Reijo Sund

• Doctor of Social Sciences (Statistics)
• Professor at University of Eastern Finland

Background Low levels of physical activity (PA), more prevalent among those with low education, require effective interventions. Fewer trials have tested interventions to decrease sedentary behavior (SB). No school-based interventions have shown lasting effects on PA or SB in vocational schools. Purpose To examine whether the Let’s Move It interve...

Background Lumbar spinal stenosis (LSS) is a clinical condition characterized by constriction of the nerve-carrying pathways of the intervertebral foramen and spinal canal. However, research examining the relationship between occupational factors and structural alterations involving the spine as well as the risk of LSS remains limited. Aims This s...

Introduction An association between intervertebral disc degeneration (IDD) and osteoarthritis (OA) of the hip and knee has been found previously. However, studies using MRI-evaluated IDD grades with large sample sizes are lacking. Total hip and knee arthroplasty (THA and TKA) can be considered an indicator of clinically evident end-stage OA. Mater...

Abdominal aortic calcification (AAC) is an independent predictor of cardiovascular diseases (CVDs). AAC is typically detected as an incidental finding in spine scans. Early detection of AAC through opportunistic screening using any available imaging modalities could help identify individuals with a higher risk of developing clinical CVDs. However,...

Many primary and secondary disorders in childhood may cause tall stature (height of +2 standard deviations above the mean height for age and sex). Growth-monitoring programs are aimed at early detection of such disorders to avoid permanent health consequences and support children’s wellbeing. However, age- and sex-specific data on the incidence of...

Objective To investigate whether increased prevalence of type 2 diabetes (T2DM) in women with polycystic ovary syndrome (PCOS) translates into increased risk of diabetic complications. Design A cohort study based on the nationwide Diabetes in Finland database. The main analysis included 1288 women with PCOS and T2DM and 177,555 women with T2DM wit...

Background: The late diagnosis rate of developmental dysplasia of the hip (DDH) with universal ultrasound screening is 0.2 per 1,000 children according to a recent meta-analysis, which is the same as in Japan where selective ultrasound screening is used. We hypothesized that Finland’s current program of universal clinical screening complemented wi...

Polypharmacy has previously been found to increase and exercise interventions to reduce the risk of falls and fall-related injuries. In this study, women who had four or more regular medications benefitted the most from the exercise intervention and had the lowest fall risk compared to the reference group. Fall injuries among older people cause sig...

The relationship between rheumatoid arthritis (RA) and fracture risk was estimated in an international meta-analysis of individual-level data from 29 prospective cohorts. RA was associated with an increased fracture risk in men and women, and these data will be used to update FRAX®. RA is a well-documented risk factor for subsequent fracture that i...

INTRODUCTION: While a vast amount of MRI data are collected for healthcare delivery, generating real-world evidence (RWE) in Alzheimer's and related diseases (ADRD) research is substantially limited by lack of methods and results showing how routine MRIs can be used for ADRD imaging studies. METHODS: We compared three established ADRD biomarkers (t...

In this study, we show that combining register and radiological visit data enables more accurate automated identification of proximal humerus fractures compared to traditional register analysis. In a cohort of 11,863 post-menopausal women, our proposed approach improved the coverage of identified fractures from 74 to 81%. The aim of this study was...

Mantle cell lymphoma is a rare type of B‐cell lymphoma, which is considered incurable yet treatable. In recent years, the treatment options of mantle cell lymphoma have multiplied, and the focus of treatment is expected to shift from traditional chemoimmunotherapy toward precision medicine. However, this development is hindered by the high costs of...

Objective To study the association between breast cancer and work burden over 25 years. Methods The study was based on the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) cohort (n = 14,220) and included women who had answered the questionnaire from the year 1994 and had no previous breast cancer. Breast cancer cases were recorded from the...

Objective We analyzed how anthropometric measures predict cardiometabolic health and how genetic and environmental factors contribute to these associations. Methods Data on 8 indicators of cardiometabolic health, 21 anthropometric measures, and 11 anthropometric indices were available for 216 twin pairs of individuals age 3 to 18 years living in t...

Background and Aims In 2006, screening of 65-year-old men for abdominal aortic aneurysm (AAA) was started in Sweden. Decline in aneurysm-related mortality has been reported since, but aneurysm incidence has been diminishing globally. Neighbouring Finland with similar population structure and health care system has no AAA screening programme. The ai...

Objective To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high‐income countries before and during the COVID‐19 pandemic. Data Sources and Study Setting Administrative patient‐level data between 2017 and 2020 of eight high‐income countries:...

Objectives Behaviour change theories have extensively been used in health behaviour change interventions and their programme theories. However, they are rarely evaluated in randomized field studies. The Let's Move It intervention targeted various psychosocial constructs to increase adolescents' physical activity. A theory‐based process evaluation a...

Background A nationwide register-based cohort study from Finland including 48 124 incident benzodiazepines and related drug (BZDR) users aged 18–65 years who initiated use in 2006 and were not dispensed BZDRs during 2004–2005. The follow-up was 5 years or until death, whichever occurred first. Aims To investigate sociodemographic and clinical fact...

Objective: We aimed to analyse patient outcomes following open (OAR) or endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA) in Finland and Sweden from 1998 to 2017. Both intact and ruptured AAAs (rAAAs) were included in the analysis. Methods: Patient-level data from national registries in Finland and Sweden were analysed, pairing opera...

This study aimed to explore whether the prediagnostic use of metformin and statins is associated with the prognosis of patients with hepatocellular carcinoma (HCC) and type 2 diabetes. We identified 1383 eligible individuals who had both type 2 diabetes and HCC diagnosed between 1998 and 2017 from several Finnish registers. Cox models were fitted f...

We investigated the association of prediagnostic use of menopausal hormone therapy (MHT) with breast cancer survival among women with type 2 diabetes (T2D). The study cohort was identified from a Finnish nationwide diabetes database, and consisted of women with T2D, who were diagnosed with breast cancer between 2000 and 2011 (n = 3189). The patient...

Purpose To analyze the shared genetic background of physical fitness tests in children. Methods Physical fitness was assessed in 198 Portuguese twin pairs (6–18 years old, 40% monozygotic) through 15 tests from the Eurofit and Fitnessgram test batteries. Genetic twin modeling was used to estimate the heritability of each test and the genetic corre...

Aim: To describe sodium and potassium intake, their sources and plasma concentrations, and the association between intake and morbidity in very-low-birthweight (VLBW, <1500 g) infants during the first week of life. Methods: This retrospective cohort study comprised 951 VLBW infants born at <32 weeks. Infants were divided into three groups accord...

Background Ankle fracture is a common injury and often requires operative treatment. This study investigated short-term (≤4 months) and long-term (>4 months) complications after ankle fracture surgery in a 23-year period with use of data from a comprehensive, nationwide, individual-level register. Methods Data regarding patients who underwent oper...

Background Benzodiazepines and related drugs (BZDRs) are widely used in the treatment of anxiety and sleep disorders, but cognitive adverse effects have been reported in long-term use, and these may increase the risk of labor market marginalization (LMM). The aim of this study was to investigate whether the risk of LMM is associated with new long-t...

Background The aim of this study was to investigate the influence of primary congenital hypothyroidism (CH) on quality of life, level of education and socioeconomic status (SES). Methods Two independent study cohorts, a national and a regional, were collected from Finnish national registers and patient records. Data on social security benefits, SE...

Purpose The worldwide prevalence of diabetes mellitus (DM) continues to increase. As DM is linked to various ophthalmological comorbidities, it is crucial to understand the incidence and the treatment patterns of these complications to minimise the treatment burden for the patient and the healthcare system. This study aims to evaluate the incidence...

Background The aim of this study was to examine the association of body composition, muscle strength, balance, and functional capacity on falls and fall injuries among community-dwelling older women. Methods The study comprised of a 2-year randomized controlled trial involving 914 women with an average age of 76.5 (SD = 3.3) years at baseline. The...

Importance Although incidence of suicide in depression varies remarkably temporally, risk factors have been modeled as constant and remain uncharted in the short term. How effectively factors measured at one point in time predict risk at different time points is unknown. Objective To examine the absolute risk and risk factors for suicide in hospit...

The relationship between self-reported falls and fracture risk was estimated in an international meta-analysis of individual-level data from 46 prospective cohorts. Previous falls were associated with an increased fracture risk in women and men and should be considered as an additional risk factor in the FRAX® algorithm. Previous falls are a well-d...

Artificial intelligence algorithms, specifically deep learning, can assist radiologists by automating mammogram density assessment. However, trust in such algorithms must be established before they are widely adopted in clinical settings. In this study, we present an evidential deep learning approach called MV-DEFEAT, incorporating the strength of...

Background: Low levels of physical activity (PA), more prevalent among those with low education, require effective interventions. Fewer trials have tested interventions to decrease sedentary behaviour (SB). No school-based interventions have shown lasting effects on PA or sedentary behaviour in vocational schools. Purpose: To examine whether the Le...

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 physi...

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...

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...

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...

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...

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 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 9 in...

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 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...