Browsing by Author "Halminen, Olli"

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Alcohol use disorder and initiation of oral anticoagulant therapy in patients with atrial fibrillation : A nationwide cohort study
(2025-03-01) Vanhanen, Miika; Jaakkola, Jussi; Airaksinen, Juhani K.E.; Halminen, Olli; Putaala, Jukka; Mustonen, Pirjo; Haukka, Jari; Hartikainen, Juha; Luojus, Alex; Niemi, Mikko; Linna, Miika; Lehto, Mika; Teppo, Konsta
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Objective: Patients with alcohol use disorders (AUD) often receive inferior care for somatic comorbidities. Our objective was to explore whether AUDs influence oral anticoagulant (OAC) initiation for stroke prevention among atrial fibrillation (AF) patients, using a nationwide dataset to assess treatment disparities. Methods: The Finnish AntiCoagulation in Atrial Fibrillation registry includes data on all 229,565 patients diagnosed with incident AF in Finland during 2007–2018, identified from national registries covering all levels of care. The main outcome was OAC initiation compared between patients with and without AUD. Results: The patients' mean age was 72.7 years, 50 % were female, 85.0 % were eligible for OAC therapy (CHA2DS2-VA score ≥ 1), and 4.7 % had AUD. OAC therapy was initiated in a smaller proportion of patients with AUD compared to those without (52.5 % vs. 71.4 %, p < 0.001). This disparity remained significant even after adjusting for comorbidities, socioeconomic status, and laboratory values influencing OAC initiation (adjusted hazard ratio [HR] 0.68; 95 % confidence interval [0.66–0.71]). The absolute difference in OAC initiation between groups stayed consistent at approximately 20 % throughout the study period. Interaction analyses indicated that the association between AUD and lower OAC initiation was stronger in patients with lower income, lower educational attainment, and lower thrombocyte levels, but there was no significant interaction with sex, bleeding history, or hemoglobin levels. Conclusions: AUDs are associated with a significantly lower rate of OAC initiation even after accounting for comorbidities that influence OAC initiation.
Alzheimerin taudin kustannukset ja niihin vaikuttavat tekijät
(2020-02-14) Nikkanen, Pauli
Perustieteiden korkeakoulu | Bachelor's thesis
Analysing the Performance of Meso-level Care Systems Including Long and Short Term Services
(2022) Halminen, Olli
School of Science | Doctoral dissertation (article-based)
Different managerial logics are relevant when managing individual care organisations, networks of interrelated care organisations, or national health systems. Individual care organisations and national health systems are often referred to as the micro and macro levels of management,whereas the networks of different organisations as the meso-level. The regional social and health care reform currently taking place in Finland will further accentuate the role of the meso-level of management. Meso-level social and health care systems have, however, received less attention inregistry-based studies than micro and macro level systems. Also, the literature on social and health care management has not focused at length on meso-level managerial issues. This thesis applies a systems approach on social and health care management to shed light on themanagerially relevant mechanisms on the meso-level. The goal of this thesis is to create ananalytical framework of meso-level social and health care system and test its applicability when analysing these systems with national routinely collected registry data. As an empirical context, this thesis studies the Finnish meso-level care system for older people.A nationally collected data set includes social and health care use of over 300,000 individuals aged over 74 years, in 65 Finnish municipalities, and is complemented with sociodemographic background information, including marital status and income level. The sub-studies included in this thesis analyse diverse meso-level system mechanisms that take place in the meso-level caresystem. The synthesis part of the thesis gathers findings from the sub-studies to create, via inductive analysis, meso-level logics of management. The results imply that the meso-level system's manager must find a balance between the costs of individual long-term states and the use of short-term services. Coordination between organisations and homogenous criteria for care can reduce the need for urgent care and the over- and under-carethat stem from discrepancy between long-term need for care and services provided. A meso-level framework enables comprehensive analysis of both the patient and system level service use distribution. This analysis is especially relevant for the care system of older people, which concerns diverse actors and time scales for care processes. The detailed definition, establishment, and management of the analytical framework must, however, be established in collaboration with all the actors within the system. Additionally, similar meso-level mechanisms might be transferable from the care management context of older people to mental health services and child welfare services, and the generalisability of the results and frameworks to these contexts of care should be considered.
Aortic Stenosis and Outcomes in Patients With Atrial Fibrillation : A Nationwide Cohort Study
(2023-05-02) Teppo, Konsta; Juhani Airaksinen, K. E.; Biancari, Fausto; Jaakkola, Jussi; Halminen, Olli; Linna, Miika; Haukka, Jari; Putaala, Jukka; Mustonen, Pirjo; Kinnunen, Janne; Luojus, Alex; Hartikainen, Juha; Aro, Aapo L.; Lehto, Mika
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
BACKGROUND: Patients with aortic stenosis (AS) have been underrepresented in the trials evaluating direct oral anticoagulants (DOACs) in atrial fibrillation (AF). We aimed to assess whether AS impacts outcomes in patients with AF and estimate the effects of DOACs versus warfarin in patients with AF and AS. METHODS AND RESULTS: The registry-based FinACAF (Finnish Anticoagulation in Atrial Fibrillation) study covered all patients with AF diagnosed during 2007 to 2018 in Finland. Hazard ratios (HRs) of first-ever gastrointestinal bleeding, intracranial bleeding, any bleeding, ischemic stroke, and death were estimated with cause-specific hazards regression adjusted for anticoagulant exposure variables. We identified 183 946 patients (50.5% women; mean age, 71.7 [SD, 13.5] years) with incident AF without prior bleeding or ischemic stroke, of whom 5231 (2.8%) had AS. The crude incidence rate of all outcomes was higher in patients with AS than in patients without AS. After propensity score matching, AS was associated with the hazard of any bleeding, gastrointestinal bleeding, and death but not with intracranial bleeding or ischemic stroke (adjusted HRs, 1.36 [95% CI, 1.25–1.48], 1.63 [95% CI, 1.43–1.86], 1.32 [95% CI, 1.26–1.38], 0.96 [95% CI, 0.78–1.17], and 1.11 [95% CI, 0.99–1.25], respectively). Among patients with AS, DOACs were associated with a lower risk of ischemic stroke when compared with warfarin, while bleeding and mortality did not differ between DOACs and warfarin. CONCLUSIONS: AS is associated with substantially higher risk of gastrointestinal bleeding in patients with AF. DOACs may be more effective in preventing ischemic stroke than warfarin in patients with AF and AS. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04645537.
Association of income and educational levels on initiation of oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study
(2023-01) Teppo, Konsta; Jaakkola, Jussi; Biancari, Fausto; Halminen, Olli; Linna, Miika; Haukka, Jari; Putaala, Jukka; Mustonen, Pirjo; Kinnunen, Janne; Hartikainen, Juha; Airaksinen, K. E.Juhani; Lehto, Mika
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Aims: Socioeconomic disparities have been reported in the outcomes of patients with atrial fibrillation (AF). We assessed the hypothesis that AF patients with higher income or educational level are more frequently initiated with oral anticoagulant (OAC) therapy for stroke prevention. Methods: The nationwide registry-based Finnish AntiCoagulation in Atrial Fibrillation cohort covers all patients with AF from all levels of care in Finland. Patients were divided into income quartiles according to their highest annual income during 2004-2018 and into three categories based on educational attainment. The outcome was the first redeemed OAC prescription. Results: We identified 239 222 patients (mean age 72.7 ± 13.2 years, 49.8% female) with incident AF during 2007-2018. Higher income was associated with higher OAC initiation rate: compared to the lowest income quartile the adjusted SHRs (95% CI) for OAC initiation were 1.09 (1.07-1.10), 1.13 (1.11-1.14) and 1.13 (1.12-1.15) in the second, third and fourth income quartiles, respectively. Patients in the highest educational category had a slightly lower OAC initiation rate than patients in the lowest educational category (adjusted SHR 0.92 [95% CI 0.90-0.93]). Income-related disparities were larger and education-related disparities only marginal among patients at high risk of ischemic stroke. The socioeconomic disparities in OAC initiation within 1-year follow-up decreased from 2007 to 2018. The adoption of direct OACs as the initial anticoagulant was faster among patients with higher income or educational levels. Conclusion: These findings highlight potential missed opportunities in stroke prevention, especially among AF patients with low income, whereas the education-related disparities in OAC initiation appear controversial.
Association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study
(2022-06) Teppo, Konsta; Jaakkola, Jussi; Biancari, Fausto; Halminen, Olli; Linna, Miika; Haukka, Jari; Putaala, Jukka; Tiili, Paula; Lehtonen, Ossi; Niemi, Mikko; Mustonen, Pirjo; Kinnunen, Janne; Hartikainen, Juha; Airaksinen, K. E.Juhani; Lehto, Mika
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Low socioeconomic status has been associated with poor outcomes in patients with atrial fibrillation (AF). However, little is known about socioeconomic disparities in adherence to stroke prevention with direct oral anticoagulants (DOACs). We assessed the hypothesis that AF patients with higher income or educational levels have better adherence to DOACs in terms of treatment implementation and persistence. The used nationwide registry-based FinACAF cohort covers all patients with incident AF starting DOACs in Finland during 2011–2018. The implementation analyses included 74 222 (mean age 72.7 ± 10.5 years, 50.8% female) patients, and persistence analyses included 67 503 (mean age 75.3 ± 8.9 years, 53.6% female) patients with indication for permanent anticoagulation (CHA2DS2-VASc score >1 in men and >2 in women). Patients were divided into income quartiles and into three categories based on their educational attainment. Therapy implementation was measured using the medication possession ratio (MPR), and patients with MPR ≥0.90 were defined adherent. Persistence was measured as the incidence of therapy discontinuation, defined as the first 135-day period without DOAC purchases after drug initiation. Patients with higher income or education were consistently more likely adherent to DOACs in the implementation phase (comparing the highest income or educational category to the lowest: adjusted odds ratios 1.18 (1.12–1.25) and 1.21 (1.15–1.27), respectively). No association with income or educational levels was observed on the incidence of therapy discontinuation. In conclusion, we observed that income and educational levels both have independent positive association on the implementation of DOAC therapy but no association on therapy persistence in patients with AF.
Building Contextual Evidence for Outcomes of Policy Interventions in Healthcare: A Case Study of the Finnish Dental Care Sector
(2021-08-24) Vesinurm, Märt
Perustieteiden korkeakoulu | Master's thesis
Building contextual evidence for the basis of better decision making is a cornerstone of good policy making. It is known that policy interventions in healthcare are reliant on the contextual setting of the intervention. Dual market healthcare sectors make up one such interesting context. These sectors of healthcare are characterized by a heavy reliance on both public and private service production. In Finland, these sectors include for example, dental care, mental health, and elderly care. I propose a theoretical model that can be used to model the outcomes of policy interventions in a dual market healthcare sector. Using the Context-Intervention-Mechanism-Outcome (CIMO) framework, I studied the Finnish dental care sector during the years 2010-2016 in Espoo, Helsinki, and Oulu. This exploratory registry study included a dataset of 17,111,625 dental operations and enveloped two interesting policy interventions. During the years 2015 and 2016 the average reimbursement of private dental care operations was cut from 33 % to 25 % and 15 % respectively. The mechanisms at work and the outcomes produced develop within differing timespans and examining changes in data within one calendar year is not sufficient to conclude how an intervention has affected the entire system. After the intervention of 2015, the out-of-pocket payments increased in the private sector, yet no significant changes were observed in any other metrics. The public sector, however, showed an increase in capacity, in patients treated and in productivity. After the intervention of 2016, the private sector out-of-pocket payments increased further, this time resulting in a significant reduction in patients treated, in capacity, in operations produced, and in productivity. This time, however, the public sector did not seem capable of handling the new inflow of patients. Only a small increase was observed in patients treated in the public sector. In addition, a reduction in capacity and a no significant change in productivity were observed. Thus, the data would lead to the conclusion that the intervention of 2015 activated any slack and additional capacity available leading to a tipping point in 2016, after which the public sector could not receive the inflow of new patients anymore. In summary, when conducting policy interventions in a dual market healthcare sector, a systemic perspective should be adopted. It is no sufficient to study only one sector within the entire system since changes in one significantly affect the other. To model these relationships and monitor the success of policy interventions I propose a theoretical model and guidelines for intervention monitoring.
Causes of care discontinuity in chronic outpatient care : A mixed method case study
(2024-12-17) Vehkamäki, Anu; Vesinurm, Märt; Helminen, Riina-Riitta; Halminen, Olli; Lillrank, Paul
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Background While health systems are primarily designed for acute health issues, managing life-long conditions often results in chronic care discontinuity. This refers to situations where a chronic patient’s planned care fails to actualise. Research Design This study descriptively explores the reasons behind chronic care discontinuity in outpatient care. Data Collection Data was collected via interviews and a focus group with healthcare professionals, and a patient survey specifically targeting chronic abdominal patients. Analysis Using grounded theorising the Discontinuity of Chronic Care (DoCC) framework was developed, to identify and categorise reasons behind chronic care discontinuity. Results The framework reveals that reasons for discontinuity can be largely divided into healthcare system related factors—including caregiver, technological, and process challenges—and patient-related factors such as situational and internal psychological challenges. Conclusions The DoCC-framework provides a valuable tool for analysing various patient processes, offering healthcare managers insights to improve the management of chronic patient journeys. Additionally, it guides healthcare professionals to better focus their development efforts on challenges they have the capacity to address.
Commercial Adoption of AI in the Healthcare Sector: An Exploratory Analysis of S&P500 Companies
(2020-06-16) Mucha, Tomasz; Halminen, Olli; Tenhunen, Henni; Seppälä, Timo
A3 Kirjan tai muun kokoomateoksen osa
The use of Artificial Intelligence (AI) technologies within the healthcare sector is growing. However, there are differences in the speed of commercial adoption of AI across sub-sectors. We employ a dataset including news mentions and executive communications of all S&P500 Health Care Index companies to explore these differences. Pharmaceutical and medicine manufacturing companies had the earliest AI-linked news presence, yet they appeared to be among the slowest commercial implementers of AI. Ambulatory health care services and hospitals, as well as insurance carriers, received media coverage later, but were the quickest to take AI into commercial use. From the theory perspective our results indicate that the classical innovation diffusion theory might not fully explain these differences.
Comparing CHA2DS2-VA and CHA2DS2-VASc scores for stroke risk stratification in patients with atrial fibrillation : a temporal trends analysis from the retrospective Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) cohort
(2024-08) Teppo, Konsta; Lip, Gregory Yoke Hong; Airaksinen, Kari Eino Juhani; Halminen, Olli; Haukka, Jari; Putaala, Jukka; Mustonen, Pirjo; Linna, Miika; Hartikainen, Juha; Lehto, Mika
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Background: Contemporary data have shown a decrease in the ischaemic stroke risk associated with female sex in patients with atrial fibrillation (AF). We evaluated temporal trends in the predictive value of a non-sex CHA2DS2-VASc risk score (ie. CHA2DS2-VA). Methods: The FinACAF study covers all patients with incident AF between 2007 and 2018 in Finland from all levels of care. The CHA2DS2-VA score was compared with the CHA2DS2-VASc using continuous and category-based net reclassification indices (NRIs), integrated discrimination improvement (IDI), c-statistics and decision curve analyses. Findings: We identified 144,879 anticoagulant naïve patients with new-onset AF between 2007 and 2018 (49.9% women; mean age 72.1 years), of whom 3936 (2.7%) experienced ischaemic stroke during one-year follow-up. Based on both continuous and category-based NRIs, the CHA2DS2-VA score was inferior to the CHA2DS2-VASc in the early years (−0.333 (95% CI −0.411 to −0.261) and −0.118 (95% CI −0.137 to −0.099), respectively). However, the differences attenuated over time, and by the end of the study period, the continuous NRI became non-significant (−0.093 (95% CI −0.165 to 0.032)), whereas the category-based NRI reversed in favor of the CHA2DS2-VA (0.070 (95% CI 0.048–0.087)). The IDI was non-significant in early years (0.0009 (95% CI −0.0024 to 0.0037)), but over time became statistically significant in favor of the CHA2DS2-VA score (0.0022 (95% CI 0.0001–0.0044)). The Cox models fitted with the CHA2DS2-VA and the CHA2DS2-VASc scores exhibited comparable discriminative capability in the beginning of the study (p-value 0.63), but over time marginal differences in favor of the CHA2DS2-VA score emerged (p-value 0.0002). Interpretation: In 2007–2008 (when females had higher AF-related stroke risks than males), the CHA2DS2-VASc score outperformed the CHA2DS2-VA score, but the initial differences between the scores attenuated over time. By the end of the study period in 2017–2018 (with limited/no sex differences in AF-related stroke), there was marginal superiority for the CHA2DS2-VA score. Funding: This work was supported by the Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, The Finnish State Research funding, and Helsinki and Uusimaa Hospital District research fund.
Comprehensive nationwide incidence and prevalence trends of atrial fibrillation in Finland
(2022-11-22) Lehto, Mika; Haukka, Jari; Aro, Aapo; Halminen, Olli; Putaala, Jukka; Linna, Miika; Mustonen, Pirjo; Kinnunen, Janne; Kouki, Elis; Niiranen, Jussi; Luojus, Alex; Tiili, Paula; Itäinen-Strömberg, Saga; Hartikainen, Juha; Airaksinen, Juhani K.E.
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Objective: Atrial fibrillation (AF) is a worldwide healthcare challenge owing to population ageing. In this study, we assessed the current trends in the incidence and prevalence of AF for the first time in an unselected, nationwide population. Methods: In the Finnish Anticoagulation in Atrial Fibrillation study, we gathered comprehensive data including all primary, secondary and tertiary healthcare visits and drug reimbursement from national healthcare registers to identify all patients with incident AF between 2004 and 2018 in Finland. Incident AF was defined as new-onset AF occurring after 2007. Time trends for the incidence and prevalence of AF were calculated and stratified by sex and age. Results: A total of 411 387 patients with AF diagnosis were documented in Finland during 2004-2018. In 2018, the incidence and prevalence of AF in the total Finnish population were 469/100 000 and 4.1%, respectively. The incidence of new-onset AF in the adult population (≥20 years) increased from 471/100 000 in 2007 to 604/100 000 in 2018, but the age-adjusted incidence remained stable. The prevalence of AF increased in the adult population from 2.5% to 5.2%, and was higher in men than in women (5.9% vs 4.6%, p<0.001). The incidence and prevalence of AF increased with age and were 3194/100 000 and 23.4% in patients older than 75 years. Conclusions: Based on comprehensive nationwide data including primary care, we observed an increasing incidence and prevalence of AF over time. This increase was strongly age-dependent with the age-standardised incidence remaining stable during 2007-2018.
Cost-effectiveness calculators for health, well-being and safety promotion: a systematic review
(2021-10-26) Hult, Marja; Halminen, Olli; Linna, Miika; Suominen, Sakari; Kangasniemi, Mari
A2 Katsausartikkeli tieteellisessä aikakauslehdessä
BACKGROUND: The health, well-being and safety of the general population are important goals for society, but forecasting outcomes and weighing up the costs and benefits of effective promotional programmes is challenging. This study aimed to identify and describe the cost-effectiveness calculators that analyze interventions that promote health, well-being and safety. METHODS: Our systematic review used the CINAHL, PsycINFO, SocINDEX, EconLit, PubMed and Scopus databases to identify peer-reviewed studies published in English between January 2010 and April 2020. The data were analyzed with narrative synthesis. RESULTS: The searches identified 6880 papers and nine met our eligibility and quality criteria. All nine calculators focussed on interventions that promoted health and well-being, but no safety promotion tools were identified. Five calculators were targeted at group-level initiatives, two at regional levels and two at national levels. The calculators combined different data sources, in addition to data inputted by users. This included empirical research and previous literature. The calculators created baseline estimates and assessed the cost-effectiveness of the interventions before or after they were implemented. The calculators were heterogeneous in terms of outcomes, the interventions they evaluated and the data and methods used. CONCLUSION: This review identified nine calculators that assessed the cost-effectiveness of health and well-being interventions and supported decision-making and resource allocations at local, regional and national levels, but none focussed on safety. Producing calculators that work accurately in different contexts might be challenging. Further research should identify how to assess sustainable evaluation of health, well-being and safety strategies.
Cost-effectiveness calculators on health and social services planning and evaluation: an explorative interview study of key informants
(2022) Hult, Marja; Kallio, Hanna; Halminen, Olli; Linna, Miika; Suominen, Sakari; Kangasniemi, Mari
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
The aim of this study was to examine the views of key experts on developing and using cost-effectiveness calculators to plan and evaluate health and wellbeing promotion interventions in health and social services. Data for this qualitative interview study were collected from 14 Finnish experts in health and wellbeing coordination, health and social service management and research and health economics in spring 2021. A semi-structured interview method with thematic analysis was used. The experts said that there is a need for cost-effectiveness evaluation tools that support local evidence-based decision-making. This would enable organizations to plan and allocate scarce resources for interventions that promote equitable and effective health and wellbeing. However, practical tools and calculators that enable users to make decisions based on the best available evidence are not widely used. Local decision-makers, researchers and service providers all need to be involved in agreeing goals and selecting the right target groups and measures. They also need to make decisions about the best available data sources and how to use calculators to define and evaluate outcomes. Cost-effectiveness calculators are needed for local evidence-based decision-making, so that municipalities can allocate scarce resources to effective services that increase the wellbeing and equality of residents. This requires key stakeholders to work together to plan, develop and evaluate comprehensive, easy-to-use cost-effectiveness calculators.
Data Sharing in Pharmaceutical Supply Chains - Case European Medicines Verification System
(2020-06-26) Levänen, Laura; Halminen, Olli; Tenhunen, Henni; Seppälä, Timo
A3 Kirjan tai muun kokoomateoksen osa
We study the perceived value derived from data sharing activities by the representatives of a Nordic pharmaceutical company in the introduction of the European Medicines Verification System (EMVS). The system is an end-to-end verification protocol that would potentially enable the pharmaceutical companies to access the sales-point data from within the system, while maintaining the control of their own data. The benefits of the system are most notably in developing data sharing with the wholesalers and end-customers. Development of data sharing practices might enable more transparent logistics, and more targeted services and products.
Discontinuity in Chronic Outpatient Care: From Research to Practice
(2021-08-24) Vehkamäki, Anu
Perustieteiden korkeakoulu | Master's thesis
Research has found chronic diseases becoming an increasingly common reason for lowered quality of life and premature deaths. However, healthcare systems are mainly built to serve acute health issues and not life-long conditions leading to chronic care discontinuity where a chronic patient’s planned care does not actualise. The aim of this study was to explore on a descriptive level the reasons why chronic care discontinuity occurs and how to mitigate it. A mixed-methods approach was used to collect data in the study in three ways; focus group with care professionals (N = 7), a patient survey with chronic abdominal patients (N = 71), and interviews with care professionals (nutritionists n=3, primary care physicians n=4, nurses n=3). Results from the different methods were analysed through grounded theory and combined to form the holistic framework on discontinuity of chronic care (DoCC) and a chronic care plan management process. The DoCC-framework describes the risk factors, indications, reasons, and consequences related to chronic care discontinuity. The care management process helps to mitigate care discontinuity through following the actualisation of care plans and addressing discontinuities as they occur. This research found two main care plan actualisation hinderances: the obscurity of responsibilities related to care plans, and the lack of control monitoring related to care plan actualisation. These findings implicate that the roles of the caregivers and the patient should be precisely defined to avoid responsibility ambiguity, and care plans should be standardised and consistently created to enable continuous treatment monitoring and symptom monitoring.
The effect of mental health conditions on the use of oral anticoagulation therapy in patients with atrial fibrillation: the FinACAF study
(2022-05) Jaakkola, Jussi; Teppo, Konsta; Biancari, Fausto; Halminen, Olli; Putaala, Jukka; Mustonen, Pirjo; Haukka, Jari; Linna, Miika; Kinnunen, Janne; Tiili, Paula; Aro, Aapo L.; Hartikainen, Juha; Airaksinen, K. E. Juhani; Lehto, Mika
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Aims Little is known about the effects of mental health conditions (MHCs) on the utilization of oral anticoagulation (OAC) therapy in atrial fibrillation (AF) patients. We aimed to assess whether MHCs affect initiation of OAC therapy among AF patients with special focus on non-vitamin K antagonist oral anticoagulants (NOACs). Methods and results The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) registry included all 239 222 patients diagnosed with incident AF during 2007–18 in Finland identified from national registries covering primary to tertiary care and drug purchases. Patients with previous depression, bipolar disorder, anxiety disorder, or schizophrenia diagnosis or a fulfilled psychiatric medication prescription within the year preceding the AF diagnosis were classified to have any MHC. The main outcome was OAC initiation, defined as first fulfilled OAC prescription after AF diagnosis. The patients’ mean age was 72.7 years and 49.8% were female. The prevalence of any MHC was 19.9%. A lower proportion of patients with any MHC compared with those without MHCs were initiated on OAC therapy (64.9% vs. 73.3%, P Conclusion MHCs are common among AF patients, and they are associated with a lower rate of OAC initiation even during the NOAC era.
Factors Affecting Venture Funding of Healthcare AI Companies
(2019-07-08) Halminen, Olli; Tenhunen, Henni; Heliste, Antti; Seppälä, Timo
A4 Artikkeli konferenssijulkaisussa
Venture Capital (VC) funding raised by companies producing Artificial Intelligence (AI) or Machine Learning (ML) solutions is on the rise and a driver of technology development. In healthcare, VC funding is distributed unevenly and certain technologies have attracted significantly more funding than others have. We analyzed a database of 106 Healthcare AI companies collected from open online sources to understand factors affecting the VC funding of AI companies operating in different areas of healthcare. The results suggest that there is a significant connection between higher funding and having research organizations or pharmaceutical companies as the customer of the product or service. In addition, focusing on AI solutions that are applied to direct patient care delivery is associated with lower funding. We discuss the implications of our findings for public health technology funding institutions.
Geographical variation in persistence to oral anticoagulation therapy and clinical outcomes among patients with atrial fibrillation initiating therapy in Denmark, Sweden, Norway and Finland
(2023-08) Vinter, Nicklas; Halminen, Olli; Lehto, Mika; Airaksinen, K. E.Juhani; Andersson, Tomas; Wändell, Per; Holzmann, Martin; Rutherford, Ole Christian; Halvorsen, Sigrun; Cordsen, Pia; Frost, Lars; Johnsen, Søren Paaske
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Aim: To examine international and regional variations in persistence of oral anticoagulation (OAC) therapy and incidence of clinical outcomes and mortality, among patients with incident atrial fibrillation (AF) in the Nordic countries. Methods: We conducted a registry-based multinational cohort study of OAC-naïve patients diagnosed with AF that redeemed at least one prescription of OAC after AF in Denmark (N = 25 585), Sweden (N = 59 455), Norway (N = 40 046) and Finland (N = 22 415). Persistence was dispensing at least one prescription of OAC from Day 365 after the first prescription and 90 days forward. Results: Persistence was 73.6% (95% confidence interval 73.0–74.1) in Denmark, 71.1% (70.7–71.4) in Sweden, 89.3% (88.2–90.1) in Norway and 68.6% (68.0–69.3) in Finland. One-year risk of ischemic stroke varied between 2.0% (1.8–2.1) in Norway and 1.5% (1.4–1.6) in Sweden and 1.5% (1.3–1.6) in Finland. One-year risk of major bleeding other than intracranial bleeding varied between 2.1% (1.9–2.2) in Norway and 5.9% (5.6–6.2) in Denmark. One-year mortality risk varied between 9.3% (8.9–9.6) in Denmark and 4.2% (4.0–4.4) in Norway. Conclusion: In OAC-naïve patients with incident AF, persistence of OAC therapy and clinical outcomes vary across Denmark, Sweden, Norway and Finland. Initiation of real-time efforts are warranted to ensure uniform high-quality care across nations and regions.
Geographical Variation in the Use of Oral Anticoagulation and Clinical Outcomes among Patients with Atrial Fibrillation in Denmark, Sweden, and Finland
(2023-04-01) Frost, Lars; Halminen, Olli; Lehto, Mika; Airaksinen, K E Juhani; Andersson, Tomas; Wändell, Per; Holzmann, Martin; Cordsen, Pia; Vinter, Nicklas; Johnsen, Søren Paaske
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Background: Geographical mapping of variations in the treatment and outcomes of a disease is a valuable tool for identifying inequity. We examined international and intranational variations in initiating oral anticoagulation (OAC) therapy and clinical outcomes among patients with atrial fibrillation (AF) in Nordic countries. We also tracked real-world trends in initiating OAC and the clinical outcomes. Methods: We conducted a registry-based multinational cohort study of OAC-naive patients with an incident hospital diagnosis of AF in Denmark ( N = 61,345), Sweden ( N = 124,120), and Finland ( N = 59,855) and a CHA 2 DS 2 -VASc score of ≥1 in men and ≥2 in women between 2012 and 2017. Initiation of OAC therapy was defined as dispensing at least one prescription between 90 days before and 90 days after the AF diagnosis. Clinical outcomes included ischemic stroke, intracerebral hemorrhage, intracranial bleeding, other major bleeding, and all-cause mortality. Results: The proportion of patients initiating OAC therapy ranged from 67.7% (95% CI: 67.5-68.0) in Sweden to 69.6% (95% CI: 69.2-70.0) in Finland, with intranational variation. The 1-year risk of stroke varied from 1.9% (95% CI: 1.8-2.0) in Sweden and Finland to 2.3% (95% CI: 2.2-2.4) in Denmark, with intranational variation. The initiation of OAC therapy increased with a preference for direct oral anticoagulants over warfarin. The risk of ischemic stroke decreased with no increase in intracranial and intracerebral bleeding. Conclusion: We documented inter- and intranational variation in initiating OAC therapy and clinical outcomes across Nordic countries. Adherence to structured care of patients with AF could reduce future variation.
Health and work well-being associated with employment precariousness among permanent and temporary nurses: A cross-sectional survey
(2022-09) Hult, Marja; Halminen, Olli; Mattila-Holappa, Pauliina; Kangasniemi, Mari
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Nursing is at risk of becoming precarious employment with low wages, poor working conditions, heavy workload and underdeveloped career development possibilities. This study aimed to explore employment precariousness, health and work well-being among permanent and temporary practical nurses and registered nurses. The data were collected from Finnish nurses (n = 5867) using an online questionnaire in autumn 2020. This cross-sectional study was reported by applying the STROBE guidelines. Temporary nurses perceived their health and work well-being as being better than permanent nurses; however, they also perceived higher employment precariousness. Vulnerability, such as being treated in an authoritarian manner, had the strongest negative association with health and work well-being among permanent and temporary nurses. Practical nurses and registered nurses perceived employment precariousness in several dimensions, but this needs to be further studied because the results of this study are somewhat contradictory. Also, further studies are required to survey post-COVID-19 care work, as the pandemic likely affected the study, resulting in higher experiences of precariousness.