El costo de la atención ambulatoria del lupus eritematoso sistémico en Colombia. Contrastes y comparaciones con otras poblaciones.

Introducción: el lupus eritematoso sistémico (LES) es considerado una enfermedad de alto costo. La expresión clínica de la enfermedad depende de la ubicación geografía y la etnicidad. El objetivo de este estudio fue el calcular los costos ambulatorios relacionado al LES en una cohorte colombiana, identificar los predictores de costos y comparar nuestro resultados con otras poblaciones. Métodos: Se realizó una aproximación de tipo prevalencia en 100 pacientes LES en quienes se evaluaron los costos directos médicos, directos no médicos, indirectos e intangibles. Todos los costos médicos fueron evaluados usando una metodología abajo hacia arriba. Los costos directos fueron valorados desde una perspectiva social usando una metodología de micro-costeo. Los costos indirectos se evaluaron mediante una aproximación de capital humano, y los costos intangibles calculados a partir de los años de vida ajustados por calidad (AVAC). Se analizaron los datos por medio de un análisis multivariado. Para comparaciones con otras poblaciones todos los costos fueron expresados como la razón entre los costos y producto interno bruto nacional per cápita. Resultados: La media de costos totales fue 13.031±9.215 USD (ajustados por el factor de conversión de paridad del poder adquisitivo), lo cual representa el 1,66 del PIB per capita de Colombia. Los costos directos son el 64% de los costos totales. Los costos médicos representan el 80% de los costos directos,. Los costos indirectos fueron el 10% y los costos intangibles el 25% de los costos totales. Los medicamentos representaron el 45% de los costos directos. Mayores costos se relacionaron con el estrato socioeconómico, seguro médico privado, AVAC, alopecia, micofenolato mofetilo, y terapia anticoagulante. Los costos directos ajustados de los pacientes con LES en Colombia fueron mayores que en Norte América y en Europa. Conclusiones: el LES impone una carga económica importante para la sociedad. Los costos relacionados con la atención médica y AVAC fueron los principales contribuyentes al alto costo de la enfermedad. Estos resultados pueden ser referencia para determinar políticas en salud pública así como comparar el gasto en salud de forma internacional.

La incidencia de la actualización del tratado de amistad India-Bután 2007 en las orientaciones en materia de política exterior de Bután. 2007-2014

El interés de este estudio de caso es analizar la incidencia de la actualización del Tratado de Amistad entre India y Bután firmado en 2007 en las disposiciones de política exterior de Bután en el periodo 2007-2014. Este trabajo se enmarca en los conceptos de identidad nacional, tomadores de decisiones, proceso de toma de decisión y análisis de política exterior, a partir de los cuales se pretende comprobar que el tratado de 2007 tuvo principalmente un efecto cristalizador en la política exterior de Bután, manifestado de manera significativa en materia de cooperación internacional, moderada en materia de representación política internacional y muy modesta en materia de apertura económica y comercial.

How do inequality affect tax morale in Latin America and Caribbean?

Latin America is well known as an inequitable region. As it is recognized, inequality and corruption perception weaken the way that political institutions works and the democratic system. Focusing on Latin American and Caribbean countries, this paper analyzes what are the elements shaping tax morale. In particular, how the context influences ethical grounds decisions such as the predisposition to pay taxes is analyzed, using the survey carried out in 2005 by Latinobarometro. The objective is to analyze how country performance determines tax morale. To do so, four probitmodels are estimated using Gini index, Transparency International Corruption Perception Index and Gross Domestic Product per capita (GDPpc) as explanatory variables. As expected we found that some socio-demographic variables play a relevant role. Interestingly, we also found that, in this attitude, LAC countries do not register a gender bias. However, those are not our main contributions to the literature on the field. The most important results are linked to: 1) the levelmatters, GDPpc increases the probability of people having tax morale, 2) moreover, income distributionalso influence on tax morale but in opposite direction and 3) corruption perception also reduces tax morale. Those results show that the quality of institutions matters and therefore, the way that democracy works play a relevant role.

Economia política da corrupção : caso dos Estados Lusófonos

Elaborar uma Economia Política da Corrupção, como falha do Estado, é reconhecer que o Estado serve elites e é necessária legislação concreta para limitar a actuação e os excessos da classe política e dos funcionários da Administração. A questão central para tese é a da verificação da existência de uma relação entre a pobreza e o nível de corrupção nos Estados Lusófonos, medida pela Transparency International. Depois de avaliado o estado da arte e feita a história do próprio estudo da corrupção, utilizando os métodos da análise económica e do estudo de opinião, concluímos que as críticas ao Índice de Percepção da Corrupção elaborado pela Transparency International não colhem. Com efeito, a tese prova que a corrupção diminui o potencial de uma economia. Usando métodos econométricos concluimos ainda pela existência de uma relação linear entre o Produto Interno Bruto per capita e o rating dos Estados Lusófonos no Índice de Percepção da Corrupção. Finalmente, um estudo de opinião sobre “a corrupção em Portugal”, elaborado em 2008, conclui que é nos Serviços de Saúde e no Fisco que há mais corrupção em Portugal, um país, contudo, que fez o upgrading legislativo nos últimos anos e onde a corrupção, apesar de tudo, não atinge os níveis de outros Países de Expressão Oficial Portuguesa.

An Integrated Assessment of changes in the thermohaline circulation

This paper discusses the risks of a shutdown of the thermohaline circulation (THC) for the climate system, for ecosystems in and around the North Atlantic as well as for fisheries and agriculture by way of an Integrated Assessment. The climate model simulations are based on greenhouse gas scenarios for the 21st century and beyond. A shutdown of the THC, complete by 2150, is triggered if increased freshwater input from inland ice melt or enhanced runoff is assumed. The shutdown retards the greenhouse gas-induced atmospheric warming trend in the Northern Hemisphere, but does not lead to a persistent net cooling. Due to the simulated THC shutdown the sea level at the North Atlantic shores rises by up to 80 cm by 2150, in addition to the global sea level rise. This could potentially be a serious impact that requires expensive coastal protection measures. A reduction of marine net primary productivity is associated with the impacts of warming rather than a THC shutdown. Regional shifts in the currents in the Nordic Seas could strongly deteriorate survival chances for cod larvae and juveniles. This could lead to cod fisheries becoming unprofitable by the end of the 21st century. While regional socioeconomic impacts might be large, damages would be probably small in relation to the respective gross national products. Terrestrial ecosystem productivity is affected much more by the fertilization from the increasing CO2 concentration than by a THC shutdown. In addition, the level of warming in the 22nd to 24th century favours crop production in northern Europe a lot, no matter whether the THC shuts down or not. CO2 emissions corridors aimed at limiting the risk of a THC breakdown to 10% or less are narrow, requiring departure from business-as-usual in the next few decades. The uncertainty about THC risks is still high. This is seen in model analyses as well as in the experts’ views that were elicited. The overview of results presented here is the outcome of the Integrated Assessment project INTEGRATION.

Greening the United Nations' Human Development Index?

The Human Development Index (HDI) introduced by the United Nations Development Programme (UNDP) in 1990 has helped facilitate widespread debate amongst development researchers, practitioners and policy makers. The HDI is an aggregate index, calculated on an annual basis by the UNDP and published in its Human Development Reports, comprising measures of three components deemed by them to be central to development: W income (the gross domestic product per capita), (ii) education (adult literacy rate) and (iii) health (life expectancy at birth). The results of calculating the HDI are typically presented as country/regional league tables, and provide a quick means for policy makers and others to judge performance. Perhaps partly because of the relative simplicity of the index, the HDI has managed to achieve a level of acceptance and use amongst politicians and policy makers that has yet to emerge with any indicator of sustainability. Indeed, despite its existence for 11 years, including nine years after the Rio Earth Summit, the HDI has not even been modified to take on board wider issues of sustainability. This paper will critically examine the potential for 'greening' the HDI so as to include environmental and resource-consumption dimensions. Copyright (C) 2003 John Wiley & Sons, Ltd and ERP Environment.

The Bureau International des Poids et Mesures: establishing standards in the physical sciences

In a vault on the outskirts of Paris, a cylinder of platinum-iridium sits in a safe under three layers of glass. It is the kilogram, kept by the Bureau International des Poids et Mesures (BIPM), which is the international home of metrology. Metrology is the science of measurement, and it is of fundamental importance to us all. It is essential for trade, commerce, navigation, transport, communication, surveying, engineering, and construction. It is essential for medical diagnosis and treatment, health and safety, food and consumer protection, and for preserving the environment—e.g., measuring ozone in the atmosphere. Many of these applications are of particular relevance to chemistry and thus to IUPAC. In all these activities we need to make measurements reliably—to an appropriate and known level of uncertainty. The financial implications of metrology are enormous. In the United States, for example, some 15% of the gross domestic product is spent on healthcare, involving reliable quantitative measurements for both diagnosis and treatment.

Is agriculture the engine of growth?

We seek to address formally the question raised by Gardner (2003) in his Elmhirst lecture as to the direction of causality between agricultural value added per worker and Gross Domestic Product (GDP) per capita. Using the Granger causality test in the panel data analyzed by Gardner for 85 countries, we find overwhelming evidence that supports the conclusion that agricultural value added is the causal variable in developing countries, while the direction of causality in developed countries is unclear. We also examine further the use of the Granger causality test in integrated data and provide evidence that the performance of the test can be increased in small samples through the use of the bootstrap.

The impact of multiskilling on UK construction manpower

The overall significance of the construction and building services sector internationally cannot be overemphasised. In the UK, the industry currently accounts for 10% gross domestic product (GDP) and employs 2 million people, which is more than 1 in 14 of the total workforce. However, regardless of its output (approximately £65 billion annually) there has been a steady decline in the number of trade entrants into the construction and building services sector. Consequently, the available ‘pool of labour’ is inadequately resourced; productivity is low; the existing labour force is overstressed; there is an increase in site deaths; and a long-term labour shortage is envisaged. Today, the evidence seems to suggest that multiskilling is a tentative redress for ameliorating the skills crisis in the construction and building sectors. A 43-year time-series of data on 23 manpower attributes was evaluated as part of this investigation. The developed linear regression models show that the concept of multiskilling obeys the ‘law of diminishing returns'. That is, a weak relation was found between construction output and a three or more combination of manpower attributes. An optimisation model is prescribed for traditional trades.

A framework for agricultural adaptation to climate change in Southern Nigeria

The agricultural sector which contributes between 20-50% of gross domestic product in Africa and employs about 60% of the population is greatly affected by climate change impacts. Agricultural productivity and food prices are expected to rise due to this impact thereby worsening the food insecurity and poor nutritional health conditions in the continent. Incidentally, the capacity in the continent to adapt is very low. Addressing these challenges will therefore require a holistic and integrated adaptation framework hence this study. A total of 360 respondents selected through a multi-stage random sampling technique participated in the study that took place in Southern Nigeria from 2008-2011. Results showed that majority of respondents (84%) were aware that some climate change characteristics such as uncertainties at the onset of farming season, extreme weather events including flooding and droughts, pests, diseases, weed infestation, and land degradation have all been on the increase. The most significant effects of climate change that manifested in the area were declining soil fertility and weed infestation. Some of the adaptation strategies adopted by farmers include increased weeding, changing the timing of farm operations, and processing of crops to reduce post-harvest losses. Although majority of respondents were aware of government policies aimed at protecting the environment, most of them agreed that these policies were not being effectively implemented. A mutually inclusive framework comprising of both indigenous and modern techniques, processes, practices and technologies was then developed from the study in order to guide farmers in adapting to climate change effects/impacts.

Extreme bounds of democracy

What determines the emergence and survival of democracy? The authors apply extreme bounds analysis to test the robustness of fifty-nine factors proposed in the literature, evaluating over three million regressions with data from 165 countries from 1976 to 2002. The most robust determinants of the transition to democracy are gross domestic product (GDP) growth (a negative effect), past transitions (a positive effect), and Organisation for Economic Co-operation and Development membership (a positive effect). There is some evidence that fuel exporters and Muslim countries are less likely to see democracy emerge, although the latter finding is driven entirely by oil-producing Muslim countries. Regarding the survival of democracy, the most robust determinants are GDP per capita (a positive effect) and past transitions (a negative effect). There is some evidence that having a former military leader as the chief executive has a negative effect, while having other democracies as neighbors has a reinforcing effect.

Rationality and momentum in real estate investment forecasts

This study examines the rationality and momentum in forecasts for rental, capital value and total returns for the real estate investment market in the United Kingdom. In order to investigate if forecasters are affected by the general economic conditions present at the time of forecast we incorporate into the analysis Gross Domestic Product(GDP) and the Default Spread (DS). The empirical findings show high levels of momentum in the forecasts, with highly persistent forecast errors. The results also indicate that forecasters are affected by adverse conditions. This is consistent with the finding that they tend to exhibit greater forecast error when the property market is underperforming and vice-versa.

A risk-based framework for assessing the effectiveness of stratospheric aerosol geoengineering

Geoengineering by stratospheric aerosol injection has been proposed as a policy response to warming from human emissions of greenhouse gases, but it may produce unequal regional impacts. We present a simple, intuitive risk-based framework for classifying these impacts according to whether geoengineering increases or decreases the risk of substantial climate change, with further classification by the level of existing risk from climate change from increasing carbon dioxide concentrations. This framework is applied to two climate model simulations of geoengineering counterbalancing the surface warming produced by a quadrupling of carbon dioxide concentrations, with one using a layer of sulphate aerosol in the lower stratosphere, and the other a reduction in total solar irradiance. The solar dimming model simulation shows less regional inequality of impacts compared with the aerosol geoengineering simulation. In the solar dimming simulation, 10% of the Earth’s surface area, containing 10% of its population and 11% of its gross domestic product, experiences greater risk of substantial precipitation changes under geoengineering than under enhanced carbon dioxide concentrations. In the aerosol geoengineering simulation the increased risk of substantial precipitation change is experienced by 42% of Earth’s surface area, containing 36% of its population and 60% of its gross domestic product.

Causal relationships vs. emergent patterns in the global controls of fire frequency

Global controls on month-by-month fractional burnt area (2000–2005) were investigated by fitting a generalised linear model (GLM) to Global Fire Emissions Database (GFED) data, with 11 predictor variables representing vegetation, climate, land use and potential ignition sources. Burnt area is shown to increase with annual net primary production (NPP), number of dry days, maximum temperature, grazing-land area, grass/shrub cover and diurnal temperature range, and to decrease with soil moisture, cropland area and population density. Lightning showed an apparent (weak) negative influence, but this disappeared when pure seasonal-cycle effects were taken into account. The model predicts observed geographic and seasonal patterns, as well as the emergent relationships seen when burnt area is plotted against each variable separately. Unimodal relationships with mean annual temperature and precipitation, population density and gross domestic product (GDP) are reproduced too, and are thus shown to be secondary consequences of correlations between different controls (e.g. high NPP with high precipitation; low NPP with low population density and GDP). These findings have major implications for the design of global fire models, as several assumptions in current models – most notably, the widely assumed dependence of fire frequency on ignition rates – are evidently incorrect.

Economic crises in England, 1270-1520: a statistical approach

The chapter examines how far medieval economic crises can be identified by analysing the residuals from a simultaneous equation model of the medieval English economy. High inflation, falls in gross domestic product and large intermittent changes in wage rates are all considered as potential indicators of crisis. Potential causal factors include bad harvests, wars and political instability. The chapter suggests that crises arose when a combination of different problems overwhelmed the capacity of government to address them. It may therefore be a mistake to look for a single cause of any crisis. The coincidence of separate problems is a more plausible explanation of many crises.