Opioid Use among Patients with Early Inflammatory Arthritides Compared to the General Population

Objective.To assess to what extent the worldwide opioid epidemic affects Finnish patients with early inflammatory arthritis (IA).Methods.From the nationwide register maintained by the Social Insurance Institution of Finland, we collected all incident adult patients with newly onset seropositive and seronegative rheumatoid arthritis (RA+ and RA–) and undifferentiated arthritis (UA) between 2010 and 2014. For each case, 3 general population (GP) controls were matched according to age, sex, and place of residence. Drug purchases between 2009 and 2015 were evaluated 1 year before and after the index date (date of IA diagnosis), further dividing this time into 3-month periods.Results.A total of 12,115 patients (66% women) were identified. At least 1 opioid purchase was done by 23–27% of the patients 1 year before and 15–20% one year after the index date. Relative risk (RR) of opioid purchases compared to GP was highest during the last 3-month time period before the index date [RR 2.81 (95% CI 2.55–3.09), 3.06 (2.68-3.49), and 4.04 (3.51–4.65) for RA+, RA–, and UA, respectively] but decreased after the index date [RR 1.38 (1.23–1.58), 1.91 (1.63–2.24), and 2.51 (2.15–2.93)]. Up to 4% of the patients were longterm users both before and after the diagnosis.Conclusion.During 2009–15 in Finland, opioid use peaked just before the diagnosis of IA but decreased rapidly after that, suggesting effective disease control, especially in seropositive RA. Further, opioids were used to treat arthritis pain of patients with incident RA and UA less often than previously reported from other countries.

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Tuberculosis in people with rheumatic disease in Finland 1995–2007: a nationwide retrospective register study

Rheumatology Advances in Practice ◽

10.1093/rap/rkz020 ◽

2019 ◽

Vol 3 (2) ◽

Cited By ~ 3

Author(s):

Marjo Vuorela ◽

Nina J Mars ◽

Juha Salonen ◽

Markku J Kauppi

Keyword(s):

General Population ◽

Rheumatic Disease ◽

Medical Records ◽

Social Insurance ◽

Clinical Manifestations ◽

Marginal Effect ◽

Incidence Trends ◽

Disease Register ◽

Tnf Α ◽

The Social

Abstract Objectives RA and its medication, especially TNF-α inhibitors, increase the risk of clinical tuberculosis (TB) infection. We aimed to investigate the clinical manifestations, incidence and temporal changes in TB occurring concurrently with rheumatic diseases (RDs) between 1995 and 2007. Methods We combined the register of the Social Insurance Institution of Finland and the National Infectious Disease Register to find adult patients with reimbursed DMARDs and with a TB notification between 1995 and 2007. After reviewing the medical records, we described their clinical manifestations and medications, explored TB incidence trends using Poisson regression, and compared the incidence of TB with that of the general population. Results We identified 291 patients with both TB and rheumatic disease (RD), 196 of whom had RA. Between 1995 and 2007, the incidence of TB in adult RD decreased from 58.8 to 30.0 per 100 000 (trend P < 0.001, average marginal effect −3.4/100 000 per year, 95% CI −4.4, −2.4). Compared with the general population, the incidence was ∼4-fold. Among RD patients, pulmonary TB was the most common form of TB (72.6%). Disseminated TB was present in 56 (19.6%) patients. Conclusion The incidence of TB among RD patients was ∼4-fold that of the general population, and it declined between 1995 and 2007. Disseminated TB was present in nearly 20% of patients.

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First-year drug therapy of new-onset rheumatoid and undifferentiated arthritis: A nationwide register-based study.

10.21203/rs.2.17684/v2 ◽

2020 ◽

Author(s):

Paula Muilu ◽

Vappu Rantalaiho ◽

Hannu Kautiainen ◽

Lauri Juhani Virta ◽

Johan Eriksson ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort ◽

Social Insurance ◽

Easy Access ◽

First Year ◽

Undifferentiated Arthritis ◽

The Social ◽

Disease Modifying ◽

Disease Modifying Antirheumatic Drug ◽

New Onset

Abstract Backgroud: In this retrospective cohort study, we evaluated the drug therapies used for early rheumatoid (RA) and undifferentiated (UA) arthritis patients. Methods: From a nationwide register maintained by the Social Insurance Institution, information on sex, date of birth, and date of special medicine reimbursement decision for all new Finnish RA and UA patients between 2011-14 were collected, and their DMARD (Disease Modifying Antirheumatic Drug) purchases during the first year after the diagnosis were analyzed. Results: A total of 7338 patients with early RA (67.3% female, 68.1% seropositive) and 2433 with early UA (67.8% female) were identified. DMARDs were initiated during the first month after the diagnosis to 92.0 % of the patients with seropositive RA, 90.3% with seronegative RA and to 87.7% with UA (p<0.001). Respectively, 72.1%, 63.4%, and 42.9% of the patients (p<0.001) purchased methotrexate; 49.8%, 35.9%, and 16.0% (p<0.001) as part of a DMARD combination during the first month. By the end of the first year after the diagnosis, self-injected biologics were purchased by 2.6%, 5.3% and 3.1% (p<0.001) of them. Only 1.4%, 2.6% and 3.0% (p<0.001) of the patients were not receiving any DMARDs. During the first year, 83.4% of the seropositive RA patients had purchased methotrexate, 50.4% sulfasalazine, 72.1% hydroxychloroquine, and 72.6% prednisolone. Conclusions: Currently, combination therapy including methotrexate is a common treatment strategy for early seropositive RA in Finland. Despite an easy access to biologics, these drugs are seldom needed during the first year after diagnosis.

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An Analysis of Claim Experience in Private Health Insurance to Establish a Relation between Deductibles and Premium Rebates

Astin Bulletin ◽

10.1017/s0515036100011569 ◽

1977 ◽

Vol 9 (1-2) ◽

pp. 257-266

Author(s):

G. W. de Wit ◽

W. M. Kastelijn

Keyword(s):

Health Insurance ◽

Social Insurance ◽

Private Health Insurance ◽

Claim Amount ◽

Class Iii ◽

The Social ◽

Specialist Treatment ◽

Class Iib ◽

One Year ◽

Image Position

Many studies concerning the frequency of claims by size in health insurance are not generally known). A possible explanation of this circumstance could be the fact that in most countries this line of insurance has been brought entirely within the ambit of social insurance. Also from the side of the social insurance very few investigations have been published).In this paper we will analyse the claim experience (relating, to the calendar year 1972) of a private health insurance business. The data have been subdivided according to three levels of coverage (in increasing order of benefits these are: class III, class IIb and class IIa). The claim payments comprise nursing costs, auxiliary costs and the fees for specialist treatment in and out of the hospital.We will use the following notations:Si: claim amount paid for the insured i in one year,n: number of claims,v: number of risks (policies insured).In many instances the premium is simply determined as a level premium. In other words each insured pays the premium p, calculated as follows:.Actually we make the assumption that the claims are normally distributed, the parameters of which can be estimated as follows:which permits the calculation of the premium according to:.

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Relation between integral effect of sub-surface temperature variation (<i>I</i>) and seismic effects

Natural Hazards and Earth System Science ◽

10.5194/nhess-9-1815-2009 ◽

2009 ◽

Vol 9 (6) ◽

pp. 1815-1821

Author(s):

H. Jalal Kamali ◽

A. A. Bidokhti ◽

H. Amiri

Keyword(s):

Temperature Variation ◽

Thermal Structure ◽

Effect Of Temperature ◽

Time Period ◽

Before And After ◽

Integral Effect ◽

Weather Stations ◽

One Year ◽

Recent Earthquakes ◽

Surface Temperature Variation

Abstract. There will be a change in the Earth's local sub-surface thermal structure before and/or after an earthquake. In this work we have introduced a new parameter (I) which relates integral effect of temperature variation and seismic activity. This parameter in its various forms integrates the temperature variations during one year before and after earthquake. Some recent earthquakes are chosen throughout Iran on Alps-Himalayas fault zone with magnitudes 4.5 and more. Subsurface temperatures up to one meter depth measured in nearby weather stations are used as there is no deeper data available. We found the new defined parameter (I) has a direct relation with earthquakes magnitude (M) and reverse relation with distance (d) between earthquake focus and station in which temperature is measured. Suitable formulas for these relations are suggested regarding the magnitude ranges and time period with respect to the earthquake time. There may be a way to use this new parameter as a quake precursor.

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Drug Use before and after Initiating Treatment with Acetylcholinesterase Inhibitors

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000497307 ◽

2019 ◽

Vol 9 (1) ◽

pp. 196-206

Author(s):

Anne Sverdrup Efjestad ◽

Hege Ihle-Hansen ◽

Vidar Hjellvik ◽

Knut Engedal ◽

Hege Salvesen Blix

Keyword(s):

General Population ◽

Psychological Symptoms ◽

Acetylcholinesterase Inhibitors ◽

Behavioral Symptoms ◽

Prescription Database ◽

Opioid Use ◽

People With Dementia ◽

Before And After ◽

Norwegian Prescription Database ◽

Behavioral And Psychological Symptoms

Background/Aims: The aim was to study the prevalence of use of different drugs prescribed for behavioral and psychological symptoms of dementia in persistent users of acetylcholinesterase inhibitors (AChEIs) before and after AChEI initiation, and to compare with the use in the general population. Methods: Use of antidepressants, antipsychotics, and analgesics in the 4 years before and 2 years after AChEI initiation was studied based on data from the Norwegian Prescription Database 2004–2016. Results: The prevalence of use of antidepressants and antipsychotics the year before AChEI initiation was twice the prevalence in the age-adjusted general population and continued to rise in the first 2 years after initiation of AChEIs. The prevalence of weak analgesics and antipsychotics increased strongly in the last year before AChEI initiation. The increase in the use of antidepressants started at least 4 years before initiation of AChEIs. Opioid use was generally lower than in the general population and was not influenced by AChEI initiation. Conclusion: Increased use of antidepressants and antipsychotics was observed both before and after initiation of AChEIs and may indicate that behavioral symptoms occur in a preclinical or early phase of Alzheimer’s disease. The prescription pattern of analgesics with a low use of opioids may indicate an undertreatment of pain in people with dementia.

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Social insecurity of freelance workers: objective position and subjective perception

Inter ◽

10.19181/inter.2019.19.4 ◽

2019 ◽

Vol 11 (19) ◽

pp. 62-80

Author(s):

Galina G. Karpova ◽

Anastasiya S. Ubogova ◽

Anna A. Fedoseeva

Keyword(s):

Social Vulnerability ◽

Social Insurance ◽

Well Being ◽

Subjective Assessment ◽

Subjective Perception ◽

Subjective Assessments ◽

The Social ◽

Social Insecurity ◽

One Year ◽

The Moment

This article is devoted to the social vulnerability of freelance workers and the way it is represented in diﬀerent dimensions of precariousness. According to the previous studies, we identifed the categories of social insurance (fnancial, juridical, lack of social guaranteesand lack of personal well-being) and the most common indicators within each. We conducted a qualitative research using in-depth semi-formal interviews with 21 employees older than 18 years, who are engaged in freelancing at the moment or had such experience in the last couple of years. The number of informants included employees for whom freelance is one of the main sources of income for at least one year. During the interview, the informants were speaking about the subjective assessment of social precariousness and also answered to some questions aimed at identifying the objective features of the precious situation in employment status. In the analysis of subjective assessments of social precariousness, it was revealed that informants cannot be divided into categories according to the degree of precariousness, because they can experience social vulnerability in one or several areas at the same time. According to the results of the study, we propose to consider precariousness as a certain scale from 0 to the maximum value of the insecurity parameters. This approach will take into account the importance of subjective assessment of freelancers’ position, while the dichotomy “precariat — free agent”, which is mostly shared by researchers, does not consider the complexity of this social phenomenon.

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Franco's Internationalists

10.1093/oso/9780198834595.001.0001 ◽

2019 ◽

Cited By ~ 1

Author(s):

David Brydan

Keyword(s):

International Organizations ◽

Social Insurance ◽

Vital Role ◽

Public Health Medicine ◽

Franco Regime ◽

Social State ◽

Progressive Movement ◽

The Social ◽

Before And After ◽

History Of

This book tells the story of the experts who sold the idea of Franco’s ‘social state’. Despite the repression, violence, and social hardship which characterized Spanish life in the 1940s and 1950s, the Franco regime sought to win popular support by promoting its apparent commitment to social justice. This book reveals the vital role which the idea of the social state also played in the regime’s ongoing search for international legitimacy. It shows how social experts, particularly those working in the fields of public health, medicine, and social insurance, were at the forefront of efforts to promote the regime to the outside world. By working with international organizations and transnational networks across Europe, Africa, and Latin America, they sought to sell the idea of Franco’s Spain as a respectable, modern, and socially just state. In doing so the book also seeks to disrupt our understanding of the modern history of internationalism. Exploring what it meant for Francoist experts to think and act internationally, it challenges dominant accounts of internationalism as a liberal, progressive movement by foregrounding the history of fascist, nationalist, imperialist, and religious forms of international cooperation. The case of Spain reveals the contested and heterogenous nature of mid-twentieth-century internationalism, characterized by the tumultuous interplay of overlapping global, regional, and imperial projects. It also brings into focus the overlooked continuities between international structures and projects before and after 1945.

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Psychotropic and anti-epileptic drug use, before and after surgery, among patients with low-grade glioma: a nationwide matched cohort study

BMC Cancer ◽

10.1186/s12885-021-07939-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Isabelle Rydén ◽

Erik Thurin ◽

Louise Carstam ◽

Anja Smits ◽

Sasha Gulati ◽

...

Keyword(s):

Index Date ◽

Low Grade Glioma ◽

Low Grade ◽

Rare Type ◽

Who Grade ◽

Patterns Of Use ◽

Anti Epileptic Drug ◽

Before And After ◽

Grade Ii ◽

One Year

Abstract Background Low-grade glioma (LGG) is a relatively rare type of brain tumour. The use of antidepressant, sedative and anti-epileptic drugs can reflect the burden of the disease. While epilepsy is well-described in patients with LGG, less is known about depression and anxiety. Methods We used nationwide registers to study the use (dispense) of antidepressants, sedatives, and anti-epileptic drugs (AEDs) before and after histopathological LGG diagnosis (WHO grade II). A total of 485 adult patients with a first-time diagnosis and a matched control cohort (n = 2412) were included. Patterns of use were analysed from one year prior to until one year following index date (date of surgery). Logistic regression analysis identified predictors for postoperative use. Results At one year before index date, patients were dispensed AEDs 4 times more than controls, while antidepressants and sedatives were similar. Sedatives and AED peaked shortly after index date at 25 and 69%, respectively. AEDs then stabilized while sedatives decreased rapidly. For antidepressants, a delayed increase was seen after index date, stabilizing at 12%. At one year after index date, the use of antidepressants, sedatives, and AEDs among patients was 2, 3, and 26 times higher, respectively, compared to controls. Predictor for use of AEDs and sedatives at one year following index was previous use and/or a related diagnosis. Female sex and later index year were additional predictors for antidepressants. Conclusions Use of antidepressants, sedatives and AEDs is elevated following diagnosis of LGG. Antidepressants were more commonly dispensed to female patients and in recent years.

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The impact of Regulation (EC) 767/2009 on the practice of feed advertising in Europe

Journal of Applied Animal Nutrition ◽

10.1017/jan.2013.1 ◽

2012 ◽

Vol 1 ◽

Cited By ~ 1

Author(s):

G. Kavanagh ◽

K. Pentieva ◽

J. Kennedy ◽

C. A. Moran

Keyword(s):

Animal Feed ◽

Feed Material ◽

Feed Industry ◽

Information Cues ◽

Market Competitiveness ◽

Time Period ◽

Before And After ◽

Nutritional Needs ◽

One Year ◽

The Impact

SummaryA drive to promote European feed market competitiveness saw the introduction of Regulation (EC) 767/2009 which addresses the placing on the market and use of feed within the European Community. The aim of this study was to determine if the feed industry has changed their advertising practice since the introduction of the Regulation, particularly in reference to Article 13 which sets out the requirements for the use of claims on animal feed. A content analysis of feed material advertisements in nine major EU based feed industry journals, representing all major animal production species, was conducted (n = 822). Relevant advertisements incorporating a time period of one year before and after the enforcement of the Regulation were included. Advertisements were assessed for the level of information provided and the use of claims. The study indicated that there has been a decrease in the provision of information cues on feed advertisements since the Regulation came into being (from 2.5 cues to 1.7 (SEM = 0.56, p < 0.001)). Furthermore, the appearance of certain claims also showed reductions in frequency (reduction in claims relating to improvements in the environmental (χ2 = 4.7, p < 0.05), the nutritional needs of the animal (χ2 = 9.7, p < 0.01) and the effect on the performance of the animal (χ2 = 4.2, p < 0.05)). It is possible that despite the intention to inspire innovation in the food industry, the Regulation may be motivating a more cautious approach to the advertising of feedingstuffs in Europe.

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