Regional variations in lumbar spine surgery in Finland

Introduction The regional variation in spine surgery rates has been shown to be large both within and between countries. This variation has been reported to be less in studies from countries with spine registers. The aim of this study was to describe the regional variation in lumbar spine surgery in Finland. Materials and methods This is a retrospective register study. Data from the Finnish National Hospital Discharge Register (NHDR) were used to calculate and compare the rates of lumbar disc herniation (LDH), decompression, and fusion surgeries in five University Hospital catchment areas, covering the whole Finnish population, from January 1, 1997, through December 31, 2018. Results A total of 138,119 lumbar spine operations (including LDH, decompression, and fusion surgery) were performed in Finland between 1997 and 2018. The regional differences in the rate of LDH surgery were over fourfold (18 vs. 85 per 100,000 person years), lumbar decompression surgery over threefold (41 vs. 129 per 100,000 person years), and lumbar fusion surgery over twofold (14 vs. 34 per 100,000 person years) in 2018. The mean age of the patients increased in all regions during the study period. Conclusions In Finland, the regional variations in spine surgeries were vast. In a country with a publicly funded healthcare system, this finding was surprising. The recently created national spine register may serve to shed more light on the reasons for this regional variation.

Tracing the lines

This article presents the results of the recent Historic Environment Scotland-funded project Tracing the Lines: Uncovering Grooved Ware Trajectories in Neolithic Scotland addressing the timing and nature of the adoption, development and ultimate demise of Grooved Ware in Scotland beyond Orkney. Following analysis within a Bayesian framework of over a hundred Grooved Ware-associated radiocarbon dates from Scotland beyond Orkney, evidence is presented that Grooved Ware pottery very closely related to Orcadian prototypes began spreading rapidly between key locales across Scotland towards the end of the 4th millennium BC. This was followed by a process of stylistic drift with regional variations. The so-called Durrington Walls sub-style was introduced some 200 years after the earliest Grooved Ware and is an exception to this pattern of gradual change. Our modelling suggests that the latest Scottish Grooved Ware has a currency that overlaps with the earliest Beakers by between 1 and 145 years and probably between 1 and 60 years. View supplementary material here: Supplementary material | References | Table S1 | Illus S40 Extracted Element

FROM REGIONALISM TO KOSLI NATIONALISM AND BEYOND: THE DEMAND FOR A SEPARATE STATE IN WESTERN ODISHA

If we analyze the discourses on regionalism in India or even while trying to make sense of such a tendency, we may find that from a long time, even during the period of British colonialism, regional forces have had their impact at the level of organization of political system in their own ways. Needless to recall that when the Britishers entered India, they could sense the regional variations very well and therefore, established ‘divide and rule’ policy to suit their administration as well as to be fitted to the regional demands and peculiarities. It is, no wonder therefore, to find that the anti-colonial freedom struggle was not a process free of contradictions and variations over different regions. The fact of the matter was that the ‘national’ issue, namely, to establish a free independent and sovereign India superseded all the parochial claims of various regions and their demands. And it is, needless to say that these regional interests and demands, which were subdued during the freedom struggle found an expression and were articulated even within the first decade of India’s independence, which has, in fact, grown both in its number and its intensity with every passage of time, which are reflected in various regional movements, over the period. In this paper, we discuss such a movement taking its stride with every passage of day, in the western part of Odisha—both in its historical as well as contemporary contexts. We make an attempt to bring out what have been the historical causes which have given birth to such a tendency and the contours and trajectories that such a movement is going through over the period, including the current state of affairs as regards Kosal Movement, which is increasingly becoming so vociferous that we can hardly ignore it—either as an observer, as an analyst or as an activist—for or against the call for a separate state in Western Odisha.

Regional variations and prevalence of psoriasis in Germany from 2010 to 2017: a cross-sectional, spatio-epidemiological study on ambulatory claims data

ObjectivesGlobal prevalence rates of psoriasis differ significantly, with lowest rates in the equator region and increasing tendencies towards the north but also differences within-country. Information on regional variations in Germany is missing. This study aims to analyse the change of psoriasis prevalence in Germany over time and to detect regional variations.DesignCross sectional, spatio-epidemiological study on regional psoriasis prevalence in Germany.SettingClaims data study based on nationwide outpatient billing data on county level.MethodsAnalyses based on outpatient billing data for 2010–2017 derived from all people insured in statutory health insurances (about 72.8 million). We performed descriptive spatio-temporal analyses of prevalence rates using probability mapping and statistical smoothing methods, identified spatial clusters and examined a north-south gradient using spatial statistics.ResultsThe prevalence increased from 147.4 per 10 000 in 2010 to 173.5 in 2017. In 2017, counties’ prevalence rates ranged between 93.8 and 340.9. Decreased rates occurred mainly in southern counties, increased rates in northern and eastern counties. Clusters of low rates occur in southern and south-western Germany, clusters of high rates in the north and north-east. The correlation between counties’ latitudes and their prevalence rates was high with Pearson’s r=0.65 (p<0.05).ConclusionIncreased prevalence of psoriasis over time and marked regional variations in Germany were observed which need further investigation.