International nursing : cultivating a culture of empowerment

International nursing has been a growing phenomenon throughout the globe. International nurses have been found to be an asset to healthcare organizations and an important part of the health care team. However, growing concern for the plight of international nurses facing obstacles such as professional stagnation and exploitation has spurred the development of strategies to mitigate and ameliorate the experiences of nurses working abroad. In this respect, the purpose of this study was to explore the management-influenced factors and the nurse team-influenced factors that promote the empowerment of the international nurse in the health care setting. The methodology used in this study was a systemic review. After a rigorous search for relevant empirical studies using OVID database, eight empirical research studies were selected using systematic review methodology to collect, analyze and synthesize data. The selected eight empirical studies were then subjected to a content analysis. The results suggested that the empowerment of an international nurse is inseparable from the empowerment of the health care organization. Based on the findings in this study, strategies to promote international nurses were found to mirror strategies evidenced to empower the nursing organization. Some of the management-influenced factors which were found to facilitate empowerment included a diversity rich work culture, transformational leadership at the management level, and a responsibility to foster the values of the organization. The team-influenced factors which were found to contribute to the empowerment of the international nurse included a united mutually-interdependent nurse team, shared accountability among the members of the nurse team, and the building of trust in work relationships. To conlude, this study indicates that efforts to empower international nurses without considering the work culture and the organization as a whole are futile because empowerment cannot take place in an environment that lacks antecedent conditions. Strategies to empower the international nurse should not focus on the deficits and special needs of the international nurse, but should focus on the similarities and commonalities of the nursing body. Empowerment of the international nurse mean open honest communication, supportive work environment, and a firm policy to quell disruptive elements that threaten the organization's values, mission, and philosophy of care.

Marketing culture of Finnish research libraries : an analysis of marketing attitude, knowledge and behaviour

The aim of the present dissertation is to investigate the marketing culture of research libraries in Finland and to understand the awareness of the knowledge base of library management concerning modern marketing theories and practices. The study was based onthe notion that a leader in an organisation can have large impact on its culture. Therefore, it was considered important to learn about the market orientation that initiates at the top management and flows throughout the whole organisationthus resulting in a particular kind of library culture. The study attempts to examine the marketing culture of libraries by analysing the marketing attitudes, knowledge (underlying beliefs, values and assumptions), behaviour (market orientation), operational policies and activities, and their service performance (customer satisfaction). The research was based on the assumption that if the top management of libraries has market oriented behaviour, then their marketing attitudes, knowledge, operational policies and activities and service performance should also be in accordance. The dissertation attempts to connect all these theoretical threads of marketing culture. It investigates thirty three academic and special libraries in the south of Finland. The library director and three to ten customers from each library participated as respondents in this study. An integrated methodological approach of qualitative as well as quantitative methods was used to gain knowledge on the pertinent issues lying behind the marketing culture of research libraries. The analysis of the whole dissertation reveals that the concept of marketing has very varied status in the Finnish research libraries. Based on the entire findings, three kinds of marketing cultures were emerged: the strong- the high fliers; the medium- the brisk runners; and the weak- the slow walkers. The high fliers appeared to be modern marketing believers as their marketing approach was customer oriented and found to be closer to the emerging notions of contemporary relational marketing. The brisk runners were found to be traditional marketing advocates as their marketing approach is more `library centred¿than customer defined and thus is in line of `product orientation¿ i.e. traditional marketing. `Let the interested customers come to the library¿ was appeared to be the hallmark of the slow walkers. Application of conscious market orientation is not reflected in the library activities of the slow walkers. Instead their values, ideology and approach to serving the library customers is more in tuneof `usual service oriented Finnish way¿. The implication of the research is that it pays to be market oriented which results in higher customer satisfaction oflibraries. Moreover, it is emphasised that the traditional user based service philosophy of Finnish research libraries should not be abandoned but it needs to be further developed by building a relational based marketing system which will help the libraries to become more efficient and effective from the customers¿ viewpoint. The contribution of the dissertation lies in the framework showing the linkages between the critical components of the marketing culture of a library: antecedents, market orientation, facilitators and consequences. The dissertationdelineates the significant underlying dimensions of market-oriented behaviour of libraries which are namely customer philosophy, inter-functional coordination,strategic orientation, responsiveness, pricing orientation and competition orientation. The dissertation also showed the extent to which marketing attitudes, behaviour, knowledge were related and impact of market orientation on the serviceperformance of libraries. A strong positive association was found to exist between market orientation and marketing attitudes and knowledge. Moreover, it also shows that a higher market orientation is positively connected with the service performance of libraries, the ultimate result being higher customer satisfaction. The analysis shows that a genuine marketing culture represents a synthesis of certain marketing attitudes, knowledge and of selective practices. This finding is particularly significant in the sense that it manifests that marketing culture consists of a certain sets of beliefs and knowledge (which form a specific attitude towards marketing) and implementation of a certain set of activities that actually materialize the attitude of marketing into practice (market orientation) leading to superior service performance of libraries.

Transforming Maritime Safety Culture. Evaluation of the impacts of the ISM Code on maritime safety culture in Finland

The purpose of the METKU Project (Development of Maritime Safety Culture) is to study how the ISM Code has influenced the safety culture in the maritime industry. This literature review is written as a part of the Work Package 2 which is conducted by the University of Turku, Centre for Maritime Studies. The maritime traffic is rapidly growing in the Baltic Sea which leads to a growing risk of maritime accidents. Particularly in the Gulf of Finland, the high volume of traffic causes a high risk of maritime accidents. The growing risks give us good reasons for implementing the research project concerning maritime safety and the effectiveness of the safety measures, such as the safety management systems. In order to reduce maritime safety risks, the safety management systems should be further developed. The METKU Project has been launched to examine the improvements which can be done to the safety management systems. Human errors are considered as the most important reason for maritime accidents. The international safety management code (the ISM Code) has been established to cut down the occurrence of human errors by creating a safety-oriented organizational culture for the maritime industry. The ISM Code requires that a company should provide safe practices in ship operation and a safe working environment and establish safeguards against all identified risk. The fundamental idea of the ISM Code is that companies should continuously improve safety. The commitment of the top management is essential for implementing a safety-oriented culture in a company. The ISM Code has brought a significant contribution to the progress of maritime safety in recent years. Shipping companies and ships’ crews are more environmentally friendly and more safety-oriented than 12 years ago. This has been showed by several studies which have been analysed for this literature research. Nevertheless, the direct effect and influence of the ISM Code on maritime safety could not be isolated very well. No quantitative measurement (statistics/hard data) could be found in order to present the impacts of the ISM Code on maritime safety. In this study it has been discovered that safety culture has emerged and it is developing in the maritime industry. Even though the roots of the safety culture have been established there are still serious barriers to the breakthrough of the safety management. These barriers could be envisaged as cultural factors preventing the safety process. Even though the ISM Code has been effective over a decade, the old-established behaviour which is based on the old day’s maritime culture still occurs. In the next phase of this research project, these cultural factors shall be analysed in regard to the present safety culture of the maritime industry in Finland.

The Concept of Betterness and Sport Competitions

It is common that people disagree on a question which athlete or team was the best in a particular sport competition. This thesis attempts to clarify these disputes by analysing the concept of betterness in the context of sport competitions. Betterness can be interpersonal, intrapersonal or a combination of the two. I focus on interpersonal betterness, that is, on superiority. For example, interpersonal betterness may be contested in a football match between the national teams of Germany and Argentina. My aim is to provide a philosophical account of interpersonal betterness. The account has two functions: descriptive and normative. It describes the shapes and forms in which superiority is instantiated in sport competitions. It also provides a consistent and accurate way to discuss superiority. The thesis consists of two parts. In the first part, I introduce, elaborate and illustrate my account, which in turn consists of three elements: (1) relations of superiority, (2) standards for the relations of superiority and (3) types of competition. I also discuss my account’s relevance to issues of sport ethics through the example of gender equity and women’s ski jumping. I conclude that this account will not end the disputes over which team or athlete was better in a particular competition. Instead, it provides tools for a more consistent discussion of the disputed issues. The second part of the thesis includes five reprinted original articles. The account presented in the first part is based on these publications.

The state of research and development in Australia: implications for future development

The scale of research and development (R&D), and other technological activities, and the way in which the available resources are managed and organized at the enterprise and national level contribute to the rate of technological change in a country. A well organized national innovation system can be a powerful engine of progress, whereas a lack of interaction between institutions results in the slowing down of technological change, thereby diminishing its contribution to economic growth and welfare. The research object of this thesis is Australia’s national innovation system and the state of R&D in Australia. In order to establish an overall picture of the situation and to be able to make recommendations for future development, the general level of R&D activity and the main performers and funders of R&D within the system are analyzed. The framework policies supporting R&D and prevalent dynamics between different actors and sectors are of specific interest of the research. The findings reveal that the Australian culture is not a culture of research and innovation and that the main challenge is building a coherent system with strong domestic and international linkages.

Games in Education and Process Development

The aim of the thesis is to devise a framework for analyzing simulation games, in particular introductory supply chain simulation games which are used in education and process development. The framework is then applied to three case examples which are introductory supply chain simulation games used at Lappeenranta University of Technology. The theoretical part of the thesis studies simulation games in the context of education and training as well as of process management. Simulation games can be seen as learning processes which comprise of briefing, micro cycle, and debriefing which includes observation and reflection as well as conceptualization. The micro cycle, i.e. the game itself, is defined through elements and characteristics. Both briefing and debriefing ought to support the micro cycle. The whole learning process needs to support learning objectives of the simulation game. Based on the analysis of the case simulation games, suggestions on how to boost the debriefing and promote long term effects of the games are made. In addition, a framework is suggested to be used in designing simulation games and characteristics of introductory supply chain simulation games are defined. They are designed for general purposes, are simple and operated manually, are multifunctional interplays, and last about 2.5 4 hours. Participants co operate during a game run and competition arises between different runs or game sessions.

Maritime Safety in the Gulf of Finland. Review on Policy Instruments

Suomenlahden lisääntynyt meriliikenne on herättänyt huolta meriliikenteen turvallisuuden tasosta, ja erityisesti Venäjän öljyviennin kasvu on lisännyt öljyonnettomuuden todennäköisyyttä Suomenlahdella. Erilaiset kansainväliset, alueelliset ja kansalliset ohjauskeinot pyrkivät vähentämään merionnettomuuden riskiä ja meriliikenteen muita haittavaikutuksia. Tämä raportti käsittelee meriturvallisuuden yhteiskunnallisia ohjauskeinoja: ohjauskeinoja yleisellä tasolla, meriturvallisuuden keskeisimpiä säätelijöitä, meriturvallisuuden ohjauskeinoja ja meriturvallisuuspolitiikan tulevaisuuden näkymiä, ohjauskeinojen tehokkuutta ja nykyisen meriturvallisuuden ohjausjärjestelmän heikkouksia. Raportti on kirjallisuuskatsaus meriturvallisuuden yhteiskunnalliseen sääntelyn rakenteeseen ja tilaan erityisesti Suomenlahden meriliikenteen näkökulmasta. Raportti on osa tutkimusprojektia ”SAFGOF - Suomenlahden meriliikenteen kasvunäkymät 2007 - 2015 ja kasvun vaikutukset ympäristölle ja kuljetusketjujen toimintaan” ja sen työpakettia 6 ”Keskeisimmät riskit ja yhteiskunnalliset vaikutuskeinot”. Yhteiskunnalliset ohjauskeinot voidaan ryhmitellä hallinnollisiin, taloudellisiin ja tietoohjaukseen perustuviin ohjauskeinoihin. Meriturvallisuuden edistämisessä käytetään kaikkia näitä, mutta hallinnolliset ohjauskeinot ovat tärkeimmässä asemassa. Merenkulun kansainvälisen luonteen vuoksi meriturvallisuuden sääntely tapahtuu pääosin kansainvälisellä tasolla YK:n ja erityisesti Kansainvälisen merenkulkujärjestön (IMO) toimesta. Lisäksi myös Euroopan Unionilla on omaa meriturvallisuuteen liittyvää sääntelyä ja on myös olemassa muita alueellisia meriturvallisuuden edistämiseen liittyviä elimiä kuten HELCOM. Joitakin meriturvallisuuden osa-alueita säädellään myös kansallisella tasolla. Hallinnolliset meriturvallisuuden ohjauskeinot sisältävät aluksen rakenteisiin ja varustukseen, alusten kunnon valvontaan, merimiehiin ja merityön tekemiseen sekä navigointiin liittyviä ohjauskeinoja. Taloudellisiin ohjauskeinoihin kuuluvat esimerkiksi väylä- ja satamamaksut, merivakuutukset, P&I klubit, vastuullisuus- ja korvauskysymykset sekä taloudelliset kannustimet. Taloudellisten ohjauskeinojen käyttö meriturvallisuuden edistämiseen on melko vähäistä verrattuna hallinnollisten ohjauskeinojen käyttöön, mutta niitä voitaisiin varmasti käyttää enemmänkin. Ongelmana taloudellisten ohjauskeinojen käytössä on se, että ne kuuluvat pitkälti kansallisen sääntelyn piiriin, joten alueellisten tai kansainvälisten intressien edistäminen taloudellisilla ohjauskeinoilla voi olla hankalaa. Tieto-ohjaus perustuu toimijoiden vapaaehtoisuuteen ja yleisen tiedotuksen lisäksi tieto-ohjaukseen sisältyy esimerkiksi vapaaehtoinen koulutus, sertifiointi tai meriturvallisuuden edistämiseen tähtäävät palkinnot. Poliittisella tasolla meriliikenteen aiheuttamat turvallisuusriskit Suomenlahdella on otettu vakavasti ja paljon työtä tehdään eri tahoilla riskien minimoimiseksi. Uutta sääntelyä on odotettavissa etenkin liittyen meriliikenteen ympäristövaikutuksiin ja meriliikenteen ohjaukseen kuten meriliikenteen sähköisiin seurantajärjestelmiin. Myös inhimilliseen tekijän merkitykseen meriturvallisuuden kehittämisessä on kiinnitetty lisääntyvissä määrin huomiota, mutta inhimilliseen tekijän osalta tehokkaiden ohjauskeinojen kehittäminen näyttää olevan haasteellista. Yleisimmin lääkkeeksi esitetään koulutuksen kehittämistä. Kirjallisuudessa esitettyjen kriteereiden mukaan tehokkaiden ohjauskeinojen tulisi täyttää seuraavat vaatimukset: 1) tarkoituksenmukaisuus – ohjauskeinojen täytyy olla sopivia asetetun tavoitteen saavuttamiseen, 2) taloudellinen tehokkuus – ohjauskeinon hyödyt vs. kustannukset tulisi olla tasapainossa, 3) hyväksyttävyys – ohjauskeinon täytyy olla hyväksyttävä asianosaisten ja myös laajemman yhteiskunnan näkökulmasta katsottuna, 4) toimeenpano – ohjauskeinon toimeenpanon pitää olla mahdollista ja sen noudattamista täytyy pystyä valvomaan, 5) lateraaliset vaikutukset – hyvällä ohjauskeinolla on positiivisia seurannaisvaikutuksia muutoinkin kuin vain ohjauskeinon ensisijaisten tavoitteiden saavuttaminen, 6) kannustin ja uuden luominen – hyvä ohjauskeino kannustaa kokeilemaan uusia ratkaisuja ja kehittämään toimintaa. Meriturvallisuutta koskevaa sääntelyä on paljon ja yleisesti ottaen merionnettomuuksien lukumäärä on ollut laskeva viime vuosikymmenien aikana. Suuri osa sääntelystä on ollut tehokasta ja parantanut turvallisuuden tasoa maailman merillä. Silti merionnettomuuksia ja muita vaarallisia tapahtumia sattuu edelleen. Nykyistä sääntelyjärjestelmää voidaan kritisoida monen asian suhteen. Kansainvälisen sääntelyn aikaansaaminen ei ole helppoa: prosessi on yleensä hidas ja tuloksena voi olla kompromissien kompromissi. Kansainvälinen sääntely on yleensä reaktiivista eli ongelmakohtiin puututaan vasta kun jokin onnettomuus tapahtuu sen sijaan että se olisi proaktiivista ja pyrkisi puuttumaan ongelmakohtiin jo ennen kuin jotain tapahtuu. IMO:n työskentely perustuu kansallisvaltioiden osallistumiseen ja sääntelyn toimeenpano tapahtuu lippuvaltioiden toimesta. Kansallisvaltiot ajavat IMO:ssa pääasiallisesti omia intressejään ja sääntelyn toimeenpanossa on suuria eroja lippuvaltioiden välillä. IMO:n kyvyttömyys puuttua havaittuihin ongelmiin nopeasti ja ottaa sääntelyssä huomioon paikallisia olosuhteita on johtanut siihen, että esimerkiksi Euroopan Unioni on alkanut itse säädellä meriturvallisuutta ja että on olemassa sellaisia alueellisia erityisjärjestelyjä kuin PSSA (particularly sensitive sea area – erityisen herkkä merialue). Merenkulkualalla toimii monenlaisia yrityksiä: toisaalta yrityksiä, jotka pyrkivät toimimaan turvallisesti ja kehittämään turvallisuutta vielä korkeammalle tasolle, ja toisaalta yrityksiä, jotka toimivat niin halvalla kuin mahdollista, eivät välitä turvallisuusseikoista, ja joilla usein on monimutkaiset ja epämääräiset omistusolosuhteet ja joita vahingon sattuessa on vaikea saada vastuuseen. Ongelma on, että kansainvälisellä merenkulkualalla kaikkien yritysten on toimittava samoilla markkinoilla. Vastuuttomien yritysten toiminnan mahdollistavat laivaajat ja muut alan toimijat, jotka suostuvat tekemään yhteistyötä niiden kanssa. Välinpitämätön suhtautuminen turvallisuuteen johtuu osaksi myös merenkulun vanhoillisesta turvallisuuskulttuurista. Verrattaessa meriturvallisuuden sääntelyjärjestelmää kokonaisuutena tehokkaiden ohjauskeinoihin kriteereihin, voidaan todeta, että monien kriteerien osalta nykyistä järjestelmää voidaan pitää tehokkaana ja onnistuneena. Suurimmat ongelmat lienevät sääntelyn toimeenpanossa ja ohjauskeinojen kustannustehokkuudessa. Lippuvaltioiden toimeenpanoon perustuva järjestelmä ei toimi toivotulla tavalla, josta mukavuuslippujen olemassa olo on selvin merkki. Ohjauskeinojen, sekä yksittäisten ohjauskeinojen että vertailtaessa eri ohjauskeinoja keskenään, kustannustehokkuutta on usein vaikea arvioida, minkä seurauksena ohjauskeinojen kustannustehokkuudesta ei ole saatavissa luotettavaa tietoa ja tuloksena voi olla, että ohjauskeino on käytännössä pienen riskin eliminoimista korkealla kustannuksella. Kansainvälisen tason meriturvallisuus- (ja merenkulku-) politiikan menettelytavoiksi on ehdotettu myös muita vaihtoehtoja kuin nykyinen järjestelmä, esimerkiksi monitasoista tai polysentristä hallintojärjestelmää. Monitasoisella hallintojärjestelmällä tarkoitetaan järjestelmää, jossa keskushallinto on hajautettu sekä vertikaalisesti alueellisille tasoille että horisontaalisesti ei-valtiollisille toimijoille. Polysentrinen hallintojärjestelmä menee vielä askeleen pidemmälle. Polysentrinen hallintojärjestelmä on hallintotapa, jonka puitteissa kaikentyyppiset toimijat, sekä yksityiset että julkiset, voivat osallistua hallintoon, siis esimerkiksi hallitukset, edunvalvontajärjestöt, kaupalliset yritykset jne. Kansainvälinen lainsäädäntö määrittelee yleiset tasot, mutta konkreettiset toimenpiteet voidaan päättää paikallisella tasolla eri toimijoiden välisessä yhteistyössä. Tämän tyyppisissä hallintojärjestelmissä merenkulkualan todellinen, kansainvälinen mutta toisaalta paikallinen, toimintaympäristö tulisi otetuksi paremmin huomioon kuin järjestelmässä, joka perustuu kansallisvaltioiden keskenään yhteistyössä tekemään sääntelyyn. Tällainen muutos meriturvallisuuden hallinnassa vaatisi kuitenkin suurta periaatteellista suunnanmuutosta, jollaisen toteutumista ei voi pitää kovin todennäköisenä ainakaan lyhyellä tähtäimellä.

The Regulation of Skeletal and Cardiac Muscle Blood Flow in Humans. Studies by positron emission tomography with special reference to exercise, adenosine and nitric oxide

Virtually every cell and organ in the human body is dependent on a proper oxygen supply. This is taken care of by the cardiovascular system that supplies tissues with oxygen precisely according to their metabolic needs. Physical exercise is one of the most demanding challenges the human circulatory system can face. During exercise skeletal muscle blood flow can easily increase some 20-fold and its proper distribution to and within muscles is of importance for optimal oxygen delivery. The local regulation of skeletal muscle blood flow during exercise remains little understood, but adenosine and nitric oxide may take part in this process. In addition to acute exercise, long-term vigorous physical conditioning also induces changes in the cardiovasculature, which leads to improved maximal physical performance. The changes are largely central, such as structural and functional changes in the heart. The function and reserve of the heart’s own vasculature can be studied by adenosine infusion, which according to animal studies evokes vasodilation via it’s a_2A receptors. This has, however, never been addressed in humans in vivo and also studies in endurance athletes have shown inconsistent results regarding the effects of sport training on myocardial blood flow. This study was performed on healthy young adults and endurance athletes and local skeletal and cardiac muscle blod flow was measured by positron emission tomography. In the heart, myocardial blood flow reserve and adenosine A_2A receptor density, and in skeletal muscle, oxygen extraction and consumption was also measured. The role of adenosine in the control of skeletal muscle blood flow during exercise, and its vasodilator effects, were addressed by infusing competitive inhibitors and adenosine into the femoral artery. The formation of skeletal muscle nitric oxide was also inhibited by a drug, with and without prostanoid blockade. As a result and conclusion, it can be said that skeletal muscle blood flow heterogeneity decreases with increasing exercise intensity most likely due to increased vascular unit recruitment, but exercise hyperemia is a very complex phenomenon that cannot be mimicked by pharmacological infusions, and no single regulator factor (e.g. adenosine or nitric oxide) accounts for a significant part of exercise-induced muscle hyperemia. However, in the present study it was observed for the first time in humans that nitric oxide is not only important regulator of the basal level of muscle blood flow, but also oxygen consumption, and together with prostanoids affects muscle blood flow and oxygen consumption during exercise. Finally, even vigorous endurance training does not seem to lead to supranormal myocardial blood flow reserve, and also other receptors than A_2A mediate the vasodilator effects of adenosine. In respect to cardiac work, atheletes heart seems to be luxuriously perfused at rest, which may result from reduced oxygen extraction or impaired efficiency due to pronouncedly enhanced myocardial mass developed to excel in strenuous exercise.

Innovative Culture – Searching for Innovativeness in a Construction Company

The purpose of the thesis is to study innovativeness in a context of the construction industry especially the front-end of the innovation process. The construction industry is often considered an old-fashioned manufacturing industry. Innovations and innovativeness are rarely linked to the industry. The construction industry, as well as other industries in Finland, is facing challenges such as productivity, the climate change and internationalization. The meaning of innovations is greater than ever in continuously changing markets, for standing out from competitors or increasing the competitiveness. Traditional production methods, tight building regulations, unique buildings, one-of-a-kind project organizations and highlighting the cheapest price in building contracts are particular challenges in the construction industry. The research questions of the thesis were: - What kind of factors shift the existing company culture towards innovativeness? - What are the phases of the front-end of the innovation process? - What kind of tools and methods enable managing the front-end of the innovation process? The theoretical part of the thesis bases on the literature review. The research methodology of the empirical part was the action research and qualitative approach. Empirical data was collected by the theme interviews from three companies. The results were practical methods and experiences from innovation activities of the companies. The results of the thesis can be clarified as follows: enhancement of the innovation activities requires support and commitment of the top management, innovative culture and innovation strategy. Innovativeness can be promoted by systematical methods for example collecting ideas from employees. Controlling and managing the front-end phase is essential to succeeding. Despite that managing the front-end is the most challenging part of the innovation process, development and management of that save companies’ money, resources and prevents useless investments. Further clarification and studies are needed to find out furthermore functional tools and methods to manage innovations and implementing them to the culture of the companies.

Efficiency of the ISM Code in Finnish Shipping Companies

Due to increasing waterborne transportation in the Gulf of Finland, the risk of a hazardous accident increases and therefore manifold preventive actions are needed. As a main legislative authority in the maritime community, The International Maritime Organization (IMO) has set down plenary laws and recommendations which are e.g., utilised in the safe operations in ships and pollution prevention. One of these compulsory requirements, the ISM Code, requires proactive attitude both from the top management and operational workers in the shipping companies. In this study, a crosssectional approach was taken to analyse whether the ISM Code has actively enhanced maritime safety in the Gulf of Finland. The analysis included; 1) performance of the ISM Code in Finnish shipping companies, 2) statistical measurements of maritime safety, 3) influence of corporate top management to the safety culture and 4) comparing safety management practices in shipping companies and port operations of Finnish maritime and port authorities. The main results found were that maritime safety culture has developed in the right direction after the launch of the ISM Code in the 1990´s. However, this study does not exclusively prove that the improvements are the consequence of the ISM Code. Accident prone ships can be recognized due to their behaviour and there is a lesson to learn from the safety culture of some high standard safety disciplines such as, air traffic. In addition, the reporting of accidents and nearmisses should be more widely used in shipping industry. In conclusion, there is still much to be improved in the maritime safety culture of the Finnish Shipping industry, e.g., a “no blame culture” needs to be adopted.

The use of dietary supplements and medication among Finnish elite athletes

Background: Dietary supplements are widely used among elite athletes but the prevalence of dietary supplement use among Finnish elite athletes is largely not known. The use of asthma medication is common among athletes. In 2009, the World Anti-Doping Agency (WADA) and the International Olympic Committee (IOC) removed the need to document asthma by lung function tests before the use of inhaled β2-agonists. Data about medication use by Paralympic athletes (PA) is limited to a study conducted at the Athens Paralympics. Aims: To investigate the prevalence of the use of self-reported dietary supplements, the use of physician-prescribed medication and the prevalence of physician-diagnosed asthma and allergies among Finnish Olympic athletes (OA). In addition, the differences in the selfreported physician-prescribed medication use were compared between the Finnish Olympic and the Paralympic athletes. Subjects and methods: Two cross-sectional studies were conducted in Finnish Olympic athletes receiving financial support from the Finnish Olympic Committee in 2002 (n=446) and in 2009 (n=372) and in Finnish top-level Paralympic athletes (n= 92) receiving financial support from Finnish Paralympic committee in 2006. The results of the Paralympic study were compared with the results of the Olympic study conducted in 2009. Both Olympic and Paralympic athletes filled in a similar semi-structured questionnaires. Results: Dietary supplements were used by 81% of the athletes in 2002 and by 73% of the athletes in 2009. After adjusting for age-, sex- and type of sport, the odds ratio OR (95% confidence interval, CI) for use of any dietary supplement was significantly less in 2009 as compared with the 2002 situation (OR 0.62; 95% CI 0.43-0.90). Vitamin D was used by 0.7% of the athletes in year 2002 but by 2% in 2009 (ns, p = 0.07). The use of asthma medication increased from 10.4 % in 2002 to 13.7% in 2009 (adjusted OR 1.71; 95% CI 1.08-2.69). For example, fixed combinations of inhaled long-acting β2-agonists (LABA) and inhaled corticosteroids (ICS) were used three times more commonly in 2009 than in 2002 (OR 3.38; 95% CI 1.26-9.12). The use of any physician-prescribed medicines (48.9% vs. 33.3%, adjusted OR 1.99; 95% CI 1.13-3.51), painkilling medicines (adjusted OR 2.61; 95% CI 1.18-5.78), oral antibiotics (adjusted OR 4.10; 95% CI 1.30-12.87) and anti-epileptic medicines (adjusted OR 37.09; 95% CI 5.92-232.31) was more common among the PA than in the OA during the previous seven days. Conclusions: The use of dietary supplements is on the decline among Finnish Olympic athletes. The intake of some essential micronutrients, such as vitamin D, is suprisingly low and this may even cause harm in those well-trained athletes. The use of asthma medication, especially fixed combinations of LABAs and ICS, is clearly increasing among Finnish Olympic athletes. The use of any physician-prescribed medicine, especially those to treat chronic diseases, seems to be more common among the Paralympians than in the Olympic athletes.