Improving the economic value of photographic screening for optical coherence tomography-detectable macular oedema:a prospective, multicentre, UK study

Objectives: To determine the best photographic surrogate markers for detecting sight-threatening macular oedema (MO) in people with diabetes attending UK national screening programmes. Design: A multicentre, prospective, observational cohort study of 3170 patients with photographic signs of diabetic retinopathy visible within the macular region [exudates within two disc diameters, microaneurysms/dot haemorrhages (M/DHs) and blot haemorrhages (BHs)] who were recruited from seven study centres. Setting: All patients were recruited and imaged at one of seven study centres in Aberdeen, Birmingham, Dundee, Dunfermline, Edinburgh, Liverpool and Oxford. Participants: Subjects with features of diabetic retinopathy visible within the macular region attending one of seven diabetic retinal screening programmes. Interventions: Alternative referral criteria for suspected MO based on photographic surrogate markers; an optical coherence tomographic examination in addition to the standard digital retinal photograph. Main outcome measures: (1) To determine the best method to detect sight-threatening MO in people with diabetes using photographic surrogate markers. (2) Sensitivity and specificity estimates to assess the costs and consequences of using alternative strategies. (3) Modelled long-term costs and quality-adjusted life-years (QALYs). Results: Prevalence of MO was strongly related to the presence of lesions and was roughly five times higher in subjects with exudates or BHs or more than two M/DHs within one disc diameter. Having worse visual acuity was associated with about a fivefold higher prevalence of MO. Current manual screening grading schemes that ignore visual acuity or the presence of M/DHs could be improved by taking these into account. Health service costs increase substantially with more sensitive/less specific strategies. A fully automated strategy, using the automated detection of patterns of photographic surrogate markers, is superior to all current manual grading schemes for detecting MO in people with diabetes. The addition of optical coherence tomography (OCT) to each strategy, prior to referral, results in a reduction in costs to the health service with no decrement in the number of MO cases detected. Conclusions: Compared with all current manual grading schemes, for the same sensitivity, a fully automated strategy, using the automated detection of patterns of photographic surrogate markers, achieves a higher specificity for detecting MO in people with diabetes, especially if visual acuity is included in the automated strategy. Overall, costs to the health service are likely to increase if more sensitive referral strategies are adopted over more specific screening strategies for MO, for only very small gains in QALYs. The addition of OCT to each screening strategy, prior to referral, results in a reduction in costs to the health service with no decrement in the number of MO cases detected. © Queen's Printer and Controller of HMSO 2013.

Kameralizmus, történelmi iskola, osztrák gazdaságtan. Három vázlat a német és osztrák közgazdasági diskurzus történetéből (Cameralism, the historical school and Austrian economics. Three outlines from the history of German and Austrian economic debate)

A kameralizmus a 16-18. századi német gyakorlati államtudomány és egyetemi tantárgy volt, amely összefoglalta a hivatalnokok képzéséhez szükséges elméleti és gyakorlati gazdasági ismereteket. Felfogása szerint az alattvalók jóléte és boldogsága feltétele az uralkodó gazdagságának, de az alattvalók önmaguktól nem képesek utat találni ehhez a boldogsághoz, szükség van az állandó külső irányításra. Igazgatásközpontúsága és egyetemi intézményesülése miatt nem tekinthető a merkantilizmus helyi változatának. Az 1840 és 1945 közötti német történeti iskola hagyományos ábrázolása több mint egy évszázadon át a német és a neoklasszikus tradíció szembenállását hangsúlyozta, kiemelve az organicizmus, a fejlődésgondolat és az egyediség jelentőségét, a szociális kérdés fontosságát, illetve a deduktív módszer és a gazdaság változatlan törvényeinek tagadását. A modern rekonstrukciók a történeti iskolát a posztklasszikus válságra adott egyik európai válaszként fogják fel, amely a történelemből levont, empirikusan megalapozott induktív alternatívát kínált. Az 1871-től kialakult osztrák iskola a neoklasszikus paradigmának egyszerre volt alkotórésze és versenytársa. A módszertani individualizmus, a szubjektivizmus, az idő fontossága, a tudás szerepe, az alternatív költségek elmélete stb. ugyan beépültek a mainstream közgazdaságtanba, de hangsúlyos kiemelésük lehetővé tette, hogy a társadalomelméleti magyarázat igényét őrző osztrák iskola megtartson valamit önálló beszédmódjából. / === / Cameralism was a practical political science and university subject in 16th–18th century Germany, summarizing the theoretical and practical economic knowledge required in the training of officials. The assumption was that the prosperity of the ruler depended on the welfare and happiness of the subjects, but the subjects themselves were not capable of achieving this happiness without permanent directions from above. Cameralism’s emphasis on administration and university institutionalization means that this approach cannot be seen as a local variant of mercantilism. The traditional account of the German historical school from 1840 to 1945 emphasized for over a century the contrast between the German and the Neoclassical traditions. It underlined the significance of the organic approach, the concept of development and individuality, the importance of the social question, and the denial of the deductive method and unalterable laws of the economy. Modern reconstructions see the historical school as one European response to the post-Classical crisis, offering an inductive alternative grounded empirically on history. The Austrian school formed in 1871 was at once a constituent of the Neoclassical paradigm and a rival to it. Methodological individualism, subjectivism, the importance of time, the role of knowledge, the theory of alternative costs etc. were absorbed into mainstream economics, but the focusing on these issues allowed the Austrian school, in keeping alive its demand for a social-theoretical explanation, to preserve something of an alternative discourse.

Lokális energiamódszer kicsi rendben gerjesztett Liénard-egyenletekre (Local energy method for little order forced equations)

Az x''+f(x) x'+g(x) = 0 alakú Liénard-típusú differenciálegyenlet központi szerepet játszik az üzleti ciklusok Káldor-Kalecki-féle [3,4] és Goodwin-féle [2] modelljeiben, sőt egy a munkanélküliség és vállalkozás-ösztönzések ciklikus változásait leíró újabb modellben [1] is. De ugyanez a nemlineáris egyenlettípus a gerjesztett ingák és elektromos rezgőkörök elméletét is felöleli [5]. Az ezzel kapcsolatos irodalom nagyrészt a határciklusok létezését vizsgálja (pl. [5]), pedig az alapvető stabilitási kérdések jóval áttekinthetőbb módon kezelhetők, s a kapott eredmények közvetve a határciklusok létezésének feltételeit is sokkal jobban be tudják határolni. Jelen dolgozatban az egyváltozós analízis hatékony nyelvezetével olyan egyszerűen megfogalmazható eredményekhez jutunk, amelyek képesek kitágítani az üzleti és más közgazdasági ciklusok modelljeinek kereteit, illetve pl. az [1]-beli modellhez újabb szemléltető speciális eseteket is nyerünk. ____ The Liénard type differential equation of the form x00 + f(x) ¢ x0 + g(x) = 0 has a central role in business cycle models by Káldor [3], Kalecki [4] and Goodwin [2], moreover in a new model describing the cyclical behavior of unemployment and entrepreneurship [1]. The same type of nonlinear equation explains the features of forced pendulums and electric circuits [5]. The related literature discusses mainly the existence of limit cycles, although the fundamental stability questions of this topic can be managed much more easily. The achieved results also outline the conditions for the existence of limit cycles. In this work, by the effective language of real valued analysis, we obtain easy-formulated results which may broaden the frames of economic and business cycle models, moreover we may gain new illustrative particular cases for e.g., [1].

Magyarország hét régiójának új gazdaságföldrajzi modellje – paraméterbecslés (The new economic-geography model of Hungary's seven regions - a parameter estimate)

Az új gazdaságföldrajz – amely napjaink egy igen népszerű közgazdaságtani tudományága – modelljének majdnem minden paramétere előállítható közvetlenül külső adatok segítségével. A helyettesítési rugalmassághoz azonban más módszerre van szükség. Puga [1999] által felvázolt új gazdaságföldrajzi modellt követve, egy regressziós egyenlettel megbecsülhetővé válik a kívánt paraméter, amit Magyarország hét régiójára vonatkozó béregyenlet becsléséből nyertünk. A helyettesítési rugalmasság értéke eltér a szakirodalomhoz képest, aminek magyarázata Magyarország fejlettségi szintjével állhat összefüggésben. ____ The model of the new economic geography - very popular material for economic study these days - allows almost every parameter to be presented directly with the aid of outside data. However, another method is required for substitution flexibility. With the new economic-geography model devised by Puga [1999], a regression equation allows an estimate to be made for the desired parameter, which yielded the wage equation for the six regions of Hungary. The value for substitution flexibility differs from that of the literature, the explanation for which may lie in Hungary's level of development.

Közjó és demokrácia. Két közgazdaságtani elmélet a demokráciáról (Common good and democracy. Two economic theories of democracy)

A tanulmány a demokrácia két közgazdaságtani elméletét mutatja be. A demokrácia klasszikus elmélete a közjó fogalmára épült: a klasszikus politikai filozófia érvelése szerint a demokrácia intézménye a közjó megvalósulásának eszköze. Schumpeter bírálta a klasszikus elméletet: a közgazdasági szemléletet alkalmazva a közjó értelmezésére leválasztotta a demokráciáról a közjó fogalmát. Schumpeter szerint a demokrácia szubsztantív felfogása nem tartható, ezért ehelyett a demokrácia procedurális értelmezését kínálta fel. Az alkotmányos közgazdaságtan nem fogadja el sem a közjó és demokrácia fogalmainak elválasztását, sem a közjó szubsztantív értelmezését, ehelyett a közjónak és a demokráciának egyaránt procedurális értelmezését javasolja. _____ This essay deals with two economic theories of democracy. The classical doctrine of democracy was built on the concept of the common good, classical political philosophy arguing that the institution of democracy was the instrument for realizing the common good. This theory was criticized by Schumpeter, who applied the method of modern economics to analysis of the concept, which he separated from democracy, arguing that the substantive concept of democracy was untenable, and proposing to replace it with the procedural concept of democracy. Constitutional economics does not accept such separation of the concepts of democracy and the common good, but it does not accept the substantive interpretation of the common good either. Rather, it proposes a procedural concept of both the common good and of democracy.

Winning Media Strategies in the Time of the Economic Crisis

At the time of the economic crisis cutting marketing and media expenses is a common corporate reaction. While this reaction is rather obvious, this may not be the winning option. To find out more about successful media strategies authors conducted a broad, multiple method research, including interviews with industry experts (N=6, leading decision makers), scrutiny of consumer narratives (N=100), content analysis of forum and blog entries (N=7086 comments) and focus group interviews (N=4). Research findings point to realignment in media spending namely better-targeted communications programs and more fragmented media choice, and besides, show the increasing role of audience participation, too. Authors argue that careful managerial efforts for harmonizing consumer problems and advertising content may result in finding the path from problem level to desired level in marketing communication practices even in crisis periods.

A prosztatarák gazdasági terhe nagy betegregiszterek alapján (The economic burden of prostate cancer. A systematic literature overview of registry-based studies)

INTRODUCTION: Prostate cancer, the most frequent malignant disease in males in Europe, accounts for a great proportion of health expenditures. AIM: A systematic review of registry-based studies about the cost-of-illness and related factors of prostate cancer, published in the last 10 years. METHOD: A MEDLINE-based literature review was carried out between January 1, 2003 and October 1, 2013. RESULTS: Fifteen peer-reviewed articles met the criteria of interest. In developed countries radiotherapy, surgical treatment and hormone therapy account for the greatest per capita costs. In Europe early stage tumours (4-7000 €, 2006), while in the USA metastatic prostate cancer (19 900-25 500 $, 2004) was associated with highest per capita expenses. In Europe the greatest costs incurred within the initial treatment (6400 €/6 months, 2008), while in the USA within the end-of-life care (depending on age: 62 200-93 400 $, 2010). CONCLUSIONS: Despite public health importance of prostate cancer, the cost-of-illness literature from Europe is relatively small.

Chaos Theory and Socio-Economic Renewal in Hungary

We utilised methods of chaos theory that were originally used in a 1990’s study to analyse the behaviour of various Hungarian socio-economic macro indicators, both historically and their expected behaviour in the future. In this study, we present the method adapted to PC and the behaviour of the selected macro indicators. We characterize the pathways our society and economy has experienced and where they are heading to into the future by the means of these indicators. Comparing the present results of analysis with the results twenty years ago (when today’s present was the future) we came to the conclusion that most of the indicators became less chaotic, thus the socio-economic courses were getting more stable over the past two decades. We conclude that the opportunity to change them is slowly diminishing, it will be more and more difficult to renew the Hungarian socio-economic indicators, and to turn the processes to more desirable courses. Recommendations for change interventions are then provided.

Az optimális ár meghatározásának módszere az értékteremtés szolgálatában (The method of determining the optimal price for the service of value creation)

A tanulmány a mikroökonómia eszközrendszerét és a hazai gépjárműpiac 2013-as adatait segítségül hívva egy új módszert mutat be az ármeghatározás területén. A kutatás központi kérdése az, hogy hol található az a pont, amikor a fogyasztó elégedett a kínált minőséggel és árral – lehetőleg megfelelő időben – és a vállalat is elégedett a megszerzett profittal. A tanulmányban tehát az ármeghatározás során központi szerepet játszik a minőség és az idő, mint értékteremtő funkció. Az elemzés egyik legfőbb következtetése, hogy a profitmaximumból levezetett optimális ár a minőség és az idő különböző paraméterei mellett meghatározható. A módszer segítségével a vállalatok közgazdasági eszközrendszer segítségével kapnak egy új szemléletet működési paramétereik és egyben versenyprioritásaik (ár, költség, minőségszint, idő) felállításához. _____ The study points to a new method for determining price with the tools of microeconomics and data of the Hungarian car market. The focus of the research is on where to find the point where the consumer is satisfied with the quality and price offered – preferably right time – and the company is satisfied with the profit achieved. In this study, therefore, in setting prices plays a central role the quality and time as a value-added feature. One of the main conclusions of the analysis is that the optimal price can be determined by various parameters of the quality and time. The method of using the economic tools help companies get a new perspective and to set up their optimal operating parameters (price, cost, quality level, time).

An exergy based engineering and economic analysis of sustainable building

To achieve the goal of sustainable development, the building energy system was evaluated from both the first and second law of thermodynamics point of view. The relationship between exergy destruction and sustainable development were discussed at first, followed by the description of the resource abundance model, the life cycle analysis model and the economic investment effectiveness model. By combining the forgoing models, a new sustainable index was proposed. Several green building case studies in U.S. and China were presented. The influences of building function, geographic location, climate pattern, the regional energy structure, and the technology improvement potential of renewable energy in the future were discussed. The building’s envelope, HVAC system, on-site renewable energy system life cycle analysis from energy, exergy, environmental and economic perspective were compared. It was found that climate pattern had a dramatic influence on the life cycle investment effectiveness of the building envelope. The building HVAC system energy performance was much better than its exergy performance. To further increase the exergy efficiency, renewable energy rather than fossil fuel should be used as the primary energy. A building life cycle cost and exergy consumption regression model was set up. The optimal building insulation level could be affected by either cost minimization or exergy consumption minimization approach. The exergy approach would cause better insulation than cost approach. The influence of energy price on the system selection strategy was discussed. Two photovoltaics (PV) systems—stand alone and grid tied system were compared by the life cycle assessment method. The superiority of the latter one was quite obvious. The analysis also showed that during its life span PV technology was less attractive economically because the electricity price in U.S. and China did not fully reflect the environmental burden associated with it. However if future energy price surges and PV system cost reductions were considered, the technology could be very promising for sustainable buildings in the future.

An Exergy Based Engineering and Economic Analysis of Sustainable Building

To achieve the goal of sustainable development, the building energy system was evaluated from both the first and second law of thermodynamics point of view. The relationship between exergy destruction and sustainable development were discussed at first, followed by the description of the resource abundance model, the life cycle analysis model and the economic investment effectiveness model. By combining the forgoing models, a new sustainable index was proposed. Several green building case studies in U.S. and China were presented. The influences of building function, geographic location, climate pattern, the regional energy structure, and the technology improvement potential of renewable energy in the future were discussed. The building’s envelope, HVAC system, on-site renewable energy system life cycle analysis from energy, exergy, environmental and economic perspective were compared. It was found that climate pattern had a dramatic influence on the life cycle investment effectiveness of the building envelope. The building HVAC system energy performance was much better than its exergy performance. To further increase the exergy efficiency, renewable energy rather than fossil fuel should be used as the primary energy. A building life cycle cost and exergy consumption regression model was set up. The optimal building insulation level could be affected by either cost minimization or exergy consumption minimization approach. The exergy approach would cause better insulation than cost approach. The influence of energy price on the system selection strategy was discussed. Two photovoltaics (PV) systems – stand alone and grid tied system were compared by the life cycle assessment method. The superiority of the latter one was quite obvious. The analysis also showed that during its life span PV technology was less attractive economically because the electricity price in U.S. and China did not fully reflect the environmental burden associated with it. However if future energy price surges and PV system cost reductions were considered, the technology could be very promising for sustainable buildings in the future.

A recessionary debate: who suffered more? A study of sectoral well-being and economic insecurity in Ireland

The aim of this thesis is to identify the relationship between subjective well-being and economic insecurity for public and private sector workers in Ireland using the European Social Survey 2010-2012. Life satisfaction and job satisfaction are the indicators used to measure subjective well-being. Economic insecurity is approximated by regional unemployment rates and self-perceived job insecurity. Potential sample selection bias and endogeneity bias are accounted for. It is traditionally believed that public sector workers are relatively more protected against insecurity due to very institution of public sector employment. The institution of public sector employment is made up of stricter dismissal practices (Luechinger et al., 2010a) and less volatile employment (Freeman, 1987) where workers are subsequently less likely to be affected by business cycle downturns (Clark and Postal-Vinay, 2009). It is found in the literature that economic insecurity depresses the well-being of public sector workers to a lesser degree than private sector workers (Luechinger et al., 2010a; Artz and Kaya, 2014). These studies provide the rationale for this thesis in testing for similar relationships in an Irish context. Sample selection bias arises when a selection into a particular category is not random (Heckman, 1979). An example of this is non-random selection into public sector employment based on personal characteristics (Heckman, 1979; Luechinger et al., 2010b). If selection into public sector employment is not corrected for this can lead to biased and inconsistent estimators (Gujarati, 2009). Selection bias of public sector employment is corrected for by using a standard Two-Step Heckman Probit OLS estimation method. Following Luechinger et al. (2010b), the propensity for individuals to select into public sector employment is estimated by a binomial probit model with the inclusion of the additional regressor Irish citizenship. Job satisfaction is then estimated by Ordinary Least Squares (OLS) with the inclusion of a sample correction term similar as is done in Clark (1997). Endogeneity is where an independent variable included in the model is determined within in the context of the model (Chenhall and Moers, 2007). The econometric definition states that an endogenous independent variable is one that is correlated with the error term (Wooldridge, 2010). Endogeneity is expected to be present due to a simultaneous relationship between job insecurity and job satisfaction whereby both variables are jointly determined (Theodossiou and Vasileiou, 2007). Simultaneity, as an instigator of endogeneity, is corrected for using Instrumental Variables (IV) techniques. Limited Information Methods and Full Information Methods of estimation of simultaneous equations models are assed and compared. The general results show that job insecurity depresses the subjective well-being of all workers in both the public and private sectors in Ireland. The magnitude of this effect differs among sectoral workers. The subjective well-being of private sector workers is more adversely affected by job insecurity than the subjective well-being of public sector workers. This is observed in basic ordered probit estimations of both a life satisfaction equation and a job satisfaction equation. The marginal effects from the ordered probit estimation of a basic job satisfaction equation show that as job insecurity increases the probability of reporting a 9 on a 10-point job satisfaction scale significantly decreases by 3.4% for the whole sample of workers, 2.8% for public sector workers and 4.0% for private sector workers. Artz and Kaya (2014) explain that as a result of many austerity policies implemented to reduce government expenditure during the economic recession, workers in the public sector may for the first time face worsening perceptions of job security which can have significant implications for their well-being (Artz and Kaya, 2014). This can be observed in the marginal effects where job insecurity negatively impacts the well-being of public sector workers in Ireland. However, in accordance with Luechinger et al. (2010a) the results show that private sector workers are more adversely impacted by economic insecurity than public sector workers. This suggests that in a time of high economic volatility, the institution of public sector employment held and was able to protect workers against some of the well-being consequences of rising insecurity. In estimating the relationship between subjective well-being and economic insecurity advanced econometric issues arise. The results show that when selection bias is corrected for, any statistically significant relationship between job insecurity and job satisfaction disappears for public sector workers. Additionally, in order to correct for endogeneity bias the simultaneous equations model for job satisfaction and job insecurity is estimated by Limited Information and Full Information Methods. The results from two different estimators classified as Limited Information Methods support the general findings of this research. Moreover, the magnitude of the endogeneity-corrected estimates are twice as large as those not corrected for endogeneity bias which is similarly found in Geishecker (2010, 2012). As part of the analysis into the effect of economic insecurity on subjective well-being, the effects of other socioeconomic variables and work-related variables are examined for public and private sector workers in Ireland.

Évaluation d’un programme de formation en matière d’agression sexuelle envers les enfants pour les communautés autochtones du Québec

L’agression sexuelle (AS) envers les enfants est une problématique majeure affectant les communautés autochtones. Considérant les conséquences à long terme associées à l’AS, il est primordial que les intervenants soient formés adéquatement pour intervenir en cas d’AS puisque que cette problématique compromet le bien-être des enfants, de leur famille et de leur communauté. Le Centre d’expertise Marie-Vincent, en partenariat avec les communautés autochtones, a mis sur pied une formation en matière d’AS spécifiquement adaptée aux besoins des intervenants. De 2013 à 2015, 161 professionnels œuvrant dans les communautés autochtones ont participé à cette formation. Deux phases de collecte de données distinctes ont été menées pour vérifier l’atteinte des objectifs du programme, soit l’amélioration des connaissances et des interventions en matière d’AS des participants. Lors de la première phase, les participants ont répondu à un questionnaire de réactions et à un test de connaissances. Une étude de cas multiples qualitative comportant quatre communautés a été réalisée lors de la deuxième phase. En plus d’un taux d’appréciation élevé, les résultats révèlent une augmentation significative des connaissances, passant de 54 % à 87 % (t(125) = 16,4, p < 0,001, ηp2 = 0,68). L’analyse des entrevues fait état d’une appropriation des contenus de formation dans la pratique professionnelle des participants. Ces derniers affirment avoir modifié la façon dont ils questionnent les enfants et être plus attentifs aux signes et symptômes d’une AS. Des changements sur le plan des attitudes, notamment sur l’importance du signalement, sont également rapportés. Finalement, la formation est considérée comme l’un des éléments déclencheurs d’une meilleure collaboration intersectorielle dans au moins une communauté.

The Causal Links between FDI and Economic Growth in Developing Countries: A Case Study of the Republic of Rwanda

The study examines the short-run and long-run causality running from real economic growth to real foreign direct investment inflows (RFDI). Other variables such as education (involving combination of primary, secondary and tertiary enrolment as a proxy to education), real development finance, unskilled labour, to real RFDI inflows are included in the study. The time series data covering the period of 1983 -2013 are examined. First, I applied Augmented Dicky-Fuller (ADF) technique to test for unit root in variables. Findings shows all variables integrated of order one [I(1)]. Thereafter, Johansen Co-integration Test (JCT) was conducted to establish the relationship among variables. Both trace and maximum Eigen value at 5% level of significance indicate 3 co-integrated equations. Vector error correction method (VECM) was applied to capture short and long-run causality running from education, economic growth, real development finance, and unskilled labour to real foreign direct investment inflows in the Republic of Rwanda. Findings shows no short-run causality running from education, real development finance, real GDP and unskilled labour to real FDI inflows, however there were existence of long-run causality. This can be interpreted that, in the short-run; education, development finance, finance and economic growth does not influence inflows of foreign direct investment in Rwanda; but it does in long-run. From the policy perspective, the Republic of Rwanda should focus more on long term goal of investing in education to improve human capital, undertake policy reforms that promotes economic growth, in addition to promoting good governance to attract development finance – especially from Nordics countries (particularly Norway and Denmark).

Testing the psychometric properties of Kidscreen-27 with Irish children of low socio-economic status

Background

Kidscreen-27 was developed as part of a cross-cultural European Union-funded project to standardise the measurement of children’s health-related quality of life. Yet, research has reported mixed evidence for the hypothesised 5-factor model, and no confirmatory factor analysis (CFA) has been conducted on the instrument with children of low socio-economic status (SES) across Ireland (Northern and Republic).

Method

The data for this study were collected as part of a clustered randomised controlled trial. A total of 663 (347 male, 315 female) 8–9-year-old children (M = 8.74, SD = .50) of low SES took part. A 5- and modified 7-factor CFA models were specified using the maximum likelihood estimation. A nested Chi-square difference test was conducted to compare the fit of the models. Internal consistency and floor and ceiling effects were also examined.

Results

CFA found that the hypothesised 5-factor model was an unacceptable fit. However, the modified 7-factor model was supported. A nested Chi-square difference test confirmed that the fit of the 7-factor model was significantly better than that of the 5-factor model. Internal consistency was unacceptable for just one scale. Ceiling effects were present in all but one of the factors.

Conclusions

Future research should apply the 7-factor model with children of low socio-economic status. Such efforts would help monitor the health status of the population.