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Background: Disparities in access to healthcare has been implied before in Finland, a country with universal healthcare but de facto tiered primary care. Less is however known about the content of care provided in different settings. Previous studies indicate potential disparities in prescribing newer medicines between healthcare sectors. We compared the preceding prescribing patterns of patients who initiated a sodium-glucose co-transporter 2 (SGLT2) inhibitor or a glucagon-like peptide-1 (GLP-1) analogue in public, occupational, and private healthcare., Methods: We used logistic models and patient-level register data from the city of Oulu, Finland, during 2014-2018. Among patients who initiated SGLT2 inhibitors or GLP-1 analogues, we studied whether it was a first-line treatment or if other antidiabetic medicines preceded the use. In addition, prior use of statins (a lipid-lowering medicine) and insulins were studied. Clinical guidelines for type 2 diabetes recommend in most cases metformin in first-line, and insulin only at later stages or in case of severe hyperglycaemia. Using a lipid-lowering medicine is typically recommended for all., Results: The examined novel antidiabetic medicines were seldom initiated in first-line, and no significant differences were observed for preceding statin use across sectors, net of patient characteristics. However, patients in the public sector were more likely to have used insulin previously compared to patients in occupational sector., Conclusions: Before the initiation of the examined novel antidiabetic medicines, no marked differences across sectors in the use of other antidiabetic medicines or statins were observed. The higher likelihood of prior insulin use in the public sector might reflect initiation at a later stage and/or unobserved differences in clinical characteristics across patient populations., Competing Interests: Declarations. Ethics approval and consent to participate: This study was based only on administrative, secondary register data, and no human subjects were contacted to collect the data. From purely register-based studies, no Ethics Board approval is required in Finland [61]. According to the General Data Protection Regulation of the European Union and the Finnish Data Protection Act, processing of personal data is permitted without informed consent of study subjects if the task is carried out in the public interest, such as scientific research [62, 63]. The data used in the study were fully pseudonymised before we accessed them, and all data preparation and linkage in the study were done with pseudo-identifiers. The study was conducted following good scientific practice, data protection guidelines and ethical standards. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Poor oral health is associated with many chronic diseases, including diabetes. As diabetes can worsen oral health and vice versa, care guidelines recommend that patients with diabetes maintain good oral health and have regular dental checkups. We analyzed the impact of receiving an initial type 2 diabetes diagnosis on dental care utilization., Methods: We used register data on residents aged over 25 in the city of Oulu, Finland, covering the years 2013-2018. We used the difference-in-differences method and individuals with no diabetes diagnosis as control group. As robustness checks, we used propensity score matching and constructed an alternative control group from patients that received the same diagnosis a few years apart., Results: Despite the guideline recommendations, we found that receiving a diabetes diagnosis did not increase the probability for dental care visits in a two-year follow-up. The findings remained similar for both high-income and low-income persons., Conclusions: The finding is concerning in terms of diabetes management and oral health. Further research is needed on the reasons behind the lack of response to guidelines., (© 2023. The Author(s).)

Mental health is one of the most important contributors to the global burden of disease in children and adolescents. Mental health conditions are associated with lower quality of life in adulthood. These conditions have an early onset and typically first occur in childhood. However, little is known about how these conditions are related to service utilization before the initial diagnosis, or about the significance of the diagnosis on later service utilization. To study this, register data on 5-15-year-old children in the city of Oulu, Finland, covering the years 2013-2018 were used. To identify the association of mental health and behavioral conditions with service utilization, counterfactuals were constructed from children who were similarly diagnosed three years later. Event study regressions on several health care and service utilization outcomes were estimated. The findings showed that primary and specialized health care utilization increased sharply before the initial diagnosis and peaked during the time of diagnosis. Primary care utilization started decreasing slowly after, while specialized health care utilization remained high for two years after the diagnosis. Probability of visiting a mental health professional, use of rehabilitation services, psychiatric medication, and utilization of child protection services increased significantly after the diagnosis. The results highlighted the importance of outpatient health care in detecting and treating the conditions in children. In a fragmented system, knowledge on utilization trajectories in different services may be of help in allocating resources to improve the health of these children., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Mikko Nurminen. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)