Constraint or choice? Disentangling fertility determinants by switching regressions

In 1953, many poor countries had not yet approached the demographic transition. Accordingly, income generally had a positive impact on fertility in poor countries, while it has a negative impact today. Easterlin´s supply-demand framework offers an explanation for this nonlinearity by attributing the positive relationship to Malthusian (or "supply") factors and the negative relationship to "demand" factors. This paper estimates Easterlin´s supply-demand framework by switching regressions in a panel data set of 152 countries from 1953 to 1998. The technique allows identifying several factors affecting the Malthusian constraint and the demand for children, such as income, the source of income, urbanization, religion and the medical environment. It is found that a combination of higher GDP per capita, a decrease in the infant death rate and an increase in education explain a substantial part of the reversal of the relationship between income and net fertility over the sample period.demographic transition, fertility determinants, income fertility relationship, supply-demand framework, switching regression

Demographie und Lohnunterschiede

Die Löhne von hoch- und geringqualifizierten Arbeitnehmern divergieren in den meisten Industrieländern seit den siebziger Jahren. Gemeinhin wird dies einer technologischen Entwicklung zugeschrieben, die geringqualifizierte Arbeit durch Kapital und hochqualifizierte Arbeit ersetzt. Der demographische Wandel könnte diese Entwicklung möglicherweise bremsen, da mit der Alterung der Gesellschaft eine Verschiebung der Nachfrage hin zu geringqualifizierten Dienstleistungen verbunden sein könnte. In dieser Arbeit wird ein einfaches Modell vorgestellt, das diesen Wandel veranschaulicht

Solow Residuen im Vergleich

In dieser Arbeit werden Solow-Residuen für 17 OECD-Länder ab 1960 berechnet und verglichen. Einem zentralen Problem - der Schwierigkeit, eine geeignete Schätzung für den Kapitalstock zu finden - wird damit begegnet, dass unterschiedliche Schätzungen verwendet und deren Auswirkungen auf die Residuen geprüft werden. Die Ergebnisse sind quantitativ je nach Kapitalsstockschätzung zwar unterschiedlich; auf die Rangfolge hingegen hat die Wahl der Schätzung in der Regel einen geringen Einfluss. Im Falle der Schweiz lässt sich kein aussergewöhnliches Wachstumsverhalten feststellen: Das geringe Wirtschaftswachstum der letzten 30 Jahre ist zu gleichen Teilen auf eine geringe Zunahme der totalen Faktorproduktivität als auch der Inputfaktoren Kapitel und Arbeit zurückzuführen

Skill-Biased Technological Change and the Real Exchange Rate

We sketch a model that shows how skill-biased technological change may reverse the classic Balassa-Samuelson effect, leading to a negative relationship between the productivity in the tradable sector and the real exchange rate. In a small open economy, export goods are produced with capital, high-skilled and low-skilled labor, and traded for imported consumption goods. Non-tradable services are produced with low-skilled labor only. A rise in the productivity of capital has two effects: (1) It may reduce the demand for labor in the tradable sector if the substitutability of low-skilled labor and capital in the tradable sector is high; and (2) it increases the demand for non-tradables and its labor input. Overall demand for low-skilled labor declines if the labor force of the tradable sector is large relative to the labor force of the non-tradable sector. This leads to lower wages and thus to lower prices and a real exchange rate depreciation

Improving ICD-based semantic similarity by accounting for varying degrees of comorbidity

Finding similar patients is a common objective in precision medicine, facilitating treatment outcome assessment and clinical decision support. Choosing widely-available patient features and appropriate mathematical methods for similarity calculations is crucial. International Statistical Classification of Diseases and Related Health Problems (ICD) codes are used worldwide to encode diseases and are available for nearly all patients. Aggregated as sets consisting of primary and secondary diagnoses they can display a degree of comorbidity and reveal comorbidity patterns. It is possible to compute the similarity of patients based on their ICD codes by using semantic similarity algorithms. These algorithms have been traditionally evaluated using a single-term expert rated data set. However, real-word patient data often display varying degrees of documented comorbidities that might impair algorithm performance. To account for this, we present a scale term that considers documented comorbidity-variance. In this work, we compared the performance of 80 combinations of established algorithms in terms of semantic similarity based on ICD-code sets. The sets have been extracted from patients with a C25.X (pancreatic cancer) primary diagnosis and provide a variety of different combinations of ICD-codes. Using our scale term we yielded the best results with a combination of level-based information content, Leacock & Chodorow concept similarity and bipartite graph matching for the set similarities reaching a correlation of 0.75 with our expert's ground truth. Our results highlight the importance of accounting for comorbidity variance while demonstrating how well current semantic similarity algorithms perform.Comment: 11 pages, 6 figures, 1 tabl

Dateninfrastrukturen für die Gesundheitsforschung: ethische Rahmenbedingungen und rechtliche Umsetzung

Die Rolle von Dateninfrastrukturen für die Gesundheitsforschung beschränkt sich nicht allein darauf, als Service oder Schnittstelle für den Datenaustausch zwischen Datenerzeuger:innen und -nutzer:innen zu fungieren. Die Infrastruktur ist vielmehr selbst ein Akteur im Prozess des Datenteilens, der für diesen auch entsprechend Verantwortung trägt. Dies gilt zuallererst für die Rechtmäßigkeit der Verarbeitung personenbezogener Daten. Fußt die Datenverarbeitung auf einer Einwilligung der betroffenen Person, ist auch seitens der Infrastruktur sicherzustellen, dass sämtliche Datenverarbeitungsprozesse von dieser Einwilligung erfasst sind. Stützt sich die Datenverarbeitung auf einen gesetzlichen Erlaubnistatbestand, müssen im Rahmen der Infrastruktur v. a. technische und organisatorische Maßnahmen ergriffen werden, damit ein möglichst hohes Datenschutzniveau sichergestellt ist. Zudem fällt der Infrastruktur eine Verantwortung zu, wenn es um die Umsetzung von Betroffenenrechten wie Auskunft, Berichtigung oder Löschung von Daten geht und um den Umgang mit Zufalls- und Zusatzbefunden. Die Frage, mit welchem Selbstverständnis sich Forscher:innen in Infrastrukturprojekte einbringen und in welcher Form auch privatwirtschaftliche Unternehmen in solcherlei Projekte eingebunden werden sollen, muss sich am Gemeinwohl orientieren. Damit einher geht die Verpflichtung, dass Infrastrukturen so weit wie möglich an den Prinzipien der Partizipation, der Transparenz und der Wissenschaftskommunikation ausgerichtet sind. Die Beachtung all dieser ethischen und rechtlichen Aspekte ist vor allem auch deshalb wichtig, weil nur auf diese Weise das Vertrauen aller Stakeholder gewonnen und damit die zentrale Basis für den erfolgreichen Aufbau und Betrieb einer Dateninfrastruktur geschaffen werden kann

Prevalence of Nosocomial Infections in Swiss Children's Hospitals

Abstract Objective: To acquire data on pediatric nosocomial infections (NIs), which are associated with substantial morbidity and mortality and for which data are scarce. Design: Prevalence survey and evaluation of a new comorbidity index. Setting: Seven Swiss pediatric hospitals. Patients: Those hospitalized for at least 24 hours in a medical, surgical, intensive care, or intermediate care ward. Results: Thirty-five NIs were observed among 520 patients (6.7%; range per hospital, 1.4% to 11.8%). Bacteremia was most frequent (2.5 per 100 patients), followed by urinary tract infection (1.3 per 100 patients) and surgical-site infection (1.1 per 100 patients; 3.2 per 100 patients undergoing surgery). The median duration until the onset of infection was 19 days. Independent risk factors for NI were age between 1 and 12 months, a comorbidity score of 2 or greater, and a urinary catheter. Among surgical patients, an American Society of Anesthesiologists (ASA) score of 2 or greater was associated with any type of NI (P = .03). Enterobacteriaceae were the most frequent cause of NI, followed by coagulase-negative staphylococci; viruses were rarely the cause. Conclusions: This national prevalence survey yielded valuable information about the rate and risk factors of pediatric NI. A new comorbidity score showed promising performance. ASA score may be a predictor of NI. The season in which a prevalence survey is conducted must be considered, as this determines whether seasonal viral infections are observed. Periodic prevalence surveys are a simple and cost-effective method for assessing NI and comparing rates among pediatric hospital

Low secondary attack rate after prolonged exposure to sputum smear positive miliary tuberculosis in a neonatal unit.

BACKGROUND Several neonatal intensive care units (NICU) have reported exposure to sputum smear positive tuberculosis (TB). NICE guidelines give support regarding investigation and treatment intervention, but not for contact definitions. Data regarding the reliability of any interferon gamma release assay (IGRA) in infants as a screening test for TB infection is scarce. We report an investigation and management strategy and evaluated the viability of IGRA (T-Spot) in infants and its concordance to the tuberculin skin test (TST). METHODS We performed an outbreak investigation of incident TB infection in a NICU after prolonged exposure to sputum smear positive miliary TB by an infant's mother. We defined individual contact definitions and interventions and assessed secondary attack rates. In addition, we evaluated the technical performance of T-Spot in infants and compared the results with the TST at baseline investigation. RESULTS Overall, 72 of 90 (80%) exposed infants were investigated at baseline, in 51 (56.7%) of 54 (60%) infants, follow-up TST at the age of 6 months was performed. No infant in our cohort showed a positive TST or T-Spot at baseline. All blood samples from infants except one responded to phytohemagglutinin (PHA), which was used as a positive control of the T-Spot, demonstrating that cells are viable and react upon stimulation. 149 of 160 (93.1%) exposed health care workers (HCW) were investigated. 1 HCW was tested positive, having no other reason than this exposure for latent TB infection. 5 of 92 (5.5%) exposed primary contacts were tested positive, all coming from countries with high TB incidences. In total, 1 of 342 exposed contacts was newly diagnosed with latent TB infection. The secondary attack rate in this study including pediatric and adult contacts was 0.29%. CONCLUSION This investigation highlighted the low transmission rate of sputum smear positive miliary TB in a particularly highly susceptible population as infants. Our expert definitions and interventions proved to be helpful in terms of the feasibility of a thorough outbreak investigation. Furthermore, we demonstrated concordance of T-Spot and TST. Based on our findings, we assume that T-Spot could be considered a reliable investigation tool to rule out TB infection in infants

Low secondary attack rate after prolonged exposure to sputum smear positive miliary tuberculosis in a neonatal unit

BACKGROUND Several neonatal intensive care units (NICU) have reported exposure to sputum smear positive tuberculosis (TB). NICE guidelines give support regarding investigation and treatment intervention, but not for contact definitions. Data regarding the reliability of any interferon gamma release assay (IGRA) in infants as a screening test for TB infection is scarce. We report an investigation and management strategy and evaluated the viability of IGRA (T-Spot) in infants and its concordance to the tuberculin skin test (TST). METHODS We performed an outbreak investigation of incident TB infection in a NICU after prolonged exposure to sputum smear positive miliary TB by an infant's mother. We defined individual contact definitions and interventions and assessed secondary attack rates. In addition, we evaluated the technical performance of T-Spot in infants and compared the results with the TST at baseline investigation. RESULTS Overall, 72 of 90 (80%) exposed infants were investigated at baseline, in 51 (56.7%) of 54 (60%) infants, follow-up TST at the age of 6 months was performed. No infant in our cohort showed a positive TST or T-Spot at baseline. All blood samples from infants except one responded to phytohemagglutinin (PHA), which was used as a positive control of the T-Spot, demonstrating that cells are viable and react upon stimulation. 149 of 160 (93.1%) exposed health care workers (HCW) were investigated. 1 HCW was tested positive, having no other reason than this exposure for latent TB infection. 5 of 92 (5.5%) exposed primary contacts were tested positive, all coming from countries with high TB incidences. In total, 1 of 342 exposed contacts was newly diagnosed with latent TB infection. The secondary attack rate in this study including pediatric and adult contacts was 0.29%. CONCLUSION This investigation highlighted the low transmission rate of sputum smear positive miliary TB in a particularly highly susceptible population as infants. Our expert definitions and interventions proved to be helpful in terms of the feasibility of a thorough outbreak investigation. Furthermore, we demonstrated concordance of T-Spot and TST. Based on our findings, we assume that T-Spot could be considered a reliable investigation tool to rule out TB infection in infants