Reijo Sund

University of Eastern Finland | UEF · Institute of Clinical Medicine

In this study, we present an evidential deep learning framework called MV-DEFEAT, incorporating the strength of Dempster-Shafer evidential theory and subjective logic, for various mammogram assessment tasks, including mammogram density assessment, BIRADS scoring, and mammogram finding as normal/benign/malignant. The framework combines evidence from...

Aims Although seasonality has been documented for mental disorders, it is unknown whether similar patterns can be observed in employee sickness absence from work due to a wide range of mental disorders with different severity level, and to what extent the rate of change in light exposure plays a role. To address these limitations, we used daily bas...

OBJECTIVE To explore the incidence of type 1 diabetes in children in relation to exposure to rotavirus infections. RESEARCH DESIGN AND METHODS A nationwide register-based ecological study on the 1995–2015 birth cohorts in Finland compared those born before and after the national implementation of the rotavirus vaccine in 2009. RESULTS When the pr...

Purpose To evaluate how comprehensively wrist fractures can be tracked from the national medical registers, and to propose a method for complementing the register data using time stamps of wrist radiography visits recorded in the radiological image archive. Patients and Methods For the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE)...

PURPOSE Although follicular lymphoma is characterized by long natural history and frequent relapses, data on the number of patients receiving subsequent therapy lines are scarce. To perform reliable health economical calculations for various treatment options, data regarding the lifetime number of therapy courses are needed. The purpose of this stu...

Unlabelled: A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. Introduction: The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the...

Background: This case-control study evaluated the incidences and outcomes of inter-prosthetic femoral fracture (IPFF) (Group I) and performed comparisons with Vancouver type C (Group II) and Rorabeck type II (Group III) periprosthetic femoral fractures (PPFF) occurring at similar anatomic sites. Methods: A retrospective analysis was performed fo...

Background: Increasing number of nurse prescribers could be part of a solution to the shortage of physicians, improve access to treatment and curb the rise in healthcare costs; however, readmissions after nurse prescribers' appointments are under-researched. Aims: To describe and compare clients' initial appointments with nurse prescribers and p...

Background and purpose: Most displaced distal radius fractures (DRF) are treated nonoperatively, with reduction and immobilization in a cast. Studies assessing intra- or inter-observer agreement on radiologic measurements of casting position have not been published, which was the aim of our study. Patients and methods: Our study is based on the...

Aim: Feeding a very low birthweight (VLBW, <1500 g) infant is challenging. Our aims were to study how prescribed enteral feeding is implemented in VLBW infants and to identify factors associating with slow enteral feeding progression. Methods: Our retrospective cohort included 516 VLBW infants born before 32 weeks of gestation during 2005-2013 a...

Context: Patients with congenital hypothyroidism (CH) are affected more often than the general population by other chronic diseases and neurological difficulties. Objective: The aim of this nationwide population-based register study was to investigate the incidence of congenital malformations, comorbidities, and the use of prescribed drugs in pa...

Preterm birth and low birthweight have been associated with increased fracture risk in children. Our aim was to analyze bone fractures during childhood in preterm, and low-birthweight newborns compared to full term and normal birthweight newborns. We conducted a nationwide register-based cohort study in Finland from 1998 to 2017 and utilized the Me...

Background: The incidence of periprosthetic femoral fractures is increasing because of an increasing number of primary THAs and TKAs. High rates of complications and mortality are associated with periprosthetic fractures, but few studies have evaluated and compared the population-based incidences of these events after fractures. Questions/purpose...

Background: Communal exercise interventions may help prevent falls and injuries. However, pragmatic trials demonstrating the effectiveness of such strategies are sparse. Methods: We determined whether a cost-free 12-month admission to the city's recreational sports facilities including initial 6 months of supervised weekly gym and Tai Chi sessio...

Background: Vitamin D supplements may only be beneficial for the prevention of osteoporotic fractures when administered with calcium and in individuals with low blood levels of 25(OH)D, but possible hazards of calcium supplements on CVD cannot be excluded. Objectives: We conducted a meta-analysis of all placebo-controlled randomized trials asses...

Aims: Type 1 diabetes has been associated with a significant reduction in life expectancy. Major advances in treatment of type 1 diabetes have been associated with improved survival. However, life expectancy for type 1 diabetes under contemporary care is not known. Methods: Health care registers were used to obtain data on all people with type 1...

Background and purpose: Studies investigating the effect of spinal surgery on both physical capability (PC) and subjective well-being (SW) are scarce. We aimed to investigate self-reported PC and SW up to 20 years after lumbar spine surgery. Patients and methods: 6,612 postmenopausal Finnish women (47–56 years at baseline [BL]), from the Osteoporos...

Background Anthropometric measures show high heritability, and genetic correlations have been found between obesity-related traits. However, we lack a comprehensive analysis of the genetic background of human body morphology using detailed anthropometric measures. Methods Height, weight, 7 skinfold thicknesses, 7 body circumferences and 4 body dia...

Attendance in special education (SE) is more common among individuals born preterm than among those born at term. Less is known about school grades of those born preterm in mainstream education (ME), and how these grades predict later educational attainment. This population-based register-linkage study assessed (1) attendance in SE, and then focuse...

This study aimed to investigate the genomics literacy of Finnish and Filipino nursing students as a basis for developing a genomics nursing education course. This is a cross-sectional online survey using the 31-item Genomic Nursing Concept Inventory, IBM SPSS version 27, and item-analysis. A total of 245 nursing students participated in the study;...

Mantle cell lymphoma (MCL) is a rare peripheral B‐cell lymphoma characterised by eventual relapse and progression towards a more aggressive disease biology. With the introduction of rituximab‐ and cytarabine‐based immunochemotherapy regimens, the prognosis of the disease has changed dramatically over the last two decades. To assess the real‐world s...

Background: Statin medication improves the prognosis of patients with lower extremity artery disease (LEAD). Research has previously focused on patients with a lowered ankle brachial index (ABI) excluding patients with a normal or elevated ankle brachial index. The aim of this study was to analyze the impact of statin use on survival and cardiovasc...

Background: Use of metformin and statins have been associated with improved prognosis of colon cancer (CC) in patients with type 2 diabetes (T2D). We examined the survival from CC in relation to the use of metformin, other oral antidiabetic medications (ADM), insulin, and statins in T2D patients. Materials and methods: A cohort (n = 2252) of per...

Background Season of birth is a risk factor of schizophrenia, and it is possible that cumulative exposure to climatic factors during childhood affects the risk of schizophrenia. We conducted a cohort study among 365,482 persons born in Finland in 1990–1995 to examine associations of 10-year cumulative exposure to global solar radiation and ambient...

Purpose: To examine seasonal patterns of hospital admissions due to mood and psychotic disorders and to investigate whether the admission rates show variation according to the seasonal daylength (photoperiods). Patients and methods: A retrospective nationwide register-based cohort of all psychiatric admissions (N=978,079) during 1987-2017 in Fin...

Background: Many primary and secondary disorders disturb growth and cause short stature (height below -2 SDS) in childhood. Growth monitoring programs aim at their early detection but are not evidence-based: epidemiology of childhood growth disorders is poorly characterized, and no consensus exists on priority target conditions. Herein, we describ...

Metformin and statin use have been associated with an improved prognosis for colorectal cancer in persons with type 2 diabetes (T2D). Data regarding rectal cancer (RC) have been inconclusive; therefore, we investigated the issue with high-quality data and a robust study design. We identified 1271 eligible patients with T2D and incident RC between 1...

Objectives To studysexually transmitted Chlamydia trachomatis infections (STCTs), teenage pregnancies, and payment defaults in individuals born preterm as proxies for engaging in risk-taking behavior. Study design Our population-based register-linkage study included all 191 705 children alive at 10yr (8492 preterm, 4.4%) born without malformations...

Importance Universal ultrasonographic screening for developmental dysplasia of the hip (DDH) has gained increasing popularity despite the lack of benefit in terms of reducing the rates of late-detected cases (age ≥12 weeks) in randomized clinical trials. Objective To report the reported incidence of DDH in the English scientific literature and com...

Background Body mass index (BMI) shows strong continuity over childhood and adolescence and high childhood BMI is the strongest predictor of adult obesity. Genetic factors strongly contribute to this continuity, but it is still poorly known how their contribution changes over childhood and adolescence. Thus, we used the genetic twin design to estim...

We tested the causality between education and smoking using the natural experiment of discordant twin pairs allowing to optimally control for background genetic and childhood social factors. Data from 18 cohorts including 10,527 monozygotic (MZ) and same-sex dizygotic (DZ) twin pairs discordant for education and smoking were analyzed by linear fixe...

Background and purpose: Currently, there is no available Finnish version of the Genomic Nursing Concept Inventory tool (GNCI). This study tested the validity, reliability, and clinical usability of a Finnish translation. Methods: A decision tree algorithm was used to guide the translation, as per International Society for Pharmacoeconomics and O...

Background Antibiotics have been associated with several individual autoimmune diseases (ADs). This study aims to discover whether pre-diagnostic antibiotics are associated with the onset of ADs in general. Methods From a cohort of 11,407 children, 242 developed ADs (type 1 diabetes, autoimmune thyroiditis, juvenile idiopathic arthritis (JIA), or...

Background and purpose: Manipulation under anesthesia (MUA) is considered to be effective in treating stiffness after total knee arthroplasty (TKA). However, not all patients achieve a satisfactory range of motion (ROM) after MUA. This retrospective study determined the outcome of MUA and identified the factors affecting it. Patients and methods:...

Purpose This study aims to elucidate the incidence of and independent risk factors for spinal cord stimulator implantations for patients who underwent lumbar spine surgery. Methods The PERFormance, Effectiveness, and Cost of Treatment (PERFECT) episodes database, which was established for selected diseases and procedures in Finland, includes all p...

Background and purpose: Total hip (THA) and knee (TKA) arthroplasty are effective pain treatment in osteoarthritis; however, there are patients with long-term pain and in need of analgesics. We studied purchases of paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and neuropathic pain medication before and after THA or TKA. Pati...

Obstructive sleep apnea is linked to severe health consequences such as hypertension, daytime sleepiness, and cardiovascular disease. Nearly a billion people are estimated to have obstructive sleep apnea with a substantial economic burden. However, the current diagnostic parameter of obstructive sleep apnea, the apnea–hypopnea index, correlates poo...

We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. Introduct...

Background Projections of the development of mobility limitations of older adults are needed for evidence-based policy making. The aim of this study was to generate projections of mobility limitations among older people in the United States, England, and Finland. Methods We applied multiple imputation modelling with bootstrapping to generate proje...

Background Type 2 diabetes (T2D) and its complications cause a significant public health and economic challenge. To enable the optimal resource allocation across different prevention and treatment policies for the management of T2D-related complications, detailed cost estimates related to the complications of T2D are needed. Therefore, the objectiv...

Background: The life expectancy of patients with follicular lymphoma (FL) has improved considerably since the introduction of rituximab. This study examined the proportion of deaths from progressive lymphoma and the impact of FL on survival compared with that in the general population. Methods: Altogether, 749 patients with grades 1 and 2 FL in...

Background and purpose: COVID-19 lockdowns have affected personal mobility and behavior worldwide. This study compared the number of emergency department (ED) visits due to injuries and typical low-energy fractures in Finland during the COVID-19 lockdown period in spring 2020 to the reference period in 2019. Patients and methods: The data was co...

Background and purpose: Ankle fractures are one of the most common fractures requiring operative treatment. They occur most commonly in postmenopausal women and younger men and recent studies suggest that the incidence of ankle fractures is increasing. In this registry study, we analyze inpatient data of operatively treated ankle fractures during...

Pulmonary embolism is listed as a cause of death in fewer and fewer cases in the twenty-first century. Autopsies reveal undiagnosed pulmonary embolism at a significant rate, but fewer and fewer autopsies are being performed. It could be that deaths from pulmonary embolism are not decreasing, but are increasingly missed because of decreasing autopsy...

Objectives: Occupational physical loading has been reported to be associated with intervertebral disc degeneration. However, previous literature reports inconsistent results for different vertebral levels. The aim of our study was to investigate the association between lumbar disc degeneration (LDD) at different vertebral levels and the self-repor...

Very low birthweight (VLBW) infants are at risk of intraventricular haemorrhage (IVH) and delayed closure of ductus arteriosus. We investigated mean arterially recorded blood pressure (MAP) changes during the first day of life in VLBW infants as potential risk factors for a patent ductus arteriosus (PDA) and IVH. This retrospective cohort study exp...

Incidences of pediatric autoimmune diseases (ADs) have been increasing without clearly identified environmental risk factors. Using national registers (special reimbursement and drug purchase register), this matched case-control study aims to discover whether antibiotic exposures are related to development of ADs in general. From a cohort of 11,407...

Background Physical capacity and subjective wellbeing are important for healthy aging. Our aim was to study how objective/subjective physical capacity and subjective health relate to life satisfaction, in a 10-year follow-up of aging women. Methods The participants ( n = 1485, mean age 67.4 years) consisted of community-dwelling older women living...

Very low birthweight (VLBW, <1500 g) infants may be predisposed to undernutrition during the nutritional transition phase from parenteral to enteral nutrition. We studied the associations among the length of the transition phase, postnatal macronutrient intake, and growth from birth to term equivalent age in VLBW infants. This retrospective cohort...

Background Oman’s healthcare system has rapidly transformed in recent years. A recent Report of Quality and Patient Safety has nevertheless highlighted decreasing levels of patient safety and quality culture among healthcare professionals. This indicates the need to assess the quality of care and patient safety from the perspectives of both patient...

Background: Maternal smoking during pregnancy causes fetal growth retardation. Thereafter, it has been associated with excessive childhood weight gain and decreased linear growth in the offspring. However, it is not known whether head circumference (HC), the surrogate of brain size in childhood, is altered after intrauterine tobacco exposure. We a...

The aim of this study was to monitor long‐term changes in bone mineral density (BMD) after menopause and factors affecting BMD. The study population consisted of a random sample of 3222 women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study, of which 62.1% were postmenopausal at the beginning of the study. This group of women...

Objective To investigate sociodemographic characteristics and physical and mental health indicators between participants and non-participants of a large-scale two-year exercise RCT including non-invited women living in nearby rural area in Finland. Study Design and Setting From a previous OSTPRE study cohort, 914 women (aged 72-84) participated in...

Comprehensive overviews of the use of psychiatric services among children and adolescents placed in out-of-home care (OHC) by child welfare authorities are scarce. We examine specialized service use for psychiatric and neurodevelopmental disorders among children and adolescents in a total population involving children in OHC. We used the longitudin...

Dual-energy X-ray absorptiometry (DXA) is the gold standard imaging method for diagnosing osteoporosis in clinical practice. The DXA images are commonly used to estimate a numerical value for bone mineral density (BMD), which decreases in osteoporosis. Low BMD is a known risk factor for osteoporotic fractures. In this study, we used deep learning t...

We investigated the survival of female patients with pre-existing type 2 diabetes (T2D) diagnosed with invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) of breast, in relation to the use of metformin, other antidiabetic medication (ADM) and statins. The study cohort consisted of 3,165 women (2,604 with IDC and 561 with ILC). The...

Background and purpose — There is lack of knowledge concerning patient-reported long-time outcome after arthroplasty. Therefore, we investigated patient self-reported physical capabilities (PC) and subjective well-being (SW) up to 20 years after total hip (THA) or knee (TKA) arthroplasty. Subjects and methods — The self-reports from postal question...