Utvärdering av hur lagen om underhåll och renhållning av gator och vissa allmänna områden (669/1978) fungerar

Lagen om underhåll och renhållning av gator och vissa allmänna områden (669/1978, den så kallade underhållslagen), som trädde i kraft 1980, är delvis föråldrad och behöver uppdateras i synnerhet i fråga om de ansvar, den terminologi och de definitioner som anges i lagen. Bara under 2010-talet har det kommit mycket ny lagstiftning som påverkar den verksamhet som avses i underhållslagen. Många av de ändringsbehov som framkom i utvärderingen hade samband med andra lagar. En noggrannare granskning och samordning av lagarna krävs bland annat till följd av den kommande lagen om områdesanvändning samt den lagstiftning som styr anläggningen och underhållet av nättillgångarna. Också ersättningsansvaret för den som är skyldig att sköta underhållet, som ofta lyfts fram och som ansetts vara strikt, förutsätter att flera lagar ses över. Andra centrala ändringsbehov som kom fram i fråga om underhållslagen handlade om att öka kommunernas bestämmanderätt i kontrollen av arbeten som utförs på gator och andra allmänna områden, att ta in en administrativ försummelseavgift och felavgift i lagen, att omvärdera ansvaret för vinterunderhållet av gångbanor, att fastställa servicenivån för vinterunderhåll samt informationshanteringen. I utvärderingen har man på bred front samlat in olika parters synpunkter på behovet att revidera underhållslagen. När det gäller de föreslagna ändrings- och uppdateringsbehoven är det skäl att utreda konsekvenserna på ett mer ingående och omfattande sätt innan underhållslagen revideras

Kadun ja eräiden yleisten alueiden kunnossa- ja puhtaanapidosta annetun lain (669/1978) toimivuusarviointi

Vuonna 1980 voimaan tullut laki kadun ja eräiden yleisten alueiden kunnossa- ja puhtaanapidosta (669/1978, ns. kunnossapitolaki) on osin vanhentunut ja vaatii päivittämistä etenkin laissa esitettyjen vastuiden, terminologian ja määritelmien osalta. Pelkästään 2010-luvulla on tullut paljon uutta kunnossapitolain alaiseen toimintaan vaikuttavaa lainsäädäntöä. Monet toimivuusarviointityössä esille tulleet muutostarpeet liittyivät muihin lakeihin. Tarkempaa tarkastelua ja lakien yhteensovitusta edellyttävät mm. tuleva alueidenkäyttölaki sekä verkosto-omaisuuden rakentamista ja ylläpitoa ohjaava lainsäädäntö. Myös useasti esille noussut, ankarana pidetty kunnossapitovelvollisen korvausvastuu edellyttää useamman lain tarkastelua. Keskeisiksi kunnossapitolain muutostarpeiksi nousivat lisäksi kuntien määräysvallan lisääminen kadulla ja muilla yleisillä alueilla tehtävien töiden hallintaan, hallinnollisen laiminlyönti- ja virhemaksun lisääminen lakiin, jalkakäytävien talvikunnossapitovastuun uudelleen arviointi, talvikunnossapidon palvelutason määritys sekä tiedonhallinta. Toimivuusarviointityössä on kerätty laajasti eri osapuolien näkemyksiä kunnossapitolain uudistamisen tarpeista. Esitettyjen muutos- ja päivitystarpeiden osalta on syytä selvittää vaikutuksia tarkemmin ja laaja-alaisesti ennen kunnossapitolain uudistamista

The impact of antihypertensive treatment initiation on health-related quality of life and cardiovascular risk factor levels: a prospective, interventional study

Background: Effective prevention and treatment of hypertension is one of the most potential interventions in terms of preventing cardiovascular deaths and disabilities. However, the treatment control is often poor. This may be partly explained by the impact of hypertension diagnoses and treatment on health-related quality of life. Quality of life is also an important outcome for a hypertensive patient. Most of the previous studies on health-related quality of life in hypertension have concentrated on patients with treated hypertension and less is known about the initiation of medication and the first treatment year. Methods: In this interventional study, we followed 111 primary care patients with newly diagnosed hypertension in real world primary care setting in Finland for 12 months. Results: We found significant decrease in both systolic and diastolic blood pressure levels, as well as modest decrease in cholesterol levels and alcohol consumption. However, the health-related quality of life also slightly deteriorated during the first treatment year. Conclusions: Our study shows that the initiation of hypertension treatment results in cardiovascular risk decrease among newly diagnosed Finnish hypertensive patients, but it is accompanied by small negative impact on health-related quality of life. However, the deterioration in health-related quality of life is of small magnitude and earlier research demonstrates several measures to enhance treatment and avoid impairment in health-related quality of life. Trial registration ClinicalTrials NCT02377960 (Date of registration: 04/03/2015).</p

Lifetime risk assessment in cholesterol management among hypertensive patients: observational cross-sectional study based on electronic health record data

Background: In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains generally insufficient, also in patients with hypertension. We analyzed Electronic Health Record (EHR) data of 7117 hypertensive patients to find the most potential age and sex subgroups in greatest need for improvement in real life dyslipidemia treatment. Taking into account the current discussion on lifetime CVD risk, we focused on the age dependence in LDL-C control. Methods: In this observational cross-sectional study, based on routine electronic health record (EHR) data, we investigated LDL-C control of hypertensive, non-diabetic patients without renal dysfunction or CVD, aged 30 years or more in Finnish primary care setting. Results: More than half (54% of women and 53% of men) of untreated patients did not meet the LDL-C target of Conclusions: Our findings indicate that dyslipidemia treatment among Finnish primary care hypertensive patients is generally insufficient, particularly in younger age groups who might benefit the most from CVD risk reduction over time. Clinicians should probably rely more on the lifetime risk of CVD, especially when treating working age hypertensive patients.</div

Feasibility of a checklist in treating hypertension in primary care – base line results from a cluster-randomised controlled trial (check and support)

Background Most patients with antihypertensive medication do not achieve their blood pressure (BP) target. The most important factor behind this failure is poor medication adherence. However, non-adherence to therapy does not concern only patients. Clinicians also tend to lack adherence to hypertension guidelines, overestimate BP control and be satisfied with inadequate BP control. The aim of this non-blinded, cluster-randomised, controlled study was to investigate if using a checklist would improve the quality of care in the initiation of new antihypertensive medication and help reduce non-adherence. Methods The study was conducted in eight primary care study centres in Central Finland, randomised to function as either intervention (n = 4) or control sites (n = 4). We included patients aged 30–75 years who were prescribed antihypertensive medication for the first time. Initiation of medication in the intervention group was carried out with a 9-item checklist, filled in together by the treating physician and the patient. Hypertension treatment in the control group was managed by the treating physician without a study-specific protocol. Results In total, 119 patients were included in the study, of which 118 were included in the analysis (n = 59 in the control group, n = 59 in the intervention group). When initiating antihypertensive medication, an adequate BP target was set for 19% of the patients in the control group and for 68% in the intervention group. Shortly after the appointment, only 14% of the patients in the control group were able to remember the adequate BP target, compared with 32% in the intervention group. The use of the checklist was also related to more regular agreement on the next follow-up appointment (64% in the control group versus 95% in the intervention group). No adverse events or side effects were related to the intervention. Conclusions Even highly motivated new hypertensive patients in Finnish primary care have significant gaps in their informational and behavioural skills. The use of a checklist for initiation of antihypertensive medication was related to significant improvement in these skills. Based on our findings, the use of a checklist might be a practical tool for addressing this problem.</div

Abnormal adherence junctions in the heart and reduced angiogenesis in transgenic mice overexpressing mutant type XIII collagen

Type XIII collagen is a type II transmembrane protein found at sites of cell adhesion. Transgenic mouse lines were generated by microinjection of a DNA construct directing the synthesis of truncated α1(XIII) chains. Shortened α1(XIII) chains were synthesized by fibroblasts from mutant mice, and the lack of intracellular accumulation in immunofluorescent staining of tissues suggested that the mutant molecules were expressed on the cell surface. Transgene expression led to fetal lethality in offspring from heterozygous mating with two distinct phenotypes. The early phenotype fetuses were aborted by day 10.5 of development due to a lack of fusion of the chorionic and allantoic membranes. The late phenotype fetuses were aborted by day 13.5 of development and displayed a weak heartbeat, defects of the adherence junctions in the heart with detachment of myofilaments and abnormal staining for the adherence junction component cadherin. Decreased microvessel formation was observed in certain regions of the fetus and the placenta. These results indicate that type XIII collagen has an important role in certain adhesive interactions that are necessary for normal development