Comparing precaution in the United States and Europe

The regulation of health and environmental risks has generated transatlantic controversy concerning precaution and the precautionary principle (PP). Conventional wisdom sees the European Union endorsing the PP and proactively regulating uncertain risks, while the United States opposes the PP and waits for evidence of harm before regulating. Without favouring either approach, this paper critically analyses the conventional depiction of transatlantic divergence. First, it reviews several different versions of the PP and their different implications. Second, it broadens the transatlantic comparison of precaution beyond the typical focus on single-risk examples, such as genetically modified foods. Through case studies, including hormones in beef and milk production and mad cow disease in beef and in blood donations, as well as reference to a wider array of risks, the paper demonstrates that relative precaution varies enormously. Sometimes the EU is more precautionary than the US (such as regarding hormones in beef), while sometimes the US is more precautionary than the EU (such as regarding mad cow disease in blood). Thus, neither the EU nor the US can claim to be categorically 'more precautionary' than the other. The real pattern is complex and risk-specific. Third, the paper seeks explanations for this complex pattern in five sets of hypotheses: optimal tailoring on the merits, political systems, risk perceptions, trade protectionism, and legal systems. None of these hypotheses fully explains the observed complex pattern of relative transatlantic precaution. The paper concludes that differences in relative precaution depend more on the context of the particular risk than on broad differences in national regulatory regimes.     

Risk of all-cause hospitalization in COPD patients initiating long-acting or short-acting beta agonist therapy

Abstract

Objective:

This retrospective claims study investigated the rates of all-cause hospitalization among chronic obstructive pulmonary disease (COPD) patients initiating treatment with short-acting beta agonists (SABA) or long-acting beta agonists (LABA).

Methods:

Data from the 5% national sample of Medicare enrollees for 2006–2008 were used. Patients initiating COPD therapy were identified as those with no COPD therapy for ≥ 6-months prior to initiating SABA or LABA (administered via dry-powder inhalers, metered-dose inhalers, or nebulizer) treatment. All patients were continuously eligible for Medicare Parts A, B, and D for 18 months. Those enrolled in Medicare Advantage, who had asthma, or were < 65 years old were excluded. Differences in the rates of all-cause hospitalizations and time to all-cause hospitalization during the 6-month follow-up period were examined, while adjusting for demographics, clinical indicators, and health service use.

Results:

Among 3017 COPD patients who met the inclusion criteria, 883 (30%) were LABA users and 2134 (70%) were SABA users. Overall, 21% of patients (16% [144/883] of LABA and 23% [492/2134] of SABA) had a hospitalization during the follow-up period. Mean time to hospitalization was 86 days for LABA vs 64 days for SABA patients (p?<?0.05). The adjusted hazard ratio for hospitalization in a Cox proportional hazards model was 0.74 (95% CI?=?0.62–0.90) for patients treated with LABA vs. SABA.

Limitations:

The analysis was adjusted for multiple background characteristics, but important measures of severity in COPD, such as measures of lung functioning, were not available and may have differed between patients treated with LABA or SABA.

Conclusions:

The results of this analysis indicate COPD patients initiating LABA treatment had a longer time to all-cause hospitalization and a 26% lower risk of hospitalization during the 6-months follow-up period compared to those initiating SABA therapy.     

基于SAS的调整人群归因危险度评估法在口岸流行病学调查中的应用研究

[目的]探索调整人群归因危险度评估法在口岸流行病学调查中的应用。[方法]基于回归模型的调整RR估计加入到PAR估计中,以一整套公式计算调整控制一个或多个变量后的PAR指标,评估多因素影响的口岸流行病发生频率及控制效果,并采用国际权威的统计分析标准软件SAS分析平台进行编程实现。[结果]以宁波口岸某病流行病学调查资料为数据源,对与该病相关的四种风险影响因素由计算机分别自动计算调整人群归因危险度,在校正其他三种因素的基础上,评估每种风险因素所致的危害程度,结果为风险因素A所致的危害占11.8%,风险因素B占30.8%,风险因素C占15.9%,风险因素D占38.2%。[结论]调整人群归因危险度能够评估导致口岸传染病流行风险因素的单独效应,可作为评价流行病发生与控制效果的有效评估方法。     

三江闸与1537年以来萧绍平原的姜片虫病

1537年三江闸建成之后,引起萧绍平原水系水流平缓、扁角螺孳生环境改善、河浜和低田大量形成以及水生作物普遍种植等一系列生态反应。嘉靖之后,水红菱又种于高田,使姜片虫病成为明清江浙水网地带名副其实的萧绍病。一项水利工程,就这样出人意料地参与和制约了一个区域独特的农业和疾病的历史。     

曲美他嗪治疗心力衰竭的临床疗效

目的：探讨曲美他嗪治疗心力衰竭的临床疗效。方法选取我院2014年1月至4月心内科收治的心力衰竭患者56例作为观察组,在常规治疗基础上给予曲美他嗪治疗。同时,选取同期收治的心力衰竭患者56例作为对照组,给予常规治疗,比较两组患者的临床疗效。结果观察组患者总有效率为92.9%,对照组患者总有效率为78.6%,差异有统计学意义（P＜0.05）;观察组患者在心脏指标、心功能改善情况明显优于对照组,差异有统计学意义（P＜0.05）。结论曲美他嗪在改善和恢复心力衰竭患者心功能方面疗效确切,心肌缺血明显缓解,有利于心力衰竭患者生存质量的提高,可作为临床上治疗心力衰竭的良好辅助药物。     

自然资源丰裕程度与经济发展水平关系的研究

“资源的诅咒”是经济学中的一个经典假说,但这一命题在一国内部不同地区是否成立尚缺乏验证。本文以中国的省际面板数据为样本,对这一假说进行了实证检验。计量结果显示,该命题在我国内部的地区层面同样成立,多数省份丰裕的自然资源并未成为经济发展的有利条件,反而制约了经济增长。自然资源的丰裕以及对这种资源的依赖,主要是通过资本投入的转移机制制约了经济增长,劳动投入的转移机制也存在这种效应,但不如前者显著。本文选择山西为典型省份,进一步揭示“资源的诅咒”的作用机制。结果表明,密集而过度的资源开采引致的制造业衰退和制度弱化是制约经济增长的主要原因。     

Endemic-epidemic models with discrete-time serial interval distributions for infectious disease prediction

Multivariate count time series models are an important tool for analyzing and predicting the spread of infectious disease. We consider the endemic-epidemic framework, a class of autoregressive models for infectious disease surveillance counts, and replace the default autoregression on counts from the previous time period with more flexible weighting schemes inspired by discrete-time serial interval distributions. We employ three different parametric formulations, each with an additional unknown weighting parameter estimated via a profile likelihood approach, and compare them to an unrestricted nonparametric approach. The new methods are illustrated in a univariate analysis of dengue fever incidence in San Juan, Puerto Rico, and a spatiotemporal study of viral gastroenteritis in the 12 districts of Berlin. We assess the predictive performance of the suggested models and several reference models at various forecast horizons. In both applications, the performance of the endemic-epidemic models is considerably improved by the proposed weighting schemes.     

The recovery of global stock markets indices after impacts due to pandemics

The COVID-19 brings back the debate about the impact of disease outbreaks in economies and financial markets. The error correction terms (ECT) and cointegration processing tools have been applied in studies for identifying possible transmission mechanisms between distinct time series. This paper adopts the vector error correction model (VECM) to investigate the dynamic coupling between the pandemics (e.g., the COVID-19, EBOLA, MERS and SARS) and the evolution of key stocks exchange indices (e.g., Dow-Jones, S&P 500, EuroStoxx, DAX, CAC, Nikkei, HSI, Kospi, S&P ASX, Nifty and Ibov). The results show that the shocks caused by the diseases significantly affected the markets. Nonetheless, except for the COVID-19, the stock exchange indices reveal a sustained and fast recovering when an identical length time window of 79 days is analyzed. In addition, our findings contribute to point a higher volatility for all financial indices during the COVID-19, a strong impact over the Ibov-Brazil and its poor recover when compared to the other indices.     

Hospital-based inpatient resource utilization associated with autosomal dominant polycystic kidney disease in the US

Abstract

Objective:

Polycystic kidney disease (PKD) is a clinically and genetically heterogeneous class of genetic disorders characterized by development of renal cysts leading to renal failure and end stage renal disease (ESRD). Autosomal dominant polycystic kidney disease (ADPKD) accounts for the majority of PKD cases and is the predominant monogenic cause of ESRD. Limited information on patient characteristics and healthcare resource utilization is available in this population. This study assessed hospital-based inpatient utilization of patients with ADPKD in the US to help further understand the disease, which may lead to treatments that delay progression and reduce healthcare resource utilization.

Methods:

A cross-sectional analysis was conducted using MedAssets Health System Data to investigate inpatient resource utilization for a total of 1876 patients hospitalized with ADPKD or chronic kidney disease (CKD). Patient characteristics and inpatient resource utilization were compared between hospitalized patients with ADPKD and CKD, including demographic and clinical characteristics, overall health, rates of complications and surgical interventions, and average length of hospital and intensive care unit stay.

Results:

Compared with patients with CKD, patients with ADPKD were more likely to have commercial insurance as their primary payer (36.1 vs 17.8%) and were significantly younger (mean age 57.9 vs 69.5 years) and generally healthier (Charlson Comorbidity Score of 2.0 vs 3.3). Patients with ADPKD also had a substantially shorter average length of hospital stay (6.3 vs 10.3 days). However, patients with ADPKD experienced more kidney-related complications and a higher surgical procedure rate (mainly for transplant and complete nephrectomy).

Conclusions:

Although patients with ADPKD were generally healthier than patients with CKD, specific kidney function complications were more frequent. Patients with ADPKD had a higher rate of major kidney procedures, which may contribute to the high burden of ADPKD-related hospital-based inpatient resource utilization.