The relationship between baseline health and longitudinal costs of hospital use

In this paper, we investigate the relationship between baseline health and costs of hospital use over a period of eight years. We combine cross-sectional survey data with information from the Dutch national hospital register. Four different indicators of health (self-perceived health, long-term impairments, ADL limitations and comorbidity) are considered. We find that for ages 50 to 70, differences in hospital costs between good health and bad health are substantial and persist during the whole time period. However, for higher ages expected hospital costs for individuals in bad health decline rapidly and become lower than those for people in good health after about six to seven years. The higher mortality rate among people in bad health is the primary cause here. Our results are confirmed for all four health indicators. We conclude that relying on better health to contain healthcare expenditures is too optimistic, and the interaction between health and mortality should be taken into account when projecting healthcare costs. Healthy ageing is important, but more for health gains than for cost savings

Being with other animals: Transitioning toward sustainable food futures

How do non-human animals (hereafter animals) fit into sustainable food futures? This question prompts ethical reflection. However, especially in times of transformative change, one should not overlook ontological assumptions before engaging in ethics. We follow up on the work of the late Australian philosopher Val Plumwood as she prominently made this move to the ontological level when considering the edibility of animals. As she invites one (1) to listen to animals as well as (2) to embody one's own edibility, salient ontological assumptions about how humans relate to other animals, and the rest of reality, rise to the surface. While Plumwood also developed a modest ethical framework to address animal edibility, her ontological approach is highlighted here, especially as it appears to point toward moral relativism. Plumwood's ontological approach is further developed, notably by unraveling the dualism between self and other. Doing so results in a more non-conceptual way of relating to other animals. As a genuinely interdependent way of engaging with reality, it appears most relevant to considering what role animals might have in sustainable food futures

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How Do Technologies Affect How We See and Treat Animals? Extending Technological Mediation Theory to Human-animal Relations

Human practices in which animals are involved often include the application of technology: some farmed animals are for example milked robotically or monitored by smart technologies, laboratory animals are adapted to specific purposes through the application of biotechnologies, and pets have their own social media accounts. Animal ethicists have raised concerns about some of these practices, but tend to assume that technologies are just neutral intermediaries in human-animal relations. This paper questions that assumption and addresses how technologies might shape human-animal relations in non-neutral ways. Building on the technological mediation approach, it proposes that technologies can influence human-animal relations by amplifying and reducing certain aspects of animals in human perception or by inviting and inhibiting certain actions towards animals. The paper next considers, in two concretizing steps, how this theoretical starting point can enrich ethical discussions on technology and human-animal relations. First, it shows how the technological mediation approach can help to conceptualize a main concern that has been raised regarding the impact of technologies on human-animal relations, namely the concern that animals might be ‘instrumentalized’ or ‘objectified’ in certain technological practices. Second, it considers how this approach can guide investigations of how particular technologies might affect human-animal relations, taking genetic selection technologies as used in livestock breeding as a case. The paper closes by briefly reviewing the prospects and challenges for the application of the technological mediation approach to human-animal relations, thus sketching directions for future research

Handling End-of-Life Situations in Small Animal Practice:What Strategies do Veterinarians Contemplate During their Decision-Making Process?

This study researched end-of-life (EoL) decision-making processes in small animal practices in the Netherlands, focusing on strategies veterinarians contemplate during this process. Fourteen veterinarians were interviewed about animal end-of-life decision-making. The results of these interviews show that the decision-making process consists of three steps. The first step is to assess the animal’s health and welfare. During the second step, veterinarians consider the position of the owner. Based on steps 1 and 2, veterinarians decide in step 3 whether their advice is to a) euthanize or b) contemplate one or more strategies to come to a decision or potentially alter the decision. These results can support members of the veterinary profession to reflect on their decision-making process. If veterinarians know what strategies their peers use to deal with EoL situations, this can help to reduce the stress they experience in such situations. In addition, veterinarians may find inspiration for new strategies in the study results. For the veterinary profession itself, the current results can be used as a starting point for describing best practices for EoL decision-making in small animal practice.</p

From trust to trustworthiness: why information is not enough in the food sector

ABSTRACT. The many well-publicized food scandals in recent years have resulted in a general state of vulnerable trust. As a result, building consumer trust has become an important goal in agri-food policy. In their efforts to protect trust in the agricultural and food sector, governments and industries have tended to consider the problem of trust as merely a matter of informing consumers on risks. In this article, we argue that the food sector better addresses the problem of trust from the perspective of the trustworthiness of the food sector itself. This broad idea for changing the focus of trust is the assumption that if you want to be trusted, you should be trustworthy. To provide a clear understanding of what being trustworthy means within the food sector, we elaborate on both the concept of trust and of responsibility. In this way we show that policy focused on enhancing transparency and providing information to consumers is crucial, but not sufficient for dealing with the problem of consumer trust in the current agri-food context

The aortic root in repaired tetralogy of Fallot:Serial measurements and impact of losartan treatment

Background: Aortic root dilatation is common in adults with repaired tetralogy of Fallot (rTOF) and might lead to aortic dissection. However, little is known on progression of aortic dilatation and the effect of pharmaceutical treatment. This study aims to determine factors associated with aortic growth and investigate effects of losartan. Methods and results: We performed a prespecified analysis from the 1:1 randomized, double-blind REDEFINE trial. Aortic root diameters were measured at baseline and after 2.0 ± 0.3 years of follow-up using cardiovascular magnetic resonance (CMR) imaging. A total of 66 patients were included (68% men, age 40 ± 12 years, baseline aortic root 37 ± 6 mm, 32% aortic dilatation (>40 mm)). There was a trend towards slow aortic root growth (+0.6 ± 2.3 mm after two years, p = 0.06) (n = 60). LV stroke volume was the only factor associated with both a larger baseline aortic root (β: 0.09 mm/ml (95% C.I.:0.02, 0.15), p = 0.010) and with aortic growth during follow-up (β: 0.04 mm/ml (95% C.I.:0.005, 0.066), p = 0.024), after correction for age, sex, and body surface area using linear regression analysis. No treatment effect of losartan was found (p = 0.17). Conclusions: Aortic root dilatation was present in about one-third of rTOF patients. A larger LV stroke volume was associated with both a larger baseline aortic root and ongoing growth. Our findings provide no arguments for lower aortic diameter thresholds for prophylactic surgery compared to the general population