Ympäristöpalveluiden merkitys ja tarve Varsinais-Suomen alueen pk-yrityksissä

Opinnäytetyön toimeksiannon pohjalla on Turun ammattikorkeakoulun hallinnoima EGreenNet-ympäristöosaamisverkostoprojekti. Tutkimuksen keskeisenä tavoitteena oli selvittää mitä ympäristöpalveluita Varsinais-Suomen alueen pk-yritykset tarvitsevat ylläpitääkseen ja kehittääkseen ympäristövastuullista yritystoimintaa. Työn teoreettinen osuus on jaettu kahteen osaan. Ensin tarkastellaan ympäristöosaamista käsitteenä ja syitä miksi yritysten tulisi ylläpitää ympäristövastuullista liiketoimintaa. Toisessa osassa tarkastellaan ympäristöosaamista tukevien ympäristöpalvelujen käsitteistöä ja pk-yritysten toiminnan kannalta keskeisimpiä työvälineitä. Opinnäytetyön empirinen osuus perustuu kvantitatiiviseen kyselytutkimukseen. Aineistonkeruu toteutettiin sähköisellä kyselyllä yhteistyössä Varsinais-Suomen Yrittäjät ry:n kanssa. Saadut tutkimustulokset osoittivat, että ympäristöosaaminen on osa pk-yritysten arkipäivää. Ympäristöpalveluja on tarjolla monipuolisesti, mutta niiden sisällössä olisi vielä kehitettävää ja kaikki palvelut eivät palvele pk-yritysten tarpeita riittävän hyvin. Erityisesti byrokraattisten ympäristöpalveluiden sisältö, yhtenäisten toimintamallien puuttuminen sekä tiettyihin ympäristöpalveluihin sisältyvät maksut ovat esteenä pk-yritysten mahdollisuuksille ylläpitää ympäristövastuullista yritystoimintaa. Osaa olemassa olevista ympäristöpalveluista pk-yritykset tarvitsevat jo nyt ja osa taas nähdään tärkeiksi tulevaisuudessa. Palveluiden tulisi kuitenkin jo nyt olla helpommin saatavilla ja yhteistyö palveluntarjoajien ja niitä tarvitsevien yritysten välillä tulisi saada toimimaan välittömästi.The assignment for this thesis origins from eGreenNet (network of environmental know-how) project conducted by Turku University of Applied Sciences. The objective for the thesis was to examine the need of environmental services in small and medium sized enterprises (SMEs) in the Southwest Finland region. The theoretical part first examines the concept of environmental know-how and driving forces and reasons for companies to maintain and develop green values in their operations. In the second part the focus is on the essential environmental services that support companies’ environmental operations. The empirical part is based on quantative survey and it was conducted by an electronic questionnaire in co-operation with Varsinais-Suomen Yrittäjät ry. The research results proved that SMEs in Southwest Finland region do have a need for certain environmental services, and that environmental matters are also a part of a small enterprise’s everyday business operations. The study also showed that even though certain environmental services are provided, they do not function in proper way and do not always fit to the needs of SMEs. Especially content of some bureaucratic environmental services, lack of coherent operations and certain high environment fees makes it difficult for small companies to maintain environmental operation models. Environmental services should be more easily available and this means that the co-operation needs to be more efficient between companies needing environmental services and service providers

Information system support for medical secretaries’ work in patient administration tasks in different phases of the care process

Medical secretaries may have several separate electronic nursing information systems in use, but regardless of the systems, their task is to make sure that the patient information is correct and usable. The purpose of this study is to describe the support provided by the hospital information systems for the work of medical secretaries in patient administration tasks in different phases of the care process. The data were collected in a central hospital where medical secretaries had long been using partly electronic information systems. The data were collected using an abridged version of the Hospital Information System Monitor (HIS-monitor). The majority of the secretaries (N=60) gave a positive assessment for the support provided by the information system for their work at patient admission, when ordering diagnostic or therapeutic examinations or procedures, and at patient discharge. In the planning and organization of care, most thought that the systems provided poor support for informing all those involved in patient care. At patient admission, nearly half considered that the support for ensuring data protection (46%) and the systems’ compliance with legal obligations (44%) was poor. In connection with ordering diagnostic and therapeutic examinations and procedures, nearly half (43%) thought that information on the availability in ancillary units was not readily and easily available. At patient discharge, 40% considered that the systems did not support the identification of missing or incorrect information. The hospital information system provides partial support for medical secretaries’ work. The implementation of fully electronic systems and their functions may improve the support.Medical secretaries may have several separate electronic nursing information systems in use, but regardless of the systems, their task is to make sure that the patient information is correct and usable. The purpose of this study is to describe the support provided by the hospital information systems for the work of medical secretaries in patient administration tasks in different phases of the care process. The data were collected in a central hospital where medical secretaries had long been using partly electronic information systems. The data were collected using an abridged version of the Hospital Information System Monitor (HIS-monitor). The majority of the secretaries (N=60) gave a positive assessment for the support provided by the information system for their work at patient admission, when ordering diagnostic or therapeutic examinations or procedures, and at patient discharge. In the planning and organization of care, most thought that the systems provided poor support for informing all those involved in patient care. At patient admission, nearly half considered that the support for ensuring data protection (46%) and the systems’ compliance with legal obligations (44%) was poor. In connection with ordering diagnostic and therapeutic examinations and procedures, nearly half (43%) thought that information on the availability in ancillary units was not readily and easily available. At patient discharge, 40% considered that the systems did not support the identification of missing or incorrect information. The hospital information system provides partial support for medical secretaries’ work. The implementation of fully electronic systems and their functions may improve the support

Partition of Marine Environment Dynamics According to Remote Sensing Reflectance and Relations of Dynamics to Physical Factors

Seawaters exhibit various types of cyclic and trend-like temporal alterations in their biological, physical, and chemical processes. Surface water dynamics may vary, for instance, when the timings, durations, or amplitudes of seasonal developments of water properties alter between years and locations. We introduce a workflow using remote sensing to identify surface waters undergoing similar dynamics. The method, called ocean surface dynamics partitioning, classifies pixels based on their temporal change patterns instead of their properties at successive time snapshots. We apply an efficient parallel computing method to calculate Dynamic Time Warping (DTW) time series distances of large datasets of Earth Observation MERIS-instrument reflectance data R-rs(510 nm) and R-rs(620 nm), and produce a matrix of time series distances between 12,252 locations/time series in the Baltic Sea, for both wavelengths. We define cluster prototypes by hierarchical clustering of distance matrices and use them as initial prototypes for an iterative process of partitional clustering in order to identify areas that have similar reflectance dynamics. Lastly, we compute distances from the time series of the reflectance data to selected physical factors (wind, precipitation, and changes in sea surface temperature) obtained from Copernicus data archives. The workflow is reproducible and capable of managing large datasets in reasonable computation times and identifying areas of distinctive dynamics. The results show spatially coherent and logical areas without a priori information about the locations of the satellite image time series. The alignments of the reflectance time series vs. the observational time series of the physical environment clarify the causalities behind the cluster formation. We conclude that following the changes in an aquatic realm by biogeochemical observations at certain temporal intervals alone is not sufficient to identify environmental shifts. We foresee that the changes in dynamics are a sensitive measure of environmental threats and therefore they will be important to follow in the future.</p

Hoitotyöntekijöiden näkemyksiä lääkehoidon hallintajärjestelmän tuesta ammattimaiseen ja turvalliseen lääkehoitoon

Safe medication administration is central part of nurses’ work. Safe medication has been studied trough medication errors, but there is less research information about supporting aspects of safe and professional medication administration. The purpose of this study is to describe nurses’ views of what supports safe and professional medication administration in the current medication administration system. Medication administration system stand for all organization’s structures and practices that supports or directs medication administration and any actions related to that. The study was conducted in one of Finland’s central hospitals. Data was collected with open-ended section and background questions of back translated Medication Administration System – Nurses Assessment Scale (MAS - NAS). Data was inductively analyzed using content analysis. Safe medication administration is supported with appropriate storing place, supplies available as needed, availability of extra information on medicines, usefulness and good&nbsp; usability of electronic system, availability of patient-specific information, opportunity to ensure medication, checkup practices and taking responsibility of own actions in medication administration. Cooperation and keeping up to date are supporting elements of professional medication administration. To support safe medication administration, it is managers’ responsibility to provide nursing staff appropriate storage facilities, supplies, and facilities to ensure medication information is available and medication verification is possible. Checkup practices should be used and ensure everyone knows their medication responsibilities. The electronic system’s good usability and usefulness for nurses is key factor of safe medication administration. Professional medication administration confirms by information disseminating and superiors encourage to cooperation, education, and to active knowledge search.Turvallinen lääkehoito on keskeinen osa sairaanhoitajan työtä. Turvallista lääkehoitoa on tutkittu lääkitysvirheiden avulla, mutta turvallista ja ammattimaista lääkehoitoa tukevista asioista on vähemmän aiempaa tutkimustietoa. Tämän tutkimuksen tarkoituksena on kuvata hoitotyöntekijöiden näkemyksiä siitä, mikä nykyisessä lääkehoidon hallintajärjestelmässä tukee turvallista ja ammattimaista lääkehoitoa. Lääkehoidon hallintajärjestelmällä tarkoitetaan kaikkia lääkehoidon antamista ja siihen liittyviä toimenpiteitä ohjaavia ja tukevia organisaation rakenteita ja käytäntöjä. Tutkimus toteutettiin yhdessä Suomen keskussairaalassa. Aineisto kerättiin kaksoiskäännetyn Medication Administration System – Nurses Assesment Scale (MAS - NAS) -mittarin avoimen osion ja taustakysymysten avulla. Aineisto analysoitiin induktiivisella sisällönanalyysilla. Turvallista lääkehoitoa tuki säilytyspaikan asianmukaisuus, tarvikkeiden tarpeenmukaisuus, lisätiedon saatavuus lääkkeistä, sähköisen järjestelmän hyödyllisyys ja hyvä käytettävyys, potilaskohtaisten tietojen saatavuus, lääkityksen varmistusmahdollisuus, tarkistuskäytäntöjen ja lääkehoidon osa-alueestaan vastuun kantaminen. Ammattimaista lääkehoitoa tuki yhteistyössä toimiminen ja ajan tasalla pysyminen. Tukeakseen turvallista lääkehoitoa johtajien tehtävänä on tarjota lääkkeille asianmukaiset säilytystilat ja hoitotyöntekijöiden käyttöön tarvittavat tarvikkeet sekä sellaiset välineet, että lääkityksessä tarvittavat tiedot ovat saatavilla ja lääkitys on mahdollista varmistaa. Tarkistuskäytännöt tulee ottaa käyttöön ja varmentaa, että kaikki tuntevat lääkehoidon vastuunsa. Sähköisen järjestelmän hyvä käytettävyys ja hyödyllisyys hoitotyöntekijöille on keskeistä turvalliselle lääkehoidolle. Ammattimaista lääkehoitoa vahvistavat tiedon jakaminen ja esimiesten kannustus yhteistyössä toimimiseen, kouluttautumiseen ja aktiiviseen tiedonhakuun

Sociodemographic Differences Between Alcohol Use and Sickness Absence : Pooled Analysis of Four Cohort Studies

Aims: We examined differences in sickness absence in relation to at-risk drinking and abstinence, taking into account potential changes in consumption. Methods: We used individual-participant data (n = 46,514) from four prospective cohort studies from Finland, France and the UK. Participants responded to a survey on alcohol use at two time points 4-6 years apart, and were linked to records of sickness absence for an similar to 6-year follow-up after the latter survey. Abstainers were those reporting no alcohol use in either survey. At-risk drinkers at T1 were labelled as 'former', at-risk drinkers at T2 as 'current' and at-risk drinkers at both times as 'consistent' at-risk drinkers. The reference group was low-risk drinkers at both times. Study-specific analyses were stratified by sex and socioeconomic status (SES) and the estimates were pooled using meta-analysis. Results: Among men (n = 17,285), abstainers (6%), former (5%), current (5%) and consistent (7%) at-risk drinkers had an increased risk of sickness absence compared with consistent low-risk drinkers (77%). Among women (n = 29,229), only abstainers (12%) had a higher risk of sickness absence compared to consistent low-risk drinkers (74%). After adjustment for lifestyle and health, abstaining from alcohol was associated with sickness absence among people with intermediate and high SES, but not among people with low SES. Conclusions: The U-shaped alcohol use-sickness absence association is more consistent in men than women. Abstinence is a risk factor for sickness absence among people with higher rather than lower SES. Healthy worker effect and health selection may partly explain the observed differences. Short summary: In a pooled analysis from four cohort studies from three European countries, we demonstrated a U-shaped association between alcohol use and sickness absence, particularly among men. Abstinence from alcohol was associated with increased sickness absenteeism among both sexes and across socioeconomic strata, except those with low SES.Peer reviewe

Sickness absence diagnoses among abstainers, low-risk drinkers and at-risk drinkers : consideration of the U-shaped association between alcohol use and sickness absence in four cohort studies

Aims To estimate differences in the strength and shape of associations between alcohol use and diagnosis-specific sickness absence. Design A multi-cohort study. Participants (n = 47 520) responded to a survey on alcohol use at two time-points, and were linked to records of sickness absence. Diagnosis-specific sickness absence was followed for 4-7 years from the latter survey. Setting and participants From Finland, we had population cohort survey data from 1998 and 2003 and employee cohort survey data from 2000-02 and 2004. From France and the United Kingdom, we had employee cohort survey data from 1993 and 1997, and 1985-88 and 1991-94, respectively. Measurements We used standard questionnaires to assess alcohol intake categorized into 0, 1-11 and > 11 units per week in women and 0, 1-34 and > 34 units per week in men. We identified groups with stable and changing alcohol use over time. We linked participants to records from sickness absence registers. Diagnoses of sickness absence were coded according to the International Classification of Diseases. Estimates were adjusted for sex, age, socio-economic status, smoking and body mass index. Findings Women who reported drinking 1-11 units and men who reported drinking 1-34 units of alcohol per week in both surveys were the reference group. Compared with them, women and men who reported no alcohol use in either survey had a higher risk of sickness absence due to mental disorders [rate ratio = 1.51, 95% confidence interval (CI) = 1.22-1.88], musculoskeletal disorders (1.22, 95% CI = 1.06-1.41), diseases of the digestive system (1.35, 95% CI = 1.02-1.77) and diseases of the respiratory system (1.49, 95% CI = 1.29-1.72). Women who reported alcohol consumption of > 11 weekly units and men who reported alcohol consumption of > 34 units per week in both surveys were at increased risk of absence due to injury or poisoning (1.44, 95% CI = 1.13-1.83). Conclusions In Finland, France and the United Kingdom, people who report not drinking any alcohol on two occasions several years apart appear to have a higher prevalence of sickness absence from work with chronic somatic and mental illness diagnoses than those drinking below a risk threshold of 11 units per week for women and 34 units per week for men. Persistent at-risk drinking in Finland, France and the United Kingdom appears to be related to increased absence due to injury or poisoning.Peer reviewe

Body-mass index and risk of obesity-related complex multimorbidity : an observational multicohort study

Background The accumulation of disparate diseases in complex multimorbidity makes prevention difficult if each disease is targeted separately. We aimed to examine obesity as a shared risk factor for common diseases, determine associations between obesity-related diseases, and examine the role of obesity in the development of complex multimorbidity (four or more comorbid diseases). Methods We did an observational study and used pooled prospective data from two Finnish cohort studies (the Health and Social Support Study and the Finnish Public Sector Study) comprising 114 657 adults aged 16-78 years at study entry (1998-2013). A cohort of 499 357 adults (aged 38-73 years at study entry; 2006-10) from the UK Biobank provided replication in an independent population. BMI and clinical characteristics were assessed at baseline. BMIs were categorised as obesity (Peer reviewe

Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study

BACKGROUND: The accumulation of disparate diseases in complex multimorbidity makes prevention difficult if each disease is targeted separately. We aimed to examine obesity as a shared risk factor for common diseases, determine associations between obesity-related diseases, and examine the role of obesity in the development of complex multimorbidity (four or more comorbid diseases). METHODS: We did an observational study and used pooled prospective data from two Finnish cohort studies (the Health and Social Support Study and the Finnish Public Sector Study) comprising 114 657 adults aged 16-78 years at study entry (1998-2013). A cohort of 499 357 adults (aged 38-73 years at study entry; 2006-10) from the UK Biobank provided replication in an independent population. BMI and clinical characteristics were assessed at baseline. BMIs were categorised as obesity (≥30·0 kg/m2), overweight (25·0-29·9 kg/m2), healthy weight (18·5-24·9 kg/m2), and underweight (<18·5 kg/m2). Via linkage to national health records, participants were followed-up for death and diseases diagnosed according to the International Classification of Diseases 10th Revision (ICD-10). Hazard ratios (HRs) with 95% CIs and population attributable fractions (PAFs) for associations between BMI and multimorbidity were calculated. FINDINGS: Mean follow-up duration was 12·1 years (SD 3·8) in the Finnish cohorts and 11·8 years (1·7) in the UK Biobank cohort. Obesity was associated with 21 non-overlapping cardiometabolic, digestive, respiratory, neurological, musculoskeletal, and infectious diseases after Bonferroni multiple testing adjustment and ignoring HRs of less than 1·50. Compared with healthy weight, the confounder-adjusted HR for obesity was 2·83 (95% CI 2·74-2·93; PAF 19·9% [95% CI 19·3-20·5]) for developing at least one obesity-related disease, 5·17 (4·84-5·53; 34·4% [33·2-35·5]) for two diseases, and 12·39 (9·26-16·58; 55·2% [50·9-57·5]) for complex multimorbidity. The proportion of participants of healthy weight with complex multimorbidity by age 75 years was observed by age 55 years in participants with obesity, and degree of obesity was associated with complex multimorbidity in a dose-response relationship. Compared with obesity, the association between overweight and complex multimorbidity was more modest (HR 2·67, 95% CI 1·94-3·68; PAF 13·3% [95% CI 9·6-16·3]). The same pattern of results was observed in the UK Biobank cohort. INTERPRETATION: Obesity is associated with diverse, increasing disease burdens, and might represent an important target for multimorbidity prevention that avoids the complexities of multitarget preventive regimens. FUNDING: Wellcome Trust, Medical Research Council, National Institute on Aging

Lifestyle factors and risk of sickness absence from work : a multicohort study

Background Lifestyle factors influence the risk of morbidity and mortality, but the extent to which they are associated with employees' absence from work due to illness is unclear. We examined the relative contributions of smoking, alcohol consumption, high body-mass index, and low physical activity to diagnosis-specific sickness absence. Methods We did a multicohort study with individual-level data of participants of four cohorts from the UK, France, and Finland. Participants' responses to a lifestyle survey were linked to records of sickness absence episodes, typically lasting longer than 9 days; for each diagnostic category, the outcome was the total number of sickness absence days per year. We estimated the associations between lifestyle factors and sickness absence by calculating rate ratios for the number of sickness absence days per year and combining cohort-specific estimates with meta-analysis. The criteria for assessing the evidence included the strength of association, consistency across cohorts, robustness to adjustments and multiple testing, and impact assessment by use of population attributable fractions (PAF), with both internal lifestyle factor prevalence estimates and those obtained from European populations (PAF external). Findings For 74 296 participants, during 446 478 person-years at risk, the most common diagnoses for sickness absence were musculoskeletal diseases (70.9 days per 10 person-years), depressive disorders (26.5 days per 10 person-years), and external causes (such as injuries and poisonings; 12.8 days per 10 person-years). Being overweight (rate ratio [adjusted for age, sex, socioeconomic status, and chronic disease at baseline] 1.30, 95% CI 1.21-1.40; PAF external 8.9%) and low physical activity (1.23, 1.14-1.34; 7.8%) were associated with absences due to musculoskeletal diseases; heavy episodic drinking (1.90, 1.41-2.56; 15.2%), smoking (1.70, 1.42-2.03; 11.8%), low physical activity (1.67, 1.42-1.96; 19.8%), and obesity (1.38, 1.11-1.71; 5.6%) were associated with absences due to depressive disorders; heavy episodic drinking (1.64, 1.33-2.03; 11.3%), obesity (1.48, 1.27-1.72; 6.6%), smoking (1.35, 1.20-1.53; 6.3%), and being overweight (1.20, 1.08-1.33; 6.2%) were associated with absences due to external causes; obesity (1.82, 1.40-2.36; 11.0%) and smoking (1.60, 1.30-1.98; 10.3%) were associated with absences due to circulatory diseases; low physical activity (1.37, 1.25-1.49; 12.0%) and smoking (1.27, 1.16-1.40; 4.9%) were associated with absences due to respiratory diseases; and obesity (1.67, 1.34-2.07; 9.7%) was associated with absences due to digestive diseases. Interpretation Lifestyle factors are associated with sickness absence due to several diseases, but observational data cannot determine the nature of these associations. Future studies should investigate the cost-effectiveness of lifestyle interventions aimed at reducing sickness absence and the use of information on lifestyle for identifying groups at risk. Copyright (c) The Author (s). Published by Elsevier Ltd. This is an open access article under the CC BY 4.0 license.Peer reviewe

Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study

Background: The accumulation of disparate diseases in complex multimorbidity makes prevention difficult if each disease is targeted separately. We aimed to examine obesity as a shared risk factor for common diseases, determine associations between obesity-related diseases, and examine the role of obesity in the development of complex multimorbidity (four or more comorbid diseases).Methods: We did an observational study and used pooled prospective data from two Finnish cohort studies (the Health and Social Support Study and the Finnish Public Sector Study) comprising 114 657 adults aged 16-78 years at study entry (1998-2013). A cohort of 499 357 adults (aged 38-73 years at study entry; 2006-10) from the UK Biobank provided replication in an independent population. BMI and clinical characteristics were assessed at baseline. BMIs were categorised as obesity (≥30·0 kg/m2), overweight (25·0-29·9 kg/m2), healthy weight (18·5-24·9 kg/m2), and underweight (2). Via linkage to national health records, participants were followed-up for death and diseases diagnosed according to the International Classification of Diseases 10th Revision (ICD-10). Hazard ratios (HRs) with 95% CIs and population attributable fractions (PAFs) for associations between BMI and multimorbidity were calculated.Findings: Mean follow-up duration was 12·1 years (SD 3·8) in the Finnish cohorts and 11·8 years (1·7) in the UK Biobank cohort. Obesity was associated with 21 non-overlapping cardiometabolic, digestive, respiratory, neurological, musculoskeletal, and infectious diseases after Bonferroni multiple testing adjustment and ignoring HRs of less than 1·50. Compared with healthy weight, the confounder-adjusted HR for obesity was 2·83 (95% CI 2·74-2·93; PAF 19·9% [95% CI 19·3-20·5]) for developing at least one obesity-related disease, 5·17 (4·84-5·53; 34·4% [33·2-35·5]) for two diseases, and 12·39 (9·26-16·58; 55·2% [50·9-57·5]) for complex multimorbidity. The proportion of participants of healthy weight with complex multimorbidity by age 75 years was observed by age 55 years in participants with obesity, and degree of obesity was associated with complex multimorbidity in a dose-response relationship. Compared with obesity, the association between overweight and complex multimorbidity was more modest (HR 2·67, 95% CI 1·94-3·68; PAF 13·3% [95% CI 9·6-16·3]). The same pattern of results was observed in the UK Biobank cohort.Interpretation: Obesity is associated with diverse, increasing disease burdens, and might represent an important target for multimorbidity prevention that avoids the complexities of multitarget preventive regimens.</p