Impact of multimorbidity on disability and quality of life in the spanish older population

BACKGROUND: Population aging is closely related to high prevalence of chronic conditions in developed countries. In this context, health care policies aim to increase life span cost-effectively while maintaining quality of life and functional ability. There is still, however, a need for further understanding of how chronic conditions affect these health aspects. The aim of this paper is to assess the individual and combined impact of chronic physical and mental conditions on quality of life and disability in Spain, and secondly to show gender trends. METHODS: Cross-sectional data were collected from the COURAGE study. A total of 3,625 participants over 50 years old from Spain were included. Crude and adjusted multiple linear regressions were conducted to detect associations between individual chronic conditions and disability, and between chronic conditions and quality of life. Separate models were used to assess the influence of the number of diseases on the same variables. Additional analogous regressions were performed for males and females. RESULTS: All chronic conditions except hypertension were statistically associated with poor results in quality of life and disability. Depression, anxiety and stroke were found to have the greatest impact on outcomes. The number of chronic conditions was associated with substantially lower quality of life [β for 4+ diseases: -18.10 (-20.95,-15.25)] and greater disability [β for 4+ diseases: 27.64 (24.99,30.29]. In general, women suffered from higher rates of multimorbidity and poorer results in quality of life and disability. CONCLUSIONS: Chronic conditions impact greatly on quality of life and disability in the older Spanish population, especially when co-occurring diseases are added. Multimorbidity considerations should be a priority in the development of future health policies focused on quality of life and disability. Further studies would benefit from an expanded selection of diseases. Policies should also deal with gender idiosyncrasy in certain cases.

Quality and analysis of administration processes in server operations

IT outsourcing refers to the way companies focus on their core competencies and buy the supporting functions from other companies specialized in that area. Service is the total outcome of numerous of activities by employees and other resources to provide solutions to customers' problems. Outsourcing and service business have their unique characteristics. Service Level Agreements quantify the minimum acceptable service to the user. The service quality has to be objectively quantified so that its achievement or non-achievement of it can be monitored. Usually offshoring refers to the transferring of tasks to low-cost nations. Offshoring presents a lot of challenges that require special attention and they need to be assessed thoroughly. IT Infrastructure management refers to installation and basic usability assistance of operating systems, network and server tools and utilities. ITIL defines the industry best practices for organizing IT processes. This thesis did an analysis of server operations service and the customers’ perception of the quality of daily operations. The agreed workflows and processes should be followed better. Service providers’ processes are thoroughly defined but both the customer and the service provider might disobey them. Service provider should review the workflows regarding customer functions. Customer facing functions require persistent skill development, as they communicate the quality to the customer. Service provider needs to provide better organized communication and knowledge exchange methods between the specialists in different geographical locations.

Towards increased productivity and quality in software development using agile, lean and collaborative approaches

Dagens programvaruindustri står inför alltmer komplicerade utmaningar i en värld där programvara är nästan allstädes närvarande i våra dagliga liv. Konsumenten vill ha produkter som är pålitliga, innovativa och rika i funktionalitet, men samtidigt också förmånliga. Utmaningen för oss inom IT-industrin är att skapa mer komplexa, innovativa lösningar till en lägre kostnad. Detta är en av orsakerna till att processförbättring som forskningsområde inte har minskat i betydelse. IT-proffs ställer sig frågan: “Hur håller vi våra löften till våra kunder, samtidigt som vi minimerar vår risk och ökar vår kvalitet och produktivitet?” Inom processförbättringsområdet finns det olika tillvägagångssätt. Traditionella processförbättringsmetoder för programvara som CMMI och SPICE fokuserar på kvalitets- och riskaspekten hos förbättringsprocessen. Mer lättviktiga metoder som t.ex. lättrörliga metoder (agile methods) och Lean-metoder fokuserar på att hålla löften och förbättra produktiviteten genom att minimera slöseri inom utvecklingsprocessen. Forskningen som presenteras i denna avhandling utfördes med ett specifikt mål framför ögonen: att förbättra kostnadseffektiviteten i arbetsmetoderna utan att kompromissa med kvaliteten. Den utmaningen attackerades från tre olika vinklar. För det första förbättras arbetsmetoderna genom att man introducerar lättrörliga metoder. För det andra bibehålls kvaliteten genom att man använder mätmetoder på produktnivå. För det tredje förbättras kunskapsspridningen inom stora företag genom metoder som sätter samarbete i centrum. Rörelsen bakom lättrörliga arbetsmetoder växte fram under 90-talet som en reaktion på de orealistiska krav som den tidigare förhärskande vattenfallsmetoden ställde på IT-branschen. Programutveckling är en kreativ process och skiljer sig från annan industri i det att den största delen av det dagliga arbetet går ut på att skapa något nytt som inte har funnits tidigare. Varje programutvecklare måste vara expert på sitt område och använder en stor del av sin arbetsdag till att skapa lösningar på problem som hon aldrig tidigare har löst. Trots att detta har varit ett välkänt faktum redan i många decennier, styrs ändå många programvaruprojekt som om de vore produktionslinjer i fabriker. Ett av målen för rörelsen bakom lättrörliga metoder är att lyfta fram just denna diskrepans mellan programutvecklingens innersta natur och sättet på vilket programvaruprojekt styrs. Lättrörliga arbetsmetoder har visat sig fungera väl i de sammanhang de skapades för, dvs. små, samlokaliserade team som jobbar i nära samarbete med en engagerad kund. I andra sammanhang, och speciellt i stora, geografiskt utspridda företag, är det mera utmanande att införa lättrörliga metoder. Vi har nalkats utmaningen genom att införa lättrörliga metoder med hjälp av pilotprojekt. Detta har två klara fördelar. För det första kan man inkrementellt samla kunskap om metoderna och deras samverkan med sammanhanget i fråga. På så sätt kan man lättare utveckla och anpassa metoderna till de specifika krav som sammanhanget ställer. För det andra kan man lättare överbrygga motstånd mot förändring genom att introducera kulturella förändringar varsamt och genom att målgruppen får direkt förstahandskontakt med de nya metoderna. Relevanta mätmetoder för produkter kan hjälpa programvaruutvecklingsteam att förbättra sina arbetsmetoder. När det gäller team som jobbar med lättrörliga och Lean-metoder kan en bra uppsättning mätmetoder vara avgörande för beslutsfattandet när man prioriterar listan över uppgifter som ska göras. Vårt fokus har legat på att stöda lättrörliga och Lean-team med interna produktmätmetoder för beslutsstöd gällande så kallad omfaktorering, dvs. kontinuerlig kvalitetsförbättring av programmets kod och design. Det kan vara svårt att ta ett beslut att omfaktorera, speciellt för lättrörliga och Lean-team, eftersom de förväntas kunna rättfärdiga sina prioriteter i termer av affärsvärde. Vi föreslår ett sätt att mäta designkvaliteten hos system som har utvecklats med hjälp av det så kallade modelldrivna paradigmet. Vi konstruerar även ett sätt att integrera denna mätmetod i lättrörliga och Lean-arbetsmetoder. En viktig del av alla processförbättringsinitiativ är att sprida kunskap om den nya programvaruprocessen. Detta gäller oavsett hurdan process man försöker introducera – vare sig processen är plandriven eller lättrörlig. Vi föreslår att metoder som baserar sig på samarbete när processen skapas och vidareutvecklas är ett bra sätt att stöda kunskapsspridning på. Vi ger en översikt över författarverktyg för processer på marknaden med det förslaget i åtanke.

The Productivity, Economy and Quality of Welding in the Different Geographical Areas of China - Today and in the Future

This master’s thesis gives out the real situation of the China welding industry and factories nowadays in different geographical areas, in order to inform the Finnish companies who have the willing to find a Chinese welding subcontractor a proper and correct selection concept by analyzing and supplying the information of different scale and form welding factories in different Chinese areas. The first section of this thesis gives out the general situation about the co-operation between China and Finland in the welding industry, also includes the general introduction of the Chinese welding industry. The second section gives out the geographical compartmentalization result of Chinese welding industry, which is where and how many areas will be studied in this thesis. The main body of this thesis is the real information of welding productivity, welding cost, and welding quality in China. All the information was collected from real factories in China by the author. The last section of this thesis is the improvements to the Chinese welding factories that have the willing to become a subcontractor, and the suggestions to the Finnish companies who may find a Chinese welding factory as their subcontractor in future.

Cost-effectiveness analysis in South Karelia Central Hospital

The target organization of this study, otherwise South-Karelia Social and Health Care District (Eksote) provides health, senior, family and social welfare services. South Karelia Central Hospital provides special health care and offers health services from all of the most important medical specialties. Eksote has in use 15D instrument to measure the health-related quality of life (HRQoL) of their patients before and after their interventions for observing the health effects of the medical care. Furthermore, 15D allows measuring the effectiveness and cost-effectiveness of health care when comparing these before and after results of the 15D measurements and adding the costs of the interventions into this research. The main purposes of this study were to analyze the effectiveness and cost-effectiveness of medical care in South Karelia Central Hospital by using the gathered 15D data to calculate effectiveness and cost-effectiveness ratios and to analyze the reliability and availability of the data. Study has been conducted using literature review and quantitative research methods. The results indicate that from the patients within the eight units selected to this study the 15D change information was available from the 52 %, the 15D change and the cost information from 38 % and the information of quality-adjusted life years (QALYs) produced and the cost information from 35 %. The effectiveness and cost-effectiveness of medical care were greatest at the units of Pain Outpatient Clinic and Rheumatic Diseases Outpatient Clinic. The most effective medical care is given in the unit where the average price of one produced QALY is the highest (Orthopedics). However, the calculated standard deviations pointed out that there are great variances in the effectiveness and cost-effectiveness within the units also.

Cost-benefit analysis of using test automation in the development of embedded software

The goal of this thesis is to make a case study of test automation’s profitability in the development of embedded software in a real industrial setting. The cost-benefit analysis is done by considering the costs and benefits test automation causes to software development, before the software is released to customers. The potential benefits of test automation regarding software quality after customer release were not estimated. Test automation is a significant investment which often requires dedicated resources. When done accordingly, the investment in test automation can produce major cost savings by reducing the need for manual testing effort, especially if the software is developed with an agile development framework. It can reduce the cost of avoidable rework of software development, as test automation enables the detection of construction time defects in the earliest possible moment. Test automation also has many pitfalls such as test maintainability and testability of the software, and if those areas are neglected, the investment in test automation may become worthless or it may even produce negative results. The results of this thesis suggest that test automation is very profitable at the company under study.

European luxury brands made in China: the effect of low-cost country manufacturing on brand image and purchase decisions

European luxury brands have an image of manufacturing their products in the same country where the brands originate. However, in the past years many luxury brands have shifted their manufacturing to countries outside Europe. China is now a common manufacturing country for European luxury brands despite the country’s poor image as a manufacturer. Chinese manufacturing is often associated with bad quality, bad labour conditions, mass production, and counterfeits. The image of China does not quite match the image luxury brands enjoy including characteristics such as high end quality, craftsmanship, details, design, or premium price. A negatively perceived country-of-manufacture may have an effect on a brand’s image and consumers’ purchase decisions. This thesis is focused on European luxury brands manufacturing in China, and how this effects the brand image and purchase decisions among luxury consumers. The empirical part of this thesis is based on focus group research, which is a popular method in the field of qualitative research. The main focus group is female luxury consumers in Finland. This main group has been divided into three categories: 1) the university students, 2) the young career women, 3) the experienced luxury consumers. This categorization has been done based on their different stages in luxury consumption. All in all, the empirical research consisted of 11 interviews and 29 participants. The main contribution of this thesis was that there is a difference between the opinions of the younger groups (university students and young career women) and the experienced luxury consumers when discussing the effect of country-of-manufacture on brand image and purchase decisions of luxury brands. The younger participants thought that manufacturing luxury products in China might affect the brand image, but their purchase decisions would not be that much affected by the country-of-origin. The experienced luxury consumers had quite a different view on the country-of-origin of luxury brands – they found it an important decisive factor prior making purchases. The majority of experienced luxury consumers would not buy luxury products made in China, and they would always check where these products are made in.

Low-cost automatic activity data recording system

We describe a low-cost, high quality device capable of monitoring indirect activity by detecting touch-release events on a conducting surface, i.e., the animal's cage cover. In addition to the detecting sensor itself, the system includes an IBM PC interface for prompt data storage. The hardware/software design, while serving for other purposes, is used to record the circadian activity rhythm pattern of rats with time in an automated computerized fashion using minimal cost computer equipment (IBM PC XT). Once the sensor detects a touch-release action of the rat in the upper portion of the cage, the interface sends a command to the PC which records the time (hours-minutes-seconds) when the activity occurred. As a result, the computer builds up several files (one per detector/sensor) containing a time list of all recorded events. Data can be visualized in terms of actograms, indicating the number of detections per hour, and analyzed by mathematical tools such as Fast Fourier Transform (FFT) or cosinor. In order to demonstrate method validation, an experiment was conducted on 8 Wistar rats under 12/12-h light/dark cycle conditions (lights on at 7:00 a.m.). Results show a biological validation of the method since it detected the presence of circadian activity rhythm patterns in the behavior of the rats

Alternative chromatographic system for the quality control of lipophilic technetium-99m radiopharmaceuticals such as [99mTc(MIBI)6]+

Knowledge of the radiochemical purity of radiopharmaceuticals is mandatory and can be evaluated by several methods and techniques. Planar chromatography is the technique normally employed in nuclear medicine since it is simple, rapid and usually of low cost. There is no standard system for the chromatographic technique, but price, separation efficiency and short time for execution must be considered. We have studied an alternative system using common chromatographic stationary phase and alcohol or alcohol:chloroform mixtures as the mobile phase, using the lipophilic radiopharmaceutical [99mTc(MIBI)6]+ as a model. Whatman 1 modified phase paper and absolute ethanol, Whatman 1 paper and methanol:chloroform (25:75), Whatman 3MM paper and ethanol:chloroform (25:75), and the more expensive ITLC-SG and 1-propanol:chloroform (10:90) were suitable systems for the direct determination of radiochemical purity of [99mTc(MIBI)6]+ since impurities such as99mTc-reduced-hydrolyzed (RH),99mTcO4- and [99mTc(cysteine)2]-complex were completely separated from the radiopharmaceutical, which moved toward the front of chromatographic systems while impurities were retained at the origin. The time required for analysis was 4 to 15 min, which is appropriate for nuclear medicine routines.

Accelerating food safety and quality control: The use of antibody engineering techniques in the detec-tion of low-molecular weight food contaminants

The increased awareness and evolved consumer habits have set more demanding standards for the quality and safety control of food products. The production of foodstuffs which fulfill these standards can be hampered by different low-molecular weight contaminants. Such compounds can consist of, for example residues of antibiotics in animal use or mycotoxins. The extremely small size of the compounds has hindered the development of analytical methods suitable for routine use, and the methods currently in use require expensive instrumentation and qualified personnel to operate them. There is a need for new, cost-efficient and simple assay concepts which can be used for field testing and are capable of processing large sample quantities rapidly. Immunoassays have been considered as the golden standard for such rapid on-site screening methods. The introduction of directed antibody engineering and in vitro display technologies has facilitated the development of novel antibody based methods for the detection of low-molecular weight food contaminants. The primary aim of this study was to generate and engineer antibodies against low-molecular weight compounds found in various foodstuffs. The three antigen groups selected as targets of antibody development cause food safety and quality defects in wide range of products: 1) fluoroquinolones: a family of synthetic broad-spectrum antibacterial drugs used to treat wide range of human and animal infections, 2) deoxynivalenol: type B trichothecene mycotoxin, a widely recognized problem for crops and animal feeds globally, and 3) skatole, or 3-methyindole is one of the two compounds responsible for boar taint, found in the meat of monogastric animals. This study describes the generation and engineering of antibodies with versatile binding properties against low-molecular weight food contaminants, and the consecutive development of immunoassays for the detection of the respective compounds.

Benefits of a low-cost one-phase current distortion detection device in appliance supply in low-voltage residential networks

In this bachelor’s thesis are examined the benefits of current distortion detection device application in customer premises low voltage networks. The purpose of this study was to find out if there are benefits for measuring current distortion in low-voltage residential networks. Concluding into who can benefit from measuring the power quality. The research focuses on benefits based on the standardization in Europe and United States of America. In this research, were also given examples of appliances in which current distortion detection device could be used. Along with possible illustration of user interface for the device. The research was conducted as an analysis of the benefits of current distortion detection device in residential low voltage networks. The research was based on literature review. The study was divided to three sections. The first explain the reasons for benefitting from usage of the device and the second portrays the low-cost device, which could detect one-phase current distortion, in theory. The last section discuss of the benefits of usage of current distortion detection device while focusing on the beneficiaries. Based on the result of this research, there are benefits from usage to the current distortion detection device. The main benefitting party of the current distortion detection device was found to be manufactures, as they are held responsible of limiting the current distortion on behalf of consumers. Manufactures could adjust equipment to respond better to the distortion by having access to on-going current distortion in network. The other benefitting party are system operators, who would better locate distortion issues in low-voltage residential network to start prevention of long-term problems caused by current distortion early on.

Cost-effectiveness of Transcatheter Mitral Valve Leaflet Repair for the Treatment of Mitral Regurgitation in Heart Failure

Contexte: La régurgitation mitrale (RM) est une maladie valvulaire nécessitant une intervention dans les cas les plus grave. Une réparation percutanée de la valve mitrale avec le dispositif MitraClip est un traitement sécuritaire et efficace pour les patients à haut risque chirurgical. Nous voulons évaluer les résultats cliniques et l'impact économique de cette thérapie par rapport à la gestion médicale des patients en insuffisance cardiaque avec insuffisance mitrale symptomatique. Méthodes: L'étude a été composée de deux phases; une étude d'observation de patients souffrant d'insuffisance cardiaque et de régurgitation mitrale traitée avec une thérapie médicale ou le MitraClip, et un modèle économique. Les résultats de l'étude observationnelle ont été utilisés pour estimer les paramètres du modèle de décision, qui a estimé les coûts et les avantages d'une cohorte hypothétique de patients atteints d'insuffisance cardiaque et insuffisance mitrale sévère traitée avec soit un traitement médical standard ou MitraClip. Résultats: La cohorte de patients traités avec le système MitraClip était appariée par score de propension à une population de patients atteints d'insuffisance cardiaque, et leurs résultats ont été comparés. Avec un suivi moyen de 22 mois, la mortalité était de 21% dans la cohorte MitraClip et de 42% dans la cohorte de gestion médicale (p = 0,007). Le modèle de décision a démontré que MitraClip augmente l'espérance de vie de 1,87 à 3,60 années et des années de vie pondérées par la qualité (QALY) de 1,13 à 2,76 ans. Le coût marginal était 52.500 $ dollars canadiens, correspondant à un rapport coût-efficacité différentiel (RCED) de 32,300.00 $ par QALY gagné. Les résultats étaient sensibles à l'avantage de survie. Conclusion: Dans cette cohorte de patients atteints d'insuffisance cardiaque symptomatique et d insuffisance mitrale significative, la thérapie avec le MitraClip est associée à une survie supérieure et est rentable par rapport au traitement médical.

Development of Safety and Quality Management System in Shrimp Farming

Shrimp Aquaculture has provided tremendous opportunity for the economic and social upliftment of rural communities in the coastal areas of our country Over a hundred thousand farmers, of whom about 90% belong to the small and marginal category, are engaged in shrimp farming. Penaeus monodon is the most predominant cultured species in India which is mainly exported to highly sophisticated, quality and safety conscious world markets. Food safety has been of concem to humankind since the dawn of history and the concern about food safety resulted in the evolution of a cost effective, food safety assurance method, the Hazard Analysis Critical Control Point (HACCP). Considering the major contribution of cultured Penaeus monodon to the total shrimp production and the economic losses encountered due to disease outbreak and also because traditional methods of quality control and end point inspection cannot guarantee the safety of our cultured seafood products, it is essential that science based preventive approaches like HACCP and Pre requisite Programmes (PRP) be implemented in our shrimp farming operations. PRP is considered as a support system which provides a solid foundation for HACCP. The safety of postlarvae (PL) supplied for brackish water shrimp farming has also become an issue of concern over the past few years. The quality and safety of hatchery produced seeds have been deteriorating and disease outbreaks have become very common in hatcheries. It is in this context that the necessity for following strict quarantine measures with standards and code of practices becomes significant. Though there were a lot of hue and cry on the need for extending the focus of seafood safety assurance from processing and exporting to the pre-harvest and hatchery rearing phases, an experimental move in this direction has been rare or nil. An integrated management system only can assure the effective control of the quality, hygiene and safety related issues. This study therefore aims at designing a safety and quality management system model for implementation in shrimp farming and hatchery operations by linking the concepts of HACCP and PRP.

Water Quality Variation, its Influence on Drinking Water Treatment and Remedial Measures - A Case Study of Peechi reservoir, Thrissur, Kerala

The Kerala Water Authority requested the School of Environmental Studies to carry out investigations on the mechanism of sporadic mobilization of iron and odour in the raw water drawn to the drinking water treatment plant. The currently used treatment process failed to remove iron completely. This led to problems in the filter and complaints of taste and colour due to iron in the finished water. The sporadic nature of the problem itself made the trouble shooting difficult. The problem was looked in from three points of view. 1. Influence of environmental (climatic) conditions on the dynamics of the relevant basin of the reservoir. 2. Influence of the physical dynamics on the physico — chemical quality of water. 3. Identification of cost-effective treatment processes to suit the existing plant. Since the problem emerged only during the post- monsoon to pre-monsoon months, a related problem was investigated, namely, influence of anions on the oxidation of Fe(II) in natural waters by air. This is presented in Part II of the dissertation.

Impact of Quality on Ethics and Social Responsibility in Marketing, in Industries in Kerala in the present Indian Scenario

The paper ‘Impact of Quality on Ethics and Social Responsibility in Marketing in Industries in Kerala in the present Indian scenario’ highlights the observations, based on a descriptive research carried out in five leading industries in Kerala, in the private and public sector. Ethics and social responsibilities, practiced in these industries, are reflected in the results of the survey conducted on specific queries like awareness of products/services provided by them, total understanding of the requirements of the customer, open discussion on technical matters, accountability of employees to the society and social needs, consumer ethics vis a vis business ethics etc. Team working goes a long way, in building relations, which in turn, results in a progressive and effective marketing strategy. This assumes paramount importance, considering the severe competition we are facing in the light of liberalization, privatization and globalization, which encompasses the globe. The prediction of India becoming a lead nation, along with USA, China and Japan, in this decade, can get fructified only if we follow a very high standards of ethics and social responsibility, in all domains including marketing. Organizations like TRW.Rane, Sundaram Fasteners, TVS Motors, in Chennai are a few among others in India, who have achieved the highest distinction in quality viz Deming Prize, and these demonstrate their commitment to quality, society and humanity at large. Cost effectiveness, without jeopardizing quality has become the need of the hour and MRTP has become history. This trait is being brought out through the survey and the results speak for themselves. Unethical practices like switch and bait, not only brings shame to the organization, and country but also results in the company getting wiped out from the market. Adherence to standards like ISO 14000 helps to maintain the minimum level of social responsibility and environmental friendliness. Like quality audit, safety audit etc, social audit is being insisted in all progressive countries to ensure that the organization comply with the minimum statutory requirements. The paper also touches upon Corporate Social Responsibility practiced in the industries and this becomes crystal clear through their commitment to improve the community. Green Marketing lays a lot of importance on the three Rs of environmentalism viz Reduce, Reuse and Recycle. The objective of any business is to achieve optimal profit and this is possible only by reducing the cost as well as waste. In this context, management tools like brainstorming, suggestion schemes, benchmarking etc becomes helpful. These characteristics are brought out through the analysis of survey results. The conclusions drawn throw a lot of information on the desirable practices with respect to Ethics and Social Responsibility in Marketing