Social Insurance Institution Research Articles

養老領域中的代際衝突與代際公平——基於儒家倫理的視閾

LANGUAGE NOTE | Document text in Chinese; abstract also in English.從世界範園看，代際公平早已經是一個與養老金改革、醫療資源配置等問題深度捆綁的核心議題。代際公平危機首先凸顯在養老金赤字上，並進一步危及到社會養老保險制度的公平性，危及到養老保障制度的基礎－－代際契約。就倫理層面而言，如何在老齡化的壓力重構代際契約成為決定代際公平辯論走向的關鍵。本文擬簡述目前在代際公平辯論中佔主導地位的解釋範式，並批判性地審查其倫理意蘊與局限性。在此基礎上，本文擬提供一種基於儒家倫理思想的替代性的解釋範式。本文試圖論證儒家倫理及其蘊含的代際契約不僅為解決代際公平問題提供了新的思路，而且也為當前中國養老制度改革提供一些重要的政策建議。From a global perspective, generational equity has long been a core issue in pension reform and medical resource allocation. Indeed, discussion of generational equity involves a financial crisis related to pension deficits and the fairness of the pension system, which is a crisis that threatens the ethical foundation of the social insurance institution, i.e., the intergenerational contract. From an ethical perspective, how to reconstruct the intergenerational contract under the pressure of aging is crucial to the debate on generational equity. This study critically examines the dominant framework of the debate on generational equity and proposes an alternative interpretation framework based on Confucian ethics. Finally, this study argues that Confucian ethics and the interpretation of the intergenerational contract not only shed new light on the issue of generational equity but also provide important policy implications for the current pension system reform in China.DOWNLOAD HISTORY | This article has been downloaded 33 times in Digital Commons before migrating into this platform.

Minors in the Insurance Protection System: Opportunities and Guarantees

Analysis of the current scientific literature has shown that at the present time very little attention is paid to the issues of insurance coverage for minors, despite their social and economic importance. The approaches to the notion of "insurance protection" are ambiguous: a critical insight into them allows the author to offer her own definition, the filiation of which leads to the concept of "system of insurance protection for minors." It is established that the form of minors participation in the insurance protection system depends on which of the areas of insurance protection it is represented, as the participation itself can be both direct and indirect. The article reveals the significance of the social insurance institution that provides the guarantees of insurance coverage to the minors and their legal representatives. It presents the features of minors insurance protection through the insurance.

Human service work and long-term sickness absence due to mental disorders: a prospective study of gender-specific patterns in 1,466,100 employees

PurposeThe aim of the study was to investigate sickness absence due to mental disorders in human service occupations. MethodsParticipants (n = 1,466,100) were randomly selected from two consecutive national 9-year cohorts from the Statistics Finland population database; each cohort represented a 33% sample of the Finnish population aged 25–54 years. These data were linked to diagnosis-specific records on receipt of sickness allowance, drawn from a national register maintained by the Social Insurance Institution of Finland, using personal identification numbers. ResultsSociodemographic-adjusted hazard ratios (HRs) for sickness absence due to mental disorders in all human service occupations combined were 1.76 for men (95% confidence interval [CI], 1.70–1.84) and 1.36 for women (95% CI, 1.34–1.38) compared with men and women in all other occupations, respectively. Of the 15 specific human service occupations, compared with occupations from the same skill/education level without a significant human service component, medical doctors, psychologists, and service clerks were the only occupations with no increased hazard for either sex, and the HRs were highest for male social care workers (HR 3.02; 95% CI, 2.67–3.41). ConclusionsMost human service occupations had an increased risk of sickness absence due to mental disorders, and the increases in risks were especially high for men.

Farmakoekonomiczna ocena kosztów terapii reumatoidalnego zapalenia stawów wybranymi lekami biologicznymi

ObjectivesAmong autoimmune diseases, rheumatoid arthritis (RA) is the most common chronic inflammatory disease of the joints. Its pathogenesis is still not fully understood, but the gained knowledge has contributed to the development of modern treatment. The introduction of biological therapy for RA has been a breakthrough in the standard approach to the treatment of this disease.Material and methodsThe study material was retrospectively collected in the Rheumatology and Systemic Tissue Diseases Clinic and Rheumatology Outpatient Clinic in dr. Jan Biziel University Hospital No. 2 in Bydgoszcz. Patients were divided into 3 groups: patients receiving infliximab – 43 patients, etanercept – 27 patients and adalimumab – 34 patients. In the study, the pharmacoeconomic analysis included direct and indirect medical costs. Direct medical costs analyzed in the study included costs for the purchase of medications, diagnostic and imaging costs, and medical consultations and hospitalization costs. The analysis included all direct medical costs incurred by the hospital and the patient, as well as indirect costs outside the healthcare sector – that is, the Polish Social Insurance Institution benefits (disability benefits, rehabilitation benefits, sickness absences). Direct medical costs are also presented from the perspective of the payer – The Polish National Health Fund – taking into account the cost and percentage share of medical expenses.ResultsThe analysis concerned resources used since the beginning of treatment with a given biological medication for 24 months or earlier if disease remission occurred.A cost-benefit analysis was carried out in the study using biosimilar medications present on the market in relation to the treatment regimens. Considering the total cost, if only Inflectra were used in therapy, PLN 18 151.98 per patient could be saved, and in the case of Remsima, PLN 16 385.14. In less than 19 months, to use infliximab for 43 patients, PLN 780 475.80 more would have to be spent than in the case of the biosimilar medication Inflectra, and PLN 704 561 in the case of Remsima.The highest total cost is generated by treatment with adalimumab, followed by etanercept, and infliximab. Of the costs analyzed, a significant majority was for biological treatment.ConclusionsGiven the Polish financial conditions, the best solution now is to reduce the prices of biological medications. This is possible through the introduction of biosimilar medications that, when placed on the market, reduce the price of the original medication, as is currently the case with Remicade and Enbrel. The introduction of Inflectra and Remsima, as well as Benepali and Erelzi, has reduced the price base of original medications to similar levels of treatment with biosimilar medications. The wider use of biological treatment would also reduce indirect costs.

Access to innovative cancer medicines in a middle-income country - the case of Mexico

BackgroundCancer has become the third cause of death in Mexico. Treatment for cancer is often complex and lengthy. New and better medicines enter the market at high prices, which may limit access. Like most Latin American countries, Mexico has an essential cancer medicines list that includes innovative medicines. Their accessibility and use in the public sector remains unknown. Therefore, we describe the use, as a proxy of access, of innovative and essential cancer medicines in the public sector in Mexico, by insurance institution, and by five regions between 2010 to 2016.MethodsWe used drug utilization research methods to assess the use of eight patented cancer medicines. Through the national transparency platform, we obtained data on the quantities of these medicines used in all public health facilities and social health insurance institutions and recalculated those figures into defined daily dose (DDD) per 1000 population per year.ResultsOverall, the use of all medicines increased over the years, especially for trastuzumab, rituximab and imatinib. The use of innovative medicines was higher per population covered in social health insurance institutions than in governmental facilities. Throughout the study period, the Central region (including Mexico City) has used more medicines per population than the other regions.ConclusionsThe use and access of some essential innovative cancer medicines has increased over the years, but remains unequal across insurance schemes and regions. Particularly, the Ministry of Health Insurance scheme and Northern and Western regions in the country would benefit from additional efforts to increase access to essential cancer medicines.

The direct and indirect costs of epilepsy in Poland estimates for 2014–2016 years

ABSTRACT Background: According to the current data, around 1% of the Poland population have epilepsy, which comprises about 400,000 people. This group of patients requires life-long therapy including both drug therapy and hospitalization. The character of the epilepsy has a significant impact on the expenses borne by individual patients, and the prevalence of the disease has a significant impact on the health care system. Methods: This article aims to measure the direct and indirect costs of epilepsy in Poland estimates for the years 2014–2016 (top-down approach). We use a modified human capital approach and a unique dataset provided by the number of Polish institutions including National Health Fund, Social Insurance Institution, and Central Statistical Office. Results: Epilepsy burden in Poland is significant. In the years 2014–2016, the total direct cost of epilepsy amounted to, respectively, 355 mln PLN (84 mln EUR), 368 mln PLN (87 mln EUR), and 373 mln PLN (88 mln EUR), but the total indirect cost amounted to 1 bn PLN (239 mln EUR), 949 mln PLN (224 mln EUR), and 848 mln PLN (200 mln EUR). Conclusions: Direct and indirect costs of epilepsy can be a useful input for health technology analyses of drugs or economic impact assessments of public health programs.

Medical certificate education: controlled study between lectures and flipped classroom

BackgroundFinnish permanent residents are covered by social security insurance administered by the Social Insurance Institution of Finland. The procedure of insurance is initiated with medical certificate written by the treating doctor. Thus, the doctor must have certificate writing skills accompanied with the knowledge of the content and goals for insurance. Quality certificates are important part of doctors’ professional skills worldwide and most effective teaching methods for learning these should be investigated.MethodsMedical certificate data were collected from two independent courses of fourth-year student taught in autumn 2015 (N = 141) and 2016 (N = 142) in the medical faculty of the University of Eastern Finland. A random sample of 40 students per course was drawn for the analysis. All certificates were analyzed as one sample. This was done to obtain reliable results with internal control group on the differences between two teaching methods, the traditional approach and the flipped classroom (FC) approach, in 2015 and 2016, respectively. The medical certificates were evaluated and scored with a rubric (range: − 4.00–14.25) by two independent experienced specialists.ResultsCompared to students in the traditional classroom, students involved in the FC received significantly higher scores in all relevant sections of the assessed certificates. The mean of the total scores was 8.87 (SD = 1.70) for the traditional group and 10.97 (SD = 1.25) for the FC group. Based on the common language effect size, a randomly selected student from the FC group had an 85% probability of receiving a higher total score than a student from the traditional group.ConclusionIn this study, the FC approach resulted in a statistical significant improvement in the content and technical quality of the certificates. The results suggest that the FC approach can be applied in the teaching of medical certificate writing.

Longitudinal study of medication use in caregivers of people with Alzheimer’s disease – Kuopio ALSOVA study

The longitudinal pattern of medication use among family caregivers of people with dementia is not well understood, despite the potential for medication over- or under-use. To investigate caregiver medication use over a five-year follow-up using data obtained via self-report and from a national prescription register, and compare agreement between medication data obtained from the two sources. Medication data for 222 family caregivers of people with Alzheimer's disease were obtained via self-report and from the Finnish Social Insurance Institution. Generalised estimating equations, Kappa statistics and related samples Wilcoxon signed rank test were used to analyse medication use over time. The mean number of medications used by caregivers increased from 3.4 to 4.1 (self-reported current regular medications) and 2.4 to 2.8 (reimbursed prescription medications during the past 90 days) over five years (p < 0.001). Significantly, more medications were identified via self-report (mean 3.6, SD = 3.3) than the national prescription register (mean 2.6, SD = 2.4, Z= -12.300, p < 0.001). Agreement between the two data sources was good for cardiovascular medications and anti-hypertensives (Kappa = 0.883-0.967, p < 0.001) and medications for acid-related disorders (Kappa = 0.508-0.092, p < 0.001). Agreement was moderate for analgesics (Kappa = 0.281-0.477, p < 0.001) and psychotropics (Kappa = 0.281-0.562, p < 0.002). The proportion of caregivers using five or more medications increased from 27.5% to 44.6% (self-report), and 16.7% to 27.7% (register) (p < 0.001). Caregivers use an increasing number of medications in the first five years of caring for persons with dementia, and self-report using a higher number of medications than data from the national prescription register suggest.

Weight change among normal weight, overweight and obese employees and subsequent diagnosis-specific sickness absence: A register-linked follow-up study.

Aims: Obesity and weight change are associated with sickness absence; however, less is known about the diagnoses for sickness absence. We examined the association between stable and changing weight by body mass index groups with sickness absence due to any, musculoskeletal and mental diagnoses among midlife female and male employees. Methods: The Finnish Helsinki Health Study phase 1 survey took place in 2000–2002 (response rate 67%) and phase 2 in 2007 (response rate 83%). Based on self-reported body mass index, we calculated the weight change between phases 1 and 2 (body mass index change ⩾5%). The data were linked with registers of the Social Insurance Institution of Finland, including information on diagnoses (ICD-10) for sickness absence >9 days. We used a negative binom ial model to examine the association with sickness absence among 3140 women and 755 men during the follow-up (2007–2013). Results are presented as rate ratios. Covariates were age, sociodemographic factors, workload, health behaviors and prior sickness absence. Results: Weight-gain (rate ratio range=1.27–2.29), overweight (rate ratio range=1.77–2.02) and obesity (rate ratio range=2.16–2.29) among women were associated with a higher rate of sickness absence due to musculoskeletal diseases, compared to weight-maintaining normal-weight women. Similarly, obesity among men was associated with sickness absence due to musculoskeletal diseases (rate ratio range=1.55–3.45). Obesity among women (rate ratio range=1.54–1.72) and weight gain among overweight men (rate ratio=3.67; confidence interval=1.72–7.87) were associated with sickness absence due to mental disorders. Conclusions: Obesity and weight gain were associated with a higher rate of sickness absence, especially due to musculoskeletal diseases among women. Preventing obesity and weight gain likely helps prevent sickness absence.

Pain and Administration of Pain Medication in the Elderly Population - A Goal Study in Finland

BACKGROUND: The aim of this population-based study was to examine older adults' self-reported SF-36 bodily pain domain (pain severity and pain-related interference) and pain-related factors. Administration of pain medication was under particular interest. METHODS: 1420 seniors aged 62-86 years self-reported SF-36 bodily pain during the past month. Four pain groups were formed based on these reports (group I [0-47.5, moderate to very severe pain intensity and interference], group II [55-70], group III [77.5-90], group IV [100, no pain at all]). Additional questionnaire-provided data regarding education, wealth, life habits and morbidity, as well as clinical and blood sample data were considered. Data regarding administration of pain medication during the previous and following 6 months were retrieved from the Finnish Social Insurance Institution. RESULTS: The overall pain prevalence was 78% (SF-36 bodily pain < 100). Prevalence of cohabiting and socioeconomic status decreased with increasing SF-36 bodily pain. Obesity and morbidity increased with pain. 84% of seniors had used some prescribed pain medication. 77% had used NSAIDs (percentage decreasing linearly from 91% in group I to 70% in group IV, p < 0.001). Opioids were used in all pain groups. INTERPRETATION: Low socio-economic status, obesity and morbidity were found to associate with pain. The majority of seniors had experienced pain despite the ample administration of analgesic drugs. NSAID: administration was remarkable in all pain groups. Increasing attention should be paid to pain management in the elderly considering especially the non-pharmacological modalities. FUNDING STATEMENT: No funding was applied or received for the study. DECLARATION OF INTERESTS: The authors report that there were no conflicts of interest. ETHICS APPROVAL STATEMENT: The approval for the study was given by the Regional Ethics Committee of Tampere University Hospital. All participants gave their written informed consent prior to data collection.

Increasing incidence and shifting profile of idiopathic inflammatory rheumatic diseases in adults during this millennium.

To explore the trends in the incidence of idiopathic inflammatory rheumatic diseases (IIRDs) after the turn of the millennium. From a nationwide register maintained by the Social Insurance Institution of Finland, we collected all adult patients with IIRDs granted a new special reimbursement for anti-rheumatic drugs between 2000 and 2014. Temporal trends in the incidences of various IIRDs were estimated in three 5-year intervals. A total of 58,405 adult patients were identified. Between 2000-2004 and 2010-2014, the age-adjusted incidence rate of IIRDs increased from 114 to 116/100000 [incidence rate ratio (IRR) 1.03 (95% CI 1.01 to 1.06)] in women and from 67 to 69/100,000 [IRR 1.10 (95% CI 1.06-1.14)] in men. The incidence of seropositive rheumatoid arthritis (RA) remained stable while that of seronegative RA decreased. For other diagnoses, the incidences either increased (unspecified arthritis, psoriatic arthritis, spondyloarthritis), remained stable (reactive arthritis), or decreased (SLE and the group of diseases with the ICD-10 code M35). The gender difference in spondyloarthritis leveled as the incidence in women increased at a higher rate than in men. Mean age at IIRD diagnosis decreased among women. The total age-adjusted incidence of IIRDs has gradually increased, due to the increase in unspecified arthritis, psoriatic arthritis, and spondyloarthritis. This, in addition to the ascending number of individuals at risk in the population, translates into a growing burden to the health care system.

An Attempt to Identify Factors Influencing Retirement Decisions in Poland

Discussions on how to prevent negative economic consequences of ageing of societies have resulted in the reforms that should prolong labour market participation and postpone retirement of longer living generations. Pension systems are among those reformed most frequently. Also in Poland – since the beginning of economic transformation in the early 1990s – retirement rules have changed many times. Pre‑retirement benefits and allowances have been introduced to help those who became unemployed at an older age. Since 2009 early retirement is not possible any more (with some exceptions), the standard retirement age continued to increase since 2013 and then it decreased again in 2017. The aim of the paper is to analyse the driving forces of retirement in Poland. Such knowledge is important to develop proper policies and expectations about labour supply decisions. We have analysed what factors influenced retirement decisions in the last decade, with a special focus on pension system regulations. The main data sources used in this paper are Labour Force Survey (BAEL) data for the years 2005–2016 and the Social Insurance Institution statistics. Probabilities of retirement from the labour force were presented and discussed. Then, individual BAEL data for persons aged 50–74 in the years 2013–2016 were used to estimate logistic regression models of odds of labour market inactivity. The results show that education or health status are significant factors influencing retirement decisions in Poland. Additionally, older workers react to economic incentives for retirement created by the pension system, mainly the retirement age.

Type 2 diabetes and treatment intensification in primary care in Finland.

To identify how the electronic health record (EHR) systems and national registers can be used for research purposes. We focused on how the primary care physicians adhere to clinical guidelines. Study population included incident type 2 diabetes patients from four selected regions. Data were collected in two phases. At the first phase study cohort was identified using the prescription registers of the Social Insurance Institution (SII) and EHR systems used within the study regions. At second phase, data were collected from SII's registers, local EHR systems, the hospital discharge and the primary care registers of National Institute for Health and Welfare. Metformin was the most common choice as first drug. Among all study patients, 8375 (76.0%) started metformin monotherapy or combinations. The treatment was intensified at variable levels of HbA1c depending on the area. DPP4-inhibitors were by far the most common agent for treatment intensification. Sulphonylureas were used less often than basal insulin as the second-line agent. The use of DPP4-inhibitors increased between years 2009-2010, when first DPP4-inhibitor received reimbursement and this class became dominant drug for treatment intensification increasingly thereafter. The EHR systems and national registers can be used for research purposes in Finland. The realization of diabetes treatment national guidelines are followed in primary care to a large extent. However, the subsequent intensification of therapy was delayed and occurred at elevated Hba1c levels.

Comorbidities and mortality in persons with type 1 diabetes: the vantage point of multiple time scales via Bayesian intensity model

Introduction Type 1 diabetes is an incurable autoimmune condition occurring typically before the age of 30 years in which the ability of pancreas to produce insulin in compromised resulting in too high levels of blood sugar. Diabetes often causes other health problems over time. Calendar year and age of diagnosis of type 1 diabetes as well as diabetes duration are considered as important predictor factors for mortality and morbidity in persons with type 1 diabetes. One of the common comorbidities in type 1 diabetes is the chronic kidney disease, which increases the risk for both cardiovascular death and end-stage renal disease (ESRD). ESRD is a life-threatening complication resulting in a poor prognosis for patients. Cardiovascular death and renal failure are therefore competing risks in patents with type 1 diabetes. So far, researchers have focused on the competing risks approach to account for mortality when evaluating the ESRD risk. Our aim is to provide an overall picture on the changes in the progression of type 1 diabetes to ESRD and/or death without ESRD, when studying the risk on multiple time scales simultaneously, and accounting for the interplay of the relevant time scales. Methods This study is based on the cohort formed in the register-based FinDM (Diabetes in Finland) study, in which incident type 1 diabetes patients were identified from the Finnish drug reimbursement register (Social Insurance Institution) and from the Finnish Hospital Discharge Register (National Institute for Health and Welfare). This study focused on those diagnosed with type 1 diabetes between 1972 and 1991 before age of 30 years (n = 11,810). Follow-up data from the date of entitlement until end of 2014 on ESRD (Finnish Registry for Kidney Diseases) and death (Statistics Finland) were obtained through a computerized register linkage. We tracked the individual's risk for ESRD or death without ESRD on the relevant time scales, age, calendar time and diabetes duration, by applying nonparametric Bayesian intensity model. The model allows incorporation of multiple time scales and multiplicative effects of different time scales. We used the informative graphical displays of the hazard, such as 3-dimesional plots and heatmaps, to present and interpret the results. Results After a mean follow-up of 26.7 years, a total of 338,492.8 person-years accumulated and 844 persons (7.1%) developed ESRD, yielding a crude incidence rate of 2.5 per 1000 person-years. Deaths of persons with ESRD (n = 440) comprised almost 19% of all of the 2345 deaths. The crude mortality rate was 5.7 and 86.2 per 1000 person-years among type 1 diabetic patients without and with ESRD, respectively. Estimation of multiplicative effect of the diabetes duration and attended age by means of Bayesian model depicted both time scales as determinants of the risk for ESRD as well as the risk of death without ESRD. After attended age of 20 years, the risk of ESRD increased steeply, reached a plateau around 30 years, and showed a slight decrease after age of 40 years. The risk of ESRD associated with diabetes duration incorporated two levels, the lower one followed by the higher one, with the change point at 15 years. The risk of death without ESRD increased gradually with increasing age, whereas a decrease in risk was seen for increasing diabetes duration in those diagnosed with type 1 after age of 8 years. Calendar time was associated with improved survival of type 1 diabetic patients without ESRD and decreased risk for ESRD. Conclusions Overall prognosis of type 1 diabetes has improved over time. Attended age and duration of diabetes, both important determinants of the morbidity and mortality in patients with type 1 diabetes, have a multiplicative effect. The strongest joint effect of two time scales on the risk of ESRD was seen for those attending 30-40 years after diabetes duration over 15 years.

Risk of Parkinson disease in agricultural occupations in Finland

Introduction Prior epidemiologic studies indicate that agricultural work and occupational exposure to pesticides may increase risk of Parkinson disease (PD). Findings may vary by country as well as by type and degree of agricultural exposures. We therefore studied whether work in agriculture, forestry, and fishing is related to the risk of PD in Finland. Methods We constructed a population-based case-control study of incident PD in Finland using a medication register maintained by the Social Insurance Institution of Finland, along with the Population Information System, which includes census records for all Finnish residents. PD cases were diagnosed (first approved to receive symptomatic therapy for PD) between 1995–2014. We randomly selected two controls per case from the general population while matching on diagnosis year, birth year (1930–1950), and sex. Individual occupational census data from 1990, allowing for a minimum of four years of exposure lagging, was used to define occupation. We included 36,398 economically active subjects (12,204 PD cases and 24,194 controls). We linked the data on occupation in 1990 to the Finnish Job Exposure Matrix (FINJEM) to identify potential for occupational exposure to pesticides and other FINJEM agents. We estimated matching variable adjusted odds ratios (ORs) and more fully adjusted odds ratios (aOR), and 95% confidence intervals (CIs) using logistic regression while respectively adjusting for matching variables only, or also for socioeconomic status and any environmental tobacco smoke at work (ETSW). Environmental tobacco smoke, including ETSW, appears to be inversely associated with PD, while socioeconomic status is likely associated with active tobacco smoking, which is well established as strongly inversely associated with PD. Results In total, 1797 PD cases (14.7%) and 3224 controls (13.3%) were working in agricultural occupations in 1990, suggesting a modestly increased risk of PD (OR 1.12; CI: 1.05–1.19 and aOR 1.13; CI: 1.03–1.24). The majority were farmers or doing any type of managerial work in agriculture (1529 PD cases, 2692 controls, aOR 1.17; CI: 1.05–1.30). We also observed a greater PD risk among workers in agriculture, horticulture and animal husbandry (147 PD cases, 260 controls, aOR 1.18; CI: 0.96–1.46). In contrast, there was no indication of a greater risk of PD in other agricultural occupational groups: aOR 0.67; CI: 0.37–1.19 for “fishermen/fish farmers” (15 PD cases, 48 controls) and aOR 0.98; CI: 0.77–1.24 for “forestry workers/lumberjacks” (106 PD cases, 224 controls). Exposure to insecticides, herbicides and fungicides were highly correlated with agricultural occupations, and yielded ORs relatively similar to the overall estimate for agricultural occupation. Conclusion We observed a modest positive association between agricultural occupations and PD in Finland. However, it is possible that this association at least in part is related to a known relatively low prevalence of active tobacco smoking among most agricultural workers in Finland outside of fishing and forestry as compared to the general population.

Conceptual Approaches to Improving the Functioning of Non-state Social Insurance Institutions in Ukraine

Conceptual Approaches to Improving the Functioning of Non-state Social Insurance Institutions in Ukraine

Asthma trigger perceptions are associated with work disability.

To study the association between perceptions of various triggers of asthma and employment status. A questionnaire was administered to all those adults living in the city of Tampere, Finland, who were entitled to special reimbursement for asthma medication by the Social Insurance Institution (n = 2613). The response rate was 79%. The study population (n = 1657) consisted of individuals who worked full-time (n = 967), were unemployed (n = 197), had all-cause work disability (n = 334), or were retired due to old age (n = 159). Given a list of potential asthma triggers, the respondents were asked how often (never/sometimes/often) the trigger caused or worsened their asthma symptoms during leisure time. After adjusting for background variables (age, sex, smoking, and professional status), frequency of asthma symptoms, and the use of asthma medication during the last year, any individual trigger identified as asthma-relevant was associated with having work disability (vs. working full-time). The highest odds ratio (OR) was found for vehicle exhaust (OR 5.0, CI 2.2-11.4). We found similar but less consistent associations between asthma trigger perceptions and unemployment. No elevated ORs were found regarding asthma trigger perceptions for old-age retirement. Perceptions of asthma triggers are associated with all-cause work disability. Our findings suggest that asthmatics have excess trigger perceptions that are not explained by asthma alone. Asthmatics need to be informed that inaccurate trigger perceptions may develop, and how they are induced, because unnecessary trigger avoidance may interfere with work life.

Vaccine-preventable disease incidence of pneumococcal conjugate vaccine in the Finnish invasive pneumococcal disease vaccine trial

Estimation of the full disease burden caused by Streptococcus pneumoniae is challenging due to the difficulties in assigning the aetiology especially in lower and upper respiratory infections. We estimated the pneumococcal disease burden by using the vaccine-preventable disease incidence (VPDI) of PHiD-CV10 vaccine (GSK) in our clinical trial setting.Finnish Invasive Pneumococcal disease (FinIP) trial was a cluster-randomized, double-blind trial in children <19 months who received PHiD-CV10 in 52 clusters or hepatitis B/A vaccine as control in 26 clusters according to 3+1 or 2+1 schedules (infants < 7 months) or catch-up schedules (children 7–18 months). Outcome data were collected using Finnish routine health-care registers, consisting of THL National Infectious Diseases Register, THL Care register, and Benefits Register of Social Insurance Institution of Finland. Blinded follow-up lasted from the date of first vaccination (trial enrolment Feb-2009 through Aug-2010) to January 31, 2012 for Invasive Pneumococcal Disease (IPD) and to end of December 2011 for four other outcomes: non-laboratory-confirmed IPD, hospital-diagnosed pneumonia, tympanostomy tube placements, and antimicrobial purchases. VPDI was estimated as difference in disease incidences between PHiD-CV10 clusters and control clusters.Altogether >47,000 children were enrolled. In 30,527 vaccinated infants <7 months at first dose, the VPDIs per 100,000 person-years were 75 for laboratory-confirmed IPD, 210 for non-laboratory-confirmed IPD, 271 for hospital-diagnosed pneumonia, 1143 for any tympanostomy tube placements and 11,381 for antimicrobial outpatient prescription, mainly due to otitis media.In a European developed-country setting, over 95% of the disease episode reductions in vaccinated children were seen in mild upper respiratory infections. The VPDIs of severe diseases are underestimated, because the majority of invasive disease goes undetected with routine blood-culture-based definitions. Evaluation of the absolute reduction achievable with vaccinations using sensitive case detection is essential for understanding the full disease burden, for valid cost-effectiveness analyses and for appropriate vaccination policy decisions.Registration: ClinicalTrials.gov, NCT00861380 and NCT00839254.

Sickness absence due to different musculoskeletal diagnoses by occupational class: a register-based study among 1.2 million Finnish employees

ObjectivesThose in lower occupational classes have an increased risk of sickness absence due to musculoskeletal diseases (MSDs), but studies examining the associations simultaneously across specified diagnostic groups within MSDs are...

Human service work, gender and antidepressant use: a nationwide register-based 19-year follow-up of 752 683 women and men

ObjectivesTo examine antidepressant use among male and female human service professionals.MethodsA random sample of individuals between 25 years and 54 years of age (n=752 683; 49.2% women; mean age 39.5...