Managing diabetes in Switzerland : a systemic approach

Executive summaryThe increasing prevalence of chronic diseases is one of the major causes of rising health expenditure, as stated by the WHO. Not only chronic diseases are very costly, but they are by far the leading cause of mortality in the world, representing 60% of all deaths. Diabetes in particular is becoming a major burden of disease. In Switzerland around 5% of the population suffer of type 2 diabetes and 5 to 10% of the annual health care budget is attributable to diabetes. If the predictions of WHO do realise, the prevalence of diabetes will double until 2030 and so is expected the attributable health expenditure.The objective of this thesis is to provide policy recommendations as to slow down the disease progression and its costly complication. We study the factors that influence diabetes dynamics and the interventions that improve health outcomes while decreasing costs according to different time horizon and use systems thinking and system dynamic.Our results show that managing diabetes requires using integrated care interventions that are effective on three fronts: (1) delaying the onset of complications, (2) slowing down the disease progression and (3) accelerating the time to diagnosis of diabetes and its complications. We recommend firstly the implementation of those interventions targeted at changing patients' behaviour which are also less expensive, but require a change in the delivery of care and medical practices. Then policies targeted at an earlier diagnosis of diabetes, its prevention and the diagnosis of complications are to be considered. This sequence of interventions allows saving money, as total costs decrease, even including the costs of interventions and result in longer life expectancy of diabetics in the long term.In diabetes management there is therefore a trade-off between medical costs and patients' benefits on the one hand and between the objectives of obtaining results in the short or long term on the other hand. Decision makers need to deliver acceptable outcomes in the short term. Considering this criterion, the preferred policy may be to focus only on diagnosed diabetics, thus attempting to slow down the progression of their disease, compared to an integrated care approach addressing all the aspects of the disease. Such a policy also yields desirable results in terms of costs and patients' benefits.

Iowa Commuting Patterns, 2000

A century ago, the majority of workers were employed near their homes—on farms or in cities and towns. As industrialization increased and suburbs surrounded central cities, commuting meant going from homes in suburbs to jobs in cities. Today, there is a growing trend of workers commuting between suburbs. On any given day, 61,775 workers commute to jobs in Iowa counties other than the one in which they live. The most important reason for increased commuting has been employment growth. Rising incomes and the growth of suburbs have also been factors. In the past, the increased employment of women added to the number of commuters. Commuting patterns are a key consideration in transportation planning. In more urban states than Iowa, there is concern that the use of mass transit continues to decline. In Iowa, where so much of our commuting is between counties, private vehicles are often the only practical means of getting to and from work. On any given day, 1,155,008 single-occupancy vehicles are driven to and from jobs somewhere in Iowa. At the same time, an additional158,699 workers share rides by participating in carpools.

Quantifying urban attractiveness from the distribution and density of digital footprints

In the past, sensors networks in cities have been limited to fixed sensors, embedded in particular locations, under centralised control. Today, new applications can leverage wireless devices and use them as sensors to create aggregated information. In this paper, we show that the emerging patterns unveiled through the analysis of large sets of aggregated digital footprints can provide novel insights into how people experience the city and into some of the drivers behind these emerging patterns. We particularly explore the capacity to quantify the evolution of the attractiveness of urban space with a case study of in the area of the New York City Waterfalls, a public art project of four man-made waterfalls rising from the New York Harbor. Methods to study the impact of an event of this nature are traditionally based on the collection of static information such as surveys and ticket-based people counts, which allow to generate estimates about visitors’ presence in specific areas over time. In contrast, our contribution makes use of the dynamic data that visitors generate, such as the density and distribution of aggregate phone calls and photos taken in different areas of interest and over time. Our analysis provides novel ways to quantify the impact of a public event on the distribution of visitors and on the evolution of the attractiveness of the points of interest in proximity. This information has potential uses for local authorities, researchers, as well as service providers such as mobile network operators.

La néphrectomie partielle dans le cancer du rein: un nouveau standard [Partial nephrectomy in renal cancer: a new standard?]

Rising renal cell carcinoma incidence is in relationship with early diagnosis during radiological exams. Radical nephrectomy was the gold standard treatment for 30 years. Partial nephrectomy is nowadays a validated therapeutic option for renal cell carcinoma up to 7 cm with comparable oncological results associated with better life quality and survival. Partial nephrectomy is tricky and laparoscopic approach remains reserved for expert centers.

A Case Study of China’s Commercial Pork Value Chain, August 2005

In China, with the cost of improved technology rising, surplus labor shrinking, and demand for food quality and safety increasing, it will be just a matter of time before the country’s hog production sector will be commercialized like that of developed countries. However, even if China’s cost of production converges to international levels, as shown in this case study, China may continue to retain some competitive advantage because of the labor-intensive nature of the marketing services involved in hog processing and meat distribution. The supply of variety meats offers the most promising market opportunity for foreign suppliers in China. The market may open further if the tariff rate for variety meats is reduced from 20% and harmonized with the pork muscle meat rate of 12%, and if the value-added tax of 13% is applied equally to both imported and domestic products. The fast-growing Western-style family restaurant and higher-end dining sector is another market opportunity for high-quality imported pork.

Social bases of changing income distributions

On the backdrop of very little sociological concern with rising income inequality, this paper examines how key changes in sociodemographic behaviour may help shed additional light on changes in household income distribution and especially on long-term income dynamics and inter-generational mobility. The paper argues that the joint effect of rising marital homogamy in terms of human capital and labour supply contributes generally to widen the income gap between households. Only uner very restrictive conditions, namely when the labour supply of low educated women grows dis-proportionally fast, will women's earnings contribute to more equality. Finally, the paper suggests that women's rising employment commitments contribute positively to equalizing the opportunity structure both via the income effect and if quality care is available, also via more homogenous cultural and cognitive stimulation of children. Mother's work does not generally have adverse effects for children's development.

Children in the welfare state. A social investment approach

Children occupy centre-stage in any new welfare equilibrium. Failure to support families may produce either of two undesirable scenarios. We shall see a society without children if motherhood remains incompatible with work. A new family policy needs to recognize that children are a collective asset and that the cost of having children is rising. The double challenge is to eliminate the constraints on having children in the first place, and to ensure that the children we have are ensured optimal opportunities. The simple reason why a new social contract is called for is that fertility and child quality combine both private utility and societal gains. And like no other epoch in the past, the societal gains are mounting all-the-while that families’ ability to produce these social gains is weakening.In the following 1 analyze the twin challenges of fertility and child development. I then examine which kind of policy mix will ensure both the socially desired level of fertility and investment in our children? The task is to identify a Paretian optimum that will maximize efficiency gains and social equity simultaneously.

Wavelet analysis residual kriging vs. neural network residual kriging

This paper deals with the problem of spatial data mapping. A new method based on wavelet interpolation and geostatistical prediction (kriging) is proposed. The method - wavelet analysis residual kriging (WARK) - is developed in order to assess the problems rising for highly variable data in presence of spatial trends. In these cases stationary prediction models have very limited application. Wavelet analysis is used to model large-scale structures and kriging of the remaining residuals focuses on small-scale peculiarities. WARK is able to model spatial pattern which features multiscale structure. In the present work WARK is applied to the rainfall data and the results of validation are compared with the ones obtained from neural network residual kriging (NNRK). NNRK is also a residual-based method, which uses artificial neural network to model large-scale non-linear trends. The comparison of the results demonstrates the high quality performance of WARK in predicting hot spots, reproducing global statistical characteristics of the distribution and spatial correlation structure.

Viikon albumi -haastattelu osana YleX-kanavan ohjelmatarjontaa

Nuorille suunnatut lähetysvirtaradioasemat käyvät Suomessa koko ajan tiukempaa taistelua kuuntelijoidensa huomiosta. Kuuntelijalukuja tarkastellaan miltei viikoittain ja kuuntelijoille tarjottavaa tuotetta pyritään kilpailun koventuessa koko ajan kehittämään. Yleisradiossa tapahtui viimeksi kanavauudistus vuonna 2003, jonka seurauksena Radiomafia -kanava sai uuden nimen YleX. Uudistuksessa radiokanavan kohdeyleisö tarkennettiin uudelleen ja kanavalla siirryttiin soittolistapohjaiseen radion tekemiseen, jossa kanavan musiikkia soitetaan etukäteen laaditulta soittolistalta. Kanavauudistusta kritisoitiin mediassa ja arkipuheessa, vaikka YleX -kanavan viikkokuulijamäärät lähtivät nousuun. Vieläkin YleX:n musiikkitarjontaa arvostellaan yksipuoliseksi ja samalla myös kanavan ohjelmat ovat joutuneet kritiikin kohteeksi. Opinnäytetyöni käsittelee viihdeartistihaastattelun tekemistä YleX-radiokanavalla. Työssäni YleX-kanavalla olen tehnyt viikoittaista viihdeartistihaastattelua, joka tunnetaan nimellä Viikon Albumi -haastattelu. Tämä haastattelu on osa arkipäiväistä YleX Tänään-ohjelmaa, missä sitä lähetetään maanantaisin kello 11.10. Omia haastatteluja reflektoimalla selvitin haastattelijan näkökulmasta, minkälaisin menetelmin nykyaikaisessa nopeatempoisessa lähetysvirtaradiossa syntyy mielenkiintoinen ja syvällinen viihdeartisti-haastattelu. Kuinka lähelle laadukkaan viihdehaastattelun tavoitteita on mahdollista päästä 15 minuutin Viikon Albumi -haastattelun aikana? Työssäni keskityn etenkin YleX:n haastatteluiden viihteelliseen luonteeseen ja nimenomaan viihdeartistin haastattelemiseen, jota on alan kirjallisuudessa käsitelty melko vähän. Viihdyttävän ja hauskan viihdeartistihaastattelun tekeminen on vaikea haastattelumuoto, jonka tekemistä pyrin valottamaan omien töideni avulla. Toivon, että työstäni on jatkossa hyötyä myös muille samankaltaisissa haastattelutilanteissa.

The impotence of price controls: failed attempts to constrain pharmaceutical expenditures in Greece.

BACKGROUND: While the prices of pharmaceuticals are relatively low in Greece, expenditure on them is growing more rapidly than almost anywhere else in the European Union. OBJECTIVE: To describe and explain the rise in drug expenditures through decomposition of the increase into the contribution of changes in prices, in volumes and a product-mix effect. METHODS: The decomposition of the growth in pharmaceutical expenditures in Greece over the period 1991-2006 was conducted using data from the largest social insurance fund (IKA) that covers more than 50% of the population. RESULTS: Real drug spending increased by 285%, despite a 58% decrease in the relative price of pharmaceuticals. The increase in expenditure is mainly attributable to a switch to more innovative, but more expensive, pharmaceuticals, indicated by a product-mix residual of 493% in the decomposition. A rising volume of drugs also plays a role, and this is due to an increase in the number of prescriptions issued per doctor visit, rather than an increase in the number of visits or the population size. CONCLUSIONS: Rising pharmaceutical expenditures are strongly determined by physicians' prescribing behaviour, which is not subject to any monitoring and for which there are no incentives to be cost conscious.

China´s Economic Security Police Towards ASEAN From

After the economic reforms of 1978, China started rising very fast and started engaging other countries in the region which has served to increase its confidence in the region. In the post cold war period, China was seen as a big threat for the region because of its claims on the South China Sea. Nevertheless, this image was eliminated when China engaged ASEAN and other multilateral and regional organizations. This paper is studying China’s economic and security policies towards ASEAN. Globalization Theory is the theory being used to explain the nature of China-ASEAN relations. This research paper argues that China’s rise is promoting peace in the region. With the engagement policy, China started promoting trade and security co operations based on mutual benefits and dialogues for the peaceful resolutions of the disputes in the region. This contributed greatly to improve China’s image in the region. Additionally, China’s posture during the economic crises of 1997 also greatly contributed to improve its image. Thus, the rise of China is providing opportunity to the other countries in East Asia. Chapter One: Background On China-ASEAN Relations The use of Soft Power and engagement policy by the Chinese government has helped to change China’s image in the region. By using these policies China has been able to clear the feeling of suspicion and mistrust among the Asian states. China has increased its participation in multilateral and regional organizations, such as ASEAN. Due to this China has been able to promote economic and security co-operation among countries in the region. Thus, from being a potential threat China became a potential co-operative partner. Chapter Two: A Look into ASEAN ASEAN was originally formed on 8th August 1967 in Bangkok, Thailand, by Indonesia, Malaysia, the Philippines, Singapore and Thailand. Nevertheless, ASEAN was not the first regional group created to act as forum for dialogue between the leaders of different countries. Thought, it is the only one which could work in the region. The aim of the foundation of ASEAN was to promote peace and stability in the Abstract 2 region and also contain the spread of communism in Southeast Asia. For this reason, China did not engage ASEAN until 1990. However, in 1978 with the establishment of the open up policy China started engaging other countries. It started building trust among its neighboring countries by using soft power. By 1992, China formalized its diplomatic ties with ASEAN as a group. The diplomatic ties between China and ASEAN focus on multilateralism and co-operation as the best way for a more peaceful Asia and the search for common security. Thus, security in the region is promoted through economic co-operation among the states. Therefore the relation between China – ASEAN emphasizes the five principles of peaceful coexistence, mutual benefits in economic co-operation, dialogue promoting trust and the peaceful settlement of disputes. Chapter Three: China-ASEAN Economic Relations Since 1978 The economic reform of 1978 has greatly contributed to the economic development of China. After the adoption of the open up policy, China has been able to establish economic and trade relations with the outside world. The realist school of thought had predicted that Asia will not be stable in the post cold war period. Nevertheless, this has not been the case in Asia. China is growing peacefully with the co-operation of countries in the region. China is establishing strong ties with its neighboring countries. China and ASEAN relations focus on mutual benefit instead of being a zero sum game. Thus these relations are aimed at encouraging trust and economic co-operation in the region. China and ASEAN have agreed on Free Trade to assure that the two parties benefit from the co-operation. The ACFTA will have a great impact on economic, political and security issues. This will enable China to increase its influence in Asia and counterbalance the influences that Japan and U.S have in the region. Chapter Four: China ASEAN Relations in the Security Perspective This Chapter is about China and ASEAN relations on security issue. The new security issues of the post cold war period need to be solved in multilateral way. China as a major power in the region, through its engagement policy has solved most Abstract 3 of the disputes in the region using multilateral means. China has also found ways to solve the dispute over Spratly Islands peacefully, through dialogue using ASEAN. Additionally, China signed the Treaty of Amity in 2003, promoted security initiatives through ARF, Declaration on Conduct of Parties in the South China Sea and documents covering non-traditional security threats, economic co-operation and agricultural co-operation in November 2002, and the Joint Declaration on Strategic. Chapter Five: Finding and Analysis This chapter provides a quantitative and qualitative analysis of the date collected throughout this research. It provides an analysis of how the rise of China is promoting peace in the region. China has been promoting mutual beneficial trade and security co-operation which has increased its influence in the region. China has also been able to solve most of the territorial and border dispute in the region through ASEAN. Thus, ASEAN has amended China’s relations with other countries in the region. Therefore, China’s foreign policy in the region has a big impact in shaping the dynamic relations in East Asia. Conclusion and Recommendations This paper concluded that the relationships between China and ASEAN are contributing to peace in the region. After China engaged ASEAN, it has been able to promote multilateral trade based on mutual benefit. This is clearly emphasized by the CAFTA. Additionally, China has solved most of the dispute in the region. It has also found way for a peaceful resolution of the dispute over Spratly Island. Nowadays, the ASEAN countries don’t see China as a threat to the region. Nevertheless, they’ve adopted deterrence measures such as establishing diplomatic relations with other big powers in the region to assure that the region continues to grow peacefully. Concerning this deterrence measures, I recommend as another way for a continued peaceful growth, the resolution of the outstanding dispute.

Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline.

The prevalence of obesity is rising progressively, even among older age groups. By the year 2030-2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years and older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20 and 30% dependent on the model used. This means 20.9 million obese 60+ people in the USA in 2010 and 32 million obese elders in 2015 in the EU. Although cut-off values of BMI, waist circumference and percentages of fat mass have not been defined for the elderly (nor for the elderly of different ethnicity), it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a BMI above 30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who also have functional impairments, metabolic complications or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should aim to minimize muscle and bone loss but also vigilance as regards the development of sarcopenic obesity - a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone - is important in the elderly, who are vulnerable to this outcome. Life-style intervention should be the first step and consists of a diet with a 500 kcal (2.1 MJ) energy deficit and an adequate intake of protein of high biological quality together with calcium and vitamin D, behavioural therapy and multi-component exercise. Multi-component exercise includes flexibility training, balance training, aerobic exercise and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older have been excluded.

The Three Horsemen of Growth: Plague, War and Urbanization in Early Modern Europe

How did Europe overtake China? We construct a simple Malthusian model with two sectors, and use it to explain how European per capita incomes and urbanization rates could surge ahead of Chinese ones. That living standards could exceed subsistence levels at all in a Malthusian setting should be surprising. Rising fertility and falling mortality ought to have reversed any gains. We show that productivity growth in Europe can only explain a small fraction of rising living standards. Population dynamics - changes of the birth and death schedules - were far more important drivers of the longrun Malthusian equilibrium. The Black Death raised wages substantially, creating important knock-on effects. Because of Engel's Law, demand for urban products increased, raising urban wages and attracting migrants from rural areas. European cities were unhealthy, especially compared to Far Eastern ones. Urbanization pushed up aggregate death rates. This effect was reinforced by more frequent wars (fed by city wealth) and disease spread by trade. Thus, higher wages themselves reduced population pressure. Without technological change, our model can account for the sharp rise in European urbanization as well as permanently higher per capita incomes. We complement our calibration exercise with a detailed analysis of intra-European growth in the early modern period. Using a panel of European states in the period 1300-1700, we show that war frequency can explain a good share of the divergent fortunes within Europe.

The Harsh Fight against Poverty in Sao Tome and Principe

post-independence, and on the other hand, the testimonies from Sao Tomeans individuals from different social conditions and different degrees of political responsibility, this article approaches some possible connections between poverty and micro-violence in Sao Tome and Principe. It is offered an outline of research for the difficulties of the eradication of poverty and, concomitantly, the diffusion of a growing feeling of social disruption, processes in all contrary to the promises of independence for this archipelago. Frequently, the archipelago’s visitors make hasty opinions about the imaginary effortlessness of governing two islands with less than one hundred and fifty thousand citizens. However, contrary to this very common prejudice, the micro-insularity is considered an obstacle to development, a notion shared by many Sao Tomeans. Could micro-insularity equally be, under this outlook, an impoverishment-inducing factor? Regarding the development, there is some truth in this diagnosis, which the Sao Tomeans also use to justify their current difficulties. Throughout the 70s and 80s, the MLSTP – Movimento de Libertação de São Tomé e Príncipe (Movement for the Liberation of Sao Tome and Principe) endorsed a development founded on an expansion of cacao cultures, at the expenses of an intensified production rate, and on an incipient industrialization, which was intended to avoid importations and economic dependency. At the time, the Sao Tomeans leaders justified the rising daily difficulties, quite the opposite of the promises made during the independence, with an economic disarticulation resulting from the gradual abandonment of economic infrastructures inflicted by the last batch of colonists, which affected the cacao plantations too. Simultaneously, both the inefficiency and cost of the industrial endeavors launched after the independence and the erosion of labor and social relationships in nationalized farms had been rather neglected.

Growing at the production frontier. European aggregate growth, 1870-1914

The view of a 1870-1913 expanding European economy providing increasing welfare to everybody has been challenged by many, then and now. We focus on the amazing growth that was experienced, its diffusion and its sources, in the context of the permanent competition among European nation states. During 1870-193 the globalized European economy reached a silver age . GDP growth was quite rapid (2.15% per annum) and diffused all over Europe. Even discounting the high rates of population growth (1.06%), per capita growth was left at a respectable 1.08%. Income per capita was rising in every country, and the rates of improvement were quite similar. This was a major achievement after two generations of highly localized growth, both geographically and socially. Growth was based on the increased use of labour and capital, but a good part of growth (73 per cent for the weighted average of the best documented European countries) came out of total factor productivity efficiency gains resulting from not well specified ultimate sources of growth. This proportion suggests that the European economy was growing at full capacity at its production frontier. It would have been very difficult to improve its performance. Within Europe, convergence was limited, and it only was in motion after 1900. What happened was more the end of the era of big divergence rather than an era of convergence.