Costs and Benefits of Two Alternative Salmonella Control Policies in Finnish Broiler Production

In this study, costs and benefits of two Salmonella control options in broiler production were compared. The first option was to control Salmonella as set by Council Directive 92/117/EEC, so-called Zoonosis Directive. The second option was more intense control programme, the so-called Finnish Salmonella control programme. The costs of controlling Salmonella in primary and secondary production and the direct and indirect losses due to Salmonella infection in humans in both options were compared. The national control option was found to be economically feasible. One prevented loss of life covered all the control costs of the national programme.Salmonella, broiler, cost-benefit, control, Food Consumption/Nutrition/Food Safety,

Costs of two alternative Salmonella control policies in Finnish broiler production

BACKGROUND: Costs and benefits of two Salmonella control policies for broiler production were described and compared. The control options were the Zoonosis Directive 92/117/EC and the more intense strategy, the Finnish Salmonella Control Programme (FSCP). METHODS: The comparison included the Salmonella control costs in primary and secondary production and the direct and indirect losses due to Salmonella infections in humans in 2000. RESULTS: The total annual costs of the FSCP were calculated to be 990 400 EUR (0.02 €/kg broiler meat). The average control costs in the broiler production chain were seven times higher with the FSCP than with the Zoonosis Directive alone. However, the public health costs were 33 times higher with the Zoonosis Directive alone. The value of one prevented loss of life per year exceeded the annual control costs of the FSCP. CONCLUSION: Due to significant savings in public health costs compared to costs of FSCP, the FSCP was found to be economically feasible

Siltasopimusten toimintamallin arviointi

Selvityksessä tarkasteltiin siltasopimusten toimintamallia, prosessia ja vaikutuksia sekä määriteltiin kriteerejä aluevalinnoille. Siltasopimuksia on tehty Lounais-Suomessa, Pirkanmaalla, Kainuussa ja Pohjos-Savossa. Menetelminä käytettiin aineistoanalyysiä, asiantuntijahaastatteluita, kyselyitä, tilastollista tarkastelua ja työpajatyöskentelyä. Siltasopimuksilla on ollut paljon myönteisiä vaikutuksia, kuten yhteistyön tiivistyminen valtioneuvoston ja alueiden välillä. Hankkeista suurin osa on keskittynyt saavutettavuuteen, koulutukseen ja työvoiman saatavuuteen eli tavoitteisiin nähden oikeanlaisiin asioihin. Tilastollisesti työvoiman saatavuus on Lounais-Suomessa parantunut, työttömiä on työllistynyt odotettua enemmän ja myös rekrytointiongelmat vähentyneet. Ehdotetaan siltasopimusten tarkempaa rajaamista, alueiden ja valtion roolien sekä vastuiden selkeää määrittelyä, keskeisten tavoitteiden listausta alueittain, seurantamittareiden kehittämistä ja tarkastelua 6 kk välein. Lisäksi ehdotetaan rahoituskokonaisuuden selkeyttämistä ja korvamerkityn rahan maksamista siltasopimuskokonaisuuden toteuttamiseen ja siltasopimusmallin rakentamista siten, että se motivoi alueita kehittämiseen ja yhteistyöhön toisten alueiden kanssa. Mallia suositellaan jatkettavaksi sekä positiivisen ja negatiivisen rakennemuutoksen alueilla. Aluevalinnat suositellaan tehtäväksi työllisyyteen liittyvien tilastojen vertailulla maakunnittain, huomioiden avointen työpaikkojen määrä, kohtaanto ja rekrytointivaikeuksia kokevien yritysten määrä. Työ- ja elinkeinoministeriön yhdyshenkilö: Pirkko Jukka, puh. +358 295 048 98

Pulmonary embolism in acute lymphoblastic leukemia - An observational study of 1685 patients treated according to the NOPHO ALL2008 protocol

Background Pulmonary embolism (PE) is a serious complication of acute lymphoblastic leukemia (ALL). We examined the cumulative incidence and clinical presentation of PE in a well-defined cohort of patients with ALL aged 1-45 years treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol. Methods As part of the mandatory toxicity reporting of NOPHO ALL2008, thromboembolism including PE was reported consecutively. The cumulative incidence of first-time PE was calculated using the Aalen-Johansen estimator during a 2.5-year period from ALL diagnosis. We used Fisher's exact test to examine categorical variables and Cox logistic regression to estimate hazard ratios (HRs) for PE. Results PE was diagnosed in 32 of 1685 patients. The 2.5-year cumulative incidence of first-time PE increased with age: 0.43% (95% CI, 0.18-1.03) in children aged 1-9 years, 3.28% (95% CI, 1.72-6.22) in children aged 10-17 years, and 7.22% (95% CI, 4.61-11.21) in adults aged 18-45 years. The majority of PEs, 78% (25/32), occurred during asparaginase treatment. HRs adjusted for age and sex were associated with male sex (HR, 2.4; 95% CI, 1.0-5.6) and older age (10-17 years: HR 7.5; 95% CI, 2.5-22.2), 18-45 years: HR, 16.5; 95% CI, 6.1-44.5). In two-thirds of the patients (63%; 17/27), PE and its treatment had no impact on the administered doses of asparaginase. PE-associated 30-day mortality was 9.4% (95% CI, 1.9-25.0). Conclusions Awareness of PE is warranted during ALL treatment. Larger multicenter studies are needed to examine predictors of PE in ALL.Peer reviewe

Regional socio-economic impacts of intensive forest management, a CGE approach

The demand for and supply of forest biomass have both been increasing in recent years, which will set new requirements for forest management. Thus, new studies on regionally suitable forest management regimes to fulfill the needs of potential new investments and the impacts on wood supply potential on regional socioeconomic welfare are called for. The aim of this study was to examine the impacts of intensive forest management due to increased demand for wood biomass, from the regional economy point of view. In particular, the impact of intensive forest management on 1) regional gross domestic product (GDP), 2) private consumption, and 3) employment were assessed. The study was carried out by using computable general equilibrium (CGE) modelling combined with the requisite statistics and simulation of regional forest potential in the future. The results showed that total regional forest biomass supply with more intensive forest management could be increased annually on average by 26% (1.7Mm(3)) by 2030 compared to the business as usual (BAU) scenario. In this study, regional demand was increased by a hypothetical saw mill (0.5Mm(3)) and biorefinery (0.7Mm(3)). Total regional socio-economic benefits could be 2.8% ((sic)150 M) for GDP, 1.5% ((sic) 49 M) for private consumption and 1.6% (780 person-years) for employment, larger by 2030 than in the BAU scenario including multiplier effects. The study demonstrated how much regional socio-economic welfare would increase if regional wood demand with new investments combined with more intensive forest management and wood supply had more attention paid to it.Peer reviewe

Treatment outcomes in persons with severe haemophilia B in the Nordic region : The B-NORD study

Introduction Data on outcome in persons with haemophilia B (PwHB) are limited and mainly extrapolated from studies of haemophilia A (HA). Aim To characterize treatment outcomes in persons with severe HB in the Nordic region, with a focus on joint health, compared with matched controls with HA. Methods PwHB attending haemophilia centres in Denmark, Finland, Norway and Sweden were enrolled and matched with controls with HA. Joint assessment using Haemophilia Joint Health Score (HJHS) and ultrasound according to Haemophilia Early Arthropathy Detection protocol (HEAD-US) was conducted. Adherence was evaluated using the Validated Haemophilia Regimen Treatment Adherence Scale (VERITAS). Results Seventy-nine males with HB, with median age of 30 years (range 1-75), were enrolled. Eleven patients (14%) had a history of or current inhibitor. Twenty-nine PwHB (37%) reported joint bleeds during the prior year, and 35% had previously undergone joint surgery. Ninety-five per cent were on prophylaxis, and 70% used recombinant concentrates, with a median factor consumption of 3,900 IU/kg/year for standard half-life products. Only two patients had a VERITAS score corresponding to 'non-adherence'. Joint health, assessed with HJHS, showed a significant lower score among PwHB compared with HA controls, explained by a difference in the 18-49 age group, without observed differences in older or younger subgroups. The HEAD-US scores were overall low. Conclusion The Nordic cohort of PwHB is well treated by prophylaxis, but the goal of zero bleeds for all is not reached. Our findings suggest that patients with severe HB suffer from a milder arthropathy than patients with severe HA.Peer reviewe

Factor IX antibodies and tolerance in hemophilia B in the Nordic countries - The impact of F9 variants and complications

Introduction: The development of inhibitory antibodies (inhibitors) in persons with hemophilia B (PwHB) causes significant morbidity. Data on the impact of the F9 variant and immune tolerance induction (ITI) outcome are limited.The aim of this study was to investigate the presence of neutralizing and non-neutralizing antibodies (NNA) in severe hemophilia B (HB) and to evaluate ITI outcome and complications in relation to the pathogenic F9 variant.Materials and methods: Persons with severe HB in the Nordic countries were enrolled and information on F9 variants, inhibitors, ITI and complications were collected. Analyses of anti-FIX antibodies with a fluorescence -immunoassay (xFLI) and an ELISA method were conducted.Results: Seventy-nine PwHB were enrolled. Null variants were seen in 33 (42 %) PwHB and 12 (15 %) had a current or former inhibitor. Eleven (92 %) of the inhibitor patients had experienced allergic manifestations and three (25 %) nephrotic syndrome. Of 10 PwHB with at least one ITI attempt, eight (80 %) were considered tolerant at enrolment. Immunosuppression was included in seven of eight successful or partially successful at-tempts. Five PwHB had at least one ITI failure before a successful or partially successful ITI. No NNA could be identified.Conclusion: A high proportion of severe F9 gene defects among persons with severe HB in the Nordic countries may explain the observed relatively high prevalence of inhibitors. ITI success was independent of the F9 variant and attained despite allergic manifestations and previous ITI failures. Inclusion of immunosuppression tenta-tively enhances the chances of ITI success. No NNA were observed.Peer reviewe

Impact of body mass index on relapse in children with acute lymphoblastic leukemia treated according to Nordic treatment protocols

Objectives High body mass index (BMI) is associated with poorer survival in childhood acute lymphoblastic leukemia (ALL), but the actual impact on the risk of relapse still needs to be clarified. We evaluated the impact of BMI at diagnosis on the risk of relapse in children with ALL treated according to Nordic Society of Paediatric Haematology and Oncology (NOPHO) protocols. Method In a multicenter study, we collected data on BMI at diagnosis and outcome of 2558 children aged 2.0-17.9 years diagnosed between 1992 and 2016. Patients were divided into four groups according to International Obesity Task Force (IOTF) childhood BMI cut-offs: underweight, = 30 kg/m(2). Results In Cox multivariate regression analyses, an increased risk of relapse was observed in children aged 10-17.9 years with unhealthy BMI at diagnosis (underweight hazard ratio HR: 2.90 [95% confidence interval: 1.24-6.78],P = .01; overweight, HR: 1.95 [1.11-3.43],P = .02, and obese HR: 4.32 [95% 2.08-8.97],P <.001), compared to children with healthy weight. BMI had no impact on relapse in children under 10 years of age. Conclusion High BMI, and especially obesity at diagnosis, is an independent adverse prognostic factor for relapse in older children with ALL.Peer reviewe

Asymptomatic Right Atrial Thrombosis After Acute Lymphoblastic Leukemia Treatment

Right atrial thrombosis is a rare, but potentially serious complication of acute lymphoblastic leukemia treatment. We conducted a retrospective multicenter study to assess the incidence, treatment, and outcome of asymptomatic right atrial thrombosis detected at routine echocardiography of children after acute lymphoblastic leukemia treatment in the Nordic and Baltic countries. Eleven (2.7%, 95% confidence interval, 1.4-4.9) of 406 patients had asymptomatic right atrial thrombosis, ranging from 10 to 25 mm at detection. Three patients were treated with anticoagulation. None of the thromboses affected cardiac function, and they showed neither sign of progress nor spontaneous or treatment-related regress at follow-up.Peer reviewe

A survey on thromboprophylaxis and coagulation assessment in children and young adults with acute lymphoblastic leukaemia (ALL) in the Nordic and Baltic countries : Different practices of assessment and management

Patients undergoing treatment for acute lymphoblastic leukaemia (ALL) are at risk of coagulopathy, especially thromboembolism. We conducted a survey on practices in the assessment and management of coagulopathy during the new ALLTogether protocol in 29 (17 paediatric, 12 adult) Nordic and Baltic cancer centres. While 92% of adult centres used thromboprophylaxis with low-molecular-weight heparin, no paediatric centre did. Almost all providers performed baseline coagulation studies, but only 59% continued the assessment. Fibrinogen replacement was conducted in 59%, and antithrombin replacement in 28% of the centres. The survey highlights the need for guidelines in the management of coagulopathy during ALL therapy.Peer reviewe