Finnish Public Health Research Articles

Experts in promotion and prevention - The 100th Anniversary of Finnish public health nurse education

Abstract Issue/Problem Two key public health issues at present are mental health problems and obesity. Both typically begin before adulthood and once occurred, typically persist. Prevention would be important but also economically and humanely sensible. For this, competent experts in preventive work and health promotion are needed. Description of the problem Public health nurse education, originally known as health sister education, was initiated in Finland in 1924, by the Mannerheim League for Child Welfare. The six-month health sister education was targeted at nurses and began from the desire to focus not only on treating diseases but also on promoting health. In the 1940s, education was reformed and in the 1950s significantly expanded. In the 1970s, the professional title changed from ‘health sister’ to ‘public health nurse’. In 1987, the education was extended to 3 years, including the education of registered nurses. In 1992, the education was further extended to 3.5 years. By the beginning of the 21st century, education evolved into 4 years bachelor’s degree. Results In 2024, eighteen Universities of Applied Sciences provide public health nurse education in Finland. The 4-year Bachelor of Health Care in Public Health Nursing -degree (240 ECTS credits) also qualifies for a registered nurse. Nearly half of the education consists of clinical training. In addition, registered nurses can supplement their degrees by completing a one-year education (60 ECTS credits) that qualifies them as public health nurses. Lessons In Finland, approximately 700 new public health nurses graduate annually. They are trained to work independently as experts in preventive work, health promotion, and public health. Around 9,500 Finnish public health nurses work in settings such as maternity and child health clinics, school health services, occupational health care, and outpatient clinics. Key messages • Due to the overcrowding in many healthcare services providing treatment, educating experts in health promotion and disease prevention is crucial now and in the future. • By ensuring competent experts in health promotion and disease prevention, future healthcare services can continue to provide economically and humanely sensible and effective help for people.

Health and social care managers' self-assessed competence in knowledge management: A descriptive cross-sectional study.

To describe health and social care managers' self-assessed competence in knowledge management and the factors associated with management competence. It has been shown that the performance of an organization is as good as the competence of its managers, so health and social care managers' competence in knowledge management should be assessed to improve organizational performance. A descriptive cross-sectional design. A total of 116 managers participated from six Finnish public health and social care organizations. The data were collected in February and August 2022 using the managers' competence in knowledge management (MCKM) instrument and analysed using descriptive statistical methods. Health and social care managers rated their self-reported total competence in knowledge management as good. Among the dimensions of knowledge management competence, managing a culture of competence received the highest rating, while planning competence development and cooperation was perceived as the weakest dimension. The results indicate that background factors such as the healthcare setting, the number of units managed and the number of direct staff had a statistically significant association with the health and social care managers' self-assessed competence in planning competence development and cooperation. Even though the health and social care managers' total self-assessed competence level in knowledge management was rated as good, the results underscore the significance of continuous competence development among these managers in all dimensions of knowledge management. By enhancing and clarifying managers' tasks and competence in knowledge management, managers can increase staff retention, attractiveness and work well-being. The results can be utilized to identify managers' strengths and weaknesses in knowledge management and, thus, effectively target their limited competence development resources. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. There is no patient or public contribution.

The use of digital tools by general practitioners in Finnish public health centres

Electronic health services (eHealth) have increased rapidly in the last few years. These services hold the potential to facilitate today’s challenging primary care. The aim of the study was to examine how digitalisation manifests in Finnish health centres in 2021. We aimed to find out which digital tools are used in health centres and how they are exploited. In addition, we were interested in general practitioners’ attitudes towards digitalisation in their everyday work. An online survey was distributed to general practitioners (GPs) working in primary health care centres throughout Finland, and 265 GPs replied. A health portal and various digital calculators were used daily. In remote communication with their patients, general practitioners preferred telephone calls over new tools (chat/video). Attitudes towards eHealth were positive, but digital tools were not yet commonly used. The implementation of digital solutions still needs more effort.

”Peruskehikko on olemassa, mutta sitä ei seurattu” – asiantuntijanäkemykset kansanterveysjärjestelmän toiminnasta ja ketterästä hallinnasta COVID-19-pandemiassa vuosina 2020–2021

“A basic framework for pandemic governance existed, but was not followed” – expert views of agile governance and performance of the Finnish public health system during the COVID-19 pandemic in 2020–2021 The aim is to examine how public health authorities acted, what kind of roles they adopted, and how the expected roles and actions appeared in relation to the legislative framework and national preparedness plans during the COVID-19 pandemic. The research is theoretically grounded in the concepts of agile and adaptive governance. Our empirical data consists of 53 qualitative interviews with public health actors at national, regional and local level collected from March 2021–February 2022. We analyzed interviews using directed content analysis. Major issues regarding the response of public health authorities included ambiguity, lack of knowledge in decision-making, and a mismatch between the locations of public health competence and public health authority.

Early orthodontic treatment in a Finnish public health centre: a retrospective cross-sectional study

Objectives The aim of this observational cross-sectional one-centre study was to assess whether the previously described national orthodontic treatment practises and international recommendations are implemented in a public health care centre in Finland. We also assessed early treatment practices and appliances used. Methods The study group comprised 801 children born in 2011 and 2012 residing in the Riihimäki health centre catchment area in Finland, representing 80% of the age cohort. The patient records were examined for data on orthodontic treatment, timing of treatment, appliances used, and occlusal traits. Results The children had been examined by four orthodontist specialists and two orthodontic postgraduate students. Mean age at occlusal examination had been 9 years. Of the children, 212 (26%) were undergoing or had undergone orthodontic treatment. An additional 4.4% were scheduled for treatment. The proportion of children deemed to need treatment was significantly different between the different orthodontists. The most frequently used appliances were quad-helix (30%), eruption guidance appliance (20%), head gear (14%), fixed appliances (10%), protraction facemask (10%), and passive mandibular lingual arch (6%). Conclusions Nearly one-third of children aged less than 12 years in the health centre were currently or had been in orthodontic treatment. Approximately half had received treatment with either quad-helix or eruption guidance appliance.

“A basic frame existed but was not followed” – Finnish public health system's response to COVID-19

Abstract Background Crisis management Managing crises often requires diverging from predetermined plans. In this paper, we investigate how public health authorities in Finland acted, what kind of roles they adopted and how the expected roles and actions appeared in relation to the legislative framework and preparedness plans during the COVID-19 pandemic. Based on inter-country comparisons, Finland has managed COVID-19 pandemic relatively well. The study provides qualitative insights on pandemic governance in a decentralized multi-stakeholder public health system. Methods Semi-structured interviews (n = 53) with key public health actors at central, regional and local levels were conducted during March 2021-February 2022. The data was analysed with thematic analysis. Results The predetermined roles and duties for pandemic management were not unequivocal in practice and appeared unrealistic considering the resources of the public health system. Responsibility was divided between several actors, but lack of interaction enhanced emerging tensions between them. Local and regional actors experienced national steering intervening in operational decisions. At central level distrust towards the capabilities of local and regional actors was expressed. The pandemic was framed and managed as a health crisis despite of its wider societal effects. This challenged local and regional decision-making, where wider societal impacts had to be considered. Conclusions Public health authorities in Finland interpreted their roles and responsibilities in pandemic governance in various ways: some actors adopted more active agency than others and the roles were not always in line with the existing regulative framework. Key messages • Interpretation of the roles outlined in preparedness plans are context dependent and may lead to conflicts between different actors. • In a system with multiple actors at multiple levels, building trust and improving interaction are important for coordinated action.

Comparing the effectiveness of competition as a method of reminding primary oral health care dentists to record diagnoses with two alternative methods used to enhance the recording of diagnoses in primary health care

ABSTRACT The purpose of this study was to investigate whether competition is an effective method to remind primary oral health care dentists to record diagnoses (RRD). The effectiveness of competition was examined in comparison with financial group bonuses (FGBs) and electronic reminders (ERs) of the electronic health record, together with superior-subordinate or development discussions. Putative differences in the diagnosis recording cultures of Finnish public health care physicians and dentists were studied. This was a retrospective quasi-experimental observational study in which the effects of the interventions on the rate of recording diagnoses were identified using a general linear regression model and proportions of visits with recorded diagnoses. The rate of increase in the recording of diagnoses in dentists was 0.995 ± 0.273%/month (mean ± SEM) after the implementation of RRDs and this did not differ from that obtained after starting FGBs (0.919 ± 0.130%/month) or ERs with superior-subordinate or development discussions (1.562 ± 0.277%/month) in physicians. As the rates of increase did not differ none of the applied methods seemed to be more effective than the others when trying to influence the behaviour of primary health care clinicians. Altogether, public primary health care physicians were more active than respective primary oral health care dentists to record diagnoses.

National Development and Regional Differences in eHealth Maturity in Finnish Public Health Care: Survey Study.

BackgroundeHealth increasingly affects the delivery of health care around the world and the quest for more efficient health systems. In Finland, the development of eHealth maturity has been systematically studied since 2003, through surveys conducted every 3 years. It has also been monitored in several international studies. The indicators used in these studies examined the availability of the electronic patient record, picture archiving and communication system, health information exchange, and other key eHealth functionalities.ObjectiveThe first aim is to study the national development in the maturity level of eHealth in primary health care and specialized care between 2011 and 2020 in Finland. The second aim is to clarify the regional differences in the maturity level of eHealth among Finnish hospital districts in 2020.MethodsData for this study were collected in 2011, 2014, 2017, and 2020, using web-based questionnaires from the Use of information and communication technology surveys in Finnish health care project. In total, 16 indicators were selected to describe the status of eHealth, and they were based on international eHealth studies and Finnish eHealth surveys in 3 areas: applications, regional integration, and data security and information and communications technology skills. The indicators remain the same in all the study years; therefore, the results are comparable.ResultsAll the specialized care organizations (21/21, 100%) in 2011, 2014, 2017, and 2020 participated in the study. The response rate among primary health care organizations was 86.3% (139/161) in 2011, 88.2% (135/153) in 2014, 85.8% (121/141) in 2017, and 95.6% (130/136) in 2020. At the national level, the biggest developments in eHealth maturity occurred between 2011 and 2014. The development has since continued, and some indicators have been saturated. Primary health care lags behind specialized care organizations, as measured by all the indicators and throughout the period under review. Regionally, there are differences among different types of organizations.ConclusionseHealth maturity has steadily progressed in Finland nationally, and its implementation has also been promoted through various national strategies and legislative changes. Some eHealth indicators have already been saturated and achieved an intensity of use rate of 100%. However, the scope for development remains, especially in primary health care. As Finland has long been a pioneer in the digitalization of health care, the results of this study show that the functionalities of eHealth will be adopted in stages, and deployment will take time; therefore, national eHealth strategies and legislative changes need to be implemented in a timely manner. The comprehensive sample size used in this study allows a regional comparison in the country, compared with previous country-specific international studies.

Deep carious lesions and their management among Finnish adolescents: a retrospective radiographic study

ObjectiveThe objective of this retrospective study was to find out (i) the prevalence of deep carious lesions, both untreated and previously treated, among 14- and 15-year olds and (ii) how deep carious lesions were managed in a Finnish public health care setting.Materials and methodsA random sample of 278 patients was taken from 3990 patients at the oral health care of the City of Helsinki. Radiographic subsample consisted of patients with bitewing and periapical radiographs (n = 128, 46% of the total sample). Deep carious lesions (extending to at least the inner half of dentine), deep restorations, direct pulp cappings, root canal treatments, and extractions in permanent premolars and molars were recorded from the radiographs. Patients with untreated deep carious lesions were followed up for 24 months.ResultsIn the total sample 12% had at least one untreated deep carious lesion, 10% at least one deep restoration, and 19% at least one untreated or previously treated deep carious lesion. The follow-up cohort included 48 deep carious lesions in 26 patients. Complete excavation was the most frequently chosen method (81% for lesions reaching the inner half of dentine and 56% the inner third or deeper), followed by stepwise excavation (19% and 37%, respectively).ConclusionsOne-fifth of 14–15-year-olds had at least one untreated or previously treated deep carious lesion. The choice for the carious tissue removal did not follow the current recommendations for less invasive methods.Clinical relevanceContinuing education is needed to improve the diagnostics and management of deep carious lesions.

Public health nurses’ professional dignity: An interview study in Finland

Dignity is a central human value supported by nurses' professional ethics. In previous studies, nurses in clinical practice have experienced that dignity increased their work well-being and pride of work. Dignity is also strictly interweaved to professional identity in the different nursing' roles, but little is known about dignity among public health nurses and primary care settings. This study aimed to describe the perceptions of nursing's professional dignity of public health nurses in primary care in Finland. An inductive qualitative descriptive approach with semi-structured focus group interviews was utilised. Twenty-seven Finnish public health nurses were interviewed via eight semi-structured focus group interviews in primary health care settings. Before data collection, research permissions were obtained from participating health care centres. This type of research in Finland, with competent adult participants, does not require ethical pre-assessment but written and oral informed consent obtained before the interviews. Based on our findings, public health nurses perceived that professional dignity was (1) part of their self-respect, an observed daily value based on their acknowledged competence. Besides, they perceived that (2) service users' trust in public health nurses was a strong expression of professional dignity, and it could be uncovered when recipients of care utilised their services. In addition, public health nurses experienced that (3) professional dignity was an expression of different intertwined interprofessional and social factors. Professional dignity is simultaneously an essential prerequisite and an outcome of public health nurses' work. In future, more information would be needed to implement strategies in primary health care to foster nurses' professional dignity also in international public health arenas.

STAR Duodecim eHealth Tool to Recognize Chronic Disease Risk Factors and Change Unhealthy Lifestyle Choices Among the Long-Term Unemployed: Protocol for a Mixed Methods Validation Study.

BackgroundLifestyle choices and socioeconomic status have a significant impact on the expected onset of diseases, age of death, and risk factors concerning long-term illnesses and morbidity. STAR is an online health examination tool, which gives users a report that includes an evaluation of their life expectancy and an estimated risk for developing common long-term illnesses based on questions about health, characteristics, lifestyle, and quality of life.ObjectiveThe goals of this study are to (1) review the capacity of STAR to recognize morbidity risks in comparison to a traditional nurse-led health examination and patient-reported health challenges; (2) evaluate the user experience and usability of STAR; and (3) assess the potential impact of STAR on the health confidence and motivation of patients to make healthier lifestyle choices.MethodsThis mixed methods validation study will consist of a quantitative part (questionnaires) and a qualitative part (phone interviews and open-ended questions from the questionnaires). The participants will include 100 long-term unemployed individuals attending a health check for the unemployed. The participants will be recruited from three Finnish public health centers in Espoo, Hämeenlinna, and Tampere. At the health centers, the participants will use STAR and attend a nurse’s health check. Surveys with multiple-choice and open-ended questions will be collected from the participants, the nurse, and a study assistant. The questionnaires include questions about the participant’s background and health challenges from the patient and nurse points of view, as well as questions about how well the health challenges matched the STAR report. The questionnaires also gather data about user experience, health confidence, and usability of STAR. A study assistant will fill out an observer’s form containing questions about use time and possible problems encountered while using STAR. A sample of the unemployed participants will be interviewed by telephone subsequently. For the quantitative data, descriptive statistics and a reliability analysis will be performed, and mean sum scores will be computed for the study variables. Thematic analysis of the qualitative data will be performed.ResultsThis study was approved by the Ethics Committee of the Expert Responsibility Area of Tampere University Hospital in June 2020 (ETL Code R20067). Data collection will begin in June 2021 and will take approximately 3-6 months.ConclusionsOnline health examinations can improve the effectiveness of primary prevention in health care by supporting efficient evidence-based morbidity risk estimation and motivating patients to change unhealthy behaviors. A multimethod approach is used to allow for assessment of the tool’s usefulness from the points of view of both professionals and patients. This study will further provide a rich understanding of how the tool can be used as part of routine health checks, and how and why the tool may or may not motivate users for making healthier lifestyle choices.International Registered Report Identifier (IRRID)PRR1-10.2196/27668

Supporting Student's Mental Health: A Cross-Sectional Survey for School Nurses.

Children’s and adolescents’ health problems are often related to mental health, and their wellbeing should be supported in schools. This study describes school nurses’ role and how equipped they are in recognizing students’ mental health needs and in supporting students’ mental health. Moreover, we explored the methods used and the barriers that exist for supporting students’ mental health. A national survey for members of the Finnish Public Health Association working as school nurses was conducted (n = 136/648, 21%). The survey questionnaire was analyzed using descriptive statistics and qualitative data using manifest content analysis. Participants (n = 127/133, 96%) agreed that they had an important role in ensuring that students’ mental health needs are met on time. Around one-third reported training needs for mental health interventions (n = 42/115, 36%), and a similar proportion (n = 42/136, 31%) indicated lacking adequate knowledge and skills for supporting mental health among culturally diverse students. Identified barriers for students getting help were a lack of options for sending students to mental health services (n = 92/134, 69%) and a lack of adequate training (n = 81/134, 68%). School nurses are key in providing early mental health support to students. Therefore, the availability of intervention education and training on assessing and supporting students’ mental health is needed and should be improved.

Experiences among migrant parents with a disabled child when interacting with professionals: recognition as an inclusionary and exclusionary mechanism in Finnish public health and social services

This article examines migrant parents’ experiences with public health and social services in Finland, relying on data from interviews with 20 parents. We apply the theory of recognition as the theoretical framework for this research. Our focus is on the recognition of and services for disabled persons for two reasons. Firstly, research on disability in the migration context remains lacking. Secondly, whilst many theoretical discussions about recognition exist, empirical studies relying on theory have received less attention. Here, we aim to explore the practical forms of recognition to parents’ everyday lives. We rely on theory-guided content analysis as an analytical tool. Based on the results of this research, parents face multiple challenges when encountering public service professionals. This drained parents’ resources and hampered their integration into Finnish society. Regardless of problems related to services, parents employed different strategies to gain recognition based on their own resources. Points of interest This research examines in detail how the migrant parents of a disabled child related with Finnish public health and social service professionals. Most parents in this study experienced problems obtaining services, caused by the lack of a shared language and an unfamiliarity with the service system. All parents wanted professionals to recognise their concerns regarding their child’s disability, to take into account the parents’ views about their child’s treatment and treat parents with respect. When parents felt unrecognised, they refused to accept it in many ways. For example, they could resist professionals’ plan during meetings or consulted repeatedly emergency room service. This research demonstrates how a delayed or an inappropriate health and social service influenced parents’ every-day lives. Consequently, it created long-lasting stress and hampered their integration process into the new country.

Self-Organizing Teams in Elderly Care in Finland: Experiences and Opportunities.

Health and social care for older people in Finland is increasingly provided in people's homes, leading to large caseloads of high-dependency patients for providers of home care, whose working conditions have deteriorated. Buurtzorg, a model of home care in the Netherlands that empowers caregivers to organize their own work processes, has shown promising results in terms of effectiveness and satisfaction of clients and caregivers. This article aims to provide insights about the challenges and effects of implementing self-organizing teams in three Finnish public health and social care organizations.

The Road to the Alcohol Act 2018 in Finland: A conflict between public health objectives and neoliberal goals

Finnish alcohol policy has aimed for decades years to mitigate alcohol-related harm by using high taxation and restrictions on the physical availability of alcohol. The state monopoly on the retail of alcohol has played a central role in reducing the availability of alcohol. In 2011, preparations began for a comprehensive reform of the Alcohol Act 1994. Over time, the issue became highly politicised, lobbied and divisive. It took intense work of two consecutive governments to finalise the reform. The new Alcohol Act came into force in 2018. It expanded the rights of grocery stores to sell alcohol and reduced the administrative burden for on-premise sales. As a result, the state monopoly on the retail of alcohol was weakened, but it still has an important impact on the physical availability of alcohol. The Finnish public health community expected an increase in alcohol sales following the reform because of greater alcohol availability and expected price reductions related to greater competition of sales in grocery stores. However, prices decreased less than expected in 2018, partly due to a simultaneous increase in alcohol taxes. It is difficult to evaluate the impact of the reform at this early stage. However, after the reform, the 10-year (2008–2017) downward trend in the total per capita alcohol consumption was discontinued despite the tax increase. According to preliminary analyses, the change in the law may have slightly increased recorded alcohol sales but the effect was not statistically significant.

Back to Basics in Asthma and COPD: Optimising the Patient Journey

The objective of this symposium was to build on the guiding principles of asthma and chronic obstructive pulmonary disease (COPD) and to address some of the most frequently encountered challenges in the management of chronic airway disease, using a mix of scientific information and guidance based on clinical practice. Prof Mäkelä opened the symposium by reviewing key achievements from the Finnish asthma, COPD, and allergy programmes. He also highlighted how these co-ordinated educational programmes were responsible for driving an improvement in Finnish public health and reducing the socioeconomic burden of disease. Prof Chrystyn then addressed some of the common misconceptions associated with high-resistance dry powder inhalers; he explained how the properties of these devices make them suitable for use by a broader range of patients than perceived by many clinicians. Next, Prof Lavorini addressed the real-world use of inhalers by highlighting how specific errors in recent real-life studies are associated with a loss of disease control and how the Easyhaler® (Orion Corporation, Espoo, Finland) meets many of the needs of doctors and patients. Finally, Prof Canonica focussed on precision and personalised medicine in chronic airway disease, with an emphasis on how clinicians can optimise patient adherence and, consequently, treatment in daily practice.

Use of Antiepileptic Drugs and Dementia Risk-an Analysis of Finnish Health Register and German Health Insurance Data.

To evaluate the association between regular antiepileptic drug (AED) use and incident dementia. Case-control analysis. Finnish public health register and German health insurance data. Individuals with dementia of any type (German data, N=20,325) and Alzheimer's disease (AD; Finnish data, N=70,718) were matched with up to four control persons without dementia. We analyzed the association between regular AED use and dementia. To address potential protopathic bias, a lag time of 2 years between AED use and dementia diagnosis was introduced. Odds ratios (ORs) were calculated by applying conditional logistic regression, adjusted for potential confounding factors such as comorbidities and polypharmacy. Regular AED use was more frequent in individuals with dementia than controls. Regular use of AEDs was associated with a significantly greater risk of incident dementia (adjusted OR=1.28, 95% confidence interval (CI)=1.14-1.44) and AD (adjusted OR=1.15, 95% CI=1.09-1.22) than no AED use. We also detected a trend toward greater risk of dementia with higher exposure. When AEDs with and without known cognitive adverse effects (CAEs) were compared, a significantly greater risk of dementia was observed for substances with known CAEs (dementia: OR=1.59, 95% CI=1.36-1.86; AD: OR=1.19, 95% CI=1.11-1.27). AEDs, especially those with known CAEs, may contribute to incident dementia and AD in older persons.

Efficacy-Based Budget Impact Analysis of Secukinumab Vs Adalimumab in the Treatment of Ankylosing Spondylitis in Finland

Biologic treatments have enhanced the treatment outcomes of patients with active ankylosing spondylitis (AS). Until recently, TNF-alpha-inhibitors have been the only biologics approved for the treatment of active AS. We assessed the potential budget impact of the first non-TNF-alpha biologic secukinumab (fully human IL-17A-inhibitor) versus adalimumab (TNF-alpha-inhibitor) in the treatment of AS in the Finnish public health care setting. The number of patients and current market share of different biologics were based on national reimbursement registry data. Patients were assumed to receive either adalimumab (40mg) or secukinumab (150mg) according to their approved dose. Among the included patients (n=827) 26% were estimated to begin their first biologic treatment, and rest were assumed to be on ongoing treatment. Response to treatment and subsequent switching was incorporated in order to take further treatment lines into account. Response rates were based on a previously published matching-adjusted indirect comparison (MAIC) between secukinumab and adalimumab. Patients not achieving response (ASAS20) were switched to another biologic treatment. All patients received full year treatment. Cost for second line biologic treatment was weighted with the corresponding market shares. According to the budget impact analysis, treating AS patients with secukinumab instead of adalimumab would lead to EUR4,8M savings within a 1-year time period. The annual total costs were EUR6,5M vs EUR11,3M with/without secukinumab, respectively. Potentially 74% more AS patients (1442 vs 827) could be treated with secukinumab instead of adalimumab under a given health care budget. The response rates for secukinumab were consistently higher compared to adalimumab, based on matching-adjusted indirect comparison. Considerably more patients could be treated more effectively with a biologic under rational allocation of resources. These results also suggest dominance of secukinumab compared to adalimumab as it gives higher treatment outcomes with lower costs in the treatment of patients with active AS in Finland.

Multi-country outbreak of Salmonella enteritidis infection linked to the international ice hockey tournament.

In April 2015, Finnish public health authorities alerted European Union member states of a possible multi-country Salmonella enteritidis outbreak linked to an international youth ice-hockey tournament in Latvia. The European Centre for Disease Prevention and Control (ECDC), Finnish and Latvian authorities initiated an outbreak investigation to identify the source. The investigation included a description of the outbreak, retrospective cohort study, microbiological investigation and trace-back. We identified 154 suspected and 96 confirmed cases from seven countries. Consuming Bolognese sauce and salad at a specific event arena significantly increased the risk of illness. Isolates from Finnish, Swedish and Norwegian cases had an identical multiple-locus variable-number of tandem repeats analysis-profile (3-10-6-4-1). Breaches in hygiene and food storing practices in the specific arena's kitchen allowing for cross-contamination were identified. Riga Cup participants were recommended to follow good hand hygiene and consume only freshly cooked foods. This investigation demonstrated that the use of ECDC's Epidemic Intelligence Information System for Food- and Waterborne Diseases and Zoonoses platform was essential to progress the investigation by facilitating information exchange between countries. Cross-border data sharing to perform whole genome sequencing gave relevant information regarding the source of the outbreak.

Identifying and Intervening in Child Maltreatment and Implementing Related National Guidelines by Public Health Nurses in Finland and Japan.

Aim. This study aimed to investigate how public health nurses identify, intervene in, and implement the guidelines on child maltreatment in Finland and Japan and to compare the data between the two countries. Method. This study employed a cross-sectional design. Public health nurses' knowledge and skills with respect to child maltreatment prevention were assessed using a questionnaire consisting of three categories: identification, intervention, and implementation of guidelines. Public health nurses working in the area of maternal and child health care in Finland (n = 193) and Japan (n = 440) were the participants. Results. A significantly higher percentage of Japanese public health nurses identified child maltreatment compared to Finnish public health nurses, while Finnish nurses intervened in child maltreatment better than their Japanese counterparts. In both countries, public health nurses who had read and used the guidelines dealt with child maltreatment better than those who did not. Conclusion. The results suggest that effective training on child maltreatment and the use of guidelines are important to increase public health nurses' knowledge and skills for identifying and intervening in child maltreatment.