Tietoa ja taitoa toisen asteen verkko-opetukseen

Artikkelissa kerrotaan Keski-Suomen Opinpolku-projektista ja sen jälkivaiheista

Sleep-Disordered Breathing in Women

Sleep-disordered breathing (SDB) is underdiagnosed in women, probably due to the different gender-related manifestation. We investigated the differences in presentation, symptoms and co-morbidities of SDB in men and in pre- and postmenopausal women by a clinical, retrospective, cross-sectional study of 601 consecutively referred women and 233 age- and BMI-matched male-female pairs studied with the static-chargesensitive bed (SCSB) and an oximeter. Data on the use of nasal CPAP were gathered from the Paimio hospital database, and the co-morbidity information was based on reimbursed medication data from the National Agency for Medicines and the Social Insurance institution. The abnormal breathing episodes at night were more frequent in men than in women, and in postmenopausal women compared to premenopausal ones. Partial upper airway obstruction was the most common type of SDB in both genders but especially in females. BMI and the major symptoms of SDB were similar in pre- and postmenopausal women, and a menopause effect on symptoms was not found. CPAP adherence did not differ between symptomatic patients with partial upper airway obstruction and those presenting with conventional obstructive sleep apnea. Comorbidities were more frequent in SDB patients than in the general Finnish population. Compared to sleep apnea, partial upper airway obstruction was associated with a threefold prevalence of asthma and/or COPD in both genders, and with a 60% reduced prevalence of hypertension in females matched for age and BMI. Our results emphasize that partial upper airway obstruction is not a milder form of SDB but a different entity, the severity of which is underestimated when using the conventional apnea-hypopnea index. It seems clinically relevant to diagnose and treat the co-morbidities and SDB also in patients with partial upper airway obstruction, especially in elderly and symptomatic women.

Externalities of Shipping in the Gulf of Finland until 2015

During the last few years, the discussion on the marginal social costs of transportation has been active. Applying the externalities as a tool to control transport would fulfil the polluter pays principle and simultaneously create a fair control method between the transport modes. This report presents the results of two calculation algorithms developed to estimate the marginal social costs based on the externalities of air pollution. The first algorithm calculates the future scenarios of sea transport traffic externalities until 2015 in the Gulf of Finland. The second algorithm calculates the externalities of Russian passenger car transit traffic via Finland by taking into account both sea and road transport. The algorithm estimates the ship-originated emissions of carbon dioxide (CO₂), nitrogen oxides (NO_x), sulphur oxides (SO_x), particulates (PM) and the externalities for each year from 2007 to 2015. The total NOx emissions in the Gulf of Finland from the six ship types were almost 75.7 kilotons (Table 5.2) in 2007. The ship types are: passenger (including cruisers and ROPAX vessels), tanker, general cargo, Ro-Ro, container and bulk vessels. Due to the increase of traffic, the estimation for NO_x emissions for 2015 is 112 kilotons. The NO_x emission estimation for the whole Baltic Sea shipping is 370 kilotons in 2006 (Stipa & al, 2007). The total marginal social costs due to ship-originated CO₂, NO_x, SO_x and PM emissions in the GOF were calculated to almost 175 million Euros in 2007. The costs will increase to nearly 214 million Euros in 2015 due to the traffic growth. The major part of the externalities is due to CO₂ emissions. If we neglect the CO2 emissions by extracting the CO₂ externalities from the results, we get the total externalities of 57 million Euros in 2007. After eight years (2015), the externalities would be 28 % lower, 41 million Euros (Table 8.1). This is the result of the sulphur emissions reducing regulation of marine fuels. The majority of the new car transit goes through Finland to Russia due to the lack of port capacity in Russia. The amount of cars was 339 620 vehicles (Statistics of Finnish Customs 2008) in 2005. The externalities are calculated for the transportation of passenger vehicles as follows: by ship to a Finnish port and, after that, by trucks to the Russian border checkpoint. The externalities are between 2 – 3 million Euros (year 2000 cost level) for each route. The ports included in the calculations are Hamina, Hanko, Kotka and Turku. With the Euro-3 standard trucks, the port of Hanko would be the best choice to transport the vehicles. This is because of lower emissions by new trucks and the saved transport distance of a ship. If the trucks are more polluting Euro 1 level trucks, the port of Kotka would be the best choice. This indicates that the truck emissions have a considerable effect on the externalities and that the transportation of light cargo, such as passenger cars by ship, produces considerably high emission externalities. The emission externalities approach offers a new insight for valuing the multiple traffic modes. However, the calculation of the marginal social costs based on the air emission externalities should not be regarded as a ready-made calculation system. The system is clearly in the need of some improvement but it can already be considered as a potential tool for political decision making.

Työhyvinvointi, koulutus ja toiminnan kehittäminen terveyskeskuksissa lääkäritilanteen näkökulmasta

Finnish health centres have suffered from a shortage of physicians in recent years. This is why more physicians are being educated, the tutelage of the young physicians has been improved and many tasks which were previously reserved for physicians have been transferred to nurses and other personnel of the health centres. Only a little research has been done about the effects of the shortage of physicians and education to the work atmosphere in the health centres The objectives of the study was to describe the situation of the physicians in the counties Satakunta and South-Western Finland at the time when the University of Turku started to decentralise its education to Satakunta and describe the health centres attitudes towards training and research co-operation with the University of Turku; to gain information about the training programmes for physicians in specific training in general medical practice (STPG); study how the shortage of physicians affects the job atmosphere, the job satisfaction and the operation of the health centres; study health centre employees opinions about their professional skills, their needs and interets in continuing education; study medical and nurse students professional indentity and their readiness to multiprofessional teamwork. The material of the study was gathered during 2003-2006 with three mail questionnaires and a questionnaire given to medical and nurse students who practised in the training health centre in Pori. The first questionnaire was sent to the chief physicians of the health centres in counties Satakunta and South-Western Finland to clarify the number of unfilled positions of physicians and the reasons for physician shortage as well as the readiness for practical training of medical students and research at the health centres. The second questionnaire was posted to doctors in specific training in general medical practice and their trainers at the health centres and it gained information about training programmes of young physicians at health centres. The third questionnaire was sent to personnel at health centres in Satakunta and South-Western Finland and included questions about job satisfaction and education. The survey for medical and nurse students gained information about their professional indentity and their readiness to multiprofessional teamwork. In spring 2003 the shortage of physicians was more severe in Satakunta than in South-Western Finland. Attitudes towards training of medical students and research co-operation with the universities were generally positive. The guidance of STGP doctors in health centres improved during 2003-2005. A shortage of physicians had only a slightly negative impact on employee job satisfaction. The shortage of physicians had also positive impact on the operation of the health centres because it led to reorganization of the operations. The personnel at Finnish health centres were willing to take more challenging tasks and also to acquire appropriate further education or training. The medical and nurse students had strong professional identity and they understood the significance of teamwork for the health care service system.