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BackgroundLearning from accidents is an important method for improving safety. In Finland, fatal occupational accidents are investigated. The data from the investigations is used for statistical purposes, but also to create occupational accident cases that are used for accident prevention.Fatal road accidents are also investigated. Due to legislation, the method used for analysis is different than in occupational accidents. The data is published as statistics, but the case information is not published, although road accident cases would also be important for improving road safety.ObjectiveThe aim of this project was to produce case-based educational material on road accidents for heavy traffic professionals. The material was produced in the same format as the accident investigation cases created for occupational accidents.The data was gathered by the Finnish Motor Insurers´ Centre. The first set of data included 10 selected fatal accidents from 1993 to 2009. The second set included 32 accidents that led to the death of the driver in a heavy vehicle from 2011 to 2013.ResultsThe 10 cases were edited into safety case materials and published as slide shows in 2013. The materials included short introductions to each case, background information on the accident, risk factors, and tools or ideas for avoiding similar accidents. The material was available for four teachers who used it in vocational education. The feedback was positive.The second set of materials included three theme studies, each including several accident cases. Reports can be used by teachers or vocational education providers.ConclusionsBoth materials are usable as learning material. The theme studies are available on an open access web page (http://totti.tvl.fi). Currently the material is only in Finnish. Case investigations about fatal occupational road accidents have not yet been published in this series, but procedures will be developed in order to conduct case investigations in the future.

BackgroundPeople in vulnerable positions, e.g. elderly or disabled people, substance abuser or mental health patients have an increased risk of becoming fire victims. To avoid this risk fire safety knowledge and good practices are needed for professionals working in the field.The social and health policy in Finland prioritise assisted living and home care. At the same time the rescue service act stresses that the responsibility of fire safety is on building owners and service providers. Therefore, care professionals are in a novel situation as they are working at clients home and required to take into consideration diverse environment and self-determination of an individual.The aim of this study was to investigate the fire risk and good practices in assisted living and home care.MethodsThe data is from six group interviews done during 2014–2015. Each group included the whole care service chain: the client and one of his/her relatives, care-giver, service provider and planner representatives and fire safety officer. Each group interviewed represented different type of clients and assisted living facilities and service. Interviews took place in various regions in Finland.ResultsEach agent at the service chain had ambition to improve fire safety. However, the knowledge among professionals what requires to be done and what others belonging to the same service chain are doing was inadequate. Some safety tools were used but oftentimes the user did not understand enough about their function. Overall, most were interested in safety information and to improve the safety, but the will to invest on safety was low.ConclusionsThe care service chain has overall good motivation to improve the safety and fire safety of vulnerable people. However requirements of rescue service act did not materialise in assisted living as well as possible. There is apparent need of knowledge and vocational education material.

BackgroundThe rescue act 2011 in Finland stresses that the responsibility of fire safety is on building owners and service providers. The regulation is justifiable, because people in vulnerable positions, for example elderly and disabled, have an increased risk being fire victims.The aim of this study was to investigate the implementation of rescue service act among service providers in residential, institutional and home care facilities and to monitor changes from 2013 to 2015.MethodsOnline surveys on fire hazard assessment and risk management practices were done in 2013 and 2015. Respondents were managers of residential, institutional and home care facilities for the vulnerable people.Information of the facilities was obtained from the nationwide Register of Institutions in Social Welfare and Health Care. The study sample was systematically selected (every other) and it consisted 1605 organisations.ResultsIn 2013 93% of institutional and 95% residential units had written guidelines to ensure fire safety. In 2015 the proportion has decreased to 84 in institutional and 88% in residential units. At home care written guidelines had less than 50%. The accident prevention guidelines had increased in institutional units from 66% to 74% and in residential units from 66% to 77%. At home care the guidelines had 50%. Safety guidelines in general e.g. crime prevention has also decreased and was now less than 50%, at home care only 22%. Patient and residential safety guidelines were increased only at home care from 55% to 60%.ConclusionsThe organisations have increased their preparedness for fire risk with sprinklers. But at the same time they made less written guidelines to prevent to fire. Fire risk assessment and management practices have improved only in home care. In IR-units the situation seems to be weaker than in 2013. The situation is not acceptable and the reasons should be diagnosed.

BackgroundFire safety in institutional care of vulnerable people in Finland is at a good level. However, in assisted living, residential and home care fatal fires still occur. Risk assessment, as well as knowledge of good procedures is therefore needed. Information of fire safety is included in vocational education of social and health care sector but for formal, non-formal and in-formal education material to improve care practices and identify the fire hazards at clients home is lacking.ObjectiveThe aim of the project was to produce evidence-based educational material about fire safety for social and health care professionals. To produce this material, data gathered by National Institute for Health and Welfare, literature and good practices from social and health care and rescue services were utilised. The project took place 2012–2016 and was sponsored by Fire Protection Fund.ResultsFire safety education material for social and health care professionals, students and planners was first published in 2014. The web-based material includes information about background, legislation, fatal fire cases, principles of risk management and learning from accidents. In addition, there are statistic, special knowledge about fire sensitive fabrics, electrical equipment and chemicals and also good practices to improve fire safety. Additional compact educational package for craft teachers is available. The material can be used also in voluntary work and for example for people taking care of their relatives.ConclusionsWeb-based material is freely available at https://www.thl.fi/fi/tutkimus-ja-asiantuntijatyo/hankkeet-ja-ohjelmat/step-hanke/stepin-koulutusaineisto. The material is available in Finnish and Swedish. English version is under consideration as there is urgent need of fire safety training also for increasing number of foreigners and immigrants in Finland.

BackgroundFinland currently uses two parallel preventive accident investigation systems. Fatal accidents occurring at work are investigated as occupational accidents. Fatal accidents occurring in traffic are investigated as road accidents.In professional driving, fatal road accidents are road and occupational accidents at the same time, but the accident investigation method used is the same as in road accidents. However, the authorities and researchers of occupational accidents are interested in learning about the investigation methods of road accidents, and vice versa. The aim of this study was to analyse past road accidents as occupational accidents, in the hope of gaining a better understanding of the work-related risks involved.MethodsThe data collected from the Finnish Motor Insurer’s Centre’s databases. One quantitative analysis was performed using data from fatal heavy traffic accidents from 1991 to 2011. Two qualitative analyses were performed: the first used data from fatal accidents from 2010 to 2012, while the second covered accidents which led to the death of the driver of a heavy vehicle from 2011 to 2013.ResultsBoth qualitative analyses indicated that there were a number of work-related risks contributing to the accidents, for example poor planning, excessive work hours and tight timetables. The quantitative analysis contained some indications of driver-related risks that, in the qualitative analyses, might also be seen as work-related risks. For example, one reason for an accident was the driver’s fatigue, while the underlying reason might have been poor logistical planning.ConclusionsThe qualitative results give more information about work-related risks and verify a new point of view for improving the safety of professional driving in heavy traffic. The work-related risks indicate that safety information is important to include in educational material, not only for drivers, but also for all planners and other people in the logistics chain.

Our objective was to examine whether gestational diabetes mellitus (GDM) or newborns' high birthweight can be prevented by lifestyle counseling in pregnant women at high risk of GDM. We conducted a cluster-randomized trial, the NELLI study, in 14 municipalities in Finland, where 2,271 women were screened by oral glucose tolerance test (OGTT) at 8-12 wk gestation. Euglycemic (n = 399) women with at least one GDM risk factor (body mass index [BMI] ≥ 25 kg/m(2), glucose intolerance or newborn's macrosomia (≥ 4,500 g) in any earlier pregnancy, family history of diabetes, age ≥ 40 y) were included. The intervention included individual intensified counseling on physical activity and diet and weight gain at five antenatal visits. Primary outcomes were incidence of GDM as assessed by OGTT (maternal outcome) and newborns' birthweight adjusted for gestational age (neonatal outcome). Secondary outcomes were maternal weight gain and the need for insulin treatment during pregnancy. Adherence to the intervention was evaluated on the basis of changes in physical activity (weekly metabolic equivalent task (MET) minutes) and diet (intake of total fat, saturated and polyunsaturated fatty acids, saccharose, and fiber). Multilevel analyses took into account cluster, maternity clinic, and nurse level influences in addition to age, education, parity, and prepregnancy BMI. 15.8% (34/216) of women in the intervention group and 12.4% (22/179) in the usual care group developed GDM (absolute effect size 1.36, 95% confidence interval [CI] 0.71-2.62, p = 0.36). Neonatal birthweight was lower in the intervention than in the usual care group (absolute effect size -133 g, 95% CI -231 to -35, p = 0.008) as was proportion of large-for-gestational-age (LGA) newborns (26/216, 12.1% versus 34/179, 19.7%, p = 0.042). Women in the intervention group increased their intake of dietary fiber (adjusted coefficient 1.83, 95% CI 0.30-3.25, p = 0.023) and polyunsaturated fatty acids (adjusted coefficient 0.37, 95% CI 0.16-0.57, p < 0.001), decreased their intake of saturated fatty acids (adjusted coefficient -0.63, 95% CI -1.12 to -0.15, p = 0.01) and intake of saccharose (adjusted coefficient -0.83, 95% CI -1.55 to -0.11, p  =  0.023), and had a tendency to a smaller decrease in MET minutes/week for at least moderate intensity activity (adjusted coefficient 91, 95% CI -37 to 219, p = 0.17) than women in the usual care group. In subgroup analysis, adherent women in the intervention group (n = 55/229) had decreased risk of GDM (27.3% versus 33.0%, p = 0.43) and LGA newborns (7.3% versus 19.5%, p = 0.03) compared to women in the usual care group. The intervention was effective in controlling birthweight of the newborns, but failed to have an effect on maternal GDM. Current Controlled Trials ISRCTN33885819. Please see later in the article for the Editors' Summary.

Introduction Chronic pelvic pain (CPP) affects over one fifth of women worldwide, and endometriosis is one of the most common causes. In the present study, we examined whether sacral neuromodulation (SNM) is effective in the treatment of refractory chronic pelvic pain in women with endometriosis. Material and methods This multicenter prospective pilot study was started in 2017 and includes patients with chronic pelvic pain with no other obvious pathology than endometriosis. Other treatment options have been tried or they are unsuitable. Patients underwent SNM implantation. The main outcome was postoperative pain reduction and secondary outcome was quality of life. The following questionnaires were used to assess the outcomes: Brief pain inventory (BPI), clinical global impression ‐ improvement (CGI‐I), 15D‐measure of health‐related quality of life, and Biberoglu and Behrman (B&B) score. Results A total of 35 patients underwent the SNM procedure and, at the time of analysis, 15 patients had returned one‐year questionnaires. The patients had a history of endometriosis for a median of 5.5 (interquartile range 2–9) years, with no correlation between the severity of symptoms and the duration of the disease (p = 0.158). A total of 31 patients (89%) were implanted with the internal pulse generator. There were statistically significant changes in BPI pain‐related items. Worst experienced daily pain decreased among those who returned 12‐month questionnaires from median 9 to 5 (p = 0.006), average daily pain from 6 to 3.5 (p = 0.004), and least daily pain from 3 to 1 (p = 0.004). Based on the CGI questionnaire (n = 14), at 12 months nine patients (60%) experienced great improvement in their symptoms, three patients (20%) much improvement and two patients (13%) minimal improvement. None of the patients experienced worsening of their symptoms. There was a statistically significant change in overall 15D score at 1 month (p < 0.001), 6 months (p = 0.001) and 12 months (p = 0.018), when the results were compared to baseline values. Median B&B score also improved significantly and decreased from a baseline value of 8 (4–12) to 4.5 (0–6), p = 0.002. Conclusions Based on the preliminary findings of our study, SNM might be a promising treatment of CPP in endometriosis patients. The treatment of chronic pelvic pain related to endometriosis is difficult and the mainstream remain medical therapy and surgery. Based on the preliminary findings of our study, it appears that SNM is a promising treatment option of CPP in endometriosis patients that do not respond to conventional therapies.

BackgroundExposure to natural environments is thought to be beneficial for human health, but the evidence is inconsistent.ObjectiveTo examine whether exposure to green and blue spaces in urban environments is associated with mental and physical health in Finland.MethodsThe Helsinki Capital Region Environmental Health Survey was conducted in 2015−2016 in Helsinki, Espoo and Vantaa in Finland (n=7321). Cross-sectional associations of the amounts of residential green and blue spaces within 1 km radius around the respondent’s home (based on the Urban Atlas 2012), green and blue views from home and green space visits with self-reported use of psychotropic (anxiolytics, hypnotics and antidepressants), antihypertensive and asthma medication were examined using logistic regression models. Indicators of health behaviour, traffic-related outdoor air pollution and noise and socioeconomic status (SES) were used as covariates, the last of these also as a potential effect modifier.ResultsAmounts of residential green and blue spaces or green and blue views from home were not associated with medications. However, the frequency of green space visits was associated with lower odds of using psychotropic medication (OR=0.67, 95% CI 0.55 to 0.82 for 3–4 times/week; 0.78, 0.63 to 0.96 for ≥5 times/week) and antihypertensive (0.64, 0.52 to 0.78; 0.59, 0.48 to 0.74, respectively) and asthma (0.74, 0.58 to 0.94; 0.76, 0.59 to 0.99, respectively) medication use. The observed associations were attenuated by body mass index, but no consistent interactions with SES indicators were observed.ConclusionsFrequent green space visits, but not the amounts of residential green or blue spaces, or green and blue views from home, were associated with less frequent use of psychotropic, antihypertensive and asthma medication in urban environments.

Background Sacral neuromodulation (SNM) is an established therapy in urology and gastroenterological surgery for treatment of overactive bladder symptoms, urge urinary incontinence or fecal incontinence. SNM has also been used with good results in patients with chronic pelvic pain (CPP). Our aim was to analyze long-term results of SNM in Finnish patients with endometriosis related CPP. Methods This is a register-based retrospective study including all the endometriosis patients treated with SNM for CPP in Finland between 2004 and 2017. There were four centers where these procedures were performed, two University Hospitals and two Central Hospitals. Long-term results were assessed by phone interview in spring 2021. Results A total of 16 women with endometriosis, with a median age of 39 (25–50) years, underwent SNM treatment for chronic pelvic pain (CPP), with the median follow-up time of 73 (48–85) months. The Implantable Pulse Generator (IPG) was implanted to 14 patients (88%). By the end of the follow-up period, 10 patients (62,5% of all patients and 71% of those who received IPG) had a functional SNM. Pain was assessed by numeral rating scale (NRS) and decreased from a median of 7.4 (3.6–10) to 2.3 (0-6.5). Conclusions SNM could be a good option in the treatment of endometriosis related chronic pelvic pain when standard therapy is not enough.

Background Women who are physically active during early pregnancy have notably lower odds of developing gestational diabetes than do inactive women. The purpose of the intervention was to examine whether intensified physical activity (PA) counseling in Finnish maternity care is feasible and effective in promoting leisure-time PA (LTPA) among pregnant women at risk of gestational diabetes. Methods Fourteen municipalities were randomized to intervention (INT) and usual care group (UC). Nurses in INT integrated five PA counseling sessions into routine maternity visits and offered monthly group meetings on PA instructed by physiotherapists. In UC conventional practices were continued. Feasibility evaluation included safety (incidence of PA-related adverse events; questionnaire), realization (timing and duration of sessions, number of sessions missed, attendance at group meetings; systematic record-keeping of the nurses and physiotherapists) and applicability (nurses’ views; telephone interview). Effectiveness outcomes were weekly frequency and duration of total and intensity-specific LTPA and meeting PA recommendation for health self-reported at 8-12 (baseline), 26-28 and 36-37 weeks’ gestation. Multilevel analysis with adjustments was used in testing for between-group differences in PA changes. Results The decrease in the weekly days of total and moderate-to-vigorous-intensity LTPA was smaller in INT (N = 219) than in UC (N = 180) from baseline to the first follow-up (0.1 vs. -1.2, p = 0.040 and −0.2 vs. -1.3, p = 0.016). A similar trend was seen in meeting the PA recommendation (−11%-points vs. -28%-points, p = 0.06). INT did not experience more adverse events classified as warning signs to terminate exercise than UC, counseling was implemented as planned and viewed positively by the nurses. Conclusions Intensified counseling had no effects on the duration of total or intensity-specific weekly LTPA. However, it was able to reduce the decrease in the weekly frequency of total and moderate-to-vigorous-intensity LTPA from baseline to the end of second trimester and was feasibly embedded into routine practices. Trial registration ISRCTN 33885819 ( http://www.isrctn.org )