Statin Adherence, Utilisation, and Prescribing Patterns. Improving effectiveness of treatment

Statins are one of the most widely studied and evidence-based medications. Randomised controlled trials have provided convincing evidence on the benefits of statin therapy in preventing cardiovascular events. Despite proven benefits, low costs, and few adverse effects, everyday effectiveness of statins is limited, since adherence to statin therapy is poor. This thesis was conducted as four pharmacoepidemiological studies using register data on statin users in real clinical care. The main purpose of the study was to evaluate prescribing patterns and to discover the lifestyle factors predicting statin nonadherence and discontinuation. This knowledge is essential in order to help physicians to motivate the adherence of their patients to treatment. In Finland, from 1998 to 2004, the number of statin initiators nearly doubled. The discovered channelling of atorvastatin and simvastatin may have affected the treatment outcomes at the public health level. It is possible that money spent on statins in Finland in 1998‒2004 could have been used in a more cost-effective way. In 2015, the percentage of patients receiving reimbursement for statins was 12% of the total population. Thus, it is a major public health and economic challenge to improve statin effectiveness and allocate therapy correctly. Among the participants with cardiovascular comorbidities, risky alcohol use or clustering of lifestyle risks were predictors of nonadherence. In addition, the prevalence of nonadherence to statins increased after retirement among both men and women. This increase in post-retirement nonadherence was highest among those receiving statins for secondary prevention. Discontinuation of statin therapy was predicted by high patient co-payment, and in women, by risky alcohol use. Recognising the predictors of nonadherence to statins is important because nonadherence is associated with an increased risk of adverse cardiovascular outcomes and higher healthcare costs. In conclusion, optimal outcomes in medical therapy require both efficacious medications and adherence to those treatments. When prescribing statins to eligible patients, the physician’s clinical expertise in recognising patients at risk of statin discontinuation and nonadherence, as well as their ability to increase adherence, may have a great effect on public health.

HR-asiantuntijapalveluiden käyttö PK-yrityksissä. Case: Virvo Oy palveluiden tarjoajana

Tutkielma on kvalitatiivinen haastattelututkimus, jonka tavoitteena on tarkastella HR-asiantuntijapalveluiden;konsultoinnin, ulkoistamisen ja vuokrajohtajuuden käyttöä sekä mahdollisuuksia PK-sektorilla. Tutkimuksessa perehdytään myös työn toimeksiantajan, case-yritys Virvon liiketoimintaan HR-asiantuntijapalveluiden markkinoilla ja siihen, miten Virvo pystyy vastaamaan näihin haasteisiin. HR-asiantuntijapalveluiden markkinoiden selvittämiseksi on haastateltu neljää HR-asiantuntijaa. Tämän pohjalta on tehty 15 PK-yrityksen toimitusjohtajan haastattelua HR-asiantuntijapalveluiden käytön selvittämiseksi. Tehdyt haastattelut ovat olleet puolistrukturoituja, jolloin on käytetty valmiita kysymyspohjia. Tutkimuksessa on selvinnyt, että HR-asiantuntijamarkkinat ovat vasta muotoutumassa ja että ala on varsin uusi. PK-yritysten HR-toimintojen haasteisiin pystytään parhaiten vastaamaan HR-asiantuntijapalveluilla, jotka ovat selkeitä kokonaisuuksia ja järkevästi hinnoiteltuja. Tärkeinä asioina on nähty esimerkiksi käytännön toteutus sekä lisäajan saaminen varsinaisen liiketoiminnan hoitamiseen. Palveluiden käyttö korostuu erityisesti erilaisissa muutostilanteissa kuten esimerkiksi yrityksen kasvuvaiheessa. Voidaan todeta myös, että liiketoiminnan tila vaikuttaa HR-asiantuntijapalveluiden käyttöön.

Geographical Studies of Underwater Light Dynamics in the Coastal Archipelago of SW Finland, Baltic Sea

The underwater light field is an important environmental variable as it, among other things, enables aquatic primary production. Although the portion of solar radiation that is referred to as visible light penetrates water, it is restricted to a limited surface water layer because of efficient absorption and scattering processes. Based on the varying content of optical constituents in the water, the efficiency of light attenuation changes in many dimensions and over various spatial and temporal scales. This thesis discusses the underwater light dynamics of a transitional coastal archipelago in south-western Finland, in the Baltic Sea. While the area has long been known to have a highly variable underwater light field, quantified knowledge on the phenomenon has been scarce, patchy, or non-existent. This thesis focuses on the variability in the underwater light field through euphotic depths (1% irradiance remaining), which were derived from in situ measurements of vertical profiles of photosynthetically active radiation (PAR). Spot samples were conducted in the archipelago of south-western Finland, mainly during the ice-free growing seasons of 2010 and 2011. In addition to quantifying both the seasonal and geographical patterns of euphotic depth development, the need and usability of underwater light information are also discussed. Light availability was found to fluctuate in multiple dimensions and scales. The euphotic depth was shown to have combined spatio-temporal dynamics rather than separate changes in spatial and temporal dimensions. Such complexity in the underwater light field creates challenges in data collection, as well as in its utilisation. Although local information is needed, in highly variable conditions spot sampled information may only poorly represent its surroundings. Moreover, either temporally or spatially limited sampling may cause biases in understanding underwater light dynamics. Consequently, the application of light availability data, for example in ecological modelling, should be made with great caution.