Matkustaja-aluksiin kohdistuvien tukien vaikuttavuus

Matkustajamerenkulkua tuetaan julkisin varoin sekä suoraan että epäsuorasti. Kaksi keskeistä tukimuotoa ovat suora miehistötuki sekä epäsuorat verotuet matkustaja-autolautoilla tapahtuvan myynnin osalta. Kokonaisuutena matkustajamerenkulkua tuetaan arvioiden mukaan noin 250–280 miljoonalla eurolla vuodessa. Merenkulun ja matkustaja-alusliikenteen julkisista tuista aiheutuu suorien julkistaloudellisten kustannusten lisäksi kustannuksia kansantaloudelle. Taloudellisessa tarkastelussa rationaalisia perusteluita matkustajamerenkulun tukemiselle eivät ole esimerkiksi kansantalouden työllisyyskysymykset. Merenkulku on Suomelle huoltovarmuuden näkökulmasta tärkeää. Viime kädessä viranomaisten ja poliittisen päätöksentekijän on harkittava, saadaanko matkustajamerenkulun julkisella tukemisella riittävästi vastinetta huoltovarmuuden näkökulmasta. Käytännössä mahdollisuudet tukimuutoksiin liittyvät suoraan miehistötukeen. Mikäli Suomessa lopetettaisiin miehistötuki matkustajamerenkulussa, tästä seuraisi todennäköisesti matkustaja-autolauttojen ulosliputtaminen Ruotsiin. Matkustajamerenkulun tuet vääristävät kilpailua. Kilpailun vääristyminen koskee kuitenkin suoraan vain niitä mantereella sijaitsevia tuottajia, jotka kilpailevat samoilla relevanteilla markkinoilla matkustajamerenkulussa tarjottavien palveluiden kanssa. Tutkimuksen suositus on se, että Suomessa varmistetaan skenaariopohjaisten, tilastofaktaan nojautuvien, suunnitelmien olemassaolo siitä, mitä Suomeen on tuotava ja Suomesta vietävä eri tilanteissa, mitä kapasiteettia tähän tarvitaan ja on käytettävissä, ja mikä matkustaja-alusten rooli voi olla. Suomessa on myös syytä kehittää matkustajamerenkulun tilastointia varmistamalla, että kauppalaivastosta tilastoidaan huoltovarmuuden suunnittelun kannalta välttämättömät asiat. Lisäksi matkustajamerenkulkua harjoittavilta varustamoilta tulee edellyttää jatkossa, liikesalaisuudet huomioiden, läpinäkyvää ja julkista tilastointia siitä, mitä liiketoimintaa aluksilla harjoitetaan

Patient-reported outcomes as predictors of remission in early rheumatoid arthritis patients treated with tight control treat-to-target approach

Identifying prognostic factors for remission in early rheumatoid arthritis (ERA) patients is of key clinical importance. We studied patient-reported outcomes (PROs) as predictors of remission in a clinical trial. We randomized 99 untreated ERA patients to receive remission-targeted treatment with three disease-modifying antirheumatic drugs and prednisolone for 24 months, and infliximab or placebo for the initial 6 months. At baseline, we measured following PROs: eight Short Form 36 questionnaire (SF-36) dimensions, patient's global assessment [PGA, visual analogue scale (VAS)], Health Assessment Questionnaire (HAQ), and pain VAS. We used multivariable-adjusted regression models to identify PROs that independently predicted modified American College of Rheumatology remission at 2 years. Follow-up data at 2 years were available for 93 patients (92%), and 58 patients (62%) were in remission. At baseline, patients who achieved remission had higher radiological score (p = 0.04), lower tender joint count (p = 0.001), lower PGA (p = 0.005) and physician's global assessment (p = 0.019), lower HAQ (p = 0.016), less morning stiffness (p = 0.009), and significantly higher scores in seven out of eight SF-36 dimensions compared with patients who did not. In multivariable models that included all PROs, remission was associated with SF-36 dimensions higher vitality (odds ratio 2.01; 95% confidence interval 1.19-3.39) and better emotional role functioning (odds ratio 1.64; 95% confidence interval 1.01-2.68). PGA, pain VAS, HAQ, and other SF-36 dimensions were not associated with remission. We conclude that self-reported vitality and better emotional role functioning are among the most important PROs for the prediction of remission in ERA.Peer reviewe

Translation, cross-cultural adaptation, and validation of the sino-nasal outcome test (snot)-22 for Finnish patients

Purpose The Sino-Nasal Outcome Test-22 (SNOT-22) is the most commonly used disease-specific quality of life questionnaire in rhinology. The purpose of this prospective study was to translate and validate SNOT-22 into Finnish. Methods The validation process followed the guidelines proposed for cross-cultural adaptation of health-related measures of quality of life. The study consisted of three groups: rhinologic out-patients (N = 96), FESS patients (N = 49) and healthy controls (N = 79). Out-patient and FESS groups completed the questionnaire twice (answers A and B), out-patients after two weeks and FESS patients after 3 months. Validity, reliability and responsiveness were evaluated. Results The mean SNOT-22 sum score of the out-patient questionnaires were 35.3 points (answer A) and 32.4 points (answer B). ICC in out-patient group was 0.879. For the FESS patients, the mean pre- and postoperative (answer A and B) SNOT-22 sum scores were 46.8 and 21.9 points, respectively (p <0.0001). The mean SNOT-22 of healthy controls was 8.9 points. The out-patients (answer A) and healthy controls had statistically significant difference in SNOT-22 scores (p <0.0001). Conclusions The results of our study show that the validated Finnish version of the SNOT-22 questionnaire demonstrates good validity, reliability and responsiveness.Peer reviewe

High burden of adverse events is associated with reduced remission rates in early rheumatoid arthritis

Adverse events (AEs) are common during disease-modifying antirheumatic drug (DMARD) treatment, but their influence on treatment results is unclear. We studied AEs in relation to disease activity in early rheumatoid arthritis (RA). Ninety-nine patients started intensive treatment with three conventional synthetic DMARDs (csDMARDs) and oral prednisolone, and were randomized to a 6-month induction treatment with infliximab or placebo. All AEs during the first 12 months of treatment were recorded. We scored each AE based on severity (scale 1-4) and defined the burden of AEs as the sum of these scores. Patients were divided into tertiles according to the burden of AEs. As outcomes, we assessed 28-joint disease activity score (DAS28) levels and remission rates at 12 and 24 months. Three hundred thirty-one AEs in 99 patients were reported, and 27 (8%) were categorized as severe or serious. Mean burden of AEs per patient was 5.4 ± 4.3. Seventy-nine AEs (24%) led to temporary (n = 52) or permanent (n = 27) csDMARD discontinuation. Of discontinuations, 1, 21, and 57 were detected in the first, second, and third tertiles, respectively. DAS28 remission rates decreased across tertiles at 12 months (94, 94, and 76%; p for linearity 0.029) and at 24 months (90, 86, and 70%; p for linearity 0.021). Mean DAS28 levels increased across tertiles at 12 months (1.5 ± 1.0, 1.7 ± 0.9, and 1.9 ± 1.2; p for linearity 0.021) and at 24 months (1.4 ± 0.8, 1.6 ± 1.0, and 1.9 ± 1.1; p for linearity 0.007). High burden of AEs is associated with higher disease activity and lower likelihood of remission in early RA.</div

Tautikohtaisen elämänlaatumittarin validointi - esimerkkinä nenä- ja sivuontelotautikohtainen SNOT-22-mittari

English summar

Translation, cross-cultural adaptation, and validation of the sino-nasal outcome test (snot)-22 for Finnish patients

Purpose The Sino-Nasal Outcome Test-22 (SNOT-22) is the most commonly used disease-specific quality of life questionnaire in rhinology. The purpose of this prospective study was to translate and validate SNOT-22 into Finnish. Methods The validation process followed the guidelines proposed for cross-cultural adaptation of health-related measures of quality of life. The study consisted of three groups: rhinologic out-patients (N = 96), FESS patients (N = 49) and healthy controls (N = 79). Out-patient and FESS groups completed the questionnaire twice (answers A and B), out-patients after two weeks and FESS patients after 3 months. Validity, reliability and responsiveness were evaluated. Results The mean SNOT-22 sum score of the out-patient questionnaires were 35.3 points (answer A) and 32.4 points (answer B). ICC in out-patient group was 0.879. For the FESS patients, the mean pre- and postoperative (answer A and B) SNOT-22 sum scores were 46.8 and 21.9 points, respectively (p p Conclusions The results of our study show that the validated Finnish version of the SNOT-22 questionnaire demonstrates good validity, reliability and responsiveness.</p