The Process of Greening Cycle as Method of Operative Environmental

The structural change of society from product-based business to service- and further to need-based business has caused the fact that work for environmental issues has spread from conventional factories and environmentally harmful production to concern services and offices as well. Almost every company has an office, so a relatively small environmental burden caused by an individual office grows remarkable already at the state level and globally even more. Motivation to work for environmental issues in an individual office could be challenging even without the fact that wasted environmental impacts bound also wasted costs. Besides cost savings, a concretely greener image of a company has its value in the B2Cas well as in the B2B-field. Consumers and clients are more and more conscious of environmental issues and demand concrete actions instead of speeches, good thoughts and meaningless certifications. Internal work for environmental issues at a strategy level is not sufficient, so operational environmental management is needed for changing old practices. This research is about the effects of operative environmental management on the greening process of an office-based business. The research is outlined to concern the operative work in the office including field sales. Target was to concretely lower the environmental impacts of Lyreco Finland and to find cost savings directly by changing the operative practices in the office and also indirectly by affecting the level of environmental knowledge of the personnel. During the greening process, the aim was also to create concrete arguments for marketing as well. The circle of greening process, which was especially created for this diploma work, was used as a method. The circle divides a year to themes and sections separated by factors of environmental impacts. Separation is based on Brett Wills’ thoughts of seven green wastes (Wills, Brett. The Green Intensions. 2009) and follows it uneasily. The circle aimed at ensuring evolutionary growth of knowledge instead of being revolutionary in the changing process. Committing personnel to the process from its start by asking ideas from them and giving them clear directions was an important part of the research of operative management. Because of working from distance, communication with personnel was operated by frequent training days and weekly greening notes via emails and intranet. Also availability for communication was an important task because of the telecommuting. Research results of this work show that operative environmental management in an officebased business today is mostly management of change. When the strategic environmental friendliness is taken into a concrete level, the most important individual factor is motivating the operating personnel. Research shows that evolutionary change is found being an efficient way to make a change. Also understanding one´s own impact on the environmental burden and on the whole greening process clearly motivates the personnel. Results show that in the operative realization of the greening process, clear directions of new working practices, being as concrete as possible, and committing personnel to follow them make the process more effective. The operative environmental management and the cycle of the greening process decrease the environmental burden and save costs. The concrete results could be used as believable arguments in marketing and therefore exploited in communication with interest groups. Commitment of the management is also one of the key factors of success in the greening process. In this research, changes in the business field by a company trade took the focus of the management away from the greening process and made the process more inefficient by decreasing the amount of training days. The circle of greening process will be used as a tool in the future, as well, and therefore it will help observe environmental impacts of a company and increase sustainable development. Commitment of management to the evolutionary environmental work helps the operating personnel lower environmental impacts, decrease costs and build a concretely greener image.

The influence of strategic entrepreneurship on firm performance

In the study the recently developed concept of strategic entrepreneurship was addressed with the aim to investigate the underlying factors and components constituting the concept and their influence on firm performance. As the result of analysis of existing literature and empirical studies the model of strategic entrepreneurship for the current study is developed with the emphasis on exploration and exploitation parts of the concept. The research model is tested on the data collected in the project ―Factors of growth and success of entrepreneurial firms in Russia‖ by Center for Entrepreneurship of GSOM in 2007 containing answers of owners and managers of 500 firms operating in St. Petersburg and Moscow. Multiple regression analysis showed that exploration and exploitation presented by entrepreneurial values, investments in internal resources, knowledge management and developmental changes are significant factors constituting strategic entrepreneurship and having positive relation to firm performance. The theoretical contribution of the work is linked to development and testing of the model of strategic entrepreneurship. The results can be implemented in management practices of companies willing to engage in strategic entrepreneurship and increase their firm performance.

Delay reduction in courts of justice – possibilities and challenges of process improvement in professional public organizations

Delays in the justice system have been undermining the functioning and performance of the court system all over the world for decades. Despite the widespread concern about delays, the solutions have not kept up with the growth of the problem. The delay problem existing in the justice courts processes is a good example of the growing need and pressure in professional public organizations to start improving their business process performance.This study analyses the possibilities and challenges of process improvement in professional public organizations. The study is based on experiences gained in two longitudinal action research improvement projects conducted in two separate Finnish law instances; in the Helsinki Court of Appeal and in the Insurance Court. The thesis has two objectives. First objective is to study what kinds of factors in court system operations cause delays and unmanageable backlogs and how to reduce and prevent delays. Based on the lessons learned from the case projects the objective is to give new insights on the critical factors of process improvement conducted in professional public organizations. Four main areas and factors behind the delay problem is identified: 1) goal setting and performance measurement practices, 2) the process control system, 3) production and capacity planning procedures, and 4) process roles and responsibilities. The appropriate improvement solutions include tools to enhance project planning and scheduling and monitoring the agreed time-frames for different phases of the handling process and pending inventory. The study introduces the identified critical factors in different phases of process improvement work carried out in professional public organizations, the ways the critical factors can be incorporated to the different stages of the projects, and discusses the role of external facilitator in assisting process improvement work and in enhancing ownership towards the solutions and improvement. The study highlights the need to concentrate on the critical factors aiming to get the employees to challenge their existing ways of conducting work, analyze their own processes, and create procedures for diffusing the process improvement culture instead of merely concentrating of finding tools, techniques, and solutions appropriate for applications from the manufacturing sector

Chemical attributes of soil and dry mass accumulation of maize fertilized with cassava wastewater

The aim of this study was to evaluate chemical attributes alterations of a clay-loam textured soil and dry mass accumulation of maize submitted to application of cassava wastewater doses in three assessment periods. The experiment was conducted under greenhouse using a completely randomized experimental design in a factorial 5 × 3, with four replicates. The analyzed factors of research were doses of cassava wastewater (0; 12.6; 25.2; 50.4; 75.6 m3 ha-1) andassessment periods (20, 40 and 52 days after germination). The following parameters were determined: electric conductivity of soil saturation extract, pH in water, content of available P, content of exchangeable K+, Ca2+, Mg2+ and Na+of soil, dry mass of leaves and stem. The application of cassava wastewater on soil enables increase of pH, electric conductivity of saturation extract, contents of available P, contents of exchangeable K+ and Na+ and dry mass of leaves and stem. However, only pH and content of exchangeable K+ of soil, the electric conductivity of saturation extract and dry mass of leaves and stem are influenced by assessment period.

Comparative study of the different degrees of risk of gastrointestinal stromal tumor

OBJECTIVE: To evaluate the applicability of the main categories of risk and morphological factors in the prognosis of gastrointestinal stromal tumors. METHODS: we retrospectively studied fifty-four cases of GIST, assessing the main prognostic factors of this neoplasis: risk levels, topography, size, mitotic index, necrosis, histological subtype and immunophenotype. We also verified their association and the reduction of overall survival. RESULTS: Univariate analysis showed that tumors with mitoses number greater than 5 per 50CGA (high-power fields), the presence of necrosis and a high risk for both the systems proposed by Fletcher and Miettinen had a significant association with reduced survival (p = 0.00001, 0.0056, 0.03 and 0.009, respectively). The remaining analyzed factors (size, histological subtype, topography and immunophenotype) had no such association. Multivariate analysis (Jacard index) showed that the Miettinen degree of risk was the one that best correlated with prognosis. CONCLUSION: the risk criteria of Fletcher and Miettinen are important in assessing the prognosis of patients with gastrointestinal stromal tumors, especially the latter, which adds to the mitotic index and the presence of tumor necrosis.

Prevalence and geographical distribution of bovine eurytrematosis in cattle slaughtered in northern Paraná, Brazil

A retrospective study of cattle slaughtered in northern Paraná during 2000 was performed to determine the prevalence and geographical distribution of bovine eurytrematosis (BE), as identified by the Federal Inspection Service (SIF). The cattle was from different regions of the State of Paraná; all regions had cattle parasitized by Eurytrema spp. BE was identified in 12.1% (12,534/103,411) of the total number of cattle inspected. Prevalence of animals parasitized by Eurytrema spp varied from 8.3% (Region G, São João do Caiuá, 1,069/12,914) to 40.5% (Region R, Ponta Grossa, 225/555). BE was more prevalent during the month of March (1.6) and markedly reduced during May (-2). A possible seasonal predominance of BE was identified: comparatively fewer cases occurred from April to August, while there was a peak from December to March. The study indicates that bovine eurytrematosis is hypoendemic and occurs in almost all geographical regions of the State of Paraná. The prevalence within this State is variable and may be directly related to factors of the biological cycle of the trematode, particularities of each region, and environmental conditions.

Pain symptoms and sleep problems among school-aged children. Long-term prevalence changes, and pain symptoms as predictors of later mental health

Children’s pain symptoms and sleep problems are among the most common health complaints. They distract children from activities, decrease the quality of life, contribute to a significant economic burden, and have shown continuity into adulthood. The main aims of this thesis were to investigate long-term changes in the prevalence of pain symptoms and sleep problems among Finnish school-aged children, and the later mental health of those who in childhood experience pain. Prevalence, co-occurrence, and associated psychosocial factors of pain symptoms and sleep problems were also assessed. In study I, prevalence changes in eight-year-old children’s pain symptoms and sleep problems were investigated in three cross-sectional population-based samples (years 1989: n=1038, 1999: n=1035, and 2005: n=1030). In study II, cross-sectional associations between pain symptoms, sleep problems, and psychosocial factors were assessed among 13-18-year-old adolescents (n=2476). In studies III and IV, associations between pain symptoms at age eight (n=6017), and register-based data on antidepressant use and severe suicidality by age 24, were examined in a nationwide birth cohort. Pain symptoms and sleep problems were common and often co-occurred. A considerable number of children’s pain symptoms remained unrecognized by the parents. The prevalence of pain symptoms, sleep problems, and multiple concurrent symptoms approximately doubled from 1989 to 2005. Psychiatric difficulties or demographic factors did not explain the increase. Psychosocial factors that were associated with pain, sleep problems, and a higher number of symptoms, were female sex, psychological difficulties, emotional symptoms, smoking, victimization, and feeling not cared about by teachers. In longitudinal analyses, the child’s own report of headache, and to a smaller degree the parental report of the child’s abdominal pain predicted later antidepressant use. Parental report of the child’s abdominal pain predicted severe suicidality among males. If one of the symptoms is present, health care professionals should inquire about other symptoms as well. Questions should be directed to the children, not only to their parents. Inquiring about psychiatric difficulties, substance use, victimization, and relations with teachers should be included as a part of the assessment. Further studies are needed to clarify the reasons that underlie the increased prevalence rates, and the factors that may increase or decrease the risk for later mental health problems among pain-suffering children.

Research of Salmonella spp. and evaluation of pathogenicity, cytotoxicity of Escherichia coli isolates proceeding from sparrows (Passer domesticus)

The aim of this study was to research the occurrence of Salmonella spp. and Escherichia coli in feces samples of sparrows, as well as to identify the pathogenicity, cytotoxicity and sensitivity profile of the isolates to antimicrobial use. Two hundred and twenty eight sparrows were captured in eight farms. The in vitro pathogenicity test was performed by the isolates culture on congo red-magnesium oxalate Agar, whilst the in vivo pathogenicity test was performed in one day-old chicks. In order to study the cytotoxic effects of indicators, samples were inoculated into Vero cells. The results obtained for Escherichia coli isolation confirmed the presence of this microorganism in 30 (13.2%) of the evaluated samples. Out of those isolates, 10 (33.3%) presented the capacity of absorbing ongo red. As for in vivo pathogenicity a 68.0% of mortality rate of the evaluated samples was observed. Out of 20 isolates tested for cytotoxin production, none of them presented cytotoxic effect in the Vero cells. The Salmonella spp was isolated only in one sample (0.04%), and it was identified as Salmonella enterica subspecies houtenae. Results obtained through this research indicate the need for new studies to identify other virulence factors of E. coli samples and to delineate the phylogenetic profile of the isolates in order to establish a relation with colibacillosis outbreaks in chickens and broilers in the studied region, as well as to analyze the critical points in the aviculture productive chain to identify the source of Salmonella enterica subspecies houtenae.

Finnish buyers’ perceptions of Indian textile and clothing suppliers: Country of origin in focus

Choosing the right supplier is crucial for long-term business prospects and profitability. Thus organizational buyers are naturally very interested in how they can select the right supplier for their needs. Likewise, suppliers are interested in knowing how their customers make purchasing decisions in order to effectively sell and market to them. From the point of view of the textile and clothing (T&C) industry, regulatory changes and increasing low-cost and globalization pressures have led to the rise of low-cost production locations India and China as the world’s largest T&C producers. This thesis will examine T&C trade between Finland and India specifically in the context of non-industrial T&C products. Its main research problem asks: what perceptions do Finnish T&C industry buyers hold of India and Indian suppliers? B2B buyers use various supplier selection models and criteria in making their purchase decisions. A significant amount of research has been done into supplier selection practices, and in the context of international trade, country of origin (COO) perceptions specifically have garnered much attention. This thesis uses a mixed methods approach (online questionnaire and in-depth interviews) to evaluate Finnish T&C buyers’ supplier selection criteria, COO perceptions of India and experiences of Indian suppliers. It was found that the most important supplier selection criteria used by Finnish T&C buyers are quality, reliability and cost. COO perceptions were not found to be influential in purchasing process. Indian T&C suppliers’ strengths were found to be low cost, flexibility and a history of traditional T&C expertise. Their weaknesses include product quality and unreliable delivery times. Overall, the main challenges that need to be overcome by Indian T&C companies are logistical difficulties and the cost vs. quality trade-off. Despite positive perceptions of India for cost, the overall value offered by Indian T&C products was perceived to be low due to poor quality. Unreliable delivery time experiences also affected buyer’s reliability perceptions of Indian suppliers. The main limiting factors of this thesis relate to the small sample size used in the research. This limits the generalizability of results and the ability to evaluate the reliability and validity of some of the research instruments.

Russia, China, India Foresight for Small and Medium size Enterprises in Uusimaa : Changes forecast in the Russian, Chinese and Indian operating environments from the viewpoint of small and middle-sized enterprises in Uusimaa

The report describes those factors of the future that are related to the growth and needs of Russia, China, and India and that may provide significant internationalisation potential for Uusimaa companies. The report examines the emerging trends and market-entry challenges for each country separately. Additionally, it evaluates the training needs of Uusimaa companies in terms of the current offerings available for education on topics related to Russia, China, and India. The report was created via the Delphi method: experts were interviewed, and both Trendwiki material and the latest literature were used to create a summary of experts’ views, statements, and reasons behind recent developments. This summary of views was sent back to the experts with the objective of reaching consensus synthesising the differing views or, at least, of providing argumentation for the various alternative lines of development. In addition to a number of outside experts and business leaders, all heads of Finpro’s Finland Trade Centers participated in the initial interviews. The summary was commented upon by all Finpro consultants and analysts for Russia, China, and India, with each focusing on his or her own area of expertise. The literature used consisted of reports, listed for each country, and an extensive selection of the most recent newspaper articles. The report was created in January-April 2010. On 22 April 2010 its results were reviewed at the final report presentation in cooperation with the Uusimaa ELY Centre.

CTQ process flow development and the impact for cost of quality

Tämä työ tehtiin Kone Industrial Oy:lle Major Projects yksikköön, laatuosastolle. Kone Major Projects yksikkö keskittyy erikoisiin ja suuriin hissi- ja liukuporras projekteihin. Työn tavoitteena oli luoda harmonisoitu prosessi hissikomponenttien laaduntarkkailua varten sekä tarkastella ja vertailla kustannussäästöjä, jota tällä uudella prosessilla voidaan saavuttaa. Tavoitteena oli saavuttaa 80-prosentin kustannussäästöt laatukustannuksissa uuden laatuprosessin avulla. Työn taustana ja tutkimusongelmana ovat lisääntyneet erikoisprojektit ja niiden myötä lisääntynyt laaduntarkkailun tarve. Ongelmana laaduntarkkailussa voitiin pitää harmonisoidun ja selkeän prosessin puuttumista C-prosessikomponenttien valmistuksessa. Lisäksi kehitysprosessin aikana luotiin vanhojen työkalujen pohjalta keskeinen laaduntarkkailutyökalu, CTQ-työkalu. Työssä käsitellään ensin Konetta yhtiönä ja selvitetään Koneen keskeisimmät prosessit työn taustaksi. Teoria osuudessa käsitellään prosessin kehitykseen liittyviä teorioita sekä yleisiä laatukäsitteitä ja esitetään teorioita laadun asemasta nykypäivänä. Lopuksi käsitellään COQ eli laatukustannusten teoriaa ja esitellään teoria PAF-analyysille, jota käytetään työssä laatukustannusten vertailuun case esimerkin avulla. Työssä kuvataan CTQ prosessin luominen alusta loppuun ja case esimerkin avulla testataan uutta CTQ prosessia pilottihankkeessa. Tässä case esimerkissä projektin bracket eli johdekiinnitysklipsi tuotetaan uuden laatuprosessin avulla sekä tehdään kustannusvertailu saman projektin toisen bracketin kanssa, joka on tuotettu ennen uuden laatuprosessin implementoimista. Työn lopputuloksena CTQ prosessi saatiin luotua ja sitä pystyttiin testaamaan käytännössä case esimerkin avulla. Tulosten perusteella voidaan sanoa, että CTQ prosessin käyttö vähentää laatukustannuksia huomattavasti ja helpottaa laadunhallintaa C-prosessikomponenttien tuotannossa.

Ensuring the efficient utilization of Business Intelligence

In recent years, chief information officers (CIOs) around the world have identified Business Intelligence (BI) as their top priority and as the best way to enhance their enterprises competitiveness. Yet, many enterprises are struggling to realize the business value that BI promises. This discrepancy causes important questions, for example: what are the critical success factors of Business Intelligence and, more importantly, how it can be ensured that a Business Intelligence program enhances enterprises competitiveness. The main objective of the study is to find out how it can be ensured that a BI program meets its goals in providing competitive advantage to an enterprise. The objective is approached with a literature review and a qualitative case study. For the literature review the main objective populates three research questions (RQs); RQ1: What is Business Intelligence and why is it important for modern enterprises? RQ2: What are the critical success factors of Business Intelligence programs? RQ3: How it can be ensured that CSFs are met? The qualitative case study covers the BI program of a Finnish global manufacturer company. The research questions for the case study are as follows; RQ4: What is the current state of the case company’s BI program and what are the key areas for improvement? RQ5: In what ways the case company’s Business Intelligence program could be improved? The case company’s BI program is researched using the following methods; action research, semi-structured interviews, maturity assessment and benchmarking. The literature review shows that Business Intelligence is a technology-based information process that contains a series of systematic activities, which are driven by the specific information needs of decision-makers. The objective of BI is to provide accurate, timely, fact-based information, which enables taking actions that lead to achieving competitive advantage. There are many reasons for the importance of Business Intelligence, two of the most important being; 1) It helps to bridge the gap between an enterprise’s current and its desired performance, and 2) It helps enterprises to be in alignment with key performance indicators meaning it helps an enterprise to align towards its key objectives. The literature review also shows that there are known critical success factors (CSFs) for Business Intelligence programs which have to be met if the above mentioned value is wanted to be achieved, for example; committed management support and sponsorship, business-driven development approach and sustainable data quality. The literature review shows that the most common challenges are related to these CSFs and, more importantly, that overcoming these challenges requires a more comprehensive form of BI, called Enterprise Performance Management (EPM). EPM links measurement to strategy by focusing on what is measured and why. The case study shows that many of the challenges faced in the case company’s BI program are related to the above-mentioned CSFs. The main challenges are; lack of support and sponsorship from business, lack of visibility to overall business performance, lack of rigid BI development process, lack of clear purpose for the BI program and poor data quality. To overcome these challenges the case company should define and design an enterprise metrics framework, make sure that BI development requirements are gathered and prioritized by business, focus on data quality and ownership, and finally define clear goals for the BI program and then support and sponsor these goals.

Cesarean section - short term maternal complications related to the mode of delivery

Cesarean section (CS) is the most common major surgery performed on women worldwide. CS can save the life of the mother or the fetus, but is associated with the typical complications of any major surgery: hemorrhage, infection, venous thromboembolism and complications of anesthesia, sometimes leading to maternal death. Recently there have been several reports from well resourced countries on increased severe maternal morbidity and even mortality. Increased rates of CS, obesity and older mothers may explain this rise. The aim of this thesis is to study the rates and risk factors of short term maternal complications associated with CS. Also, we compared maternal morbidity by mode of delivery and over time. The complication rates were assessed in a prospective study involving 2496 CS performed in the 12 largest delivery units in Finland in 2005. The rates of severe complications were studied by mode of delivery in a register-based study comparing national cohorts in 1997 and 2002. The impact of several risk factors on severe maternal morbidity by mode of delivery was studied in a register-based study of all singleton deliveries in 2007-2011. In the prospective study, 27% of the women who underwent CS had one or more intraoperative or postoperative complications during their hospital stay, and 10% had a severe complication. In the register-based study the incidence of life-threatening maternal complications was 7.6 in 1000 deliveries. The incidence was lowest for vaginal delivery (VD), followed by instrumental VD and elective CS, and highest in emergency CS. An attempt of VD, including the risks associated with emergency CS, seems to be the safest mode of delivery, even for most high-risk women.

The duality of tactical thought : a study of how Swedish land forces' commanders view tactics in irregular warfare

This is a sociological study of the views of officers in the Swedish Army and its Amphibious Forces on tactics in Irregular Warfare (IW), in particular, Counterinsurgency (COIN). IW comprises struggles, where the military weaker part uses an indirect approach with smaller units and integrates the civilian and military dimensions in a violence spectrum including subversion, terrorism, Guerrilla Warfare and infantry actions. IW is the main armed warfare style in insurgencies. COIN is the combined political, military, economic, social and legal actions in counter insurgencies. Data has been collected by means of interviews with almost all (n =43) officers, who were either commanding battalions or rifle and manoeuvre companies while undergoing training for general warfare and international operations. The main theoretical and methodological inspiration is the traditional one for research on social fields, inaugurated by the French sociologist Pierre Bourdieu. The statistical technique used is Multiple Correspondence Analysis. As a background and context base, an inquiry inspired by the Begriffsgechichte (Conceptual History) tradition explores the genesis and development of understandings of the term Irregular Warfare. The research question is outlined as; “how can contemporary Swedish military thought on tactics in Irregular Warfare be characterized using descriptive patterns, mapped in relation to background factors and normative standards? The most significant findings are that there are two main opposing notions separating the officers’ views on tactics in Irregular Warfare: (1) a focus on larger, combat oriented and collectively operating military units versus smaller and larger, more intelligence oriented and dispersed operating units, and (2) a focus on military tasks and kinetic effects versus military and civilian tasks as well as “soft” effects. The distribution of these views can be presented as a two-dimensional space structured by the two axes. This space represents four categories of tactics, partly diverging from normative military standards for Counterinsurgency. This social space of standpoints shows different structural tendencies for background factors of social and cultural character, particularly dominant concerning military backgrounds, international mission experiences and civilian education. Compared to military standards for Counterinsurgency, the two tactical types characterized by a Regular Warfare mind-set stands out as counter-normative. Signs of creative thought on military practice and theory, as well as a still persistent Regular Warfare doxa are apparent. Power struggles might thus develop, effecting the transformation to a broadened warfare culture with an enhanced focus also on Irregular Warfare. The result does not support research results arguing for a convergence of military thought in the European transformation of Armed Forces. The main argument goes beyond tactics and suggests sociological analysis on reciprocal effects regarding strategy, operational art, tactics as well as leadership, concerning the mind-set and preferences for Regular, Irregular and Hybrid Warfare.

Dialysis, time and death: comparisons of two consecutive decades among patients treated at the same Brazilian dialysis center

The survival of hemodialysis patients is likely to be influenced not only by well-known risk factors like age and comorbidity, but also by changes in dialysis technology and practices accumulated along time. We compared the survival curves, dialysis routines and some risk factors of two groups of patients admitted to a Brazilian maintenance hemodialysis program during two consecutive decades: March 1977 to December 1986 (group 1, N = 162) and January 1987 to June 1997 (group 2, N = 237). The median treatment time was 22 months (range 1-198). Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank method. The Cox proportional hazard regression model was used to investigate the more important variables associated with outcome. The most important changes in dialysis routine and in patient care during the total period of observation were the progressive increase in the dose of dialysis delivered, the prohibition of potassium-free dialysate, the use of bicarbonate as a buffer and the upgrading of the dialysis equipment. There were no significant differences between the survival curves of the two groups. Survival rates at 1, 5 and 10 years were 84, 53 and 29%, respectively, for group 1 and 77, 42 and 21% for group 2. Patients in group 1 were younger (45.5 ± 15.2 vs 55.2 ± 15.9 years, P<0.001) and had a lower prevalence of diabetes (11.1 vs 27.4%, P<0.001) and of cardiovascular disease (9.3 vs 20.7%, P<0.001). According to the Cox multivariate model, only age (hazard ratio (HR) 1.04, confidence interval (CI) 1.03-1.05, P<0.001) and diabetes (HR 2.55, CI 1.82-3.58, P<0.001) were independent predictors of mortality for the whole group. Patients of group 2 had a lower prevalence of sudden death (19.1 vs 9.7%, P<0.001). After adjusting for age, diabetes and other mortality risk factors, the risk of death was 17% lower in group 2, although this difference was not statistically significant. We conclude that the negative effects of advanced age and of higher frequency of comorbidity on the survival of group 2 patients were probably offset by improvements in patient care and in the quality and dose of dialysis delivered, so that the survival curves did not undergo significant changes along time.