Sairaanhoidolliset tukipalvelut (laboratorio ja kuvantaminen) sote-rakenteissa.

Sosiaali- ja terveydenhuollon (sote) palvelurakenteen uudistuksen valmisteluun liittyen sosiaali- ja terveysministeriö teetti loppuvuodesta 2016 esiselvityksen julkisten sairaanhoidollisten tukipalvelujen (laboratorio ja kuvantaminen) valtakunnallisesta tilanteesta. Selvityksen kohteina olivat: 1) millä tavalla sairaanhoidolliset tukipalvelut (laboratorio ja kuvantaminen) ovat tällä hetkellä Suomessa organisoitu julkisella sektorilla, 2) mitkä ovat maakunta- ja sote-uudistuksen johdosta tapahtuvat muutokset näiden palvelujen tuottamiseen sekä 3) mitä näkökohtia pitäisi ottaa huomioon eri vaihtoehtoja arvioitaessa? Arvioitavina olivat myös palvelujen järjestämiseen ja tuottamiseen liittyvät oikeudelliset kysymykset. Sairaanhoitopiirit tekevät nykyisin mittavaa yhteistyötä laboratorio- ja kuvantamispalveluiden (jäljempänä diagnostiset palvelut) tuottamisessa. Kaksitoista sairaanhoitopiiriä tuottaa kokonaan joko laboratorio- tai kuvantamispalvelut taikka molemmat myös jäsenkuntiensa perusterveyden-huollon tarpeisiin. Muiden sairaanhoitopiirien osalta integrointi on tehty osittain. Parantunut tieto-järjestelmien käyttö on mahdollistanut potilaiden oman internetpohjaisen ajanvaraustoiminnan alueellisen laboratorio-organisaation eri toimipisteistä. Sairaanhoitopiirit ovat joutuneet jossain määrin turvautumaan ostopalveluihin mm. tiettyjen erikoisalojen erikoislääkäripulasta johtuen. Kaikki merkittävimmät laboratoriot ovat halunneet osoittaa asiakkailleen akkreditoinnin kautta pätevyytensä tuottaa luotettavia laboratoriopalveluja. Selvityshenkilöt esittivät suosituksinaan, että 1) sotessa diagnostiset palvelut organisoidaan maa-kuntien lakiin perustuvana yhteistyönä tai useamman maakunnan muodostaman osakeyhtiön avulla, 2) sairaanhoitopiirit ja niiden jäsenkunnat toteuttavat alueellisen yhteistyön mahdollisimman kattavasti vuoteen 2019 mennessä, 3) laboratorio- ja kuvantamispalveluja ei tule saattaa suoran valinnanvapauden piiriin, 4) erikoislääkärikoulutuksen järjestämisestä vastuullisten tulee huolehtia siitä, ettei katvealueita lääketieteen erikoisalojen osaajista pääse muodostumaan, 5) palvelujen järjestäjä edellyttää ulkoista laadunarviointia diagnostisten palvelujen tuottajilta ja 6) diagnostiikkakeskusvaihtoehdon pohtimista maakunnissa ja toimimista yhtenä maakunnan liikelaitoksena

Akateeminen kapitalismi nykyisessä tiedepolitiikassa

Artikkelissa analysoidaan nykyistä suomalaista tiedepolitiikkaa akateemisen kapitalismin teorian näkökulmasta. Keskitymme erityisesti uuden yliopistolain jälkeiseen tilanteeseen, koska vuonna 2010 voimaan tullut uusi yliopistolaki ja siihen liittynyt yliopistouudistus muuttivat yliopistojen suhdetta valtioon ja markkinoihin sekä nostattivat laajaa tiedepoliittista keskustelua. Siten on kiinnostavaa kysyä, mihin suomalainen tiedepolitiikka on suuntautunut yliopistolain jälkeisessä tilanteessa. Pyrimme vastaamaan tähän kysymykseen analysoimalla teoriaohjaavasti nykyistä tiedepolitiikkaa suuntaavia asiakirjoja akateemisen kapitalismin teorian näkökulmasta. Johtopäätöksemme on, että asiakirjojen tavoitteenasettelussa ja toimenpidesuosituksissa näkyvät selvästi akateemisen kapitalismin teorian korostamat piirteet. Lopuksi osoitamme joitain nykyisen tiedepolitiikan ongelmia ja sen perustelujen hataruuden.Peer reviewe

Two Drinking Water Outbreaks Caused by Wastewater Intrusion Including Sapovirus in Finland

Drinking water outbreaks occur worldwide and may be caused by several factors, including raw water contamination, treatment deficiencies, and distribution network failure. This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In addition, traditional fecal indicator bacteria and host-specific microbial source tracking (MST) markers (GenBac3 and HF183) were analyzed from water. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. The MST markers proved useful in the detection of contamination and to ensure the success of contaminant removal from the water distribution system. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study highlights the emerging role of sapoviruses as a waterborne pathogen and warrants the need for testing of multiple viruses during outbreak investigation

Two Drinking Water Outbreaks Caused by Wastewater Intrusion Including Sapovirus in Finland

Drinking water outbreaks occur worldwide and may be caused by several factors, including raw water contamination, treatment deficiencies, and distribution network failure. This study describes two drinking water outbreaks in Finland in 2016 (outbreak I) and 2018 (outbreak II). Both outbreaks caused approximately 450 illness cases and were due to drinking water pipe breakage and subsequent wastewater intrusion into the distribution system. In both outbreaks, the sapovirus was found in patient samples as the main causative agent. In addition, adenoviruses and Dientamoeba fragilis (outbreak I), and noroviruses, astroviruses, enterotoxigenic and enterohemorragic Escherichia coli (ETEC and EHEC, respectively) and Plesiomonas shigelloides (outbreak II) were detected in patient samples. Water samples were analyzed for the selected pathogens largely based on the results of patient samples. In addition, traditional fecal indicator bacteria and host-specific microbial source tracking (MST) markers (GenBac3 and HF183) were analyzed from water. In drinking water, sapovirus and enteropathogenic E. coli (EPEC) were found in outbreak II. The MST markers proved useful in the detection of contamination and to ensure the success of contaminant removal from the water distribution system. As mitigation actions, boil water advisory, alternative drinking water sources and chlorination were organized to restrict the outbreaks and to clean the contaminated distribution network. This study highlights the emerging role of sapoviruses as a waterborne pathogen and warrants the need for testing of multiple viruses during outbreak investigation

Surface Water Intrusion, Land Use Impacts, and Bacterial Community Composition in Shallow Groundwater Wells Supplying Potable Water in Sparsely Populated Areas of a Boreal Region

Rural communities often rely on groundwater for potable water supply. In this study, untreated groundwater samples from 28 shallow groundwater wells in Finland ( IMPORTANCE Standard physicochemical water quality analyses and microbial indicator analyses leave much of the (largely uncultured) complexity of groundwater microbial communities unexplored. This study combined these standard methods with additional analyses of stable water isotopes, bacterial community data, and environmental data about the surrounding areas to investigate the associations between physicochemical and microbial properties of 28 shallow groundwater wells in Finland. We detected impaired groundwater quality in some wells, identified potential land use impacts, and revealed indications of surface water intrusion which were negatively correlated with bacterial alpha diversity. The potential influence of surface water intrusion on groundwater wells and their bacterial communities is of particular interest and warrants further investigation because surface water intrusion has previously been linked to groundwater contamination, which is the primary cause of waterborne outbreaks in the Nordic region and one of the major causes in the United States and Canada.Peer reviewe

A comparative analysis employing a gene- and genome-centric metagenomic approach reveals changes in composition, function, and activity in waterworks with different treatment processes and source water in Finland

The emergence and development of next-generation sequencing technologies (NGS) has made the analysis of the water microbiome in drinking water distribution systems (DWDSs) more accessible and opened new perspectives in microbial ecology studies. The current study focused on the characterization of the water microbiome employing a gene- and genome-centric metagenomic approach to five waterworks in Finland with different raw water sources, treatment methods, and disinfectant. The microbial communities exhibit a distribution pattern of a few dominant taxa and a large representation of low-abundance bacterial species. Changes in the community structure may correspond to the presence or absence and type of disinfectant residual which indicates that these conditions exert selective pressure on the microbial community. The Archaea domain represented a small fraction (up to 2.5%) and seemed to be effectively controlled by the disinfection of water. Their role particularly in non-disinfected DWDS may be more important than previously considered. In general, non-disinfected DWDSs harbor higher microbial richness and maintaining disinfectant residual is significantly important for ensuring low microbial numbers and diversity. Metagenomic binning recovered 139 (138 bacterial and 1 archaeal) metagenome-assembled genomes (MAGs) that had a >50% completeness andPeer reviewe

Bacterial Genes Encoding Resistance Against Antibiotics and Metals in Well-Maintained Drinking Water Distribution Systems in Finland

Information on the co-occurrence of antibiotic resistance genes (ARGs) and metal resistance genes (MRGs) among bacterial communities in drinking water distribution systems (DWDSs) is scarce. This study characterized ARGs and MRGs in five well-maintained DWDSs in Finland. The studied DWDSs had different raw water sources and treatment methods. Two of the waterworks employed artificially recharged groundwater (ARGW) and used no disinfection in the treatment process. The other three waterworks (two surface and one groundwater source) used UV light and chlorine during the treatment process. Ten bulk water samples (two from each DWDS) were collected, and environmental DNA was extracted and then sequenced using the Illumina HiSeq platform for high-throughput shotgun metagenome sequencing. A total of 430 ARGs were characterized among all samples with the highest diversity of ARGs identified from samples collected from non-disinfected DWDSs. Furthermore, non-disinfected DWDSs contained the highest diversity of bacterial communities. However, samples from DWDSs using disinfectants contained over double the ratio of ARG reads to 16S rRNA gene reads and most of the MRG (namely mercury and arsenic resistance genes). The total reads and types of ARGs conferring genes associated with antibiotic groups namely multidrug resistance, and bacitracin, beta-lactam, and aminoglycoside and mercury resistance genes increased in waterworks treating surface water with disinfection. The findings of this study contribute toward a comprehensive understanding of ARGs and MRGs in DWDSs. The occurrence of bacteria carrying antibiotic or metal resistance genes in drinking water causes direct exposure to people, and thus, more systematic investigation is needed to decipher the potential effect of these resistomes on human health.Peer reviewe

Monitoring groundwater quality with real-time data, stable water isotopes, and microbial community analysis : A comparison with conventional methods

Groundwater provides much of the world's potable water. Nevertheless, groundwater quality monitoring programmes often rely on a sporadic, slow, and narrowly focused combination of periodic manual sampling and laboratory analyses, such that some water quality deficiencies go undetected, or are detected too late to prevent adverse consequences. In an effort to address this shortcoming, we conducted enhanced monitoring of untreated groundwater quality over 12 months (February 2019-February 2020) in four shallow wells supplying potable water in Finland. We supplemented periodic manual sampling and laboratory analyses with (i) real-time online monitoring of physicochemical and hydrological parameters, (ii) analysis of stable water isotopes from groundwater and nearby surface waters, and (iii) microbial community analysis of groundwater via amplicon sequencing of the 16S rRNA gene and 16S rRNA. We also developed an early warning system (EWS) for detecting water quality anomalies by automating real-time online monitoring data collection, transfer, and analysis - using electrical conductivity (EC) and turbidity as indirect water quality indicators. Real-time online monitoring measurements were largely in fair agreement with periodic manual measurements, demonstrating their usefulness for monitoring water quality; and the findings of conventional monitoring, stable water isotopes, and microbial community analysis revealed indications of surface water intrusion and faecal contamination at some of the studied sites. With further advances in technology and affordability expected into the future, the supplementary methods used here could be more widely implemented to enhance groundwater quality monitoring - by contributing new insights and/or corroborating the findings of conventional analyses.Peer reviewe