{"id":4041,"date":"2021-09-30T12:43:30","date_gmt":"2021-09-30T10:43:30","guid":{"rendered":"https:\/\/sites.uef.fi\/vaikuttavuuden-talo\/?page_id=4041"},"modified":"2021-09-30T12:43:31","modified_gmt":"2021-09-30T10:43:31","slug":"sessio-2-2021","status":"publish","type":"page","link":"https:\/\/sites.uef.fi\/vaikuttavuuden-talo\/sessio-2-2021\/","title":{"rendered":"Sessio 2 \/ 2021"},"content":{"rendered":"\n

SESSION 2: Register data in effectiveness research<\/strong><\/h1>\n\n\n\n

Chair: Reijo Sund (UEF)<\/strong><\/p>\n\n\n\n

Impact of COVID-19 pandemic in health services of coronary heart disease and type 2 diabetes patients in North Karelia \u2013 Spatial approach<\/h2>\n\n\n\n

Teppo Repo, Olli Lehtonen, Markku Tykkyl\u00e4inen and Tiina Laatikainen<\/strong><\/p>\n\n\n\n

The global COVID-19 pandemic resulted in major changes in everyday life all over the world. The early proactive measures prevented wider spread of the disease in Finland, but this may have also brought adverse effects on wellbeing. Currently these indirect impacts of COVID-19 are not well known.<\/p>\n\n\n\n

In this study we focus on mapping the effects of COVID-19 pandemic in treatment of type 2 diabetes (T2D) and coronary heart disease (CHD) patients during the first year of the disruption. Despite the low number of identified covid infections in the study region, North Karelia, the \u201chidden crisis of COVID-19\u201d via health service cancellations and care avoidance may have caused long-term effects in health of chronic patients. Also, this may have turned out differently among specific population groups and spatial disparities in screening and health outcomes may have formed.<\/p>\n\n\n\n

The research aim is to explore how different stages of pandemic are occurring spatially in health service use and outcomes and if local factors e.g., demographics are linked. We analyse the spatiotemporal patterns of LDL-cholesterol level measurement activity among CHD-patients and haemoglobin A1c (HbA1c) screening among patients with diagnosed T2D. Preliminary analysis indicates that screening activity among T2D patients dropped more in rural areas during the \u201clockdown\u201d period, compared to town centre areas. Similar adverse change in measurement activity of LDL-cholesterol among CHD patients was evident, but less associated with the spatial structure.<\/p>\n\n\n\n

Electronic health records from Siun sote – Joint municipal authority for North Karelia social and health services are used as a primary data in the analysis. Geocodable location data enables exploring the analysis with different spatial scales and utilisation of additional spatial data.<\/p>\n\n\n\n

\n\n\n\n

Prevalence of oral anticoagulant use among people with and without Alzheimer\u2019s disease<\/h2>\n\n\n\n

Barkat Babar, Mai Vu, Marjaana Koponen, Heidi Taipale, Antti Tanskanen, Raimo Kettunen, Miia Tiihonen, Sirpa Hartikainen and Anna-Maija Tolppanen<\/strong><\/p>\n\n\n\n

Background<\/strong><\/p>\n\n\n\n

Although cardio- and cerebrovascular diseases are common among people with Alzheimer\u2019s disease (AD), it is unknown how the prevalence of oral anticoagulant (OAC) use changes in relation to AD diagnosis. We investigated the prevalence of OAC use in relation to AD diagnosis in comparison to a matched cohort without AD.<\/p>\n\n\n\n

Methods<\/strong><\/p>\n\n\n\n

Register-based Medication Use and Alzheimer\u2019s disease (MEDALZ) cohort includes 70,718 Finnish people with AD diagnosed between 2005-2011. Point prevalence of OAC use (prescription register) was calculated every three months with three-month evaluation periods, from five years before to five years after clinically verified diagnosis and compared to matched cohort without AD. Longitudinal association between AD and OAC use was evaluated by generalized estimating equations (GEE).<\/p>\n\n\n\n

Results<\/strong><\/p>\n\n\n\n

OAC use was more common among people with AD until AD diagnosis, (OR 1.17; 95% CI 1.13-1.22), and less common after AD diagnosis (OR 0.87; 95% CI 0.85-0.89), compared to people without AD. At the time of AD diagnosis, prevalence was 23% and 20% among people with and without AD, respectively. OAC use among people with AD began to decline gradually two years after AD diagnosis while continuous increase was observed in the comparison cohort. Warfarin was the most common OAC and atrial fibrillation was the most common comorbidity in both groups.<\/p>\n\n\n\n

Conclusion<\/strong><\/p>\n\n\n\n

Decline in OAC use among people with AD after diagnosis may be attributed to high risk of falling and problems in monitoring. In the care of older people with AD, prescribing must be individualized by balancing risks and benefits.<\/p>\n\n\n\n

\n\n\n\n

Statin discontinuation stratified by primary and secondary prevention in persons with and without Alzheimer\u2019s Disease<\/h2>\n\n\n\n

Mai Vu, Raimo Kettunen, Anna-Maija Tolppanen, Sirpa Hartikainen, Heidi Taipale<\/strong><\/p>\n\n\n\n

Background<\/strong><\/p>\n\n\n\n

Benefits of statin use in people with advanced dementia have been questioned. However, time to statin discontinuation and factors associated with discontinuation in persons with Alzheimer\u2019s disease (AD) have not been studied before. We compared the risk of statin discontinuation and associated factors, including secondary and primary prevention indication, in persons with and without AD.<\/p>\n\n\n\n

Methods<\/strong><\/p>\n\n\n\n

The register-based Medication Use and Alzheimer\u2019s disease (MEDALZ) cohort includes community dwellers with a clinically verified AD diagnosis during 2005\u20132011 in Finland. On the AD diagnosis date (index date), each person with AD was matched with a comparison person without AD. We included 25137 people with AD and 22692 without AD who used statin on the index date or initiated within 90 days after. The outcomes were analyzed by Cox regression models. Follow-up was restricted to four years.<\/p>\n\n\n\n

Result<\/strong><\/p>\n\n\n\n

The median time to statin discontinuation was 1.46 years in people with AD and 1.36 years in people without AD. People with AD were more likely to discontinue than people without AD (adjusted HR (aHR) 1.20 (1.18-1.24)). This was observed for both primary (aHR 1.11 (1.06-1.16)) and secondary prevention (aHR 1.30 (1.25-1.35)) purpose. Factors associated with discontinuation included higher age and female gender, whereas concomitant cardiovascular drug use and previous statin use were associated with decreased risk.<\/p>\n\n\n\n

Conclusion<\/strong><\/p>\n\n\n\n

The more frequent discontinuation in persons with AD could be due to weight loss and frailty which lead to lowered lipid levels. Deprescribing in advanced stage of dementia may also explain discontinuation in some cases.<\/p>\n\n\n\n

\n\n\n\n

Disease-modifying anti-rheumatic drugs and risk of Parkinson\u2019s disease: nested case-control study of people with rheumatoid arthritis<\/h2>\n\n\n\n

Anne Paakinaho, Marjaana Koponen, Miia Tiihonen, Markku Kauppi, Sirpa Hartikainen and Anna-Maija Tolppanen<\/p>\n\n\n\n

Background<\/strong><\/p>\n\n\n\n

Epidemiological studies have suggested a link between rheumatoid arthritis and Parkinson\u2019s disease (PD). Disease modifying anti-rheumatic drugs (DMARDs) might explain this association.<\/p>\n\n\n\n

Objective<\/strong><\/p>\n\n\n\n

To evaluate the association between DMARDs and risk of PD in persons with rheumatoid arthritis.<\/p>\n\n\n\n

Methods<\/strong><\/p>\n\n\n\n

Nested nationwide case-control study was conducted within the Finnish Parkinson\u2019s disease (FINPARK) cohort that includes 22,189 Finnish persons who got clinically verified PD diagnosis in 1996-2015. Cases were Finnish persons with PD diagnosed during 1999-2015 and rheumatoid arthritis diagnosed \u22653 years before PD (N=315). Cases were matched with up to seven control persons by age, sex, duration of rheumatoid arthritis and university hospital district (N=1,571). DMARDs were categorised into five classes and data on drug use was identified from the Prescription Register since 1995. Associations were studied with conditional logistic regression adjusted for confounders.<\/p>\n\n\n\n

Results<\/strong><\/p>\n\n\n\n

Use of DMARDs was not associated with risk of PD with three-year lag period applied between exposure and outcome, except chloroquine\/hydroxychloroquine which associated with decreased risk (adjusted odds ratio 0.74; 95% confidence interval 0.56-0.97). Other DMARDs, including sulfasalazine, methotrexate, gold preparations and immunosuppressants, had no association with risk of PD.<\/p>\n\n\n\n

Discussion<\/strong><\/p>\n\n\n\n

Our results suggest that the lower risk of PD in people with rheumatoid arthritis is not explained by DMARD use as these drugs in general did not modify the risk of PD among persons with rheumatoid arthritis. Association between chloroquine\/hydroxychloroquine and lower risk of PD as well as the possible underlying mechanisms should be further investigated.<\/p>\n","protected":false},"excerpt":{"rendered":"

SESSION 2: Register data in effectiveness research Chair: Reijo Sund (UEF) Impact of COVID-19 pandemic in health services of coronary heart disease and type 2 diabetes patients in North Karelia \u2013 Spatial approach Teppo Repo, Olli Lehtonen, Markku Tykkyl\u00e4inen and Tiina Laatikainen The global COVID-19 pandemic resulted in major changes in everyday life all over […]<\/p>\n","protected":false},"author":473,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-4041","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\nSessio 2 \/ 2021 - Vaikuttavuuden talo<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sites.uef.fi\/vaikuttavuuden-talo\/sessio-2-2021\/\" \/>\n<meta property=\"og:locale\" content=\"fi_FI\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Sessio 2 \/ 2021 - 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