Pirkanmaa Region Research Articles

Climate leadership competencies in public sector organisations in the Pirkanmaa region of Finland

Piirkonnad saavad sobivaid meetmeid kasutusele võttes kliimamuutusi leevendada ja nendega kohanemist toetada. Selle uuringu raames küsisime Soome Pirkanmaa maakonna avaliku sektori organisatsioonide kliimastrateegia koostamise ja rakendamisega tegelevate töötajate arvamust selle kohta, mida on vaja kliimapoliitika eestvedamiseks piirkondlikus organisatsioonis. Kirjeldame piirkondliku tasandi avaliku sektori organisatsioonides töötavate kliimamuutuste leevendamise ja nendega kohanemisega tegelevate juhtide ehk kliimapoliitika juhtide omadusi ressursside, protsesside, probleemide ja motivatsiooni kaudu ning piirkondlikul tasandil kliimapoliitika eestvedamiseks vajalikke pädevusi. Selle uuringu eesmärk on toetada hariduse kavandamist selliselt, et see vastaks paremini piirkondliku kliimapoliitika elluviijate vajadustele. Full text

Climate leadership competencies in public sector organisations in the Pirkanmaa region of Finland

Regions play an important role in concretising climate change mitigation and adaptation action. In this study, we asked those who work in designing and implementing climate strategies in regional public sector organisations in the Pirkanmaa region of Finland, for their views on what is needed for climate leadership in a regional organisation. We characterise the attributes of a climate leader in the context of regional public sector organisations in terms of the resources, processes, challenges and motivations in their work on climate change mitigation and adaptation, and describe the competencies needed for regional climate leadership. This research aims to support education design better to respond to the needs of regional climate actors.

N42 New tool for IBD nurses to support IBD patients

Abstract Background There are about 58000 Inflammatory Bowel Disease (IBD) patients in Finland. The number has doubled in ten years. Over 5500 IBD patients live in the Pirkanmaa region. Patients are treated in three different hospitals and there are eight trained IBD nurses in adult services. Patients can contact a call back-system at any hour of the day. With growing number of patient contacts there is a need for additional contact channels and ways of support for patients care. Methods TaysPolku is an app developed by Buddy HealthCare where IBD patients can see their appointments, upcoming procedures, information packages, medication instructions, videos and questionnaires related to their treatment all in one place. TaysPolku provides automatic reminders and enables them to contact their own care unit directly via message. IBD nurses has been part of creating material for TaysPolku. IBD nurse explains the app and creates TaysPolku for the patient after providing the necessary information. The app is downloaded from app stores, verified by strong authentication. The app works with any face ID or pin number chosen by the patient. Results TaysPolku was introduced in June 2021 and the first users were patients receiving intravenous biologicals. IBD nurses informed about the new service during the infusion visits and provided written material. In the next phase, TaysPolku was set up for biological self-injecting patients. Currently, TaysPolku have been created 299 patients at Tampere University Hospital Tays. The utilization rate of the created TaysPolku is high. Messages on TaysPolku has been send/received 3896 times. The messages feature enables the care unit to reach everyone using TaysPolku simultaneously. It is used in all three hospitals and every IBD nurses take care of it. Satisfaction with TaysPolku has been good for both patients and IBD nurses. Patient questionnaire highlighted the benefits, and the answers highlighted the ease of use of the service. "A well-functioning system " "Reminds me very much of the lab, questions and treatment days. Easy to useand connect. There could also be a connection to other departments when care is taken in other departments as well" Conclusion Different forms of service are needed with the growing number of patients, and a digital app that supports the patient's self-care has been proven to work. Further development is underway to offer a similar service to all IBD patients in the region.

Home Care Employees’ Experiences of Collegial Peer Support during the Pandemic

Employee wellbeing has in many cases weakened and peer support has lessened. Nurses’ exhaustion and decisions to change jobs are major challenges to the social and health care field. The purpose of this study was to chart home care employees’ experiences of collegial peer support during the pandemic. The study questions were what is employees’ collegial peer support like? And how could collegial peer support be developed? This study is part of a national project. The data were collected through themed group interviews conducted via the Teams platform. The participants were 15 nurses who work in the Pirkanmaa region. The data were analyzed through inductive content analysis. The home care nurses’ collegial peer support is based on trust and is visible as peer support that reinforces employee agency, multichannel communication and a customer-focused, organization-based approach. The respondents wished for supervisors’ support, official permission and training in experimenting with different forms of peer support. Through this study, collegial peer support in nursing has been made visible and modelled on a new conceptual level. The organization-based peer support that rose as part of the results offers an important perspective on the growing labor shortage in the social and health care field. The opportunities offered by collegial peer support between social and health care professionals require further study. Keywords: collegiality, peer support, employees, home care, Finland

Incidence of surgically treated post-traumatic hydrocephalus 6 months following head injury in patients undergoing acute head computed tomography

BackgroundPost-traumatic hydrocephalus (PTH) is a well-known complication of head injury. The percentage of patients experiencing PTH in trauma cohorts (0.7–51.4%) varies greatly in the prior literature depending on the study population and applied diagnostic criteria. The objective was to determine the incidence of surgically treated PTH in a consecutive series of patients undergoing acute head computed tomography (CT) following injury.MethodsAll patients (N = 2908) with head injuries who underwent head CT and were treated at the Tampere University Hospital’s Emergency Department (August 2010–July 2012) were retrospectively evaluated from patient medical records. This study focused on adults (18 years or older) who were residents of the Pirkanmaa region at the time of injury and were clinically evaluated and scanned with head CT at the Tampere University Hospital’s emergency department within 48 h after injury (n = 1941). A thorough review of records for neurological signs and symptoms of hydrocephalus was conducted for all patients having a radiological suspicion of hydrocephalus. The diagnosis of PTH was based on clinical and radiological signs of the condition within 6 months following injury. The main outcome was surgical treatment for PTH. Clinical evidence of shunt responsiveness was required to confirm the diagnosis of PTH.ResultsThe incidence of surgically treated PTH was 0.15% (n = 3). Incidence was 0.08% among patients with mild traumatic brain injury (TBI) and 1.1% among those with moderate to severe TBI. All the patients who developed PTH underwent neurosurgery during the initial hospitalization due to the head injury. The incidence of PTH among patients who underwent neurosurgery for acute traumatic intracranial lesions was 2.7%.ConclusionThe overall incidence of surgically treated PTH was extremely low (0.15%) in our cohort. Analyses of risk factors and the evaluation of temporal profiles could not be undertaken due to the extremely small number of cases.

Chronic subdural hematoma\u2014incidence, complications, and financial impact

ObjectiveTo examine the population-based incidence, complications, and total, direct hospital costs of chronic subdural hematoma (CSDH) treatment in a neurosurgical clinic during a 26-year period. The aim was also to estimate the necessity of planned postoperative follow-up computed tomography (CT).MethodsA retrospective cohort (1990–2015) of adult patients living in Pirkanmaa, Finland, with a CSDH was identified using ICD codes and verified by medical records (n = 1148, median age = 76 years, men = 65%). Data collection was performed from medical records. To estimate the total, direct hospital costs, all costs from hospital admission until the last neurosurgical follow-up visit were calculated. All patients were followed until death or the end of 2017. The annual number of inhabitants in the Pirkanmaa Region was obtained from the Statistics Finland (Helsinki, Finland).ResultsThe incidence of CSDH among the population 80 years or older has increased among both operatively (from 36.6 to 91/100,000/year) and non-operatively (from 4.7 to 36.9/100,000/year) treated cases. Eighty-five percent (n = 978) underwent surgery. Routine 4–6 weeks’ postoperative follow-up CT increased the number of re-operations by 18% (n = 49). Most of the re-operations (92%) took place within 2 months from the primary operation. Patients undergoing re-operations suffered more often from seizures (10%, n = 28 vs 3.9%, n = 27; p < 0.001), empyema (4.3%, n = 12 vs 1.1%, n = 8; p = 0.002), and pneumonia (4.7%, n = 13 vs 1.4%, n = 12; p = 0.008) compared with patients with no recurrence. The treatment cost for recurrent CSDHs was 132% higher than the treatment cost of non-recurrent CSDHs, most likely because of longer hospital stay for re-admissions and more frequent outpatient follow-up with CT. The oldest group of patients, 80 years or older, was not more expensive than the others, nor did this group have more frequent complications, besides pneumonia.ConclusionsBased on our population-based study, the number of CSDH patients has increased markedly during the study period (1990–2015). Reducing recurrences is crucial for reducing both complications and costs. Greater age was not associated with greater hospital costs related to CSDH. A 2-month follow-up period after CSDH seems sufficient for most, and CT controls are advocated only for symptomatic patients.

The incidence of chronic subdural hematomas from 1990 to 2015 in a defined Finnish population.

The aim of this study was to determine the population-based epidemiology of chronic subdural hematoma (CSDH) over a 26-year period. A retrospective study was conducted of all adult patients (≥ 18 years and residents of Pirkanmaa [Finland]) with a diagnosis of CSDH between 1990 and 2015. The cases were identified using ICD codes. Detailed data collection was performed using medical records and death certificates. All patients were monitored until death or the end of year 2017. The annual number of inhabitants in the Pirkanmaa region was obtained from Statistics Finland (Helsinki, Finland). A total of 1168 patients with CSDH were identified from hospital records and death certificates; patients were considered as new-incidence cases if 2 years had elapsed following primary treatment and in cases involving a new contralateral CSDH. From 1990 to 2015, the overall incidence of CSDH doubled from 8.2 to 17.6/100,000/year. Among adults younger than 70 years, the incidence remained quite stable, whereas the incidence clearly increased among the ≥ 80-year-old population, from 46.9 to 129.5/100,000/year. The median age for a CSDH diagnosis increased from 73 to 79 years during the 26-year period. Head trauma was documented in 59% of cases. A ground-level fall was related to the CSDH in 31% of patients younger than 60 years and in 54% of those 80 years or older. The proportion of alcohol-related cases decreased toward the end of the study period (1990-1995: 16% and 2011-2015: 7%), because alcohol abuse was less frequent among the growing group of elderly patients. In contrast, the percentage of patients receiving anticoagulant or antiplatelet medication almost doubled toward 2015 (1990-1995, 27%; and 2011-2015, 49%). The patients' neurological condition on admission, based on both Glasgow Coma Scale score (score < 13: 1990-1995, 18%; and 2011-2015, 7%; p < 0.001) and the modified Rankin Scale score (score 0-2: 1990-1995, 8%; and 2011-2015, 19%; p < 0.001), was better in recent years than in the early 1990s. From 1990 to 2015, the incidence of CSDH has increased markedly. The incidence of CSDH among the population 80 years or older has nearly tripled since 1990. The use of anticoagulants has increased, but there has been no change regarding the ratio between a traumatic and a spontaneous CSDH etiology. As the world population becomes progressively older, the increasing incidence of CSDH will be a burden to patients and a future challenge for neurosurgical clinics.

The effect of a movement-to-music video program on the objectively measured sedentary time and physical activity of preschool-aged children and their mothers: A randomized controlled trial.

Regular physical activity (PA) and the avoidance of prolonged sitting are essential for children’s healthy growth, and for the physical and mental wellbeing of both children and adults. In the context of exercise, music may promote behavioral change through increased exercise adherence and participation. The purpose of this study was to determine whether a movement-to-music video program could reduce sedentary behavior (SB) and increase PA in mother-child pairs in the home environment. A randomized controlled trial was conducted in the Pirkanmaa region, Finland, in 2014–2016. The participants consisted of 228 mother-child pairs (child age 5–7 years). The primary outcomes of interest were tri-axial accelerometer-derived SB and PA, which were measured in weeks one (baseline), two, and eight in both the intervention and control groups. Further, the mothers and children in the intervention group used a movement-to-music video program from the beginning of week two to the end of week eight. Secondary outcomes included self-reported screen time. The statistical methods employed comprised an intention-to-treat and linear mixed effects model design. No statistically significant differences between groups were found in primary or secondary outcomes. Among the children in the control group, light PA decreased significantly over time and screen time increased from 89 (standard deviation, SD 37) to 99 (SD 41) min/d. Among mothers and children in the intervention group, no statistical differences were found. In supplementary analysis, the children who stayed at home instead of attending daycare/preschool had on average 25 (95% confidence interval, CI 19–30) min/d more sedentary time and 11 (95% CI 8–14) min/d less moderate-to-vigorous PA than those who were at daycare/preschool. The higher body mass index of mothers was related with 5 (95% CI 2–7) min/d more sedentary time and 1 (95% CI 0–2) min/d less moderate-to-vigorous PA. The movement-to-music video program did not change the objectively measured SB or PA of the mother-child pairs. However, mothers and children seemed to be more sedentary at home, and therefore interventions for decreasing SB and increasing PA should be targeted in the home environment.

Differences in sedentary time and physical activity among mothers and children using a movement-to-music video program in the home environment: a pilot study.

Measured objectively, less than a quarter of adults and under half of preschool children in Finland meet the physical activity recommendations. Moreover, higher sedentary time among parents (such as watching television) is associated with higher sedentary time of their children. The study introduces an intervention based on reducing sedentary behavior among mothers and their children. It utilizes a combination of music and exercise via a motivation-targeting movement-to-music video program in the home environment. Data were collected in summer 2014 from Finland’s Pirkanmaa region. Each mother–child pair (n = 24, child age: 4–7 years) was assigned to the intervention and control group. Both groups used an accelerometer and completed physical activity diaries for two consecutive weeks (14 days) during waking hours. In addition, the intervention group was instructed to use the movement-to-music video program during the second week. Differences between groups were expected in analysis of sedentary time and physical activity between weeks 1 and 2. The parameters assessed were sedentary time (i.e., lying down or sitting), standing still, and time spent in physical activity. Less sedentary time was revealed in week 2 than in week 1 among both intervention group mothers (56.6 vs. 53.3 %) and for intervention group children (49.5 vs. 46.0 %). The opposite was true of control group mothers (52.1 vs. 52.4 %) and children (46.7 vs. 49.8 %). Within-group differences in mothers’ sedentary time correlated moderately with the children’s sedentary time (Spearman’s r = 0.56). All groups exhibited slightly more standing in the second week than in week 1. Both sets of intervention participants also engaged in more light physical activity in week 2, with the opposite evident for the two control sets. In all groups, except the control children, the proportion of moderate to vigorous physical activity was higher in the second week than the first. The use of music and video content together may yield added benefits in efforts to reduce sedentary behavior and increase physical activity among mothers and their children in the home environment.

Rationale and methods for a randomized controlled trial of a movement-to-music video program for decreasing sedentary time among mother-child pairs.

BackgroundMeasured objectively, under a quarter of adults and fewer than half of preschool children meet the criteria set in the aerobic physical activity recommendations of the Centers for Disease Control and Prevention. Moreover, adults reportedly are sedentary (seated or lying down) for most of their waking hours. Importantly, greater amounts of sedentary time on parents’ part are associated with an increased risk of more sedentary time among their children. A randomized controlled trial targeting mother-child pairs has been designed, to examine whether a movement-to-music video program may be effective in reducing sedentary time and increasing physical activity in the home environment.MethodsMother-child pairs (child age of 4–7 years) will be recruited from among NELLI lifestyle-modification study five-year follow-up cohort participants, encompassing 14 municipalities in Pirkanmaa region, Finland.Accelerometer and exercise diary data are to be collected for intervention and control groups at the first, second and eighth week after the baseline measurements. Background factors, physical activity, screen time, motivation to exercise, and self-reported height and weight, along with quality of life, will be assessed via questionnaires. After the baseline and first week measurements, the participants of the intervention group will receive a movement-to-music video program designed to reduce sedentary time and increase physical activity. Intervention group mother-child pairs will be instructed to exercise every other day while watching the video program over the next seven weeks. Information on experiences of the use of the movement-to-music video program will be collected 8 weeks after baseline. Effects of the intervention will be analyzed in line with the intention-to-treat principle through comparison of the changes in the main outcomes between intervention and control group participants. The study has received ethics approval from the Pirkanmaa Ethics Committee in Human Sciences.DiscussionThe study will yield information on the effectiveness of movement-to-music video exercise in reducing sedentary behavior. Intervention-based methods have proven effective in increasing physical activity in home environments. Music may improve exercise adherence, which creates a possibility of achieving long-term health benefits.Trial registrationThe study is registered at ClinicalTrials.gov, as NCT02270138. It was registered on October 2, 2014.

Non-iatrogenic civilian vascular trauma in a well-defined geographical region in Finland.

The purpose of this study was to assess the incidence, treatment and outcome of vascular trauma in a well-defined geographical region in Finland. A retrospective analysis was conducted of patients admitted to Tampere University Hospital (TAUH), Pirkanmaa, Finland, due to vascular trauma between January 2006 and December 2010. Data regarding trauma mechanism, anatomical location, treatment, and short-term outcome were collected from patients' files and vascular register. Altogether, 143 non-iatrogenic vascular traumas occurred during the study period resulting in an annual trauma incidence of 5.8/100,000/year in the TAUH region. The majority of the injuries were located in the upper extremities (N = 83, 58%). Penetrating injuries comprised 58% (83 patients) of all vascular trauma admissions and were significantly more common among men compared to women (83 and 17%, respectively). The majority (N = 93, 65%) of the injuries were treated surgically, while in 15 (11%) patients the trauma was resolved by endovascular means. The remaining 35 (24%) patients were successfully managed conservatively, i.e., by observation or wound exploration only without the need for later (30-day) vascular repair. Two out of 17 patients (12%) with lower extremity vascular trauma required major amputation. Procedure-related complications occurred in five patients. In-hospital and 30-day mortality was zero. This paper demonstrates that the incidence of non-iatrogenic civilian vascular trauma in the Pirkanmaa region is low and mainly caused by penetrating injury. Further, the majority of vascular traumas are still treated surgically. In general, the short-term survival of patients who survive the initial trauma is good.

Natural Course of Lower Urinary Tract Symptoms in Men Not Requiring Treatment – A 5-Year Longitudinal Population-based Study

To evaluate the natural course of lower urinary tract symptoms (LUTS) by quantifying their longitudinal changes. A population-based study of men aged 55, 65, or 75 years in Pirkanmaa region, Finland was conducted with a 5-year follow-up (1999-2004). Mailed self-administered questionnaire with the Danish Prostatic Symptom Score instrument was used to evaluate LUTS. Men with any treatment for LUTS or a history of prostate cancer were excluded. A total of 1331 men were included in the study. All 12 symptoms exhibited considerable fluctuation over time. Incidence of specific symptoms varied by a factor of 10 and remission by a factor of 4. Overall, common symptoms varied most strongly in terms of incidence and remission, whereas the less common ones such as incontinence behaved in a more stable fashion. Remission was more frequent than incidence for all individual LUTS components. The highest incidence was found for post-micturition symptoms and urgency. Remission was most common in weak stream and least frequent in urgency and urgency incontinence. LUTS are dynamic conditions with strong spontaneous fluctuation over time. Remission was more common than incidence. The strong propensity for spontaneous resolution should also be borne in mind in treatment decisions including prescription practices.

Prevalence and bother of postmicturition dribble in Finnish men aged 30–80 years: Tampere Ageing Male Urologic Study (TAMUS)

The aim of this study was to determine the prevalence and bother of postmicturition dribble in relation to age in the male population. Information for a population-based study was collected by means of a mailed self-administered questionnaire, which was returned by 4384 men out of 7470 (58.7%). The participants were men aged 30-80 years from the Pirkanmaa Region in Finland. The Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire was used to evaluate their urinary symptoms. SPSS was used in the data analysis. Two-sided chi-squared test and Kendall tau-b test were used for analysis. The overall prevalence of postmicturition dribble was 58.1% (95% confidence interval 56.6-59.6). Prevalence of postmicturition dribble increased with age (p < 0.001). In men aged 60-80 years, two-thirds reported postmicturition dribble and approximately one out of four had dribbling into their trousers after voiding. In the 30-year-old group, over 40% reported postmicturition dribble and almost one out of five had also dribbling into their trousers. One out of five men in the 30-year-old group reported minor bother; the proportion of men reporting bother increased with age to one-third of the men in the oldest cohort (p < 0.001). The prevalence of the postmicturition dribble was found to be high in this survey. Half of the 30-year-old men and two-thirds of the men aged 60-80 years had postmicturition dribble. Dribbling into trousers increased with age but as a severe symptom, it was rare (0.5%). Minor problems from postmicturition dribble were common, but major bother occurred seldom (1.1%).

Effect of surgeon's caseload on the quality of surgery and breast cancer recurrence

The aim of this study was to evaluate the effects of the caseloads of individual surgeons on breast cancer primary care and outcome. The extent of primary breast cancer and axillary surgery and the appearance of local recurrences were evaluated for 1377 women operated in Pirkanmaa region between 1.1.1997 and 31.12.2001 and followed- up at least until 31.12.2008 or death. Caseloads of each surgeon were divided into three categories: over 550, 100–200 and under 60. Breast conserving surgery was performed more often by surgeons with the highest (OR 1.32) and the middle (OR 1.54) caseload volumes compared to those with the lowest volumes (p = 0.018). Surgeons with the lowest caseloads also dissected fewer lymph nodes (mean 9.4 versus 11.2 in the highest and 10.9 in the middle caseload volumes; p ≤ 0.001). There were no differences in recurrences between the groups during the mean follow-up time of 8.9 years.

Participatory and multiobjective development of watercourse regulation—creation of regulation alternatives from stakeholders' preferences

Summary: Multicriteria decision analysis methods have been recently applied in many multifaceted and complex environmental problems. Major aims have been to structure and to analyse the complex problems, to compare incommensurable impacts and to clarify the preference order of alternatives. Most of the MCDM tools concentrate on describing the choice among the alternatives. The choice often occurs at the end of the decision-making process, but the process can be assisted with MCDM tools also earlier. The regulation development project of the Pirkanmaa region was a very complex one. There are four large regulated lakes which are connected to each other and a large constructed river downstream. The goal of the lake regulation development project of Pirkanmaa was to create new more sustainable regulation strategies for these lakes. The aim of this study was to clarify the objectives of various stakeholders and to analyse how the differences in their opinions affect target water levels. To structure the regulation development problem a new value-tree based Excel spreadsheet model (REGAIM) was developed. In the model the ecological, social and economic impacts of water levels fluctuation were combined with subjective preferences related to the importance of various impacts. The goal was to support generation of a regulation practice which would satisfy the objectives of the respondent. All in all 36 face to face computer aided interviews with the REGAIM model were undertaken. In this article we present how decision analysis interviews were applied in the first phase of the project. We also analyse the general applicability of this approach to regulation development projects.

Primary health care practitioners' tools for mental health care.

The purpose of this study was to describe and analyse the content of mental health care from the practitioner's point of view. The specific aim of this paper was to outline the types of mental health care tools and the ways in which they are used by primary health care practitioners. The data were derived from interviews with doctors and nurses (n = 29) working in primary health care in six different health care centres of the Pirkanmaa region in Finland. The data were analysed by using qualitative content analysis. The tools of mental health care used in primary health care were categorized as communicative, ideological, technical and collaborative tools. The interactive tools are either informative, supportive or contextual. The ideological tools consist of patient initiative, acceptance and permissiveness, honesty and genuineness, sense of security and client orientation. The technical tools are actions related to the monitoring of the patient's physical health and medical treatment. The collaborative tools are consultation and family orientation. The primary health care practitioner him/herself is an important tool in mental health care. On the one hand, the practitioner can be categorized as a meta-tool who has control over the other tools. On the other hand, the practitioner him/herself is a tool in the sense that s/he uses his/her personality in the professional context. The professional skills and attitudes of the practitioner have a significant influence on the type of caring the client receives. Compared with previous studies, the present informants from primary health care seemed to use notably versatile tools in mental health work. This observation is important for the implementation and development of mental health practices and education.

Carotid Artery Surgery — Critical Analysis of Indications in a Regional Finnish Vascular Center

Background : The purpose of this study was to analyze retrospectively the treatment of patients referred for carotid artery stenosis to a vascular surgical unit in the 1990’s. Main attention was paid to the appropriateness of the indications for CEA.Material and methods : In the Pirkanmaa region (population of 440 000), all carotid surgery is performed in the regional University Hospital. All new referrals for vascular surgery because of carotid stenosis or bruit in 1990, 1992, 1994, 1996 and 1998 were included and case records reviewed.Results : Four hundred patients were referred. Indication for referral was a neurologic event in 46.2%, indefinite symptom in 27.9% and asymptomatic stenosis or carotid bruit in 25.9%. Most patients underwent carotid ultrasound as first imaging (93.7%). Almost half of the patients were operated (n=176). The 30-day combined stroke and death rate was 6.5%. Appropriate indication for CEA was found in 31.6%. Over half (57.0%) of the indications were considered uncertain and 11.4% inappropriate, most of these patients having asymptomatic stenosis.Conclusion : Patients with asymptomatic stenosis underwent CEA relatively often and the proportion of inappropriate indications was too high. Evaluation of indications and perioperative complications is highly important in carotid surgery.

Increased risk of asthma among Finnish construction workers.

To determine the risk of asthma among 7891 Finnish construction workers in the Pirkanmaa Region of southern Finland. Retrospective cohort study of hospital records of the Tampere University Hospital. A population of Pirkanmaa paper mill workers (n=2686) and the Pirkanmaa working age population (n=252,500) served as reference populations. There were 147 new cases of asthma among the construction workers in 1991-1995. The annual rate was 37 per 10,000 workers and the odds ratio was 2.1 [95% confidence interval (CI)=1.2-3.6] for the women and 1.8 (95% CI=1.5-2.2) for the men when compared with the general working age population. In general, the risk of asthma among the paper mill workers did not differ from the risk of asthma among the general working age population. The construction workers had an increased risk for asthma, although the number of reported cases of occupational asthma was lower for the construction workers than for the paper mill workers or for the working population. Construction work, especially dusty tasks, was associated with an elevated risk of asthma. Thus the effect of exposure to irritant agents may have a role in the development of asthma among construction workers. For the most part, these cases of asthma do not meet the criteria for occupational asthma because the specified causal agent can not be defined. The aetiologic agents and mechanisms of asthma in construction work should be clarified for preventive measures.

Ruptured abdominal aortic aneurysm in a well-defined geographic area

Objective: Despite an increasing number of elective operations on abdominal aortic aneurysms (AAAs), the age- and sex-standardized mortality rate of ruptured AAA (RAAA) continues to increase. In the Pirkanmaa region, population 440,000, all aortic surgery is performed at Tampere University Hospital (TAUH). Procedures have been collected into the vascular registry. The purpose of this study was (1) to establish the incidence, modes of treatment, and mortality of RAAA in a defined geographic area; (2) to evaluate the prerupture history to determine if there are any ways to prevent rupture; and to make a forecast about the increase of RAAAs in the next decades. Methods: Population and outcome data in the Pirkanmaa region and information on all patients who died of RAAA during 1990-1997 were provided by Statistics Finland. All operated RAAAs that underwent procedures during 1990 to 1999 were identified from the local vascular registry. To make a forecast for the next decades, an incidence of RAAA was calculated separately for each age group in 5-year intervals. Results: From 1990 to 1997, 221 patients presented with RAAA. The mean incidence was 6.3/100,000 inhabitants. The incidence in the population over 65 years was 35.5/100,000. The total RAAA mortality was 76.9%. A total of 139 patients reached TAUH and 111 underwent emergency surgery. The overall hospital mortality in TAUH was 63.3%. The calculated annual number of RAAA will increase 49.6% in the next 2 decades, and the overall incidence will increase from 6.3 to 8.9/100,000 inhabitants. According to the vascular registry, 166 patients were operated on for RAAA during 1990 to 1999 in TAUH. The 30-day mortality was 50.6%. A minority of the patients (n = 18, 10.8%) had a previously documented AAA. The median diameter at the time of rupture was 7 cm. Seven (5.0%) men and six (24.0%) women had a diameter of less than 5.5 cm. Conclusion: The incidence of RAAA in the Pirkanmaa region in 1990s was the Finnish average. In the next two decades, the number of individuals with RAAA will increase significantly. One quarter of women had a diameter of AAA at the time of rupture that was under the current threshold indicator for elective operation. (J Vasc Surg 2002;36:291-6.)

Projected Workload for a Vascular Service in 2020

Objective to estimate the workload of a vascular service during the next two decades as the proportion of people aged over 65 years increases. Methods the study used the vascular registry data of Tampere University Hospital and the population data of Pirkanmaa region provided by the Central Statistical Office in Finland. The current workload is 1420 vascular procedures per million inhabitants yearly (951 surgical and 207 endovascular). Sixty-five per cent of all procedures are done on people over 65 years old. Pirkanmaa has a population of 440 000 persons of whom 15.6% are over 65 years. According to the population data the population will increase to 460 000 persons by the year 2020 and 22.9% of them will be over 65 years old. Results the total amount of procedures will rise by 40.5% (1906) and the increase in endovascular and surgical group will be 39.2% (640) and 43.5% (1265) respectively. The proportion of treated patients over 65 years will rise from 65.0% to 70.5%. In the next two decades the amount of patients with claudication will increase by 35.4%, critical limb ischaemia by 44.2%, carotid surgery by 34.0%, abdominal aortic aneurysms by 40.7%, acute limb ischaemia by 45.0% and access surgery by 27.4%. Conclusion in the next two decades the number of elderly people will increase so rapidly that, whatever happens to the incidence and prevalence of peripheral vascular disease, the workload for a vascular service will increase significantly.