Fibromyalgia is often connected with disability pension : a very long-term follow-up study in Finland

Non peer reviewe

Monitoring and assessment of forest damage in regional and national scale.

Contribution to the International Co-operative Programme on the Assessment and Monitoring of Air Pollution Effects in Forest

Decreasing trend in the incidence of serious pneumonias in Finnish children with juvenile idiopathic arthritis

OBJECTIVES: Children with juvenile idiopathic arthritis (JIA) may be predisposed to serious pneumonia due to modern disease-modifying anti-rheumatic treatment. In this nationwide retrospective study with clinical data, we describe the pneumonia episodes among children with JIA. METHODS: Patients under 18 years of age with JIA and pneumonia during 1998-2014 were identified in the National Hospital Discharge Register in Finland. Each individual patient record was reviewed, and detailed data on patients with JIA and pneumonia were retrieved, recorded, and analyzed. If the patient was hospitalized or received intravenous antibiotics, the pneumonia was considered serious. RESULTS: There were 157 episodes of pneumonia among 140 children with JIA; 111 episodes (71%) were serious (80% in 1998-2006 and 66% in 2007-2014). The mean age of the patients was 9 years. Forty-eight percent had active JIA and 46% had comorbidities. Disease-modifying anti-rheumatic drugs (DMARD) were used at the time of 135 episodes (86%): methotrexate (MTX) by 62% and biologic DMARDs (bDMARD) by 30%. There was no significant difference in the use of bDMARDs, MTX and glucocorticoids between the patient groups with serious and non-serious pneumonia episodes. During six of the episodes, intensive care was needed. Two patients (1.3%) died, the remaining ones recovered fully. CONCLUSIONS: Although the incidence of pneumonia and the use of immunosuppressive treatment among children with JIA increased from 1998 to 2014, the proportion of serious pneumonias in these patients decreased. There was no significant difference in the use of anti-rheumatic medication between patients with serious and non-serious pneumonia.Key Points• The incidence of serious pneumonias decreased from 1998 to 2014 among children with juvenile idiopathic arthritis (JIA).• There was no significant difference in the use of the disease-modifying anti-rheumatic medication between JIA patients with serious and non-serious pneumonias.• Active JIA, comorbidities, and combination medication were associated with nearly half of the pneumonias.Peer reviewe

Puu palaa ilman tukiakin

Suomi kohkaa bioenergiasta, mutta sivuuttaa parhaat mahdollisuutensa. Käsitykset energiatuotannon tehokkuudesta ja ympäristöystävällisyydestä ovat huteralla pohjalla

Suomen metsät on myytävä Brysselille

Talouselämä: www.talouselama.fiMetsätalous ja -teollisuus tarjoavat tehokkaita keinoja Suomen kasvuhuonepäästöjen vähentämiseksi. Brysselin päättäjät on vain saatava ymmärtämään metsien merkitys

Cost-Effectiveness Modelling of Sequential Biologic Strategies for the Treatment of Moderate to Severe Rheumatoid Arthritis in Finland

Abstract: Objective: The main objective was to compare the cost-effectiveness of therapeutic options in moderate or severe rheumatoid arthritis (RA) when a clinical response to a first TNF-blocker, either etanercept (ETA), adalimumab (ADA), or infliximab (INF), is insufficient. Methods: Effectiveness criteria were defined as remission (RS), low disease activity (LDAS), and moderate to high disease activity (MHDAS). Cost-effectiveness was derived as cost per day in RS and in LDAS using simulation modelling to assess six sequential biologic strategies over 2 years. Each sequential treatment strategy was composed of three biologic agents and included a first anti-TNF agent, ETA, ADA or INF, followed by either abatacept (ABA) or rituximab (RTX) as a second therapeutic option in case of an insufficient response, followed by another anti-TNF agent in case of further insufficient response. Results: Over two years and taking into account biologic costs, the following estimated mean costs per day in RS and LDAS were respectively of �829 and �428 for the biologic sequence composed of ADA-ABA-ETA, �1292 and �516 for the sequence ADA-RTX-ETA, �829 and �429 for the sequence ETA-ABA-ADA, �1292 and �517 for the sequence ETA-RTX-ADA, �840 and �434 for the sequence INF-ABA-ETA, and �1309 and �523 for the sequence INF-RTX-ETA. Conclusion: The treatment sequences including ABA as the second biologic option appear more cost-effective than those including RTX in a patients with moderate to severe RA and an insufficient response to a first anti-TNF agent. Keywords: Cost-effectiveness, rheumatoid arthritis, biologics, modelling

Institutional pressures and sustainability assessment in supply chains

Purpose: Firms are increasingly held accountable for the welfare of workers across entire supply chains and so it is surprising that standard forms of governance for socially sustainable supply chain management have not yet emerged. Assessment initiatives have begun to develop as a proxy measure of social sustainable supply chain management. This research aims to examine how social sustainability assessment initiatives instigate and use institutional pressures to drive third-party accreditation as the legitimate means of demonstrating social sustainability in a global supply chain. Design/methodology/approach: Ten assessment initiatives focused on assuring social sustainability across supply chains are examined. Data are collected through interviews with senior managers and publicly available secondary material. Findings: The findings show how the social sustainability assessment initiatives act by instigating institutional pressures indirectly rather than directly. Coercive pressures are the most prevalent and are exerted through consumer and compliance requirements. The notion of pressures operating as a chain is proposed, and the recognition that actors within and outside of a supply chain are crucial to the institutionalization of social sustainability is discussed. Originality/value: Studies on sustainable supply chain management often focus on how companies sense and act upon institutional pressures. To add to the extant body of knowledge, this study focuses on the sources of the pressures and demonstrates how assessment initiatives use coercive, normative and mimetic pressures to drive the adoption of social sustainability assessment in supply chains