{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T07:52:19Z","timestamp":1792396339998,"version":"4.4.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T00:00:00Z","timestamp":1732838400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T00:00:00Z","timestamp":1732838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100013506","name":"Kuopion Seudun Hengityss\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013506","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008309","name":"Hengityssairauksien Tutkimuss\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008309","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007753","name":"University of Eastern Finland","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007753","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Lung"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To clarify the associations of climatic indices with chronic respiratory symptoms, with a final aim to approximate the effects of climate change on them.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An e-mail survey was directed to the members of the Finnish Pensioners` Federation. The mean 20-years\u2019 precipitation and temperature in each subjects\u2019 home municipality were obtained from the Finnish Meteorological Institute, separately for summer and winter. Adjusted multivariate models were utilized to investigate the associations of the climatic indices with chronic rhinosinusitis, chronic cough, wheezing with dyspnea, and sleep apnea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 6189 responders from 283 municipalities. Chronic rhinosinusitis and chronic cough were most prevalent in the southeastern regions of the country, where the precipitation counts were highest. In the multivariate models, winter precipitation in the home municipality increased the risks of chronic rhinosinusitis and chronic cough [adjusted OR 1.80 (1.30\u20132.51) per 100 mm,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, and 1.57 (1.19\u20132.07) per 100 mm,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001, respectively]. Wheezing with dyspnea and sleep apnea were not associated with the climatic indices.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Chronic rhinosinusitis and chronic cough were associated with long-term winter precipitation. Given the anticipated increase in winter precipitation in Northern America and Northern Europe, the prevalences of chronic rhinosinusitis and chronic cough may increase there.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00408-024-00763-6","type":"journal-article","created":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T02:15:33Z","timestamp":1732846533000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Associations of Long-Term Temperature and Precipitation with Chronic Respiratory Symptoms: Projections for the Changing Climate"],"prefix":"10.1007","volume":"203","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3386-3262","authenticated-orcid":false,"given":"Heikki O.","family":"Koskela","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0728-9903","authenticated-orcid":false,"given":"Johanna T.","family":"Kaulamo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7747-6021","authenticated-orcid":false,"given":"Anne M.","family":"L\u00e4tti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,29]]},"reference":[{"key":"763_CR1","doi-asserted-by":"publisher","DOI":"10.1002\/asl.895","author":"I Lehtonen","year":"2019","unstructured":"Lehtonen I, Jylh\u00e4 K (2019) Tendency towards a more extreme precipitation climate in the Coupled Model Intercomparison Project Phase 5 models. Atmospheric Sci Lett. https:\/\/doi.org\/10.1002\/asl.895","journal-title":"Atmospheric Sci Lett"},{"key":"763_CR2","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1016\/j.jaci.2023.09.001","volume":"152","author":"Z \u00c7elebi S\u00f6zener","year":"2023","unstructured":"\u00c7elebi S\u00f6zener Z, Treffeisen ER, \u00d6zdel \u00d6zt\u00fcrk B, Schneider LC (2023) Global warming and implications for epithelial barrier disruption and respiratory and dermatologic allergic diseases. J Allergy Clin Immunol 152:1033\u20131046. https:\/\/doi.org\/10.1016\/j.jaci.2023.09.001","journal-title":"J Allergy Clin Immunol"},{"key":"763_CR3","doi-asserted-by":"publisher","first-page":"6765","DOI":"10.1038\/s41467-021-27031-y","volume":"12","author":"MR McCrystall","year":"2021","unstructured":"McCrystall MR, Stroeve J, Serreze M et al (2021) New climate models reveal faster and larger increases in Arctic precipitation than previously projected. Nat Commun 12:6765. https:\/\/doi.org\/10.1038\/s41467-021-27031-y","journal-title":"Nat Commun"},{"key":"763_CR4","first-page":"39","volume":"56","author":"K Ruosteenoja","year":"2021","unstructured":"Ruosteenoja K, Jylha K (2021) Projected climate change in Finland during the 21st century calculated from CMIP6 model simulations. Geophysica 56:39\u201369","journal-title":"Geophysica"},{"key":"763_CR5","doi-asserted-by":"publisher","first-page":"13308","DOI":"10.1073\/pnas.1921628117","volume":"117","author":"MC Kirchmeier-Young","year":"2020","unstructured":"Kirchmeier-Young MC, Zhang X (2020) Human influence has intensified extreme precipitation in North America. Proc Natl Acad Sci U S A 117:13308\u201313313. https:\/\/doi.org\/10.1073\/pnas.1921628117","journal-title":"Proc Natl Acad Sci U S A"},{"key":"763_CR6","first-page":"832","volume":"64","author":"CR Finley","year":"2018","unstructured":"Finley CR, Chan DS, Garrison S et al (2018) What are the most common conditions in primary care? Systematic review. Can Fam Physician Med Fam Can 64:832\u2013840","journal-title":"Can Fam Physician Med Fam Can"},{"key":"763_CR7","doi-asserted-by":"publisher","first-page":"2201960","DOI":"10.1183\/13993003.01960-2022","volume":"62","author":"AM Vicedo-Cabrera","year":"2023","unstructured":"Vicedo-Cabrera AM, Mel\u00e9n E, Forastiere F et al (2023) Climate change and respiratory health: a European Respiratory Society position statement. Eur Respir J 62:2201960. https:\/\/doi.org\/10.1183\/13993003.01960-2022","journal-title":"Eur Respir J"},{"key":"763_CR8","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1016\/j.chest.2023.04.009","volume":"164","author":"B Balakrishnan","year":"2023","unstructured":"Balakrishnan B, Callahan SJ, Cherian SV et al (2023) Climate change for the pulmonologist: a focused review. Chest 164:963\u2013974. https:\/\/doi.org\/10.1016\/j.chest.2023.04.009","journal-title":"Chest"},{"key":"763_CR9","unstructured":"Finnish Meteorological Institute Suomen ilmastovy\u00f6hykkeet - Ilmatieteen laitos. https:\/\/www.ilmatieteenlaitos.fi\/suomen-ilmastovyohykkeet. Accessed 7 Nov 2023"},{"key":"763_CR10","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1007\/s00408-022-00525-2","volume":"200","author":"JT Kaulamo","year":"2022","unstructured":"Kaulamo JT, L\u00e4tti AM, Koskela HO (2022) Cough in the elderly during the COVID-19 pandemic. Lung 200:161\u2013168. https:\/\/doi.org\/10.1007\/s00408-022-00525-2","journal-title":"Lung"},{"key":"763_CR11","first-page":"1","volume":"50","author":"WJ Fokkens","year":"2012","unstructured":"Fokkens WJ, Lund VJ, Mullol J et al (2012) European position paper on rhinosinusitis and nasal polyps 2012. RhinologySupplement 50:1\u2013298","journal-title":"RhinologySupplement"},{"key":"763_CR12","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/j.chest.2017.10.016","volume":"153","author":"RS Irwin","year":"2018","unstructured":"Irwin RS, French CL, Chang AB, Altman KW (2018) Classification of cough as a symptom in adults and management algorithms: CHEST guideline and expert panel report. Chest 153:196\u2013209","journal-title":"Chest"},{"key":"763_CR13","doi-asserted-by":"publisher","first-page":"1901136","DOI":"10.1183\/13993003.01136-2019","volume":"55","author":"AH Morice","year":"2020","unstructured":"Morice AH, Millqvist E, Bieksiene K et al (2020) ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J 55:1901136. https:\/\/doi.org\/10.1183\/13993003.01136-2019","journal-title":"Eur Respir J"},{"key":"763_CR14","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/2045-7022-4-24","volume":"4","author":"A Sa-Sousa","year":"2014","unstructured":"Sa-Sousa A, Jacinto T, Azevedo LF et al (2014) Operational definitions of asthma in recent epidemiological studies are inconsistent. Clin Transl Allergy 4:24\u201324. https:\/\/doi.org\/10.1186\/2045-7022-4-24","journal-title":"Clin Transl Allergy"},{"key":"763_CR15","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1097\/ALN.0b013e31816d83e4","volume":"108","author":"F Chung","year":"2008","unstructured":"Chung F, Yegneswaran B, Liao P et al (2008) STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 108:812\u2013821. https:\/\/doi.org\/10.1097\/ALN.0b013e31816d83e4","journal-title":"Anesthesiology"},{"key":"763_CR16","unstructured":"Statistics Finland Classifications. https:\/\/www.stat.fi\/en\/luokitukset\/. Accessed 7 Nov 2023"},{"key":"763_CR17","doi-asserted-by":"publisher","first-page":"e147","DOI":"10.1016\/S2542-5196(21)00325-9","volume":"6","author":"A Dimitrova","year":"2022","unstructured":"Dimitrova A, McElroy S, Levy M et al (2022) Precipitation variability and risk of infectious disease in children under 5 years for 32 countries: a global analysis using Demographic and Health Survey data. Lancet Planet Health 6:e147\u2013e155. https:\/\/doi.org\/10.1016\/S2542-5196(21)00325-9","journal-title":"Lancet Planet Health"},{"key":"763_CR18","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s40001-015-0151-3","volume":"20","author":"T Hoshino","year":"2015","unstructured":"Hoshino T, Hoshino A, Nishino J (2015) Relationship between environment factors and the number of outpatient visits at a clinic for nonallergic rhinitis in Japan, extracted from electronic medical records. Eur J Med Res 20:60. https:\/\/doi.org\/10.1186\/s40001-015-0151-3","journal-title":"Eur J Med Res"},{"key":"763_CR19","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1111\/ina.12052","volume":"24","author":"JL Nguyen","year":"2014","unstructured":"Nguyen JL, Schwartz J, Dockery DW (2014) The relationship between indoor and outdoor temperature, apparent temperature, relative humidity, and absolute humidity. Indoor Air 24:103\u2013112. https:\/\/doi.org\/10.1111\/ina.12052","journal-title":"Indoor Air"},{"key":"763_CR20","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1007\/s00484-015-1019-5","volume":"60","author":"JL Nguyen","year":"2016","unstructured":"Nguyen JL, Dockery DW (2016) Daily indoor-to-outdoor temperature and humidity relationships: a sample across seasons and diverse climatic regions. Int J Biometeorol 60:221\u2013229. https:\/\/doi.org\/10.1007\/s00484-015-1019-5","journal-title":"Int J Biometeorol"},{"key":"763_CR21","doi-asserted-by":"publisher","first-page":"757","DOI":"10.2741\/e284","volume":"3","author":"J-H Park","year":"2011","unstructured":"Park J-H, Cox-Ganser JM (2011) Mold exposure and respiratory health in damp indoor environments. Front Biosci Elite Ed 3:757\u2013771. https:\/\/doi.org\/10.2741\/e284","journal-title":"Front Biosci Elite Ed"},{"key":"763_CR22","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1289\/ehp.1002410","volume":"119","author":"MJ Mendell","year":"2011","unstructured":"Mendell MJ, Mirer AG, Cheung K et al (2011) Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence. Environ Health Perspect 119:748\u2013756. https:\/\/doi.org\/10.1289\/ehp.1002410","journal-title":"Environ Health Perspect"},{"key":"763_CR23","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1016\/j.jaci.2013.07.028","volume":"132","author":"MS Jaakkola","year":"2013","unstructured":"Jaakkola MS, Quansah R, Hugg TT et al (2013) Association of indoor dampness and molds with rhinitis risk: a systematic review and meta-analysis. J Allergy Clin Immunol 132:1099-1110.e18. https:\/\/doi.org\/10.1016\/j.jaci.2013.07.028","journal-title":"J Allergy Clin Immunol"},{"key":"763_CR24","doi-asserted-by":"publisher","first-page":"9456","DOI":"10.3390\/ijms24119456","volume":"24","author":"G Guarnieri","year":"2023","unstructured":"Guarnieri G, Olivieri B, Senna G, Vianello A (2023) Relative humidity and its impact on the immune system and infections. Int J Mol Sci 24:9456. https:\/\/doi.org\/10.3390\/ijms24119456","journal-title":"Int J Mol Sci"},{"key":"763_CR25","doi-asserted-by":"publisher","DOI":"10.1016\/j.agrformet.2024.109948","author":"F Mousavi","year":"2024","unstructured":"Mousavi F, Oteros J, Shahali Y, Carinanos P (2024) Impacts of climate change on allergenic pollen production: a systematic review and meta-analysis. Agric For Meteorol. https:\/\/doi.org\/10.1016\/j.agrformet.2024.109948","journal-title":"Agric For Meteorol"},{"key":"763_CR26","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.1016\/j.jaci.2020.04.010","volume":"145","author":"PW Hellings","year":"2020","unstructured":"Hellings PW, Steelant B (2020) Epithelial barriers in allergy and asthma. J Allergy Clin Immunol 145:1499\u20131509. https:\/\/doi.org\/10.1016\/j.jaci.2020.04.010","journal-title":"J Allergy Clin Immunol"},{"key":"763_CR27","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1177\/03946320110240S402","volume":"24","author":"GL Marseglia","year":"2011","unstructured":"Marseglia GL, Merli P, Caimmi D et al (2011) Nasal disease and asthma. Int J Immunopathol Pharmacol 24:7\u201312. https:\/\/doi.org\/10.1177\/03946320110240S402","journal-title":"Int J Immunopathol Pharmacol"},{"key":"763_CR28","doi-asserted-by":"publisher","first-page":"91","DOI":"10.3402\/ijch.v66i2.18237","volume":"66","author":"HO Koskela","year":"2007","unstructured":"Koskela HO (2007) Cold air-provoked respiratory symptoms: the mechanisms and management. Int J Circumpolar Health 66:91\u2013100","journal-title":"Int J Circumpolar Health"},{"key":"763_CR29","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1016\/S2213-2600(20)30363-5","volume":"8","author":"ZW El-Husseini","year":"2020","unstructured":"El-Husseini ZW, Gosens R, Dekker F, Koppelman GH (2020) The genetics of asthma and the promise of genomics-guided drug target discovery. Lancet Respir Med 8:1045\u20131056. https:\/\/doi.org\/10.1016\/S2213-2600(20)30363-5","journal-title":"Lancet Respir Med"},{"key":"763_CR30","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1183\/09031936.99.13100899","volume":"13","author":"LR Skadhauge","year":"1999","unstructured":"Skadhauge LR, Christensen K, Kyvik KO, Sigsgaard T (1999) Genetic and environmental influence on asthma: a population-based study of 11,688 Danish twin pairs. Eur Respir J 13:8\u201314. https:\/\/doi.org\/10.1183\/09031936.99.13100899","journal-title":"Eur Respir J"},{"key":"763_CR31","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1038\/s41586-023-06794-y","volume":"625","author":"AR Gottlieb","year":"2024","unstructured":"Gottlieb AR, Mankin JS (2024) Evidence of human influence on Northern Hemisphere snow loss. Nature 625:293\u2013300. https:\/\/doi.org\/10.1038\/s41586-023-06794-y","journal-title":"Nature"},{"key":"763_CR32","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1007\/s11325-014-0965-1","volume":"19","author":"DG Ingram","year":"2015","unstructured":"Ingram DG, Matthews CK, Plante DT (2015) Seasonal trends in sleep-disordered breathing: evidence from Internet search engine query data. Sleep Breath Schlaf Atm 19:79\u201384. https:\/\/doi.org\/10.1007\/s11325-014-0965-1","journal-title":"Sleep Breath Schlaf Atm"},{"key":"763_CR33","doi-asserted-by":"publisher","first-page":"50755","DOI":"10.1007\/s11356-022-18922-8","volume":"29","author":"W-T Liu","year":"2022","unstructured":"Liu W-T, Wang Y-H, Chang L-T et al (2022) The impacts of ambient relative humidity and temperature on supine position-related obstructive sleep apnea in adults. Environ Sci Pollut Res Int 29:50755\u201350764. https:\/\/doi.org\/10.1007\/s11356-022-18922-8","journal-title":"Environ Sci Pollut Res Int"},{"key":"763_CR34","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/s11606-022-07699-8","volume":"38","author":"AJ Barsky","year":"2023","unstructured":"Barsky AJ, Silbersweig DA (2023) The amplification of symptoms in the medically Ill. J Gen Intern Med 38:195\u2013202. https:\/\/doi.org\/10.1007\/s11606-022-07699-8","journal-title":"J Gen Intern Med"},{"key":"763_CR35","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1097\/PSY.0000000000001101","volume":"84","author":"F Creed","year":"2022","unstructured":"Creed F (2022) The predictors of somatic symptoms in a population sample: the lifelines cohort study. Psychosom Med 84:1056\u20131066. https:\/\/doi.org\/10.1097\/PSY.0000000000001101","journal-title":"Psychosom Med"}],"container-title":["Lung"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00408-024-00763-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00408-024-00763-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00408-024-00763-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T04:42:18Z","timestamp":1766378538000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00408-024-00763-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,29]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["763"],"URL":"https:\/\/doi.org\/10.1007\/s00408-024-00763-6","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-4749602\/v1","asserted-by":"object"}]},"ISSN":["0341-2040","1432-1750"],"issn-type":[{"value":"0341-2040","type":"print"},{"value":"1432-1750","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,29]]},"assertion":[{"value":"16 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 October 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 November 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Heikki O Koskela has received funding for the present study from Kuopion Seudun Hengityss\u00e4\u00e4ti\u00f6 and Hengityssairauksien Tutkimuss\u00e4\u00e4ti\u00f6 Foundations, payments for lectures from Boehringer Ingelheim and MSD, and owns shares of a medical company Orion. Johanna T Kaulamo has received funding for the present study from Kuopion Seudun Hengityss\u00e4\u00e4ti\u00f6, Hengityssairauksien Tutkimuss\u00e4\u00e4ti\u00f6, Suomen Tuberkuloosin vastustamisyhdistyksen S\u00e4\u00e4ti\u00f6, V\u00e4in\u00f6 ja Laina Kiven S\u00e4\u00e4ti\u00f6, and Suomen Kulttuurirahasto foundations, and travel support from Boehringer-Ingelheim for attending a scientific meeting. Anne M L\u00e4tti has received funding for the present study from Kuopion Seudun Hengityss\u00e4\u00e4ti\u00f6, Hengityssairauksien Tutkimuss\u00e4\u00e4ti\u00f6, KYS:n Tutkimuss\u00e4\u00e4ti\u00f6, Suomen Tuberkuloosin Vastustamisyhdistyksen S\u00e4\u00e4ti\u00f6, and V\u00e4in\u00f6 ja Laina Kiven S\u00e4\u00e4ti\u00f6 Foundations, travel support from Orion, Boehringer Ingelheim and Roche for attending a scientific meeting, and payment for lectures and Advisory Board participations from Farmasian oppimiskeskus, MSD and GlaxoSmithKline. The authors have no other financial or non-financial competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interests"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Kuopio University Hospital (289\/2015).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"The decision to respond to the questionnaire was considered as an informed consent.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Publish"}}],"article-number":"7"}}