Alueelliset kehitysnäkymät keväällä 2023

Alueelliset kehitysnäkymät 1/2023 on ELY-keskusten yhdessä muiden aluekehittäjien kanssa muodostama näkemys alueiden nykytilasta ja lähiajan näkymistä. Katsauksen arviot on tuotettu kuluvan vuoden huhtikuussa. Alueilla on eletty viimeiset kolme vuotta epävarmuudessa ja erilaisten uhkien varjossa. Alueiden talouden ja työllisyyden arvioissa näkyvät riskeinä globaali epävarmuus, kohonnut korkotaso, kustannusten nousu ja työvoiman saatavuuden haasteet. Osa alueista ennakoi kasvun hidastumista, mutta osa alueista näkee jo orastavia positiivisia merkkejä tulevaisuudesta mm. vihreään siirtymän investointeihin liittyen. Alueiden, toimialojen ja yritysten välillä on kuitenkin suuriakin eroja tulevaisuuden näkymissä. Venäjän jo toista vuotta jatkunut hyökkäyssota Ukrainassa aiheuttaa epävarmuutta kansainväliseen talouteen ja vaikeuttaa monen yrityksen ja toimialan toimintaa. Alueiden arvioiden mukaan yritykset ovat osoittaneet merkittävää sopeutumiskykyä, ja Venäjän hyökkäyssodan vaikutukset ovat jääneet pelättyä vähäisimmiksi. Suomen Nato-jäsenyyden nähdään vakauttavan myös taloudellista toimintaympäristöä. Työvoiman saatavuuden haasteet jatkavat pahenemistaan ja työvoimapulasta kärsitään eri puolilla maata. Sosiaali- ja terveysalan työvoimapulasta on kerrottu jo pitkään, mutta ongelmia on myös teollisuudessa, maataloudessa, palvelualoilla ja rakentamisessa

Evaluation of Heart Rate Variation Analysis during Rest and Tilting in Patients with Temporal Lobe Epilepsy

Objective. To evaluate spectral heart rate (HR) variation using short-term ECG recordings at rest and during the tilt table test. Methods. The values of spectral components of total power (TP), high-frequency power (HF), low-frequency power (LF) and LF: HF ratio were measured at rest and during the head-up tilt in patients with temporal lobe epilepsy (TLE) and their control subjects. Results. Compared to the control subjects, patients with TLE had lower HF (P < 0.05) and LF : HF ratio (P < 0.05) at rest and lower TP (P < 0.001), HF (P < 0.05), and LF (P < 0.05) during the head-up tilt. Upon changing from supine to standing position TP (P < 0.05) and LF (P < 0.05) were attenuated in patients with TLE compared to the control subjects. Conclusion. These results suggest that spectral analysis of HR variation from ECG recordings of short duration may add value to assessment of autonomic nervous system function using autonomic cardiac tests in patients with TLE

Vesistö- ja valuma-aluekunnostukset Natura 2000 -alueilla: suunnittelun toimintamalli

Vesienhoidon ja luonnonsuojelun tavoitteet ovat useimmiten yhdenmukaisia. Ne tähtäävät paitsi vesiekosysteemien hyvään tilaan, myös lajien ja luontotyyppien suotuisaan suojelutasoon. Vesien ja luontotyyppien tilan parantamisen ohella vesistökunnostustoimenpiteitä voidaan suunnitella myös virkistyskäyttöedellytysten kohentamiseksi ja maisemansuojelun edistämiseksi. Vesistöjen ekologisen tilan parantaminen edellyttää useimmiten riittävää ulkoisen kuormituksen vähentämistä. Näin ollen vesiensuojelutoimet valuma-alueella ovat keskeisiä hoitotoimia vesistökunnostuksissa ja valuma-aluetasoisen kunnostussuunnittelun tarve on nostettu esille useissa ohjelmissa ja strategioissa. Toistaiseksi Natura 2000 -alueiden huomioiminen on kuitenkin jäänyt valuma-aluetason kunnostussuunnittelun ohjeistuksessa vähälle huomiolle. Vesienhoidon ja virkistyskäytön toimenpiteet voivat toisinaan aiheuttaa luontodirektiivin lajien lisääntymis- ja levähdyspaikkojen paikallista heikentymistä ja maisemansuojelulliset hoitotoimenpiteet voivat puolestaan olla ristiriidassa vesiensuojelutavoitteiden kanssa. Myös luonto- ja lintudirektiivin tavoitteet saattavat ajoittain olla ristiriidassa toistensa kanssa. Natura 2000 -alueilla tehtävien vesistökunnostusten ja vesiensuojelutoimenpiteiden tulisi parantaa paitsi vesistön tilaa, myös alueen suojeluperusteena olevan luontotyypin tilaa, sekä edistää luontotyypille ominaisten lajien elinmahdollisuuksia. Luontodirektiivin lajien suotuisan suojelutason sekä lajien lisääntymis- ja levähdyspaikkojen säilyminen on turvattava. Freshabit LIFE IP -hankkeessa (2016–2022) toteutettiin vesistö- ja valuma-aluekunnostuksia yhteensä 33 Natura 2000 -alueella, jotka sijoittuivat 11 vesistöalueelle eri puolille Suomea. Hankkeen tavoitteena oli parantaa Suomen sisävesien luonnon monimuotoisuutta ja kohdevesistöjen ekologista tilaa kehittämällä valuma-aluetason suunnittelun toimintatapoja ja testaamalla niitä hankkeen kohdevesistöissä. Hankkeen kokemusten perusteella koottiin tämä toimintamalli, jossa kuvataan vesistö- ja valuma-aluekunnostusten suunnittelun periaatteet Natura 2000 -alueilla, jotta mahdolliset ristiriidat pystytään huomioimaan ja ratkaisemaan. Natura 2000 -alueilla valuma-aluetason kunnostussuunnittelun keskiössä ovat paitsi erityistä huomiota vaativien lajien ja luontotyyppien tunnistaminen ja huomioiminen toimenpiteiden ajoituksessa ja sijoittamisessa, myös sidosryhmien osallistaminen jo suunnittelun alkuvaiheessa. Sidosryhmistä oleellisimpia ovat maa- ja vesialueiden omistajat. Vesistökunnostusmenetelmät valitaan kohdekohtaisesti, seurantatietojen perusteella tunnistettujen ongelmien ja niiden pohjalta muodostettujen tavoitteiden mukaisesti. Kunnostusten seurantaan tulee varata riittävästi resursseja, jotta vaikuttavuutta pystytään arvioimaan. Seurantaa tulisi tehdä niin vedenlaadun ja biologisten tekijöiden kuin direktiivilajien osalta myös kunnostusten jälkeen. Ulkoisen kuormituksen vähentäminen on avainasemassa, jotta kunnostuksilla voidaan saavuttaa vaikuttavuutta pitkällä tähtäimellä. Restoration and water protection of aquatic ecosystems at Natura 2000 sites: framework for planning The goals of water resource management and nature conservation are most often consistent. Both can aim at a good status of aquatic ecosystems, and at a favorable conservation status of species and habitats. In addition to improving the condition of aquatic ecosystems, restoration measures can also be targeted to improve the prerequisites for recreational use and to promote landscape protection. Improving the ecological status of water bodies typically requires a sufficient reduction of the external loading. Consequently, water protection measures in the catchment area are key management measures on a watershed level. The need for planning restoration measures at the catchment scale has been brought up in several national programs and strategies. However, the consideration of Natura 2000 sites has so far received less attention in such guidelines. Some restoration measures targeted to improve the status of water bodies and their recreational value can sometimes cause a local deterioration of breeding and resting habitats for species that are included in the European Union’s Birds and Habitats Directives. Also, some landscape protection measures can, in turn, conflict with the goals of water protection. Additionally, the objectives of the Birds and Habitats Directives may sometimes conflict with each other. The restoration of water bodies and water protection measures carried out at sites under Natura 2000 network should not only improve the status of aquatic ecosystems and certain habitat types to which protection of the areas are based on, but they should also promote the survival of species that are typical for the given habitat types. A favorable conservation status for species and habitats must be secured. In the Freshabit LIFE IP -project (2016–2022), restoration and water protection measures were carried out at a total of 33 Natura 2000 sites located in 11 separate watersheds around the country. The aim of the project was to improve the biodiversity of Finnish inland waters and the ecological status of the target lakes and streams by developing and implementing planning procedures at a catchment scale. Based on the project’s experiences, this framework for planning was put together to describe the principles of planning restoration and water protection measures at Natura 2000 sites, so that possible conflicts can be considered and resolved. At Natura 2000 sites, the focus of planning restorations at the catchment level is not only about identification and consideration of species and habitats that require special attention in the timing and placement of different measures. It is also about the involvement of stakeholders, most importantly the owners of land and water areas, already in the initial stages of planning. The restoration methods are selected site-specifically, according to the problems identified and targets set on the basis of validated monitoring data. Sufficient resources should always be set aside for monitoring the impacts of restorations, that should be carried out before, during and after the easures allowing for evaluating their effectiveness. Monitoring should include both water quality, morphology and the species included in the Directives. Reducing the external loading is always a key to achieve effectiveness in the long term

National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio : a pooled analysis of 458 population-based studies in Asian and Western countries

Background: Although high-density lipoprotein (HDL) and non-HDL cholesterol have opposite associations with coronary heart disease, multi-country reports of lipid trends only use total cholesterol (TC). Our aim was to compare trends in total, HDL and nonHDL cholesterol and the total-to-HDL cholesterol ratio in Asian and Western countries. Methods: We pooled 458 population-based studies with 82.1 million participants in 23 Asian and Western countries. We estimated changes in mean total, HDL and non-HDL cholesterol and mean total-to-HDL cholesterol ratio by country, sex and age group. Results: Since similar to 1980, mean TC increased in Asian countries. In Japan and South Korea, the TC rise was due to rising HDL cholesterol, which increased by up to 0.17 mmol/L per decade in Japanese women; in China, it was due to rising non-HDL cholesterol. TC declined in Western countries, except in Polish men. The decline was largest in Finland and Norway, at similar to 0.4 mmol/L per decade. The decline in TC in most Western countries was the net effect of an increase in HDL cholesterol and a decline in non-HDL cholesterol, with the HDL cholesterol increase largest in New Zealand and Switzerland. Mean total-to-HDL cholesterol ratio declined in Japan, South Korea and most Western countries, by as much as similar to 0.7 per decade in Swiss men (equivalent to similar to 26% decline in coronary heart disease risk per decade). The ratio increased in China. Conclusions: HDL cholesterol has risen and the total-to-HDL cholesterol ratio has declined in many Western countries, Japan and South Korea, with only a weak correlation with changes in TC or non-HDL cholesterol.Peer reviewe

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe