Finnish Municipalities Research Articles

Effectiveness of screening for breast cancer in women under 50 years at entry: The Kotka pilot project in Finland

It is still uncertain whether mammography is beneficial to women under 50 years of age. We report a follow-up of 4 1-year birth cohorts in 13 Finnish municipalities subjected to service screening. The women in these cohorts were born in even calendar years and they were 40-47 years old at the time of first screening, which was repeated every other year. At the beginning, 4,163 women were invited and 86% attended. Women were screened with mammography, physical breast examination and information on detection and early diagnosis of breast cancer by breast self-examination (BSE) was given. Incident cases of breast cancer and breast-cancer deaths were recorded. The expected numbers of incident breast-cancer cases and deaths from breast cancer were derived from control women who were residents of the same municipalities but who were born in adjacent calendar years (odd years) to those screened. In the screened cohorts 13 cancers were screen-detected, 32 cancers were interval cases and 8 cases were diagnosed among the non-attenders, while in the controls 85 cancers were detected during a 9-year follow-up from 1982 to 1990. One death from breast cancer occurred in the screened cohorts among cases diagnosed between 1982 and 1990, against 10 expected breast-cancer deaths during a 10-year follow-up from 1982 to 1991 of women initially free of breast cancer. Breast-cancer mortality in the screened cohorts was significantly lower than in the controls (Rate Ratio 0.11), but it is not clear how much of the reduction in mortality could be accounted for by the mammography itself and how much to other activities included in the screening programme (especially training in BSE) or to chance variation. It is unlikely that a programme sensitivity of 25% (13/53) would have resulted in 89% (100-11) effectiveness or reduction in the risk of death from breast cancer.

The use of GIS-system in catastrophe and emergency management in Finnish municipalities

MEMbrain will develop and make commercially available an industrial-quality system to support the major activities of the Management of Major Emergencies (MEM). Its main goal is to define and implement a standard software and hardware platform for MEM, configurable to operate in a variety of national and application domains. This goal will be attained through enhancing the performance of the people bearing the responsibility of decision-making in the case of a Major Emergency (Cap Gemini Innovation, 1992). MEMbrain is the EUREKA project EU904 consisting of numerous participants in seven European countries. The aim of the Finnish subproject is to develop a modern and open GIS-system for the rescue brigades and environmental offices in typical Finnish communities (SNI). Furthermore there will be another subproject “Real-time Use of Safety Studies” by the Technical Research Centre of Finland (VTT). Vaisala Oy joins to the project as SNI's partner. The rescue brigades are responsible for fire and emergency management activities in the Finnish communities. They want to get useful extensions to their existing open GIS and operative systems. The software as well as hardware platform is based on open Client-Server architecture, LAN, WAN and PC's, relational database management system, MS-Windows and UnifAce-4GL language. Also 3rd party SW will be used such as AutoCad. The functionalities to be implemented in the pilot applications will have to be approved of by the user municipalities. In addition, they should represent relevant extensions to the existing IT-systems. The Finnish pilot applications show that a low cost and small scale GIS-system is useful in the emergency management and environmental monitoring activities in Finnish municipalities.

Determinants of expenditure variation in health care and care of the elderly among Finnish municipalities.

In Finland, municipal health care expenditure varies from FIM 3 800 per capita to FIM 7 800 per capita. The objective of this study was to estimate the impact of different economic, structural and demographic factors on the per capita costs of health services and care of the elderly. Using regression analysis we attempted to explain observed differences in expenditure by determining separately the effects of allocative and productive inefficiency and the effects of factors influencing the demand for services. We found income level of local population, generosity of central government matching grant, allocative efficiency (the mix of care between institutional and non-institutional care), productive efficiency of service providers, and factors associated with the need of services (age structure, morbidity) to be the most important determinants of health care expenditure. Our results reveal that municipalities have the means at their disposal (by shifting resources to outpatient care and increasing productivity) to significantly reduce expenditure on health services and care of the elderly.

Dermatoses determined in a population of farmers in a questionnaire-based clinical study including methodology validation.

The study analyzed skin diseases in a population sample of Finnish farmers descriptively and in the process validated the question "Do you have a skin disease now?" All farmers from one Finnish municipality were surveyed for dermatoses, first with a questionnaire and then with a clinical examination of those who reported dermatoses. Another population of farmers answered a set of questions immediately before a clinical examination, and the self-report of current dermatosis was validated. Eczema was diagnosed for 66% of the women and 53% of the men who had reported dermatosis in the questionnaire study 6 to 12 months earlier. Toe-web maceration, psoriasis, folliculitis, and acne were, after eczema, the most frequent diagnoses (in that order). In more than 50% of the cases, the location of clinically determined dermatoses corresponded with the skin disease areas reported 6 to 12 months earlier. In the validation study, everyone who reported a skin disease immediately before the clinical examination were found to have a skin disease. In addition 22% of those not reporting dermatosis were found to have a skin disease. Toe-web maceration was the most common dermatosis not reported by the farmers. Finnish farmers suffered from the same type of dermatoses as other populations. The prevalence of eczema and hand eczema was similar to that of other risk populations. A self-report of current dermatosis is probably a good indicator of the point prevalence of explicit skin diseases in populations.

Risk factors for recurrent falls in the elderly in long-term institutional care

All the persons aged 70 years or older and living in long-term institutional care in five rural northern Finnish municipalities ( N = 145) were followed up for two years, and all their fall incidents were recorded through diary reporting by the nursing staff and by examining the medical records in hospitals, health centres and nursing homes. The study population was examined halfway through the follow-up period by two nurses, a physiotherapist and a physician. Of the 93 ambulatory subjects, 57% of the men and 56% of the women experienced at least two falls in six months (recurrent falls): 10% of the recurrent falls resulted in a major soft tissue injury and 5% in a fracture. Logistic regression analyses showed the independent risk factors for recurrent falls to be slow walking speed, a change in living conditions during the previous two years, reduced quadriceps strength and existence of an ophthalmic disease. Many of the risk factors are potentially remediable, and they should be minimized by optimizing the care and by improving or maintaining the functional abilities of the elderly.

Drinking water mutagenicity and gastrointestinal and urinary tract cancers: an ecological study in Finland.

The purpose of this study was to investigate the relationship between exposure to mutagenic drinking water and cancers of the gastrointestinal and urinary tract. Past exposure to drinking water mutagenicity was assessed in 56 Finnish municipalities for the years 1955 and 1970. The cases of bladder, kidney, stomach, colon, and rectum cancers were derived from two periods (1967 to 1976 and 1977 to 1986). Age, sex, social class, urban living, and time period were taken into account in the Poisson regression analysis. Statistically significant exposure-response association was observed between exposure and incidence of bladder, kidney, and stomach cancers. In an ordinary municipality using chlorinated surface water, this exposure would indicate a relative risk of 1.2 for bladder cancer and of 1.2 to 1.4 for kidney cancer compared with municipalities where nonmutagenic drinking water was consumed. The acidic mutagenic compounds present in drinking water may play a role in the etiology of kidney and bladder cancers, but, because the results are based on aggregate data, they should be interpreted with caution.

Finnish municipalities and planning in transition: Empowerment, impulses and strategies

Abstract In a complex and turbulent environment, planning should have a different form from planning in a time of stable development. The modes of action of planning are changing with the environment. The main features of changes concerning planning in the Finnish local government crystallize in a shift from government to governance. The focus of this article is on: (a) an evolution of Finnish municipalities; (b) a possible new form of planning according to principles of governance (including empowerment, impulse planning and strategies); and (c) a quest for a new solution for the future in three Finnish municipalities.

Distribution and attenuation of hazardous substances in uncontrolled solid waste landfills

The distribution, concentrations in various phases, attenuation and emissions of hazardous substances in Finnish municipal and industrial mixed-waste landfills were investigated in a 5 year field study. Pronounced irregular spatial variation in substance concentrations was observed within, and especially between, the sites. Most frequency distributions of contaminant concentrations in the fills were skewed toward small values. Related norms or reference values were occasionally exceeded. The attenuation of contaminants in the various phases within and around landfills varied according to the substance and site, reflecting retention and removal mechanisms. Lead and zinc were the most easily leached heavy metals in old landfills. The concentration distributions of toxicants in waterborne emissions were dominated by small values, but the maxima exceeded drinking water norms by up to 400 times. In municipal landfill gas, some halomethane concentrations (100 mg Nm −3) exceeded air quality norms. The estimates of contaminant fluxes were minor compared with, for example, industrial emissions. The overall toxic impacts of Finnish landfills thus seem relatively small, but may be important locally and require further study and caution. Associated issues in disposal risk assessment and management are briefly discussed.

Distribution and Attenuation of Hazardous Substances in Uncontrolled Solid Waste Landfills

The distribution, concentrations in various phases, attenuation and emissions of hazardous substances in Finnish municipal and industrial mixed-waste landfills were investigated in a 5 year field study. Pronounced irregular spatial variation in substance concentrations was observed within, and especially between, the sites. Most frequency distributions of contaminant concentrations in the fills were skewed toward small values. Related norms or reference values were occasionally exceeded. The attenuation of contaminants in the various phases within and around landfills varied according to the substance and site, reflecting retention and removal mechanisms. Lead and zinc were the most easily leached heavy metals in old landfills. The concentration distributions of toxicants in waterborne emissions were dominated by small values, but the maxima exceeded drinking water norms by up to 400 times. In municipal landfill gas, some halomethane concentrations (100 mg Nm-3) exceeded air quality norms. The estimates of contaminant fluxes were minor compared with, for example, industrial emissions. The overall toxic impacts of Finnish landfills thus seem relatively small, but may be important locally and require further study and caution. Associated issues in disposal risk assessment and management are briefly discussed.

Acceptability of fluoride use in Finnish municipalities.

The aim of this study was, firstly, to determine what methods of delivering fluorides might be acceptable to Finnish municipalities and, secondly, to investigate which characteristics of the municipalities best explain the variation in acceptability of fluorides. A sample, composed of 46 Finnish municipalities and representing the communes according to number of inhabitants was drawn and a mail survey sent to decision-makers (n = 1922). In this survey we assessed the characteristics of each commune and its decision-makers and asked how acceptable various methods of fluoride delivery were. The acceptability of the various methods was: toothpaste 95%, gels and varnishes 81%, rinses 63%, salt 48%, piped water 33%, and milk 11%. In industrialized communes these methods of delivery were usually slightly better accepted than in non-industrialized areas. Acceptability of fluorides seemed to differ in the various regions of Finland, Uusimaa region being the most liberal towards use of fluorides. Members of the labour parties seemed to accept piped water containing fluoride and fluoridated milk significantly more often than did conservatives. Among decision-makers, the various methods of delivery were best accepted by dentists, physicians and members of health councils.

Diffusion of Innovations in Finnish Municipal Administration

This article discusses how innovations gave diffused over time in the municipal administration in Finland. This is done by presenting first a theoretical frame of reference and then empirical data over eight policy‐innovations in Finnish cities and 39 rural communes. The results show that more research is needed before diffusion of innovations in the municipal administration can be more completely understood.