Comparing the performance of the EQ-5D-3L and the EQ-5D-5L in young Portuguese adults

Background Some studies have reported a ceiling effect in EQ-5D-3L, especially in healthy and/or young individuals. Recently, two further levels have been included in its measurement model (EQ-5D-5L). The purposes of this study were (1) to assess the properties of the EQ-5D-5L in comparison with the standard EQ-5D-3L in a sample of young adults, (2) to foreground the importance of collecting qualitative data to confirm, validate or refine the EQ-5D questionnaire items and (3) to raise questions pertaining to the wording in these questionnaire items. Methods The data used came from a sample of respondents aged 30 or under (n = 624). They completed both versions of the EQ-5D, which were compared in terms of feasibility, level of inconsistency and ceiling effect. Agreement between the instruments was assessed using correlation coefficients and Bland-Altman plots. Known-groups validity of the EQ-5D-5L was also assessed using non-parametric tests. The discriminative properties were compared using receiver operating characteristic curves. Finally, four interviews were conducted for retrospective reports to elicit respondents’ understanding and perceptions of the format, instructions, items, and responses. Results Quantitative results show a ceiling effect reduction of 25.3 % and a high level agreement between both indices. Known-groups validity was confirmed for the EQ-5D-5L. Explorative interviews indicated ambiguity and low degree of certainty in regards to conceptualizing differences between levels moderate-slight across three dimensions. Conclusions The EQ-5D-5L performed better than the EQ-5D-3L. However, the explorative interviews demonstrated several limitations in the EQ-5D questionnaire wording and high context-dependent answers point to lack of illnesses’ experience amongst young adults.

A value chain analysis of tuna industry in Ghana

Every can of tuna purchased by the consumer has taken a long journey before reaching the supermarket shelves. For each can bought there is a lengthy process from sea to shelf. A large proportion of the tuna cans purchased in the European Union come all the way from West Africa; a developing region with a high dependency on fisheries. Amidst an ever-increasing demand for tuna products the global tuna fisheries are set to continue expanding, apparently one of the last natural resource based industries fit to do so in West Africa. Tuna is the biggest fisheries export and dominates the fisheries sector in Ghana, a country situated in West Africa. This thesis aims to understand how this globally important industrial fisheries functions in terms of procedures, practices, Governance and finance. Socioeconomic influences, in the setting of a developing country, were also examined. For these purposes a Value Chain Analysis was employed. A Value Chain Analysis is a tool commonly used to understand how different companies and organizations participate in a domestic policy environment, which directs conclusion in the global economy. This analysis has the potential to allow researchers to fully understand a commodity chain and hence identify realistic opportunities for consequential improvements. Interviews and questionnaires were employed in-field Ghana along with secondary data collection techniques. It was found that the fisheries functions at the production level under influences from large multinational companies and tends to operate with a certain degree of lawlessness. Governance over the value chain is well defined, however implementation is poor or non-existent. The processors, whom are also dominated by multinationals, exert some control over the producers and their sales, however the high value links which are highlighted occur at the retail stage. Socioeconomic dynamics acting in the chain included the lack of communication between the public and private sector, power imbalances amongst players at production, the role of local businesswomen as actors in the chain and the general characteristics of the workers in the industry. Value addition and upgrading are needed the most in Governance over the chain, especially within Monitoring, Control and Surveillance. The results of the study provide a wealth of material about the components of a cost-heavy fishing industry in a developing country; an industry on which many eyes have recently turned due to illegal fishing activities. It highlights clearly where funding and future focus are needed. This value chain can be used as a guide for those that need to comprehend the financial complexities and real life dynamics of the Ghanaian tuna fishing industry today.

Reinventing America on the battlefields of Spain or following the party line: conflicting perceptions of the Spanish Civil War in the present and in the past

Isolationism and neutrality are two of the recurrent themes in the study of the history of the U.S. foreign policy in the interwar years. The trauma of the Great War, which had swept away 130.000 U.S. lives and had cost $30 billion, had led public opinion to strongly oppose any involvement with European affairs. Besides, the urgent need for economic recovery during the dismal years of the Great Depression did not leave Roosevelt much room for manoeuvre to influence international events. His positions regarding the intentions of the Fascist states remained, at best, ambivalent. These facts notwithstanding, about 2800 U.S. citizens crossed the Atlantic and rushed in to help democratic Spain, which was on the verge of becoming one more hostage in the hands of the Fascism. They joined the other British, Irish and Canadian volunteers and formed the XV International Brigade. 900 Americans never returned home. This alone should challenge the commonly held assumption that the American people were indifferent to the rise of the Fascist threat in Europe. But it also begs other questions. Considering the prevailing isolationist mood, what really motivated them? With what discursive elements did these men construct their anti Fascist representations? How far did their understanding of the Spanish democracy correspond to their own American democratic ideal? In what way did their war experience across the Atlantic mould their perception of U.S. politics (both domestic and foreign)? How far did the Spanish Civil War constitute one first step towards the realization that the U.S. might actually be drawn into another international conflict of unpredictable consequences? Last but not the least, what ideological, political and cultural complicity existed between the men from the English-speaking battalions? In order to unearth some of the answers, I intend to examine their letters and see how these men recorded the historical events in which they took part. Their correspondence emerged from the desire to prove their commitment to a common cause and spoke of a common war experience, but each letter, in its uniqueness, ends up mirroring not only the social and political background of each individual fighter, but also his own particular perspective of the war, of world politics and of the Spanish people. We shall see how these letters differ and converge and how these particular accounts weave, as in an epistolary novel, a larger-than-life narrative of outrage and solidarity, despair and hope.

Radiographers perceptions of magnetic resonance imaging: a study of the causes that lead to the exams repetition

Purpose: To know how often occur the repetitions of MRI exams and sequences in radiology departments. Methods and Materials: A self applied-questionnaire was used as instrument and assigned to 57 radiographers who performed MRI exams to determine which were the causes that lead to the repetition. The questionnaires were interpreted and statistically analyzed through descriptive statistics and Spearman’s rho correlations. Results: At a 95% confidence interval, the major results suggest that the patient’s movement during de MRI exams is the main cause to repeat this exams (mean of 3.88 on a 5 points likert scale). However, there are causes related to the radiographer’s and the results showed that the introduction of wrong imaging parameters by the performer are a major cause too (N=26). Spearman rho correlations between radiographer’s time of experience and frequency of MRI exams repetitions were poor and not significant (r=0.141; p=0.297). The correlations between radiographer’s tiredness and frequency of MRI exams repetitions were negative, weak and not significant (r= -0.151; p=0.263). Conclusion: The patients’ movement may disrupt the examination or degrade the images with artifacts. The level of experience doesn’t influence the repetitions of MRI exams, it seems that seniors radiographers don’t have improvements in performance as it should be expected. It’s recommendable to do training courses regularly to improve the performance and systematically evaluate. Several features will need to be identified which would decrease the MRI exams repetitions.