Objective:Age at rheumatoid arthritis (RA) onset varies by geographical latitude. We have investigated to what extent differences in patient-specific factors and country-level socioeconomic... Show moreObjective:Age at rheumatoid arthritis (RA) onset varies by geographical latitude. We have investigated to what extent differences in patient-specific factors and country-level socioeconomic indicators explain this variability. Methods: Patients with RA from the worldwide METEOR registry were included. Bayesian multilevel structural equation models were used to study the relationship between the absolute value of (hospital) geographical latitude and age at diagnosis (as a proxy for age at RA onset). We examined to what extent this effect is mediated by individual patient characteristics and by country-specific socioeconomic indicators and disentangled whether the observed effects occurred at the patient, hospital, or country levels. Results: We included 37 981 patients from 93 hospitals in 17 geographically widespread countries. Mean age at diagnosis per country ranged from 39 (Iran) to 55 (Netherlands) years. Per degree increase in country latitude (between 9.9 degrees and 55.8 degrees), mean age at diagnosis increased by 0.23 years (95% credibility interval: 0.095 to 0.38) (reflecting >10 years difference in age at RA onset). For hospitals within a country, this latitude effect was negligible. Inclusion of patient-specific factors (eg, gender, anticitrullinated protein antibodies status) in the model augmented the main effect from 0.23 to 0.36 years. Inclusion of country-level socioeconomic indicators (eg, gross domestic product per capita) in the model almost effaced the main effect (from 0.23 to 0.051 (-0.37 to 0.38)). Conclusions: Patients living closer to the equator get RA at a younger age. This latitude gradient was not explained by individual patient characteristics, but rather by countries' socioeconomic status, providing a direct link between countries' level of welfare and the clinical onset of RA. Show less
This paper introduces a variety of concepts and methods to examine living standards improvements in Nepal in a dynamic perspective. Using data from three rounds of Nepal Living Standards Surveys... Show moreThis paper introduces a variety of concepts and methods to examine living standards improvements in Nepal in a dynamic perspective. Using data from three rounds of Nepal Living Standards Surveys conducted in the past two decades, together with data from a nationally representative survey that was implemented in 2014 specifically to collect information on social and economic mobility, the paper presents novel statistics on the extent of inter- and intra-generational mobility in Nepal. The findings suggest that there has been appreciable upward mobility in education; that is, Nepalis today are increasingly more likely to be better educated than their parents. However, inter-generational mobility of occupations has been much more muted, with 47 percent of Nepal today remaining in the same occupation as their parents. Upward mobility is higher for younger cohorts and for individuals who move from their rural areas of birth to an urban area. There are also significant differences in mobility by social groups, with Dalits and Terai caste groups having lower upward mobility odds. Examining mobility within generations using synthetic panel techniques, the paper finds that: (a) for every two people who escape poverty, one slides back, suggesting significant churning around the poverty line; (b) a large fraction of those who have escaped poverty remain vulnerable to falling back, with an overall vulnerable population of 45 percent; and (c) the share of the middle class—defined as those with sufficiently low likelihood of falling back into poverty—has increased steadily over the past two decades, reaching 22 percent in 2010–11. However, triangulating subjective well-being data from Gallup, it appears that a majority of even those who constitute the middle class are fundamentally insecure about their economic futures. The prevalence of a large vulnerable population and a nascent, growing but struggling middle class represents a key challenge to consolidating recent gains in moving people out of poverty. Show less
The aim of this thesis was to investigate the limitations in daily life, outcome measures, clinical outcomes with the emphasis on patient satisfaction, and economic aspects of the treatment of hand... Show moreThe aim of this thesis was to investigate the limitations in daily life, outcome measures, clinical outcomes with the emphasis on patient satisfaction, and economic aspects of the treatment of hand osteoarthritis (OA). Patients with hand OA report severe restrictions in daily life, in particular in opening food packaging. We defined guidelines for the industry on the production of easy-to-open food packaging to make life easier for patients in the future. For evaluating the outcome of an intervention, numerous patient-reported outcome measures are used at present with questionable measurement properties. We could show that the Michigan Hand Outcomes Questionnaire demonstrates good measurement properties in patients with trapeziometacarpal (TMC) OA. Many variables determine patient satisfaction with treatment; expectations being fulfilled, relief of pain or symptoms, and the restoration of hand function are the most important determinants. Evaluation of the outcomes of conservative and surgical management in patients with TMC OA showed that surgery leads to significantly improved hand function after one year, while conservative treatment is most effective in the first 6 months. From an economic point of view, surgery is associated with considerably higher costs than conservative treatment, with respect to both healthcare costs and loss of productivity. Show less
J.F.M. van boven; Chavannes, N.H.; Molen, T. van der; Rutten-van Molken, M.P.M.H.; Postma, M.J.; Vegter, S. 2014
De Leidse hoogleraar theoretische fysica Paul Ehrenfest (1880-1933) was goed bevriend met Niels Bohr en Albert Einstein. In tegenstelling tot zijn beroemde tijdgenoten lag zijn kracht niet bij het... Show moreDe Leidse hoogleraar theoretische fysica Paul Ehrenfest (1880-1933) was goed bevriend met Niels Bohr en Albert Einstein. In tegenstelling tot zijn beroemde tijdgenoten lag zijn kracht niet bij het doen van grote ontdekkingen. Wel had hij een uitzonderlijk talent voor het verhelderen van complexe vraagstukken in de fysica. Het leven en werk van Ehrenfest biedt een intrigerend perspectief op de manier waarop wetenschappers uit dat tijdsgewricht hun weg probeerden te vinden in een periode van roerige wetenschappelijke, maatschappelijke en politieke ontwikkelingen. Behalve dat Ehrenfest een bloeiende onderzoeksschool opbouwde droeg hij ook bij aan de ontwikkeling en internationalisering van de Nederlandse natuurkunde, het universitaire onderwijs, en het ontstaan van een nieuw vakgebied __ de econometrie. Hij stimuleerde de ontwikkeling van de Russische en Amerikaanse theoretische fysica en versterkte de band tussen universiteit en industrie. Zijn tijdgenoten kenden Ehrenfest als een invloedrijk persoon die veel had bereikt. Tragisch is dat iedereen, behalve hij zelf, dat zag. Show less
The Asia-Pacific region accounts for 35-40% of the four to five million workers who take to their heels in search of employment each year. In scale, diversity and socio-economic consequences for... Show moreThe Asia-Pacific region accounts for 35-40% of the four to five million workers who take to their heels in search of employment each year. In scale, diversity and socio-economic consequences for the countries involved, contemporary movements of labour fundamentally differ from those of the past. Transnational labour migration can no longer be controlled by political measures or economic arrangements and is in need of a new approach beyond the limitations of neoclassical economic analysis. Show less
When the Asian economic crisis struck Indonesia in 1997 it was generally thought to signal the end of a system of power defined by the corrupt and collusive relationships of KKN (Korupsi, Kolusi... Show moreWhen the Asian economic crisis struck Indonesia in 1997 it was generally thought to signal the end of a system of power defined by the corrupt and collusive relationships of KKN (Korupsi, Kolusi dan Nepotisme). Surely the days of the crony were over, and their corporate empires would be taken over by large international investors. Show less
