Districts In Finland Research Articles

Connection between Trimethoprim-Sulfamethoxazole Use and Resistance in Streptococcus pneumoniae, Haemophilus influenzae , and Moraxella catarrhalis

The association between trimethoprim-sulfamethoxazole use and resistance among the major respiratory tract pathogens was investigated by comparing regional consumption of the drug to regional resistance in the following year in 21 central hospital districts in Finland. A total of 23,530 Streptococcus pneumoniae isolates, 28,320 Haemophilus influenzae isolates, and 14,138 Moraxella catarrhalis isolates were tested for trimethoprim-sulfamethoxazole susceptibility during the study period (1998-2004). Among the S. pneumoniae isolates, a statistically significant connection was found between regional consumption and resistance. No statistically significant connection was found between regional trimethoprim-sulfamethoxazole use and resistance among H. influenzae and M. catarrhalis isolates. According to our results, it seems that only in pneumococci can the development of trimethoprim-sulfamethoxazole resistance be influenced by restricting its use. However, trimethoprim-sulfamethoxazole remains an important antimicrobial agent because of its reasonable price. Hence, resistance to trimethoprim-sulfamethoxazole among these pathogens needs continuous monitoring.

Environmental Impacts of Rural Second Home Tourism – Case Lake District in Finland

Second homes are widespread in the Finnish countryside and represent a significant part of domestic tourism. In this paper impacts of rural second home tourism on natural environment and landscape are discussed mainly from a non‐anthropocentric point of view and from the perspective of ecological sustainability. Both negative and positive impacts of second home tourism on nature, climate and landscape are distinguished. Environmental impacts caused by housing and living, shoreline building and physical mobility related to second home tourism are highlighted. It is argued that mobility related to second home tourism and year‐round use of second homes are likely to increase in the near future and consequently pose negative environmental impacts. The argument is based on current societal trends and on results of a questionnaire survey conducted amongst second‐home owners living in the metropolitan region of Helsinki and possessing second homes in eastern Finnish Lake District. There is today a large political will to enhance second home tourism in Finland, which is seen crucial for revitalizing the declining countryside. Contradictions between rural development policy on one hand, and environmental protection on the other, are critically discussed and ecological sustainability of second home tourism explored.

Videoconferencing in child and adolescent psychiatry in Finland – an inadequately exploited resource

To assess the current role of videoconferencing and the purposes for which it has been used in child and adolescent psychiatry in Finland, we sent a 16-item questionnaire to all providers of child and adolescent psychiatry services in specialised health care in Finland, i.e. the 42 child and adolescent units in 21 hospital districts. All service providers responded. The responses to both open-ended and structured questions were analysed manually and classified quantitatively and qualitatively. Use of videoconferencing was reported by 16 of the 21 hospital districts in Finland. Videoconferencing had been used for more than 5.5 years in only three hospital districts, for 3-5 years in 14 units and for 1-3 years in six units. Videoconferencing was used for clinical work in 12 and for distance education in another 12 hospital districts. Videoconferencing was used weekly for clinical work and for supervision by two districts; it was used for education by three districts. Although the workers' experiences of and attitudes towards videoconferencing were favourable, it has not been widely used in child and adolescent psychiatry. The implementation of videoconferencing seems to depend more on the activity of service providers than on the number of people involved.

Explaining young registered Finnish nurses’ intention to leave the profession: A questionnaire survey

Background Regardless of the current global nursing shortage, many nurses are planning to leave their profession. According to previous research, young nurses in particular are the most eager to leave—there is, however, no research available as to why this is. Objectives The aim of this survey study was to discover what proportion of young nurses intends to leave the profession in Finland and what the reasons behind this are. Design Quantitative, survey study. Settings Six hospital districts in Finland. Participants A total of 147 Registered Nurses, under the age of 30, working mainly in hospitals. Method Data was collected as part of the NEXT (Nurses Early Exit) -Study. A structured postal questionnaire, BQ-12, was used to collect the data in autumn 2003. Quantitative data were analysed using χ 2, the Fisher exact-test and Mann–Whitney U-test, and qualitative data were analysed using quasi-statistics. Results During the course of the past year, 26% of young nurses have often thought of giving up nursing. This was associated with personal burnout, poor opportunities for development, lack of affective professional commitment, low job satisfaction, work–family conflicts and higher quantitative work demands. In open-ended question, nurses stated that the main reasons for them considering leaving the profession included dissatisfaction with salary, the demands of nursing work, the inconvenience of shift work/working hours and uncertain work status. Conclusions Findings illustrate that there were several factors influencing the young nurses’ intentions. By identifying the factors responsible, it could be possible to retain young nurses in the field.

A national Finnish e-health development project ‘ProViisikko’

The ProViisikko project comprises the pilot projects of the five hospital districts in Finland. The work concerns the development of tools for controlling and monitoring care chains and the development of interactive tools for steering service demand. Five hospital districts, businesses, research institutes, universities, NGOs and other key partners are concentrating, each in their own region, on implementing a specific entity which, together, will produce an overall solution which can be expanded for national or international use, either as a whole or in modular form. Routine functions related to the provision of information will eventually be performed by clients themselves on a variety of terminals rather than at visits to health centres. Call-centres and interactive portals will direct demand accurately to the appropriate social welfare and health care resources. Close cooperation between hospital districts local authorities and development organizations will permit the development of services and products with a population base of 1.2 million and also ensure comparability between regions.

Macrolide and Azithromycin Use Are Linked to Increased Macrolide Resistance in Streptococcus pneumoniae

The connection between regional rates of antimicrobial resistance in Streptococcus pneumoniae and regional antimicrobial use in Finland was investigated. During the 6-year study period of 1997 to 2002, a total of 31,609 S. pneumoniae isolates were tested for penicillin resistance and a total of 23,769 isolates were tested for macrolide resistance in 18 central hospital districts in Finland. The regional macrolide resistance rates were compared with the local use of (i) all macrolides pooled and (ii) azithromycin. The penicillin resistance levels were compared with the consumption data for (i) penicillins, (ii) cephalosporins, (iii) all beta-lactams pooled, and (iv) all macrolides pooled. A statistically significant association between macrolide resistance and total use of macrolides and the use of azithromycin was found. Moreover, total use of beta-lactams and total use of cephalosporins were significantly connected to low-level penicillin resistance. A statistically significant association between penicillin-nonsusceptible isolates and penicillin or total macrolide consumption was not found. In conclusion, total macrolide use and azithromycin use are associated with increased macrolide resistance, and beta-lactam use and cephalosporin use are connected to increased low-level penicillin resistance in S. pneumoniae. Unnecessary prescribing of macrolides and cephalosporins should be avoided.

Evidence of lay and professional forest-based development discourses in three contrasting regions of Finland

The paper examines the perceived importance of forests and forestry for rural development in three contrasting districts in Finland: an area of intensive farming and moderate forest cover, and two dairying farming regions with extensive forest cover, one of which has long suffered from socio-economic marginalisation. Forest-related rural discourses that have been elicited in other European countries are identified in Finland: namely, a private-use, production-oriented discourse, a collective-use non-timber benefits discourse and an environmental benefits discourse. Farmers in the intensive farming district do not identify strongly with any of the forest discourses. Conversely, farmers in the poorer farming regions with extensive forests identify with each of the discourses. Advisors in each district identify mostly with the production-oriented discourse. A strong dichotomy therefore exists between lay farmers (who own the land) and professional advisors (who often administer policy) with respect to forest-related discourses. The dichotomy can have considerable repercussions on how forest policy instruments and rural policy programmes are promoted, as advisors do not seem to recognise that non-timber resources are a basis for rural enterprise.

Time‐based analysis of total cost of patient episodes

Healthcare in the public and private sectors is facing increasing pressure to become more cost-effective. Time-based competition and work-in-progress have been used successfully to measure and improve the efficiency of industrial manufacturing. Seeks to address this issue. Presents a framework for time based management of the total cost of a patient episode and apply it to the six sigma DMAIC-process development approach. The framework is used to analyse hip replacement patient episodes in Päijät-Häme Hospital District in Finland, which has a catchment area of 210,000 inhabitants and performs an average of 230 hip replacements per year. The work-in-progress concept is applicable to healthcare--notably that the DMAIC-process development approach can be used to analyse the total cost of patient episodes. Concludes that a framework, which combines the patient-in-process and the DMAIC development approach, can be used not only to analyse the total cost of patient episode but also to improve patient process efficiency. Presents a framework that combines patient-in-process and DMAIC-process development approaches, which can be used to analyse the total cost of a patient episode in order to improve patient process efficiency.

Associations between stress at work and attitudes towards retirement in hospital physicians

There is a need to understand the associations between attitudes towards retirement in specific occupations and various psychosocial and work-related factors. This study identified correlates of retirement thoughts and retirement preference in hospital physicians. The sample comprised 447 (251 male and 196 female) physicians from three hospital districts in Finland. After adjustment for gender, age and salary, minor psychiatric morbidity increased likelihood of retirement thoughts and retirement preference. Retirement thoughts and retirement preference were more common in doctors reporting low job control, poor teamwork and unjust supervision than in doctors perceiving their working conditions more favorably. Work preference was associated with high overwork. The associations of work characteristics with retirement thoughts and retirement preference largely persisted after control for indicators of health and social circumstances. In conclusion, in addition to demographic and financial factors and health, retirement attitudes in hospital physicians seem to be related to organizational and managerial factors that are potentially amendable to intervention. This has implications for retaining hospital physicians who might otherwise retire.

Making Friends and Caring – Data From Integrated Sex Education

The present study examined connections between building and maintaining future relationships, being able to look after themselves, and after others (3 outcome variables) with perceptions of 6th-graders about sex education topics covered at school (20 explanatory variables). The study utilized a convenience sample (N=108/118; 91.5% response) from 4 schools at the Rauma School District in Finland; one school provided two classes of 6th graders, another provided one combined class of 5th and 6th graders. The students were 12.3 years of age (median 12 years). Boys and girls did not differ in their responses to outcome variables. They received adequate amounts of information for future purposes of being able to look after themselves (n=98/102) or after others (n=81/108) but less for the purposes of building and maintaining relationships (n=53/103). The outcome variable of building and maintaining relationships was associated with tolerance and understanding of difference, showing of emotions, and dating.

The logistics of food supply following radioactive fallout

Discussions at the national level about critical infrastructure and its vulnerability are more common now following the events of September 11. The National Emergency Supply Agency organised a training exercise to test the logistics of food supply following passage of a plume containing radioactive material over a district in Finland. This short paper summarises the problems that had to be faced and suggests a way forward for improving emergency preparedness in this area.

Finnish young people's narrative construction of consumer identity

AbstractThis article examines how young Finns represent their consumer identity through narratives. Young consumers are easily seen as careless spenders and selfish hedonists in the contemporary consumer society. However, an empirical approach is required in order to find out whether this generation of young Finnish consumers is one of ‘raving hedonists’ or ‘ultimate materialists’, as their peers are often presented in public discussion in many western societies. The empirical data was collected in five upper secondary schools between the end of November 2001 and the beginning of January 2002. These schools are located in five different districts in Finland, varying from metropolitan to rural areas. The study focused on students aged 16–19 years and used essay writing as the method for collecting qualitative data. The data thus consists of 159 life stories as a consumer written by young Finnish people. Qualitative research methods, such as narrative analysis, were used in this study. It is argued that Finnish young people are representing their identities as consumers through a combination of various levels of consumer discourses besides hedonism and squandering: rationality and economizing are an essential part of their consumer identities. Some youngsters also present themselves as responsible consumers including ecological and ethical choices as part of their narrative. The way these youngsters combine discourses gives evidence of the various features of the present‐day young consumer. It is also suggested that their consumer identity develops and changes with age. Young people describe their identity changing through a hedonist/squanderer discourse to a rational and economical one or vice versa. They also combine hedonist, rational, economical and responsible discourses simultaneously.

Fate of patients with adenocarcinoma of the esophagus and the esophagogastric junction: a population-based analysis.

At the population level, a detailed picture of the nature of adenocarcinoma at the distal esophagus and esophagogastric junction under modern treatment is lacking. We evaluated the fate of these patients and the results of various types of therapeutic procedures using unselected population-based data. Primary data on patients with these adenocarcinomas in two health care districts in Finland were retrieved from the Finnish Cancer Registry. The fate of all 402 patients treated between 1990 and 1998 in 23 units was analyzed. The 5-yr survival rate of these patients was 12.5%. Median survival was 36.5 days (0 days- 68.1 months) with best supportive care (18.9%), 116.5 days (0 days-59.5 months) with palliative (33.8%), mainly either endoscopic or oncological treatment, 211 days (113 days-26.6 months) with exploratory surgery (4.7%), and 17.6 months (0-101.1) after esophageal resection (42.5%). The 5-yr and 8-yr survival rates in this unselected material after esophageal resection including 8.8% operative mortality were 29.0% and 26.0%. The best chance for cure and long-term survival came from esophagectomy with 2-field lymphadenectomy compared to less extensive operations (50.0%vs 23.2% survival at 5 yrs, p= 0.005). Between these groups no statistically significant difference (p= 0.4) existed in pathological TNM stages or in the distribution of node-negative tumors (47.6%vs 41.8%). Although overall prognosis for adenocarcinoma near the esophagogastric junction is poor, a substantial percentage of patients eligible for major surgery achieve long-term survival.

Uveitis in juvenile idiopathic arthritis

The purpose of the present study was to extend our knowledge of the occurrence, characteristics and prognosis of uveitis in patients with juvenile idiopathic arthritis (JIA: arthritis of unknown cause of at least six weeks' duration in a child under 16 years of age). The occurrence of uveitis was examined retrospectively in subjects entitled under the nationwide sickness insurance scheme to receive specially reimbursed medication for JIA in 5/21 central hospital districts in Finland (population basis about 1 300 000 inhabitants) during 1980, 1985 and 1990. A total of 114 children with JIA were found and uveitis was diagnosed in 16% of them. Uveitis was chronic (duration >6 months) in nine cases, the most severe cases being those three in whom uveitis was detected at the onset of arthritis. In 49 sibling pairs with JIA from the Rheumatism Foundation Hospital uveitis was detected in 26%. These 80 familial JIA cases belonging to 37 families with two or three affected siblings were collected from about 2000 children seen at the Hospital during 15 years. The observed concordance rate for uveitis (three pairs) did not differ from that expected (3.4 pairs). Uveitis was chronic in most instances, but its course was usually mild. In the clinic-based cohort of 426 patients with newly diagnosed JIA from the Rheumatism Foundation Hospital the most important determinants of associated uveitis were early onset of arthritis (at the age of 2 to 4 years) and antinuclear antibody (ANA) positivity. During the mean follow-up time of 4.5 years a total of 104 (24%) children with JIA developed uveitis. The condition was in most cases (99 out of 104) asymptomatic and was found early in the disease process, in a majority of cases during the first four years from the onset of arthritis. Proportionally uveitis was as frequent in rheumatoid factor-seronegative polyarthritis as in oligoarthritis and there was no predominance of girls. The prognosis of uveitis in this prospective series was better than that in most earlier reports; complications in 24% of cases, none of the patients became blind. In the above cohort, 372 children had seronegative oligoarthritis or polyarthritis. Within this group, the activity of arthritis was compared between patients with associated uveitis and

Challenging behaviour, and staff responses to it, in residential environments for people with intellectual disability in Finland

The frequency and severity of challenging behaviour in all 261 adult residents of a single special care district in Finland were assessed using the modified version of the Scales of Independent Behavior Problem Behavior Inventory. The results showed that 70% of the residents with intellectual disability exhibited challenging behaviour that was considered to be more than a mild problem by the staff. The incidence of dangerous behaviour was 10%. Some form of negative intervention (restraints, punishment or environmental restrictions) was used for 56% of cases in which challenging behaviour was exhibited. Punishment was the most common consequence for dangerous behaviour. The staff in the small community care homes used more positive interventions and less mechanical restraints than staff in the institution. The implications of the findings are discussed.

DRG-related prices applied in a public health care system—can Finland learn from Norway and Sweden?

In the early 1990s, DRG based hospital financing was introduced into some hospital districts in Finland. The 1993 state subsidy reform decentralising all hospital financing to municipalities, and the aim of improving productivity, were the driving forces for introducing DRG. This study addresses the pros and cons of DRG in hospital financing in the Finnish health care system and puts forward several solutions to avoid potential problems. We consider the objectives and optimal features of hospital financing systems in the context of the public health care system, where the public sector owns and finances hospitals. We analyse impacts of introducing different types of DRG based hospital financing systems, taking into account earlier experiences in countries such as Sweden and Norway, as well as Finnish system specific features. DRG could assist the Finnish municipalities to compare quality, costs and prices of services between hospitals, and related cost information might help them budget expenditure more accurately. System specific features mean that traditional uses of DRG in hospital pricing are not feasible in Finland. But some benefits of DRG could be exploited, for instance in the controlled contracts between municipalities and hospitals.

Stand Structure in Pine, Spruce and Deciduous Forests: A Comparison Between Finnish and Russian Karelia

This study investigated the stand structure in pine, spruce and deciduous forests in the border district of Finland and Russia. A total of 46 mature forest stands was selected as pairs, the members of each pair being as similar as possible with respect to their forest site type, age, moisture and topography. The stands were then compared between the two countries by means of basal areas and number of stems. The proportions of dominating tree species were 2-12% lower, and correspondingly the proportions of secondary tree species higher, in Russian forests. The density of the forest stock was also higher in each forest type in Russia. The forests in the two countries differed most radically in terms of the abundance of dead trees. The amount was two to four times higher in Russian deciduous and spruce forests, and in pine forests the difference was 10-fold. The stand structures indicated that Russian coniferous stands, in particular, were more heterogeneous than intensively managed pine and spruce stands in Finland.

Changes in the incidence of juvenile rheumatoid arthritis in Finland.

To study trends in the incidence of juvenile rheumatoid arthritis (JRA). The study covered subjects who were entitled under the nation-wide sickness insurance scheme to receive specially reimbursed medication for juvenile rheumatic diseases in 11 of 21 central hospital districts in Finland (the base population comprised about 445,000 children <16 yr of age) in 1995. Data from the years 1980, 1985 and 1990 were compared with data from 1995 concerning the central part of the area, which had been included in a previous study by us. A total of 87 incident cases (58 girls and 29 boys) satisfied criteria for JRA in 1995 in the study area. The incidence of JRA was 19.5 per 100 000 [95% confidence interval (CI) 15.6-24.1] of the population <16 yr of age for the whole area. It was 22.7 per 100,000 (95% CI 17.3-29.2) for the area that had been covered by the earlier study (five districts) and 14.9 per 100,000 (95% CI 9.8-21.7) for the new area (six additional districts). The incidence of JRA was significantly higher than in the earlier years (1980, 1985 and 1990) in the same district (trend, P=0.024). The highest incidence, 60.3 per 100,000 (95% CI 35.8-95.4), was noted in 1995 among girls in the age group 10-15 yr in the southernmost part of the study area. There was both temporal and regional variation in the incidence of JRA. Results of the present study suggest that environmental factors may influence the frequency of JRA.

Integrating and decomposing the sources of bias: an addendum

While electoral research has become one of political science’s most fertile areas, to date no empirical contribution has addressed the three mechanisms of the electoral chain – strategic entry, strategic voting, and the electoral system’s mechanical effect – in a unified analytical framework. This paper addresses this shortcoming by analysing the effect of electoral systems on party system size, accounting for all three mechanisms. Our study yields three major findings drawing on constituency-level data covering 462 electoral districts in Finland and Portugal between 1962 and 2011. First, macro-sociological context, measured as cleavages, operate at the district level: An increase in the heterogeneity within a constituency significantly increases party system size. Second, in the two established democracies we examine, we observe that district-level bottom-up coordination takes places. Finally, while our analyses reveal that some strategic voting takes places, it is blurred by a comparatively large amount of non-strategic behaviour by voters. The variance we find surrounding psychological effects is too large to exert a targeted impact. In sum, the mechanical effect turns out to be the most decisive link of the electoral chain.

Condition, Potential Recovery Rate, and Productivity of Lichen (&lt;i&gt;Cladonia&lt;/i&gt; spp.) Ranges in the Finnish Reindeer Management Area

The focus of the work was to investigate dependency between reindeer density and lichen (Cladonia spp.) ranges in the Finnish semidomesticated reindeer management area. Secondly, we formed a model on the recovery rate of ungrazed woodland lichen ranges (29 sites) after forest fires to evaluate the potential productivity and time needed for Finnish lichen ranges to recover at optimal production. During 1974-95, 59% of the variation in mean semidomesticated reindeer density (range: 0.7-3.0 reindeer/km² of the total land area) among the reindeer herding districts in Finland was explained by the proportion of land area covered by lichen ranges in these districts. Reindeer densities were highest in the districts where lichen ranges covered 20% to 30% of the area. Reindeer density on the total land area did not explain the condition of lichen ranges, but 58% of the condition was explained by the reindeer density on the lichen ranges. A condition level for lichen ranges of 1000 kg dry matter per hectare (d.m./ha) of lichen biomass can be considered adequate to ensure survival of reindeer and continued production of lichen. To maintain this level within the sedentary Finnish grazing system, winter reindeer densities on lichen ranges must remain below 5-7 reindeer/km². According to our model, the maximum amount of living lichen in the woodland lichen stand at the climax stage is on average about 7000 kg d.m./ha. The maximum annual yield of lichen (175 kg d.m./ha) is produced by lichen stands that contain 2600-2800 kg d.m./ha of living lichen. Using our model and our 1995-96 data, we calculated that the average lichen biomass on lichen ranges in the Finnish reindeer management districts was 13.0% of this optimum, and the average lichen production was 36% of the possible maximum annual yield. Our model indicates that the Finnish lichen ranges would have to remain ungrazed for an average of 18 years to recover to maximum production levels. However, the average time needed for the lichen ranges to recover to the level of 1000 kg lichen d.m./ha, would be only about 7 years.