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Medicine shortages prevail as a worldwide problem causing life-threatening situations for adults and children. Epinephrine auto-injectors are used for serious allergic reactions called anaphylaxis, and alternative auto-injectors are not always available in pharmacies. Healthcare professionals in Finland use the dedicated internet source, Physician's Database (PD), when seeking medical information in practice, while Health Library (HL) provides health information for citizens (S1 Data). The objectives were to assess whether (1) professionals' searches for epinephrine auto-injectors and (2) citizens' anaphylaxis article openings relate to epinephrine shortages in Finland. Monthly log data on epinephrine auto-injectors (EpiPen®, Jext®, Emerade®) from PD and on openings of anaphylaxis articles from HL were collected during 2016-2022. Professionals' searches of seven auto-injectors and citizens' openings of four anaphylaxis articles were compared to information on epinephrine shortages reported by Finnish Medicines Agency. Professionals' auto-injector prescriptions provided by Social Insurance Institution were also assessed. Total searches in EpiPen® (N = 111,740), Jext® (N = 25,631), and Emerade® (N = 18,329) could be analyzed during 2016-2022. EpiPen® only could visually show seasonal patterns during summertime, peaking vigorously in the summer of 2018 when the major EpiPen® shortage appeared worldwide. Anaphylaxis articles equaled 2,030,855 openings altogether. Openings of one anaphylaxis article (\"Bites and Stings\") peaked during summertime, while another article (\"Anaphylactic Reaction\") peaked only once (three-fold increase) at the end of 2020 when COVID-19 vaccinations started, and auto-injector prescriptions were lowest. Fifty EpiPen®, one Jext®, and twelve Emerade® shortages were reported. Almost a two-fold increase in peaks of auto-injector prescriptions was found during summertime. This study shows that (1) epinephrine shortages related to professionals' searching for auto-injectors, and (2) citizens' information seeking on anaphylaxis related to summertime and shortages with lesser prescriptions. Therefore, the dedicated internet databases aimed at professionals and citizens could be used as additional information sources to detect anaphylactic reactions and auto-injector shortages.

Background The aim of this study is to assess dental no-shows or missed scheduled dental appointments among children and adolescents in public oral health services in Helsinki, Finland, where under 18-year-olds receive subsidized oral health care. Methods This retrospective register-based study focused under 18-year-olds in Helsinki who had dental no-shows, which was defined as any failure to arrive for a scheduled appointment without notifying, in the public oral health services from 2006 to 2020. The study utilized retrospectively collected data from the City of Helsinki’s electronic patient health information register systems, Effica (2006–2017) and Lifecare (2018–2020), which were in use during the respective periods. In the context of this study, children refer age group 0–9 years and adolescents 10–17 years. Results A total of 2,513,376 appointments were found from patient register; 92.6% ( n  = 2,326,878) were actualized visits and 7.4% ( n  = 186,498) no-shows. Dental no-shows among children and adolescents showed decreasing trend from 9.9% to 5.8% between 2006 and 2020 except of slight increase in year 2019. Of all dental no-shows, 5.2% were registered among children and 8.6% among adolescents. Boys had more frequently no-shows than girls ( p  < 0.01). Of the study population, 5% had 21.8% of all no-shows. Conclusions The 15-year trend analysis showed a reduction in yearly dental no-show prevalence among children and adolescents, in general. However, there is a positive correlation between age and the frequency of no-shows. There was a strong polarization of the no-show phenomenon, only 5% of the children and adolescents accounting more than one fifth of all missed appointments. This polarized group needs to be characterized, so that potential underlying causes can be studied.

School absenteeism and school dropout jeopardize the future health and wellbeing of students. Reports on the participation of school health care in absenteeism reduction are infrequent, although physical and mental health problems are the most common causes of school absenteeism. Our aim was to explore what reasons different professionals working in schools recognize for absenteeism and which factors either promote or inhibit the inclusion of school health care in absenteeism reduction. Data for this qualitative study was gathered from ten focus groups conducted in two municipalities in southern Finland. The groups included (vice) principals, special education/resource/subject teachers, guidance counselors, school social workers, school psychologists, school nurses, school doctors, and social workers working in child protective services. Data analysis was predominantly inductive but the categorization of our results was based on existing literature. Study participants identified student-, family-, and school-related reasons for absenteeism but societal reasons went unmentioned. A number of reasons promoting the inclusion of school health care in absenteeism reduction arose, such as expertise in health-related issues and the confidentiality associated with health care. Inclusion of school health care was hindered by differences in work culture and differing perceptions regarding the aims of school health care. Professionals working in schools were knowledgeable about the different causes of school absenteeism. Clarifying both the aims of school health care and the work culture of different professionals could facilitate the inclusion of school health care in absenteeism reduction.

Previous studies have evaluated the accuracy of the diagnostics of electronic symptom checkers (ESCs) and triage using clinical case vignettes. National Omaolo digital services (Omaolo) in Finland consist of an ESC for various symptoms. Omaolo is a medical device with a Conformité Européenne marking (risk class: IIa), based on Duodecim Clinical Decision Support, EBMEDS. This study investigates how well triage performed by the ESC nurse triage within the chief symptom list available in Omaolo (anal region symptoms, cough, diarrhea, discharge from the eye or watery or reddish eye, headache, heartburn, knee symptom or injury, lower back pain or injury, oral health, painful or blocked ear, respiratory tract infection, sexually transmitted disease, shoulder pain or stiffness or injury, sore throat or throat symptom, and urinary tract infection). In addition, the accuracy, specificity, sensitivity, and safety of the Omaolo ESC were assessed. This is a clinical validation study in a real-life setting performed at multiple primary health care (PHC) centers across Finland. The included units were of the walk-in model of primary care, where no previous phone call or contact was required. Upon arriving at the PHC center, users (patients) answered the ESC questions and received a triage recommendation; a nurse then assessed their triage. Findings on 877 patients were analyzed by matching the ESC recommendations with triage by the triage nurse. Safe assessments by the ESC accounted for 97.6% (856/877; 95% CI 95.6%-98.0%) of all assessments made. The mean of the exact match for all symptom assessments was 53.7% (471/877; 95% CI 49.2%-55.9%). The mean value of the exact match or overly conservative but suitable for all (ESC's assessment was 1 triage level higher than the nurse's triage) symptom assessments was 66.6% (584/877; 95% CI 63.4%-69.7%). When the nurse concluded that urgent treatment was needed, the ESC's exactly matched accuracy was 70.9% (244/344; 95% CI 65.8%-75.7%). Sensitivity for the Omaolo ESC was 62.6% and specificity of 69.2%. A total of 21 critical assessments were identified for further analysis: there was no indication of compromised patient safety. The primary objectives of this study were to evaluate the safety and to explore the accuracy, specificity, and sensitivity of the Omaolo ESC. The results indicate that the ESC is safe in a real-life setting when appraised with assessments conducted by triage nurses. Furthermore, the Omaolo ESC exhibits the potential to guide patients to appropriate triage destinations effectively, helping them to receive timely and suitable care. RR2-10.2196/41423.

Background Leg cramps are common among older adults and often lead to sleep disturbances and reduced quality of life. However, there is no consensus on how to treat this condition. This study aimed to evaluate the effectiveness of compression stockings in preventing leg cramps in individuals aged 50 to 85. Methods This study was a three-arm, parallel-group, partially blinded, randomized placebo-controlled trial conducted in Finland. Participants were recruited nationwide through online advertisements and primary care centers. Eligible individuals had experienced at least two leg cramps per week during the previous 4 weeks. Participants were randomized to receive either knee-high medical compression stockings, magnesium hydrochloride, or placebo pills, to be used daily for 4 weeks. The primary outcome was the change in leg cramp frequency at week 8. Secondary outcomes included the number of leg cramp-related nocturnal awakenings and the perceived pain intensity on an ordinal scale. Results A total of 121 participants were randomized, and 109 (90.1%) completed the trial. The primary outcome analysis included 114 participants. The mean age was 65.8 years ( SD 7.8), and 87 (71.9%) were women. At baseline, the median number of weekly leg cramps was 4 ( IQR 3–7). At week 8, the median weekly leg cramp frequency was 2 ( IQR 1–2.5) in the compression stockings group, 3 ( IQR 2–6) in the magnesium group, and 3 (IQR 2–5) in the placebo group. The baseline-adjusted mean difference in leg cramp frequency between the compression stockings and placebo group was −1.43 (95% CI −2.36 to −0.50; P  = .001). No significant difference was observed between the magnesium and placebo groups, with an adjusted mean difference of −0.20 (95% CI −1.49 to 1.09; P  = 0.929). Four participants discontinued compression stockings due to adverse reactions. No serious adverse events were reported. Conclusions Among older adults, daily use of compression stockings was effective in reducing the frequency and pain intensity of leg cramps, as well as the number of nocturnal awakenings caused by them. Trial registration ClinicalTrials.gov NCT04694417. Registered on 4 January 2021.

Health care professionals working in primary and specialized care typically search for medical information from Internet sources. In Finland, Physician's Databases are online portals aimed at professionals seeking medical information. As dosage errors may occur when prescribing medication to children, professionals' need for reliable medical information has increased in public health care centers and hospitals. Influenza continues to be a public health threat, with young children at risk of developing severe illness and easily transmitting the virus. Oseltamivir is used to treat children with influenza. The objective of this study was to compare searches for children's oseltamivir and influenza diagnoses in primary and specialized care, and to determine if the searches could aid detection of influenza outbreaks. We compared searches in Physician's Databases for children's oral suspension of oseltamivir (6 mg/mL) for influenza diagnoses of children under 7 years and laboratory findings of influenza A and B from the National Infectious Disease Register. Searches and diagnoses were assessed in primary and specialized care across Finland by season from 2012-2016. The Moving Epidemic Method (MEM) calculated seasonal starts and ends, and paired differences in the mean compared two indicators. Correlation was tested to compare seasons. We found that searches and diagnoses in primary and specialized care showed visually similar patterns annually. The MEM-calculated starting weeks in searches appeared mainly in the same week. Oseltamivir searches in primary care preceded diagnoses by -1.0 weeks (95% CI: -3.0, -0.3; p = 0.132) with very high correlation ([tau] = 0.913). Specialized care oseltamivir searches and diagnoses correlated moderately ([tau] = 0.667). Health care professionals' searches for children's oseltamivir in online databases linked with the registers of children's influenza diagnoses in primary and specialized care. Therefore, database searches should be considered as supplementary information in disease surveillance when detecting influenza epidemics.

ObjectiveTo evaluate the association between the concerns of parents, teachers, and nurses regarding each child’s well-being and the school doctor actions conducted in routine general health checks.DesignA blinded, observational study. Prior to the health check parents, teachers, and nurses completed questionnaires assessing their concerns. Doctors, blinded to the responses, routinely examined all children accompanied by parents and reported their actions after each health check. Multilevel logistic regression was used to analyse the association of the concerns with the actions.Setting21 primary schools in four municipalities in Finland.ParticipantsBetween August 2017 and August 2018, we randomly recruited 1341 children from grades 1 and 5, aged 7 and 11 years, respectively.Outcome measuresOutcome measures were the respondents’ concerns and the school doctor actions. The extent of concerns was assessed on a five-point Likert scale. Concern refers to ‘Quite a lot or a great deal of concern’ by at least one respondent. The school doctor actions included instructions and/or significant discussions, prescriptions, laboratory tests and/or medical imaging, scheduling of follow-up appointments, referrals to other professionals, and referrals to specialised care.ResultsAltogether, respondents were concerned about 47.5% of children. The top three concerns comprised growth/and or physical symptoms (22.7%), emotions (16.2%), and concentration (15.1%). All concerns were associated with some type of school doctor action (ORs: 1.66–4.27, p≤0.05); but only concerns regarding growth and/or physical symptoms were associated with all actions. Almost all concerns were associated with referrals to other professionals (ORs: 1.80–4.52, p≤0.01); emotions had the strongest association OR 4.52 (95% CI 3.00 to 6.80, p<0.0001).ConclusionsHealth checks by school doctors may lead to referrals of children to other professionals especially for children’s psychosocial problems. This should be considered when developing the roles, training, and multiprofessional collaboration of school health care professionals.Trial registrationNCT03178331.

Background Every physician has a unique professional identity. However, little is known about the diversity of identities among physicians. This study aimed to quantitatively assess the professional identity of physicians in Finland using descriptions of professional identity. Methods This study was part of a larger cross-sectional Finnish Physician 2018 Study. The target population consisted of all Finnish physicians under the age of 70 ( N  = 24,827) in 2018. The sample was drawn from physicians born on even numbered days ( N  = 11,336) using the Finnish Medical Association register. A total of 5,187 (46%) physicians responded. Professional identity was examined by 27 given characterisations using a five-point Likert scale. Multivariate logistic regression was used in assessing how place of work, graduation year and gender were associated with identity descriptions. Results The descriptions which most physicians identified with were “member of a working group/team” (82%), “helper” (82%), and “health expert” (79%); the majority reported these as describing them very or quite well. Identity descriptions such as “prescriber of medications” (68% vs. 45%), “prioritiser” (57% vs. 35%) and “someone issuing certificates” (52% vs. 32%) were more popular among junior than senior physicians. The biggest differences between the genders were found in the descriptions “provider of comfort” (62% vs. 40%) and “someone engaged in social work” (45% vs. 25%), with which women identified more frequently than men. Conclusions Strong identification as a member of a team is an important finding in the increasingly multiprofessional world of health care. Importantly, most physicians shared several core professional identity descriptions (i.e., helper, health expert) that reflect the traditional image of an exemplary doctor.

Background School health services provide an excellent opportunity for the detection and treatment of children at risk of later health problems. However, the optimal use of school doctors’ skills and expertise remains unknown. Furthermore, no validated method for screening children for school doctors’ assessments exists. The aims of the study are 1) to evaluate the benefits or harm of school doctors’ routine health checks in primary school grades 1 and 5 (at ages 7 and 11) and 2) to explore whether some of the school doctors’ routine health checks can be omitted using study questionnaires. Methods This is a prospective, multicenter observational study conducted in four urban municipalities in Southern Finland by comparing the need for a school doctor’s assessment to the benefit gained from it. We will recruit a random sample of 1050 children from 21 schools from primary school grades 1 and 5. Before the school doctor’s health check, parents, nurses and teachers fill a study questionnaire to identify any potential concerns about each child. Doctors, blinded to the questionnaire responses, complete an electronic report after the appointment, including given instructions and follow-up plans. The child, parent, doctor and researchers assess the benefit of the health check. The researchers compare the need for a doctor’s appointment to the benefit gained from it. At one year after the health check, we will analyze the implementation of the doctors’ interventions and follow-up plans. Discussion The study will increase our knowledge of the benefits of school doctors’ routine health checks and assess the developed screening method. We hypothesize that targeting the health checks to the children in greatest need would increase the quality of school health services. Trial registration ClinicalTrials.gov Identifier: NCT03178331 , date of registration June 6 th 2017.

ObjectiveTo evaluate the association between health and study-related factors measured by an Electronic Health Questionnaire (eHQ), participation in a health examination process and graduation in a university student population.DesignNationwide, retrospective, register-based cohort study with a 6-year follow-up.SettingStudent health care in Finland. Finnish Student Health Service (FSHS) provides statutory student health services to university students in Finland. The health examination process of FSHS includes the eHQ provided annually to university entrants and a subsequent health check when necessary based on students’ eHQ response.ParticipantsA national cohort of university entrants from the 2011–2012 academic year (n=14 329, n (female)=8075, n (male)=6254).Outcome measuresThe primary outcome measure was graduation, measured based on whether a student had completed a bachelor’s, licentiate or master’s degree during the 6-year follow-up.ResultsSome 72% of the women and 60% of the men had graduated during the follow-up. The predictors in the eHQ associated with non-graduation differed by sex. Among the women’s low enthusiasm about studies (OR 2.6, 95% CI 1.9 to 3.6), low engagement with studies (OR 2.5, 95% CI 1.8 to 3.4) and daily smoking (OR 1.9, 95% CI 1.4 to 2.6) were the strongest predictors to non-graduation. Among the men, low engagement with studies (OR 3.7, 95% CI 2.5 to 5.5) and obesity (body mass index≥35) (OR 4.0, 95% CI 1.9 to 8.8) were the strongest predictors to non-graduation. Not attending the health check when referred was associated with non-graduation in both sexes: the OR for not graduating was 1.6 (95% CI 1.3 to 1.9) in women and 1.3 (95% CI 1.0 to 1.6) in men.ConclusionsEngagement and enthusiasm about studying in the first year are important predictors of graduation and therefore a potential intervention target. Health promotion initiatives conducted early in the studies may have a positive effect on students’ academic achievement.