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Article ; Online: The incidence of iatrogenic deaths in the Finnish cause-of-death statistics; a retrospective study.

Kuvaja, Paula / Keinänen, Noora / Pakanen, Lasse

2022 Volume 86, Page(s) 102302

Abstract: Purpose: An adverse event in health care leading to death is a significant event when assessing patient safety. This study was designed in order to assess, how many iatrogenic deaths are registered in Finland annually, and what type of treatment they ... ...

Abstract	Purpose: An adverse event in health care leading to death is a significant event when assessing patient safety. This study was designed in order to assess, how many iatrogenic deaths are registered in Finland annually, and what type of treatment they are mostly related to. Methods: Material was collected using cause of death-statistics that includes "manner of death"-classification in Finland in 2014-2015. Results: There were 350 cases that met the criteria of the study. In a majority of the cases (264, 75%), a medico-legal autopsy was performed. This represents only 1.4% of all medicolegal autopsies during the study period in Finland. The cases were most often related to medication (30%) or known high-risk procedures such as gastrointestinal surgery (23%) and cardiothoracic surgery (11%). Only 12% of the cases had no prior significant medical history. Patient characteristics were somewhat different among the surgical disciplines, probably reflecting treatment practices. Conclusion: Deaths that are classified as iatrogenic are mostly related to known high-risk surgery or medication. Further studies are needed to assess the true incidence of malpractice among this material.
MeSH term(s)	Cause of Death ; Finland/epidemiology ; Humans ; Iatrogenic Disease/epidemiology ; Incidence ; Retrospective Studies
Language	English
Publishing date	2022-01-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2268721-X
ISSN	1878-7487 ; 1752-928X
ISSN (online)	1878-7487
ISSN	1752-928X
DOI	10.1016/j.jflm.2021.102302
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Article: Unnatural-cause mortality patterns of Northern Finnish men and women diverge in adolescence - A 52-year follow-up.

Junno, Juho-Antti / Pakanen, Lasse / Oura, Petteri

Preventive medicine reports

2021 Volume 22, Page(s) 101337

Abstract: The Finnish population has a long life expectancy but ranks high in unnatural deaths on the European scale. Mortality has historical regional discrepancy in Finland, as Northern Finns are overrepresented in both natural and unnatural deaths. This study ... ...

Abstract	The Finnish population has a long life expectancy but ranks high in unnatural deaths on the European scale. Mortality has historical regional discrepancy in Finland, as Northern Finns are overrepresented in both natural and unnatural deaths. This study aimed to characterize the age- and sex-related trends in unnatural mortality among Northern Finns. Altogether 12 143 individuals, constituting >95% of births in Northern Finland in 1966, were followed up for a median of 52 years. The mortality patterns of this population were studied using death record data. Crude annual mortality rates were calculated and graphed for 10-year age strata (all-cause, natural-cause, and unnatural-cause mortality, as well as accident, suicide, and homicide mortality). Cox regression was used to analyze the sex discrepancy in mortality. A total of 874 deaths (7.2%) occurred during the follow-up period. Women had 47% and 73% lower risks of any death and unnatural death than men, respectively. From the second decade of life onwards, the unnatural mortality of men was 3-5 times that of women. Accident and suicide mortality rates of men were 2-13 and 2-3 times those of women, respectively. Homicides were rare among either sex. We conclude that Northern Finnish women have a substantially lower risk of all-cause mortality and unnatural mortality than men. To aid the development of preventive strategies, future studies should aim to identify the underlying factors behind unnatural mortality. Primarily, emphasis should be placed on the increased mortality of men from the second decade of life onwards.
Language	English
Publishing date	2021-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2785569-7
ISSN	2211-3355
ISSN	2211-3355
DOI	10.1016/j.pmedr.2021.101337
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Article ; Online: Autopsy-Based Learning is Essential But Underutilized in Medical Education: A Questionnaire Study.

Pakanen, Lasse / Tikka, Julius / Kuvaja, Paula / Lunetta, Philippe

Anatomical sciences education

2021 Volume 15, Issue 2, Page(s) 341–351

Abstract: To this day, autopsies and dissections have been essential in medical education, but declining autopsy numbers have endangered this long-standing tradition. Students' perceptions of these teaching methods should be constantly updated to help educators ... ...

Abstract	To this day, autopsies and dissections have been essential in medical education, but declining autopsy numbers have endangered this long-standing tradition. Students' perceptions of these teaching methods should be constantly updated to help educators understand how to achieve their teaching goals. The purpose of this study was to explore the state of autopsy- and dissection-based teaching in two Finnish universities based on the experiences of the students, survey their perceptions of such teaching, and to compare the Finnish situation with students' perceptions in other countries as it emerges from medical literature. A questionnaire went to 859 second-, fourth-, and sixth-year medical students. The questions concerned dissection and autopsy classes these students had attended, the views of the students in regard to the number of classes, and the benefits of and attitudes towards autopsy teaching. An open question of how to improve autopsy teaching was included. The response rate was 19.4%. Most respondents requested more autopsy and dissection classes, especially practical education. They found autopsies most beneficial in learning anatomy and dealing with one's own emotions related to death. Their experiences proved least beneficial for interaction with the relatives of a deceased patient and for people skills. Integrational methods and focusing on the main learning outcomes were suggested as improvements. Overall, students found dissection and autopsy teaching important, but felt concerned about the diminishing autopsy numbers. Focusing on main learning objectives and better integration of autopsies in the teaching of different specialties could help to utilize autopsies to a greater extent.
MeSH term(s)	Anatomy/education ; Autopsy ; Curriculum ; Education, Medical ; Education, Medical, Undergraduate/methods ; Humans ; Students, Medical/psychology ; Surveys and Questionnaires
Language	English
Publishing date	2021-05-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2483491-9
ISSN	1935-9780 ; 1935-9772
ISSN (online)	1935-9780
ISSN	1935-9772
DOI	10.1002/ase.2073
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Zs.A 6787: Show issues

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Article ; Online: COVID-19 vaccination was a rare potential etiology for cause of death after medicolegal autopsy. A Finnish nationwide study

Pakanen, Lasse / Nieminen, Tuomo / Kuvaja, Paula / Nohynek, Hanna / Goebeler, Sirkka / Artama, Miia / Hovi, Petteri

medRxiv

Abstract: COVID-19 vaccinations began globally at the end of 2020. By the end of 2021, 9.8 million doses were given in Finland. Regarding safety, most vaccine-related adverse reactions have been mild, but serious and lethal ones have also occurred. Autopsies in ... ...

Abstract	COVID-19 vaccinations began globally at the end of 2020. By the end of 2021, 9.8 million doses were given in Finland. Regarding safety, most vaccine-related adverse reactions have been mild, but serious and lethal ones have also occurred. Autopsies in post vaccination deaths may give insight to the extent of fatal health conditions with potential COVID-19 vaccine etiology and provide new hypotheses of possible causalities between vaccination and severe health conditions. We searched the complete documentation on all medicolegal autopsies in Finland between December 2020 and December 2021 to assess how often the basis for autopsy was a suspected fatal adverse reaction to COVID-19 vaccination, and whether vaccination remained a potential etiology for any health condition determined as a cause of death after the autopsy. We linked register-based data on individual COVID-19 vaccination course and pre-existing health conditions. We found 428 autopsy cases with a mention of COVID-19 vaccination, and prior to autopsy, vaccination was suspected to play a part in 76 deaths. Post autopsy, a forensic pathologist considered vaccination as a potential etiology in five underlying and seven contributory causes of death. These included seven thromboembolisms, two diabetic ketoacidoses, one myocarditis, one acute pancreatitis, and one eosinophilic granulomatosis with polyangiitis. In relation to the number of vaccinations within Finland, a suspicion of vaccine-related serious adverse reaction was rarely an indication for medicolegal autopsy. Even less frequently was vaccination considered to play a part in the process leading to death, although considerable doubt remains in the accuracy of individual considerations, and autopsy cannot definitively confirm causality between vaccination and death. Regarding vaccination safety, continuing evaluation of suspected vaccine-related deaths is essential, and an autopsy should be part of the investigation when such a suspicion arises.
Keywords	covid19
Language	English
Publishing date	2024-02-14
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2024.02.13.24302742
Database	COVID19

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Article ; Online: Low myocardial transcript variant alt-a of cyclin dependent kinase inhibitor p21 expression differentiates hypothermia from cardiac/respiratory causes of death.

Kaija, Helena / Pakanen, Lasse / Porvari, Katja

Medicine

2020 Volume 99, Issue 9, Page(s) e19399

Abstract: Gene expressions in the myocardium have been shown to vary between different causes of death, which can be utilized in the recognition of varied processes. Our previous work with a limited number of cases showed a high messenger ribonucleic acid ... ...

Abstract	Gene expressions in the myocardium have been shown to vary between different causes of death, which can be utilized in the recognition of varied processes. Our previous work with a limited number of cases showed a high messenger ribonucleic acid expression of the transcript variant alt-a of cyclin dependent kinase inhibitor p21 (p21 alt-a) in chronic cardiac ischemia deaths and a low expression in hypothermia deaths and acute myocardial ischemia deaths. In present work, p21 alt-a expression in the myocardium of human cadavers was calculated using glyceraldehyde-3-phosphate dehydrogenase (GAPDH) as reference gene. In this collection of 143 samples, the p21 alt-a expression was significantly lower in hypothermia than in chronic cardiac ischemic heart disease with (P < .001) or without (P < .001) acute myocardial infarction and in other cardiac and respiratory disease deaths (P < .000). Chronic ischemic heart disease in hypothermia cases did not increase the expression. The p21 alt-a expression did not correlate with postmortem interval, quality of RNA or with the age of the deceased. The p21 alt-a referenced to GAPDH expression in cadaver myocardium has apparent potential as a marker distinguishing between hypothermia and cardiac/respiratory diseases as causes of death.
MeSH term(s)	Cause of Death ; Cyclin-Dependent Kinase Inhibitor p21/analysis ; Finland ; Heart Diseases/pathology ; Heart Diseases/physiopathology ; Humans ; Hypothermia/pathology ; Hypothermia/physiopathology ; Myocardium/pathology
Chemical Substances	Cyclin-Dependent Kinase Inhibitor p21
Language	English
Publishing date	2020-03-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000019399
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Article ; Online: Sudden cardiac death after alcohol intake: classification and autopsy findings.

Holmström, Lauri / Kauppila, Janna / Vähätalo, Juha / Pakanen, Lasse / Perkiömäki, Juha / Huikuri, Heikki / Junttila, Juhani

Scientific reports

2022 Volume 12, Issue 1, Page(s) 16771

Abstract: Alcohol is known to have an immediate effect on cardiac rhythm, and previous studies have found that a notable proportion of sudden cardiac deaths (SCD) occur after alcohol intake. The objective of the present study was to investigate the association ... ...

Abstract	Alcohol is known to have an immediate effect on cardiac rhythm, and previous studies have found that a notable proportion of sudden cardiac deaths (SCD) occur after alcohol intake. The objective of the present study was to investigate the association between the timing of alcohol intake and SCD. Our study population is drawn from the Fingesture study, which includes 5869 consecutive SCD cases from Northern Finland who underwent medicolegal autopsy 1998-2017. Toxicological analysis was performed if there was any suspicion of toxic exposure, or if there was no obvious immediate cause of SCD at autopsy. We found that 1563 (27%) of all SCD victims had alcohol in blood or urine at autopsy (mean age (61 ± 10 years, 88% male). Eighty-six percent of alcohol-related SCD victims had higher urine alcohol concentration than blood alcohol concentration, referring to the late-stage inebriation. These results suggest that the majority of alcohol-related SCDs occur at the late stage of inebriation.
MeSH term(s)	Aged ; Alcohol Drinking/adverse effects ; Alcohols ; Autopsy ; Blood Alcohol Content ; Cause of Death ; Death, Sudden, Cardiac/epidemiology ; Death, Sudden, Cardiac/etiology ; Female ; Humans ; Male ; Middle Aged ; Risk Factors
Chemical Substances	Alcohols ; Blood Alcohol Content
Language	English
Publishing date	2022-10-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-20250-3
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Temporal Trends in the Incidence and Characteristics of Sudden Cardiac Death among Subjects under 40 Years of Age in Northern Finland during 1998-2017.

Vähätalo, Juha / Holmström, Lauri / Pakanen, Lasse / Kaikkonen, Kari / Perkiömäki, Juha / Huikuri, Heikki / Junttila, Juhani

Cardiology

2022 Volume 147, Issue 3, Page(s) 328–331

Abstract: Background: Although the mean age of sudden cardiac death (SCD) victims has increased during recent decades, overall incidence has remained relatively stable. Small but very important proportion of SCDs occur in subjects under 40 years of age and ... ...

Abstract	Background: Although the mean age of sudden cardiac death (SCD) victims has increased during recent decades, overall incidence has remained relatively stable. Small but very important proportion of SCDs occur in subjects under 40 years of age and temporal trends in the incidence and characteristics of SCD in this age-group are not well known. Methods: The Fingesture study has prospectively gathered data from 5,869 consecutive autopsy verified SCD victims in Northern Finland during 1998-2017. On the basis of Finnish law, all who die unexpectedly undergo autopsy. Results: Out of total 5,869 SCDs, 160 occurred in subjects under 40 years of age (3%) indicating a total incidence of 2.9/100,000/year. Incidence decreased during the study period: 4.0/100,000/year (n = 50) in 1998-2002, 3.7/100,000/year (n = 45) in 2003-2007, 2.5/100,000/year (n = 36) in 2008-2012, and 1.5/100,000/year (n = 29) in 2013-2017. Coronary artery disease (CAD) was the cause of death in 46 SCD victims (29%). Among nonischemic causes, most common were obesity-related hypertrophic myocardial disease (24%), primary myocardial fibrosis (19%), and hypertensive myocardial disease (6%). The incidence of SCD caused by CAD decreased as follows: 1.5/100,000/year in 1998-2002, 1.2/100,000/year in 2003-2007, 0.6/100,000/year in 2008-2012, and 0.2/100,000/year in 2013-2017. Proportion of male gender (81%) and obesity as a comorbidity (body mass index >30 kg/m2, 40%) remained relatively stable during the period (p = 0.58 and p = 0.79, respectively). Conclusions: The incidence of SCD in subjects under 40 years of age has decreased in Northern Finland during 1998-2017. According to autopsy data, most of the deaths are due to nonischemic myocardial diseases and relative proportion of CAD has decreased.
MeSH term(s)	Cardiomyopathies/complications ; Coronary Artery Disease/complications ; Death, Sudden, Cardiac/epidemiology ; Death, Sudden, Cardiac/etiology ; Finland/epidemiology ; Humans ; Incidence ; Male ; Obesity/complications ; Risk Factors
Language	English
Publishing date	2022-02-11
Publishing country	Switzerland
Document type	News
ZDB-ID	80092-2
ISSN	1421-9751 ; 0008-6312
ISSN (online)	1421-9751
ISSN	0008-6312
DOI	10.1159/000522554
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Article ; Online: Incidence and autopsy rates for sudden cardiac death in Northern Finland.

Mäntyniemi, Lassi / Pakanen, Lasse / Tikkanen, Jani / Holmström, Lauri / Hämaläinen, Jessica / Ruuska, Laura / Vähätalo, Juha / Haukilahti, Anette / Perkiömäki, Juha / Huikuri, Heikki / Junttila, Juhani

Heart rhythm

2024

Language	English
Publishing date	2024-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2023.12.026
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Zs.A 6278: Show issues

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Article ; Online: RNU6B, a frequent reference in miRNA expression studies, differentiates between deaths caused by hypothermia and chronic cardiac ischemia.

Kaija, Helena / Pakanen, Lasse / Porvari, Katja

International journal of legal medicine

2019 Volume 134, Issue 1, Page(s) 159–162

Abstract: Here, we tested the usefulness of small non-coding RNAs as references in quantitative RT-PCR expression analyses in hypothermia and chronic cardiac ischemia as the primary causes of death. Cq values of RNU6B, SCARNA17, SNORD25, and SNORA73A were ... ...

Abstract	Here, we tested the usefulness of small non-coding RNAs as references in quantitative RT-PCR expression analyses in hypothermia and chronic cardiac ischemia as the primary causes of death. Cq values of RNU6B, SCARNA17, SNORD25, and SNORA73A were determined from human cadaver samples of hypothermia and cardiac deaths. Average Cq values of RNU6B were higher in hypothermic and average SCARNA17 Cq values in chronic ischemic samples, but no difference in SNORD25 and SNORA73A Cq values could be seen between the groups. RNU6B expression levels were calculated using SNORD25, SNORA73A, and their combination as the reference in normalization. Expression of RNU6B, a widely used reference, was found to be significantly lower in hypothermia than in chronic cardiac ischemia. In these conditions, RNU6B is a useful marker differentiating hypothermia deaths from chronic ischemic heart disease deaths, but not a valid reference for normalization in expression studies.
MeSH term(s)	Biomarkers/analysis ; Cadaver ; Cause of Death ; Humans ; Hypothermia/genetics ; Myocardial Ischemia/genetics ; RNA Stability ; RNA, Small Untranslated/analysis ; Real-Time Polymerase Chain Reaction ; Reference Values
Chemical Substances	Biomarkers ; RNA, Small Untranslated
Language	English
Publishing date	2019-03-23
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1055109-8
ISSN	1437-1596 ; 0937-9827
ISSN (online)	1437-1596
ISSN	0937-9827
DOI	10.1007/s00414-019-02041-0
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Article ; Online: Day-of-the-week variation of sudden unexpected cardiac death.

Latola, Hanna / Mattila, Severi M / Pakanen, Lasse / Holmström, Lauri / Kauppila, Janna / Ukkola, Olavi H / Junttila, M Juhani / Huikuri, Heikki V / Perkiömäki, Juha S

International journal of cardiology. Cardiovascular risk and prevention

2024 Volume 20, Page(s) 200246

Abstract: Background: There has been some controversy about the day-of-the-week (septadian) variation of unexpected sudden cardiac death (SCD).: Methods: We evaluated the incidence of unexpected SCD on different days of the week in a consecutive series of 5869 ...

Abstract	Background: There has been some controversy about the day-of-the-week (septadian) variation of unexpected sudden cardiac death (SCD). Methods: We evaluated the incidence of unexpected SCD on different days of the week in a consecutive series of 5869 SCD victims from Northern Finland [the FINGESTURE study (Finnish Genetic Study of Arrhythmic Events)]. As it is mandatory in Finland, a medico-legal autopsy was performed on all unexpected sudden death victims. The autopsies were performed between the years 1998-2017. Results: The mean incidence of unexpected SCD was higher at weekends (during the days from Friday to Sunday, peaking on Saturday) than during the days from Monday to Thursday (8.54 ± 0.72 vs. 7.22 ± 0.19 SCDs per day of the week per 100,000 inhabitants per year, p < 0.001). Regardless of sex or ischemic versus non-ischemic etiology of SCD, the distribution of the occurrence of SCD among the days of the week was similar compared with the whole SCD cohort. Conclusion: The incidence of unexpected SCD was highest at weekends (during the days from Friday to Sunday, peaking on Saturday).
Language	English
Publishing date	2024-02-09
Publishing country	Netherlands
Document type	Journal Article
ISSN	2772-4875
ISSN (online)	2772-4875
DOI	10.1016/j.ijcrp.2024.200246
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