Browsing by Subject "risk"

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  • Ollila, A.; Vikatmaa, Leena; Virolainen, J.; Vikatmaa, Pirkka; Leppaniemi, A.; Albäck, Anders; Salmenperä, Markku; Pettilä, Ville (2017)
    Background and Aims: Perioperative myocardial infarction is an underdiagnosed complication causing morbidity, mortality, and considerable costs. However, evidence of preventive and therapeutic options is scarce. We investigated the incidence and outcome of perioperative myocardial infarction in non-cardiac surgery patients in order to define a target population for future interventional trials. Material and Methods: We conducted a prospective single-center study on non-cardiac surgery patients aged 50years or older. High-sensitivity troponin T and electrocardiograph were obtained five times perioperatively. Perioperative myocardial infarction diagnosis required a significant troponin T release and an ischemic sign or symptom. Perioperative risk calculator was used for risk assessment. Results: Of 385 patients with systematic ischemia screening, 27 patients (7.0%) had perioperative myocardial infarction. The incidence was highest in vascular surgery19 of 172 patients (11.0%). The 90-day mortality was 29.6% in patients with perioperative myocardial infarction and 5.6% in non-perioperative myocardial infarction patients (p Conclusion: Perioperative myocardial infarction is a common complication associated with a 90-day mortality of 30%. The ability of the perioperative risk calculator to predict perioperative myocardial infarction was fair supporting its routine use.
  • Behrens, Jorn; Lovholt, Finn; Jalayer, Fatemeh; Lorito, Stefano; Salgado-Galvez, Mario A.; Sorensen, Mathilde; Abadie, Stephane; Aguirre-Ayerbe, Ignacio; Aniel-Quiroga, Inigo; Babeyko, Andrey; Baiguera, Marco; Basili, Roberto; Belliazzi, Stefano; Grezio, Anita; Johnson, Kendra; Murphy, Shane; Paris, Raphael; Rafliana, Irina; De Risi, Raffaele; Rossetto, Tiziana; Selva, Jacopo; Taroni, Matteo; Del Zoppo, Marta; Armigliato, Alberto; Bures, Vladimir; Cech, Pavel; Cecioni, Claudia; Christodoulides, Paul; Davies, Gareth; Dias, Frederic; Bayraktar, Hafize Basak; Gonzalez, Mauricio; Gritsevich, Maria; Guillas, Serge; Harbitz, Carl Bonnevie; Kanoglu, Utku; Macias, Jorge; Papadopoulos, Gerassimos A.; Polet, Jascha; Romano, Fabrizio; Salamon, Amos; Scala, Antonio; Stepinac, Mislav; Tappin, David R.; Thio, Hong Kie; Tonini, Roberto; Triantafyllou, Ioanna; Ulrich, Thomas; Varini, Elisa; Volpe, Manuela; Vyhmeister, Eduardo (2021)
    Tsunamis are unpredictable and infrequent but potentially large impact natural disasters. To prepare, mitigate and prevent losses from tsunamis, probabilistic hazard and risk analysis methods have been developed and have proved useful. However, large gaps and uncertainties still exist and many steps in the assessment methods lack information, theoretical foundation, or commonly accepted methods. Moreover, applied methods have very different levels of maturity, from already advanced probabilistic tsunami hazard analysis for earthquake sources, to less mature probabilistic risk analysis. In this review we give an overview of the current state of probabilistic tsunami hazard and risk analysis. Identifying research gaps, we offer suggestions for future research directions. An extensive literature list allows for branching into diverse aspects of this scientific approach.
  • Hinchliffe, Steve; Butcher, Andrea; Rahman, Muhammad Meezanur; Guilder, James; Tyler, Charles; Verner-Jeffries, David (2021)
    Improved biosecurity and livestock disease control measures in low resource settings are often regarded as beneficial for agricultural productivity, rural incomes, global health, and sustainability. In this paper we present data from a study of shrimp and prawn aquaculture in Bangladesh to argue that this relationship is not as straightforward as it would seem. Analysing quantitative and qualitative data from a multi‐method field study involving 300 “missing middle” farmers, we demonstrate the importance of socio‐economic and ecological conditions to any disease management strategy. We describe how a technical programme to introduce “disease‐free” seed faltered partly as a result of the farmers' tendency to offset disease and livelihood risks by frequently re‐stocking their ponds. Changes to seed provision were accompanied by calls to alter farmers' livestock production practices. Paradoxically, these changes exposed farmers to more intense risks, potentially locking them into unsustainable disease management practices. The analysis emphasises that vernacular farming practices should be considered as key assets rather than barriers to disease management strategies, and that closer attention be paid to value chain and other risks as drivers of unsustainable practices.
  • Benoni, Henrik; Eloranta, Sandra; Dahle, Dag O.; Svensson, My H. S.; Nordin, Arno; Carstens, Jan; Mjoen, Geir; Helanterä, Ilkka; Hellstrom, Vivan; Enblad, Gunilla; Pukkala, Eero; Sorensen, Soren S.; Lempinen, Marko; Smedby, Karin E. (2020)
    Kidney transplant recipients (KTRs) have an increased cancer risk compared to the general population, but absolute risks that better reflect the clinical impact of cancer are seldom estimated. All KTRs in Sweden, Norway, Denmark, and Finland, with a first transplantation between 1995 and 2011, were identified through national registries. Post-transplantation cancer occurrence was assessed through linkage with cancer registries. We estimated standardized incidence ratios (SIR), absolute excess risks (AER), and cumulative incidence of cancer in the presence of competing risks. Overall, 12 984 KTRs developed 2215 cancers. The incidence rate of cancer overall was threefold increased (SIR 3.3, 95% confidence interval [CI]: 3.2-3.4). The AER of any cancer was 1560 cases (95% CI: 1468-1656) per 100 000 person-years. The highest AERs were observed for nonmelanoma skin cancer (838, 95% CI: 778-901), non-Hodgkin lymphoma (145, 95% CI: 119-174), lung cancer (126, 95% CI: 98.2-149), and kidney cancer (122, 95% CI: 98.0-149). The five- and ten-year cumulative incidence of any cancer was 8.1% (95% CI: 7.6-8.6%) and 16.8% (95% CI: 16.0-17.6%), respectively. Excess cancer risks were observed among Nordic KTRs for a wide range of cancers. Overall, 1 in 6 patients developed cancer within ten years, supporting extensive post-transplantation cancer vigilance.
  • Rönnqvist, Maria; Välttilä, Ville; Heinola, Katriina; Ranta, Jukka; Niemi, Jarkko; Tuominen, Pirkko (Evira, 2018)
    Evira Research Reports 3/2018
    Food items of animal origin, such as pork products, have been suggested as the main source of zoonotic salmonella infections in Europe. Contaminated feed can potentially introduce the pathogen into the animal-derived food chains. The prevalence of salmonella in different feeds for Finnish pigs was estimated as below 2% (medians) and on average in pigs 0.25% (mean). Feed was estimated on average as the cause of 35% of salmonella infections in fattening pigs and 55% in sows. Around 5% of the 300–400 domestic human salmonella infections reported per year were estimated as attributable to pig feeds. Year 2013 was employed as a reference. The present costs for the prevention of salmonella contamination in pig feeds were estimated at 1.8–3.0 million euros per year for the year 2013. The costs due to feed contamination, measures due to detected contamination and the resulting salmonella infections in pigs and humans were estimated at €2.4 (0.3–6.1) million annually. According to a scenario, if salmonella prevalence in Finnish pig feed would be similar to that acquired using data from other EU counties, the prevalence in fattening pigs and people could increase by 55-fold on average. If specific measures to eliminate salmonella from feed were not carried out, the costs due to preventive actions against salmonella were at least €1.1–1.8 million per year. Additionally, the costs due to the eradication of feedborne salmonella on pig farms, consequential measures at slaughterhouses, and the health costs to humans could rise to approximately €33 million per year. According to the results, the present feed salmonella control, including the preventive
  • EFSA Panel on Animal Health and Welfare (AHAW); Sihvonen, Liisa; Nielsen, Søren Saxmose; Alvarez, Julio; Bicout, Dominique (2019)
    The European Commission requested EFSA to estimate the risk of spread of African swine fever (ASF) and to identify potential risk factors (indicators) for the spread of ASF, given introduction in the southeastern countries of Europe (region of concern, ROC), namely Albania, Bosnia and Herzegovina, Croatia, Greece, Kosovo, Montenegro, North Macedonia, Serbia and Slovenia. Three EU Member States (MS) - Croatia, Greece and Slovenia - were included in the ROC due to their geographical location and ASF-free status. Based on collected information on potential risk factors (indicators) for each country and the relevant EU regulations in force, the estimated probability of spread of ASF within the ROC within one year after introduction into the ROC was assessed to be very high (from 66% to 100%). This estimate was determined after considering the high number of indicators present in most of the countries in the ROC and the known effect that these indicators can have on ASF spread, especially those related to the structure of the domestic pig sector, the presence of wild boar and social factors. The presence of indicators varies between countries in the ROC. Each country is at risk of ASF spread following introduction; however, some countries may have a higher probability of ASF spread following introduction. In addition, the probability of ASF spread from the ROC to EU MSs outside the ROC within one year after introduction of ASF in the ROC was estimated to be very low to low (from 0% to 15%). This estimate was based on the comparison of the indicators present in the ROC and the already affected countries in south-eastern Europe, such as Bulgaria and Romania, where there was no evidence of ASF spread to other EU MS within one year. (C) 2019 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of European Food Safety Authority.
  • Chen, Sam Li-Sheng; Fann, Jean Ching-Yuan; Sipeky, Csilla; Yang, Teng-Kai; Chiu, Sherry Yueh-Hsia; Yen, Amy Ming-Fang; Laitinen, Virpi; Tammela, Teuvo L. J.; Stenman, Ulf-Håkan; Auvinen, Anssi; Schleutker, Johanna; Chen, Hsiu-Hsi (2019)
    Purpose:Combined information on single nucleotide polymorphisms and prostate specific antigen offers opportunities to improve the performance of screening by risk stratification. We aimed to predict the risk of prostate cancer based on prostate specific antigen together with single nucleotide polymorphism information.Materials and Methods:We performed a prospective study of 20,575 men with prostate specific antigen testing and 4,967 with a polygenic risk score for prostate cancer based on 66 single nucleotide polymorphisms from the Finnish population based screening trial of prostate cancer and 5,269 samples of 7 single nucleotide polymorphisms from the Finnish prostate cancer DNA study. A Bayesian predictive model was built to estimate the risk of prostate cancer by sequentially combining genetic information with prostate specific antigen compared with prostate specific antigen alone in study subjects limited to those with prostate specific antigen 4 ng/ml or above.Results:The posterior odds of prostate cancer based on 7 single nucleotide polymorphisms together with the prostate specific antigen level ranged from 3.7 at 4 ng/ml, 14.2 at 6 and 40.7 at 8 to 98.2 at 10 ng/ml. The ROC AUC was elevated to 88.8% (95% CI 88.6-89.1) for prostate specific antigen combined with the risk score based on 7 single nucleotide polymorphisms compared with 70.1% (95% CI 69.6-70.7) for prostate specific antigen alone. It was further escalated to 96.7% (95% CI 96.5-96.9) when all prostate cancer susceptibility polygenes were combined.Conclusions:Expedient use of multiple genetic variants together with information on prostate specific antigen levels better predicts the risk of prostate cancer than prostate specific antigen alone and allows for higher prostate specific antigen cutoffs. Combined information also provides a basis for risk stratification which can be used to optimize the performance of prostate cancer screening.
  • Keipi, Teo; Kaakinen, Markus; Oksanen, Atte; Räsänen, Pekka (2017)
    Online interaction through the use of social networking sites (SNS) continues to be a significant component of the socialization of young people today, yet little research exists toward linking various relational forms to prevalent and much-studied online risks cross-nationally. This article provides a link between relational dynamics and online risks identified in previous research toward a new perspective on how social tie strength is related to experiences of hate victimization and harassment online. The analysis is based on survey data of Finnish (n = 555), American (n = 1033), German (n = 978), and British (n = 999) young people aged 15-30 years. Variables, including age, gender, main activity, SNS use, quantity, and extent of online and offline social networks including social tie strength and online community identification, were analyzed toward finding their associations with online hate victimization and harassment. Results showed that experiences of hate victimization and harassment were similar cross-nationally and that those who were personally harassed online also reported high SNS activity. Furthermore, no association was found between social network size and negative experiences. Notable cross-national differences were also detected in the results. Findings emphasize the importance of understanding variables fostering online risks for young people while providing a new perspective on what aspects of social life may help negate negative effects online.
  • Nyqvist, Linda (Helsingfors universitet, 2013)
    Cholesterol-lowering statins are well-tolerated and effective in prevention of cardiovascular diseases. One of the target groups in treatment of dyslipidaemia is type 2 diabetics, who benefit from reducing cholesterol levels even without a history of cardiovascular disease or high cholesterol levels. Common adverse events associated with statins are myopathy and an increase in liver enzymes. Statins have also been shown to slightly increase the risk of developing type 2 diabetes and increase blood glucose levels. The risk seems to increase with higher doses. Higher doses, however, prevent cardiovascular events more than moderate doses. In this cohort study we assessed the relationship between statins and development of diabetes in a Finnish diabetes prevention study. In addition, we assessed the effects of statins on blood glucose levels. The diabetes risk associated with statins was evaluated by a parametric survival-analysis and the impact on blood glucose levels by a mixture model. The material consisted of the follow-up data from the Diabetes Prevention Study (DPS) from year 1993 to 2009 and along with that statistics on reimbursements for prescription medicines from Kela's reimbursement database. The purpose of DPS was initially to determine if type 2 diabetes can be prevented or delayed by lifestyle intervention. Participants with impaired glucose tolerance were randomly assigned to the intervention group or the control group. The intervention group received intensive and individual counseling on healthy lifestyle while the control group was given general information on health behavior. The study revealed that 36,8 % (n = 182) of the participants had used statins during follow-up. Statin use was more common in the intervention than the control group. Simvastatin was the most used statin and statins had been used for four years on average. Statins were associated with a slight increase in risk of developing diabetes and an increase in fasting plasma glucose and 2 h glucose levels. The risk of diabetes was slighter in the intervention group. Further research is needed to determine the mechanism causing the increase in risk of diabetes, if different statins differ in the extent of risk and if a specific patient group or characteristic is more vulnerable to develop diabetes when exposed to statins. The diabetes risk associated with statins should be taken into account when designing a statin trial. Develoment of diabetes should be a pre-specified endpoint and blood glucose and insulin levels monitored during follow-up.
  • Poropat, Goran; Archibugi, Livia; Korpela, Taija; Cardenas-Jaen, Karina; de-Madaria, Enrique; Capurso, Gabriele (2018)
    Background: Statins are perceived as potential etiological factors for acute pancreatitis (AP), but recent evidence suggests the opposite. Our aim was to evaluate the association between statin use and risk of AP in observational studies. Methods: Medline, Scopus, and Web of Science were searched for cohort (C) and case-control (CC) studies evaluating statins as intervention and AP as outcome. Pooled adjusted odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated. Results: Thirteen studies (seven CC, six C) with 34,899 AP patients and 5,377,894 controls were included. Prevalence of statin use was 9.8% among AP patients and 25% among controls. Pooled adjusted OR was 1.00 (95% CI = 0.63 to 1.59) with considerable heterogeneity (I-2 = 98%). CC studies were associated with increased AP risk (OR = 1.33; 95% CI = 1.20 to 1.47), unlike C studies (OR = 0.69; 95% CI = 0.37 to 1.31). No association with increased risk was found for studies from Western countries (OR = 0.90; 95% CI = 0.52 to 1.56), unlike for studies conducted in Asia (OR = 1.39; 95% CI = 1.10 to 1.75). Conclusion: Statin use is not associated with increased risk of AP. Increased risk was limited to CC studies, which are more prone to bias, while C studies showed no global effect. Further research is needed to clarify whether statin type, dosage, treatment duration or AP etiology might account for this difference.
  • Tang, Xiaona (2008)
    This paper explores optimal hedging policies for multinational corporations that have flexible production sourcing and financial hedging capability. The sources of risk examined are exchange rate movements and uncertain foreign currency cash flow, and th firm's aim is to hedge such risk exposure, and at the same time to maximize its firm value. The objective of this paper is to find the optimal hedging policies - what, how, and when should a multinational corporation implement financial and/ or operational hedging, and to what extent should each type of hedging policy be. Following Mello, Parsons and Triantis (1995), and Chowdhry and Howe (1999), the firm's ability to exploit its competitive position depends on the degree to which its flexibility is matched by the construction of an appropriate hedging strategy. The firm's need for hedging is directly related to the degree of production flexibility, and the production plan it chooses is a function of the hedging strategy it employs. Multinational corporations will engage in operational hedging only when both exchange rate uncertainty and demand uncertainty are present. Operational hedging is less important for managing short-term exposures, as demand uncertainty is lower in short term; also operational hedging is less important for commodity-based firms, which face price but not quantity uncertainty. Multinational corporations are likely to use financial instruments to a greater extent to hedge short term exposure and rely on operational hedging more heavily to hedge long term risk. The optimal financial hedging policy cannot be implemented with forward contracts alone, but with foreign currency call and put options and forward contracts together.
  • Cullen, Jay; Mähönen, Jukka Tapio (Cambridge University Press, 2019)
    Cambridge Law Handbooks
    A traditional response to information asymmetries in financial markets has been to require disclosure and heightened transparency in investment chains. We argue in this chapter that the trust placed in such regulatory techniques will fail to deliver sustainable investment for two reasons. The first is the structure of equity markets, which are focused on shareholder returns and excessive turnover of portfolios, preventing meaningful engagement with companies. The second is that both investors and intermediaries make a category error in placing trust in modern risk management to quantify the financial risks from climate change and other environmental changes. Our analysis leads us logically to three micro- and macroprudential policy prescriptions, namely: increasing the capital requirements on assets with so-called ‘brown’ credentials; reforming bank stress tests to reflect the uncertain financial implications of environmental damage; and pivoting central bank bond buying programmes toward green financial assets.
  • Pesonen, Jori S.; Cartwright, Rufus; Vernooij, Robin W. M.; Aoki, Yoshitaka; Agarwal, Arnav; Mangera, Altaf; Markland, Alayne D.; Tsui, Johnson F.; Santti, Henrikki; Griebling, Tomas L.; Pryalukhin, Alexey E.; Riikonen, Jarno; Tähtinen, Riikka M.; Vaughan, Camille P.; Johnson, Theodore M.; Auvinen, Anssi; Heels-Ansdell, Diane; Guyatt, Gordon H.; Tikkinen, Kari A. O. (2020)
    Purpose: Nocturia (waking from sleep at night to void) is a common cause of sleep disruption associated with increased comorbidity and impaired quality of life. However, its impact on mortality remains unclear. We performed a systematic review and meta-analysis to evaluate the association of nocturia with mortality as a prognostic factor and a causal risk factor. Materials and Methods: We searched PubMed (R), Scopus (R), CINAHL (R) (Cumulative Index of Nursing and Allied Health Literature) and major conference abstracts up to December 31, 2018. Random effects meta-analyses were done to address the adjusted RR of mortality in people with nocturia. Metaregression was performed to explore potential determinants of heterogeneity, including the risk of bias. We applied the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) framework to rate the quality of evidence for nocturia as a prognostic risk factor for mortality and separately as a cause of mortality. Results: Of the 5,230 identified reports 11 observational studies proved eligible for inclusion. To assess nocturia 10 studies used symptom questionnaires and 1 used frequency-volume charts. Nocturia was defined as 2 or more episodes per night in 6 studies (55%) and as 3 or more episodes per night in 5 (45%). Pooled estimates demonstrated a RR of 1.27 (95% CI 1.16-1.40, I-2=48%) with an absolute 1.6% and 4.0% 5-year mortality difference in individuals 60 and 75 years old, respectively. The pooled estimates of relative risk did not differ significantly across varying age, gender, followup, nocturia case definition, risk of bias or study region. We rated the quality of evidence for nocturia as a prognostic factor as moderate and as a cause of mortality as very low. Conclusions: Nocturia is probably associated with an approximately 1.3-fold increased risk of death.
  • Gritsenko, Daria; Fedi, Laurent; Faury, Olivier (2018)
    The existing risk weighing on vessel, crew and ecosystem in the Arctic and more globally in Polar waters promoted the adoption of the Polar Code (PC) early 2017, a mandatory international legal framework intended for enhanced safety and environmental protection. While the substance of the PC has been extensively analyzed, few studies have focused on the underlying relationships between the PC and underwriters. Based on an extensive literature review, documentary materials and interviews with insurance companies, this article conceptualizes the PC as a toolbox and analyzes how underwriters can exploit it in their work within the emerging Arctic market. The PC does not only regulate the navigation in Arctic waters in legal terms, but is also aimed at mitigating risks in the Polar areas through the identification of hazard sources and proceduralization of risk assessment. As a result we observe a certain Polar Code paradox. Even though the PC is a risk-based instrument and constitutes a key step for improving ship insurability, it has only limited capacity to assist underwriters in assessing risks and insuring vessels. Marine insurers still face a lack of data and high pending uncertainties leading them to exercise extreme caution with Arctic risks appraisal.
  • Ellonen, Noora; Rantanen, Heidi; Lepistö, Sari; Helminen, Mika; Paavilainen, Eija (2019)
    Objective: The purpose of this research was to analyze psychometric information in the Brief Child Abuse Potential Inventory (BCAP) in a Finnish general population sample. Design: A self-report survey of parents in a primary health care setting and a hospital setting was used to evaluate the use of the BCAP. Setting: The study population consisted of parents who were visiting one of the following contexts: a primary maternity health care clinic, a child health care clinic, and the maternity outpatient clinic, various pediatric outpatient clinics, the general pediatric ward, the pediatric surgical ward, or the neonatal intensive care unit in a hospital setting. Subjects: The BCAP was given to parents at the 30-34th week of pregnancy, when the child was 5 months old or all parents depending on the context. The BCAP was delivered to 759 parents. The final size of the sample was 453 respondents. Main outcome measure: The BCAP, which consisted of 25 items to screen child abuse potential and nine items for evaluation of respondent validity. Results: The internal consistency of the Abuse Risk Scale was good (.770), and the validity scales worked well. The factor structure mirrors with the original factors structure. Conclusion: The psychometric properties of the BCAP reported in the analysis suggest that the BCAP could be a valid instrument to detect child abuse potential in the general population in Finnish health care settings. However, among Finnish respondents there is very little variation in some parts of the measure, which suggests that further research should assess the validity of the instrument in representative samples. Further analysis is also needed to evaluate the correct classification rate of the BCAP.
  • Hautamaki, Lotta (2018)
    In psychiatric clinical practice, professionals pursue risk management alongside various uncertainties concerning diagnoses and treatment decisions. In this article, I draw on an ethnographic study of understandings of bipolar disorder in Finland to argue that risk management in psychiatry is better characterised as practical uncertainty work. I show how both the clinicians and the patients coordinate the uncertainties of bipolar disorder symptoms, risks and treatment decisions, into something that can be managed. I examine the ways in which temporality structures this uncertainty work and I explore two different modes of framing time. Clinical time stems from the current psychiatric thinking committed to the standardised diagnosis and the ideals of evidence-based medicine. Through this, professionals frame a task-oriented and linear treatment path from diagnosis and treatment to a managed life with bipolar disorder. Experienced time, in contrast, relates to the logics of care and self-care amid the embodied experiences of different actors. This framing of time involves a cyclical process where the patient, the clinician and the treatment interventions each need to adjust to changing situations.
  • Peremanova, Kateryna (Helsingfors universitet, 2011)
    This paper identifies an issue of under-investment in wind energy in Poland and analyses it from the perspective of market efficiency. It argues that higher required returns from wind energy assets in Poland are a result of both greater investment risks as well as a certain market inefficiency which leads to wind asset under-pricing and reduced investment.We hypothesize that the same risks which affect investment directly through the cost of capital for wind projects create conditions which are potential sources of market inefficiency. The conditions discussed are: information and transaction costs and market entry barriers. We explore the general wind energy investment environment as well as the electricity market structure and renewable energy policy design to identify the presence of the three conditions above. In the course of this discussion, we find that the wind asset market in Poland contains specific information and transaction costs and entry barriers, substantiating a case for market inefficiency and requiring further research.
  • van Dongen, Myrna M. E.; Aarnio, Karoliina; Martinez-Majander, Nicolas; Pirinen, Jani; Sinisalo, Juha; Lehto, Mika; Kaste, Markku; Tatlisumak, Turgut; de Leeuw, Frank-Erik; Putaala, Jukka (2019)
    Background: Knowledge on the use of secondary preventive medication in young adults is limited. Methods: We included 936 first-ever ischemic stroke 30-day survivors aged 15-49, enrolled in the Helsinki Young Stroke Registry, 1994-2007. Follow-up data until 2012 came from Finnish Care Register, Statistics Finland, and Social Insurance Institution of Finland. Usage thresholds were defined as non-users, low (prescription coverage 80%). Adjusted Cox regression allowed assessing the association of usage with all-cause mortality and recurrent vascular events. Results: Of our patients, 40.5% were non-users, 7.8% had low usage, 11.8% intermediate usage and 40.0% high usage. Median follow-up was 8.3 years. Compared to non-users, risk of mortality and recurrent stroke or TIA was lower for patients with low-intermediate (HR 0.40, 95% CI 0.22-0.65; HR 0.31, 95% CI 0.18-0.53) and high usage (HR 0.25, 95% CI 0.15-0.42; HR 0.30, 95% CI 0.19-0.46), after adjustment for confounders. Conclusions: Use of antihypertensives was suboptimal in one-third of patients in whom antihypertensives were initially prescribed. Users were at lower risk of mortality and recurrent stroke or TIA compared to non-users.Key Messages The use of antihypertensive medication is suboptimal in one-third of patients in whom antihypertensive medication was initially prescribed after ischemic stroke at young age. The risk of mortality and recurrent stroke or TIA is lower for users of antihypertensive medication after ischemic stroke at young age compared to non-users, after adjustment for relevant confounders including pre-existing hypertension and prior use of antihypertensive medication. Specific guidelines on antihypertensive medication use after ischemic stroke at young age are lacking. However, our results may motivate doctors and patients in gaining better usage of antihypertensive medication, since better usage was associated with more favorable outcome in this study.
  • Setälä, Iiris (Helsingfors universitet, 2010)
    The purpose of this study is to find out weather or not the users of internet bank are aware of the security threats concerning the use of the service. The intention is to find out also if the interviewees have created some methods of their own to raise the security level of their use of internet bank. Still, the purpose of the study is to clarify the interviewees’ opinions about the economically responsible party in case of economic losses. Research material consists of eight internet bank users’ interviews. The statements of the interviewees are considered from factual point of view and analysed by dividing them under certain themes and types. In addition to the interviews of consumers, also two experts were interviewed. This material works more like source of information and it is not analysed like the other interviews. These two interviews were carried out to get information about the security level of Finnish internet banks. Phishing is criminal activity by which the criminals’ objective is to gather confidential information, such as access codes for internet bank, from the victims. This research revealed that the interviewees were quite unaware of the different forms of phishing attacks. However, almost everyone had heard of the phishing e-mails. They were not seen as a threat because the interviewees knew how to identify those e-mails and also that they should never be answered but deleted immediately. Consumers can enhance the security of internet transactions by their own behaviour. The interviewees seemed to be quite careful when using internet bank even though they had not gotten much directions from the bank. The different parts of internet bank access codes were kept separately and the fixed parts were mostly known by heart. Some interviewees used internet bank merely at home or at work place and public computers were broadly avoided for that purpose. The interviewees thought that the economically responsible party in the case of economical losses depends on the situation. Bank could not be held responsible if the access codes were given to outsiders by self. In other cases however the interviewees saw bank as the responsible party. Greater awareness of security threats seems in this research material to increase the responsibility of consumer. Consumers’ responsibility would also increase if banks would increasingly inform consumers about these security threats.
  • Akiala, Anna- Kaisa (2008)
    Avsikten med min forskning var att utreda vilken roll tidig identifikation av barn i riskzonen har inom barnskyddets praktiska arbete. Den växande oron över barnens illamående har väckt samhällets hjälpinstanser till att bygga upp och utveckla sin verksamhet till att bättre nå de barn och familjer som mår dåligt. Förebyggande arbete och speciellt tidig identifikation av barn i riskzon har fått allt mer uppmärksamhet. Avsikten med min forskning var att utreda hur socialarbetarna på barnskyddet upplevde fenomenet samt hur stor del av arbetet inom barnskyddet kunde avses vara tidig identifikation. Jag samlade in mitt forskningsmaterial genom att intervjua sex stycken socialarbetare, som alla arbetade inom ett familjecenter i Helsingfors. Intervjumetoden i forskningen var temaintervju. I avhandlingen redogör jag bl.a över barnskyddsarbetet och den nya barnskyddslagen som stigit i kraft 1.1.2008. Jag behandlar även barnens välmående i dagens samhälle samt redögör över barn i riskzon. De centrala verken i min avhandling är bl.a. Lagerberg& Sundelins (2003) verk om barn i riskzon samt olika undersökningar angående barnens välmående i Finland (Bl.a Bardy et al. 2001, Järventie 1999). Enligt forskningsresultaten i denna forskning har tidig identifikation av barn i riskzonen en väldigt liten roll inom barnskyddets praktiska arbete. De största orsakerna till detta var enligt socialarbetarna den stora mängden arbete samt själva naturen av arbetet. Barnskyddet koncentrerade sig enligt socialarbetarna huvudsakligen på att stöda barn och familjer i kris. Hälften av socialarbetarna ansåg dessutom att tidig identifikation inte borde ha en roll inom barnskyddet. Själva fenomenet i sig hade enligt socialarbetarna positiva effekter. Väldig få negativa effekter nämndes under intervjuerna.