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Only the boldest, or most inconsiderate, scholars entered thefield,and they did so at their own risk. The same can be said of economic historians: with few exceptions, they have been reluctant to apply the tools of their trade to the 'postwar' period, more often than not leaving it as the domain of applied economists.

Things are changing, however, and the half century following the end of the Second World War is now increasingly seen as being ripe for historical investigation, much beyond the Marshall Plan years that have attracted much recent attention. This chapter aims at reviewing the performance of the European economy since in a longer-run perspective, which sees the period from to as being an exceptional one in the history of 'modern economic growth', in that it departed from the secular trendfirst by under- and then by overperforming.

In this chapter, the European economy is tentatively seen as an aggregate, at least in fieri. If the interwar years of slow and volatile growth were characterized by nationalism and wars that crystallized national economic peculiarities, the subsequent period of high growth resulted in a convergence of per-capita incomes that can be seen and understood as being both the cause and the effect of a broader social and institutional convergence.

European growth, average annual growth Period Real GDP 1 2. Countries are those for which col. Some of them, the pioneers, had already proceeded a long way along the road leading to ever increasing material welfare; others, the late-comers, were just taking their first steps.

The secular trend fits well with Kuznets' definition of'modern economic growth' as a process characterized by 'rates of growth in per capita income rang[ing] mostly from about 10 percent to over 20 percent per decade' Kuznets, While the long-run trends follow the steady quantitative change predicted by such authors as Colin Clark, Kuznets, Abramovitz and Chenery, Table 1. The perspective of secular trends in 'modern economic growth' is a useful starting point in considering the economic history of Europe during the half century following the end of the Second World War.

In particular, such a perspective is helpful when considering the standard subdivision into two distinct periods, the first, to about , being characterized by very high growth rates and near-full employment, the second showing a rather sluggish performance in terms both of output and employment. Here, the longer-run view conveys two messages: 1 the period was truly exceptional in the process of'modern economic growth', 2 the subsequent growth record can hardly be regarded as unsatisfactory.

The exceptional character of the 'high-growth years' is better judged in the light of the poor European performance during the previous three decades. Whether or not one agrees with Kuznets2 that major wars are somehow endogenous to the process of modern economic growth, they certainly coincide with a considerable slowdown in European growth between and , plausibly not unrelated to the boom of Postwar growth: an overview 3 the following two decades.

As we shall see, the catch-up for ground lost in two world wars and in the most severe economic depression to date is one of the reasons explaining the much above average growth rates of the s and s: other reasons, discussed in section 6, relate to domestic and international factors likely to be exceptional in the history of modern economic growth.

Post growth looked uncomfortably low in the light of expectations created during the previous quarter of a century.

However, if both the longer run and the predictions of the then-prevailing theory are taken into account, the picture looks considerably less dismal. Having assessed the postwar European performance against the longer-run background of'modern economic growth', we may now turn to a brief appraisal of some quantitative features of the main subperiods. Table 1. In the GDP of France, of the three Axis countries and of the Netherlands had fallen back to late nineteenth-century or early twentieth-century levels.

One or two generations of work and accumulation had been lost. Belgium fared a little better. Of the belligerent countries, only the United Kingdom managed to contain the post economic collapse to minor proportions; it could not, however, avoid a serious post-war slump. Neutral countries in our sample fared distinctly better and, in fact, managed to grow throughout the conflict.

If the economic effect of the war was devastating, the speed of recovery was so impressive as to take by surprise informed observers, trade unions, entrepreneurs and policy-makers alike.

In five years at most, Europe recovered the ground lost relative to the highest prewar income levels. Not only were growth rates exceptionally high Table 1. Source: Data from Maddison Statistiek in stappen Dat wordt deels veroorzaakt door de verwachting dat statistiek Psychologie, wat is er mogelijk?

Ikzelf zit ook midden in de opleiding en ik wil wel even proberen om mijn ervaring met de statistiek en de wiskunde, tot nu toe, weer te geven. Kuurne - Wikipedia ; Geschiedenis. De lijst sp. Google ; Search the world's information, including webpages, images, videos and more. Google has many special features to help you find exactly what you're looking for. Boek: Statistiek voor Dummies - Boekenbestellen.

Vind je statistiek een lastig onderwerp? Geen nood,deze tweede editie van Statistiek voor Dummies Deborah Rumsey.

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Pearson Education, - pages. Antwoord op vele vragen die dagelijks afkomen op degene die beroepshalve There are 2 benefits of treating strabismus. The initial one is functional gain including the improvement of visual acuity and stereopsis. The second one is the cosmetic improvement. Phoria is detected by the simple cover-uncover test. The test is performed while the patient fixates a distant object. The physician covers one eye for seconds and then the other eye. If orthophoria is present, no movement is detected.

If latent deviation exists movement of eyes towards the opposite of the deviation is observed. For example in a patient with inward latent deviation, the uncovered eye move from inwards to outwards.

Latent deviations may become manifest temporarily, when the child is tired or ill. It can also become permanently manifest during the follow-up. Horizontal deviations are the most commonly observed types of strabismus. Esotropia is the manifest inward deviation of eyes, while esophoria is the latent inward deviation of eyes. Exotropia is the manifest outward deviation of eyes, while exophoria is the latent outward deviation of eyes. Esotropia is by far the most common form of strabismus.

Infantile esotropia constitutes almost half of all cases of esotropia. Infantile esotropia is the inward deviation of eyes, which is diagnosed at 6 months of age. The angle of deviation is usually large and surgery is usually indicated.

Pseudo-strabismus is the illusion of deviation in a child with orthophoria. It is most commonly in the form of pseudo-esotropia. The most common reason for this false appearance of inward deviation is broad nasal bridge with prominent epicanthal folds.

Paralytic strabismus in children may be in form of third, fourth or sixth cranial nerve palsy. Cranial imaging must be ordered in all forms of acquired paralytic strabismus to exclude cranial masses Harley, The angle of deviation in eyes with all types of deviations is measured objectively by using special prisms.

The prism cover test is preferred if the child cooperates. In severe amblyopia and in very young children prism reflex test Krimsky test is performed. The patient fixates a light and the prism is placed in front of the deviating or bad eye to center the corneal reflex.

Abnormal eye movements are frequently associated with pediatric eye deviations and they can influence the management of the cases. Accommodative types of esotropias may be completely cured with spectacles. Surgical correction is decided according to the angle of deviation, if the deviation is not corrected by the spectacles during follow-up.

All types of strabismus must be referred to an ophthalmologist, since early treatment by spectacles or surgery is important for normal binocular visual development. Common eyelid and orbital diseases in children The most important issue in pediatric eyelid disorders is to identify whether the lesions affect the visual development or not.

If it occludes the visual axis, the pathology must be treated promptly to prevent the development of amblyopia. Entropion, ectropion, distichiasis, epicanthal folds, and telecanthus increased distance between the medial canthus of each eye are common congenital anomalies of the eyelids.

Although they are solely cosmetic problems in most cases, they may result in corneal changes secondary to corneal irritation and exposure due to mal-position of the eyelids. Congenital ptosis is the most important disease of the eyelids in a child. It is usually unilateral and occurs sporadically in most cases. The underlying pathology is the dysplasia of the levator palpebralis muscle.

Surgical correction during the preschool years must be performed. If the disease is severe, early surgery to prevent amblyopia may be performed.

The infections are mostly innocent and respond well to conservative therapies Hughes, The infections occur in two clinical forms; preseptal cellulitis or orbital cellulitis. Orbital cellulitis is the most common cause of protrusion of the eyeball in children.

It is a life-threatening disease of the tissues behind the orbital septum. On the other hand, preseptal cellulits involves tissues anterior to the orbital septum. Preseptal cellulitis usually responds to ampiric antibiotic treatment, whereas orbital cellulitis may be associated with serious complications requiring longer periods of treatment and surgical interventions Kanski, Protrusion of the eyeball, limitations of the eye movements and decreased visual acuity are signs of orbital cellulitis.

Skin trauma, sinusitis, lacrimal sac infections and rarely remote infections may be the source of preseptal or orbital cellulitis. Preseptal cellulitis rarely progresses to orbital cellulitis. Left orbital cellulitis Subperiosteal and orbital abscesses, intracranial complications meningitis, brain abscess and ocular complications such as optic neuropathy and endophthalmitis may complicate orbital cellulitis.

Hospitalization and aggressive medical treatment to prevent lifethreatening complications is indicated in orbital cellulitis Sullivan, Any painful periorbital edema or pain associated with eye movements should raise the suspicion of serious orbital cellulitis and referral to an ophthalmologist is indicated.

Conjunctival diseases in children It is still a significant cause of blindness in underdeveloped countries. It can be bacterial, viral and chemical. The most serious form is caused by Neisseria gonorrhoeae. Onset is typically within the first days of life. It causes a severe purulent discharge. Treatment includes systemic 18 Complementary Pediatrics ceftriaxone and topical penicillin as well. Infection with herpes is rarer but requires prompt therapy with acyclovir.

Chemical cases are caused by silver nitrate and occur within 24 hours life. Tetracyclin, erythromyicin ointments or povidone-ioidine drops can be used for prophylaxis. Majority of these infections are self-limited and does not require therapy.

This section covers a variety of infectious conjunctival diseases that might be confronted in routine pediatrics practice. Red eye is one of the most important ophthalmological emergencies.

There are several causes such as conjunctivitis, keratitis, uveitis etc. Fortunately, majority of the red eye occurs due to conjunctivitis. The underlying etiology is almost always bacterial in children. However, it can be viral or allergic. During examination there are some key points that will help to differentiate the etiology: Symptoms: Allergic cases will always have prominent itching.

Bacterial cases will always have discharge.

Presence and nature of discharge: Bacterial infections will have a purulent, yellow-green discharge. Viral cases will have a serous or mucoid discharge. Allergic cases will have serous discharge with excessive tearing. Laterality: Bacterial cases can be either unilateral or bilateral. Viral and allergic conjunctivitis occur almost always bilateral. Cul-de-sac: Always pull the lower eyelid away from the globe to examine the cul-de-sac.

Bacterial conjunctivitis will have tarsal papillae. Viral and allergic conjunctivitis will have tarsal follicles.

Systemic associations: Viral conjunctivitis might be associated with upper respiratory infections. Allergic conjunctivitis might be seen with upper respiratory allergic symptoms.

First-line therapy for bacterial conjunctivitis is topical flouroquinolone. Viral conjunctivitis is selflimited. For allergic cases topical antihistaminic drops are effective. Corneal diseases in children The cornea is the anterior transparent, avascular anatomical structure of the human eye. There are many congenital and acquired corneal diseases, which may lead to blindness if left untreated.

Corneal dystrophies, congenital anomalies, corneal ectasias, metabolic keratopathies and infectious diseases are the main corneal diseases that may be diagnosed in a child. Most of the corneal pathologies disturb the transparency of the organ and should be referred to an ophthalmologist immediately.

Microcornea, megalocornea, anophthalmos and microphthalmos are rare congenital anomalies that affect cornea. Microphthalmos is defined as the developmental arrest of all ocular structures, while anophthalmos is the complete failure of the eye development.

The treatment of the systemic disease is the mainstay treatment of these metabolic keratopathies.

Corneal dystrophies and corneal ectasias are frequently diagnosed during puberty or later. They are structural diseases of the cornea and mostly genetically determined, but the clinical picture rarely occurs in childhood. Keratoconus is the most common corneal ectasia of the human eye. It is typically diagnosed during puberty with unilateral impairment of vision.

Corneal thinning and irregular astigmatism are the main features of the keratoconus. Bacterial keratitis usually occurs in patients with damaged corneal epithelial integrity. However, Neisseria gonorrhoeae, Corynebacterium diphteriae, Listeria and Haemophilus species may lead to keratitis in the presence of intact epithelium.

Bacterial keratitis is characterized by oval shaped corneal infiltrations surrounded by corneal edema, conjunctival hyperemia injection , ocular pain and photophobia. Gonococcal keratoconjunctivitis Pseudomonas aeruginosa keratitis tend be very severe and typically produces stromal necrosis with a shaggy surface and adherent mucopurulent exudates. It is an infection usually seen in contact lens users with a damaged corneal epithelial surface. The infection may progress rapidly ending with corneal perforation.

In the management of keratitis, ampiric broad-spectrum therapy is recommended until the offending microorganism is identified in the culture. If the type of bacteria is identified from the stained diagnostic smear, then appropriate single drug therapy may be considered. Herpes simplex virus HSV infection is more commonly acquired in adolescence than in childhood.

It can be transmitted to neonates as they pass through the birth canal of a mother with genital infection that can lead to serious systemic disorders in the newborns. Primary ocular HSV infection is a form of HSV infection that typically manifests in children aged between 6 months and 5 years. It causes unilateral blepharoconjunctivitis that has signs such 20 Complementary Pediatrics as cutaneous or eyelid marginal vesicles, or ulcers on the bulbar conjunctiva that can be rarely accompanied by dendritic epithelial keratitis.

Primary ocular HSV infection is a self limited disease that usually resolves spontaneously. Oral antiviral therapy can speed up the resolution. Dendritic ulcers, stromal necrotizing keratitis and disciform keratitis are forms of recurrent ocular infection of HSV. These may also occur in this age group.

Topical and oral antiviral therapy can be used in the management of recurrent HSV keratitis. Adenoviruses are the most common viral pathogens that may cause viral keratitis in a child. Pharyngoconjunctival fever PCF and epidemic keratoconjunctivitis EPC are 2 different clinical pictures that are caused by different serotypes of adenoviruses.


Corneal involvement is much more common and severe in EPC. Keratitis may persist for years in some cases. PCF is the less severe form of the disease. Keratitis is usually mild and self limiting.

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Mild to moderate fever may accompany PCF. The management of adenoviral keratitis is usually conservative. Topical steroids and cyclosporine may be tried to reduce inflammation. Reduction of transmission risk by avoiding contact with infected patients during the initial days of the active disease and by good hygiene is much more important than its management.

Ophthalmologists are well experienced about EKC, because unfortunately the eye clinics are usually the most common places to come in contact with the adenovirus and many ophthalmologists are infected once or more with adenoviruses.

Many outbreaks occur due to improperly disinfected diagnostic instruments Kanski, Symptoms include itching, photophobia, and mucoid discharge. Corneal findings consist of Horner-Trantas dots degenerated eosinophils and epithelial cells in the limbal area, punctate epithelial erosions and shield ulcer an oval noninfectious epithelial ulcer. Corneal findings are generally accompanied by conjunctival ones which are hyperemia, conjunctival edema chemosis and papillary hypertrophy.

Topical antihistamines and mast-cell stabilizers can be used in the management of vernal conjunctivitis. Severe cases may require topical corticosteroid or topical immune-modulating agents such as cyclosporine. Atopic keratoconjunctivitis is a rare bilateral allergic eye disease that is most commonly diagnosed in young men, but also in children.

Clinical picture is similar to vernal keratoconjunctivitis, but more severe. The papillary hypertrophy are less developed compared to vernal keratoconjunctivitis. The history of allergy such as allergic asthma or atopic dermatitis is commonly associated. Keratopathy leading to total corneal neovascularization may occur. Management is similar to vernalis keratoconjunctivitis, but the disease is less responsive. Corneal diseases usually respond to topical corticosteroids Kanski, Pediatric uveitis The uvea is a pigmented structure that primarily lies between the retina and the sclera and constitutes the vascular portion of the eye.

It comprises the iris, ciliary body and choroid. Uveitis, by strict definition implies an inflammation of the uveal tract.

Uveitis is named according to the anatomical location of inflammation in the uvea. Anterior uveitis may be subdivided into: Iritis and iridocyclitis. Iritis is primarily the inflammation of the iris tissue. On the other hand, iridocyclitis involves both the iris and the pars plicata of the ciliary body. Intermediate uveitis is defined as inflammation predominantly involving the pars plana, the peripheral retina and the vitreous.

Posterior uveitis involves the fundus posterior to the vitreous base. Panuveitis implies involvement of the entire uveal tract without a predominant site of inflammation Kanski, Pediatric uveitis may be categorized into 4 types of uveitis based on the anatomical location of the inflammatory process.

These are anterior non-granulomatous and granulomatous , intermediate and posterior uveitis. Etiologic factors associated with these uvetis in children are as follows. Anterior non-granulomatous uveitis: Idiopathic, HLA-B27 associated, juvenile rheumatoid arthritis JRA , ankylosing spondylitis, Reiter's disease, psoriasis, inflammatory bowel disease, nephritis, systemic lupus erythematosus, Herpes Simplex virus HSV , Lyme disease, leukemia, drug-induced.

Anterior granulomatous uveitis: Sarcoidosis, inflammatory bowel disease, syphilis, Herpes simplex virus, tuberculosis, Behcet's disease, multiple sclerosis, fungal disease, Whipple's disease, leprosy. Anterior uveitis is the most common form of uveitis. Features are typically with sudden onset of unilateral pain, photophobia and redness, which may be associated with lacrimation. Occasionally patients may notice mild ocular discomfort a few days before the acute attack when clinical signs are absent.

Visual acuity is usually good. The presence of vitreal cells in an active vitritis are the main signs of pars planitis. Posterior uveitis encompasses retinitis, choroiditis and retinal vasculitis.

Some lesions may originate primarily in the retina or choroid but often there is involvement of both Sauberan, Special investigations such as skin tests, serology and radiology are indicated in posterior uveitis, granulomatous inflammation, recurrent uveitis and bilateral uveitis.

Treatment of the majority of uveitis involves predominantly the use of anti-inflammatory and immunosuppressive agents. Antibiotic therapy for infectious diseases may be 22 Complementary Pediatrics necessary. Topical steroids are the mainstay treatment for anterior uveitis, while systemic steroids are indicated in most cases of intermediate and posterior uveitis.

Retinal detachment in children Retinal detachment is not common in infants and children. While the incidence of retinal detachment is 12 in in all age groups, only between 1. The association of retinal detachment with complex intraocular pathologies in young children often presents a challenge to treatment. There are 3 types of retinal detachment: Rhegmatogenous retinal detachment develops when there is a hole or tear in the retina, which transmits intraocular fluid underneath the retina and subsequent separation of the retina from the underlying pigment epithelium occurs.

The second most common form is tractional, where the retina is pulled away from the underlying tissues. It is important to recognize that most of the small children cannot express loss of visual acuity and often vision may already be low due to concomitant ocular pathologies. Therefore the delay in diagnosis is more common in the pediatric retinal detachments compared to that in the adult retinal detachments.

In a significant proportion of the patients, the diagnosis is made by chance during a routine eye examination or by noticing leukocoria. It is important to realize that retinal detachment in children may occur in both eyes frequently. Ocular trauma is an important cause of retinal abnormalities in children and it is more common in boys. Retinal dialyses may be found in the superonasal or inferotemporal quadrant. Traumatic retinal detachment is seen most commonly in older children and is usually caused by blunt trauma Sarrazin et al.

The second frequent etiological factor is high myopia in children and if it is congenital may indicate an underlying abnormality. Retinal detachment may also result from intraocular infection or inflammation. The existence of systemic or hereditary diseases such as Trisomy 13 Patau syndrome , Walker Warburg syndrome, Meckel syndrome, Norrie disease and incontinentia pigmenti should be investigated in retinal detachments of early childhood year.

In such cases, central nervous system imaging and detailed neurological examination should be requested. Also it is important to rule out retinoblastoma.

Some of these children do not live very long due to these systemic or hereditary diseases. That should be ruled out with ultrasound or CT scan.

Ocular abnormalities include high myopia, empty vitreous with membranes and bands. Retinal detachment in childhood and adolescence is different from adult cases due to higher rate of complicating predisposing factors such as trauma and high myopia and also due to the delay in the diagnosis that is mostly made after macular involvement.

By appropriate surgical treatment the anatomic success rate may be as high as adult cases, however lower functional results are usually achieved because of higher rate of macular involvement Butler et al.

It is important for the pediatrician to refer the children with signs and symptoms of retinal detachment, children with systemic disorders associated with retinal detachment and also children with ocular trauma history to an ophthalmologist. The tumor develops from the immature retina. It can be unilateral or bilateral. The hereditary form is usually bilateral and multifocal, whereas the nonhereditary form is unilateral and unifocal. The RB gene is recognized to be a recessive suppresser gene located on chromosome 13 at the 13q14 segment and some affected children have other systemic features of the 13 q deletion syndrome.

More advanced tumors can cause painful secondary glaucoma or signs of orbital cellulitis. The diagnosis of RB is best made by slit lamp bio-microscopy and indirect ophthalmoscopy.

Ancillary studies are ultrasonography and computed tomography. The red-reflex examination is the best way to screen for retinoblastoma. Leukocoria due to RB Second non-ocular cancers are leading cause of death in patients with the familial form of RB. Most common second tumors are soft tissue sarcoma, osteogenic sarcoma of the skull or the long bones, primitive neuroectodermal brain tumor and cutaneous melanoma. Trilateral RB refers to bilateral retinoblastoma associated with an intracranial primitive neuroectodermal tumor in the pineal or supraseller region Murphree, RB treatment typically requires the cooperation of an ophthalmic oncologist, pediatric oncologist and radiation therapist.

Treatment varies depending on the number, size, and location of the tumors. Protocols are currently being evaluated to use chemoreduction therapy to shrink the RB in order to treat them with thermotherapy, laser therapy, cryotherapy, and local episcleral plaque radiation.

More advanced tumors are managed by enucleation.

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External beam radiotherapy is typically reserved for eyes that fail the above methods, especially if retinoblastoma is bilateral. Lifelong monitoring is important to diagnose second primary tumor in the healthy eye as early as possible Valenzuela, Systemic disease and eye in children The principal ophthalmic manifestations are chorioretinal scar or an active chorioretinitis, and congenital cataract.

When they are present in congenital toxoplasmosis, herpes simplex, and cytomegalovirus, they are associated with extensive eye involvement Mets, MB. The gangliosidoses: Defects in lysosomal degradation of gangliosides can result in abnormal accumulation of these lipids.

Strabismus, nystagmus and mild corneal cloudy can be seen. Niemann-Pick disease: The principal ophthalmic manifestations are macular cherry red spot, mild corneal haze and fine lens opacities. The principal ophthalmic manifestations are retinal hypopigmentation, foveal hypoplasia, misrouting of optic nerve fibers at the chiasm with altered visual function, iris hypopigmentation, photophobia, nystagmus, strabismus and high refractive errors.

Galactosemia: The principal ophthalmic manifestation is cataract Martyn, Subluxation of crystalline lens, strabismus and retinal detachment may be seen in Marfan syndrome Traboulski, Treatment of the majority of uveitis involves predominantly the use of anti-inflammatory and immunosuppressive agents. Optic nerve disease in children The optic nerve is approximately 50 mm long from the globe to the chiasm. Belgium 7. Surgical correction during the preschool years must be performed. Important systemic associations are Basen-Kornzweig syndrome abetalipoproteinaemia , Refsum disease, Bardet- Biedl syndrome and Usher syndrome Drack, In this book volume, beyond classical themes, a different approach was made to current pediatric issues and topics.

Abrasions are common and present with foreign body sensation, lacrimation and photophobia. Protrusion of the eyeball, limitations of the eye movements and decreased visual acuity are signs of orbital cellulitis.