Seinäjoki Central Hospital

Background and aims There is no consensus on which Lisfranc injuries can be treated non-operatively. The aim of the study was to compare non-operative treatment and open reduction and internal fixation (ORIF) in the treatment of non-displaced Lisfranc injuries. Materials and methods This study was a multicenter randomized controlled trial (RCT) conducted at two hospitals in Finland between 19 March 2012, and 20 December 2022, with a target sample size of 60 patients. The primary outcome was Visual Analogue Scale Foot and Ankle (VAS-FA) at 2 years. The secondary outcomes included VAS-FA pain, function, and other complaints subscales and the American Orthopedic Foot & Ankle Society (AOFAS) Midfoot Scale. All outcomes were measured at 6 months, 1 and 2 years. Results Altogether 27 patients with computed tomography (CT)-confirmed non-displaced Lisfranc injuries were enrolled in this trial resulting in an underpowered trial. In patients with non-displaced Lisfranc injuries, the mean VAS-FA overall score in the non-operative group was 96.1 [confidence interval (CI): 91.5–100] and 91.8 [86.9–96.7] in the ORIF group at 2 years with no statistically significant difference between the groups (mean between-group difference (MD) 4.3 [CI, −2.4 to 11], Cohen’s d = 0.706) in this underpowered RCT. Conclusion There was no difference in VAS-FA between non-operative and ORIF in patients with non-displaced Lisfranc injuries, but the trial is underpowered to draw robust conclusions.

Study design Prospective cohort study. Objectives To study the mortality rates of TSCI patients compared to matched controls and to examine possible TSCI-related mortality risk factors and causes of death. Setting Oulu and Tampere University Hospital, Finland. Methods All consecutive patients with a new TSCI were included in a prospective study (n = 344, 2012-16). All patients were followed until death or the end of 2019. Patients were compared to a control group formed by randomly choosing gender, age, municipality, and calendar time-matched controls (5 controls/TSCI patient). Standardized mortality ratios (SMR) were calculated using general population mortality rates. Mortality information was extracted from the Statistics of Finland (Helsinki, Finland). Results TSCI patients had an increased mortality (SMR = 2.9) compared with the Finnish population. During the observation period, 26% of TSCI patients and 12% of the matched controls died. Of the TSCI patient deaths, 51% occurred within the first two years postinjury. Increased age, severity of TSCI (as per International SCI Core Data Set) and fall were related to mortality (p < 0.05). The two most common etiologies of death were: circulatory (30%), and pulmonary diseases (28%). Pneumonia was the single most frequent disease leading to death among TSCI patients. Conclusions During the first years after injury, the mortality of the patients with TSCI is double compared to the controls. Most deaths occur within two years postinjury. Elderly patients with more severe fall-related injury have the highest mortality risk. Circulatory diseases and pulmonary diseases, especially pneumonia, are the foremost causes of death after TSCI.

Background Trajectories of asthma and allergy in children are heterogeneous and commonly derived from parental report of disease or clinical records. This study combined parental‐reported and register‐based dispensed medication data to characterize childhood trajectories of co‐existing asthma, allergic rhinitis, and eczema. Methods From a Swedish population‐based birth cohort (N = 5654), survey responses collected at the age of 1, 4.5, 8, and 12 years were linked to dispensed medication register data for the period of 2–13 years. Trajectories were identified with latent class analysis. Statistical metrics and clinical interpretability guided the model selection. Results Nine distinct trajectories were identified: three asthma‐dominated (early‐onset remitting [n = 189, 3.3%], late‐onset [n = 117, 2.1%], and persistent [n = 149, 2.6%]), two eczema‐dominated (persistent [n = 190, 3.4%] and remitting [n = 432, 7.6%]), one allergic rhinitis‐dominated (late‐onset [n = 259, 4.6%]), two multimorbidity (mid‐childhood asthma and late‐onset allergic rhinitis [n = 144, 2.5%], and persistent eczema and late‐onset allergic rhinitis [n = 90, 1.6%]), and one low‐disease burden trajectory (n = 4084, 72.2%). Differences were seen across the trajectories in the proportion of parental report of disease and dispensed medication as well as by class and quantity of medication dispensed. Conclusion Combined parental‐reported and dispensed medication data enriches characterization of longitudinal trajectories of asthma and allergy in children by merging subjective experience of disease with healthcare utilization. The identified trajectories were characterized by distinct disease development and prescription patterns suggesting clinically differential morbidity burden.

Background Antibiotics have been reported as an efficient and safe treatment option for uncomplicated acute appendicitis without an appendicolith diagnosed using computed tomography (CT). The aim of this study was to assess the association of a CT-diagnosed appendicolith and its characteristics with appendicitis severity. Methods A large prospective patient cohort with suspected acute appendicitis enrolled between April 2017 and November 2018 was retrospectively reviewed. The initial analysis evaluated the association of a CT-diagnosed appendicolith with complicated acute appendicitis; then, based on the availability of CT images, a subset of patients was analysed for the correlation of appendicolith characteristics with appendicitis severity. The final appendicitis assessment (uncomplicated or complicated—including perforation, gangrene, an abscess, or a tumour) was determined for all patients. Results Out of 3512 eligible patients, 3085 patients with appendicitis were selected and 380 patients with an appendicolith and with a CT image available for reassessment were included. Out of the 3085 patients with CT-diagnosed acute appendicitis, 1101 (35.7%) patients presented with both acute appendicitis and an appendicolith and, out of these, 519 (47.1%) had complicated acute appendicitis. In the patients without an appendicolith (1984 patients), 426 (21.5%) had complicated appendicitis (P < 0.001). Re-evaluation of CT images for 380 patients showed that a larger appendicolith diameter (OR = 1.15 (95% c.i. 1.06 to 1.25); P < 0.001), appendicolith location at the base of the appendix (55.1% versus 44.9%; P = 0.008), and heterogeneous appendiceal wall enhancement around the appendicolith (68.4% versus 31.6%; P < 0.001) were associated with an increased risk of complicated acute appendicitis. Conclusion The presence of an appendicolith in patients with acute appendicitis is correlated with the risk of complicated appendicitis. This risk is further increased by a larger appendicolith diameter or appendicolith location at the base of the appendix.

Importance Prophylactic placement of a mesh has been suggested to prevent parastomal hernia. Evidence to support this practice is contradictory. Objective To determine whether funnel-shaped permanent synthetic parastomal mesh is effective and safe in parastomal hernia prevention. Design, Setting, and Participants The Chimney Trial was a randomized single-blinded multicenter trial conducted in 4 hospitals in Finland and 1 in Sweden from February 2019 and September 2021. Of 439 patients with rectal adenocarcinoma undergoing either laparoscopic or robotic-assisted abdominoperineal resection or the Hartmann procedure, 143 were enrolled in the trial, 135 received their allocated intervention, and 121 were analyzed at 12-month follow-up. Data were analyzed from December 2023 to May 2024. Intervention In the intervention group, a permanent colostomy was created with a funnel-shaped intraperitoneal mesh and compared to a control group with a stoma without the mesh. Main Outcome and Measure The primary end point was the incidence of computed tomography (CT)–confirmed parastomal hernia 12 months after surgery. Results There were 68 patients (mean [SD] age, 68.7 [11.6] years; 36 [53% male and 32 [47%] female) who received the intended allocation in the mesh group and 67 (mean [SD] age, 66.4 [11.7] years; 48 [72%] male and 19 [28%] female) who received the intended allocation in the control group. CT scans were available for 58 patients in the mesh group and 59 patients in the control group at the 12-month follow-up. CT scans confirmed parastomal hernia in 6 of 58 patients (10%) in the mesh group compared to 22 of 59 patients (37%) in the control group (difference, 27%; 95% CI, 12-41; P < .001). Clinical parastomal hernia as a secondary outcome was recorded in 1 of 60 patients (2%) in the mesh group compared to 27 of 61 (43%) in the control group (difference, 41%; 95% CI, 29-55; P < .001). The number of patients with Clavien-Dindo class II ileus was 23 (35%) in the mesh group compared to 11 (17%) in the control group (difference, 18%; 95% CI, 3-32; P = .006). Only slight differences between the groups were detected in other stoma-related complications, readmissions, operative time, surgical site infections, reoperations, and quality of life. Conclusions and Relevance In this study, funnel-shaped parastomal mesh prevented a significant number of parastomal hernias without predisposing patients to mesh- or stoma-related complications during 12-month follow-up. The results of this study suggest the funnel-shaped mesh is a feasible option to prevent parastomal hernia. Trial Registration ClinicalTrials.gov Identifier: NCT03799939

Background Obesity, assessed by body mass index (BMI), is an established risk factor for 13 cancers. We aimed to identify further potential obesity-related cancers and to quantify their association with BMI relative to that of established obesity-related cancers. Methods Using Cox regression models on 4,142,349 individuals in Sweden (mean age 27.1 years at weight measurement), we calculated hazard ratios (HRs) for the association between BMI and the risk of 122 cancers and cancer subtypes, grouped by topography and morphology. Cancers with a positive association (i.e., HR >1) at an α-level of 0.05 for obesity (BMI ≥30 kg/m²) vs. normal weight (BMI 18.5–24.9 kg/m²) or per 5 kg/m² higher BMI, for which obesity is not an established risk factor, were considered potentially obesity related. Findings After 100.2 million person-years of follow-up, 332,501 incident cancer cases were recorded. We identified 15 cancers in men and 16 in women as potentially obesity related. These were cancers of the head and neck, gastrointestinal tract, malignant melanoma, genital organs, endocrine organs, connective tissue, and haematological malignancies. Among these, there was evidence of differential associations with BMI between subtypes of gastric cancer, small intestine cancer, cervical cancer, and lymphoid neoplasms (P values for heterogeneity in HRs <0.05). The HR (95% confidence interval) per 5 kg/m² higher BMI was 1.17 (1.15–1.20) in men and 1.13 (1.11–1.15) in women for potential obesity-related cancers (51,690 cases), and 1.24 (1.22–1.26) in men and 1.12 (1.11–1.13) in women for established obesity-related cancers (84,384 cases). Interpretation This study suggests a large number of potential obesity-related cancers could be added to already established ones. Importantly, the magnitudes of the associations were largely comparable to those of the already established obesity-related cancers. We also provide evidence of specific cancer subtypes driving some associations with BMI. Studies accounting for cancer-specific confounders are needed to confirm these findings. Funding 10.13039/501100004359Swedish Research Council, 10.13039/501100002794Swedish Cancer Society, Mrs. Berta Kamprad’s Cancer Foundation, Crafoord Foundation, 10.13039/100002002Cancer Research Foundation at the Department of Oncology, Malmö University Hospital, and China Scholarship Council.

Conclusion Education, but not occupation, was differentially associated with adult asthma phenotypes in the general population. Further research into socioeconomic status variation in various asthma phenotypes is warranted.

Background Cardiac sarcoidosis (CS) is a rare but potentially fatal inflammatory cardiomyopathy. Objectives The authors studied temporal changes in the incidence, characteristics, and outcome of CS. Methods A retrospective analysis was made of a 30-year nationwide cohort of CS. Results The cohort comprised 511 patients with a median age of 52 years and female preponderance (69%). Altogether 77, 166, and 268 cases of CS were diagnosed in years 1988 to 2009, 2010 to 2014, and 2015 to 2019, respectively; the 5-year count of 2015 to 2019 was 134-fold the count of 1990 to 1994 (268/2) and 18-fold the count of 2000 to 2004 (268/15). Prior to 2010, compared with the later periods, CS presented more often with ventricular tachycardia/fibrillation (prevalence 36% vs 19% in 2010-2014 and 11% in 2015-2019, P < 0.001), left ventricular ejection fraction <50% (49%, 35%, and 31%; P = 0.010), and elevation of natriuretic peptides (87%, 57%, and 49%; P < 0.001). On magnetic resonance imaging, late gadolinium enhancement involved a median of 15% (IQR: 11%-22%) of left ventricular mass in studies of 1988 to 2009 (n = 16), 15% (IQR: 9%-22%) in studies of 2010 to 2014 (n = 87), and 11% (IQR: 5%-19%) in studies of 2015 to 2019 (n = 150) (P = 0.031). The respective 5-year incidences of the composite of death, heart transplantation, left ventricular–assisted device implantation, or ventricular tachyarrhythmia were 40% (95% CI: 29%-51%), 32% (95% CI: 25%-39%), and 23% (95% CI: 16%-30%) (P = 0.002). The prognostic trend disappeared after adjustment for differences in the presenting phenotype. Conclusions Diagnoses of incident CS have increased exponentially in Finland. Concurrently, the phenotype has turned milder and prognosis better, suggesting detection of CS at an earlier stage of its course.

Purpose Patients with asthma and low levels of type 2 inflammatory biomarkers (T2 low) have limited effective treatment options. Such biomarkers include eg blood eosinophils (b-eos) and fractional exhaled nitric oxide (FeNO). The healthcare resource utilisation (HCRU) of severe uncontrolled T2 low asthma remains unexplored. Thus, this study aimed to estimate the HCRU of T2 low and non-T2 low severe uncontrolled asthma patients using real-world data in Finland. Patients and Methods Adult patients with an asthma diagnosis during baseline (2012–2017) at the pulmonary department of Turku University Hospital were included and followed during 2018–2021, or until death. Total HCRU costs and respiratory-related HCRU costs were evaluated. The main drivers for the HCRU and costs were assessed with gamma and negative binomial regression models. Results Of the severe uncontrolled asthma patients with T2 status available, 40% (N=66) were identified with T2 low and 60% (N=103) with non-T2 low asthma. The average cumulative cost per patient was similar in patients with T2 low compared with non-T2 low, with all-cause costs cumulating in four years of follow-up to 37,524€ (95% CI: 27,160, 47,888) in T2 low compared to 34,712€ (25,484, 43,940) in non-T2 low. The corresponding average cumulative respiratory-related costs were 5178€ (3150, 7205) in T2 low compared to 5209€ (4104, 6313) in non-T2 low. Regression modelling identified no differences between the T2-status groups when assessing all-cause healthcare costs per patient-year (PPY). On the other hand, the regression modelling predicted more inpatient days PPY for severe uncontrolled patients with T2 low status compared to the patients with non-T2 low status. Conclusion Patients with uncontrolled severe T2 low asthma use equal healthcare resources as corresponding non-T2 low patients. This study brought new insights into the HCRU of severe uncontrolled asthma patients per T2 status, which has not previously been investigated.

Background Rhinitis encompasses diverse forms. Each form has distinct pathophysiology and clinical manifestations and may be influenced by differential risk factors. The association between socioeconomic status (SES) and different forms of rhinitis remains poorly understood. Our aim was to examine SES variations in allergic rhinitis, chronic rhinitis, and chronic rhinosinusitis in adults. Methods Based on a 2016 postal questionnaire survey within the West Sweden Asthma Study, we analyzed data from 36,213 subjects aged 16–75 years. The measures of SES were levels of education and occupation. Adjusted logistic regression was used to examine associations between SES and the rhinitis outcomes. Results Attaining a secondary school and tertiary education, compared to a primary school, were associated with increased risk of allergic rhinitis (secondary OR 1.33, 95% CI 1.22–1.45; tertiary 1.54, 1.41–1.69) and chronic rhinitis (secondary 1.18, 1.08–1.29; tertiary 1.17, 1.06–1.28). The influence of occupation was consistent with respect to allergic rhinitis. For instance, compared to the lowest occupational skill level, the highest level (OR 1.24, 95% CI 1.04–1.48) and the lower high occupation levels (1.24, 1.04–1.49) were associated with an increased risk of allergic rhinitis. No significant link was found between education and chronic rhinosinusitis or between occupation levels and risk of either chronic rhinitis or chronic rhinosinusitis. Conclusion Individuals with higher education and those at higher occupational levels may be at higher risk of having different forms of rhinitis than those at lower education and occupation levels. Assessment of rhinitis burden via SES can be one strategy to develop preventive strategies.

Purpose Urinary incontinence (UI) is known to be common among older female hip fracture patients. Little is known about different subtypes of UI among these patients. Our aim was to identify factors associated with subtypes of UI in a cross-sectional design. Methods 1,675 female patients aged ≥ 65 and treated for their first hip fracture in Seinäjoki Central Hospital, Finland, during 2007–2019, were included in a prospective cohort study. Of these, 1,106 underwent comprehensive geriatric assessment (CGA), including questions on continence, at our geriatric outpatient clinic 6 month post-fracture. A multivariable-adjusted multinomial logistic regression model was used to examine factors associated with UI subtypes. Results Of the 779 patients included, 360 (46%) were continent and 419 (54%) had UI 6-month post-fracture. Of the women with UI, 117 (28%) had stress UI, 183 (44%) had urgency UI and 119 (28%) had mixed UI, respectively. Mean age of the patients was 82 ± 6,91. In multivariable analysis, depressive mood and poor mobility and functional ability were independently associated with stress UI. Fecal incontinence (FI) and Body Mass Index (BMI) over 28 were independently associated with urgency UI. Mixed UI shared the aforementioned factors with stress and urgency UI and was independently associated with constipation. Conclusions Mixed UI was associated with most factors, of which depressive mood and impaired mobility and poor functional ability were shared with stress UI, and FI and higher BMI with urgency UI. CGA is key in assessing UI in older hip fracture patients, regardless of subtype.

Objectives The primary aim was to investigate if frozen embryo transfer (FET) without a corpus luteum increases the risk of hypertensive disorders of pregnancy (HDP). The secondary aim was to investigate other adverse maternal and perinatal outcomes. Methods This was a retrospective cohort study of 1168 singleton pregnancies and live births following a FET with either an artificial cycle (AC‐FET) (n = 631) or a natural/modified natural/stimulated cycle (CL‐FET) (n = 537) between 2012 and 2020. The data were collected from patient records. The primary outcome was HDP. Secondary outcomes included cesarean sections, placental retention problems, postpartum hemorrhage (PPH), the duration of pregnancy, birth weight, low birth weight, macrosomia, length of gestation, preterm birth, small for gestational age, and large for gestational age. Results In the AC‐FET group, there was an increased incidence of pre‐eclampsia, gestational hypertension, cesarean sections, PPH over 500 and 1000 mL, and retained placental tissue, compared with the CL‐FET group. These associations remained significant in logistic regression analyses with clinically relevant adjustments. Conclusion The risk of HDP and several other maternal complications seems to be increased after AC‐FET compared with CL‐FET. Our findings support most earlier studies regarding HDP and add to the knowledge on other maternal and perinatal risks involved in AC‐FET, including an increased risk of milder forms of placental retention. More studies are needed to confirm these findings.

Study design Cross-sectional survey of the Finnish population with spinal cord injury (SCI). Objectives To explore the frequencies of perceived environmental barriers (EB) that made participation harder for the Finnish population with SCI and to compare the occurrence of perceived EBs by gender, age, time since injury, and injury severity. Setting Participants were recruited from the registers of the three SCI outpatient clinics responsible for the lifelong care of people with SCI in Finland. Methods The self-administered Nottwil Environmental Factors Inventory Short Form (NEFI-SF) collected in the Finnish Spinal Cord Injury Study (FinSCI) ( n = 1772) was used. Nonparametric tests and multinomial logistic regression models were utilized. Results 880 individuals responded to the NEFI-SF items (response rate 50%). Climate was perceived as a barrier by 72% and a serious one by 44% of the respondents. The rates regarding public access were 59% and 24%, private home access 46% and 18%, and long-distance transport 45% and 20%. Four out of ten respondents reported that finances, lack of assistive devices for short-distance transport, and political decisions restricted their participation. The NEFI-SF total scores were higher (meaning more perceived restrictions by EBs) for those more severely injured. Conclusions Climate, access to public and private places, challenges with transport, finances, and political decisions were the EBs most frequently perceived to restrict participation by the Finnish population with SCI. Most EBs that were prominent causes of restrictions are modifiable. Greater accessibility to the built environment, equal services to all, and positive special treatment could reduce their effects.

Importance Current short-term evidence has shown that uncomplicated acute appendicitis can be treated successfully with oral antibiotics alone, but longer-term results are lacking. Objective To assess the treatment effectiveness of oral antibiotic monotherapy compared with combined intravenous (IV) and oral antibiotics in computed tomography–confirmed uncomplicated acute appendicitis at a longer-term follow-up. Design, Setting, and Participants This secondary analysis of a predefined year 3 follow-up of the Appendicitis Acuta II (APPAC II) noninferiority, multicenter randomized clinical trial compared oral moxifloxacin with combined IV ertapenem plus oral levofloxacin and metronidazole for the treatment of uncomplicated acute appendicitis. The trial was conducted at 9 university and central hospitals in Finland from April 2017 to November 2018, with the last follow-up in November 2022. Participants included patients aged 18 to 60 years, who were randomized to receive either oral antibiotics monotherapy (n = 301) or combined IV and oral antibiotics (n = 298). Interventions Antibiotics monotherapy consisted of oral moxifloxacin, 400 mg/d, for 7 days. Combined IV and oral antibiotics consisted of IV ertapenem sodium, 1 g/d, for 2 days plus oral levofloxacin, 500 mg/d, and metronidazole, 500 mg 3 times/d, for 5 days. Main Outcomes and Measures The primary end point was treatment success, defined as the resolution of acute appendicitis and discharge from hospital without the need for surgical intervention and no appendicitis recurrence at the year 3 follow-up evaluated using a noninferiority design. The secondary end points included late (after 1 year) appendicitis recurrence as well as treatment-related adverse events, quality of life, length of hospital stay, and length of sick leave, which were evaluated using a superiority design. Results After exclusions, 599 patients (mean [SD] age, 36 [12] years; 336 males [56.1%]) were randomized; after withdrawal and loss to follow-up, 582 patients (99.8%) were available for the year 3 follow-up. The treatment success at year 3 was 63.4% (1-sided 95% CI, 58.8% to ∞) in the oral antibiotic monotherapy group and 65.2% (1-sided 95% CI, 60.5% to ∞) in the combined IV and oral antibiotics group. The difference in treatment success rate between the groups at year 3 was −1.8 percentage points (1-sided 95% CI, −8.3 percentage points to ∞; P = .14 for noninferiority), with the CI limit exceeding the noninferiority margin. There were no significant differences between groups in treatment-related adverse events, quality of life, length of hospital stay, or length of sick leave. Conclusions and Relevance This secondary analysis of the APPAC II trial found a slightly higher appendectomy rate in patients who received oral antibiotic monotherapy; however, noninferiority of oral antibiotic monotherapy compared with combined IV and oral antibiotics could not be demonstrated. The results encourage future studies to assess oral antibiotic monotherapy as a viable treatment alternative for uncomplicated acute appendicitis. Trial Registration ClinicalTrials.gov Identifier: NCT03236961

Background and Aim The relationship between socioeconomic status (SES), asthma and mortality is complex and multifaceted, and it is not established if educational level modifies the association between asthma and mortality. The aim was to study the association between asthma and mortality in Sweden and Norway and to what extent educational level modifies this association. Participants and Methods Within the Nordic EpiLung Study, >56,000 individuals aged 30–69 years participated in population-based surveys on asthma and associated risk factors in Sweden and Norway during 2005–2007. Data on educational level and 10-year all-cause mortality were linked by national authorities. The fraction of mortality risk attributable to asthma was calculated, and Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for mortality related to asthma, stratified by educational level. Results In total, 5.5% of all deaths was attributed to asthma. When adjusted for potential confounders, the HR for mortality related to asthma was 1.71 (95% CI 1.52–1.93). Those with primary level of education had higher hazard of all-cause death related to asthma than those with tertiary level (HR 1.80, 95% CI 1.48–2.18, vs HR 1.39, 95% CI 0.99–1.95). Conclusion Asthma was associated with an overall 71% increased all-cause mortality and 5.5% of deaths can be attributed to asthma. Educational levels modified the risk of mortality associated with asthma, with the highest risk among those with primary education.

Introduction In epidemiological studies, the age at asthma onset is often defined by patients’ self-reported age at diagnosis. The reliability of this report might be questioned. Our objective was to evaluate the agreement between self-reported and registered age at asthma diagnosis and assess features contributing to the agreement. Methods As part of the FinEsS respiratory survey in 2016, randomly selected population samples of 13,435 from Helsinki and 8000 from Western Finland were studied. Self-reported age at asthma diagnosis was compared to age at asthma diagnosis registered in the Finnish register on special reimbursement for asthma medication. The reimbursement right is based on lung function criteria according to GINA and Finnish guidelines. If the difference was less than 5 years, self-reported diagnosis was considered reliable. Features associated with the difference between self-reported and registered age at asthma diagnosis were evaluated. Results Altogether 197 subjects from Helsinki and 144 from Western Finland were included. Of these, 61.9% and 77.8%, respectively, reported age at diagnosis reliably. Median difference between self-reported and registered age at diagnoses was − 2.0 years (IQR − 9.0 to 0) in Helsinki and − 1.0 (IQR − 4.3 to 0) in Western Finland indicating earlier self-reported age at diagnosis. More reliable self-report was associated with non-allergic subjects and subjects who reported having asthma diagnosis more recently. Conclusions Agreement between self-reported and registered age at asthma diagnosis was good especially with adult-onset asthma patients. Poor agreement in early-onset asthma could be related to delay in registration due to reimbursement criteria.

Background There is no consensus whether the primary surgical method should be open reduction and internal fixation (ORIF) or primary arthrodesis (PA) for Lisfranc injuries. The aim of our randomized controlled trial was to compare ORIF and PA for displaced Lisfranc injuries. Methods This study was a national multicenter randomized controlled trial. Altogether 43 displaced Lisfranc injuries were enrolled in this trial. The primary outcome measure was Visual Analogue Scale Foot and Ankle (VAS-FA) at a 24-months follow-up. The secondary outcome measures were VAS-FA pain, function, and other complaints subscales and the American Orthopaedic Foot & Ankle Society (AOFAS) Midfoot Scale. All outcomes were measured at 6, 12, and 24 months. We were unable to reach the planned sample size of 60 patients; thus, the study remains underpowered. Results The mean VAS-FA Overall score in the ORIF group was 86.5 (95% CI 77.9, 95.1) and 80.1 (95% CI 72.0, 88.1) in the PA group at the 24-month follow-up. We did not find eligible evidence of a difference in VAS-FA Overall scores (mean between-group difference 6.5 [95% CI −5.3, 18.2], Cohen d = 0.100). Conclusion We did not find evidence of a difference in VAS-FA between ORIF and PA in patients with displaced Lisfranc injuries, and thus both are viable options for the initial surgical method. The trial is underpowered; however, the data may be included in a meta-analysis of similarly designed randomized controlled trials. Trials registration ClinicalTrials.gov identifier: NCT02953067 24 October 2016. Level of Evidence Level I, randomized controlled trial.