Methods: For this meta-epidemiological review, we searched PubMed and Scopus databases in November 2023. We included all meta-analyses focusing on ventilation, published in past 5 years, and reporting either mortality or bronchopulmonary dysplasia (BPD) as an outcome. We extracted the information about how the authors had analyzed risk of bias and evidence certainty. Results: We screened 494 abstracts and included 40 meta-analyses. Overall, 13 of the 40 reviews assessed blinding properly. Australian and European authors were most likely to perform correct assessment of the blinding (p = 0.03) and the use of RoB 2.0 tool was also associated with proper assessment (p < 0.001). In multivariate regression, the use of RoB 2.0 was the only factor associated with a proper assessment (Beta 0.57 [95% confidence interval: 0.29–0.99]). GRADE ratings were performed in 25 reviews, and the authors downgraded the evidence certainty due to risk of bias in 19 of these and none of these reviews performed the blinding assessment correctly. Conclusion: In past neonatal evidence syntheses, the role of blinding has been mostly overestimated, which has led to downgrading of evidence certainty. Objective outcomes (such as mortality and BPD) do not need to be downgraded due to lack of blinding, as the knowledge of the received intervention does not influence the outcome assessment. [ABSTRACT FROM AUTHOR]

I analyze how personal advertising affected marital and sexual culture in Finland during World War II. The practice of seeking intimate company through newspapers was nearly non-existent in Finland before the war, but in wartime grew into a nationwide mass phenomenon due to the gender imbalance caused by men's departure for the front. Wartime personal advertising was different than that in peacetime. Unlike the typical situation, when advertisements are mostly used by the middle-aged, most of the advertisers during the war were young adults in the prime age of courtship. Their active advertising accounted for the high marriage rates during the war and had a liberating effect on Finnish sexual culture. The active posting of personal advertisements by women was also noteworthy. Traditionally, they were expected to passively await men's initiatives in the marital market. However, during the war, women advertised in the same numbers as men, indicating that the freedom offered by advertisements was particularly important for them. Nevertheless, the transformation of sexual culture is not explicitly evident in the advertisements. The Finnish personal advertising culture was unique in that even adults undoubtedly seeking serious relationships only expressed wishes for correspondence in advertisements due to the conservative sexual culture of the country. The case illustrates challenges in using personal advertisements in the historical analysis of mate selection. [ABSTRACT FROM AUTHOR]

Aim: To analyse the evidence of non‐invasive neurally adjusted ventilatory assist (NIV‐NAVA) in preterm neonates compared to nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV). Methods: We performed a systematic review and meta‐analysis of randomised controlled trials and included studies where NIV‐NAVA was analysed in preterm (<37 gestational weeks) born neonates. Our main outcomes were the need for endotracheal intubation, the need for surfactant therapy, and reintubation rates. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results: A total of five studies were included. The endotracheal intubation rate was 25% in the NIV‐NAVA group and 26% in the nCPAP group (RR 0.91, CI: 0.56–1.48). The respective rates for surfactant therapy were 30% and 35% (RR 0.85, CI: 0.56–1.29). The reintubation rate in neonates previously invasively ventilated was 8% in the NIV‐NAVA group and 29% in the nCPAP/NIPPV group (RR 0.29, 95%CI: 0.10–0.81). Evidence certainty was rated as low for all outcomes. Conclusions: NIV‐NAVA as the primary respiratory support did not reduce the need for endotracheal intubation or surfactant therapy. NIV‐NAVA seemed to reduce the reintubation rate after extubation in pre‐term neonates. [ABSTRACT FROM AUTHOR]

Introduction: In spontaneously breathing neonates, surfactant can be administered via thin catheter while enabling the own breathing (less invasive surfactant administration [LISA]). Alternatively, the neonate is intubated for surfactant delivery (intubation, surfactant, rapid extubation [INSURE]). Thus, the aim was to provide an overview of the efficacy of the LISA compared to INSURE. Methods: We performed an umbrella review of previous meta-analyses including randomized controlled trials. We searched PubMed, Scopus, and Web of Science in July 2023. Two authors screened the search results, and systematic reviews with meta-analyses that focused on LISA versus INSURE were included. One author extracted, and another author validated the extracted data. AMSTAR-2 and ROBIS evaluations were performed by two authors independently. Results: A total of 9 systematic reviews with meta-analyses were included. The quality according to AMSTAR-2 was high in one, moderate in one, low in three, and critically low in four. According to ROBIS, the risk of bias was low in three and high in six of the reviews. LISA was more effective than INSURE in preventing mechanical ventilation (8/8 reviews), death or BPD (4/4 reviews), death (3/9 reviews), and BPD (3/9 reviews). Conclusions: All the included systematic reviews and meta-analyses reported LISA to be more effective than INSURE in terms of need for mechanical ventilation and death or BPD. However, the quality of the published systematic reviews has been mostly deficient. Future systematic reviews should focus on reporting quality. [ABSTRACT FROM AUTHOR]

The article evaluates the performance of the ChatGPT-4o large language model in risk of bias assessments using Cochrane's RoB 2.0 tool. The study found that ChatGPT-4o had slight agreement in the overall assessment and varied agreement rates in different bias domains. The results suggest that ChatGPT-4o may not be suitable for risk of bias assessments with simple prompts, highlighting the need for further research on improving its performance. [Extracted from the article]

Harnessing the full power of memristors as artificial synapses demands a simple and scalable crossbar architecture enabling their seamless integration into diverse applications. This Letter presents the 3 × 3 memristor crossbar array configuration featuring a grid of interconnected devices. The composition includes Al as the reactive top electrode connecting the device columns and Gd1−xCaxMnO3 (GCMO, x = 0.8) serving as the bottom electrode connecting the device rows as well as the memristive material eliminating the need for additional layers and fabrication steps. Controlled-sized vias through insulating the Al2O3 layer connect the electrodes forming the active interface. The idea is validated with a test sample of 3 × 3 crossbars with the Au/GCMO/Al structure, Au enabling Ohmic contact to GCMO, with device resistive switching ratios mostly around 102 and yield of over 90%. The devised crossbar structure could provide a highly scalable, yet simple, geometry suitable for synaptic networks. [ABSTRACT FROM AUTHOR]

Previous studies have shown that older people are more satisfied with their finances than younger individuals, even when they have a low income. We examine to what extent this can be observed when studying the risk of subjective economic hardship among the adult population in 28 European countries. Our study describes the association between age and the risk of subjective economic hardship and how the association varies by level of income. Additionally, we examine the role of assets and debt in explaining the association. The data come from the 2020 EU-SILC survey and its ad-hoc module on over-indebtedness, consumption, and wealth. We estimate logistic regression models that control for country-level variation. We show that there is substantial variation across Europe regarding how the likelihood of experiencing subjective economic hardship varies by age. The income position of different age groups explains, to a large extent, the different age patterns for hardship across countries. When controlling for country-level variation and level of income, older people are less likely than younger age groups to experience subjective economic hardship. We find indications that older people have a lower risk of subjective economic hardship especially in the lower bottom of the income distribution. Older people's lower risk seems to be largely explained by their more frequent ability to use savings to maintain their standard of living. [ABSTRACT FROM AUTHOR]

Background: The effect of major trauma on subsequent fertility is poorly described. If women have lower fertility after trauma, they would have a lower risk of anti‐D mediated hemolytic disease of the fetus and newborn in a future pregnancy following the transfusion of RhD‐positive blood to RhD‐negative women during their resuscitation. Study Design and Methods: Data was obtained from the Care Register for Health Care, National Medical Birth Register, and open access data from Statistic Finland to evaluate the effect of major trauma (traumatic brain injuries, spine, pelvic, hip/thigh fractures) on the age‐specific number of births during years 1998–2018. The total number of births before a specific maternal age for different trauma populations was calculated and these were compared to the corresponding number of births in the general population. Results: There were 50,923 injured women in this study. All injured women, including when analyzed by the nature of their injury, demonstrated lower expected numbers of births starting at approximately 28 years of age compared to the general population of women in Finland. At age 49, the expected number of births in the general population was approximately 1.8, whereas for all injured women 0.6, women with TBIs and spine fractures 0.6, women with pelvic fractures 0.5, and women with hip or thigh fractures 0.3. Discussion: Injured women are predicted to have lower fertility rates compared to the general population of Finnish women. The lower fertility rate should be considered when planning a blood product resuscitation strategy for injured women. [ABSTRACT FROM AUTHOR]

Child poverty is impacted to a great extent by family demography, with large families and single parents having a greater risk of being poor. Using the EU‐SILC microdata, we examine the extent to which social transfers reduce the risk of poverty among large families compared with smaller families in 29 European countries. Large families are defined as families with three or more children. First, we look at the reduction of poverty rates before and after the social transfers for large and small families. Second, we examine which types of social benefits are of most importance in alleviating poverty of large families. Poverty threshold is set at 60% of the national equivalent disposable income. In addition to poverty rates, poverty gaps are analysed. Results show that European countries seem to have different kinds of profiles in terms of overall child poverty reduction and whether the reduction is stronger among large families. [ABSTRACT FROM AUTHOR]

A study published in the Journal of Evidence-Based Medicine found that incorrect assessments of blinding are common in meta-analyses published in high impact journals. Blinding is an important practice to reduce biases in clinical studies, particularly for subjective outcomes. The study examined systematic reviews and meta-analyses published in top medical journals and Cochrane, and found that non-Cochrane reviews were less likely to include both subjective and objective outcomes in the same review. The use of the revised Risk of Bias (RoB) 2.0 tool was associated with a higher proportion of correct assessments. The authors recommend the use of the RoB 2.0 tool for accurate risk of bias assessment. [Extracted from the article]

Objective: To analyze the optimal postextubation respiratory support in pediatric cardiac surgery patients. Design: Systematic review of randomized controlled trials. Setting: Pediatric or neonatal intensive care units. Participants: All aged children (<16 years) having cardiac surgery and postoperative invasive ventilation. Intervention: Noninvasive respiratory support, including high flow nasal cannula (HFNC), conventional oxygen therapy (COT), noninvasive positive pressure ventilation (NIPPV), continuous positive pressure (CPAP), and noninvasive high‐frequency oscillatory ventilation (NHFOV). Measurement and Main Results: Studies were not pooled for statistical synthesis due to the limited number and quality of the included studies. Risk ratios with 95% confidence intervals were calculated for individual studies. A total of 167 studies were screened and six were included. The risk of bias was low in one, high in one, and had some concerns in four of the studies. Extubation failure (defined as reintubation) was the main outcome of interest. Risk ratio for reintubation was 0.10 (CI 0.02–0.40) and 1.07 (CI 0.16–7.26) in HFNC versus COT, 0.49 (CI 0.05–5.28) in HFNC versus NIPPV, 0.40 (CI 0.08–1.94) in HFNOV versus CPAP, 0.75 (CI 0.26–2.18) in HFNOV versus NIPPV, and 1.37 (CI 0.33–5.73) in CPAP versus NIPPV. Treatment durations did not differ between the groups. Conclusion: We did not find clear evidence of a difference in reintubation rates and other clinical outcomes between different noninvasive ventilation strategies. Evidence certainty was assessed to be very low due to the risk of bias, the small number of included studies, and high imprecision. Future quality studies are needed to determine the optimal postextubation support in pediatric cardiac surgery patients. [ABSTRACT FROM AUTHOR]

Objectives: A systematic review with met‐analysis was performed to summarise the evidence on the effect of intrapartum azithromycin on maternal and neonatal infections and deaths. Search strategy: PubMed, Scopus and Web of Science databases were searched in March 2023. Selection criteria: Randomised controlled trials comparing intrapartum single‐dose of azithromycin with placebo. Data collection and analysis: Maternal infections, maternal mortality, neonatal sepsis, neonatal mortality. We used the random‐effects Mantel–Haenszel method to calculate risk ratios (RR) with 95% confidence intervals (95% CI). We assessed risk of bias of the included studies and estimated the evidence certainty using the GRADE approach. Main results: After screening 410 abstracts, five studies with 44 190 women and 44 565 neonates were included. The risk of bias was low in four and had some concerns in one of the studies. The risk of endometritis was 1.5% in the azithromycin group and 2.3% in the placebo group (RR 0.64, 95% CI 0.55–0.75), and the evidence certainty was high. The respective risk for chorioamnionitis was 0.05% and 0.1% (RR 0.50, 95% CI 0.22–1.18; evidence certainty moderate). The wound infection rate was lower in the azithromycin group (1.6%) than in the placebo group (2.5%), RR 0.52 (95% CI 0.30–0.89; moderate certainty evidence). The maternal sepsis rate was 1.1% in the azithromycin group and 1.7% in the placebo group (RR 0.66, 95% CI 0.56–0.77; evidence certainty high). Mortality rates did not show evidence of a difference (0.09% versus 0.08%; RR 1.26, 95% CI 0.65–2.42; moderate certainty evidence). The neonatal mortality rate was 0.7% in the azithromycin group and 0.8% in the placebo group (RR 0.94, 95% CI 0.76–1.16; moderate certainty evidence). The neonatal sepsis rate was 7.6% in the azithromycin group and 7.4% in the placebo group (RR 1.02, 95% CI 0.96–1.09; moderate certainty evidence). Conclusions: Intrapartum administration of azithromycin to the mother reduces maternal postpartum infections, including sepsis. Impact on maternal mortality remains undecided. Azithromycin does not reduce neonatal sepsis or mortality rates. [ABSTRACT FROM AUTHOR]

The objective of the study is to summarize current literature on high-flow nasal cannula (HFNC) use for different indications in pediatric patient excluding acute bronchiolitis and neonatal care. The study design is a systematic scoping review. Pubmed, Scopus, and Web of Science databases were searched in February, 2023. All abstracts and full texts were screened by two independent reviewers. Randomized controlled trials focusing on HFNC use in pediatric patients (age < 18 years) were included. Studies focusing on acute bronchiolitis and neonatal respiratory conditions were excluded. Study quality was assessed by Cochrane risk of bias 2.0 tool. The main outcomes are patient groups and indications, key outcomes, and risk of bias. After screening 1276 abstracts, we included 22 full reports. Risk of bias was low in 11 and high in 5 studies. We identified three patient groups where HFNC has been studied: first, children requiring primary respiratory support for acute respiratory failure; second, perioperative use for either intraprocedural oxygenation or postoperative respiratory support; and third, post-extubation care in pediatric intensive care for other than postoperative patients. Clinical and laboratory parameters were assessed as key outcomes. None of the studies analyzed cost-effectiveness. Conclusion: This systematic scoping review provides an overview of current evidence for HFNC use in pediatric patients. Future studies should aim for better quality and include economic evaluation with cost-effectiveness analysis. Protocol registration: Protocol has been published https://osf.io/a3y46/. What is Known: • High flow nasal cannula has been effective in acute bronchiolitis and neonatal respiratory care. • The use of HFNC on other conditions is also common and increasing, but the evidence supporting this has not been previously summarized. What is New: • We found that HFNC has been studies in relatively few studies in children for other indication than bronchiolitis. • We indetified three main patient populations for which HFNC has been studied: perioperative patients, postintubation patients in intensive care units, and as primary support in acute respiratory failures. None of the studies have estimated possible cost-effectiveness of HFNC, compared to alternative strategies. [ABSTRACT FROM AUTHOR]

The following is a commentary on Vazquez' two-part study of mothers' everyday uses of music and their relationships to the quality of mother-child interaction and bonding. The commentary considers how Vazquez' findings are linked to the experiences and meanings of motherhood in modern times, including the stressors and pressures that many women experience as they begin their journeys as new mothers. The commentary presents three main points: the necessity to listen to maternal voices, the need to diversify study samples, and the recognition that mothers are a diverse group. [ABSTRACT FROM AUTHOR]

There is mounting evidence of increases in tick (Acari: Ixodidae) contacts in Finland during the past few decades, highlighted by increases in the incidence of Lyme borreliosis and tick-borne encephalitis (TBE). While nationwide field studies to map distributions of ticks are not feasible, crowdsourcing provides a comprehensive method with which to assess large-scale changes in tick contact areas. Here, we assess changes in tick contact areas in Finland between 1958 and 2021 using three different nationwide crowdsourced data sets. The data revealed vast increases in tick contact areas, with ticks estimated to be contacted locally approximately 400 km further north in western and approximately 100 km further north in eastern Finland in 2021 than 1958. Tick contact rates appeared to be highest along the coastline and on the shores of large lakes, possibly indicating higher tick abundance therein. In general, tick observations per inhabitant increased from 2015 to 2021. Tick contact areas have expanded in Finland over the past 60 years. It appears that taiga ticks (Ixodes persulcatus) are behind most of the northwards shifts in tick contact areas, with Ixodes ricinus contributing mostly to new contact areas in the south. While ticks are now present in most of Finland, there are still areas where tick abundance is low and/or establishment not possible, mainly in northern Finland. [ABSTRACT FROM AUTHOR]

The current work investigates the relationship between the crack growth rate (CGR) and the cyclic crack‐tip opening displacement (ΔCTOD) of microstructurally small fatigue cracks by using high‐resolution digital image correlation (DIC). Load‐controlled fatigue tests were conducted on small‐scale specimens of 18%Cr body‐centered cubic ferritic stainless steel. Microstructurally small fatigue crack growth was analyzed based on accurate high sample‐rate measurements, starting from a sub‐grain crack length up to seven times the volume‐weighted grain size dv = 224 μm. Under these experimental conditions, the high‐resolution analyses reveal that variation from the otherwise linear relationship between CGR and ΔCTOD on double logarithmic scale is due to the crack‐tip bypassing an inhomogeneous shear strain localization zone. In this zone, ΔCTOD is not able to characterize the behavior of microstructurally small fatigue cracks. Outside the shear strain localization zone, ΔCTOD still is a valid crack driving force parameter. Highlights: Crack tip opening displacement range ΔCTOD and CGR show mostly linear relationship.ΔCTOD and CGR relationship becomes non‐linear if shear strain accumulation is present.If the crack tip penetrates the hardened region, CGR decreases.Strain accumulation is influenced by grain orientation and grain size. [ABSTRACT FROM AUTHOR]

To analyze the optimal lumbar puncture position in infants. A systematic review and meta-analysis. Infants (age < 1 year). December 2022 in PubMed, Scopus, and Web of Science. Randomized controlled trials focusing on lumbar puncture positions were included. Other lumbar puncture position than standard lateral decubitus position. First puncture success and overall success rate. Secondary outcome was desaturation during puncture and procedure-related harms. Risk of bias 2.0 assessment was performed. Outcomes are reported as risk ratios (RR) with 95% confidence intervals (CI). We screened 225 abstracts, and six studies were included. Four studies compared sitting position, one study head elevated lateral position, and one study prone position to lateral position. Risk of bias was high in two studies. First puncture success rate in sitting position (RR 1.00, CI: 0.78–1.18; 2 studies) and overall success rate in sitting position were similar to lateral position (RR 0.97, CI: 0.87–1.17; 3 studies). First attempt success rate was higher in elevated lateral position (RR 1.48, CI: 1.14–1.92; 1 study) and in prone position (RR 1.09, CI: 1.00–1.17; 1 study). Conclusion: Sitting position seems to be equally effective in terms of first attempt and overall success in lumbar puncture than standard lateral position. Elevated lateral position and prone positions had better first attempt success than standard lateral position, but these were assessed only in one study each and thus further studies in these positions are needed. Trial registration: This review was registered in PROSPERO. ID: CRD42022382953. What is Known: • Success rate in lumbar puncture has been poor and first attempt success rate has varied between 50 to 80% in literature. • Optimal lumbar puncture positions for infants have been debated between sitting and lateral decubitus position mostly. What is New: • This is the first meta-analysis focused on lumbar puncture positions in infants, and it found that sitting position was equal to standard lateral position. • Prone position and head elevated lateral positions had higher first puncture success rates, but these were assessed both only in one study, which creates uncertainty to the finding. [ABSTRACT FROM AUTHOR]

Aims: Despite recent findings that traumatic brain injury (TBI) is a possible risk factor for type 2 diabetes (DM2) and that a strong association exists between gestational diabetes (GDM) and the risk for the development of DM2, no previous studies have investigated the effects of TBI on the risk for the development of GDM. Therefore, this study aims to determine the possible association between a previous traumatic brain injury and later gestational diabetes. Methods: In this retrospective register-based cohort study, data from the National Medical Birth Register were combined with data from the Care Register for Health Care. Women who had sustained a TBI before pregnancy were included in the patient group. Women who had sustained previous fractures of the upper extremity, pelvis, or lower extremity were included in the control group. A logistic regression model was used to assess the risk for the development of GDM during pregnancy. Adjusted odds ratios (aOR) with 95% confidence intervals between the groups were compared. The model was adjusted by prepregnancy body mass index (BMI) and maternal age during pregnancy, the use of in vitro fertilization (IVF), maternal smoking status, and multiple pregnancies. The risk for the development of GDM during different periods following the injury (0–3 years, 3–6 years, 6–9 years, and 9+ years) was calculated. Results: In total, a 75 g 2-h oral glucose tolerance test (OGTT) was performed on 6802 pregnancies of women who had sustained a TBI and on 11 717 pregnancies of women who sustained fractures of the upper extremity, pelvis, or lower extremity. Of these, 1889 (27.8%) pregnancies were diagnosed with GDM in the patient group and 3117 (26.6%) in the control group. The total odds for GDM were higher after TBI compared to the other traumas (aOR 1.14, CI 1.06–1.22). The odds were highest at 9 + years after the injury (aOR 1.22, CI 1.07–1.39). Conclusion: The total odds for the development of GDM after TBI were higher when compared to the control group. Based on our findings, more research on this topic is warranted. Moreover, a history of TBI should be considered a possible risk factor for the development of GDM. [ABSTRACT FROM AUTHOR]

To analyze the efficacy of using honey to treat acute cough in children. Systematic review, synthesis without meta-analysis. We searched PubMed, Scopus, CENTRAL, CINAHL, and Web of Science databases on August 15, 2022, for words honey and cough. Randomized controlled trials conducted in children were included. Risk-of-bias and evidence quality were assessed. Studies were not pooled due to lack of key information. Instead, we provided the range of observed effects for the main outcomes. Three hundred ninety-six papers were screened, and 10 studies were included. Two studies had high risk-of-bias and six had some concerns. Honey seemed to decrease cough frequency more than placebo/no treatment (range of observed effect 0.0–1.1 points) and cough medication (0.2–0.9 points). Sleep improved more often in the honey group (range of effect was 0.0–1.1) compared to placebo/no treatment and (− 0.2–1.1 points) compared to cough medication. Quality of the evidence was low to very low. Conclusion: We found low quality evidence that honey may be more effective than cough medication or placebo/no treatment in relieving symptoms and improving sleep in children with acute cough. Better quality randomized, placebo-controlled blinded trials are needed to confirm the effectiveness of honey in treating acute cough in children. Trial registration: CRD42022369577. What is Known: • Honey has been suggested to be effective as a symptomatic treatment in acute cough. • Prior randomized trials have had conflicting results and thus an overview of the literature was warranted. What is New: • Based on low quality evidence honey may be more effective than placebo or over-the-counter medications for acute symptom reliwef in cough. • Future studies with better reporting are needed to confirm the results. [ABSTRACT FROM AUTHOR]

Background Rapid point-of-care testing for respiratory pathogens has gained increasing popularity, but its impact on antibiotic consumption is unclear. Thus, the aim of this systematic review and meta-analysis was to estimate the effect of rapid point-of-care testing on antibiotic prescriptions. Methods The search for this systematic review with meta-analysis was performed in February 2023. Randomized controlled trials investigating the impact of testing for respiratory pathogens in all-aged patients were included regardless of the comparator. The main outcome was the antibiotic prescription rate. Analyses were stratified by test type, test setting, and patient age. A random-effects Mantel-Haenszel model was used to calculate risk ratios with 95% confidence intervals. Risk of bias was assessed for included studies, and the quality of the evidence was rated according to GRADE. Results A total of 754 abstracts were screened, and 10 studies were included in the analysis. Risk of bias was high in 2, low in 4, and had some concerns in 4 studies. Four studies analyzed influenza and respiratory syncytial virus tests, and 6 studies analyzed multiplex (viral and/or bacterial) testing. The prescription rate was 48.2% (496/1029) in the influenza and respiratory syncytial virus test group and 48.7% (540/1109) in the control group (risk ratio [RR], 0.97; 95% CI, 0.92–1.02; moderate-quality evidence). The prescription rate in the multiplex testing group was 54.3% (1554/2859), and it was 57.3% (1336/2326) in the control group (RR, 1.00; 95% CI, 0.96–1.04; moderate-quality evidence). In an age-stratified analysis, the prescription rates showed no evidence of a difference (children: RR, 1.03; 95% CI, 0.81–1.30; adults: RR, 0.98; 95% CI, 0.96–1.01; very low- and moderate-quality evidence). Conclusions We found moderate-quality evidence that rapid point-of-care testing for respiratory pathogens does not decrease the antibiotic prescription rate. [ABSTRACT FROM AUTHOR]

BACKGROUND: The goal of this study was to compare video head impulse test, video-oculography, and clinical balance test changes induced by ethanol consumption, in order to acquire a model for acute bilateral vestibular syndrome. METHODS: Four healthy adult men and 5 healthy adult women were recruited as volunteers in the study. Initial video head impulse test, videooculography, and clinical balance test examinations were made. Participants proceeded to drink standard alcohol doses until a maximum of 1.2‰ breath alcohol concentration was reached. Video head impulse test and clinical balance tests were repeated at every 0.2‰ breath alcohol concentration interval and at the final 1.0-1.2‰ breath alcohol concentration range. Video-oculography examinations were repeated at 1.0-1.2‰ breath alcohol concentration. RESULTS: Decrease in mean vestibulo-ocular gain at 60 ms between the 0‰ and 1.0-1.2‰ was 0.16 on the left side (P < .05) and 0.16 on the right side (P < .05). A borderline abnormality (mean 0.79/0.82) (left/right) was observed in vestibulo-ocular gain at the highest breath alcohol concentration. Corrective saccades increased significantly in amplitude and latency. There was a statistically significant, symmetrical decrease in video-oculography smooth pursuit gain. Saccade latency increased but statistically significantly only with right-sided cycles. Saccade accuracy remained constant. Optokinetic reflex gain showed significant decrease. Romberg's test was performed with normal results initially and at 1.0-1-2‰ breath alcohol concentration. CONCLUSION: Ethanol produces a symmetrical loss in vestibulo-ocular gain measured by video head impulse test. Ethanol also decreases smooth eye pursuit gain and increases pro-saccade latency. Similar findings can be made in vestibular disorders as well as in cerebellar dysfunction. Central pathology should be ruled out in acute bilateral vestibular syndrome. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to assess the incidence of all major fractures and surgery during pregnancy and the outcomes of pregnancy in Finland between 1998 and 2017. Materials and methods: A retrospective cohort study using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register. As participants we included all women aged between 15 and 49 years from January 1, 1998 to December 31, 2017 and their ≥ 22-week pregnancies. Results: Of a total 629,911 pregnancies, 1813 pregnant women were hospitalized with a fracture diagnosis, yielding an incidence of 247 fractures/100,000 pregnancy-years. Of these, 24% (n = 513/2098) were treated operatively. The most common fractures were fractures of the tibia, ankle, and the forearm, which made up half of all fractures. The incidence of pelvic fractures was 6.8/100,000 pregnancy-years, with an operation rate of 14%. The stillbirth rate of all fracture patients was low at 0.6% (n = 10/1813), although this was 1.5-fold the overall stillbirth rate in Finland. Lumbosacral and comminuted spinopelvic fractures resulted in preterm delivery in 25% (n = 5/20) of parturients, with a stillbirth rate of 10% (n = 2/20). Conclusion: The incidence of fracture hospitalization during pregnancy is lower than in the general population, and fractures in this population are more often treated conservatively. A higher proportion of preterm deliveries and stillbirths occurred in women with lumbosacral and comminuted spinopelvic fractures. Maternal mortality and stillbirth rates remain low among women with fractures leading to hospitalization or surgery during pregnancy. [ABSTRACT FROM AUTHOR]

The mechanical displacements in piezoelectric materials carry along macroscopic electric fields, allowing tunneling of acoustic waves across a vacuum gap beyond the charge-charge interaction distance. However, no rigorous proof of complete acoustic wave tunneling has been presented, and the conditions to achieve complete tunneling have not been identified. Here, we demonstrate analytically the condition for such phenomenon for arbitrary anisotropic crystal symmetries and orientations, and that complete transmission of the incoming wave occurs at the excitation frequency of leaky surface waves. We also show that the complete transmission condition can be related to the surface electric impedance and the effective surface permittivity of the piezoelectric material, relevant to realize the complete tunneling experimentally. We support our findings with numerical results for the maximum power transmittance of a slow transverse wave tunneling between identical ZnO crystals. The results show that complete tunneling can be achieved for a large range of orientations. The coupling of mechanical displacements with electric fields in piezoelectric materials enables tunneling of acoustic waves across vacuum, but the conditions to achieve complete tunneling are still unexplored. This work demonstrates complete tunneling of acoustic waves occurring when leaky surface waves are excited, for arbitrary orientations of the anisotropic crystals. [ABSTRACT FROM AUTHOR]

The article discusses the impact of GLP-1 receptor agonists on pregnancy and offspring, particularly focusing on the risk of congenital malformations. Two studies included in a systematic review found no increased risk of congenital malformations in pregnancies where GLP-1 receptor agonists were used in the first trimester. However, the studies had limitations due to small sample sizes and wide confidence intervals in outcome estimates. While the evidence suggests no increased risk, further research with larger cohorts is needed to confirm these findings and monitor for rarer malformations. [Extracted from the article]

The probability of social assistance exit decreasing over time is called negative duration dependence. This is one of the most debated aspects of social assistance receipt. This study analyses duration dependence among young adults in Finland and aims to show how social assistance receipt per se affects the likelihood of exiting social assistance. It also examines whether parental recipiency is associated with duration dependence. While the intergenerational transmission of social assistance has received extensive research attention, there is a scarcity of evidence on whether parental recipiency is associated with social assistance exits and duration effects. This study uses full monthly history of social assistance receipt between the ages of 19 and 29 years. The analyses are based on Finnish register data and conducted using discrete-time event-history models (pooled logistic, random-effect logistic and fixed-effect logistic). The findings indicate that controlling for all time-invariant characteristics significantly reduces but does not completely remove duration dependence among young adults. They also show that those whose parents received social assistance are less likely to exit social assistance. In models controlling for all time-invariant characteristics, parental social assistance receipt is also linked with stronger duration dependence. The implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Introduction: The effect of lockdown on the incidence of fractures and severe injuries has been widely studied, whereas studies regarding muscle, tendon, and ligament injuries have not received as much attention. The aim of the study was to investigate the effect of the lockdown and later regional regulations due to the COVID pandemic on the incidence of muscle, tendon, and ligament injuries and related surgical procedures. Materials and methods: This study focuses on the working-age population in the catchment areas of three major Finnish hospitals. Patients were divided into three age groups 18–34, 35–50 and 51–65 years of age. Suitable injuries were retrieved from the data using appropriate ICD-10 codes and procedure codes. The monthly incidence rate ratio (IRR), with 95% confidence intervals (CI), were compared between the year 2020 and the reference years 2017–2019. Results: Upper and lower extremity injury ED visits decreased by 15.7 and 8.2%. For upper extremity injuries, a decrease in incidence was observed for all three age groups in March (IRR 0.52, CI 0.33–0.80), (IRR 0.53, CI 0.31–0.91), (IRR 0.60, CI 0.38–0.95), respectively. An increase in 18–34 years of age group was detected in June (IRR 1.49, CI 1.05–2.13). Lower extremity injuries decreased in 18–34 years of age group in March (IRR 0.62, CI 0.43–0.90) and April (IRR 0.60, CI 0.42–0.87). A decrease on the incidence of surgeries was observed in April for the 35–50 (IRR 0.53, CI 0.29–0.97) and 51–65 years of age groups (IRR 0.58, CI 0.34–0.98). Conclusions: The nationwide lockdown in spring 2020 led to a notable decrease in the incidence of emergency department visits and the surgical treatment of muscle, tendon, and ligament injuries in Finland. [ABSTRACT FROM AUTHOR]

[Display omitted] Additively manufactured drug products, typically produced using small-scale, on-demand batch mode, require rapid and non-destructive quantification methods. A tunable modular design (TMD) approach combining porous polymeric freeze-dried modules and an additive manufacturing method, inkjet printing, was proposed in an earlier study to fabricate accurate and patient-tailored doses of an antidepressant citalopram hydrobromide. This approach addresses the unmet medical needs associated with antidepressant tapering. Non-destructive quantification of printed porous structures is challenging due to the presence of residual solvents and frequent fluctuation of the material density. These shortcomings were mitigated by utilizing a spinning near-infrared spectroscopy (NIRS) measurement setup and a post-print drying step. A machine learning algorithm (ML), specifically support vector regression, was implemented to lessen potential non-linearities caused by the complex structure of TMD drug products. The non-linear support vector regression models performed better than linear partial least squares (PLS) models when modeling the entire sample set (prediction error improved by 19 %). By dividing the TMD samples into subtypes and creating individual models for each subtype improved model performance: linear PLS models performed better or equally to non-linear models. It was hypothesized that this outcome was due to the structural differences between different TMD sample subtypes that was later confirmed by stimulated Raman scattering (SRS) microscopy. It was demonstrated that for complex porous drug products ML algorithms can improve NIRS model performance when a single universal robust model is preferred, and SRS is a powerful tool to explain the challenges that printing onto porous drug products can introduce to the NIRS quantification. [ABSTRACT FROM AUTHOR]

Background: Social restrictions due to COVID-19 have impacted the everyday life of adolescents and young adults, with increased levels of stress and anxiety being reported. Therefore, we report primary care visits due to mental health problems and the use of psychotropic medication in Finland. Methods: We conducted a nationwide register-based study and included primary care visits with mental health problems (F*-class ICD-10 diagnosis) for patients aged 15–24 years. We calculated incidence for visits and used incidence rate ratios (IRR) for comparisons. Psychotropic medication purchases for patients aged 13–24 years were included. Annual psychotropic medication user prevalence per 1000 was calculated and prevalence rate ratios (PRR) with 95% confidence intervals (CI) were used for comparisons. The years 2020 and 2021 were compared to the pre-pandemic reference year 2019. Results: A total of 396534 visits to primary care due to mental health problems were included. Annual visit incidences per 1000 were 151.7 in 2019, 193.6 in 2020, and 306.7 in 2021, indicating a 28% (IRR 1.28, CI 1.27–1.29) increase from 2019 to 2020 and a 102% (IRR 2.02, CI:2.01–2.04) increase from 2019 to 2021. Highest reported increases in 2020 were sleeping disorders (IRR 1.79, CI 1.72–1.87) and anxiety disorders (IRR 1.39, CI 1.37–1.42). Prevalence of antidepressant use increased by 25% (PRR 1.25, CI 1.23–1.26) in 2021. An increase was also seen in the use of antipsychotics (+ 19%, PRR 1.19. CI 1.16–1.21). Conclusions: The COVID-19 pandemic increased the need for mental health services and medication among Finnish adolescents and young adults. Our health care system needs the capacity to manage the increased number of visits, and we must be better prepared for future crises. [ABSTRACT FROM AUTHOR]

• The overall incidence of pediatric traumatic brain injury increased by 118% from 1998 to 2018 in Finland. • Most of this was due to an increase in mild injuries (concussions), which had more than a two-fold increase from 2010 to 2018. • Boys had a higher incidence of traumatic brain injuries in all age groups. The purpose of this study is to document the annual incidence and incidence trends of pediatric traumatic brain injury (pTBI) in Finland over the course of 21 years. We conducted a retrospective nationwide register-based cohort study and used the Finnish Care Register and Population information statistics from 1998 to 2018. The patient group includes all patients aged <18 at the time of injury. We included all emergency department (ED) visits and subsequent inpatient admissions (meaning at least one night in the hospital) with International Classification of Diseases diagnostic code S06*. We calculated pTBI incidences per 100,000 person-years with 95% confidence intervals and the incidences were compared by incidence rate ratios (IRR), including age, diagnosis, and gender stratified analyses. A total of 71,972 patients were included with 76,785 ED visits or hospitalizations for pTBI diagnoses. The annual incidence of diagnosed pTBI was 251 (CI: 241–260) per 100,000 in 1998 and 547 (CI: 533–561) per 100,000 in 2018, indicating a 118% increase in the incidence (IRR 2.18 CI: 2.09–2.28). Boys had 32% higher incidence (IRR 1.32 CI: 1.30–1.34) than girls. The highest cumulative incidence was observed among boys aged <1 years, 525 (CI: 507–543) per 100,000, and boys had higher incidences in all age groups. The most used diagnostic code was concussion, which included 92.1% of the diagnoses followed by diffuse brain injury, which included 2.3% of the diagnoses. The increase in the incidence of diagnosed pTBI was notably high after 2010. Concussion diagnoses and pTBI cases that were discharged directly from the ED had more than a two-fold increase from 2010 to 2018, whereas the incidence of inpatient admissions for pTBI increased by 53%. The overall incidence of diagnosed pTBI has increased in Finland especially since 2010. Boys have higher incidence of diagnosed pTBI in all age groups. Most of the increase was due to increase in the concussion diagnoses, which may be due to the centralization of EDs into bigger units and increased diagnostic awareness of mild pTBI. [ABSTRACT FROM AUTHOR]

Background The optimal treatment duration of community-acquired pneumonia (CAP) in children has been controversial in high-income countries. We conducted a meta-analysis to compare short antibiotic treatment (3–5 days) with longer treatment (7–10 days) among children aged ≥6 months. Methods On 31 January 2022, we searched PubMed, Scopus, and Web of Science databases for studies published in English from 2003 to 2022. We included randomized controlled trials focusing on antibiotic treatment duration in children with CAP treated as outpatients. We calculated risk differences (RDs) with 95% confidence intervals and used the fixed-effect model (low heterogeneity). Our main outcome was treatment failure, defined as need for retreatment or hospitalization within 1 month. Our secondary outcome was presence of antibiotic-related harms. Results A total of 541 studies were screened, and 4 studies with 1541 children were included in the review. Three studies had low risk of bias, and one had some concerns. All 4 studies assessed treatment failures, and the RD was 0.1% (95% confidence interval, −3.0% to 2.0%) with high quality of evidence. Two studies (1194 children) assessed adverse events related to antibiotic treatment, and the RD was 0.0% (−5.0% to 5.0%) with moderate quality of evidence. The diagnostic criteria varied between the included studies. Conclusions A short antibiotic treatment duration of 3–5 days was equally effective and safe compared with the longer (current) recommendation of 7–10 days in children aged ≥6 months with CAP. We suggest that short antibiotic courses can be implemented in treatment of pediatric CAP. [ABSTRACT FROM AUTHOR]

Background Context: Both lumbar disc herniation in the general population and lower back pain in the pregnant population are known to be common conditions. The physiological and anatomical of the mother predispose to increased strain of the lumbar disc, whereas pregnancy may promote caution in physicians contemplating surgical care.Purpose: We aimed to report the incidence of lumbar discectomy during pregnancy and 12 months postpartum in Finland between 1999 and 2017.Study Design: Retrospective register-based cohort study.Patient Sample: Using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register, all women aged 15 to 49 years with a lumbar discectomy or pregnancy ending in delivery from 1st January, 1999 to 31st December, 2017 were included.Outcome Measures: Incidence rates and their 95% confidence intervals were calculated for lumbar discectomy. Incidence rate ratios (IRR) were calculated between the study population and the control population. The effect of smoking on surgery risk was reported using odds ratios.Methods: A retrospective statistical analysis was performed to identify patients undergoing lumbar discectomy during pregnancy or the first 12 months after delivery. Incidence rates were compared with the age-adjusted values of the age-matched female general population. The effect of smoking on the risk of lumbar discectomy was analyzed using age-adjusted odds ratios.Results: In total, 91 discectomies were performed during pregnancy and 508 within 12 months postpartum. The total incidence of lumbar discectomy during pregnancy was 11 operations per 100,000 person-years with an IRR of 0.2 (95% CI 0.1-0.2) when compared with the age-adjusted female general population. Women with active smoking before pregnancy were at a higher risk for lumbar discectomy during pregnancy (OR 2.0, 95% CI 1.2-3.2). Caesarean section was more common after lumbar discectomy (22%). No perinatal mortality was observed. During the first-year postpartum the rate of lumbar discectomy increased to 47 per 100 000 person-years with an IRR of 0.7 (95% CI 0.6-0.8). 90-day reoperation rates were higher than in the general population with an IRR of 1.7 (95% CI 1.1- 2.7).Conclusions: Lumbar discectomy during pregnancy is rare, but smoking increases the risk. Lumbar discectomy during pregnancy seems to be safe for the neonate. Postpartum incidences increased towards the end of the first year, but remained below the rates in the general population with a higher risk for short-term reoperation. [ABSTRACT FROM AUTHOR]

This article introduces the Finnish Army in World War II Database (FA2W) currently under construction that is being built to study the effects of World War II on Finnish society. The database is a stratified sample of 4,253 representative of the men who served in the Finnish Army in World War II. The data have been gathered from the military service record collection of the Finnish Army, which holds files on practically all draft-age Finnish men of the birth cohort 1903-1926 and around 70% of the birth cohorts 1897-1902. The amount of data is extensive, containing over 60 different variables. The main part of the database consists of men's military careers, comprising longitudinal data on their positions in society and in the army (e.g., civilian/conscript/frontline service), military unit, military branch, task, rank, and service class. Other information includes socio-economic information from the draft and wartime and war experiences, such as wounds, illnesses, medical treatments, death, and honors. In the future the database will be expanded with men's postwar life trajectories to study the long-term effects of the war. [ABSTRACT FROM AUTHOR]

A rapid review of real-world studies on the effectiveness of nirsevimab in preventing respiratory syncytial virus (RSV) hospitalizations found that the results were similar to those of randomized trials. The review analyzed three observational cohort studies from Luxembourg, Spain, and the United States. The studies showed that nirsevimab was effective in reducing RSV hospitalizations, with effectiveness rates ranging from 70% to 90%. However, the results may be less relevant in areas with different RSV season dynamics and severity. Larger studies are needed to monitor the real-world effectiveness of nirsevimab, and ongoing surveillance of epidemic dynamics is important. [Extracted from the article]

Objectives: Few studies have assessed pregnancies and deliveries after traumatic brain injury (TBI). We report the incidence of TBIs and TBI-related surgeries in fertile-aged females and investigate subsequent pregnancy outcomes. Methods: All fertile-aged (15–49) women with TBI diagnosis during our study period (1998–2018) were retrieved from the Care Register for Health Care and combined with data from the National Medical Birth Register. TBIs were categorized into three subgroups based on the length of the hospitalization period and the need for neurosurgery. Logistic regression was used to analyze preterm deliveries, cesarean sections (CS) and neonatal health. Results are reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI). Results: The incidence of TBIs increased from 103 per 100 000 person-years in 1998 to 257 per 100 000 (149.5%) in 2018. The incidence of TBI-related surgeries remained stable during our study period. The rate of preterm deliveries was 5.6% in the TBI group and 3.0% in the control group (AOR 1.23, CI 1.17–1.28). The CS rate in the TBI group was 19.2% and 15.9% in the control group (AOR 1.23, CI 1.18–1.29). The use of labor analgesia was higher among women with previous TBI. The rate of neonates requiring intensive care in the TBI group was 13.1% and 9.9% in the control group (AOR 1.30, CI 1.24–1.37). Conclusion: The incidence of TBI hospitalizations increased during our study period, whereas the number of surgically treated TBI remained stable. Preterm deliveries, CS, instrumental vaginal deliveries and labor analgesia were more prevalent in women with previous TBI. Furthermore, more neonates required intensive care in this group. Therefore, a history of TBI should be acknowledged as a possible factor affecting the delivery and health of the neonate. [ABSTRACT FROM AUTHOR]

Chronic pain represents one of the most serious worldwide medical problems, in terms of both social and economic costs, often causing severe and intractable physical and psychological suffering. The lack of biological markers for pain, which could assist in forming clearer diagnoses and prognoses, makes chronic pain therapy particularly arduous and sometimes harmful. Opioids are used worldwide to treat chronic pain conditions, but there is still an ambiguous and inadequate understanding about their therapeutic use, mostly because of their dual effect in acutely reducing pain and inducing, at the same time, tolerance, dependence, and a risk for opioid use disorder. In addition, clinical studies suggest that opioid treatment can be associated with a high risk of immune suppression and the development of inflammatory events, worsening the chronic pain status itself. While opioid peptides and receptors are expressed in both central and peripheral nervous cells, immune cells, and tissues, the role of opioids and their receptors, when and why they are activated endogenously and what their exact role is in chronic pain pathways is still poorly understood. Thus, in this review we aim to highlight the interplay between pain and immune system, focusing on opioids and their receptors. [ABSTRACT FROM AUTHOR]

Introduction: There are only few studies on the effects of pelvic or hip fractures on subsequent delivery outcomes. The aim for this study is to evaluate in a nationwide sample whether the rate of elective CS and emergency CS would decrease during the time after maternal hip and pelvic fracture.Material and Methods: In this nationwide registry-based study, data on all women aged 15-49 years with pelvic or hip fractures leading to hospitalization were retrieved from the Care Register for Health Care for the years 1998-2018. Wrist fractures were used as a control group. The data were linked with data from the National Birth Register, where each first pregnancy during the 14-year follow-up is collected. The delivery outcomes of these pregnancies were analyzed. The results were interpreted with odds ratios (OR), adjusted odds ratios (aOR), and 95 % confidence intervals (CI).Results: A total of 2878 women with pelvic fracture, 1330 women with hip fracture, and 29 580 with wrist fracture found in the Care Register for Health Care. Of these, a total of 586 (20.4 %) women gave birth during the following 14 years after pelvic fracture, 147 (11.0 %) women after hip fracture, and 5255 (17.7 %) women after wrist fracture. Women with pelvic fracture had higher odds for CS during each time period. The aOR for CS was 1.62 (CI 1.22-2.12) during first 5 years, 1.87 (CI 1.33-2.62) during years 5-10, and 1.97 (CI 1.11-3.41) during years 10-14. Women with hip fractures had notably higher odds for CS during first 5 years after fracture (aOR 1.64, CI 1.40-2.67).Conclusions: The results of this study advocate that vaginal delivery is generally possible rather quickly after hip or pelvic fracture. Unplanned CS after hip fractures was more common at the beginning, but the exact reason for this remains unknown and further research should be made on this topic. [ABSTRACT FROM AUTHOR]

The only randomised trial that compared nasogastric tubes to bottles was in 1999, but the groups used by Kliethermes et al. were unbalanced, and the randomisation was not completely successful.[18] For example, only 27% of the mothers in the bottle group had successfully breastfed compared with 56% in the nasogastric tube group. BOTTLES Bottle feeding has been criticised and controversial in neonatal care, as previous BFHI guidelines were against it and promoted alternative enteral feeding methods.[8] Mothers have mixed feelings about bottle feeding and may feel guilt and anger if breastfeeding is unsuccessful. Abbreviations BFHI Baby-Friendly Hospital Initiative SIDS sudden infant death syndrome WHO World Health Organisation INTRODUCTION Direct breastfeeding has numerous benefits and promoting successful breastfeeding is one of the most important local and global goals in neonatal care.[[1]] The World Health Organisation (WHO) goal is that 50% of the babies should be exclusively breastfed in the first 6 months.[3] The Baby-Friendly Hospital Initiative (BFHI) aims to promote breastfeeding globally, and hospitals may apply for BFHI status.[4] In 2020, the WHO published a preterm and neonatal care extension to the BFHI.[5] This repeats Step 9 in the original version, which states that parents should be informed about the use and risks of pacifiers and bottles.[[6]] Although the wording has been softened since previous versions, and the benefits of all feeding strategies are stated, the advice is still not neutral.[3] Furthermore, the BFHI material does not present the evidence well, in particular the quality and uncertainty of the evidence.[[4], [8]] However, the material does highlight the need to promote informed decision making by parents better, which is an improvement on previous versions. [Extracted from the article]

COVID‐19 vaccination effectiveness has been monitored in observational studies (test‐negativity design or traditional cohort design), but these studies have not addressed the potential behavioral bias between vaccinated and unvaccinated individuals. We aimed to address this by comparing COVID‐19 testing rates between vaccination status and whether vaccination changes the testing rates. We found that three times vaccinated had least tests performed during the pandemic and unvaccinated had the highest testing rate. Each vaccination dose increased the testing rate. In conclusion the observational studies addressing vaccine effectiveness should also present testing rates between vaccinated and unvaccinated to address the potential behavioral bias. [ABSTRACT FROM AUTHOR]

Background: The incidences of spine fractures and fusion surgeries have increased. A few studies have reported an increased rate of caesarean sections (CS) in women who have undergone spine surgery but have not reported on the health of neonates. Objective: We report the incidence of spine fractures, spine fracture surgeries and fusion surgery for other reasons and the effect of these injuries and procedures on later pregnancy outcomes in Finland. Methods: Data on all fertile-aged women (1998–2018) who had undergone spine fracture or spine fusion surgery were retrieved from the Care Register for Healthcare and combined with data from the National Medical Birth Register. Women with spine fracture or spine surgery before pregnancy were compared with women without previous spine fracture or surgery. We calculated incidences of spine fracture, spine fracture surgery and fusion surgery for other reasons with 95% confidence intervals (CI). We used multivariable logistic regression to evaluate CS and neonatal health. Results are reported as adjusted odds ratios (AOR). Results: The main finding of our study was the increasing incidence (156%) of spine fusion surgeries for other reasons in fertile-aged women. A total CS rate (including elective and unplanned CS) in the spine fracture group was 19.7% (AOR 1.26, CI 1.17–1.34), in fusion surgery for other reasons group 25.3% (AOR 1.37, CI 1.30–1.49) and 15.9% in the control group. The rate for neonates requiring intensive care in the spine fracture group was 12.2% (AOR 1.18, CI 1.08–1.29), in fusion surgery for other reasons group 13.6% (AOR 1.12, CI 1.02–1.23) and 10.0% in the control group. Conclusions: The incidence of fusion surgery for other reasons increased during our study period. The rate of CS was higher in women with preceding spine fracture or fusion surgery. Our results suggest that vaginal delivery after fractures of the spine is both possible and safe for mother and neonate. [ABSTRACT FROM AUTHOR]

Social restrictions interrupted the circulation of common respiratory viruses among children in spring 2020. In the winter season 2020–2021, only rhinovirus spread in Finland. As the restrictions were ended in September 2021, we saw record high epidemic peak of parainfluenza. Typically, the epidemic peak is in springtime, but now, it started in the early fall 2021. The monthly incidence among children aged 0–4 years (120 per 100,000 children) was six times higher than the second highest reported monthly incidence (21 per 100,000 children) during the last 10 years. Our finding highlights the importance of active surveillance of viral respiratory pathogens during the pandemic. [ABSTRACT FROM AUTHOR]

Objectives: We analyzed the incidence of obese and severely obese parturients and the impact of maternal obesity on mode of delivery, perinatal and neonatal mortality, and neonatal health.Study Design: We included all singleton births from the medical birth register of Finland from 2004 to 2018 (n = 792 437). Maternal body mass index (BMI) was categorized into three classes: non-obese (BMI < 30 kg/m2), obese (BMI 30 - 39.9 kg/m2), and morbidly obese (BMI 40 kg/m2 or more). The yearly incidence of obese and severely obese parturients per 10000 births was calculated. Logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI).Results: Between 2004 and 2018, the incidence of obese and morbidly obese parturients increased by 44% and 103%, respectively. Cesarean section rates were 23.6% and 30%, respectively (aOR 1.63 CI 1.61 - 1.66 and 2.33 CI: 2.23 - 2.44). Neonates born to morbidly obese parturients had an increased need for intensive care unit treatment (aOR 2.21 CI: 2.10 - 2.32), higher perinatal mortality (aOR 1.65 CI: 1.28 - 2.14), and higher neonatal mortality (aOR 1.68 CI: 1.04 - 2.72). The need for neonatal intensive care (aOR 1.50 CI: 1.47 - 1.53), perinatal mortality (aOR 1.25 CI: 1.13 - 1.39), and neonatal mortality (aOR 1.33 CI: 1.09 - 1.62) increased also among obese parturients.Conclusions: We report a worrying increase in obese and morbidly obese parturients. Neonates born to these parturients were more likely delivered by cesarean sections and had higher rates of perinatal and neonatal mortality, and intensive care unit treatment. This highlights the importance of preventing obesity among fertile-aged females. [ABSTRACT FROM AUTHOR]

This article examines religious and patriotic languages in digitized letters written by ordinary Finnish people in the Second World War. We combine qualitative and quantitative methods to analyse how religious and patriotic languages were used throughout the war years. Our findings show that the frequency of religious and patriotic vocabulary fluctuated widely during the war. Religious words were most notably connected to the intensity of the warfare, peaking during the periods of heated combat and dropping in the period of stationary warfare. Patriotic words were likewise common during the early periods of combat, but their use waned in the later war years. The analysis of words occurring in close proximity to the religious and patriotic words suggests that this was due to the different functions of the two languages. Religious parlance was essentially a vehicle of private emotional coping, while patriotic style gave a collective meaning to the sacrifices of the war. Religion and patriotism diverged during the war because the collective meaning of the war vanished but the need for emotional comfort persisted until its end. [ABSTRACT FROM AUTHOR]