Subcutaneous interferon β-1a in pediatric patients with multiple sclerosis: Regional differences in clinical features, disease management, and treatment outcomes in an international retrospective study

AbstractBackgroundTo further understand management of pediatric patients with multiple sclerosis (MS), we examined disease features, clinical practice patterns, and response to treatment in the United States (US) and seven other countries ('rest of World'; ROW).MethodsAnonymized data, recorded as part of routine clinical practice, were obtained from medical records (1997–2009) of study participants (who received subcutaneous interferon β-1a before age 18years) from the US and ROW. Samples were stratified by age (preadolescents [<12years] and adolescents [12–17years]).ResultsUS adolescents had a higher mean body mass index versus ROW adolescents (BMI; 27.2 versus 22.5kg/m2), started disease-modifying therapy (DMT) earlier after the first relapse, were more likely to have received a DMT before initiating subcutaneous interferon β-1a, had a higher relapse rate, and were more likely to switch from subcutaneous interferon β-1a to another DMT before the end of the observation period.ConclusionsThis retrospective analysis of a multinational sample of pediatric MS patients who received subcutaneous interferon β-1a found that those from the US had higher BMI, relapsed more frequently, and were managed differently, compared with ROW patients. Future prospective studies are needed to confirm these observations and ascertain their clinical significance

Why do presidents fail? political leadership and the Argentine crisis (1999–2001)

This article explores why Argentine president Fernando de la Rúa (1999–2001) failed to govern and the factors that prevented him from completing his constitutional mandate. This study draw on current literature about leadership. We argue that President De la Rúa’s ineffective performance was characteristic of an inflexible tendency towards unilateralism, isolationism, and an inability to compromise and persuade. Moreover, we examine how de la Rúas performance, in the context of severe political and economic constraints, discouraged cooperative practices among political actors, led to decision-making paralysis, and ultimately to a crisis of governance.This work seeks to make four contributions. First, it conceptualizes political leadership by providing an analytical framework that integrates individual action, institutional resources and constraints, and policy context, thus filling a gap in the literature. Second, it explains the importance of effective leadership in building up and maintaining multiparty coalitions in presidential systems. Third, it complements existing institutional approaches to improve our understanding of a new type of instability in Latin America: the failure of more than a dozen of presidents to complete their constitutional mandates. Fourth, it analyzes the way political and economic variables interact in times of crisis