Competing risks to breast cancer mortality in Catalonia

Background: Breast cancer mortality has experienced important changes over the last century. Breast cancer occurs in the presence of other competing risks which can influence breast cancer incidence and mortality trends. The aim of the present work is: 1) to assess the impact of breast cancer deaths among mortality from all causes in Catalonia (Spain), by age and birth cohort and 2) to estimate the risk of death from other causes than breast cancer, one of the inputs needed to model breast cancer mortality reduction due to screening or therapeutic interventions. Methods: The multi-decrement life table methodology was used. First, all-cause mortality probabilities were obtained by age and cohort. Then mortality probability for breast cancer was subtracted from the all-cause mortality probabilities to obtain cohort life tables for causes other than breast cancer. These life tables, on one hand, provide an estimate of the risk of dying from competing risks, and on the other hand, permit to assess the impact of breast cancer deaths on all-cause mortality using the ratio of the probability of death for causes other than breast cancer by the all-cause probability of death. Results: There was an increasing impact of breast cancer on mortality in the first part of the 20th century, with a peak for cohorts born in 1945–54 in the 40–49 age groups (for which approximately 24% of mortality was due to breast cancer). Even though for cohorts born after 1955 there was only information for women under 50, it is also important to note that the impact of breast cancer on all-cause mortality decreased for those cohorts. Conclusion: We have quantified the effect of removing breast cancer mortality in different age groups and birth cohorts. Our results are consistent with US findings. We also have obtained an estimate of the risk of dying from competing-causes mortality, which will be used in the assessment of the effect of mammography screening on breast cancer mortality in Catalonia.

Risks in R&D Collaboration between Small and Large Firms

The main aim of this thesis was to find out what kinds of risks arise from collabo-ration in R&D between small and large firms. The suitability and gain of some buyer/supplier risk frameworks in examining of R&D collaboration has been in-vestigated. A risk model has been based on the buyer/supplier risks models found in the literature. Its applicability has been tested empirically by means of theme interviews with firm representatives. The risk classification framework received some confirmation. But the study also showed that the theoretical framework was not completely adequate, as a new risk class arose from communication. Collaboration causes risks, and these risks should be taken into account when R&D collaboration is planned. The advantage of risk examination is the possibility to decrease failures and losses, and to in-crease possibilities for success and economical benefits. This study should be used as a managerial analysis tool in trying to understand the form and concept of risk in risk expectancy.

Increased risks of early sexual initiators: time makes a difference

BACKGROUND: Years since onset of sexual intercourse (YSSI) is a rarely used variable when studying adolescents- sexual outcomes. The aim of this study is to evaluate the influence of YSSI on the adverse sexual outcomes of early sexual initiators. METHODS: Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health database, a nationally representative cross-sectional survey including 7429 adolescents in post mandatory school aged 16-20 years. Only adolescents reporting sexual intercourse (SI) were included (N=4388; 45% females) and divided by age of onset of SI (early initiators, age<16: N=1469, 44% females; and late initiators, age≥16: N=2919, 46% females). Analyses were done separately by gender. Groups were compared for personal characteristics at the bivariate level. We analyzed three sexual outcomes (≥4 sexual partners, pregnancy and non-use of condom at last SI) controlling for all significant personal variables with two logistic regressions first using age, then YSSI as one of the confounding variables. Results are given as adjusted odds ratios (aOR) using lSI as the reference category. RESULTS: After adjusting for YSSI instead of age, negative sexual outcomes among early initiators were no longer significant, except for multiple sexual partners among females, although at a much lower level. Early initiators were less likely to report non-use of condom at last SI when adjusting for YSSI (females: aOR=0.59 [0.44-0.79]; p<0.001; males aOR=0.71 [0.50-1.00]; p=0.053). CONCLUSION: YSSI is an important explanatory variable when studying adolescents- sexuality and needs to be included in future research on adolescents- sexual health.

Transactional sex and HIV risks - evidence from a cross-sectional national survey among young people in Uganda.

BACKGROUND: Transactional sex is associated with the HIV epidemic among young people in Uganda. Few quantitative studies based on nationally representative survey data explored the relationship between sexual behaviors, HIV infection, and transactional sex. OBJECTIVE: This study aimed to determine the associations between risky sexual behaviors, participation in transactional sex, and HIV sero-status among men and women aged 15-24 in Uganda. DESIGN: The study uses data from the Uganda AIDS Indicator Survey, a cross-sectional national HIV serological study conducted in 2011. We analyzed data on 1,516 men and 2,824 women aged 15-24 who had been sexually active in the 12 months preceding the survey. Private, face-to-face interviews were also conducted to record the sociodemographics, sexual history, and experiences of sexual coercion. Logistic regression analysis was performed to measure associations between sexual behaviors and transactional sex, and associations between HIV sero-status and transactional sex. RESULTS: Among young people who had been sexually active in the 12 months prior to the survey, 5.2% of young men reported paying for sex while 3.7% of young women reported receiving gifts, favors, or money for sex. Lower educational attainment (ORadjusted 3.25, CI 1.10-9.60) and experience of sexual coercion (ORadjusted 2.83, CI 1.07-7.47) were significantly associated with paying for sex among men. Multiple concurrent sexual relationships were significantly associated with paying for sex among young men (ORadjusted 5.60, CI 2.08-14.95) and receiving something for sex among young women (ORadjusted 8.04, CI 2.55-25.37). Paying for sex among young men and having three to five lifetime sexual partners among young women were associated with increased odds of testing positive for HIV. CONCLUSIONS: Transactional sex is associated with sexual coercion and HIV risk behaviors such as multiple concurrent sexual partnerships among young people in Uganda. In addition, transactional sex appears to place young men at increased risk for HIV in Uganda. Both sexes appear equally vulnerable to risks associated with transactional sex, and therefore should be targeted in intervention programs. In addition, strengthening universal education policy and improving school retention programs may be beneficial in reducing risky sexual behaviors and transactional sex.

Identification and Management of Operational Risks in IT Organization of Financial Service Provider

Työn tavoitteena on tunnistaa toiminnallisia riskitekijöitä rahoituspalveluita tarjoavan yrityksen IT-organisaatiossa sekä löytää arkipäiväisiä keinoja hallita näitä riskejä. Työssä riskejä on myös tarkasteltu mahdollisen ulkoistuksen yhteydessä. Fuusiot ovat yleisiä rahoitusalan yrityksissä. Yhteenliittymien tuloksena yritysten IT-arkkitehtuuri voi olla monimutkainen ja kulttuurierot yrityksessä suuria. Synergia- ja mittakaavaetuja saadakseen yritys keskittää toimintojaan ja IT-ratkaisujaan. Riskien tunnistaminen on riskienhallintaprosessin tärkein vaihe. Tässä tutkimuksessa riskit ja riskitekijät tunnistettiin itsearvioinnin avulla kysymyssarjoja hyväksikäyttäen. Monet riskitekijät liittyivät sisäisen valvonnan ja seurannan puutteisiin. Myöhemmin näille riskeille pohdittiin työryhmässä käytännönläheisiä hallintakeinoja. Yritys voi siirtää tai jakaa IT -riskejä ulkoistamalla. Ulkoistaminen voi kuitenkin tuoda mukaan myös uusia riskitekijöitä. Ennen ulkoistamispäätöstä yrityksen sisäisten prosessien ja organisaation on oltava järjestyksessä, jotta sopimuksen kannattavuutta voidaan verrata luotettavasti saman palvelun tuottamiseen sisäisesti.

Product Launch in Industrial Markets – Financial Risks in New AMD Elevator Door Launch

Tuotekehitys ja uusien tuotteiden lanseeraus on teollisen yrityksen menestyksekkään liiketoiminnan elinehtoja tämän päivän kilpailussa. Teollisuusyrityksen tuotteiden innovaatioaikakausia on ollut lukuisia, samoin kuin uuden tuotteen lanseerauksen lähtökohtia. Aikakausista, jolloin tuotteita kehitettiin yrityksen omista lähtökohdista, kuten valmistuksellisista eduista, on edetty tilanteeseen, jossa markkinoiden tarpeita tulee ottaa yhä enemmän huomioon. Kuitenkin, teollisuudessa esitellään tuotteita yhä puhtaasti tuotantolähtöisesti, ja tutkimuksen tavoitteena on selvittää taloudellisia riskejä, joita liittyy puhtaasti teknologiavetoiseen tuotteiden kehitystyöhön, valmistukseen ja lanseeraukseen. Normatiivisena tutkimuksena työ pyrkii asiakastarpeita ja teollisuusyrityksen loppuasiakkaiden näkökulmia huomioon ottaen osoittamaan markkinoinnin keinojen merkityksen tuotantolähtöisen tuotelanseerauksen taloudellisten riskien minimoimiseksi. Uuden teollisen tuotteen asiakastarpeita on selvitetty kyselymuotoisen markkinointitutkimuksen menetelmiä hyväksikäyttäen. Tuotteen tärkeimpien ominaisuuksien, kuten turvallisuuden, kestävyyden ja hinnan merkitystä voidaan hyödyntää ennen tuotteen kaupallista esittelyä potentiaalisten asiakassegmenttien kartoitukseen ja menestyksellisen lanseerauksen edesauttamiseksi.

Responding to Young People's Health Risks in Primary Care: A Cluster Randomised Trial of Training Clinicians in Screening and Motivational Interviewing.

OBJECTIVE: To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians' detection of health risks and patients' risk taking behaviour, compared to a didactic seminar on young people's health. DESIGN: Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. SETTING: General practices in metropolitan and rural Victoria, Australia. PARTICIPANTS: General practices with at least one interested clinician (general practitioner or nurse) and their 14-24 year old patients. INTERVENTION: This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients' risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. OUTCOME MEASURES: Primary outcomes were patient report of (1) clinician detection of at least one of six health risk behaviours (tobacco, alcohol and illicit drug use, risks for sexually transmitted infection, STI, unplanned pregnancy, and road risks); and (2) change in one or more of the six health risk behaviours, at three months or at 12 months. Secondary outcomes were likelihood of future visits, trust in the clinician after exit interview, clinician detection of emotional distress and fear and abuse in relationships, and emotional distress at three and 12 months. Patient acceptability of the screening tool was also described for the intervention arm. Analyses were adjusted for practice location and billing type, patients' sex, age, and recruitment method, and past health risks, where appropriate. An intention to treat analysis approach was used, which included multilevel multiple imputation for missing outcome data. RESULTS: 42 practices were randomly allocated to intervention or comparison arms. Two intervention practices withdrew post allocation, prior to training, leaving 19 intervention (53 clinicians, 377 patients) and 21 comparison (79 clinicians, 524 patients) practices. 69% of patients in both intervention (260) and comparison (360) arms completed the 12 month follow-up. Intervention clinicians discussed more health risks per patient (59.7%) than comparison clinicians (52.7%) and thus were more likely to detect a higher proportion of young people with at least one of the six health risk behaviours (38.4% vs 26.7%, risk difference [RD] 11.6%, Confidence Interval [CI] 2.93% to 20.3%; adjusted odds ratio [OR] 1.7, CI 1.1 to 2.5). Patients reported less illicit drug use (RD -6.0, CI -11 to -1.2; OR 0·52, CI 0·28 to 0·96), and less risk for STI (RD -5.4, CI -11 to 0.2; OR 0·66, CI 0·46 to 0·96) at three months in the intervention relative to the comparison arm, and for unplanned pregnancy at 12 months (RD -4.4; CI -8.7 to -0.1; OR 0·40, CI 0·20 to 0·80). No differences were detected between arms on other health risks. There were no differences on secondary outcomes, apart from a greater detection of abuse (OR 13.8, CI 1.71 to 111). There were no reports of harmful events and intervention arm youth had high acceptance of the screening tool. CONCLUSIONS: A complex intervention, compared to a simple educational seminar for practices, improved detection of health risk behaviours in young people. Impact on health outcomes was inconclusive. Technology enabling more efficient, systematic health-risk screening may allow providers to target counselling toward higher risk individuals. Further trials require more power to confirm health benefits. TRIAL REGISTRATION: ISRCTN.com ISRCTN16059206.

Net Neutrality: Measuring the Problem, Assessing the Legal Risks

Network neutrality is a growing policy controversy. Traffic management techniques affect not only high-speed, high-money content, but by extension all other content too. Internet regulators and users may tolerate much more discrimination in the interests of innovation. For instance, in the absence of regulatory oversight, ISPs could use Deep Packet Inspection (DPI) to block some content altogether, if they decide it is not to the benefit of ISPs, copyright holders, parents or the government. ISP blocking is currently widespread in controlling spam email, and in some countries in blocking sexually graphic illegal images. In 1999 this led to scrutiny of foreclosure of Instant Messaging and video and cable-telephony horizontal merger. Fourteen years later, there were in 2013 net neutrality laws implemented in Slovenia, the Netherlands, Chile and Finland, regulation in the United States and Canada , co-regulation in Norway, and self-regulation in Japan, the United Kingdom and many other European countries . Both Germany and France in mid-2013 debated new net neutrality legislation, and the European Commission announced on 11 September 2013 that it would aim to introduce legislation in early 2014. This paper analyses these legal developments, and in particular the difficulty in assessing reasonable traffic management and ‘specialized’ (i.e. unregulated) faster services in both EU and US law. It also assesses net neutrality law against the international legal norms for user privacy and freedom of expression

Lésions induites par les pistolets à impulsion électrique de type Taser [Health Risks Concerning Electronic Control Devices]

Les pistolets à impulsion électrique (PIE) sont de plus en plus fréquemment utilisés en Europe ces dernières années, le modèle le plus connu étant le Taser®. Les connaissances scientifiques concernant les PIE et leurs effets potentiels restent toutefois limitées. Nous avons conduit une revue de littérature afin d'évaluer les implications potentielles de leur utilisation en termes de sécurité, de morbidité et de mortalité. Une exposition unique chez un individu sain peut généralement être considérée comme peu dangereuse. Les sujets à risque de complications sont les individus exposés à de multiples décharges, les personnes sous l'influence de substances psychoactives, ceux qui montrent des signes d'agitation extrême, ou encore les individus présentant des comorbidités médicales. L'éventail des complications pouvant survenir lors de leur exposition est large et inclut les lésions provoquées par les impacts des électrodes, les traumatismes liés à la chute induite par la paralysie transitoire ou des complications cardiovasculaires. Dans ce contexte, les personnes exposées doivent être examinées attentivement, et les éventuelles lésions traumatiques doivent être exclues. The use of electronic control devices (ECD), such as the Taser®, has increased in Europe over the past decade. However, scientific data concerning the potential health impact of ECD usage remains limited. We reviewed the scientific literature in order to evaluate the safety, mortality, and morbidity associated with ECD use. Exposure of a healthy individual to a single ECD electroshock can be considered generally safe. Complications can, however, occur if the patient is subject to multiple electroshocks, if the patient has significant medical comorbidities, or when exposure is associated with drug abuse or agitated delirium. The broad spectrum of potential complications associated with ECD exposure includes direct trauma caused by the ECD electrodes, injuries caused by the transient paralysis-induced fall, and cardiovascular events. An ECD-exposed patient requires careful examination during which traumatic injuries are actively sought out.