Ohje moniresistenttien mikrobien tartunnantorjunnasta

Ohje on tarkoitettu ensisijaisesti sairaanhoitopiirien ja kuntien tartunnantorjunnasta vastaaville henkilöille ja sen tavoitteena on yhtenäistää moniresistenttien mikrobien torjuntaa Suomessa. Infektiontorjuntatiimit soveltavat ohjetta ottaen huomioon paikalliset olosuhteet. Sairaanhoitopiirin on huolehdittava, että sillä on käytettävissä riittävästi infektioiden torjuntaan perehtyneitä asiantuntijoita varmistamaan moniresistenttien mikrobien torjunnan käytännön toteutuminen. Moniresistenttien mikrobien torjunta koostuu hoitoon liittyvien infektioiden ehkäisystä, mikrobilääkkeiden asianmukaisesta käytöstä sekä tartunnantorjunnasta. Tässä ohjeessa käsitellään vain tartunnantorjuntaa

Ohje moniresistenttien mikrobien tartunnantorjunnasta

Tämän vanhan painoksen korvaa uusi, muutettu painos osoitteessa: http://urn.fi/URN:ISBN:978-952-343-463-9</a

Cattle Production for Exports in Water-Abundant Areas: The Case of Finland

Water scarcity is a severe global threat, and it will only become more critical with a growing and wealthier population. Annually, considerable volumes of water are transferred virtually through the global food system to secure nations’ food supply and to diversify diets. Our objective is to assess, whether specializing water-intensive production for exports in areas with an abundance of natural resources, would contribute to globally resource-efficient food production. We calculated Finland’s virtual water net export potential (four scenarios) by reallocating the present underutilized agricultural land and combining that with a domestic diet change (three scenarios) to maximize the exports of cattle products. Assessed scenarios indicate that the greatest potential to net export virtual water (3.7 billion m3 year−1, 25-time increase to current) was achieved when local production was maximized with domestic and exported feed, and bovine meat consumption in Finland was replaced with a vegetarian substitute. This corresponds to annual virtual water consumption for food of about 3.6 million global citizens (assuming 1032 m3 cap−1 year−1). Therefore our results suggest, that optimizing water-intensive production to water-rich areas, has a significant impact on global water savings. In addition, increasing exports from such areas by decreasing the domestic demand for water-intensive products to meet the nutrition recommendation levels, saves water resources

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Background: Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs). Methods: We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature. Findings: From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece. Interpretation: Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases

A multi-centre randomized controlled trial comparing arthroscopic osteochondroplasty and lavage with arthroscopic lavage alone on patient important outcomes and quality of life in the treatment of young adult (18-50) Femoroacetabular impingement

Background: Several cross-sectional studies have estimated that the prevalence of femoroacetabular impingement (FAI) ranges from 14-17% among asymptomatic young adults to almost 95% among competitive athletes. With FAI, there is abnormal contact between the proximal femur and the acetabulum, resulting in abnormal mechanics with terminal motion such as hip flexion and rotation. This condition results from bony anomalies of the acetabular rim (Pincer) and or femoral head/neck junction (CAM) and typically causes hip pain and decreased hip function. The development of hip pain potentially serves as an indicator for early cartilage and labral damage that may result in hip osteoarthritis. Although surgical correction of the misshaped bony anatomy and associated intra-articular soft tissue damage of the hip is thought to improve hip pain and alter the natural history of degenerative disease, the supportive evidence is based upon low quality observational studies. The Femoroacetabular Impingement RandomiSed controlled Trial (FIRST) compares outcomes following surgical correction of the impingement morphology (arthroscopic osteochondroplasty) with/without labral repair versus arthroscopic lavage of the hip joint in adults aged 18 to 50 diagnosed with FAI. Methods and design: FIRST is a multi-centre, randomized controlled trial with a sample size of 220 patients. Exclusion criteria include the presence of hip syndromes, previous surgery or trauma to the affected hip, and significant medical comorbidities. The primary outcome is pain and the secondary outcomes include patient function, quality of life, complications, and cost-effectiveness - all within one year of follow-up. Patients are stratified based on centre and impingement sub-type. Patients, outcome assessors, data analysts, and the Steering Committee are blinded to surgical allocation. Using an intention-to-treat approach, outcome analyses will be performed using an analysis of covariance and descriptive statistics. Discussion: Symptomatic FAI is associated with chronic hip pain, functional limitations, and secondary osteoarthritis. Therefore, optimizing treatment has the potential to improve the lives millions of young, active persons who are diagnosed with this condition. Few orthopaedic surgical trials have similar potential to shift the paradigm of care dramatically towards (or away) from surgical bony and soft tissue interventions.Peer reviewe

Special Acknowledgements:

The Mobile Games 2010 report looks at how mobile gaming could be like in year 2010 from three points of view: games and players, technology, and business. The study was done by interviewing about 20 mobile game publishers, developers, operators, and inviting experts to write articles on the topic. The invited articles are attached in the end. The report reflects the opinions of the interviewees and authors of the articles- not Nokia’s game strategy or future product releases

Haitallisten orgaanisten yhdisteiden ja lääkeaineiden esiintyminen biokaasulaitosten käsittelyjäännöksissä sekä niiden elintarvikeketjuun aiheuttaman vaaran arviointi

Hankkeessa selvitettiin biokaasulaitosten käsittelyjäännösten haitallisten orgaanisten yhdisteiden ja lääke-aineiden pitoisuuksia sekä niistä mahdollisesti aiheutuvaa riskiä elintarvikkeiden käytön turvallisuudelle. Tutkimuksessa oli mukana suurin osa hankkeen aikana Suomessa toiminnassa olleista keskitetyistä bio-kaasulaitoksista, joissa yhteiskäsiteltiin erilaisia jäteperäisiä raaka-aineita. Tutkitut yhdisteryhmät olivat: polyklooratut dibentso-p-dioksiinit ja -furaanit (PCDD/F), polyklooratut bifenyylit (PCB), polyaromaatti-set hiilivedyt (PAH), bis(2-ethyyliheksyyli)ftalaatti (DEHP), perfluoratut alkyyliyhdisteet (PFC), lineaari-set alkyylibentseenisulfonaatit (LAS), nonyylifenolit ja nonyylifenolietoksylaatit (NP+NPEO) ja seuraa-vat bromatut palonsuoja-aineet: polybromatut difenyylieetterit (PBDE), heksabromisyklododekaani (HBCD) ja tetrabromibisfenoli A (TBBPA). Lisäksi tutkittiin 25 lääkeaineen esiintymistä käsittelyjään-nöksissä. Kaikkien tutkittujen biokaasulaitosten käsittelyjäännöksissä esiintyi useita haitallisia orgaanisia yhdisteitä ja lääkeaineita. Niiden pitoisuudet vaihtelivat paljon sekä laitosten välillä että samalta laitokselta eri ai-kaan otetuissa näytteissä. Mitatut pitoisuudet käsittelyjäännöksissä olivat samaa luokkaa kuin kirjallisuu-dessa esitetyt muissa Euroopan maissa mitatut pitoisuudet puhdistamolietteissä tai biokaasulaitosten kä-sittelyjäännöksissä. Haitallisia orgaanisia yhdisteitä löytyi niin puhdistamoliete- kuin biojäte- ja elintarviketeollisuuden sivu-tuote ja lantapohjaisistakin lopputuotteista. Tilastollisesti merkittävä korrelaatio havaittiin raaka-aineena käytetyn puhdistamolietteen ja mädätysjäännösten kolmen lääkeaineen pitoisuuksien välillä. Tutkittujen mädätysjäännösten peltolevitys ja ilmalaskeuma aiheuttivat samaa suuruusluokkaa olevan laskennallisen maaperäkuormituksen lähes kaikkien tutkittujen yhdisteryhmien osalta. Bromattuihin pa-lonestoaineisiin kuuluvien PBDE-yhdisteiden osalta mädätysjäännösten aiheuttama kuormitus oli kuiten-kin 400 - 1000-kertainen verrattuna kirjallisuudessa esitettyyn ilmalaskeumaan. Rejektivesien käyttö lannoitevalmisteena ei aiheuttanut suurempaa haitta-aineiden maaperäkuormitusta kuin mädätysjäännök-sen tai kuivajakeen käyttö. Biokaasulaitosten käsittelyjäännösten maatalouskäytöstä mahdollisesti aiheutuvaa riskiä elintarvikkeiden käytön turvallisuudelle arvioitiin kirjallisuustietojen perusteella. Arvioinnin mukaan nykyisissä pitoisuuk-sissa käsittelyjäännösten sisältämät dioksiinien, PCB:n, PAH:n, DEHP:n LAS:n NP+NPEO:n ja TBBPA:n määrät eivät aiheuta merkittävää riskiä elintarvikkeiden käytön turvallisuudelle. Ne joko ha-joavat maaperässä melko nopeasti, ne eivät kerry maaperästä elintarvikkeisiin tai niitä päätyy käsittely-jäännöksen mukana maaperään niin vähän, että kertyminen kasveihin tai eläinperäisiin elintarvikkeisiin on vähäistä. PBDE:n, HBCD:n, PFC:n ja lääkeaineiden osalta riskin arvioimiseksi tarvitaan lisää tietoa.In this study, the concentrations of hazardous organic compounds and pharmaceuticals in biogas plant digestates were analyzed. In addition, the risk for food safety, caused by the use of digestate as a fertilizer in agriculture, was examined. Most of the centralized Finnish biogas plants, which used various waste materials as substrate, took part in the study. The following groups of organic compounds were analyzed: polychlorinated dibenzo-p-dioxins and –furans (PCDD/F), polychlorinated bifenyls (PCB), polyaromatic hydrocarbons (PAH), bis(2-ethylhexyl)phtlalate (DEHP), perfluorinated compounds (PFC), linear alkyl-benzene sulfonate (LAS), nonylphenol and nonylphenol ethoxylate (NP+NPEO), and brominated flame retardants including polybrominated diphenylethers (PBDE), hexabromocyclododecane (HBCD) and tetrabromobisphenol A (TBBPA). Moreover the occurrence of 25 different pharmaceuticals in digestate was determined. Several hazardous organic compounds and pharmaceuticals were found in all digestates from the biogas plants included in the study. The concentrations varied a lot both between the plants and between samples taken from the same plant at different times. The concentrations measured from the digestates were at the same level than the values found in the literature for wastewater sludge or biogas plant digestates in other European countries. All the digestates produced from various waste materials, such as waste water sludge, municipal bio-waste, manure, and by-products from food industry, contained some hazardous organic compounds. Sta-tistically significant correlations were observed for three different pharmaceuticals when waste water sludge was used as a substrate for biogas production. For the studied compounds, a calculated median soil burden of the compound after a single addition of the digestate as a fertilizer was at the same level to the annual atmospheric deposition of the compound or compound group in Finland or other Nordic countries. However, the soil burden for PBDEs (brominated flame retardants) coming from digestate was 400 – 1000 times higher compared to the annual atmos-pheric deposition. The soil burden for studied compounds coming from liquid fraction of digestate was either lower or at the same level as the soil burden coming from digestate as such or from its solid frac-tion. The risk for the food safety caused by the fertilizer use of a biogas plant digestate was evaluated based on the literature. According to the risk assessment, agricultural use of biogas plant end products is unlikely to cause significant risk for food safety in Finland for most of the compound groups studied. They are either degraded in the soil, or they are not taken up by the plant and further migrated in the food chain, or the concentration in the soil is at a very low level when also the uptake by the plant is minor. However with PBDEs, PFCs, HBCD and pharmaceuticals, further research is needed to be able to evaluate the risk caused by the fertilizer use of the biogas plant digestates