Very preterm infants in Finland - Use of health care services and economic consequences during the first five years of life

The aim of this thesis was to study the health, the hospitalisations, and the use of communal health care services in very preterm children during the first five years of life. In addition, the effect of very preterm birth and prematurity-related morbidities on the costs of hospitalisations, other health care services and the cost per quality adjusted life years (QALY) were studied. This population-based study included all very preterm children (gestational age (GA) <32 weeks or birth weight<1501g, N=2 064) and full-term controls (GA 37+0−41+6, N=200 609) born in Finland during 2000-2003. The data sources included national register data, costing data from the participating hospitals and parental questionnaires. This study showed that most very preterm infants born in Finland survived without prematurity-related morbidities diagnosed during the first years of life. They required relatively little hospital care after the initial discharge, which accounted for the vast majority of the total four-year hospitalisation costs. However, a minority of children born very preterm later developing morbidities had a long initial length of stay and more re-admissions and outpatient visits during the five-year follow-up period. In particular, the number and costs of non-emergency outpatient visits were considerable in individuals with prematurity-related morbidities. The need and costs of hospitalisations decreased clearly with each follow-up year, even in individuals with morbidities. The health-care related costs during the fifth year of life in children born very preterm without prematurity-related morbidities were close to the costs in infants born healthy at term. The cost per QALY of 19,245 € was at an acceptable level already by four years of age in the very preterm population as a whole. Prematurity-related later morbidities and decreasing GA increased the costs per QALY. As the initial hospital stay accounted for a great majority of the total four-year costs, and the costs of hospitalisation decreased with each follow-up year, the cost per QALY is likely to decrease with age. In conclusion, the majority of costs arising after the initial hospitalisation were associated with morbidities related to prematurity. Therefore offering high-quality neonatal care to prevent later morbidities in very preterm survivors has a long-term impact on the cost per QALY. In addition, this study indicates that when estimating the costs of prematurity after the first year of life, one should calculate not only the hospitalisation costs, but also other costs for social welfare services, primary care, and therapies, as these exceed the hospitalisation costs in very preterm infants during the fifth year of life.

Identification, assessment and ordering of concepts for agro-energy planning and possibilities of spatial analysis

ABSTRACT The present study aims to present the main concepts of the sugarcane straw to energy planning. Throughout the study, the subject is contextualized highlighting broader aspects of sustainability, which is considered the main driver towards agro-energy modernization. Concerning sugarcane straw, we first evaluated its availability regarding technical and economic aspects, and then it summarized the straw production chain for energy supply purposes. As a proposal to support agro-energy planning, it is presented some spatial tools that have been barely used in the Brazilian energy planning context so far. Therefore, working on straw to electricity associated with supply chain basis, we developed a conceptual model to spatially assess this bioenergy system. Using the model proposed, it is described the whole supply chain at state level, which accounted the potential of a single mill to explore straw, as well as main costs associated with straw acquisition, investments on the straw recovery routes and electricity transmission. Bearing these concepts in mind, it is fully believed that spatial analysis can bring important information for agro-energy action plans.

An Infant with Food Allergy and Eczema in the Family – The Mental and Economic Burden of Caring

Allergic diseases including food allergy and eczema in an infant in combination with the everyday activities of caring for a family will pose challenges to parents. Only fragments of these challenges are revealed to health care professionals. Families have varying mental, social and economic resources to help them care for an allergic infant, and all such resources are important in determining how families succeed in meeting these challenges and the quality of the infant’s care. This study evaluated the whole burden to the family caused by an infant's allergic disease during the first 24 months of life. As the primary caregiver during this period is usually the mother, her perspective was considered important. Ecocultural theory, which considers families as capable of modifying the positive and negative forces facing them, was taken as the frame of reference. Data were collected as part of an ongoing prospective mother-infant study, and the methods included severity scoring of atopic dermatitis, dietary records, health-related quality of life measurements and assessments of the use of health care services and medications for treating the infant’s eczema, food allergy and asthma. Interviews with mothers were analysed by deductive content analysis on the basis of ecocultural theory and the family empowerment model. The theme “Living an ordinary family life” guided the organization of family activities essential for treating the infant's food allergy and eczema. These activities were sources of both strain and support for the mothers, the allergy-related supporting factors being the mother’s own knowledge of the allergy, hopes for an improvement in the infant’s condition, social support and work. An infant’s food allergy at the age of one year caused considerable strain for the mother in cases where the introduction of new foods into the child’s diet was delayed. This delay was still causing the mother additional strain when the child was 24 months of age. The infants waking at night at the ages of 12 and 24 months because of itching related to eczema caused strain for the mothers. The infants’ health-related quality of life was impaired at ages of 6 and 12 months compared with healthy infants. The principal reasons for impairments were itching, scratching and sleep disturbances at 6 and 12 months and treatment difficulties at 6 months. Problems with getting to sleep were reported at all stages irrespective of eczema and were also present in healthy infants. The economic impact of the treatment of allergic diseases on families during the first 24 months was 131 EUR (2006 value) in cases of eczema and 525 EUR in cases of food allergy. From the societal perspective, the costs of food allergy were a median of 3183 EUR (range 628–11 560 EUR) and of eczema a median of 275 EUR (range 94–1306 EUR). These large variations in costs in food allergy and eczema indicate that disease varies greatly . In conclusion, food allergy and eczema cause extra activities and costs to families which arrange these disease-related activities in such a way that they support the leading family theme “Living an ordinary family life”. Health care professionals should consider this thematic character of family life and disease-related activities in order to ensure that new treatments are sustainable, meaningful and tailored to daily activities. In addition, those mothers who are experiencing difficulties with food allergic infants or infants with eczema should be recognized early and provided with individual encouragement and support from health clinics. In the light of the present results, early detection of symptoms and effective parental guidance can contribute to the well-being and health-related quality of life of the child and family.

Logistics of North-West Russia and Rail Baltica: Standpoints of Private Sector

The main aims of the present report are to describe the current state of railway transport in Russia, and to gather standpoints of Russian private transportation logistics sector towards the development of new railway connection called Rail Baltica Growth Corridor, connecting North-West Russia with Germany through the Baltic States and Poland. North-West Russia plays important role not only in Russian logistics, but also wider European markets as in container sea ports handling is approx. 2.5 mill. TEU p.a. and handling volume in all terminals is above 190 million tons p.a. The whole transportation logistics sector is shortly described as an operational environment for railways – this is done through technical and economic angles. Transportation development is always going in line with economics of the country, so the analysis on economical development is also presented. Logistics integration of the country is strongly influenced by its engagement in the international trade. Although, raw material handling at sea ports and container transports (imports) are blossoming, domestic transportation market is barely growing (in long-term perspective). Thus, recent entrance of Russia into World Trade Organization (WTO) is analyzed theme in this research, as the WTO is an important regulator of the foreign trade and enabler of volume growth in foreign trade related transportation logistics. However, WTO membership can influence negatively the development of Russia’s own industry and its volumes (these have been uncompetitive in global markets for decades). Data gathering in empirical part was accomplished by semi-structured case study interviews among North-West Russian logistics sector actors (private). These were conducted during years 2012-2013, and research compiles findings out of ten case company interviews. Although, there was no sea port involved in the study, most of the interviewed companies relied in European Logistics within significant parts in short sea shipping and truck combined transportation chains (in Russian part also using railways). As the results of the study, it could be concluded that Rail Baltica is seen as possible transport corridor in most of the interviewed companies, if there is enough cargo available. However, interviewees are a bit sceptical, because major and large-scale infrastructural improvements are needed. Delivery time, frequency and price level are three main factors influencing the attractiveness of Rail Baltica route. Price level is the most important feature, but if RB can offer other advantages such as higher frequency, shorter lead times or more developed set of value-added services, then some flexibility is possible for the price level. Environmental issues are not the main criteria of today, but are recognized and discussed among customers. Great uncertainty exists among respondents e.g. on forthcoming sulphur oxide ban on Baltic Sea shipping (whether or not it is going to be implemented in Russia). Rather surprisingly, transportation routes to Eastern Europe and Mediterranean area are having higher value and price space than those to Germany/Central Europe. Border crossing operations (traction monopoly at rails and customs), gauge widths as well as unclear decision-making processes (in Russia), are named as hindering factors. Performance standards for European connected logistics among Russian logistics sector representatives are less demanding as compared to neighbourhood countries belonging to EU.

Design and testing of an armature-reaction-compensated permanent magnet synchronous generator for island operation

At present, permanent magnet synchronous generators (PMSGs) are of great interest. Since they do not have electrical excitation losses, the highly efficient, lightweight and compact PMSGs equipped with damper windings work perfectly when connected to a network. However, in island operation, the generator (or parallel generators) alone is responsible for the building up of the network and maintaining its voltage and reactive power level. Thus, in island operation, a PMSG faces very tight constraints, which are difficult to meet, because the flux produced by the permanent magnets (PMs) is constant and the voltage of the generator cannot be controlled. Traditional electrically excited synchronous generators (EESGs) can easily meet these constraints, because the field winding current is controllable. The main drawback of the conventional EESG is the relatively high excitation loss. This doctoral thesis presents a study of an alternative solution termed as a hybrid excitation synchronous generator (HESG). HESGs are a special class of electrical machines, where the total rotor current linkage is produced by the simultaneous action of two different excitation sources: the electrical and permanent magnet (PM) excitation. An overview of the existing HESGs is given. Several HESGs are introduced and compared with the conventional EESG from technical and economic points of view. In the study, the armature-reaction-compensated permanent magnet synchronous generator with alternated current linkages (ARC-PMSG with ACL) showed a better performance than the other options. Therefore, this machine type is studied in more detail. An electromagnetic design and a thermal analysis are presented. To verify the operation principle and the electromagnetic design, a down-sized prototype of 69 kVA apparent power was built. The experimental results are demonstrated and compared with the predicted ones. A prerequisite for an ARC-PMSG with ACL is an even number of pole pairs (p = 2, 4, 6, …) in the machine. Naturally, the HESG technology is not limited to even-pole-pair machines. However, the analysis of machines with p = 3, 5, 7, … becomes more complicated, especially if analytical tools are used, and is outside the scope of this thesis. The contribution of this study is to propose a solution where an ARC-PMSG replaces an EESG in electrical power generation while meeting all the requirements set for generators given for instance by ship classification societies, particularly as regards island operation. The maximum power level when applying the technology studied here is mainly limited by the economy of the machine. The larger the machine is, the smaller is the efficiency benefit. However, it seems that machines up to ten megawatts of power could benefit from the technology. However, in low-power applications, for instance in the 500 kW range, the efficiency increase can be significant.

Impact of socio-cultural and economic factors on vegetable consumption behaviours: case of Giresun province, Turkey

Many factors impact on food consumption behaviours. The aim of the study is to determine the impact of socio-demographic and ecological factors on vegetable consumption. A 14-question questionnaire was applied on a voluntary basis to 200 individuals who accepted to participate in the study. Their socio-demographic attributes and the vegetable consumption habits of their families were determined. Their average monthly budget for vegetables is € 31.82±12.72. The two attributes of purchased vegetables with most demand are cleanliness (61.5%) and freshness (22%). The maximum price per 1 kg of vegetables, which individuals with an income of € 301-450 can afford, is € 0.96, but for individuals with an income of > € 450, it is € 1.25. It was observed that the amount of purchased vegetables increased with the increase in the budget allocated for vegetables.

Modelling of changes in electricity end-use and their impacts on electricity distribution

The electricity distribution sector will face significant changes in the future. Increasing reliability demands will call for major network investments. At the same time, electricity end-use is undergoing profound changes. The changes include future energy technologies and other advances in the field. New technologies such as microgeneration and electric vehicles will have different kinds of impacts on electricity distribution network loads. In addition, smart metering provides more accurate electricity consumption data and opportunities to develop sophisticated load modelling and forecasting approaches. Thus, there are both demands and opportunities to develop a new type of long-term forecasting methodology for electricity distribution. The work concentrates on the technical and economic perspectives of electricity distribution. The doctoral dissertation proposes a methodology to forecast electricity consumption in the distribution networks. The forecasting process consists of a spatial analysis, clustering, end-use modelling, scenarios and simulation methods, and the load forecasts are based on the application of automatic meter reading (AMR) data. The developed long-term forecasting process produces power-based load forecasts. By applying these results, it is possible to forecast the impacts of changes on electrical energy in the network, and further, on the distribution system operator’s revenue. These results are applicable to distribution network and business planning. This doctoral dissertation includes a case study, which tests the forecasting process in practice. For the case study, the most prominent future energy technologies are chosen, and their impacts on the electrical energy and power on the network are analysed. The most relevant topics related to changes in the operating environment, namely energy efficiency, microgeneration, electric vehicles, energy storages and demand response, are discussed in more detail. The study shows that changes in electricity end-use may have radical impacts both on electrical energy and power in the distribution networks and on the distribution revenue. These changes will probably pose challenges for distribution system operators. The study suggests solutions for the distribution system operators on how they can prepare for the changing conditions. It is concluded that a new type of load forecasting methodology is needed, because the previous methods are no longer able to produce adequate forecasts.

Cooperation, social capital and economic performance

The objective of this paper is to define social capital as social infrastructure and to try to include this variable in an economic growth model. Considering social capital in such a way could have an impact on the productivity of production factors. Firstly, I will discuss how institutional variables can affect growth. Secondly, after analyzing several definitions of social capital, I will point out the benefits and problems of each one and will define social capital as social infrastructure, aiming to introduce this variable into an economic growth model. Finally, I will try to open the way for subsequent empirical studies, both in the area of measuring the stock of social infrastructure as well as those comparing economies, with the idea of showing the impact of social infrastructure on economic growth.

States and Economic Development

Today the Washington Consensus on development lies in tatters. The recent history of the developing world has been unkind to the core claim that a nation that opens its economy and keeps government's role to a minimum invariably experiences rapid economic growth. The evidence against this claim is strong: the developing world as a whole grew faster during the era of state intervention and import substitution (1950-1980) than in the more recent era of structural adjustment (1990-2005); and the recent economic performance of both Latin America and Sub-Saharan Africaregions that truly embraced neoliberalismhas lagged well behind that of many Asian economies, which have instead pursued judicial and unorthodox combinations of state intervention and economic openness. As scholars and policy makers reconstruct alternatives to the Washington Consensus on development, it is important to underline that prudent and effective state intervention and selective integration with the global economy have been responsible for development success in the past; they are also likely to remain the recipes for upward mobility in the global economy in the future."

A note on inflation targeting and economic growth in Brazil

This paper analyzes the relation between monetary policy and economic performance in Brazil during the period 1999-2006. In particular, it discusses the growth effects of the inflation targeting regime through its effects on aggregate demand. It is argued that monetary policy under IT reacts in a procyclical and asymmetric way to fluctuations in economic activity (too "tight" during recessions, not so "loose" during expansions). Such pattern may generate a downward bias in aggregate demand, with negative real effects on output growth and employment. Our results suggest that monetary policy has been procyclical and asymmetrical in Brazil under inflation targeting. The main economic policy implication of this study is that central banks should consider more seriously the real effects of monetary policy on output and employment.

EU Strategy for the Baltic Sea Region: its added value in environmental social and economic dimensions

The European Council has invited the European Commission to present the first macro-regional strategy – the EU Strategy for the Baltic Sea Region (EUSBSR) on the 14th of December 2007, primarily to address collective challenges and opportunities of the Region and also to engender cohesion in support of an European integration policy. However, macro-regional strategies conceived to aid European integration and territorial cohesion were viewed by academics with skepticism, obscuring the strategies’ potential impact. This thesis intends to investigate and measure the added value of the EUSBSR in order to analyze its impact on regional development and its feasibility as a guide for future programs intending to strengthen European cohesion and integration. To determine the added value of the EUSBSR the thesis is organized into three sections, so as to address environmental, social, and economic concerns, respectively. The first case examines EU-Russia cooperation in an environmental context to investigate how environmental cooperation with an external neighbor could forge increased cohesion in a macro-regional setting. To figure the added cooperation that academic cooperation among universities would contribute to social dimension, the work has chosen several study results. Lastly, to measure out the added value for the economic strategy objective, the study employs the project for Improved Global Competitiveness in an example of ‘A Baltic Sea Region Program for Innovation, Cluster and SME-Networks’ as an economic plan.

Effects of overvaluation and exchange rate volatility over industrial investment: empirical evidence and economic policy proposals for Brazil

The present article aims to analyze the recent behavior of real exchange rate in Brazil and its effects over investment per worker in Brazilian manufacturing and extractive industry. Preliminary estimates presented in the article shows an over-valuation of 48% of real exchange rate in Brazil. The reaction between the level (and volatility) of real exchange rate and investment (per worker) in Brazil is analyzed by means of a panel data econometric model for 30 sectors of Brazilian manufacturing and extractive industry. The empirical results show that the level and volatility of real exchange rate has a strong effect over investment per worker in Brazilian industry. Finally, we conclude the article presenting a proposal for a new macroeconomic regime that aims to produce an acceleration of economic growth of Brazilian economy and, by that, a catching-up process with developed countries.

The new blockbuster film sequel : changing cultural and economic conditions within the film industry

Film sequels are a pervasive part of film consumption practices and have become an important part of the decision making process for Hollywood studios and producers. This thesis indicates that sequels are not homogenous groups of films, as they are often considered, but offer a variety of story construction and utilize a variety of production methods. Three types of blockbuster sequel sets are identified and discussed in this thesis. The Traditional Blockbuster Sequel Set, as exemplified by Back to the Future (1985, 1989, 1990) films, is the most conventional type of sequel set and capitalizes on the winning formula of the first film in the franchise. The MultiMedia Sequel Set, such as The Matrix (1999,2003) trilogy, allows the user/viewer to experience and consume the story as well as the world of the film through many different media. The Lord a/ the Rings (2001, 2002, 2003) set of films is an illustration of The Saga Sequel Set where plot lines are continuous over the entire franchise thus allowing the viewer to see the entire set as a unified work. The thesis also demonstrates how the blockbuster sequel sets, such as the Pirates a/ the Caribbean (2003, 2006, 2007) franchise, restructure the production process of the Hollywood film industry.