Excess winter deaths caused by cardiovascular diseases are associated with both mild winter temperature and socio-economic inequalities in the U.S.

Mortality from cardiovascular diseases (CVD) exhibits seasonal variation. For example, 30% more deaths occurred in winter compared to summer in a multicountry study [1]. The effect of cold temperature on several CVD risk factors and on seasonal influenza infection may partially underlie this seasonal variation [2] and [3]. However an unexplained paradox has been observed: seasonality in CVD mortality is larger in temperate mid-latitude countries (e.g. Portugal) than in colder northern countries (e.g. Scandinavian countries) [1]. This paradox has also been previously observed in Europe for overall mortality, and it may relate to uneven proportions between countries of people who are unable to adequately protect themselves against cold due to low socio-economic status (SES), e.g. inadequate clothing, housing insulation and heating systems [4] and [5]. We hypothesized that the seasonal variability in CVD mortality is larger in low socio-economic U.S. states experiencing mild winters compared to high socio-economic states experiencing cold winters.

Clinical management and burden of bipolar disorder: a multinational longitudinal study (WAVE-bd Study)

BACKGROUND: Studies in bipolar disorder (BD) to date are limited in their ability to provide a whole-disease perspective--their scope has generally been confined to a single disease phase and/or a specific treatment. Moreover, most clinical trials have focused on the manic phase of disease, and not on depression, which is associated with the greatest disease burden. There are few longitudinal studies covering both types of patients with BD (I and II) and the whole course of the disease, regardless of patients' symptomatology. Therefore, the Wide AmbispectiVE study of the clinical management and burden of Bipolar Disorder (WAVE-bd) (NCT01062607) aims to provide reliable information on the management of patients with BD in daily clinical practice. It also seeks to determine factors influencing clinical outcomes and resource use in relation to the management of BD. METHODS: WAVE-bd is a multinational, multicentre, non-interventional, longitudinal study. Approximately 3000 patients diagnosed with BD type I or II with at least one mood event in the preceding 12 months were recruited at centres in Austria, Belgium, Brazil, France, Germany, Portugal, Romania, Turkey, Ukraine and Venezuela. Site selection methodology aimed to provide a balanced cross-section of patients cared for by different types of providers of medical aid (e.g. academic hospitals, private practices) in each country. Target recruitment percentages were derived either from scientific publications or from expert panels in each participating country. The minimum follow-up period will be 12 months, with a maximum of 27 months, taking into account the retrospective and the prospective parts of the study. Data on demographics, diagnosis, medical history, clinical management, clinical and functional outcomes (CGI-BP and FAST scales), adherence to treatment (DAI-10 scale and Medication Possession Ratio), quality of life (EQ-5D scale), healthcare resources, and caregiver burden (BAS scale) will be collected. Descriptive analysis with common statistics will be performed. DISCUSSION: This study will provide detailed descriptions of the management of BD in different countries, particularly in terms of clinical outcomes and resources used. Thus, it should provide psychiatrists with reliable and up-to-date information about those factors associated with different management patterns of BD. TRIAL REGISTRATION NO: ClinicalTrials.gov: NCT01062607.

Cardiovascular disease and the changing face of global public health : a focus on low and middle income countries

Eighty percent of the global 17 million deaths due to cardiovascular disease (CVD) occur in low and middle income countries (LMICs). The burden of CVD and other noncommunicable diseases (NCDs) is expected to markedly increase because of the global aging of the population and increasing exposure to detrimental lifestyle-related risk in LMICs. Interventions to reduce four main risks related to modifiable behaviors (tobacco use, unhealthy diet, low physical activity and excess alcohol consumption) are key elements for effective primary prevention of the four main NCDs (CVD, cancer, diabetes and chronic pulmonary disease). These behaviors are best improved through structural interventions (e.g., clean air policy, taxes on cigarettes, new recipes for processed foods with reduced salt and fat, urban shaping to improve mobility, etc.). In addition, health systems in LMICs should be reoriented to deliver integrated cost-effective treatment to persons at high risk at the primary health care level. The full implementation of a small number of highly cost effective, affordable and scalable interventions ("best buys") is likely to be the necessary and sufficient ingredient for curbing NCDs in LMICs. NCDs are both a cause and a consequence of poverty. It is therefore important to frame NCD prevention and control within the broader context of social determinants and development agenda. The recent emphasis on NCDs at a number of health and economic forums (including the September 2011 High Level Meeting on NCDs at the United Nations) provides a new opportunity to move the NCD agenda forward in LMICs.

Trace element monitoring in the ICU: quality and economic impact of a change in sampling practice.

BACKGROUND & AIMS: Trace elements (TE) are involved in the immune and antioxidant defences which are of particular importance during critical illness. Determining plasma TE levels is costly. The present quality control study aimed at assessing the economic impact of a computer reminded blood sampling versus a risk guided on-demand monitoring of plasma concentrations of selenium, copper, and zinc. METHODS: Retrospective analysis of 2 cohorts of patients admitted during 6 months periods in 2006 and 2009 to the ICU of a University hospital. INCLUSION CRITERIA: to receive intravenous micronutrient supplements and/or to have a TE sampling during ICU stay. The TE samplings were triggered by computerized reminder in 2006 versus guided by nutritionists in 2009. RESULTS: During the 2 periods 636 patients met the inclusion criteria out of 2406 consecutive admissions, representing 29.7% and 24.9% respectively of the periods' admissions. The 2009 patients had higher SAPS2 scores (p = 0.02) and lower BMI compared to 2006 (p = 0.007). The number of laboratory determinations was drastically reduced in 2009, particularly during the first week, despite the higher severity of the cohort, resulting in à 55% cost reduction. CONCLUSIONS: The monitoring of TE concentrations guided by a nutritionist resulted in a reduction of the sampling frequency, and targeting on the sickest high risk patients, requiring a nutritional prescription adaptation. This control leads to cost reduction compared to an automated sampling prescription.

Demand-based structural change and balanced economic growth

[eng] We analyze the equilibrium of a multi-sector exogenous growth model where the introduction of minimum consumption requirements drives structural change. We show that equilibrium dynamics simultaneously exhibt structural change and balanced growth of aggregate variables as is observed in US when the initial intensity of minimum consumption requirements is sufficiently small. This intensity is measured by the ratio between the aggregate value of the minimum consumption requirements and GDP and, therefore, it is inversely related with the level of economic development. Initially rich economies benefit from an initially low intensity of the minimum consumption requirements and, as a consequence, these economies end up exhibiting balanced growth of aggregate variables, while there is structural change. In contrast, initially poor economies suffer from an initially large intensity of the minimum consumption requirements, which makes the growth of the aggregate variables unbalanced during a very large period. These economies may never exhibit simultaneously balanced growth of aggregate variables and structural change.

Demand-based structural change and balanced economic growth

[eng] We analyze the equilibrium of a multi-sector exogenous growth model where the introduction of minimum consumption requirements drives structural change. We show that equilibrium dynamics simultaneously exhibt structural change and balanced growth of aggregate variables as is observed in US when the initial intensity of minimum consumption requirements is sufficiently small. This intensity is measured by the ratio between the aggregate value of the minimum consumption requirements and GDP and, therefore, it is inversely related with the level of economic development. Initially rich economies benefit from an initially low intensity of the minimum consumption requirements and, as a consequence, these economies end up exhibiting balanced growth of aggregate variables, while there is structural change. In contrast, initially poor economies suffer from an initially large intensity of the minimum consumption requirements, which makes the growth of the aggregate variables unbalanced during a very large period. These economies may never exhibit simultaneously balanced growth of aggregate variables and structural change.

Value and Prices in Russian Economic Thought: A journey inside the Russian Synthesis, 1890-1920

This book explores Russian synthesis that occurred in Russian economic thought between 1890 and 1920. This includes all the attempts at synthesis between classical political economy and marginalism; the labour theory of value and marginal utility; and value and prices. The various ways in which Russian economists have approached these issues have generally been addressed in a piecemeal fashion in history of economic thought literature. This book returns to the primary sources in the Russian language, translating many into English for the first time, and offers the first comprehensive history of the Russian synthesis. The book first examines the origins of the Russian synthesis by determining the condition of reception in Russia of the various theories of value involved: the classical theories of value of Ricardo and Marx on one side; the marginalist theories of prices of Menger, Walras and Jevons on the other. It then reconstructs the three generations of the Russian synthesis: the first (Tugan-Baranovsky), the second, the mathematicians (Dmitriev, Bortkiewicz, Shaposhnikov, Slutsky, etc.) and the last (Yurovsky), with an emphasis on Tugan-Baranovsky's initial impetus. This volume is suitable for those studying economic theory and philosophy as well as those interested in the history of economic thought.

The Impact of EU Membership on the Economic Governance of Spain

[spa] España no fue admitida en la Comunidad Económica Europea durante el régimen de Franco por razones políticas. Integrarse a la Comunidad Europea en enero de 1986 fue el último peldaño hacia la consolidación definitiva de la democracia en España y de la apertura de su economía.. Los resultados de los veinticinco años como miembro de la UE se han traducido en un impulso sin precedentes de modernización y progreso. España adoptó el “Acervo Comunitario” y recibió considerables beneficios de su integración a la Comunidad, eliminando barreras, siguiendo las políticas comunes, recibiendo fondos europeos y adoptando la moneda europea común. A partir de un nivel del 60% del promedio europeo de renta per capita en 1986, el nivel actual –incluso con la crisis que estalló en 2008- se sitúa en torno al 105 por ciento. Los últimos tres años han sido diferentes y difíciles como consecuencia de la severa crisis económica y financiera.En este contexto este trabajo analiza como los sucesivos gobiernos de España han organizado la gobernanza económica para adaptarla a los cambios cuantitativos y cualitativos que se han ido produciendo en la integración europea.

The Impact of EU Membership on the Economic Governance of Spain

[spa] España no fue admitida en la Comunidad Económica Europea durante el régimen de Franco por razones políticas. Integrarse a la Comunidad Europea en enero de 1986 fue el último peldaño hacia la consolidación definitiva de la democracia en España y de la apertura de su economía.. Los resultados de los veinticinco años como miembro de la UE se han traducido en un impulso sin precedentes de modernización y progreso. España adoptó el “Acervo Comunitario” y recibió considerables beneficios de su integración a la Comunidad, eliminando barreras, siguiendo las políticas comunes, recibiendo fondos europeos y adoptando la moneda europea común. A partir de un nivel del 60% del promedio europeo de renta per capita en 1986, el nivel actual –incluso con la crisis que estalló en 2008- se sitúa en torno al 105 por ciento. Los últimos tres años han sido diferentes y difíciles como consecuencia de la severa crisis económica y financiera.En este contexto este trabajo analiza como los sucesivos gobiernos de España han organizado la gobernanza económica para adaptarla a los cambios cuantitativos y cualitativos que se han ido produciendo en la integración europea.

Economic ideas and economists in the Parliament in the liberal age: The attempt to implement a tax on incomes in Spain in 1868-1869

[spa] El estudio de la presencia de ideas económicas en los debates parlamentarios se ha convertido recientemente en un objeto importante dentro de la investigación sobre el proceso de institucionalización de la economía política en Europa Occidental en la llamada era liberal. En este marco general, este artículo se centra en el análisis de un caso de particular interés: La relevancia del pensamiento económico y el papel jugado por los economistas en los debates parlamentarios que siguieron a la creación de un nuevo impuesto que trataba de captar la renta personal, que fue lanzado por el ministro de Hacienda Laureano Figuerola en 1868. El artículo intenta demostrar, en primer lugar, que las ideas económicas jugaron efectivamente un papel relevante en las discusiones sobre el impuesto sobre la renta y que la presencia e influencia de los economistas en el Legislativo en este tiempo fue notable. En segundo lugar, que este fue un intento serio de modernizar la estructura fiscal española llevado a cabo por el Gobierno Provisional, el cual trató de diseñar un sistema impositivo capaz de fomentar el crecimiento económico del país.

Economic ideas and economists in the Parliament in the liberal age: The attempt to implement a tax on incomes in Spain in 1868-1869

[spa] El estudio de la presencia de ideas económicas en los debates parlamentarios se ha convertido recientemente en un objeto importante dentro de la investigación sobre el proceso de institucionalización de la economía política en Europa Occidental en la llamada era liberal. En este marco general, este artículo se centra en el análisis de un caso de particular interés: La relevancia del pensamiento económico y el papel jugado por los economistas en los debates parlamentarios que siguieron a la creación de un nuevo impuesto que trataba de captar la renta personal, que fue lanzado por el ministro de Hacienda Laureano Figuerola en 1868. El artículo intenta demostrar, en primer lugar, que las ideas económicas jugaron efectivamente un papel relevante en las discusiones sobre el impuesto sobre la renta y que la presencia e influencia de los economistas en el Legislativo en este tiempo fue notable. En segundo lugar, que este fue un intento serio de modernizar la estructura fiscal española llevado a cabo por el Gobierno Provisional, el cual trató de diseñar un sistema impositivo capaz de fomentar el crecimiento económico del país.

Venäjälle suuntautuva tavaraliikenne ja sen ympäristöhaittojen minimointi

Tavaranvaihto Suomen itärajalla on aina ollut hyvin vilkasta. Neuvostoliiton romahtamisen jälkeen kauppaan tuli hetkellisesti erittäin syvä notkahdus, joka kääntyi voimakkaaksi nousuksi lähestyttäessä 1990-luvun puoliväliä. Pelkän vientikaupan oheen tuli välityskauppaa, sekä transitoliikennettä, jolla on ollut huomattavaa paikallista vaikutusta Kaakkois-Suomen työllisyyteen, sekä kuljetusalalle maanlaajuisestikin. Venäjän devalvaatio elokuussa 1998 romahdutti, sekä kaupan, että transitoliikenteen, mutta on sittemmin kääntynyt uuteen nousuun. Koko Venäjän tulevaisuus ja sitä kautta maamme itärajan liikennemäärät ovat varsin vaikeasti ennustettavissa, mutta todennäköisintä on Venäjän talouskasvun jatkuminen, jonka hyödyntämisessä ja tukemisessa myös Suomen tulisi olla. Liikennemäärien kasvu on aiheuttanut paikallisia ympäristöongelmia myös Suomen puolella rajaa. Ongelmat ovat kasaantuneet rajanylityspaikoille Nuijamaalle ja Vaalimaalle valtavien rekkajonojen myötä. Paikallisten asukkaiden elämän helpottamiseksi olisi valtiovallan pyrittävä kehittämään rajanylityspaikkoja, joista erityisesti Nuijamaa on käynyt jo kauan sitten liian pieneksi. Tekninen kehitys pienentää yksittäisen auton aiheuttamaa kuormitusta luonnolle, mutta liikennemäärien kasvu aiheuttaa kasaantuvia paikallisia ongelmia. Olemme toistaiseksi Suomessa EU:n itärajalla. Viron ja muiden Baltian maiden liittymiseen saakka, ja maantieteellisessä erityisasemassa koko unionin alueella. Samalla Suomen olisi muistettava, että meidän itärajalla on toistaiseksi maailman suurin elintasokuilu ja eurooppalainen vastakkain asettelu: EU vastaan Venäjä, länsi vastaan itä.

Two-year outcome of an observe-and-plan regimen for neovascular age-related macular degeneration: how to alleviate the clinical burden with maintained functional results.

PurposeThe purpose of this study was to report the 2-year outcome of an individually tailored 'observe-and-plan' treatment regimen for neovascular age-related macular degeneration (nAMD), and to investigate its clinical value in terms of functional outcome. This regimen aimed to reduce the clinical burden (visits) by employing individually fixed injection intervals, based on the predictability of an individual's need for retreatment.MethodsThis prospective case series included 104 patients (115 eyes) with nAMD. Following three loading doses of ranibizumab, the disease recurrence interval was determined in monthly observation visits. Retreatment was applied in a series of three injections with individually fixed intervals (2 weeks shorter than the recurrence interval), combined with periodic adjustment of the intervals. The allowed injection intervals in treatment plans ranged from 1 to 3 months. If there was no recurrence at 3 months, the patient could change to monitoring alone.ResultsMean visual acuity (VA) improved by 8.7, 9.7, and 9.2 letters at months 3, 12, and 24, respectively. The mean number of injections was 7.8 and 5.8 during years 1 and 2, respectively, whereas the mean number of ophthalmic examinations was 4.0 and 2.9, respectively. The mean treatment interval (after the loading doses) was 2.0 months during year 1, and 2.2 months during year 2.ConclusionThe observe-and-plan regimen significantly improved and maintained VA over the course of 2 years. This favourable functional outcome was achieved with fewer clinic visits compared with other regimens. Therefore, this observe-and-plan regimen has the potential to alleviate the clinical burden of nAMD treatment.

CITRICULTURE ECONOMIC AND FINANCIAL EVALUATION UNDER CONDITIONS OF UNCERTAINTY

ABSTRACT The citriculture consists in several environmental risks, as weather changes and pests, and also consists in considerable financial risk, mainly due to the period ofreturn on the initial investment. This study was motivated by the need to assess the risks of a business activity such as citriculture. Our objective was to build a stochastic simulation model to achieve the economic and financial analysis of an orange producer in the Midwest region of the state of Sao Paulo, under conditions of uncertainty. The parameters used were the Net Present Value (NPV), the Modified Internal Rate of Return(MIRR), and the Discounted Payback. To evaluate the risk conditions we built a probabilistic model of pseudorandom numbers generated with Monte Carlo method. The results showed that the activity analyzed provides a risk of 42.8% to reach a NPV negative; however, the yield assessed by MIRR was 7.7%, higher than the yield from the reapplication of the positive cash flows. The financial investment pays itself after the fourteenth year of activity.

INCLUDING RISK IN ECONOMIC FEASIBILITY ANALYSIS:A STOCHASTIC SIMULATION MODEL FOR BLUEBERRY INVESTMENT DECISIONS IN CHILE

ABSTRACT The traditional method of net present value (NPV) to analyze the economic profitability of an investment (based on a deterministic approach) does not adequately represent the implicit risk associated with different but correlated input variables. Using a stochastic simulation approach for evaluating the profitability of blueberry (Vaccinium corymbosum L.) production in Chile, the objective of this study is to illustrate the complexity of including risk in economic feasibility analysis when the project is subject to several but correlated risks. The results of the simulation analysis suggest that the non-inclusion of the intratemporal correlation between input variables underestimate the risk associated with investment decisions. The methodological contribution of this study illustrates the complexity of the interrelationships between uncertain variables and their impact on the convenience of carrying out this type of business in Chile. The steps for the analysis of economic viability were: First, adjusted probability distributions for stochastic input variables (SIV) were simulated and validated. Second, the random values of SIV were used to calculate random values of variables such as production, revenues, costs, depreciation, taxes and net cash flows. Third, the complete stochastic model was simulated with 10,000 iterations using random values for SIV. This result gave information to estimate the probability distributions of the stochastic output variables (SOV) such as the net present value, internal rate of return, value at risk, average cost of production, contribution margin and return on capital. Fourth, the complete stochastic model simulation results were used to analyze alternative scenarios and provide the results to decision makers in the form of probabilities, probability distributions, and for the SOV probabilistic forecasts. The main conclusion shown that this project is a profitable alternative investment in fruit trees in Chile.