The clinical effectiveness and cost-effectiveness of exercise referral schemes: A systematic review and economic evaluation

- Background Exercise referral schemes (ERS) aim to identify inactive adults in the primary-care setting. The GP or health-care professional then refers the patient to a third-party service, with this service taking responsibility for prescribing and monitoring an exercise programme tailored to the needs of the individual. - Objective To assess the clinical effectiveness and cost-effectiveness of ERS for people with a diagnosed medical condition known to benefit from physical activity (PA). The scope of this report was broadened to consider individuals without a diagnosed condition who are sedentary. - Data sources MEDLINE; EMBASE; PsycINFO; The Cochrane Library, ISI Web of Science; SPORTDiscus and ongoing trial registries were searched (from 1990 to October 2009) and included study references were checked. - Methods Systematic reviews: the effectiveness of ERS, predictors of ERS uptake and adherence, and the cost-effectiveness of ERS; and the development of a decision-analytic economic model to assess cost-effectiveness of ERS. - Results Seven randomised controlled trials (UK, n = 5; non-UK, n = 2) met the effectiveness inclusion criteria, five comparing ERS with usual care, two compared ERS with an alternative PA intervention, and one to an ERS plus a self-determination theory (SDT) intervention. In intention-to-treat analysis, compared with usual care, there was weak evidence of an increase in the number of ERS participants who achieved a self-reported 90-150 minutes of at least moderate-intensity PA per week at 6-12 months' follow-up [pooled relative risk (RR) 1.11, 95% confidence interval 0.99 to 1.25]. There was no consistent evidence of a difference between ERS and usual care in the duration of moderate/vigorous intensity and total PA or other outcomes, for example physical fitness, serum lipids, health-related quality of life (HRQoL). There was no between-group difference in outcomes between ERS and alternative PA interventions or ERS plus a SDT intervention. None of the included trials separately reported outcomes in individuals with medical diagnoses. Fourteen observational studies and five randomised controlled trials provided a numerical assessment of ERS uptake and adherence (UK, n = 16; non-UK, n = 3). Women and older people were more likely to take up ERS but women, when compared with men, were less likely to adhere. The four previous economic evaluations identified suggest ERS to be a cost-effective intervention. Indicative incremental cost per quality-adjusted life-year (QALY) estimates for ERS for various scenarios were based on a de novo model-based economic evaluation. Compared with usual care, the mean incremental cost for ERS was £169 and the mean incremental QALY was 0.008, with the base-case incremental cost-effectiveness ratio at £20,876 per QALY in sedentary people without a medical condition and a cost per QALY of £14,618 in sedentary obese individuals, £12,834 in sedentary hypertensive patients, and £8414 for sedentary individuals with depression. Estimates of cost-effectiveness were highly sensitive to plausible variations in the RR for change in PA and cost of ERS. - Limitations We found very limited evidence of the effectiveness of ERS. The estimates of the cost-effectiveness of ERS are based on a simple analytical framework. The economic evaluation reports small differences in costs and effects, and findings highlight the wide range of uncertainty associated with the estimates of effectiveness and the impact of effectiveness on HRQoL. No data were identified as part of the effectiveness review to allow for adjustment of the effect of ERS in different populations. - Conclusions There remains considerable uncertainty as to the effectiveness of ERS for increasing activity, fitness or health indicators or whether they are an efficient use of resources in sedentary people without a medical diagnosis. We failed to identify any trial-based evidence of the effectiveness of ERS in those with a medical diagnosis. Future work should include randomised controlled trials assessing the cinical effectiveness and cost-effectivenesss of ERS in disease groups that may benefit from PA. - Funding The National Institute for Health Research Health Technology Assessment programme.

Income, deprivation and economic stress in the enlarged European Union

At risk of poverty indicators based on relative income measures suggest that within the enlarged EU societies located at quite different points on a continuum of affluence have similar levels of poverty. Substantial differences in levels of income between societies do not in themselves invalidate this approach. However, the relative income approach fails to capture the fact that, if countries are grouped in terms of level of GDP, between economic cluster differences in life-style deprivation are sharper at lower income levels. Support for the argument relating to restricted reference groups is found in relation to the contrast between the twelve most affluent EU countries and all others. The limitations of relative income poverty lines have little to do with the process of enlargement as such. Instead the major problem involves the weak association between income and deprivation in the more affluent countries. However, as a consequence of such difficulties, such indicators do not provide entirely meaningful comparisons of levels of disadvantage across economic clusters. The current analysis, rather than supporting the alternative of a focus on absolute income or an EU wide poverty line, suggests that we should take the argument for adopting a multidimensional approach to the measurement of poverty more seriously.

The Social and Economic Mobility of Ethnic Minority Communities in Northern Ireland

This report provides evidence of the degree, nature and drivers of poverty across the different ethnic minority groups in Northern Ireland. The 2011 Census highlighted some very different outcomes for ethnic minority groups in Northern Ireland across various indicators related to poverty. Through focus groups and interviews with employees and employers, this study further reveals how far the labour market is segmented among different ethnic minority communities. It also reviews government legislation and strategies relevant to Northern Ireland and the impact of these on poverty among ethnic minority groups. The report: • highlights employees’ difficulties in accessing relevant employment; • investigates employers’ procedures for recruitment, staff retention and development; • outlines government initiatives and programmes to support employees; and • reviews the level of uptake and success of government support for ethnic minority groups seeking employment or setting up a business.

Sustainability and economic evaluation of microalgae grown in brewery wastewater

This article evaluates the sustainability and economic potential of microalgae grown in brewery wastewater for biodiesel and biomass production. Three sustainability and two economic indicators were considered in the evaluation within a life cycle perspective. For the production system the most efficient process units were selected. Results show that harvesting and oil separation are the main process bottlenecks. Microalgae with higher lipid content and productivity are desirable for biodiesel production, although comparable to other biofuel’s feedstock concerning sustainability. However, improvements are still needed to reach the performance level of fossil diesel. Profitability reaches a limit for larger cultivation areas, being higher when extracted biomass is sold together with microalgae oil, in which case the influence of lipid content and areal productivity is smaller. The values of oil and/or biomass prices calculated to ensure that the process is economically sound are still very high compared with other fuel options, especially biodiesel.

Social policies and socioeconomic indicators for transitional economies

Includes bibliography

Social and economic problems in Cuba during the crisis and subsequent recovery

Includes bibliography

The development of science and technology indicators in the Caribbean

Includes bibliography

Manual for the compilation of science and technology indicators in the Caribbean

Includes bibliography

Economic indicators

Includes bibliography

MORPHO-PHYSIOLOGICAL INDICES AND ECONOMIC PRODUCTIVITY OF JAMBU CULTIVARS INFLUENCED BY THE ORGANIC AND MINERAL FERTILIZERS

The jambu belongs to the family Asteraceae, tropical crop, nowadays, this plant has been considered as a promising vegetable crop, because to its pharmacological properties. Despite this novelty, the vegetable remains invisible in the statistics of production and market in the state of Para, Brazil. This research was carried out with the aim of comparing the economic productivity and phenological development by the morpho-physiological growth indexes of two cultivars of jambu organic manure and mineral fertilizers. The experiment was carried out at the Sao Manuel Experimental Farm (Sao Manuel-SP), which belongs to the Faculdade de Ciencias Agronomicas - UNESP, campus Botucatu. The experimental design was a factorial randomized blocks (2 x 2) with two fertilization (organic and mineral) and two cultivars (Jambuarana and Nazareth), with six replications, two fertilization (organic and mineral) and two cultivars (Jambuarana and Nazareth). The following characteristics were evaluated: Plant height (cm), Leaf area (cm(2)), Fresh mass (g), Dry mass (g), Leaf area index (LAI), Leaf area ratio (LAR), Specific leaf Area (SLA), Leaf Weight Ratio (LWR), Amount of water in the plant (QAPA) (g per plant set), Leaf specific weight (LSW) (g cm(-2) per plant set) and Economic productivity. All data were statistically analyzed by analysis of variance and the Tukey test (1%) for mean comparison, with the software SISVAR. In the conditions of this experiment was carried out, it was possible to verify that the cultivar Jamburana had not only a good agronomic development and economic productivity under organic fertilization but also the best morpho-physiological indexes, showing that this kind of fertilization increases the agronomic effectiveness of this cultivar.

Nitrogen Fertirrigation: an Integrated Agronomic and Environmental Study

Proper management of the N applied to crops is necessary in order to increase yield, improve water use efficiency (WUE) and reduce the pollutions risks with the least economic, environmental and health costs. A field study with melon crops was conducted during 2005, 2006 and 2007 in central Spain, using 11 different amounts of N. Some environmental indexes have been proposed, to provide an essential tool for determining the groundwater pollution risks associated with common agricultural practices. These indexes are related to variation in the nitrate concentration of drinking water (Impact Index (II)) and groundwater (Environmental Impact Index (EII)). Also, the Management Efficiency (ME) was calculated, which is related to the amount of fruit produced per gram of N leached (Nl). To determine the optimum dose of N, it was also necessary to know the N mineralisation (NM). Our results show that 160 kg ha?1 of available N (Nav) produced the maximum fruit yield (FY), enhanced WUE and gave an NM of 85 kg ha?1, while the impact indexes did not exceed the fixed maximum allowable limits and ME was adequate. The proposed indexes proved to be an effective tool for determining the risk of nitrate contamination and confirmed that the optimum dose of N corresponded to the maximum FY with minimal loss of Nl.

Indicators of sustainability of agriculture and livestock in Spain - Indicadores de sostenibilidad de la agricultura y ganadería española

Sustainability is an adjective used to characterize agriculture according to the degree of fulfillment of goals. Those goals are related to agro-ecological, environmental and socio-economic dimensions. Sustainability is a dynamic and temporal character. In absolute terms there is not an ending value because it changes as its dimensions make it. Spain is one of the main agricultural countries of the European Union both in terms of crop land and value of productions. The object of this study is to present a methodology of sustainability account to be incorporated into national statistical and to assess their performance in the course of the years. For that reason the data sources used have been the statistics of the Department of Agriculture and from others database. We presented a set of indicators of sustainability and its evaluation in a time series of at least 30 years. The trend analysis offers the evolution of the numerical values of the indicators in terms of efficiency, physical units used for a unit of product or its value in euros. The analyzed crops have been: wheat, barley, maize, sunflower, sugar beet, wine grape, olive oil, citrus, melon and tomato. Physical indicators were: land, water, energy, erosion, soil organic matter, and carbon balance; socio-economic indicators were: agricultural final production, prices, income, employment and use of fertilizers. In general, all crops increased their productive efficiency, higher in irrigated than on dry land. Spanish agricultural carbon sequestration capacity has multiplied by five in the last seventy years, as a result of the increase in the productivity of crops, in terms of total biomass and the modification of the soil management techniques. Livestock sector presents data of pork, broilers and laying hen. Those showed an improvement in efficiency and economic indicators. Overall we can say that Spanish agriculture and livestock subsector have a tendency towards sustainability, being its main threats extreme meteorological factors and the instability of todays markets.

Nitrogen fertigation: An integrated agronomic and environmental study

Proper management of the N applied to crops is necessary in order to increase yield, improve water use efficiency (WUE) and reduce the pollutions risks with the least economic, environmental and health costs. A field study with melon crops was conducted during 2005, 2006 and 2007 in central Spain, using 11 different amounts of N. Some environmental indexes have been proposed, to provide an essential tool for determining the groundwater pollution risks associated with common agricultural practices. These indexes are related to variation in the nitrate concentration of drinking water (Impact Index (II)) and groundwater (Environmental Impact Index (EII)). Also, the Management Efficiency (ME) was calculated, which is related to the amount of fruit produced per gram of N leached (Nl). To determine the optimum dose of N, it was also necessary to know the N mineralisation (NM). Our results show that 160 kg ha−1 of available N (Nav) produced the maximum fruit yield (FY), enhanced WUE and gave an NM of 85 kg ha−1, while the impact indexes did not exceed the fixed maximum allowable limits and ME was adequate. The proposed indexes proved to be an effective tool for determining the risk of nitrate contamination and confirmed that the optimum dose of N corresponded to the maximum FY with minimal loss of Nl.

Analysis of the impact of globalization and economic growth on food security in developing countries

A pesar de los importantes avances en la reducción del hambre, la seguridad alimentaria continúa siendo un reto de dimensión internacional. La seguridad alimentaria es un concepto amplio y multidimensional, cuyo análisis abarca distintas escalas y horizontes temporales. Dada su complejidad, la identificación de las causas de la inseguridad alimentaria y la priorización de las medias para abordarlas, son dos cuestiones que suscitan un intenso debate en la actualidad. El objetivo de esta tesis es evaluar el impacto de la globalización y el crecimiento económico en la seguridad alimentaria en los países en desarrollo, desde una perspectiva macro y un horizonte temporal a largo plazo. La influencia de la globalización se aborda de una manera secuencial. En primer lugar, se analiza la relación entre la inversión público-privada en infraestructuras y las exportaciones agrarias. A continuación, se estudia el impacto de las exportaciones agrarias en los indicadores de seguridad alimentaria. El estudio del impacto del crecimiento económico aborda los cambios paralelos en la distribución de la renta, y cómo la inequidad influye en el comportamiento de la seguridad alimentaria nacional. Además, se analiza en qué medida el crecimiento económico contribuye a acelerar el proceso de mejora de la seguridad alimentaria. Con el fin de conseguir los objetivos mencionados, se llevan a cabo varios análisis econométricos basados en datos de panel, en el que se combinan datos de corte transversal de 52 países y datos temporales comprendidos en el periodo 1991-2012. Se analizan tanto variables en niveles como variables en tasas de cambio anual. Se aplican los modelos de estimación de efectos variables y efectos fijos, ambos en niveles y en primeras diferencias. La tesis incluye cuatro tipos de modelos econométricos, cada uno de ellos con sus correspondientes pruebas de robustez y especificaciones. Los resultados matizan la importancia de la globalización y el crecimiento económico como mecanismos de mejora de la seguridad alimentaria en los países en desarrollo. Se obtienen dos conclusiones relativas a la globalización. En primer lugar, los resultados sugieren que la promoción de las inversiones privadas en infraestructuras contribuye a aumentar las exportaciones agrarias. En segundo lugar, se observa que las exportaciones agrarias pueden tener un impacto negativo en los indicadores de seguridad alimentaria. La combinación de estas dos conclusiones sugiere que la apertura comercial y financiera no contribuye por sí misma a la mejora de la seguridad alimentaria en los países en desarrollo. La apertura internacional de los países en desarrollo ha de ir acompañada de políticas e inversiones que desarrollen sectores productivos de alto valor añadido, que fortalezcan la economía nacional y reduzcan su dependencia exterior. En relación al crecimiento económico, a pesar del incuestionable hecho de que el crecimiento económico es una condición necesaria para reducir los niveles de subnutrición, no es una condición suficiente. Se han identificado tres estrategias adicionales que han de acompañar al crecimiento económico con el fin de intensificar su impacto positivo sobre la subnutrición. Primero, es necesario que el crecimiento económico sea acompañado de una distribución más equitativa de los ingresos. Segundo, el crecimiento económico ha de reflejarse en un aumento de inversiones en salud, agua y saneamiento y educación. Se observa que, incluso en ausencia de crecimiento económico, mejoras en el acceso a agua potable contribuyen a reducir los niveles de población subnutrida. Tercero, el crecimiento económico sostenible en el largo plazo parece tener un mayor impacto positivo sobre la seguridad alimentaria que el crecimiento económico más volátil o inestable en el corto plazo. La estabilidad macroeconómica se identifica como una condición necesaria para alcanzar una mayor mejora en la seguridad alimentaria, incluso habiéndose mejorado la equidad en la distribución de los ingresos. Por último, la tesis encuentra que los países en desarrollo analizados han experimentado diferentes trayectorias no lineales en su proceso de mejora de sus niveles de subnutrición. Los resultados sugieren que un mayor nivel inicial de subnutrición y el crecimiento económico son responsables de una respuesta más rápida al reto de la mejora de la seguridad alimentaria. ABSTRACT Despite the significant reductions of hunger, food security still remains a global challenge. Food security is a wide concept that embraces multiple dimensions, and has spatial-temporal scales. Because of its complexity, the identification of the drivers underpinning food insecurity and the prioritization of measures to address them are a subject of intensive debate. This thesis attempts to assess the impact of globalization and economic growth on food security in developing countries with a macro level scale (country) and using a long-term approach. The influence of globalization is addressed in a sequential way. First, the impact of public-private investment in infrastructure on agricultural exports in developing countries is analyzed. Secondly, an assessment is conducted to determine the impact of agricultural exports on food security indicators. The impact of economic growth focuses on the parallel changes in income inequality and how the income distribution influences countries' food security performance. Furthermore, the thesis analyzes to what extent economic growth helps accelerating food security improvements. To address the above mentioned goals, various econometric models are formulated. Models use panel data procedures combining cross-sectional data of 52 countries and time series data from 1991 to 2012. Yearly data are expressed both in levels and in changes. The estimation models applied are random effects estimation and fixed effects estimations, both in levels and in first differences. The thesis includes four families of econometric models, each with its own set of robustness checks and specifications. The results qualify the relevance of globalization and economic growth as enabling mechanisms for improving food security in developing countries. Concerning globalization, two main conclusions can be drawn. First, results showed that enhancing foreign private investment in infrastructures contributes to increase agricultural exports. Second, agricultural exports appear to have a negative impact on national food security indicators. These two conclusions suggest that trade and financial openness per se do not contribute directly to improve food security in development countries. Both measures should be accompanied by investments and policies to support the development of national high value productive sectors, to strengthen the domestic economy and reduce its external dependency. Referring to economic growth, despite the unquestionable fact that income growth is a pre-requisite for reducing undernourishment, results suggest that it is a necessary but not a sufficient condition. Three additional strategies should accompany economic growth to intensifying its impact on food security. Firstly, it is necessary that income growth should be accompanied by a better distribution of income. Secondly, income growth needs to be followed by investments and policies in health, sanitation and education to improve food security. Even if economic growth falters, sustained improvements in the access to drinking water may still give rise to reductions in the percentage of undernourished people. And thirdly, long-term economic growth appears to have a greater impact on reducing hunger than growth regimes that combine periods of growth peaks followed by troughs. Macroeconomic stability is a necessary condition for accelerating food security. Finally, the thesis finds that the developing countries analyzed have experienced different non-linear paths toward improving food security. Results also show that a higher initial level of undernourishment and economic growth result in a faster response for improving food security.

Patents and Economic Activity: The Need to Develop Prediction Methods for Patent Applications

Since the decade of the 1980’s the literature on economic development began paying attention to the cases of countries which were industrialized after the first industrial revolution. One of the most relevant aspects analyzed has been the role of technology as a factor which promotes or delays the process of catching up with technology leaders. As result of this interest, new and more adequate indicators were identified to provide a coherent explanation for technological activities and their relationship with economic efficiency. Although the earliest studies focused on analyzing the activities of research and development (R&D), recently the focus of analysis has shifted to another type of variables, more oriented towards the processes of innovation and the gathering of knowledge and capabilities, in which patents provide relevant information.