Maatalouden muutokset ja niiden ympäristövaikutukset Saaristomeren valuma-alueella

Raportissa käsitellään maatalouden muutoksia sekä näihin liittyviä ympäristövaikutuksia ja -ongelmia ratkaisuvaihtoehtoineen Saaristomeren valuma-alueen eri osissa. Selvitys on osa Lounais-Suomen ympäristökeskuksen hallinnoimaa MUUSA- eli ”Muuttuvan maatalouden ympäristönsuojelu Saaristomeren valuma-alueella” –yhteistyöhanketta, joka on toteutettu Varsinais-Suomen TE-keskuksen ELMA-rahoituksella. Selvitys sisältää yhteenvedon maatalouden muutosennusteista, jotka on koottu 2000-luvulla julkaistuista kotimaisista tutkimusraporteista sekä 2006 julkaistun viljelijäkyselyn tuloksista. Näissä alueellisia ennusteita ja tuloksia on kuitenkin esitetty vain tukialueittain (A- tai B-alue) tai TE-keskuksittain. Saaristomeren valuma-alueen viljelijöiden käsityksiä sekä eri osa-alueilla mahdollisesti esiintyviä eroja selvitettiin talvella 2006 – 2007 järjestetyllä viljelijäkyselyllä. Siihen vastasi 10 % alueen viljelijöistä. Kysely toteutettiin ympäristötuen koulutustilaisuuksissa, laivaseminaareissa ja sokerijuurikkaanviljelijöiden kokouksissa. Kysely tehtiin 51 kysymystä sisältävällä lomakkella, jossa viljelijöitä pyydettiin arvioimaan viiden vuoden kuluessa tapahtuvaa muutosta sekä omalla tilallaan että omassa asuinkunnassaan. Vastauksia käsiteltiin osa-alueittain sekä viljelijöiden ikäryhmien ja tilakoon mukaisesti. Kyselystä saadut tulokset vastasivat hyvin 2000-luvulla tehtyjä ennusteita, eikä vastauksissa ilmennyt kovinkaan suuria eroja eri osa-alueiden välillä. Maataloudessa voidaan Saaristomeren valuma-alueella nähdä selkeät kehityssuunnat. Tuotanto keskittyy alueellisesti ja yksikkökoot kasvavat sekä kasvinviljely- että kotieläintiloilla, samoin koneiden koko. Kuluja pyritään vähentämään kustannustehokkailla ja työtä vähentävillä tekniikoilla. Ravinnekuormituksen ja eroosion arvioidaan pienenevän väkilannoituksen vähenemisen ja tarkentumisen sekä uusien viljelytekniikoiden ja lisääntyvän kasvipeitteisyyden myötä. Energia- ja öljykasvien viljelyn ennustetaan lisääntyvän. Kotieläintuotannon keskittyminen ja peltojen korkea fosforitila sekä näistä johtuva lannan levitysalan puute tuottavat ongelmia erityisesti Vakka-Suomessa. Lannan ennustetaan muuallakin leviävän yhä laajemmille alueille, mikä lisää kuljetusmatkoja ja saattaa lisätä esim. hajuhaittoja ellei lantaa käsitellä hajuttomammaksi. Viljelijöillä on selvästi kiinnostusta ympäristönsuojelun edistämiseen mm. suojavyöhykkeiden, kosteikkojen ja maiseman hoidon avulla. Yleisesti kaivataan kuitenkin sopivien toimenpiteiden yksilöllistä ja tilakohtaista suunnittelua. Viljelijäkyselyn tuloksia käsiteltiin alueellisissa kokouksissa ja erilaisissa tilaisuuksissa vuoden 2007 aikana. Näiden näkemysten perusteella tehtiin toimenpide-ehdotukset maatalouden ympäristönsuojelun painopisteiksi viidelle eri osa-alueelle: 1) saaristo, 2) Vakka-Suomi, 3) Aurajoen alue ja sen lähialue, 4) Paimionjoen alue sekä 5) Salon ja Kiskon-Pernionjoen alueet

Association between case volume and mortality in pre-hospital anaesthesia management: a retrospective observational cohort

Background: Pre-hospital anaesthesia is a core competency of helicopter emergency medical services (HEMS). Whether physician pre-hospital anaesthesia case volume affects outcomes is unknown in this setting. We aimed to investigate whether physician case volume was associated with differences in mortality or medical management. Methods: We conducted a registry-based cohort study of patients undergoing drug-facilitated intubation by HEMS physician from January 1, 2013 to August 31, 2019. The primary outcome was 30-day mortality, analysed using multivariate logistic regression controlling for patient-dependent variables. Case volume for each patient was determined by the number of pre-hospital anaesthetics the attending physician had managed in the previous 12 months. The explanatory variable was physician case volume grouped by low (0-12), intermediate (13-36), and high (>= 37) case volume. Secondary outcomes were characteristics of medical management, including the incidence of hypoxaemia and hypotension. Results: In 4818 patients, the physician case volume was 511, 2033, and 2274 patients in low-, intermediate-, and high-case-volume groups, respectively. Higher physician case volume was associated with lower 30-day mortality (odds ratio 0.79 per logarithmic number of cases [95% confidence interval: 0.64-0.98]). High-volume physician providers had shorter on-scene times (median 28 [25th-75th percentile: 22-38], compared with intermediate 32 [23-42] and lowest 32 [23-43] case-volume groups; P Conclusions: Mortality appears to be lower after pre-hospital anaesthesia when delivered by physician providers with higher case volumes.Peer reviewe

The impact of urban trees on concentrations of PAHs and other gaseous air pollutants in Yanji, northeast China

It is generally conceived that trees can clean polluted air in urban areas sufficiently enough to be considered providers of a vital ecosystem service, although there have not been many field studies showing this in practice in the neighbourhood scale. Using passive sampling methods, we investigated the effect of urban park trees on the concentrations of gaseous polycyclic aromatic hydrocarbons (PAHs), nitrogen dioxide (NO2), ground-level ozone (O3) and sulfur dioxide (SO2) in early summer in the temperate zone city of Yanji, northeast China. Concentrations of total gaseous PAHs and certain PAH constituents were higher and concentrations of O3 lower in tree-covered areas compared to nearby open areas, while tree cover did not affect the concentrations of NO2 and SO2. The higher PAH concentrations under tree canopies may associate with air-soil gas exchange and the trapping of polluted air under canopies. Lower O3 concentrations in tree-covered areas may result from a combination of absorption of O3 by tree canopies, and lower temperatures and solar radiation under tree canopies compared to open areas.Peer reviewe

Gaseous polycyclic aromatic hydrocarbon concentrations are higher in urban forests than adjacent open areas during summer but not in winter – Exploratory study

Peer reviewe

Itämerirehua kotimaisista kalavirroista

Luken kirjat, raportit, oppaat ja esitteet. Loppuraportti201

Advising and limiting medical treatment during phone consultation : a prospective multicentre study in HEMS settings

Background We investigated paramedic-initiated consultation calls and advice given via telephone by Helicopter Emergency Medical Service (HEMS) physicians focusing on limitations of medical treatment (LOMT). Methods A prospective multicentre study was conducted on four physician-staffed HEMS bases in Finland during a 6-month period. Results Of all 6115 (mean 8.4/base/day) paramedic-initiated consultation calls, 478 (7.8%) consultation calls involving LOMTs were included: 268 (4.4%) cases with a pre-existing LOMT, 165 (2.7%) cases where the HEMS physician issued a new LOMT and 45 (0.7%) cases where the patient already had an LOMT and the physician further issued another LOMT. The most common new limitation was a do-not-attempt cardiopulmonary resuscitation (DNACPR) order (n = 122/210, 58%) and/or 'not eligible for intensive care' (n = 96/210, 46%). In 49 (23%) calls involving a new LOMT, termination of an initiated resuscitation attempt was the only newly issued LOMT. The most frequent reasons for issuing an LOMT during consultations were futility of the overall situation (71%), poor baseline functional status (56%), multiple/severe comorbidities (56%) and old age (49%). In the majority of cases (65%) in which the HEMS physician issued a new LOMT for a patient without any pre-existing LOMT, the physician felt that the patient should have already had an LOMT. The patient was in a health care facility or a nursing home in half (49%) of the calls that involved issuing a new LOMT. Access to medical records was reported in 29% of the calls in which a new LOMT was issued by an HEMS physician. Conclusion Consultation calls with HEMS physicians involving patients with LOMT decisions were common. HEMS physicians considered end-of-life questions on the phone and issued a new LOMT in 3.4% of consultations calls. These decisions mainly concerned termination of resuscitation, DNACPR, intubation and initiation of intensive care.Peer reviewe

Cerebral oxygen desaturation events during and functional outcomes after prehospital anaesthesia : A prospective pilot study

Background: During prehospital anaesthesia, oxygen delivery to the brain might be inadequate to match the oxygen consumption, with unknown long-term functional outcomes. We aimed to evaluate the feasibility of monitoring cerebral oxygenation during prehospital anaesthesia and determining the long-term outcomes. Methods: We performed a prospective observational feasibility study in two helicopter emergency medical services units. Frontal lobe regional oxygen saturation (rSO(2)) of adult patients undergoing prehospital anaesthesia was monitored with near-infrared spectroscopy (NIRS) by a Nonin H500 oximeter. The outcome was evaluated with a modified Rankin Scale (mRS) at 30 days and 1 year. Health-related quality of life (HRQoL) was measured with a 15D instrument at 1 year. Results: Of 101 patients enrolled, 83 were included. The mean baseline rSO(2) was 79% (73-84). Desaturation for at least 5 min to rSO(2) below 50% or a decrease of 10% from baseline occurred in four (5%, 95% CI 2%-12%) and 19 (23%, 95% CI 15-93) patients. At 1 year, 32 patients (53%, 95% CI 41-65) achieved favourable neurological outcomes. The median 15D score was 0.889 (Q1-Q3, 0.796-0.970). Conclusion: Monitoring cerebral oxygenation with a hand-held oximeter during prehospital anaesthesia and collecting data on functional outcomes and HRQoL are feasible. Only half of the patients achieved a favourable functional outcome. The effects of cerebral oxygenation on outcomes during prehospital critical care need to be assessed in future studies.Peer reviewe