scholarly journals Professionalization and Professionalism: the Case of Italian Dentistry

2015 ◽  
Vol 5 (3) ◽  
Author(s):  
Giovanna Vicarelli ◽  
Elena Spina
Keyword(s):  
Economic Crisis ◽  
Historical Perspective ◽  
Self Regulation ◽  
First Line ◽  
Current Configuration ◽  
The Third ◽  
Dental Profession ◽  
Third Line ◽  
The Impact ◽  
Over Time

The aim of this article is to reconstruct the process of professionalization of Italian dentists and the profession’s current configuration. It is based on three lines of inquiry. The first line adopts a historical perspective through the analysis of legislation that has regulated the dental sector over time. The second line depicts the current configuration of the profession through institutional and sectoral statistics. The third line focuses on the impact of the 2008 economic crisis, using the main findings of a survey conducted among the profession’s representatives. The economic crisis has exacerbated the profession’s structural weaknesses caused by the difficulties associated with self-regulation and by organizational–managerial inefficiency. Given this situation, one may inquire as to the actual professional nature of dentistry in Italy: It is not pointless to ask whether—and, if so, what type of—professionalism exists in dentistry in Italy today. Keywords: Italian dental profession, professionalization, professionalism, economic crisis, occupational change.

Understanding Rising Income Inequality and Stagnating Ordinary Living Standards in Germany

2018 ◽  
Author(s):  
Gerhard Bosch ◽  
Thorsten Kalina
Keyword(s):  
Income Inequality ◽  
Labour Market ◽  
Economic Crisis ◽  
Household Income ◽  
Wage Bargaining ◽  
Living Standards ◽  
Social Model ◽  
Real Wages ◽  
The Impact ◽  
Over Time

This chapter describes how inequality and real incomes have evolved in Germany through the period from the 1980s, through reunification, up to the economic Crisis and its aftermath. It brings out how reunification was associated with a prolonged stagnation in real wages. It emphasizes how the distinctive German structures for wage bargaining were eroded over time, and the labour market and tax/transfer reforms of the late 1990s-early/mid-2000s led to increasing dualization in the labour market. The consequence was a marked increase in household income inequality, which went together with wage stagnation for much of the 1990s and subsequently. Coordination between government, employers, and unions still sufficed to avoid the impact the economic Crisis had on unemployment elsewhere, but the German social model has been altered fundamentally over the period

scholarly journals AB0751 SAFETY AND PERSISTENCE OF USTEKINUMAB IN PATIENTS WITH PSORIATIC ARTHRITIS IN BIOBADASER

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1672.2-1672
Author(s):  
N. Busquets-Pérez ◽  
C. Sánchez-Piedra ◽  
P. Vela-Casasempere ◽  
M. Freire-Gonzalez ◽  
C. Bohórquez ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Adverse Events ◽  
First Year ◽  
Line Treatment ◽  
Minimal Disease Activity ◽  
First Line ◽  
The Third ◽  
Minimal Disease ◽  
Second Year ◽  
Third Line

Background:Ustekinumab has been efficacy and safety for psoriatic artritis in clinical trials.Objectives:To assess effectiveness, by means of drug persistence analisys, and safety of ustekinumab in patients with psoriastic arthritis in Biobadaser.Methods:BIOBADASER is the Spanish registry of biological drugs of the Spanish Society of Rheumatology and the Spanish Medicines Agency. We identified patients aged 18 years or more with psoriatic arthritis on Ustekinumab. A descriptive analysis was performed.The persistence of ustekinumab therapy was calculated with a Kaplan-Meier curve and was compared with the persistence of anti-TNF, according to line treatment. Log Rank test was used to establish a comparison. Adverse events occurring with ustekinumab are described according to year treatment.Results:One hundred and twelve patients were on ustekinumab. Most of them were on their second or third line treatment: 53.57% more than one biological therapy (BT), 19.64% second BT, 26.79% were naïve for BT. Most of them were on 45 mg dose: 88.24%. Median duration of disease at Ustekinumab initiation was 10.1 SD 7.2 years; 69.23% had peripheral arthritis; 45.24% had obesity and 39.29% were overweight; 40,6% were on prednisone and 59.82% on DMARD. The cause of discontinuation of treatment was mainly inefficacy (82.61%) and less common an adverse event (6.52%). The probability of persistence of treatment with ustekinumab was 0.83 (95% CI 0.63-0.92) at year 1, 0.79 (0.58-0.90) at year 2 and 0.79 (0.58-0.9) at year 3 when ustekinumab was prescribed as the first line treatment. The persistence decrease when ustekinumab was prescribe as a second and third treatment: being 0.53 (0.27-0.73) the first year, 0.46 (0.22-0.67) the second year and 0.46 (0.22-0.67) as a second line treatment and 0.58 (0.44-0.70) the first year, 0.33 (0.17-0.50) the second year and 0.33 (0.17-0.50) the third year as a third line treatment.The persistence was similar to anti-TNF treatment, according to line treatment. Adverse events were mainly mild (97.83%) and occurred the first year of treatment. Most of the adverse events were classified as “infections and infestations” (36.96%).Conclusion:The persistence of ustekinumab was high, being 83% at the end of the first year on treatment and 79% the second and the third year of treatment. The persistence of ustekinumab was higher when if it was the first line treatment compared as if it was used as the second o third BT option. The persistence of Ustekinumab is similar to the persistence of anti-TNF treatments in all the analyzed treatment lines (no statistically differences were found). Adverse events occurred mainly during the first year treatment. They were mainly mild adverse events and the frequency decreased within the second and third year of treatment.References:[1]Treatment with ustekinumab in a Spanish cohort of patients with psoriasis and psoriatic arthritis in daily clinical practice.Almirall M, Rodriguez J, Mateo L, Carrascosa JM, Notario J, Gallardo F. Clin Rheumatol. 2017 Feb;36(2):439-443;[2]Minimal disease activity in patients with psoriatic arthritis treated with ustekinumab: results from a 24-week real-world study.Napolitano M, Costa L, Caso F, Megna M, Scarpa R, Balato N, Ayala F, Balato A. J Clin Rheumatol. 2018 Oct;24(7):381-384;[3]Minimal Disease Activity and Patient-Acceptable Symptom State in Psoriatic Arthritis: A Real-World Evidence Study With Ustekinumab.Queiro R, Brandy A, Rosado MC, Lorenzo A, Coto P, Carriles C, Alperi M, Ballina J. Actas Dermosifiliogr. 2018 Jun 28;[4]An analysis of Drug Survival, Effectiveness, and Safety in Moderate to Severe Psoriasis Treated With Ustekinumab: An Observational Study of 69 Patients in Routine Clinical Practice.Salgüero Fernández I, Gil MH, Sanz MS, Gullón GR;Disclosure of Interests:None declared

HSR19-090: Changes in Adherence to Tyrosine Kinase Inhibitor Treatment Patterns Among Patients With Chronic Myeloid Leukemia and the Impact on Costs: 2001–2017

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-090
Author(s):  
Henry J. Henk ◽  
Lena E. Winestone ◽  
Jennifer J. Wilkes ◽  
Laura Becker ◽  
Pamela Morin ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Myeloid Leukemia ◽  
Healthcare Costs ◽  
Myeloid Leukemia ◽  
First Line ◽  
Tki Treatment ◽  
The Impact ◽  
Care Costs ◽  
Over Time ◽  
Privately Insured

Background: Chronic myeloid leukemia (CML) treatment improved considerably after introduction of oral tyrosine kinase inhibitors (TKI). As a result, the number of patients living with CML may reach 250,000 by 2040. We track changes in TKI treatment adherence since 2001 and provide an early assessment of treatment costs following the availability of second-generation TKIs and generic imatinib. Methods: A retrospective cohort from the OptumLabs Data Warehouse, which includes claims data for privately insured and Medicare Advantage (MA) enrollees in a large private U.S. health plan with medical and pharmacy benefits, was used. Patients with CML initiated TKI treatment between May 2001 and October 2016 and were continuously enrolled in the health plan 6 months prior through 12 months following TKI start. Adherence was defined by medication possession ratio (MPR1=total days’ supply of imatinib in 1st year divided by 365, 1=perfect adherence). Total health care costs include medical and prescription medication benefits. MPR1 was modeled using ordinary least squares regression. The association between MPR1 and healthcare costs was estimated using a generalized linear model specified with a gamma error distribution and a log link. Results: We identified 1,793 eligible patients. First-line TKI has changed over time (dasatinib and nilotinib represent 45% of all 2016 starts; imatinib 55%). From 2001 to 2016, adherence increased (Table 1). MPR1 was higher in men and increased with age until age ∼62 after which it declined. MPR1 was lower for patients with more comorbid conditions prior to treatment. Overall, MPR1 was inversely associated with total health care costs (medical and pharmacy) among privately insured (P<.001) but not MA enrollees. The net impact of MPR1 on total healthcare costs diminished over time (P<.001) where a 10% point decrease in MPR1 was associated with 12% and 4% lower total costs, prior to and following availability of 2nd generation TKIs, respectively. When examining medical costs only, MPR1 was inversely associated with medical costs for both privately insured (P<.001) and MA enrollees (P=.016). Conclusions: We found that adherence to TKI treatment increased over time. While imatinib is still used more frequently than other TKIs as first-line therapy, second-generation TKIs are becoming increasingly used as first-line agents. Possible cost-offsets are decreasing over time but it may be too early to formally evaluate the impact of generic imatinib.

scholarly journals THE NEWLY DISCOVERED PERSIAN INSCRIPTION OF THE XII CENTURY IN THE FORTRESS OF BJNI

2019 ◽  
pp. 324-331
Author(s):  
TIGRAN MIKAYELYAN
Keyword(s):  
Horizontal Line ◽  
Second Line ◽  
National Academy Of Sciences ◽  
First Line ◽  
Stone Fragment ◽  
The Third ◽  
Arabic Characters ◽  
Third Line ◽  
Academy Of Sciences

In 2007 during its excavations within the citadel of Bjni fortress the expedition of the Institute of Archaeology and Ethnology of the National Academy of Sciences of Armenia discovered a stone with an inscription in Arabic characters. We have read this Persian inscription in five lines sculpted on a stone fragment showing missing parts from all sides. The first line is damaged and is unreadable, the second line mentions the name of some Isfahsalar Muhammad/Mohammad طوسي... Tusi محمد سلار] سفه ا ....[ The third line is also unclear, except for the guessable word ‘Islam’. The fourth line reads ‘May the God bless all’ in Persian. The fifth line communicates the date, which is ... [ئه [ما خمس و عين ...The date is incomplete, however it is definitely the 500th year of Hijra or the XII century AD. To define the decade we need to offer numbers ending with عين ..These are forty اربعين seventy سبعين or ninety تسعين . From these figures we prefer seventy سبعين because of a few considerations: if it is forty اربعين horizontal line of alif would be visible even if it is damaged; there is a dot over عين... even though ‘ba’s dot has been put over and not under the letter. سبعين or ninety also has no dots. So by choosing seventy, we can date the inscription to the period of 1175-1183. We can’t offer a more precise date as the first number before seventy is lost. We also believe that this inscription is not an epitaph as there are no Islamic formulas for the deceased put right before the name; also the sculpted characters are too big for a gravestone and in addition they are positioned perpendicularly to the stone unlike Armenia’s Muslim gravestones. Therefore, this must be a fragment of an inscription commemorating some construction or maybe a repair or strengthening of the Bjni fortress or citadel executed by the order of Isfahsalar Muhammad Tusi. Unfortunately the inscription does not communicate the dynasty to which it belongs. However, there is another Arabic inscription of 1174 by Shaddadids carved on a citadel of Nerkin Talin/Dashtadem (Aragatsotn region of Armenia). The newly discovered Persian inscription is evidence that Muslim military had some presence during the last decades of the XII century in the Armenian fortress of Bjni.

scholarly journals A non-compensatory time analysis of material deprivation in the EU.

2021 ◽  
pp. 118-137
Author(s):  
Andrea Ciacci ◽  
Susanna Traversa
Keyword(s):  
Economic Crisis ◽  
Durable Goods ◽  
Material Deprivation ◽  
Economic Stress ◽  
Time Analysis ◽  
Statistical Tool ◽  
Exogenous Shocks ◽  
Mediterranean Countries ◽  
The Impact ◽  
Over Time

The financial and economic crisis that hit Europe since 2009 has highlighted the need to measure more effectively the impact that certain exogenous shocks can have in the social field. In order to fill this gap and to provide a statistical tool useful to measure phenomena evolving over time, we perform a non-compensatory time analysis of material deprivation in Europe by using the quantitative method known as Adjusted Mazziotta and Pareto Index (AMPI). Material deprivation is a proxy to identify the most suffering groups of people in a specific environment. We consider the material deprivation as the sum of economic stress and forced lack of durable goods. Using Eurostat EU-SILC data, we aim at determining which countries have suffered the most material deprivation and identifying clusters of deprivation. We also determine how material deprivation is evolved over time, from 2005 to 2019. Subsequently, through Influence Analysis, the robustness of the index obtained is evaluated. Our results show that the material deprivation gap between Eastern and Mediterranean countries and all the remaining countries, which already existed before the economic crisis, seems to have widened in the years up to 2015.

scholarly journals MICRO- AND MACROECONOMIC IMPACT OF CRYPTOCURRENCY BUSINESS

2021 ◽  
pp. 78-86
Author(s):  
Ihor Honak
Keyword(s):  
Self Regulation ◽  
Research Abstract ◽  
The United States ◽  
Invisible Hand ◽  
International Economy ◽  
Economic Activities ◽  
Negative Effects ◽  
Fiat Money ◽  
The Third ◽  
The Impact

Introduction. The active development of the international economy leads to the emergence of new financial instruments, which expands the capabilities of economic entities in carrying out efficient economic activities. However, cryptocurrency coins have become a relatively new, widely used financial instrument used by economic entities to increase the efficiency of payments and investments. The cryptocurrency market is growing rapidly and its capitalization is estimated at trillions of dollars. The main purpose of the article is to study the impact of cryptocurrencies on the international and national micro- and macroeconomics in the third decade of the XXI century. Methods. The theoretical and methodological basis of the article is the fundamental provisions of modern economics, the work of scientists. In the process of research, in particular, the following methods were used: analysis - to study the object and subject of research; abstract and logical (theoretical generalizations and formulation of conclusions on the impact of cryptocurrencies on national and international micro- and macroeconomics). Results. It has been established that cryptocurrency mining and trading has become an objective reality in the second decade of the XXI century, and at the beginning of the third decade already has a significant impact on the national and international economy, competing significantly with fiat money and, as far as possible, filling niches, filled fiat money. It has been proven that mining and trading of cryptocurrencies causes both positive and negative effects at both micro and macro levels, both in the international and national markets. It is noted that the circulation of cryptocurrencies is carried out mainly without legislative regulation (except for El Salvador, the United States and several other countries); however, self-regulation through the “invisible hand of the market” is quite effective. As long as there is no significant regulation of the cryptocurrency market, in our opinion, the cryptocurrency market will develop extremely actively, and its regulation by government agencies may hinder its development. Discussion. The obtained results can be used to expand knowledge about certain aspects of the impact of “mining” and circulation of cryptocurrencies on the activities of economic entities at the micro and macro levels. Keywords: mining, cryptocurrency, Monero cryptocurrency (XMR).

scholarly journals HEALTH TRAJECTORIES OVER TIME IN THE ATHLOS PROJECT: FINDINGS FROM MULTIPLE COHORTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S798-S798
Author(s):  
Matthew Prina
Keyword(s):  
Physical Activity ◽  
Alcohol Consumption ◽  
Cohort Studies ◽  
Healthy Ageing ◽  
The Third ◽  
Health Trajectories ◽  
Working Together ◽  
The Impact ◽  
Over Time

Abstract The ATHLOS (Ageing Trajectories of Health: Longitudinal Opportunities and Synergies) project is a consortium of 15 partners across Europe who are working together to understand patterns of healthy ageing trajectories, and to seek the factors that determine those patterns, in a harmonised dataset of 17 international cohort studies of ageing. During this symposium we will be presenting some of the work that has recently been carried out within this project. The symposium will consist of four talks: the first talk will introduce the project, and describe the preliminary work that took place within the first few years of the project, and the challenges faced by the consortium. The second talk will focus on the harmonisation process and on the development of the health metric, an indicator used to measure healthy ageing in this project. The third talk will focus on inequalities in healthy ageing, specifically investigating the impact of education and wealth across cohorts. Finally, in the last talk we will describe the role of lifestyle behaviours (specifically physical activity, smoking and alcohol consumption) and their impact on healthy ageing trajectories.

Use and findings of K-ras in colorectal cancer (CRC) testing in administrative and electronic medical records (EMR) data from 2005 through 2010.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14146-e14146
Author(s):  
Satish Valluri ◽  
Sean D Sullivan ◽  
Scott David Ramsey ◽  
Charles Kreilick ◽  
Susan H Foltz Boklage ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Clinical Decision Making ◽  
Stage Iv ◽  
Second Line ◽  
Wild Type ◽  
First Line ◽  
Number Of Patients ◽  
Third Line ◽  
Line Of Therapy ◽  
The Impact

e14146 Background: The use of K-ras testing in clinical decision-making has grown over the past few years. The objective of this study was to evaluate, in a real world context, the trends and diagnostic findings of K-ras testing using managed care and EMR data. Methods: The Georgia Cancer Specialists Database EMR (2005-2010) and administrative data from the MarketScan and IMPACT database(s) was used to select patients with newly diagnosed colorectal cancer (CRC). We looked for trends in use of K-ras in relation to timing of chemotherapy administration. The EMR data provided information on k-ras mutation type. Results: In MarketScan, of the 23,548 patients with a diagnosis of CRC, 1,730 (7.3%) patients had a test ordered for K-ras between 2005 and 2010. The number of patients receiving K-ras increased with line of therapy: first line 336 patients (8.2%) of 4,098 treated, second line 455 patients (15.2%) of 2,984 treated, and third line 529 patients (33%) of 1,603 treated. We found similar results using the IMPACT database: 2,256 (7.8%) CRC patients had a test ordered for K-ras between 2005 and 2010. K-ras testing increased with line of therapy: first line 244 patients (7.8%), second line 510 (14.6%), and third line 650 patients (33.1%). EMR lab results from stage IV disease (n=349) consisted of 15% mutated type, 60% unknown and 25% wild type. For confirmed test results wild type represented 62.5% and mutated type 37.5%. Conclusions: Over the last six years, use of K-ras testing has increased in use in patients with CRC. The increase has occurred in later lines of therapy. The timing occurring late in therapy may limit the use of agents specific for this test.

A systematic review of post first-line treatments for advanced gastrointestinal stromal tumor (GIST): Direct pairwise meta-analyses and indirect comparisons.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 195-195
Author(s):  
Keya Shah ◽  
Kelvin K. Chan ◽  
Yoo-Joung Ko
Keyword(s):  
Systematic Review ◽  
Indirect Comparison ◽  
Phase Iii ◽  
Controlled Trials ◽  
First Line ◽  
The Third ◽  
Third Line ◽  
Line Setting ◽  
Meta Analyses ◽  
Indirect Comparisons

195 Background: Treatment for metatastatic or unresectable GIST is with imatinib. The majority of patients eventually acquire imatinib resistance, prompting the development of a growing number of agents as post-first-line treatment. Currently no studies directly compare these treatments. Methods: A systematic review was performed through MEDLINE, EMBASE, CENTRAL, and ASCO meeting abstracts up to July 2014 to identify randomized controlled trials that included GIST patients who were previously treated with a first-line chemotherapy for advanced disease. Progression-free survival (PFS) and overall survival (OS) with 95% credible regions were extracted using the Parmar method. Direct pairwise meta-analyses and indirect comparisons using the Bucher method were performed. Results: Four studies were identified for the systematic review. 1 study (n=312) showed that sunitinib in the second-line setting (vs. placebo) improved PFS but not OS. 3 studies (n=528) examined the third-line setting (imatinib resumption vs. placebo; regorafenib vs. placebo; nilotinib vs. best supportive care with or without imatinib or sunitinib). Of the 3 third-line studies, there was significant heterogeneity between placebo-controlled trials and the non-placebo controlled trial (I2= 98%). Direct pairwise meta-analysis using random-effects of the 2 placebo-controlled studies showed that the PFS hazard ratio (HR) was 0.63 (0.22-0.61, p=0.0001), whereas the PFS HR for the non-placebo controlled study was 0.90 (0.65-1.26, p=0.56). These 2 HRs are different statistically (interaction: p=0.002). Indirect comparisons of imatinib resumption vs. regorafenib suggested that the PFS HR was 0.59 (0.31-1.11, p=0.10), trending in favor of regorafenib. OS HRs were not significant for direct or indirect comparison in the third-line setting. Conclusions: The number and size of completed phase III studies and the lack of a standard comparator arm limit the use of direct and indirect comparison methods to determine the best therapeutic option for patients who have progressed on imatinib. At this time, clinicians should interpret the available evidence at an individual level.

Third and successive–lines of chemotherapy in NSCLC patients without therapeutic targets: Experience of the Grupo Gallego de Cáncer de Pulmón.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20579-e20579
Author(s):  
Francisco Javier Afonso Afonso ◽  
Natalia Fernández Núñez ◽  
Rocio Vilchez Simo ◽  
Jose-luis Firvida ◽  
Noemi De Dios Alvarez ◽  
...  
Keyword(s):  
Advanced Nsclc ◽  
Therapeutic Option ◽  
Performance Status ◽  
Antiangiogenic Agents ◽  
First Line ◽  
Durable Response ◽  
The Third ◽  
Systemic Treatments ◽  
Cáncer De Pulmón ◽  
Third Line

e20579 Background: The current treatment of advanced non-small cell lung cancer (NSCLC) is conditioned by the presence of molecular and immunohistochemical biomarkers. In the absence of these, the therapeutic option is the use of chemotherapy with or without antiangiogenic agents. The efficacy of non-target systemic treatments is not proven, beyond a second-line and the experiences in their use are limited to retrospective analyzes. We present the experience of the Grupo Gallego de Cáncer de Pulmón in patients with advanced NSCLC treated exclusively with three or more lines of chemotherapy. Methods: Retrospective analysis of patients with advanced NSCLC, treated with three or more lines of chemotherapy in standard regimen, with or without antiangiogenic agents, in Galicia´s hospitals, Spain. Results: We included 168 patients (134 male and 34 female) treated with three or more chemotherapy lines, with a median age at the time of receiving the first-line, of 60.84 years (41-83). Of these, 51 (30,35%) received a fourth-line and 18 (10,74%) a fifth-line of treatment. None received antitarget therapy or immunotherapy. The median overall survival (OS) was 18.1 months. The median OS after the third line was 6.1 months, with 73% of patients alive at three months and 44% six months after the start of that therapeutic line. We did not appreciate differences in OS between those who received three lines and those who received the largest number of subsequent treatments. Our multivariate analysis (age, gender, histology, performance status at initiation of each teatment-line, response to previous treatments) identified that the individuals who benefited the most were those under the age of 60 years, PS-ECOG 0-1 at diagnosis and those with a more durable response to the first-line. Conclusions: The third-line of chemotherapy can benefit those patients with advanced NSCLC, under 60 years of age at the time of diagnosis, with good performance status and with long-lasting responses to the first line of treatment. We did not see benefit in adding fourth or fifth-line of chemotherapy. All data will be presented in the 2019 ASCO annual meeting.

Sign in / Sign up

Export Citation Format

Share Document