Psychotropic drugs and the risk of fractures in old age: a prospective population-based study

<p>Abstract</p> <p>Background</p> <p>There is evidence that the use of any psychotropic and the concomitant use of two or more benzodiazepines are related to an increased risk of fractures in old age. However, also controversial results exist. The aim was to describe associations between the use of a psychotropic drug, or the concomitant use of two or more of these drugs and the risk of fractures in a population aged 65 years or over.</p> <p>Methods</p> <p>This study was a part of a prospective longitudinal population-based study carried out in the municipality of Lieto, South-Western Finland. The objective was to describe gender-specific associations between the use of one psychotropic drug [benzodiazepine (BZD), antipsychotic (AP) or antidepressant (AD)] or the concomitant use of two or more psychotropic drugs and the risk of fractures in a population 65 years or over. Subjects were participants in the first wave of the Lieto study in 1990-1991, and they were followed up until the end of 1996. Information about fractures confirmed with radiology reports in 1,177 subjects (482 men and 695 women) during the follow-up was collected from medical records. Two follow-up periods (three and six years) were used, and previously found risk factors of fractures were adjusted as confounding factors separately for men and women. The Poisson regression model was used in the analyses.</p> <p>Results</p> <p>The concomitant use of two or more BZDs and the concomitant use of two or more APs were related to an increased risk of fractures during both follow-up periods after adjusting for confounding factors in men. No similar associations were found in women.</p> <p>Conclusions</p> <p>The concomitant use of several BZDs and that of several APs are associated with an increase in the risk of fractures in older men. Our findings show only risk relations. We cannot draw the conclusion that these drug combinations are causes of fractures.</p

Clinical manifestations and outcome in Staphylococcus aureus endocarditis among injection drug users and nonaddicts: a prospective study of 74 patients

BACKGROUND: Endocarditis is a common complication in Staphylococcus aureus bacteremia (SAB). We compared risk factors, clinical manifestations, and outcome in a large, prospective cohort of patients with S. aureus endocarditis in injection drug users (IDUs) and in nonaddicts. METHODS: Four hundred and thirty consecutive adult patients with SAB were prospectively followed up for 3 months. Definite or possible endocarditis by modified Duke criteria was found in 74 patients: 20 patients were IDUs and 54 nonaddicts. RESULTS: Endocarditis was more common in SAB among drug abusers (46%) than in nonaddicts (14%) (odds ratio [OR], 5.12; 95% confidence interval [CI], 2.65–9.91; P < 0.001). IDUs were significantly younger (27 ± 15 vs 65 ± 15 years, P < 0.001), had less ultimately or rapidly fatal underlying diseases (0% vs 37%, P < 0.001) or predisposing heart diseases (20% vs 50%, P = 0.03), and their SAB was more often community-acquired (95% vs 39%, P < 0.001). Right-sided endocarditis was observed in 60% of IDUs whereas 93% of nonaddicts had left-sided involvement (P < 0.001). An extracardiac deep infection was found in 85% of IDUs and in 89% of nonaddicts (P = 0.70). Arterial thromboembolic events and severe sepsis were also equally common in both groups. There was no difference in mortality between the groups at 7 days, but at 3 months it was lower among IDUs (10%) compared with nonaddicts (39%) (OR, 5.73; 95% CI, 1.20–27.25; P = 0.02). CONCLUSION: S. aureus endocarditis in IDUs was associated with as high complication rates including extracardiac deep infections, thromboembolic events, or severe sepsis as in nonaddicts. Injection drug abuse in accordance with younger age and lack of underlying diseases were associated with lower mortality, but after adjusting by age and underlying diseases injection drug abuse was not significantly associated with mortality

Variation in clutch size in relation to nest size in birds

Peer reviewe

Rationale for adopting activity-based costing in hospitals:three longitudinal case studies

Abstract In the 1990's, a large number of Finnish hospitals began implementing new cost accounting systems, which were aimed at pricing the hospital outputs at full cost. Often the method of choice was activity-based costing, which was in the process of being transferred from the manufacturing industry to health care service production. The aim of this study is to analyse the motivations and rationale of this phenomenon in the light of three longitudinal case studies. The first case study is archival, using documents produced between 1996 and 2002. In the second case study, the data consists mainly of research diaries and personal observation and covers a hospital district activity-based costing and pricing project of 2000–2001. The third case study covers budgeting and costing development in a private, non-profit hospital by analysing documents and field notes. Institutional theory is used to interpret the findings in the three case studies. The theoretical framework used in analysing the data draws on Roberts and Greenwood's (1997) ideas, according to which an organisation's rational and efficiency-seeking actions are constrained by both economic (bounded rationality) and institutional factors. The results indicate that different constraints imposed on efficiency-seeking behaviour such as activity-based costing implementation may lead to different solutions concerning implementation. It is noteworthy that while all three case organisations represent the health care sector, their approaches to activity-based costing have been quite dissimilar. While institutional theory leads us to believe that managerial accounting systems may be converging due to the institutional pressures, evidence from the case studies supports the notion that this convergence seems limited to the adoption of the systems – function of the systems seems to remain characteristically different.Tiivistelmä Useat suomalaiset sairaalat aloittivat 1990-luvulla laajamittaisia kustannuslaskentaprojekteja, joissa tähdättiin täyskatteiseen hinnoitteluun. Usein valittuna menetelmänä oli toimintolaskenta, jota siirrettiin teollisesta toimintaympäristöstä terveydenhuollon palvelutuotantoon. Tutkimuksen tavoitteena on tarkastella tämän ilmiön syitä ja motiiveja kolmen tapaustutkimuksen valossa, joista kaksi on sairaanhoitopiirejä ja kolmas on voittoa tavoittelemattoman yhteisön omistama yksityinen sairaala. Ensimmäisessä tapaustutkimuksessa aineisto on dokumentteihin perustuvaa arkistomateriaalia vuosilta 1996–2002. Lisäksi kustannuslaskentamallien rakennetta on tarkasteltu käymällä läpi laskelmissa tehtyjä rakenteellisia ja teknisiä ratkaisuja sekä laskentasääntöjä. Toisessa tapaustutkimuksessa aineisto koostuu pääasiassa tutkijan päiväkirjoista ja havainnoista, ja sisältää sairaanhoitopiirin laajuisen kustannuslaskenta- ja hinnoitteluprojektin kuvauksen vuosilta 2000–2001. Kolmannessa tapaustutkimuksessa käydään läpi yksityisen sairaalan budjetoinnin ja kustannuslaskennan kehitystä dokumentteihin ja tutkijan muistiinpanoihin nojautuen. Teoreettisena viitekehyksenä aineiston tulkinnassa käytetään Robertsin ja Greenwoodin (1997) rajoitetun tehokkuuden mallia, jonka mukaan organisaation tehostamispyrkimyksiä rajoittavat sekä taloudelliseen rationaalisuuteen liittyvät tekijät (rajoitettu rationaalisuus) että institutionaaliset tekijät. Tutkimuksen tulokset osoittavat, että erityyppiset rajoittavat tekijät vaikuttavat organisaatioiden tehokkuuspyrkimyksiin (joihin toimintolaskentaprojektit on luettava) siten, että lopputuloksena on erilaisia sovelluksia toimintolaskennan käyttöönotosta. On huomionarvoista, että vaikka kaikki tutkimuksen kohteena olleet tapaukset ovat erikoissairaanhoidon organisaatiota, niiden tavat ottaa toimintolaskenta käyttöön ovat olleet toisistaan hyvin poikkeavia. Vaikka institutionaaliseen teoriaan perustuvasta tutkimuksesta voikin tehdä sellaisen johtopäätöksen, että ulkoiset paineet muovaavat organisaatioita samanlaisiksi, näiden tapaustutkimusten perusteella on mahdollista väittää, että samanlaisuuden paineet liittyvät laskentajärjestelmien käyttöönottoon järjestelmien toiminnan jäädessä varsin erityyppisiksi

Customer profitability analysis using time-driven activity-based costing:three interventionist case studies

Abstract Time-driven activity-based costing (TDABC) is a potential solution for customer profitability analysis (CPA), especially in industries with high overhead costs and a high number of logistical and/or sales transactions. Accordingly, this study draws on the typology provided by Lind and Strömsten (2006) to investigate how companies with different customer interfaces make use of time-driven activity-based costing in their customer profitability analyses. We build our investigation primarily on the interventionist method and participant observation. Our findings highlight the potential benefit for firms when modern costing connects with customer-focused operations. However, challenges include a lack of process time information as well as functioning information systems and the ability to develop strong service delivery capabilities. We contribute to the scarce knowledge on the implementation and use of sophisticated costing methods in SMEs from a customer-oriented perspective

Understanding the concept of subjectivity in performance evaluation and its effects on perceived procedural justice across contexts

Abstract This study explores the notion of subjectivity in performance evaluation as a multidimensional concept, including ex ante specified and ex post subjective evaluation, which are determined at different phases of an evaluation period. This distinction is important as these subjectivity types have different purposes and varying impacts on organisational outcomes. Based on a survey of 160 Vietnamese middle managers, we uncover their assorted impacts on perceived procedural justice across contexts of formalisation and job autonomy. As such, this study seeks to offer important insights on the literature of subjective evaluation and organisational justice

The role of a predictive analytics project initiator in the integration of financial and operational forecasts

Abstract Purpose: The purpose of this paper is to investigate the initiation of accounting information system projects. Specifically, it examines the role of the predictive analytics (PA) project initiator in the integration of financial and operational sales forecasts. Design/methodology/approach: The study uses a field study method to address the studied phenomenon in eight Finnish companies that have recently adopted PA systems. The data are primarily based on 19 interviews in the companies and five interviews with the PA consultants. Findings: The authors found that initiators appear to play a major role regarding the degree of integration of financial and operational sales forecasts. The initiators from an accounting function have a tendency to pay more attention to the integration than the representatives from other functions, such as operations and sales. Practical implications: The study also makes a practical contribution to companies in showing and discussing the important role of the accounting department as an initiator of a project if the target is to achieve a tight coupling of financial and operational forecast figures, i.e., “one set of numbers”. Originality/value: Even though companies have increasingly adopted PA systems in recent years, we still know little about how the initiation affects the design of accounting information systems overall. The central contribution of the paper, therefore, is to show that if a PA project is initiated by the accounting department, data integration becomes more likely. It contributes also to the discussion related to the appropriateness of data integration in the context of forecasting

Understanding political accountability in a strong structuration framework

Abstract Purpose: Research was conducted to investigate whether, and how, political accountability might stabilise when agents are faced with profound changes in external structures such as competition laws and austerity policies. Design/methodology/approach: We performed a field study from 2007 to 2015 in a regional hub in Finland and worked with data from document analysis, interviews and meeting observations. We have used embedded research design, where we apply methodological bracketing as well as composite sequence analysis for field research. Findings: Accountability declined when irresistible external structures were the dominant influence on the unreflective actions of agents-in-focus. With time, however, the agents started acting critically by drawing on structures that could facilitate strategic actions to stabilise political accountability. Research limitations/implications: The field research and interpretation of the data were limited to the organisation analysed; however, the theoretical arguments allow for analytical generalisations. Practical implications: The research demonstrates how public officials and political decision-makers can eventually adopt a strategic approach when faced with irresistible change in external structures. Social implications: The research demonstrates how public officials and political decision-makers can eventually adopt a strategic approach when faced with irresistible changes in external structures. Originality/value: The study locates political accountability in the context of strong structuration theory and discusses how it is redefined by external structures