Tools and Methods for Supporting Regional Decision-Making in Relation to Climate Risks

Climate change has had a major impact on the Nordic region. For example, the mean temperature rise is expected to be 4–6°C by 2080. In Finland, the regional authorities are responsible for climate change adaptation. Some of the most vulnerable sectors include energy, tourism, transport and water supply. Currently, it appears that the authorities are not familiar with the tools for assessing climate risks and lack knowledge about the impact of climate change. In this paper, we provide a review of risk assessment methods and decision-making tools, focusing on adapting to climate change in a Finnish context. Our research method comprises a systematic qualitative literature review dealing with relevant journals, dissertations and deliverables of relevant EU projects since 2005

Laparoscopic versus hybrid approach for treatment of incisional ventral hernia : a prospective randomised multicentre study, 1-year results

Purpose Laparoscopic incisional ventral hernia repair (LIVHR) is often followed by seroma formation, bulging and failure to restore abdominal wall function. These outcomes are risk factors for hernia recurrence, chronic pain and poor quality of life (QoL). We aimed to evaluate whether LIVHR combined with defect closure (hybrid) follows as a diminished seroma formation and thereby has a lower rate of hernia recurrence and chronic pain compared to standard LIVHR. Methods This study is a multicentre randomised controlled clinical trial. From November 2012 to May 2015, 193 patients undergoing LIVHR for primary incisional hernia with fascial defect size from 2 to 7 cm were recruited in 11 Finnish hospitals. Patients were randomised to either a laparoscopic (LG) or a hybrid (HG) repair group. The main outcome measure was hernia recurrence, evaluated clinically and radiologically at a 1-year follow-up visit. At the same time, chronic pain scores and QoL were also measured. Results At the 1-year-control visit, we found no difference in hernia recurrence between the study groups. Altogether, 11 recurrent hernias were found in ultrasound examination, producing a recurrence rate of 6.4%. Of these recurrences, 6 (6.7%) were in the LG group and 5 (6.1%) were in the HG group (p > 0.90). The visual analogue scores for pain were low in both groups; the mean visual analogue scale (VAS) was 1.5 in LG and 1.4 in HG (p = 0.50). QoL improved significantly comparing preoperative status to 1 year after operation in both groups since the bodily pain score increased by 7.8 points (p <0.001) and physical functioning by 4.3 points (p = 0.014). Conclusion Long-term follow-up is needed to demonstrate the potential advantage of a hybrid operation with fascial defect closure. Both techniques had low hernia recurrence rates 1 year after operation. LIVHR reduces chronic pain and physical impairment and improves QoL. Trial Registry: Clinical trial number NCT02542085.Peer reviewe

Care organisations role as intermediaries between the authorities and the marginalised in crisis management

Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).Social service providers work to alleviate social disadvantages, which may particularly loom during crises. These organisations have a close understanding of the needs of their clients. However, this knowledge is rarely taken into account in tailoring crisis measures, which may lead to increased vulnerability and create additional suffering. In this paper, we take a novel look at the role of care organisations as intermediaries between their clients and the authorities in representing the needs and capabilities of vulnerable people and explore the factors hindering or facilitating this representation. We focused on care organisations in Europe and collected data from 32 interviews, followed by 5 workshops and an international colloquium with 6 language-based discussion groups with participants from organisations offering care services to socially marginalised individuals. The results demonstrate the role these organisations had in advocating their clients' needs to the authorities to adapt the crisis measures accordingly (“bottom-up approach”), and communicating official information about the risks and government rules to their clients (“top-down approach”). We found effective mediation to stem from long-term, trusting client relationship to be able to reflect on clients’ needs, while the lack of collaboration protocol and tradition can be seen as the main barrier to inclusive crisis management. Networking with social care services to bring their expertise into crisis management systems is essential to promote the resilience of the diverse society.Care organisations role as intermediaries between the authorities and the marginalised in crisis managementpublishedVersio

Digitaalinen kotirintama - kansallisen resilienssin joukkoistaminen

Digitaalinen kotirintama -hankkeessa selvitettiin, miten vapaaehtoisten osallistumista häiriötilanteiden hallintaan voitaisiin tukea digitaalisen alustan avulla. Hankkeessa tutkittiin yhteistoiminta-alustan toimintaedellytyksiä, tunnistettiin eri käyttäjäryhmien tarpeita yhteistoiminta-alustalle sekä tekijöitä, jotka edesauttavat kansalaisten osallistumista ja osaamisen tarjoamista. Esiselvitys jäsensi alustan toimintamallin mahdollisuuksia tukea uutta joukkoistamisen toimintatapaa kuten myös malliin liittyviä haasteita ja rajoitteita. Hankkeessa tarkasteltiin erityisesti spontaanin vapaaehtoisuuden eli järjestökentän ulkopuolisen vapaaehtoisuuden kautta nousevaa halua auttaa ja osallistua häiriötilanteiden hallintaan. Nopeasti, usein äkillisen kriisitilanteen kautta syntyvälle vapaaehtoisuudelle ei ole olemassa kattavia toimintatapoja, joiden avulla spontaanit vapaaehtoiset saataisiin mukaan toimintaan. Hankkeessa selvitettiin alustavasti, voisiko digitaalinen alusta mahdollistaa vapaaehtoisten osallistumista ja minkälaisia rajoitteita tai reunaehtoja toiminnalle tulisi asettaa. Vapaaehtoisten mahdollisuuksia, halua ja kykyä osallistua häiriötilanteiden hallintaan viranomaisten tukena voidaan edistää sopivan toimintamallin ja sähköisen alustan kehittämisellä ja käyttöönotolla. Tekijät suosittavat ottamaan seuraavat näkökulmat huomioon toimintamallin kehittämisessä: 1) Spontaanille vapaaehtoisuudelle tulee kehittää helppokäyttöinen sähköinen työväline, mikä mahdollistaa osallistumisen häiriötilanteiden hallintaan; 2) Sähköisen työvälineen omistajuus tulee määrittää ja lainsäädännön vaatimukset valittuun toimintatapaan tulee selvittää; 3) Toimintamallia tulee testata paikallisissa käyttötapauksissa; 4) Toimintaan osallistuvien viranomaisten, järjestöjen ja vapaaehtoisten toimintamahdollisuuksia ja rooleja tulee määrittää aiempien kokemusten perusteella; 5) Osallistamisen alustan tulee tukea ja täydentää nykyisiä toimivia vapaaehtoistoiminnan rakenteita ja käytäntöjä; 6) Luotettavan tiedon kulkua tulee tukea ja varmistaa kaksisuuntaisella viestinnällä

Lägesbild av regional säkerhet (ATT) – en modell för uppföljning, bedömning och framsyn som stöder regional säkerhetsplanering och beredskap

ATT-modellen som utvecklats för uppföljning av förändring i säkerhetsmiljön (Lägesbild av regional säkerhet) stöder den regionala säkerhetsplaneringen samt beredskapen för störningar och exceptionella situationer. Modellen vägleder en organisering av uppföljningen av säkerheten som ett samarbete mellan flera myndigheter och för att välja säkerhetsindikatorer som lämpar sig för området. Införandet av ATT-modellen får stöd av anvisningar för metoder med vilka man kan identifiera de grundläggande orsakerna till utmaningar i säkerhet och fenomen i anknytning till dessa samt ta i bruk framsynsmetoder som lämpar sig för regional säkerhetsplanering. ATT-modellen är en del av informationsstyrd säkerhetsplanering och beredskap. I kärnan av verksamhetsmodellen finns en framsynsgrupp med många aktörer, vars uppgift är att analysera information från området som beskriver säkerheten och att göra bedömningar av hur situationen utvecklas. Informationen som gruppen får grundas till stor del på verksamheten i framsynsnätverket som följer säkerhetsindikatorerna, statistiken och tyst kunskap som rör området enligt anvisningar från framsynsgruppen. Säkerhetsforumet tolkar den analyserade informationen från framsynsgruppen och lägger fram förslag antingen till en enskild ledningsgrupp eller exempelvis till ledningsgrupper i olika organisationer angående åtgärder som förbättrar säkerhetssituationen. I ATT-modellen granskas regional säkerhet med hjälp av fyra teman som riskerar och/eller försvagar säkerheten: naturfenomen och miljö, funktionen i tekniska system, mänskliga förhållanden samt avsiktlig skadegörelse och brottslighet. Det tvärsektoriella valet av teman stöder samarbete mellan många aktörer. Projektet gav indikatorer för olika teman som områdena kan ta i bruk för att bedöma sin säkerhetssituation. En övergripande utvärdering av säkerhetsmiljön förutsätter också att indikatorerna beskriver både upplevd (subjektiv) känsla av säkerhet och säkerhet som är oberoende av personen som tolkar den (objektiv). ATT-modellen utvecklades i VN-TEAS MATTI-projekt i samarbete med olika myndigheter och aktörer. Stöd och hjälp gavs av närmare 100 personer från 43 olika organisationer, däribland 16 kommuner. EKTURVA som fungerar i Södra Karelens område var en betydelsefull hjälp tack vare kommentarer och hjälp vid organisering av två arbetsgrupper. Projektet förverkligades av Teknologiska forskningscentralen VTT, Polisyrkeshögskolan, Räddningsbranschens Centralorganisation i Finland och Försvarshögskolan.Den här publikation är en del i genomförandet av statsrådets utrednings- och forskningsplan. (tietokayttoon.fi) De som producerar informationen ansvarar för innehållet i publikationen. Textinnehållet återspeglar inte nödvändigtvis statsrådets ståndpunkt

Vulnerability and vulnerable groups from an intersectionality perspective

In general, the identification and protection of vulnerable groups in the case of hazards or when a crisis unfolds is an issue that any crisis and disaster risk management should address, since people have different levels of exposure to hazards and crises. In this article, we promote the application of the intersectionality perspective in the study of vulnerable groups, and we call for intersectionality as a guiding principle in risk and crisis management, to provide a better and more nuanced picture of vulnerabilities and vulnerable groups. This can help national and local authorities and agencies to formulate specific guides, to hire staff with the skills necessary to meet particular needs, and to inform vulnerable groups in a particular way, taking into account the differences that may coexist within the same group. Intersectionality allows us to read vulnerability not as the characteristic of some socio-demographic groups. It is rather the result of different and interdependent societal stratification processes that result in multiple dimensions of marginalisation. In this vein, we argue that research should focus on 1) self-perceived vulnerability of individuals and an intersectionality approach to unpack vulnerable groups; 2) cases of crises according to the level and/or likelihood of individual exposure to hazards, to better nuance issues of vulnerability.publishedVersio

Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomised multicentre study, 1-year results

Purpose Laparoscopic incisional ventral hernia repair (LIVHR) is often followed by seroma formation, bulging and failure to restore abdominal wall function. These outcomes are risk factors for hernia recurrence, chronic pain and poor quality of life (QoL). We aimed to evaluate whether LIVHR combined with defect closure (hybrid) follows as a diminished seroma formation and thereby has a lower rate of hernia recurrence and chronic pain compared to standard LIVHR.Methods This study is a multicentre randomised controlled clinical trial. From November 2012 to May 2015, 193 patients undergoing LIVHR for primary incisional hernia with fascial defect size from 2 to 7 cm were recruited in 11 Finnish hospitals. Patients were randomised to either a laparoscopic (LG) or a hybrid (HG) repair group. The main outcome measure was hernia recurrence, evaluated clinically and radiologically at a 1-year follow-up visit. At the same time, chronic pain scores and QoL were also measured.Results At the 1-year-control visit, we found no difference in hernia recurrence between the study groups. Altogether, 11 recurrent hernias were found in ultrasound examination, producing a recurrence rate of 6.4%. Of these recurrences, 6 (6.7%) were in the LG group and 5 (6.1%) were in the HG group (p > 0.90). The visual analogue scores for pain were low in both groups; the mean visual analogue scale (VAS) was 1.5 in LG and 1.4 in HG (p = 0.50). QoL improved significantly comparing preoperative status to 1 year after operation in both groups since the bodily pain score increased by 7.8 points (p Conclusion Long-term follow-up is needed to demonstrate the potential advantage of a hybrid operation with fascial defect closure. Both techniques had low hernia recurrence rates 1 year after operation. LIVHR reduces chronic pain and physical impairment and improves QoL.</p