Southwest Finland Research Articles

Interlobate esker architecture and related hydrogeological features derived from a combination of high-resolution reflection seismics and refraction tomography, Virttaankangas, southwest Finland

A novel high-resolution (2–4 m source and receiver spacing) reflection and refraction seismic survey was carried out for aquifer characterization and to confirm the existing depositional model of the interlobate esker of Virttaankangas, which is part of the Säkylänharju-Virttaankangas glaciofluvial esker-chain complex in southwest Finland. The interlobate esker complex hosting the managed aquifer recharge (MAR) plant is the source of the entire water supply for the city of Turku and its surrounding municipalities. An accurate delineation of the aquifer is therefore critical for long-term MAR planning and sustainable use of the esker resources. Moreover, an additional target was to resolve the poorly known stratigraphy of the 70–100-m-thick glacial deposits overlying a zone of fractured bedrock. Bedrock surface as well as fracture zones were confirmed through combined reflection seismic and refraction tomography results and further validated against existing borehole information. The high-resolution seismic data proved successful in accurately delineating the esker cores and revealing complex stratigraphy from fan lobes to kettle holes, providing valuable information for potential new pumping wells. This study illustrates the potential of geophysical methods for fast and cost-effective esker studies, in particular the digital-based landstreamer and its combination with geophone-based wireless recorders, where the cover sediments are reasonably thick.

Enhancing the Resilience of Electricity Networks by Multi-stakeholder Risk Assessment: The Case Study of Adverse Winter Weather in Finland

Electricity networks in Finland are subject to adverse winter weather, particularly a combination of heavy snowfall with strong winds, causing electricity outages especially in the rural areas. The severe consequences of such events require that electricity distributors and the entire network of stakeholders establish a proactive risk management for achieving enhanced situational awareness during adverse weather events, efficient and effective recovering after electricity outage as well as improved preparedness against future events. This paper shows how a risk assessment performed with an Action Error Analysis (AEA) were conducted in order to enhance the resilience of electricity networks against adverse winter weather. This also encompassed an assessment of co-operation and communication structures about such risks. Adverse winter weather that took place in Pirkanmaa, in South-West Finland in November 2015, serves as a case study and laboratory for the assessments. The results of the AEA underscore the importance of co-operation and communication-related challenges that electricity distributors, rescue authorities and municipalities face in maintaining and obtaining a high level of resilience of electricity networks during and after heavy snowfalls. Against this background, novel ways and measures related to co-operation and communication of stakeholders to improve the resilience of electricity networks against future events are discussed.

Simple dietary criteria to improve serum n-3 fatty acid levels of mothers and their infants.

Sufficient maternal dietary intake of n-3 fatty acids (FA) supports offspring development. We aimed to construct simple criteria for dietary counselling to improve intake of n-3 FA. Serum phospholipid FA from mothers and infants were analysed by GC one month after delivery. Dietary intake of foods during pregnancy and one month after delivery were recorded using 3 d food diaries and an index for healthy eating was calculated. Fish consumption was established by questionnaires. Dietary consumption of foods resulting in an increase in serum n-3 FA was defined. A mother-child follow-up study in Southwest Finland. Mothers (n 90) and 1-month-old infants (n 63). After delivery, the mother's consumption of fish at least three times per week resulted in an increase in total serum n-3 FA (mean difference (95 % CI): 1·7 (0·7, 2·8) % of total FA, P<0·001) and DHA (1·1 (0·5, 1·8) % of total FA, P<0·001) compared with non-consumers. Persistent fish intake once weekly throughout pregnancy increased total serum n-3 FA (P=0·001) and DHA (P<0·001). Overall, a healthy diet (middle and highest tertiles of healthy eating index score v. the lowest tertile) resulted in higher total serum n-3 FA (P=0·004) and DHA (P=0·008). Mother's diet along with higher serum levels of n-3 FA were related to serum FA levels in 1-month-old infants. An overall healthy diet and persistent consumption of fish at least once weekly throughout pregnancy or more frequent fish intake three times per week increases n-3 FA in serum phospholipids of both mothers and their infants.

Frequency and occurrence of the carrot pathogen ‘Candidatus Liberibacter solanacearum’ haplotype C in Finland

Occurrence of ‘Candidatus Liberibacter solanacearum’ (CLso) was studied in field‐grown carrots (Daucus carota) in different regions of Finland. In addition, the frequency of CLso in carrots and in field populations of its vector, the carrot psyllid (Trioza apicalis), was studied in southwestern Finland. CLso was detected in six of the seven regions where the main carrot cultivation areas are located. The highest disease incidence was found in southwestern Finland, in the area where this carrot pathogen was originally found. In the Tavastia Proper and Southwest Finland regions, CLso was detected in 26 out of 30 randomly chosen fields inspected in 2013 and 2014, and in a third of those fields more than 10% of plants showed symptoms. Of those carrots showing both psyllid feeding‐associated leaf curling and CLso infection‐associated leaf discolouration symptoms, 77% were CLso positive in the PCR test. Some symptomless carrots from the affected fields also tested positive. Of the carrot psyllid individuals collected from the same area, 60% were CLso positive. Elsewhere, disease incidence was variable in South Ostrobothnia in western Finland and low but established in South Savonia in eastern Finland. CLso was not detected in the North Ostrobothnia region. Sequencing of the amplified DNA fragments confirmed that the bacteria in the carrot samples from different areas within Finland all represented CLso haplotype C. The frequent occurrence and wide distribution of this pathogen, transmitted by a psyllid that does not migrate over long distances, suggest that it is persistent in Finland.

After the Merger:

&#x0D; Democratic innovations are often considered a solution to the widespread citizen disengagement from politics at both national and local levels of government. However, it is still not clear what forms of engagement citizens prefer and whether the innovations can help sustain popular involvement in times of political turmoil. In this study, we examine whether inhabitants consider democratic innovations to be an important way to sustain citizen engagement after a municipal merger and whether introducing new ways of involvement can help mobilise otherwise disengaged groups of citizens. The data come from a survey answered by 2000 respondents in 14 current municipalities in the Turku region of Southwest Finland. The 14 municipalities are all currently involved in plans for a municipal merger to create a larger municipality. In the survey, we ask the respondents about their attitudes towards the use of various democratic innovations in the case of a municipal merger. The results suggest that citizens consider democratic innovations as important for creating a functioning democracy after a municipal merger. However, it is unlikely that democratic innovations will mobilise people not already involved in politics, regardless of the characteristics of the previous municipality.&#x0D;

Spatial patterns of littoral zooplankton assemblages along a salinity gradient in a brackish sea: A functional diversity perspective

The distribution patterns and diversity of littoral zooplankton are both key baseline information for understanding the functioning of coastal ecosystems, and for identifying the mechanisms by which the impacts of recently increased eutrophication are transferred through littoral food webs. In this study, zooplankton community structure and diversity along a shallow coastal area of the northern Baltic Sea were determined in terms of horizontal environmental gradients. Spatial heterogeneity of the zooplankton community was examined along the gradient. Altogether 31 sites in shallow sandy bays on the coast of southwest Finland were sampled in the summer periods of 2009 and 2010 for zooplankton and environmental variables (surface water temperature, salinity, turbidity, wave exposure, macrophyte coverage, chlorophyll a and nutrients). Zooplankton diversity was measured as both taxonomic as well as functional diversity, using trait-based classification of planktonic crustaceans. Salinity, and to a lesser extent turbidity and temperature, were found to be the main predictors of the spatial patterns and functional diversity of the zooplankton community. Occurrence of cyclopoid copepods, as well as abundances of the calanoid copepod genus Acartia and the rotifer genus Keratella were found to be key factors in differentiating sites along the gradient. As far as we know, this is the first extensive study of functional diversity in Baltic Sea coastal zooplankton communities.

The Population of the Southeast Shore of the Gulf of Finland and its Contacts with Regions of the Baltic Sea in the First Millennium AD

In recent years, the area to the southeast of the Gulf of Finland (on the Izhora plateau and in the lower reaches of the River Luga) has opened up a number of archaeological sites dating from the first to the tenth century AD. There are stone graves from the Pre-Roman and Roman Iron Age, settlements with scratched ceramics, cremation burials from the Migration Period, hill-forts and cemeteries from the Viking Age. These sites can be built into a cultural and chronological sequence. Finds from these sites are very similar to objects from Estonia and southwest Finland. At the beginning of the second millennium, Medieval Russian culture, which levelled local cultural characteristics, spread on the Izhora plateau. Key words: East Baltic, Gulf of Finland, Izhora plateau, Pre-Roman and Roman Iron Age, Migration Period, Viking Age, Medieval Russian culture. DOI: http://dx.doi.org/10.15181/ab.v23i0.1305

A Comparison of Medical Birth Register Outcomes between Maternity Health Clinics and Integrated Maternity and Child Health Clinics in Southwest Finland.

Introduction:Primary maternity care services are globally provided according to various organisational models. Two models are common in Finland: a maternity health clinic and an integrated maternity and child health clinic. The aim of this study was to clarify whether there is a relation between the organisational model of the maternity health clinics and the utilisation of maternity care services, and certain maternal and perinatal health outcomes.Methods:A comparative, register-based cross-sectional design was used. The data of women (N = 2741) who had given birth in the Turku University Hospital area between 1 January 2009 and 31 December 2009 were collected from the Finnish Medical Birth Register. Comparisons were made between the women who were clients of the maternity health clinics and integrated maternity and child health clinics.Results:There were no clinically significant differences between the clients of maternity health clinics and integrated maternity and child health clinics regarding the utilisation of maternity care services or the explored health outcomes.Conclusions:The organisational model of the maternity health clinic does not impact the utilisation of maternity care services or maternal and perinatal health outcomes. Primary maternity care could be provided effectively when integrated with child health services.

Risk of osteoporotic fractures in multiple sclerosis patients in southwest Finland.

Increased risk of osteoporotic fractures in multiple sclerosis (MS) patients compared with general population has been reported. The purpose of this study was to assess the risk of osteoporotic and other low-energy fractures in an MS cohort from a large hospital district in southwest Finland. Age-adjusted total and gender-specific prevalence for definite MS per 100000 in a population of 472139 was calculated as a point prevalence in December 31, 2012. Patients with MS and comorbid fractures were identified by searching for ICD-9 and ICD-10 codes during a period from 2004 to 2012 from hospital administrative data in Turku University Hospital (TYKS) in southwest Finland Case ascertainment was performed by review of medical records. Osteoporotic fracture was defined as a low-energy fracture of the pelvis, hip, femur, tibia, humerus, collar bone, ulna/radius, vertebrae, or rib. The control population was a 10-fold age- and gender-matched population. The point prevalence (N 1004) of MS was 212.6/105 (CI 199.5-225.8) in December 31, 2012. A total of 100 (9.9%) of 1004 confirmed MS cases experienced at least one fracture during the study period. Relative risks (RRs) for all fractures (1.33, 95% CI 1.10-1.60) and osteoporotic fractures (1.50, 95% CI 1.18-1.90) were significantly increased in patients with MS compared with controls. In particular, RRs for hip fractures (5.00, 95% CI 2.96-8.43) and fractures of humerus (2.36, 95% CI 1.32-4.42) were elevated in patients with MS vs controls. We observed high prevalence of MS in southwest Finland and confirmed increased age-adjusted comorbid risk for osteoporotic fractures and other low-energy fractures compared with individually matched controls.

Factors associated with objectively measured physical activity and sedentary time of 5–6-year-old children in the STEPS Study

ABSTRACTBackground: The factors associated with preschool-aged children’s physical activity (PA) remains unclear. The aim of this cross-sectional study was to examine how different factors were associated with preschool-aged children’s objectively measured PA and sedentary time. Methods: The study population was 5–6-year-old children (n = 140) and their parents (n = 138) from the STEPS Study in Turku in Southwest Finland in 2013–2014. PA and sedentary time were measured objectively by accelerometers from children and parents and body mass index with Tanita scale. Other factors (siblings, day care, organized PA and parents’ education) were collected with questionnaires. Linear models were conducted. Results: Child’s PA was positively associated with mother’s PA and day care attendance. Child’s sedentary time was positively associated with mother’s sedentary time. Father’s PA and sedentary time were associated with respective variables in children, but only among fathers with high education. Conclusion: Parental role modelling is essential in developing child’s physically active and less sedentary lifestyle.

Moss bag (Sphagnum papillosum) magnetic and elemental properties for characterising seasonal and spatial variation in urban pollution

This study investigates the seasonal and spatial variation of traffic-induced particle matter in order to evaluate the pollutant distribution and the representativeness of the single air quality monitoring station in the city centre of Turku, southwest Finland. Study focused on parks, kindergarten and school yards as well as heavily trafficked sites. Sampling was done using active magnetic biomonitoring, which is highly applicable in polluted areas lacking native species. Sphagnum papillosum moss bags were exposed separately in road dust period, which is experienced after snow melt and the resuspension of sanding material in spring, and summer season for about 60 days in 2013. Moss bags are magnetically and elementally (e.g. Al, Cr, Fe, Na, Ni, Pb) more enriched in road dust period and near heavily trafficked sites than in summer season and in the courtyard or park sites. Magnetic properties indicate that particle matter is composed of fine-grained pseudo-single-domain magnetite towards superparamagnetic–single-domain grain sizes. Intensive road dust period overrides the variation of prevailing conditions as indicated by three paired samples showing finer grain sizes and higher element levels in courtyard/park sites than in traffic sites in summer. The results emphasise the effectiveness of active magnetic biomonitoring for the assessment of spatially representative air quality monitoring stations and related modelling approaches.

Internet-Assisted Parent Training Intervention for Disruptive Behavior in 4-Year-Old Children: A Randomized Clinical Trial.

There is a large gap worldwide in the provision of evidence-based early treatment of children with disruptive behavioral problems. To determine whether an Internet-assisted intervention using whole-population screening that targets the most symptomatic 4-year-old children is effective at 6 and 12 months after the start of treatment. This 2-parallel-group randomized clinical trial was performed from October 1, 2011, through November 30, 2013, at a primary health care clinic in Southwest Finland. Data analysis was performed from August 6, 2015, to December 11, 2015. Of a screened population of 4656 children, 730 met the screening criteria indicating a high level of disruptive behavioral problems. A total of 464 parents of 4-year-old children were randomized into the Strongest Families Smart Website (SFSW) intervention group (n = 232) or an education control (EC) group (n = 232). The SFSW intervention, an 11-session Internet-assisted parent training program that included weekly telephone coaching. Child Behavior Checklist version for preschool children (CBCL/1.5-5) externalizing scale (primary outcome), other CBCL/1.5-5 scales and subscores, Parenting Scale, Inventory of Callous-Unemotional Traits, and the 21-item Depression, Anxiety, and Stress Scale. All data were analyzed by intention to treat and per protocol. The assessments were made before randomization and 6 and 12 months after randomization. Of the children randomized, 287 (61.9%) were male and 79 (17.1%) lived in other than a family with 2 biological parents. At 12-month follow-up, improvement in the SFSW intervention group was significantly greater compared with the control group on the following measures: CBCL/1.5-5 externalizing scale (effect size, 0.34; P < .001), internalizing scale (effect size, 0.35; P < .001), and total scores (effect size, 0.37; P < .001); 5 of 7 syndrome scales, including aggression (effect size, 0.36; P < .001), sleep (effect size, 0.24; P = .002), withdrawal (effect size, 0.25; P = .005), anxiety (effect size, 0.26; P = .003), and emotional problems (effect size, 0.31; P = .001); Inventory of Callous-Unemotional Traits callousness scores (effect size, 0.19; P = .03); and self-reported parenting skills (effect size, 0.53; P < .001). The study reveals the effectiveness and feasibility of an Internet-assisted parent training intervention offered for parents of preschool children with disruptive behavioral problems screened from the whole population. The strategy of population-based screening of children at an early age to offering parent training using digital technology and telephone coaching is a promising public health strategy for providing early intervention for a variety of child mental health problems. clinicaltrials.gov Identifier: NCT01750996.

Phosphorus speciation in agricultural catchment soils and in fresh and dried sediments of five constructed wetlands

Constructed wetlands and ponds (CWs) are installed to trap suspended material and particulate phosphorus (P) in agricultural runoff. This study investigated whether the P speciation and P sorption capacity of source soils differ from those of CW sediments and whether drying of dredged sediment changes its characteristics. Samples collected from five agricultural CW sites in south-west Finland, two with chemical-aided (aluminium chloride and ferric sulphate) P precipitation and all representing fine-textured mineral soils, were analysed for various P plant availability indices. Clay contents of the CW sediments were much higher than in catchment soils, likely because of selective erosion. All CW sediments were characterised by similar total P content but clearly higher content of anion exchange resin-extractable P in fresh sediments than the source soils. In general, sediment content of NH4F-extractable (aluminium (Al)-associated) P was significantly lower and NaOH-extractable (iron (Fe)-associated) significantly higher than in source soils. Reduced conditions, conducive to mobilisation of Fe-associated P, were observed in all CWs. Accumulation of sulphur (S) in sediments and a pH decline of up to two units upon drying suggested presence of Fe sulphides. Drying also increased oxalate-extractable Al and Fe (hydr)oxide content by 9–47%, resulting in lower degree of P saturation. These results indicate that dredged CW sediments differ greatly in their P retention characteristics from their parent soils. Returning CW sediments to fields is likely to decrease the amount of readily available P for crop uptake.

Causes of stillbirth in Turku, Finland, 2001-2011

The objective of the study was to examine the causes of stillbirth in the district of Southwest Finland and to assess the importance of post-mortem examination, and the selection of a suitable classification system for classifying stillbirths. This study is a cohort study where the fetal autopsies were performed in the Department of Pathology at Turku University Hospital, Finland, 2001-2011. Stillbirths from singleton pregnancies at the gestational age of {greater than or equal to}24+0 weeks (if unknown, gestational weight {greater than or equal to}500g) (n=98) were selected. In addition, stillbirths from multiple gestations (n=6) were also analyzed. The causes of stillbirths were classified according to the Relevant Condition at Death (ReCoDe) classification system. Maternal risk factors and the role of fetal gestational age and weight for the causes of stillbirth were assessed. The most common causes of singleton stillbirth were lethal congenital anomalies, placental insufficiencies, and constricting loops and knots of the umbilical cord. The cause of singleton stillbirth could be determined for 78% of the cases, leaving 22% unclassified. There were no significant differences in the causes of stillbirth by gestational age or weight. Smoking may increase the incidence of placental abruption (p < 0.01). The most common causes of stillbirth in Turku, Finland are consistent with findings from other high-income countries. With careful post-mortem examination and ancillary studies it is possible to find the cause of stillbirth for most of the cases. Even if the stillbirth is left unexplained, many other harmful conditions can be excluded thus benefiting both the parents and the health care unit.

The factors associated with toddlers’ screen time change in the STEPS Study: A two-year follow-up

Background and ObjectivesEarly childhood screen time seems to persist into later childhood. This study examined the factors affecting the screen time change during the first two years of toddler’s lives in Finland. We hypothesized that parents’ sedentary behaviour and physical activity habits correlate significantly with children’s screen time change. MethodsThe data consists of 1797 mothers, 1658 fathers and their 1827 children from the STEPS Study (Steps to the healthy development) in Southwest Finland. Screen time change during the two-year follow-up was calculated for those (n=634) who had both 13 and 36months screen time measures (13months, n=940; 36months, n=845). Demographic correlates and parental behavioural correlates were measured with questionnaires, and anthropometric measurements in study visits. ResultsThe mean change in the children’s screen time was a 55min increase from 13 to 36months. A linear mixed model analysis showed that the father’s longer duration of sitting time was statistically significantly associated with a smaller increase in screen time of the child. Parents’ physical activity was not associated with children’s screen time change. The mother’s advanced education, a younger age, and a lower screen time, the child attending day care and the child’s lower body mass index were associated with children’s smaller increase in screen time. ConclusionThe mother’s advanced education as well as the father’s sitting time, including sitting at the office, implied that children of higher educated parents have a smaller increase in screen time. Future studies should focus on studying why parental education has a greater influence on children’s screen time change than parents’ behaviour.

Measuring the economic value of morning stiffness: consistency over 1 year

Objectives: The aims of this study were to determine the within-patient variation in the duration of morning stiffness (MS) over 1 year and the corresponding monetary equivalents assigned to its changes using the willingness-to-pay (WTP) methodology.Method: A sample of 100 patients with rheumatoid arthritis (RA) was drawn from the register of the Hospital District of Southwest Finland. Subjects were interviewed by telephone on recruitment and 1 year later, using the same structured questionnaire. The subjects were asked to estimate in minutes the typical duration of their MS during the previous week. Sociodemographic background data and subjects’ WTP for a 25, 50, 75, and 100% reduction in MS duration were requested, and years with RA diagnosis and serological data were obtained from hospital records.Results: After 1 year, there was a reduction in average MS duration from 44.7 min to 39.0 min (ns); duration was reduced in 35% of patients, unchanged in 35%, and prolonged in 30%. Changes in MS duration were reflected by within-patient variation in WTP estimates. In linear regression models, change in duration of MS significantly (p < 0.03) explained the variation in change of WTP for symptom reduction.Conclusions: WTP methodology produces consistent monetary values to assess the relative values patients with RA place on reduction in duration of MS.

Democratic Innovations to the Rescue? Political Trust and Attitudes Toward Democratic Innovations in Southwest Finland

ABSTRACTIt is difficult to govern when citizens are unsupportive of the political system. This problem is relevant for municipalities formed through municipal mergers since new political entities need to build political trust. Democratic innovations provide possible solutions to increase citizens’ confidence, but it is unclear whether distrusting citizens demand these opportunities for involvement. This study examines the link between political trust and support for democratic innovations in Southwest Finland with a survey of 2000 respondents in 14 municipalities. The results suggest that distrusting citizens are less supportive of democratic innovations; hence it is unlikely that they increase political trust.

Teacher diversity awareness in the context of changing demographics

This study examined awareness of and knowledge of how to address increasing linguistic and cultural diversity among 89 teachers in an ethnically and racially diverse school located in Southwest Finland. The empirical evidence suggests that in a school with many years of experience with a diverse student population the levels of awareness and knowledge among teachers are relatively low and teachers themselves expressed the need for much more information, in particular, strategies for meeting the needs of their students. In addition, teachers showed distinct levels of awareness of diversity which successively predicted their knowledge of strategies for addressing diversity in the classroom. Implications for research and teacher education are discussed.

Assessing the abundance, seasonal questing activity, and Borrelia and tick-borne encephalitis virus (TBEV) prevalence of Ixodes ricinus ticks in a Lyme borreliosis endemic area in Southwest Finland

Studies have revealed that Ixodes ricinus (Acari: Ixodidae) have become more abundant and their geographical distribution extended northwards in some Nordic countries during the past few decades. However, ecological data of tick populations in Finland are sparse. In the current study, I. ricinus abundance, seasonal questing activity, and their Borrelia spp. and tick-borne encephalitis virus (TBEV) prevalence were evaluated in a Lyme borreliosis endemic area in Southwest Finland, Seili Island, where a previous study mapping tick densities was conducted 12 years earlier. A total of 1940 ticks were collected from five different biotopes by cloth dragging during May–September 2012. The overall tick density observed was 5.2 ticks/100m2 for nymphs and adults. Seasonal questing activity of ticks differed between biotopes and life stages: bimodal occurrences were observed especially for nymphal and adult ticks in forested biotopes, while larvae in pastures exhibited mostly unimodal occurrence. Prevalence of Borrelia and TBEV in ticks was evaluated using conventional and real-time PCR. All samples were negative for TBEV. Borrelia prevalence was 25.0% for adults (n=44) and the minimum infection rate (MIR) 5.6% for pooled nymph samples (191 samples, 1–14 individuals per sample; 30/191 positive). No Borrelia were detected in pooled larval samples (63 samples, 1–139 individuals per sample). Five species of Borrelia were identified from the samples: B. afzelii, B. burgdorferi s.s., B. garinii, B. valaisiana and B. miyamotoi. In Finland, B. valaisiana and B. miyamotoi have previously been reported from the Åland Islands but not from the mainland or inner archipelago. The results of the present study suggest an increase in I. ricinus abundance on the island.

Adherence to surgical hand rubbing directives in a hospital district of Southwest Finland*

Background: The primary objective was to measure the compliance with alcohol-based surgical hand rubbing (SHR) among operation room personnel. The secondary objective was to evaluate the effect of feedback sessions on compliance. Methods: This was a prospective observational before-after intervention study. Between October 2010 and June 2012 the hygiene nurses observed SHR among operation room personnel in the hospital district of Southwest Finland. After feedback sessions a second observation round was conducted in the main operation room of Turku University Hospital. The first observation round comprised 477 observations: 259 (54%) were doctors, 190 (40%) nurses and 28 (5%) other personnel. In the second observation round a total of 210 observations were made. Results: During the first round in 42% of observations the 3 min SHR time recommended by WHO was used. Median times for SHR were 1 min 50 s (range 0 min to 5 min 44 s) for doctors and 3 min 25 s (range 1 min 1 s to 8 min 15 s) for nurses, respectively (p < 0.0001). In 40% of observations hands were not properly dried after a wash before applying SHR and in 45% hands were not allowed to dry properly after SHR before donning surgical gloves. After feedback, time for SHR did not significantly improve but technique did. Conclusions: SHR was performed incorrectly in most observations even after feedback. The results stress the importance of more effective education, helping techniques and positive role models for operation room personnel to promote SHR.