Persistent high-risk human papillomavirus (hrHPV) infections predispose to long follow-ups in cervical cancer screening. We aimed to examine the role of different persistent hrHPV genotypes in causing cervical disease in long-term follow-up. This study included 76 482 women who participated in Finland's national cervical cancer screening program in the Tampere region between 2012 and 2023. Partial HPV genotyping identified HPV16, HPV18, and 12 other hrHPV-types. Participants were grouped by age: less than 40, 40-50, and more than 50 years. Women with persistent HPV infections and baseline cytology of atypical squamous cells of undetermined significance (ASC-US) or milder were followed to assess their risk of developing high-grade squamous intraepithelial lesion or worse (HSIL+). Out of 4646 baseline HPV-positive women with ASC-US or lower cytology, 38.0% (n = 1765) had a type-specific persistent infection. The mean interval between consecutive positive samples was 15.8 months (range: 0.5-4 years). HPV16 demonstrated the highest persistence rate (39.8%). HPV16 coinfection was associated with the highest risk of HSIL+ (hazard ratio: 2.34, 95% confidence interval: 1.38-3.97) and significantly slower viral clearance (HR: 0.35, 95% CI: 0.17-0.70) compared with other hrHPV genotypes. The youngest age group (<40 years) was more prone to developing HSIL+ (P < 0.001) but cleared persistent infections significantly faster (P = 0.0028) than older cohorts. Our findings highlight that the oncogenic potential and persistence potential of the specific partial HPV genotypes vary across age groups. These differences should be considered when designing follow-up stratification strategies for cervical cancer screening programs.
BACKGROUND: In Finland, postgraduate medical education (PGME) is coordinated by five medical schools and delivered in training units. Following a national reform from time-based to competency-based medical education in 2020, all programme directors (PDs) collaboratively developed unified specialty-specific curricula. This study aimed to evaluate the national quality of PGME from the perspective of PDs. METHODS: A survey including 36 Likert-scale and 12 open-ended questions was constructed using the World Federation for Medical Education (WFME) standards as a framework. The national electronic survey was conducted with REDCap in 2024 and e-mailed to all 253 PDs. The response rate (n = 82) was 35%, covering 90% of specialties. RESULTS: Results showed broad alignment with WFME standards, particularly regarding mission clarity and competency-based structures. Variation existed in pedagogical training, mentoring resources, and assessment practices across universities. Most PDs reported having structured feedback practices and supervisory support, although structures for workplace supervision quality and trainee support varied. Only a few specialties had established clinical competency committees. CONCLUSIONS: From the PDs’ perspective, the national implementation of competency-based PGME has progressed as expected, yet notable variation remains at the grassroot level between specialties. The study reveals areas for further development, especially in harmonizing assessment practices and strengthening supervisory structures nationally, and further research is needed from the perspectives of trainees and clinical supervisors.
In diverse healthcare teams, insufficient cultural awareness can lead to communication challenges, interpersonal conflict, and staff turnover, negatively impacting patient care and organizational performance. Culturally competent environments foster inclusive team climates, enhance collaboration, and contribute to higher job satisfaction-key factors in staff retention and the delivery of effective care. This study aims to explore team climate, job satisfaction, cultural competence, and intent to stay among healthcare professionals working in multicultural healthcare teams. A quantitative, cross-sectional research design (n = 490) utilizing descriptive, bivariate, and multivariate statistical analyses. The electronic survey consisted of three standardized instruments: the Team Climate Inventory, the Kuopio University Hospital Job Satisfaction Scale, and the Cross-Cultural Competence of Healthcare Professionals, all using a 5-point Likert scale. Additionally, one item assessed intention to stay. A total of 490 healthcare professionals participated in this survey. The participants rated their team climate (M = 3.72, SD = 0.74), job satisfaction (M = 3.76, SD = 0.62), and cultural competence (M = 3.59, SD = 0.55) as moderate. One quarter of the respondents were not satisfied with their current profession. We observed correlations between cultural competence (r = 0.316), team climate (r = 0.709), and job satisfaction. Team climate (r = 0.342) and job satisfaction (r = 0.452) also showed a correlation with the intention to stay. Furthermore, women evaluated their cultural competence higher than men (p < 0.001). Intention to stay was statistically significantly related to team climate (p < 0.001), job satisfaction (p < 0.001), and cultural competence (p = 0.015). Educational level had a statistical association (p = 0.003) with job satisfaction. These findings highlight the importance of supportive work environments and international collaboration in fostering retention and inclusivity. Future research should investigate the directionality of the relationships between team climate, job satisfaction, cultural competence, and intention to stay using more advanced multivariate approaches. This could further support organizations in their efforts to foster well-being in multicultural healthcare teams.
While higher income is generally associated with better health outcomes, this study examined whether that pattern applied to healthcare workers (HCWs) during the COVID-19 pandemic. Using register-based data from Finland's Capital region, we analyzed 26,271 confirmed COVID-19 cases among working-age individuals, including 2,201 HCWs, over the first 15 months of the pandemic, assessing hospitalization, ICU admission, and mortality across income levels. HCWs had slightly higher odds of hospitalization than the general working-age population (OR 1.28, 95% CI 1.04-1.56), with no significant differences in ICU admission or mortality. Unexpectedly, higher income among HCWs was associated with an increased risk of hospitalization (OR 2.02, 95% CI 1.17-3.49), contrary to its usual protective effect. These findings suggest that occupational exposure may override typical socioeconomic advantages, underscoring the need for tailored protective measures and further research on HCW-specific risks.
Current European guidelines recommend screening <30-year-old hypertensive patients for secondary hypertension, but the evidence behind this recommendation is limited. Our objective was to assess secondary hypertension prevalence and etiology among young adults and to determine the characteristics linked with secondary hypertension in these patients. We retrospectively studied 243 Finnish hypertensive adults aged 16-30 years (mean age 25.5 years; 49% women) evaluated at a tertiary care hospital in Finland between 2002 and 2023. Data were collected from electronic health records. Patients were classified under three hypertension subtypes: primary, secondary, or exogenic hypertension. We examined the association between participants characteristics and hypertension subtype (primary versus secondary) using logistic regression. A total of 133 patients had primary hypertension, while 98 patients had secondary hypertension. The most common causes of secondary hypertension were renal disease (n = 77) and sleep apnea (n = 13), whereas other causes were limited to 1-2 cases. Individuals with diabetes mellitus had odds of 2.79 (95% confidence interval [95% CI], 1.21-6.43; P = 0.02) for having secondary versus primary hypertension. A plasma creatinine increase of 1 mmol/l was associated with 1.03-fold (95% CI 1.01-1.04; P = 0.002) odds of secondary hypertension. Apart from renal disease and sleep apnea, other forms of secondary hypertension are extremely rare in young adults with hypertension. In this population, renal parenchymal disease and diabetes mellitus emerged as the most important risk factors for secondary hypertension. Extensive universal screening for secondary hypertension without suspicion of such condition for all hypertensive patients <30 years may be unnecessary.
Respiratory syncytial virus (RSV) incidence among adults in Finland remains underreported, mostly due to non-specific RSV symptoms, infrequent standard-of-care testing, and reduced sensitivity of single-specimen nasal/nasopharyngeal RT-PCR testing among adults. We retrospectively estimated RSV-attributable incidence of all-cause respiratory hospitalizations and mortality in adults in Finland between 2011 and 2019. We estimated incidence using time-series modeling by comparing the week-to-week variability in RSV diagnosis trends with the week-to-week variability in the events with any respiratory diagnosis. Weekly aggregated data on all-cause respiratory hospitalizations and deaths (J00-J99) were obtained from the Care Register for Health Care (HILMO) and Statistics Finland, respectively. Hospitalization data on RSV and influenza were obtained from HILMO. Data on all-cause respiratory diseases for age groups that showed a seasonal pattern were included in a hierarchical Bayesian model, sharing information across the age groups while accounting for seasonal fluctuations, and RSV and influenza circulation. The highest annual incidence rates of RSV-attributable respiratory hospitalizations were observed in adults aged ≥ 75 years (range 145-240 hospitalizations per 100,000 person-years), on average 7-fold higher than in adults aged 45-64 years (range 19-37 hospitalizations per 100,000 person-years). A biennial (low-high incidence) fluctuation of all-cause respiratory hospitalization incidence and mortality rate was observed in all age groups. A seasonal pattern for all-cause respiratory deaths was observed only for adults aged ≥ 75 years, who had an estimated RSV-attributable mortality rate of 8-14 deaths per 100,000 person-years. RSV-attributable deaths accounted for 3-5% of all all-cause respiratory deaths in this age group. Respiratory morbidity and mortality associated with RSV infection among adults in Finland are substantial, particularly for those aged ≥ 75 years. Newly introduced RSV vaccines, which appear effective for the oldest adults, could have a substantial impact on this respiratory disease burden.
Partial human papillomavirus (HPV) genotyping is increasingly used to triage high-risk (HR)-HPV-positive women in national cervical cancer screening. This study evaluated whether separate triage for HPV genotypes 16 and 18 could enhance the effectiveness of Finland's program. Data from 76,482 women participating in primary HPV screening in Tampere and surrounding municipalities (2012-2023) were analyzed. Partial genotyping identified HPV16, HPV18, and 12 other HR-HPV-types, and the association between genotype and high-grade squamous intraepithelial lesions or worse (HSIL +) detection was assessed. Among 6031 HR-HPV-positive women, HSIL + prevalence was highest in HPV16-positive women (37.3%) followed by HPV18 (26.0%) and other HR-HPV types (20.3%). HSIL + detection declined with age: 26.2%(age < 45), 15.9%(age 45-50), and 11%(age > 50)(p < 0.001). HPV16 showed the highest persistence upon re-testing (69.6% single; 84.6% co-infections), compared to 53.8% for other HR-HPV types. Among women with NILM cytology, HPV16 infections conferred a significantly higher risk of HSIL + compared to infections with other HR-HPV types. This risk was evident for both single HPV16 infection (OR 2.41;95%CI:1.55-3.75) and HPV16 coinfections (OR 3.86;95%CI:2.14-6.96). These findings support the integration of age-specific strategies and partial HPV16/18 genotyping into Finland's screening program. A refined triage model, including immediate colposcopy referral for HPV16/18-positive women, could improve patient management and screening efficiency.
Flexible partial retirement schemes are intended to give individuals the opportunity to reduce working hours before moving into full retirement, the expectation being that the reduced workload will contribute to postponed old-age retirement. Yet, there is limited research about whether and how flexible partial pensions are used to exit the labor force, as an income supplement, or as a way of bridging the transition into retirement through part-time employment. During the study period, individuals in Finland could take part of their accrued old-age pension after reaching age 61 regardless of their employment status. Using high-quality register data with monthly information on retirement and wage income, this study uses sequence analysis to analyze how previously employed individuals adjust their employment after taking up a partial old-age pension. Only around one in five continued to work at a reduced wage income level, indicating a reduction in working hours. Around one in six left paid employment just before or after pension take-up. Most individuals did not reduce their working hours when taking up the pension, contrary to the policy goal of the partial old-age pension.
The demand for Electroconvulsive Therapy (ECT) has been increasing. The aim of this study was to analyze changes in the rate of ECT use at Oulu University Hospital in Northern Finland from 2012 to 2022 and to explore factors associated with these changes. The data include all patients who received ECT between April 2012 and the end of 2022 at the neuromodulation unit in the department of psychiatry at Oulu University Hospital. The unit's catchment area covers a population of 484,400 people. The study focuses on the annual number of ECT and maintenance ECT (M-ECT) sessions, the ECT use rate per 100,000 people, and the number of individual patients and their characteristics, with a focus on yearly changes. The number of ECT sessions has increased significantly during the follow-up period. There were 1373 ECT sessions in the first full year of 2013 and 3000 sessions in 2022. The growth was particularly notable in M-ECT. ECT was performed on 96 unique patients in 2013 and 189 in 2022. The ECT use rate in 2022 was 45.7 per 100,000 population. 54.6% of the patients were female. The most common diagnosis was major nonpsychotic depression (45.9%). The results show a steady increase in the demand for ECT. The use rate in Northern Finland is higher than in the previous Finnish study and among the highest in Europe. Improved strategies to prevent post-ECT relapses and alternative treatment methods for treatment-resistant depression (TRD) are needed.
The study examines how key stakeholders sought to influence the outcome of Finland's 2018 Alcohol Act reform in the formal consultation rounds. Drawing on the Advocacy Coalition Framework, we analyzed 224 stakeholder statements to uncover competing belief systems and framing strategies regarding alcohol-related harm. We identified and named two main advocacy coalitions according to their standpoints on the reform's liberalization aspirations: the Public Health Coalition advocated for maintaining restrictive regulation based on population-level evidence and the Total Consumption Model, and the Alcohol Industry Coalition promoted deregulation through individual-level framings of responsibility and selective use of evidence. Both coalitions pursued epistemic dominance by reinforcing their own credibility and challenging that of their opponents. Although the Public Health Coalition relied on established scientific consensus, the Alcohol Industry Coalition appropriated the language of evidence-based policymaking to legitimize liberalization, aligning with broader neoliberal and populist discourses that question expert authority. Despite the scientific coherence of the public health side, the reform advanced in favour of deregulation, reflecting a broader shift toward a new public health and harm paradigm, in which individual responsibility is emphasized. The analysis shows how competing belief systems and discursive strategies shape alcohol policy in contexts where scientific expertise is increasingly politicized. It highlights a need for public health advocates to adjust their strategies to this new reality.
Health care service providers face increasing challenges in delivering high-quality care due to an aging population, workforce shortages, and limited financial budgets. Mobile Integrated Healthcare (MIH) offers an alternative value-based solution for elderly patients with manageable acute conditions at home. Finland is piloting this model, but its value, task redesign, and cost-efficiency require thorough evaluation before formal integration. This study explores the value of MIH for patients and the health care system through the lens of value creation, delivery, and capture. Qualitative data were collected via semistructured interviews with 21 frontline health care professionals (HCPs) involved in Finland's MIH service. MIH provides human-centered acute care for the elderly, enabling convenient access to emergency services at home and reducing unnecessary hospital visits. Value is cocreated through integrated networks of emergency and social services, leveraging paramedics' and geriatric nurses' expertise while standardizing care pathways. Effective implementation requires coordination and task-shifting across emergency departments, MIH teams, and social care providers. MIH enhances care quality, supports elderly independence, and contributes to the sustainability of the health care system by reducing emergency interventions and hospitalizations. Health managers should prioritize skill development for health care professionals (HCPs), integration across governance, service, HCPs, and patient levels, and the establishment of coordinated information systems. This study offers policymakers a valuable example of how MIH can be organized within a collective, publicly funded health care system to promote equity, accessibility, and sustainability for value-based health care.
Postponements of non-acute care during the COVID-19 pandemic commonly raised concerns about harmful health consequences and increased healthcare costs, particularly among older individuals. Using nationwide register data from Finland, we employ a regression discontinuity design to examine the effect of an age-specific stay-at-home recommendation on healthcare utilization during the first wave of the pandemic. We find that the recommendation reduced non-acute visits, such as dental care, physiotherapy, and specialized care visits, but had no effect on acute care use, including emergency department visits or inpatient stays. The reductions in dental care use were partly compensated for after the lockdown was lifted, but not in other non-acute services. Additionally, we find indicative evidence of a slight increase in mortality during the three-months post-period after the lockdown. Our findings suggest that a Scandinavian-type social distancing recommendation targeting the elderly may reduce non-acute healthcare use in the short term, thereby temporarily alleviating pressure on healthcare resources during a pandemic. However, the absence of rebound in some non-acute services highlight potential unmet needs, which may imply longer-term risks of functional decline, preventable hospitalizations, and associated healthcare costs. These findings point to the importance of policies that ensure continued access to essential non-acute care for older populations.
In the context of competency-based postgraduate education, professional progression is often tracked through milestones, particularly in North American settings. This study aimed to explore the perceptions of residents and preceptors regarding newly implemented milestones in self-assessment and formative assessment within Finland's 6-year national postgraduate education (PGE) program for family medicine/general practice. We conducted a qualitative study involving preceptors and residents participating in a nationwide 1-year pilot study that utilized a mobile application for milestone tracking. All five universities responsible for PGE recruited a total of 35 preceptors and 36 residents for the study, which began in April 2022. Participants for the focus group interviews were recruited via email from those study participants still involved in training or serving as preceptors between late 2022 and March 2023. Subsequently, six preceptors and six residents participated in semi-structured interviews, conducted in groups of three participants each. The interviews were conducted separately for preceptors and residents. We employed a constructionist approach and used inductive thematic analysis to examine the data from a sociocultural perspective. We identified six major themes reflecting perceptions from both groups: 1) Enhancing goal orientation, 2) Facilitation of supervisory meetings, 3) Milestones document as a tool, 4) Support in assessment, 5) Variability in the search for the zone of proximal development, and 6) Provocation of emotions. The major theme of 'enhancing goal orientation' including the subthemes, was perceived similarly across the groups. However, we found differing emphases in 14 out of 22 subthemes. The study provided insights into previously unexplored themes, including the emotional impact of milestones, the role of supervisory meetings, and variability in strategies for searching for the zone of proximal development. Other themes we identified, such as enhancing goal orientation, milestone documentation, and support in assessment, aligned with existing literature.
BACKGROUND: Chronic (≥ 3 months) pain and obesity (body mass index [BMI] ≥ 30 kg/m2) are both associated with long-term sickness absence (LTSA). This study aimed to examine the contribution of acute (< 3 months) and chronic pain to total and diagnosis-specific LTSA (> 10 working days) at different levels of BMI among young and early midlife employees. METHODS: Helsinki Health Study questionnaire data covering 19–39-year-old employees were collected in 2017 (n = 4091). Pain was classified as no pain, acute pain, or chronic pain. BMI was classified as healthy weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25.0–29.9 kg/m2), or obesity. Diagnosis-specific follow-up data on LTSA covering 5 years after the survey collection were obtained from the Social Insurance Institution of Finland’s registers. Negative binomial regression analyses were conducted, adjusting for key covariates. RESULTS: Acute (RR 1.57, 95% CI 1.19 − 2.08) and chronic (RR 2.05, 95% CI 1.52 − 2.75) pain, and overweight (RR 1.42, 95% CI 1.09 − 1.85) and obesity (RR 2.20, 95% CI 1.58 − 3.05) were all associated with LTSA after adjusting for age and gender. The strongest association with LTSA was found for coexistent chronic pain and obesity (RR 3.49, 95% CI 1.89 − 6.43). Adjusting further for other sociodemographic, lifestyle and work-related factors marginally attenuated the associations. Having coexistent acute pain and a healthy weight or having no pain and overweight were not associated with LTSA. CONCLUSIONS: Employees with coexistent pain and overweight/obesity have an increased risk of LTSA, particularly employees with coexistent chronic pain and obesity. These employees could benefit from targeted primary and secondary preventive measures at the workplaces and in occupational healthcare to reduce LTSA.
The Russian invasion of Ukraine displaced millions of children who face acute stress and require rapid adaptation to unfamiliar environments, potentially affecting lifelong health outcomes. This qualitative study explored factors influencing dietary acculturation and eating habits of Ukrainian children resettled in Finland. Five focus groups were conducted in August 2024 with 16 mothers and 12 children (aged 8-13 years) recruited through the Ukrainian Association in Finland. Interviews were conducted in Ukrainian, and transcripts were analysed in English using ATLAS.ti software, applying a socio-ecological framework to identify drivers and barriers across societal, school, family, and child levels. Major barriers included financial constraints and unfamiliar mixed ingredients in school meals at societal and school levels; strict adherence to Ukrainian food practices, unstructured snacking, and stress eating at family level; and resistant food preferences and picky eating at child level. Key drivers were affordable fresh produce and fish availability, free school lunches, and immigrant support; mandatory meal attendance, repeated exposure, and early food education; transition to bicultural eating patterns and adopting Finnish parental practices; and gradual food tasting and increased vegetable and fish consumption. Age-dependent patterns emerged as both barriers and drivers, with younger children showing less entrenched preferences and stronger peer conformity, facilitating dietary change, while older children's established tastes hindered acculturation. Dietary acculturation is shaped by multi-level factors, including children's age, family practices, food policy, and Finland's supportive context. Quantitative studies are needed to confirm findings across socio-ecological levels.
Ontario's health system holds one of the richest and most diverse datasets in the world, yet barriers to access and fragmented governance limit its potential to drive innovation and improve outcomes. This project explores how Ontario can responsibly navigate health data privatization to support research and private-sector collaboration while maintaining public trust. The project engages key stakeholders to identify enablers and risks in developing a unified framework for responsible data access. Grounded in the foundational principles of the Ontario Health Data Council, the work examines current data-sharing pathways, legal constraints under PHIPA, governance gaps, and comparative international models such as the UK's Trusted Research Environments and Finland's Findata authority. The project aims to produce actionable recommendations for a policy framework that balances innovation with ethical stewardship, enabling privacy-protected access to data that advances patient care, population health, and economic growth. Through this research, Ontario's health data can be responsibly unlocked to foster public-private partnerships, accelerate discovery, and strengthen its position as a leader in digital health and life sciences.
To assess the impact of large-scale severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination campaigns in real-world settings across regions, we performed a reproducible cross-border comparison of the real-world effectiveness of primary vaccination in preventing SARS-CoV-2 infections across three sites: Aragon (Spain), Brussels and Wallonia (Belgium), and Finland. This observational study emulated a target trial by daily matching primary vaccinated individuals 1:1 to un- or partially vaccinated individuals using propensity scores estimated on a set of relevant confounders from January to September 2021. Matched individuals were followed up until a SARS-CoV-2 infection was contracted or a censoring event occurred. Vaccine effectiveness in preventing infections was estimated by the difference in restricted mean survival time (RMST). Primary vaccination extended the average free-of-infection time by 35.9 [95% confidence interval (CI) (34.9-37.0)], 59.6 [95% CI (59.3-60.0)], and 1.6 [95% CI (1.1-2.0)] days over 365 days in the population cohort of Aragon (Spain), Brussels and Wallonia (Belgium), and Finland, respectively. This federated population-based observational study showed the effectiveness of the SARS-CoV-2 primary vaccination campaign in prolonging the mean time to infection in the Aragon (Spain) and Brussels and Wallonia (Belgium) population cohorts. Only a minor difference over this time frame was found in Finland's population cohort.
A large variation in surgery rates can be indicative of its overuse. In Finland, surgeries for carpal tunnel syndrome (CTS) and ulnar nerve disorder (UN) are common, but regional differences in their incidence rates remain unexplored. This study examined how the incidence rates of these surgeries vary across hospital districts in Finland to evaluate regional consistency. We compared regional age- and sex-adjusted incidence rates per 100,000 person-years based on data from Finland's Care Register for Health Care for CTS and UN surgeries from 2010 to 2021, calculated relative to population size as reported by Statistics Finland. The study included 21 hospital districts in Finland. During the 4-year period from 2018 to 2021, the difference between the lowest (99.6 cases per 100,000 person-years (95% confidence interval (CI) 80.7-122)) and the highest (351 cases per 100,000 person-years (95% CI 336-367)) adjusted incidence rates for CTS surgery was 3.5-fold, with a median adjusted incidence rate of 213 cases per 100,000 person-years. Over the same period, the difference between the lowest (1.04 cases per 100,000 person-year (95% CI 0.03-5.78)) and the highest (81.9 cases per 100,000 person-years (95% CI 73.2-91.5)) adjusted incidence rates for UN surgery was up to 79-fold, with a median adjusted incidence rate of 17.8 cases per 100,000 person-years. Surgery for CTS shows up to a 3.5-fold variation across Finland's hospital districts. Although less common in absolute numbers, surgical treatment rates for UN vary up to 79-fold among these regions. Such significant variations are unlikely to be attributed solely to differences in population morbidity. Instead, the findings indicate that the criteria for performing these surgeries vary considerably across the Finland's hospital districts, suggesting a potential overuse in certain areas.
Depression and anxiety disorders are the leading causes of work disability in most developed countries. Psychotherapies are evidence-based treatments for these disorders, but evidence of the psychotherapy effects on changes in work disability remains limited. This study examined changes in work disability in patients receiving psychotherapy and matched controls and their associations with employee and employer-related factors. We used register-based data from Terveystalo Plc., Finland's largest occupational health service provider, linked with national registers (Statistics Finland, Social Insurance Institution). The study included patients who received primary care-level psychotherapy (N = 3,912) between 2018 and 2021, matched with controls (N = 11,733) using propensity scores. Group-based trajectory modelling identified work disability patterns based on three-month means of mental health-related sickness absence day intervals. Multinomial logistic regression assessed associations between sickness absence trajectory membership and baseline sociodemographic, clinical, and employer characteristics. Three distinct work disability trajectory groups emerged: a group including those employees with a highly increasing level of work disability (6% of the population), ranging from 17 to 1 day of work disability and those with a slightly increasing (7% of the population) level of work disability ranging from 5 to 1 days of work disability. In both groups, the level of work disability peaked around psychotherapy onset and decreased after it. The third group, stable low (87% of the population), included those with nearly no work disability throughout the study. In multinomial regression models, history of mental disorders, related sickness absences, and somatic and psychiatric comorbidity were associated with the likelihood of belonging to either of the adverse work disability trajectory groups. Psychotherapy may decrease long-term work disability, especially among individuals with a high level of baseline work disability. Those with a previous mental disorder burden and related work disability require special attention to enable timely treatment to prevent prolonged work disability.
Antimicrobial resistance (AMR) is one of the most pressing public health threats of the 21st century. The development of resistance to antimicrobial agents is multifactorial. However, a major driver of AMR is the remarkable capacity of microorganisms to rapidly evolve, continually challenging the practice of infectious diseases and undermining the effectiveness of miracle drugs we call antibiotics. Dr. Maxwell Finland was a pioneer in this field, uniquely positioned to witness-and help shape-the transition from an era without antimicrobials to one transformed by life-saving therapies that revolutionized medicine. As AMR continues to rise and antibiotics cease to be effective, Dr. Finland's legacy is more relevant than ever.