Attitudes and Considerations towards Pharmaceuticals-Related Environmental Issues among Finnish Population

A number of policy recommendations identify the general public as a key participant in environmentally sustainable pharmaceutical policies. However, research into pharmaceuticals-related environmental issues from the population perspective is scarce. We studied the awareness among Finnish adults (n = 2030) of pharmaceutical residues in Finnish waterways, their perceived environmental sources, views on pharmaceuticals-related environmental issues, and their association with background characteristics. Of the respondents, 89.5% were aware of the presence of pharmaceuticals in Finnish waterways. Wastewaters from the pharmaceutical industry were most frequently, and pharmaceuticals excreted by humans least frequently, considered a major environmental source of pharmaceuticals. The vast majority of the respondents were worried about the environmental and health impact of pharmaceutical residues and emphasized issues such as the importance of environmentally sustainable actions by pharmaceutical companies and the recyclability of the pharmaceutical packaging materials. Age, education, use of prescription medicines, and environmental attitude were associated with awareness of pharmaceutical residues, while gender, age, education level, and environmental attitude were associated most frequently with pharmaceuticals-related environmental considerations. These results indicate a need for improved communication about the environmental effects of pharmaceuticals and the significance of different pharmaceutical emission sources in order to promote a more environmentally friendly, effective pharmaceutical policy.

Modeling Rare Human Disorders in Mice: The Finnish Disease Heritage

The modification of genes in animal models has evidently and comprehensively improved our knowledge on proteins and signaling pathways in human physiology and pathology. In this review, we discuss almost 40 monogenic rare diseases that are enriched in the Finnish population and defined as the Finnish disease heritage (FDH). We will highlight how gene-modified mouse models have greatly facilitated the understanding of the pathological manifestations of these diseases and how some of the diseases still lack proper models. We urge the establishment of subsequent international consortiums to cooperatively plan and carry out future human disease modeling strategies. Detailed information on disease mechanisms brings along broader understanding of the molecular pathways they act along both parallel and transverse to the proteins affected in rare diseases, therefore also aiding understanding of common disease pathologies.

Incidence of atrial fibrillation. A comprehensive nationwide analysis in Finland

Introduction Atrial fibrillation (AF) is a chronic condition, and once diagnosed, most of the patients need life-long treatment for AF; rate and rhythm control for symptom relief and oral anticoagulation to mitigate the associated risk of stroke. Incidence of AF is strongly associated with age, and with longer life-expectancy the number of AF patients is worldwide rapidly increasing. Purpose The FinACAF study is a nationwide registry study including all AF patients searched from comprehensive national health care registers. To our knowledge, FinACAF is the first nationwide study including both primary, secondary, and tertiary health care register data. The aim of this study was to assess the incidence of new-onset AF in unselected nationwide population in Finland. Methods In the FinACAF study we gathered data (hospitalizations, outpatient specialist and primary health care visits, and drug reimbursement) from all national health care registers to identify new-onset AF patients from 01st January 2004 to 31st December 2018. To minimize the risk of misclassification, we considered a patient to have incident AF only if the new-onset AF diagnosis emerged after 1st January 2007 allowing at least three years of registration in Finnish health care registers without diagnosis of AF. Furthermore, patients with warfarin prescriptions during 2004–2006 were excluded. Raw incidence rates (1/100 000) were calculated using the total number of incident AF cases during a given year as numerator, and the total number of Finnish population free of AF on the last day of that year as denominator. The age-standardized incidence rates (1/100 000) were calculated using the total number of new-onset AF cases per year compared to the Nordic population free of AF age distribution. Results In total, 411 080 patients with the diagnosis of AF were documented during 2004–2018 in Finland, and the number of new-onset AF patients during 2007–2018 was 256 323. The incidence of AF in relation to age is shown in the Figure 1, and the increasing incidence with advancing age is outstandingly seen. Incidence of AF was more than 2000/100 000 in the population 80 years or older. The incidence of new-onset AF in the whole Finnish population increased during the study period from 330/100 000 and peaked to 456/100 000 in 2018. However, after adjustment for age, the age-adjusted AF incidence remained unchanged during 2007–2018 (Figure 2), but an obvious leap in the incidence emerged during 2011–2013 when the national primary care register was established. Conclusions In 2018 the incidence of AF per the whole population was 456/100 000. Based on very novel data and including all the known, diagnosed AF patients in Finland, this is the highest reported incidence rate of AF. Incidence of AF is strongly age-dependent, but the age-standardized incidence was not significantly changed from 2007 to 2018. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District research fundThe Finnish Foundation for Cardiovascular Research The incidence of AF in relation to age Age-adjusted annual incidence of AF

Genome-wide association study of atrial fibrillation in 114,539 Finnish individuals reveals novel locus associated with cardiac remodelling

Background/Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia and it is associated with serious complications, such as stroke, heart failure, and premature death. Previous genome-wide association studies (GWAS) have associated more than 140 genomic loci with AF; however, these studies predominantly include subjects of European ancestry. Although, the Finnish population is European, it is genetically considered different from other European populations as it has been isolated and developed through multiple bottlenecks followed by population growth. Therefore, pathogenic variants are more easily discovered and heritably diseases are more prevalent. Methods We accessed summary statistics on atrial fibrillation and flutter (I48) from the Finngen project. Loci were defined as 1 megabase regions around lead SNPs, and loci were considered novel when the SNPs had P-values <5x10–8 after conditional analysis, and no previously reported SNPs were within the loci. FINEMAP was done with a Finnish LD reference panel, and colocalization of GWAS and eQTL signals were analysed with MetaXcan. Results A GWAS on 17,325 Finnish AF cases and 97,214 controls confirms 16 previous identified loci and reveals one novel locus on chromosome 19. The novel lead SNP, rs190065070 (odds ratio [OR] = 1.44, 95% confidence interval [CI] = 1.29–1.61, P-value = 5.96x10–11), is close to the gene EMC10, which encodes the endoplasmic reticulum membrane protein complex subunit 10. While the locus harbours other genes, our MetaXcan analysis could not provide conclusive evidence for other plausible genes. The EMC complex consists of 10 subunits and is a chaperone in endoplasmic reticulum-resident membrane proteins. Previous mouse studies have shown EMC10 to be important in angiogenesis after myocardial infarction, and it has recently been associated with a novel neurodevelopment syndrome. The EMC1 subunit has been associated with congenital heart disease. Conclusion We present a novel susceptibility locus associated with AF in the Finnish population. The locus is in proximity to the gene EMC10, which is involved in structural remodelling of the heart after myocardial infarction. These results propose a potentially novel pathophysiological pathway in AF. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): The Research Foundation RigshospitaletThe John and Birthe Meyer Foundation

Prevalence of comorbidities and secondary health conditions among the Finnish population with spinal cord injury

Study design A cross-sectional study. Objectives To explore the prevalence of comorbidities, secondary health conditions (SHCs), and multimorbidity in the Finnish population with spinal cord injury (SCI). Setting The data were collected from the Finnish Spinal Cord Injury Study (FinSCI). Participants were identified from three SCI outpatient clinics responsible for the lifelong follow-up of persons with SCI in Finland, (n = 884 participants, response rate; 50%). Methods The FinSCI-questionnaire included a question from the National Study of Health, Well-being, and Service (FinSote) for screening 12 comorbidities. The reference data of the general population for that question were received from the Finnish Institute for Health and Welfare. The Spinal Cord Injury Secondary Condition Scale (SCI-SCS) was used to screen 16 SHCs. The data were analysed with univariate testing and multivariable negative binomial regression modelling. Results The most common comorbidities were high blood pressure/hypertension (38%), back problems (28%), and high cholesterol (22%). The most common SHCs were joint and muscle pain (81%), muscle spasms (74%), chronic pain (71%), and bowel problems (71%). The prevalence of comorbidities was highest among persons aged ≥76 years (mean; 2.0; scale range; 0–12). The prevalence of SHCs was highest in the severity of SCI group C1–4 AIS A, B, and C (mean; 8.9; scale range; 0–16). Conclusions Further research on geriatrics in SCI, non-traumatic SCI, and knowledge of the needs of persons with cervical lesion AIS A, B, or C is required, due to the fact that the prevalence of multimorbidity is high in these groups.