The economic burden of depression among adults with rheumatoid arthritis in the United States

Aims: Depression is the most frequent comorbidity reported among patients with rheumatoid arthritis (RA). Comorbid depression negatively impacts RA patients’ health-related quality-of-life, physical function, mental function, mortality, and experience of pain and symptom severity. The objective of this study was to assess healthcare utilization, expenditures, and work productivity among patients with RA with or without depression.

Materials and methods: Data from adult patients who had at least two visits each related to RA and depression over a 1-year period were extracted from the Truven Health MarketScan research databases. Outcomes comprised healthcare resource utilization, work productivity loss, and direct healthcare costs comparing patients with RA with depression (n?=?3,478) vs patients with RA without depression (n?=?43,222).

Results: Patients with RA and depression had a significantly greater relative risk of hospitalization and number of all-cause and RA-related hospitalizations, utilization of emergency services, days spent in the hospital, physician visits, and RA-related surgeries compared with RA patients without depression. Patients with RA and depression had a higher risk of and experienced more events and days of short-term disability compared with patients without depression. The incremental adjusted annual all-cause and RA-related direct costs were $8,488 (95% CI = $6,793–$10,223) and $578 (95% CI = –$98–$1,243), respectively, when comparing patients with RA and depression vs RA only.

Limitations: The current analysis is subject to the known limitations of retrospective studies based on administrative claims data.

Conclusions: This study suggested increased healthcare utilization, work productivity loss, and economic burden among RA patients due to comorbid depression. These findings emphasize the importance of managing depression and including depression as a factor when devising treatment algorithms for patients with RA.     

Can investors time their exposure to private equity?

Private equity performance, both for buyouts and venture capital, has been highly cyclical: periods of high fundraising have been followed by periods of low performance. Despite this seemingly predictable variation, we find modest gains, at best, to pursuing realistic, investable strategies that time capital commitments to private equity. This occurs, in part, because investors can only time their commitments to funds; they cannot time when commitments are called or when investments are exited. There is a high degree of time-series correlation in net cash flows even across commitment strategies that allocate capital in a very different manner over time.     

Influence of livelihoods on climate change adaptation for smallholder farmers in the Mekong Delta Vietnam

Farmers in the Vietnamese Mekong Delta face a wide range of climate-related and hydrological factors which threaten rice production. Smallholder farmers must adapt to climate change to sustain rice production as their central and most important livelihood activity. A sample was stratified across agro-ecological areas in the Delta affected by flooding, alluvial soils, acid sulphate soils, and saline water intrusion and by derived farmer typologies. A rural livelihoods approach was used in focus group discussions and in-depth interviews to identify and enumerate enabling and constraining adaptation factors. Smallholders experienced diverse natural hazards such as floods, abnormal rains, high temperatures, water scarcity, and salinity intrusion specific to the agro-ecological areas. Adaptation was constrained by labour shortages, water quality, topography, access to combine harvesters, transportation infrastructure, dryers and household savings. Adaptation was enabled by farming techniques and experience, cooperative groups, water quantity, access to information, and ability to purchase agro-chemicals through credit. Small farmers (< 1?ha) were more constrained than large farmers (> 1?ha) who had an expanded livelihood asset base. A range of policy implications are discussed, but adaptation is not just about technological fixes but requires overall improvements in a range of human, social and financial components.     

Risk-Adjusted Discount Rates and Projects of Unequal Lives

When evaluating mutually exclusive projects of unequal lives and with differing risk, standard approaches such as the constant chain of replacement, lowest common multiple and equivalent annual value techniques are usually applied. In using these techniques to rank projects, a critical issue is the manner in which uncertainty in the cashflows is resolved through time. We explore the applicability of net present value techniques to the problem of valuing assets with unequal lives, emphasising the use of equivalent annual value and lowest common multiple methods, and the correct choice of discount rate. Our results have direct application to practical capital budgeting problems such as choosing the optimum lifespan for a single asset, choosing between assets with different lifespans, and deciding whether to "run an asset for another year".     

State Trading Enterprises as an Impediment to Improved Market Access: The Case of the Korean Rice Market

The trade and welfare effects of tariffs are well known. Less well known, and more difficult to analyze, are the economic effects of state trading enterprises (STEs). Despite STEs in importing countries having the potential to limit market access, they are no longer on the agriculture agenda in the Doha Round Negotiations in the WTO, because some Members have asserted that importing STEs do not distort international trade. We evaluate this assertion through the use of a theoretical model of an STE, which is calibrated to data for the Korean rice market. We show that this STE does distort international trade by restricting market access relative to a Cournot benchmark, and that it affects the domestic and international distribution of social welfare. This finding permits the conclusion that an important opportunity is being missed in the negotiations to improve market access, because importing STEs are not on the agenda.     

Forecasting Emerging Market Exchange Rates from Foreign Equity Options

The use of derivatives to infer future exchange rates has long been a subject of interest in the international finance literature. With the recent currency crises in Mexico, Southeast Asia, and Brazil, work on exchange rate expectations in emerging markets is of particular interest. For some emerging markets, foreign equity options are the only liquid exchange‐traded derivatives with currency information embedded in their prices. Given that emerging markets sometimes undergo currency realignment with discrete jumps in their exchange rate, estimation of risk‐neutral probability density functions from foreign equity option data provides valuable evidence concerning market expectations. To illustrate the use of foreign equity options in estimating market beliefs, we consider Telmex options around the 1994 peso devaluation and find evidence that markets anticipated the change in the Mexican government's foreign exchange policy.     

Negotiating the Evolution of the Hr Function: Practical Advice From the Health Care Sector

This paper has two aims. First, to consider explanations for the apparent gap between the paradigm of strategic human resource management on the one hand and actual HR practice on the other. Second, to generate practical advice for senior HR specialists who are aspriring to develop a strategic role for their function. the research underpinning these findings was based on case studies in three hospitals in Adelaide and a comparison of the findings with the situation at Leicester General NHS Trust where the first named author of this article was the HR director and a senior board member. the analysis reveals that specific features of each organisation's history, current structure and management, shape powerfully the nature of the HR function. Moreover, the local shaping factors define the degrees of freedom open to the HR function, so much so, that the notion that it can choose its organisational stance is here challenged.