Yhdyskuntarakenne, elämäntavat ja ilmastonmuutos

Keskustelua aluekehityksen vaikutusmahdollisuuksista ilmastonmuutoksen hillinnässä on käyty vilkkaasti jo pitkään. Päähuomio on kohdistunut perinteistesti liikkumisen ja rakennusten energiankulutuksen päästöihin. Useissa tutkimuksissa löydetty aluerakenteen tiiveyden ja matalien kasvihuonekaasupäästöjen yhteys on johtanut tiiviiden aluerakenteiden suosimiseen ja esimerkiksi Suomessa kiteytynyt yhdyskuntarakenteen eheyttämisen tavoitteeksi koko maamme ilmastopolitiikassa. Merkittävästi vähemmän huomiota on kiinnitetty polttoaineenkulutuksen ja rakennusten energiankulutuksen ulkopuolelle jääviin päästöihin, ja erityisesti näiden päästöjen ja aluerakenteiden välisiin yhteyksiin. Nämä niin sanotut epäsuorat päästöt saattavat kuitenkin muodostaa erittäin merkittävän osan kokonaispäästöistämme. Useat tuoreet tutkimukset esittävät lisäksi suhteellisen vahvoja näyttöjä siitä, että epäsuoratkin päästöt riippuvat merkittävässä määrin aluerakenteesta. Lisäksi jopa liikkuminen ja rakennusten energiankulutus sisältävät päästöihin merkittävästi vaikuttavia tekijöitä, jotka saatetaan helposti rajata tutkimusten ulkopuolelle. Mikäli nämä tekijät jätetään huomioimatta, saatetaan saada hyvin vinoutunut kuva erilaisten yhdyskuntien aiheuttamista päästöistä ja maankäytön tai aluesuunnittelun vaikutusmahdollisuuksista. Tässä artikkelissa esitetään, miten sekä suorat että epäsuorat kasvihuonekaasupäästöt kertyvät erilaisten yhdyskuntien toiminnan seurauksena, ja arvioidaan aluerakenteen ja päästöjen välisiä yhteyksiä. Näkökulmana on kulutus ja sen heijastuminen kasvihuonekaasupäästöihin. Kulutusnäkökulman avulla pystytään tarkastelemaan päästöjen aiheutumista kokonaisvaltaisesti ilman sattumanvaraisia alueellisia rajauksia. Artikkelissa nostetaan esiin viisi kasvihuonekaasupäästöjen aiheutumisen ymmärtämisen kannalta tärkeää näkökulmaa: 1. Yksityisautoilun päästöt alenevat merkittävästi vähemmän kuin ajosuoritteet aluerakenteiden tiivistyessä Polttoaineen kulutus on ajosuoritetta parempi indikaattori liikkumisen kasvihuonekaasupäästöille. Vaikka matkat lyhenevät tiiviimmissä rakenteissa, mikä näkyy keskimääräisissä ajosuoritteissa, nousevat kasvihuonekaasupäästöt per ajettu kilometri kaupunkiajossa merkittävästi maantieajoa korkeammiksi. Lisäksi ajoneuvoja omistetaan suhteellisen paljon myös kaupungeissa, ja korkeamman varallisuuden seurauksena niissä jopa ostetaan enemmän uusia autoja kuin maaseutumaisemmilla alueilla. Kaupungit asuinympäristöinä saattavat myös maaseutumaisempien alueiden tapaan tukea kulutuskäyttäytymistä, joka vaatii autojen omistamista ja käyttöä. Esimerkiksi kesämökkejä, joille kuljetaan pääsääntöisesti omilla autoilla, omistetaan enemmän kaupungeissa. 2. Liikkumisen kokonaispäästöt (auto-, juna-, laiva- ja lentoliikkuminen huomioiden) eivät välttämättä laske kaupungistumisasteen noustessa Tarkasteltaessa kaiken liikkumisen aiheuttamia kasvihuonekaasupäästöjä Suomessa, havaitaan yhteenlaskettujen päästöjen olevan suhteellisen tasaisia erityyppisillä alueilla johtuen erityisesti kasvavasta lentomatkailun määrästä pääkaupunkiseudulla. 3. Asumisen energiankulutuksesta aiheutuvat kokonaispäästöt kasvavat kaupunkimaisemmilla alueilla ja vähenevät maaseutumaisilla alueilla,kun uusiutuvan energian käyttö lämmityksessä ja toisaalta kerrostalojen piiloenergiankulutus huomioidaan arvioinneissa. Energiamuotojen näkökulmasta uusiutuvan energian käyttö lämmityksessä näyttäisi kasvavan kaupungistumisasteen laskiessa. Lisäksi kerrostaloissa merkittävä osa energiankulutuksesta tapahtuu yhteisenä ”piilokulutuksena”, joka ei kohdennu suoraan yksittäiselle asukkaalle. Kerrostaloissa on esimerkiksi paljon yhteisiä tiloja, joita lämmitetään ja valaistaan taloyhtiön kirjanpitoon kohdistuvilla energiakustannuksilla, hissejä operoidaan samoin ainoastaan taloyhtiön kulutuksena näkyvällä sähköllä. Lisäksi kiinteistön hoito ja ylläpito vaatii energiaa, mikä ei sekään näy yksittäisten huoneistojen sähkölaskuilla. Kun nämä energiat ja niiden tuotantotavat huomioidaan samoin kuin yhtiövastikkeissa ja vuokrissa tavanomaisesti maksettava lämpöenergia, näyttää energiankulutus kaupunkimaisessa asumisessa aiheuttavan maaseutumaista asumista korkeammat päästöt. 4. Muun kulutuksen aiheuttamat päästöt ovat korkeimpia kaupunkimaisimmilla alueilla Korkeampi tulotaso ja tarjolla olevat kulutusmahdollisuudet näyttävät johtavan korkeampaan kulutukseen ja aiheutettuihin kasvihuonekaasupäästöihin kaupungeissa suhteessa maaseutumaisempiin alueisiin. Suomessa pääkaupunkiseudulla on erityisen korkea tulotaso, joka näkyy korkeana kulutuksena ja korkeina kasvihuonekaasupäästöinä. 5. Aluerakenteen tiiveys ei ole tehokas indikaattori aluerakenteen ja kasvihuonekaasujen yhteyksien arvioimisessa Edellä esitetyt kohdat 1-4 näyttävät, että yhteys aluerakenteen ja kasvihuonekaasupäästöjen välillä on niin monimutkainen, ettei tiiveyden avulla voida tehdä arvioita päästöistä suuntaan tai toiseen. Lisäksi esimerkiksi alueella käytettävät energiaratkaisut vaikuttavat lopputulokseen niin oleellisesti, että muut tekijät peittyvät helposti energiaratkaisujen alle

Need for critical care in gynaecology: a population-based analysis

INTRODUCTION: The purpose of this study was to note potential gynaecological risk factors leading to intensive care and to estimate the frequency, costs and outcome of management. MATERIALS AND METHODS: In a cross-sectional study of intensive care admissions in Kuopio from March 1993 to December 2000, 23 consecutive gynaecological patients admitted to a mixed medical-surgical intensive care unit (ICU) were followed. We recorded demographics, admitting diagnoses, scores on the Acute Physiological and Chronic Health Evaluation (APACHE) II, clinical outcome and treatment costs. RESULTS: The overall need for intensive care was 2.3 per 1000 women undergoing major surgery during the study period. Patients were 55.4 ± 16.9 (mean ± SD) years old, with a mean APACHE II score of 14.07 (± 5.57). The most common diagnoses at admission were postoperative haemorrhage (43%), infection (39%) and cardiovascular disease (30%). The duration of stay in the ICU was 4.97 (± 9.28) (range 1–42) days and the mortality within 6 months was 26%, although the mortality in the ICU was 0%. The total cost of intensive care was approximately US$7044 per patient. CONCLUSIONS: Very few gynaecological patients develop complications requiring intensive care. The presence of gynaecological malignancy and pre-existing medical disorders are clinically useful predictors of eventual outcome, but many cases occur in women with a low risk and this implies that the risk is relevant to all procedures. Further research is needed to determine effective preventive approaches

Obstetric prognosis in sisters of preeclamptic women – implications for genetic linkage studies

BACKGROUND: To investigate obstetric prognosis in sisters of preeclamptic women. METHODS: We identified consecutive 635 sib pairs from the Birth Registry data of Kuopio University Hospital who had their first delivery between January 1989 and December 1999 in our institution. Of these, in 530 pairs both sisters had non-preeclamptic pregnancies (the reference group), in 63 pairs one of the sisters had preeclampsia and the unaffected sisters were studied (study group I). In 42 pairs both sister's first delivery was affected (study group II). Pregnancy outcome measures in these groups were compared. RESULTS: Unaffected sisters of the index patients had uncompromised fetal growth in their pregnancies, and overall, as good obstetric outcomes as in the reference group. The data on affected sisters of the index patients showed an increased prematurity rate, and increased incidences of low birth weight and small-for-gestational age infants, as expected. CONCLUSION: Unaffected sisters of the index patients had no signs of utero-placental insufficiency and they were at low risk with regard to adverse obstetric outcome, whereas affected sisters were high-risk. Clinically, affected versus unaffected status appears to be clear-cut in first-degree relatives regardless of their genetic susceptibility and unaffected sisters do not need special antepartum surveillance

Breaking the myth : the association between the increasing incidence of labour induction and the rate of caesarean delivery in Finland - a nationwide Medical Birth Register study

Objectives To determine the association between the rate of labour induction and caesarean delivery. Design Medical Birth Register-based study. We used data from the nationwide Medical Birth Register collecting data on delivery outcomes on all births from 22+0 weeks and/or birth weight of at least 500 g. Setting Finland. Participants 663 024 live births in Finland from 2008 to 2019. Main outcome measures The rates of labour induction and caesarean delivery. Results The rate of labour induction increased from 17.8% to 30.3%; p Conclusions The 70% increase in the rate of labour induction in Finland has not led to a significant increase in the rate of caesarean delivery, which has remained one of the lowest in the world. Pregnant women in Finland are more frequently obese, older and diagnosed with gestational diabetes, which may partly explain the increase in the rate of labour induction.Peer reviewe

Neonatal outcome in vaginal breech labor at 32+0-36+0 weeks of gestation : a nationwide, population-based record linkage study

Background In many countries, vaginal breech labor at term is an option in selected cases. However, the safety of vaginal breech labor in preterm is still unclear. Therefore our study aimed to evaluate the safety of vaginal breech labor in late preterm deliveries. Design A retrospective register-based study. Setting Maternity hospitals in Finland, 2004-2017. Participants The study population included 762 preterm breech deliveries at 32 + 0-36 + 6 gestational weeks according to the mode of delivery, 535 (70.2%) of them were born vaginally in breech presentation, and 227 (29.8%) were delivered by non-urgent cesarean section. Methods The study compared short-term neonatal adverse outcomes of singleton vaginal breech deliveries with non-urgent cesarean deliveries at 32 + 0 to 36 + 6 weeks of gestation. An odd ratio with 95% confidence intervals was calculated to estimate the relative risk of adverse outcomes. Outcome measures Neonatal death, an arterial umbilical pH below seven, a five-minute Apgar score below four and seven, admission to neonatal intensive care unit, neonatal intubation, neonatal antibiotic therapy, neonatal birth trauma, respiratory distress syndrome, neonatal convulsions, cerebral ischemia, hypoxic-ischemic encephalopathy, congenital hypotonia, and a composite of severe adverse outcomes. Results A five-minute Apgar scores below seven were increased in vaginal breech labor at 32 + 0 to 36 + 6 weeks of gestation compared to non-urgent cesarean sections (aOR 2.48, 95% CI 1.08-5.59). Neonatal antibiotic therapy, the admission to neonatal intensive care unit, and neonatal respiratory distress syndrome were decreased after vaginal breech labor compared to the outcomes of non-urgent cesarean section (neonatal antibiotic therapy aOR 0.60, 95% CI 0.40-0.89; neonatal NICU admission aOR 0.47, 95% CI 0.33-0.68; respiratory distress syndrome aOR 0.30, 95% CI 0.19-0.48). Conclusion Vaginal breech labor at 32 + 0-36 + 6 gestational weeks does not increase severe neonatal short-term morbidity or mortality compared to cesarean section.Peer reviewe

Early detection of mental illness for women suffering high-risk pregnancies : an explorative study on self-perceived burden during pregnancy and early postpartum depressive symptoms among Chinese women hospitalized with threatened preterm labour

Background The mental health of pregnant women, particularly those with elevated risks, has been an issue of global concern. Thus far, few studies have addressed the mental health of pregnant women with threatened preterm labour (TPL). This study investigated the prevalence of self-perceived burden (SPB) among Chinese women hospitalized due to TPL during pregnancy and early postpartum depressive disorders, exploring the effect of SPB and other potential risk factors on the early signs of postpartum depressive disorders. Methods A self-reported survey was conducted in the obstetrics department of Anhui Provincial Hospital, China. Women hospitalized with TPL were approached 1 week after delivery. One hundred fifty women were recruited from January 2017 to December 2017. The Self-Perceived Burden Scale (SPBS) and Edinburgh Postnatal Depression Scale (EPDS) were the main measures. Descriptive statistics, Spearman correlations, and a multiple logistic regression were employed for data analysis. Results SPB and early postpartum depressive disorders were commonly experienced by Chinese women hospitalized with TPL, and SPB was positively and significantly correlated with depressive symptoms. A multiple logistic regression analysis revealed that for the women hospitalized with TPL during pregnancy, the emotional aspect of SPB (OR = 1.42, 95% CI = 1.11-1.83, p = 0.006), age (OR = 1.14, 95% CI = 1.02-1.27, p = 0.023), occupation (OR = 3.48, 95% CI = 1.18-10.20, p = 0.023), the history of scarred uterus (OR = 7.96, 95% CI = 1.49-42.48, p = 0.015), the delivery mode of the present birth (OR = 6.19, 95% CI = 1.72-22.30, p = 0.005), and family support during pregnancy (OR = 0.60, 95% CI = 0.45-0.82, p = 0.001) were significant factors predicting early postpartum depressive symptoms. Conclusion This study indicates that SPB and early postpartum depressive disorders are prevalent mental issues among Chinese women hospitalized with TPL, and that SPB, especially perceived emotional burden, is a strong predictor of early postpartum depressive disorders. Our study suggests the necessity of paying attention to mental health issues, e.g. SPB and postpartum depressive symptoms among hospitalized women with TPL, and providing appropriate interventions at the prenatal stage to prevent adverse consequences.Peer reviewe

Comparison of delivery outcomes in low-dose and high-dose oxytocin regimens for induction of labor following cervical ripening with a balloon catheter : A retrospective observational cohort study

A variety of oxytocin regimens are used for labor induction and augmentation. Considering the increasing rates of labor induction, it is important to assess the most optimal oxytocin regimen without compromising maternal and fetal safety. The aim of this study was to compare delivery outcomes of low-dose and high-dose oxytocin induction protocols. This retrospective cohort study of 487 women comparing low-dose oxytocin protocol (n = 280) and high-dose oxytocin protocol (n = 207) in labor induction following cervical ripening by balloon catheter was performed in Helsinki University Hospital after implementation of a new oxytocin induction protocol. The study included two six-month cohorts from 2016 and 2019. Women with vital singleton pregnancies >= 37 gestational weeks, cephalic presentation, and intact amniotic membranes were included. The primary outcome was the rate of vaginal delivery. The secondary outcomes were the rates of maternal and neonatal infections, postpartum hemorrhage, umbilical artery blood pH-value, admission to neonatal intensive care, and induction-to-delivery interval. Statistical analyses were performed by using IBM SPSS Statistics for Windows (Armonk, NY, USA). The rate of vaginal delivery was higher [69.9% (n = 144) vs. 47.9% (n = 134); pPeer reviewe

The effect of maternal alcohol and drug abuse on first trimester screening analytes: a retrospective cohort study

Background: The purpose of this study was to determine whether first trimester trisomy screening (FTS) parameters are affected by alcohol and drug use. Methods: A routine combined FTS including measurements of maternal serum levels of free beta-human chorionic gonadotropin subunit (free beta-hCG) and pregnancy-associated plasma protein A (PAPP-A) were measured at 9-11 weeks of gestation, and fetal nuchal translucency thickness (NTT) at 11-13 weeks of gestation. In total 544 women with singleton pregnancies [71 alcohol and drug abusers, 88 smokers, 168 non-smokers delivering a small for gestational age (SGA) child, and 217 unexposed control women] were assessed. Results: Free beta-hCG levels were higher in alcohol and drug abusing than in unexposed pregnant women [mean 1.5 vs. 1.2 multiples of medians (MoM); P=0.013]. However, stepwise multiple linear regression analyses suggested that smoking could explain increased free beta-hCG. Additionally, we observed lower PAPP-A levels in the smoking mothers (0.9 vs. 1.2 MoM; P=0.045) and in those giving birth to an SGA child compared to the controls (1.1 vs.. 1.2 MoM; P Conclusions: The present study shows increased free beta-hCG levels in alcohol and drug abusers, but maternal smoking may explain the result. Maternal serum PAPP-A levels were lower in smoking than non-smoking mothers, and in mothers delivering an SGA child. However, FTS parameters (PAPP-A, free beta-hCG and NTT) seem not to be applicable for the use as alcohol biomarkers because of their clear overlap between alcohol abusers and healthy controls.Peer reviewe

Risk factors for adverse outcomes in vaginal preterm breech labor

cited By 0Purpose To assess the risk factors for adverse outcomes in attempted vaginal preterm breech deliveries. Methods A retrospective case-control study, including 2312 preterm breech deliveries (24 + 0 to 36 + 6 gestational weeks) from 2004 to 2018 in Finland. The preterm breech fetuses with adverse outcomes born vaginally or by emergency cesarean section were compared with the fetuses without adverse outcomes with the same gestational age. A multivariable logistic regression analysis was used to calculate the risk factors for adverse outcomes (umbilical arterial pH below 7, 5-min Apgar score below 4, intrapartum stillbirth and neonatal death <28 days of age). Results Adverse outcome in vaginal preterm breech delivery was associated with maternal obesity (aOR 32.19, CI 2.97-348.65), smoking (aOR 2.29, CI 1.12-4.72), congenital anomalies (aOR 4.50, 1.56-12.96), preterm premature rupture of membranes (aOR 1.87, CI 1.00-3.49), oligohydramnios (28-32 weeks of gestation: aOR 6.50, CI 2.00-21.11, 33-36 weeks of gestation: aOR 19.06, CI 7.15-50.85), epidural anesthesia in vaginal birth (aOR 2.44, CI 1.19-5.01), and fetal growth below the second standard deviation (28-32 weeks of gestation: aOR 5.89, CI 1.00-34.74, 33-36 weeks of gestation: aOR 12.27, CI 2.81-53.66). Conclusion The study shows that for each subcategory of preterm birth, there are different risk factors for adverse neonatal outcomes in planned vaginal breech delivery. Due to the extraordinary increased risk of adverse outcomes, we would recommend a planned cesarean section in very preterm breech presentation (28 + 0 to 32 + 6 weeks) with severe maternal obesity, oligohydramnios, or fetal growth restriction and in moderate to late preterm breech presentation (33 + 0 to 36 + 6 weeks) with oligohydramnios or fetal growth restriction.Peer reviewe