Ethnic disparities in health and health care: a focused review of the evidence and selected examples of good practice. Full report

This report arises from a project commissioned by the Department of Health's Equality and Human Rights Group to produce an evidence-based review with a national perspective that addresses (i) ethnic differentials in health and healthcare and (ii) evidence of effective NHS and other action, including seective examples of good practice to illustrate each area. Rather than aiming for comprehensive coverage, the Department suggested a document that focuses on selective topics and population health priorities drawn from the NHS plan, existing and developing National Service Frameworks, and other policy documents and which, collectively, are encompassed in the NHS's 10-point Race Equality Action Plan. The authors were not asked to review the evidence on other key areas (such ashypertension, stroke, disability, etc.), ethnic disparities in the wider determinants of health, and on some specific groups such as Gypsy Travellers and refugees and asylum seekers. Some of these topics are covered in other reviews.

Ethnic disparities in health and health care: a focused review of the evidence and selected examples of good practice. Executive summary

This report arises from a project commissioned by the Department of Health's Equality and Human Rights Group to produce an evidence-based review with a national perspective that addresses (i) ethnic differentials in health and healthcare and (ii) evidence of effective NHS and other action, including seective examples of good practice to illustrate each area. Rather than aiming for comprehensive coverage, the Department suggested a document that focuses on selective topics and population health priorities drawn from the NHS plan, existing and developing National Service Frameworks, and other policy documents and which, collectively, are encompassed in the NHS's 10-point Race Equality Action Plan. The authors were not asked to review the evidence on other key areas (such ashypertension, stroke, disability, etc.), ethnic disparities in the wider determinants of health, and on some specific groups such as Gypsy Travellers and refugees and asylum seekers. Some of these topics are covered in other reviews.

The Common Strategy on the Mediterranean Region: Evidence and Analysis

The present working paper aims at assessing the Common Strategy on the Mediterranean, taking into account its possible articulation as a coherent instrument of the European Foreign Policy. The study wants to answer some questions related to this instrument. The Common Strategy on the Mediterranean is an excellent case study and is a potential source of several questions about the external action of the European Union. Specifically, the present study has in mind two main questions to answer. Firstly, which are the main reasons behind the adoption of this instrument of the European Foreign Policy? In other words, which was/is the rationale for the existence of this Common Strategy? Secondly, which is the real impact of the Common Strategy? Which are its real achievements?

Monetary policy rules and macroeconomic stability: Evidence and some theory

We estimate a forward-looking monetary policy reaction function for thepostwar United States economy, before and after Volcker's appointmentas Fed Chairman in 1979. Our results point to substantial differencesin the estimated rule across periods. In particular, interest ratepolicy in the Volcker-Greenspan period appears to have been much moresensitive to changes in expected inflation than in the pre-Volckerperiod. We then compare some of the implications of the estimated rulesfor the equilibrium properties of inflation and output, using a simplemacroeconomic model, and show that the Volcker-Greenspan rule is stabilizing.

Is confidence in decisions related to feedback? Evidence-and lack of evidence-from random samples of real-world managerial behavior?

Confidence in decision making is an important dimension of managerialbehavior. However, what is the relation between confidence, on the onehand, and the fact of receiving or expecting to receive feedback ondecisions taken, on the other hand? To explore this and related issuesin the context of everyday decision making, use was made of the ESM(Experience Sampling Method) to sample decisions taken by undergraduatesand business executives. For several days, participants received 4 or 5SMS messages daily (on their mobile telephones) at random moments at whichpoint they completed brief questionnaires about their current decisionmaking activities. Issues considered here include differences between thetypes of decisions faced by the two groups, their structure, feedback(received and expected), and confidence in decisions taken as well as inthe validity of feedback. No relation was found between confidence indecisions and whether participants received or expected to receivefeedback on those decisions. In addition, although participants areclearly aware that feedback can provide both confirming and disconfirming evidence, their ability to specify appropriatefeedback is imperfect. Finally, difficulties experienced inusing the ESM are discussed as are possibilities for further researchusing this methodology.

The referent : a new referential methodology and procedure in live drawing

My research in live drawing and new technologies uses a combination of a human figure in live in composition, overlaid with a digital projection of a second human figure. The aim is to explore, to amplify and thoroughly analyse the search for distinctive identities and graphic languages of representation for live and projected models.

Available evidence and outcome of off-label use of rituximab in clinical practice

Purpose: To analyze the therapeutic indications for off-label use of rituximab, the available evidence for its use, the outcomes, and the cost. Methods: This was a retrospective analysis of patients treated with rituximab for off-label indications from January 2007 to December 2009 in two tertiary hospitals. Information on patient characteristics, medical conditions, and therapeutic responses was collected from medical records. Available evidence for the efficacy of rituximab in each condition was reviewed, and the cost of treatment was calculated. Results: A total of 101 cases of off-label rituximab use were analyzed. The median age of the patients involved was 53 [interquartile range (IQR) 37.568.0] years; 55.4 % were women. The indications for prescribing rituximab were primarily hematological diseases (46 %), systemic connective tissue disorders (27 %), and kidney diseases (20 %). Available evidence supporting rituximab treatment for these indications mainly came from individual cohort studies (53.5 % of cases) and case series (25.7 %). The short-term outcome (median 3 months, IQR 24 months) was a complete response in 38 % of cases and partial response in 32.6 %. The highest short-term responses were observed for systemic lupus erythematosus and membranous glomerulonephritis, and the lowest was for neuromyelitis optica, idiopathic thrombocytopenic purpura, and miscellaneous indications. Some response was maintained in long-term follow-up (median 23 months IQR 1230months) in 69.2%of patients showing a short-term response. Median cost per patient was 5,187.5 (IQR 5,187.57,781.3). Conclusions: In our study, off-label rituximab was mainly used for the treatment of hematological, kidney, and systemic connective tissue disorders, and the response among our patient cohort was variable depending on the specific disease. The level of evidence supporting the use of rituximab for these indications was low and the cost was very high. We conclude that more clinical trials on the off-label use of rituximab are needed, although these may be difficult to conduct in some rare diseases. Data from observational studies may provide useful information to assist prescribing in clinical practice.

Das GRADE-System: ein internationaler Ansatz zur Vereinheitlichung der Graduierung von Evidenz und Empfehlungen in Leitlinien. [The GRADE System: an international approach to standardize the graduation of evidence and recommendations in guidelines]

Clinical practice guidelines have become an important source of information to support clinicians in the management of individual patients. However, current guideline methods have limitations that include the lack of separating the quality of evidence from the strength of recommendations. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group, an international collaboration of guideline developers, methodologists, and clinicians have developed a system that addresses these shortcomings. Core elements include transparent methodology for grading the quality of evidence, the distinction between quality of the evidence and strength of a recommendation, an explicit balancing of benefits and harms of health care interventions, an explicit recognition of the values and preferences that underlie recommendations. The GRADE system has been piloted in various practice settings to ensure that it captures the complexity involved in evidence assessment and grading recommendations while maintaining simplicity and practicality. Many guideline organizations and medical societies have endorsed the system and adopted it for their guideline processes.

Systematic review of evidence and consensus on diverticulitis: an analysis of national and international guidelines.

AIM: The study aimed to analyse the currently available national and international guidelines for areas of consensus and contrasting recommendations in the treatment of diverticulitis and thereby to design questions for future research. METHOD: MEDLINE, EMBASE and PubMed were systematically searched for guidelines on diverticular disease and diverticulitis. Inclusion was confined to papers in English and those < 10 years old. The included topics were classified as consensus or controversy between guidelines, and the highest level of evidence was scored as sufficient (Oxford Centre of Evidence-Based Medicine Level of Evidence of 3a or higher) or insufficient. RESULTS: Six guidelines were included and all topics with recommendations were compared. Overall, in 13 topics consensus was reached and 10 topics were regarded as controversial. In five topics, consensus was reached without sufficient evidence and in three topics there was no evidence and no consensus. Clinical staging, the need for intraluminal imaging, dietary restriction, duration of antibiotic treatment, the protocol for abscess treatment, the need for elective surgery in subgroups of patients, the need for surgery after abscess treatment and the level of the proximal resection margin all lack consensus or evidence. CONCLUSION: Evidence on the diagnosis and treatment of diverticular disease and diverticulitis ranged from nonexistent to strong, regardless of consensus. The most relevant research questions were identified and proposed as topics for future research.

Available evidence and outcome of off-label use of rituximab in clinical practice

Purpose: To analyze the therapeutic indications for off-label use of rituximab, the available evidence for its use, the outcomes, and the cost. Methods: This was a retrospective analysis of patients treated with rituximab for off-label indications from January 2007 to December 2009 in two tertiary hospitals. Information on patient characteristics, medical conditions, and therapeutic responses was collected from medical records. Available evidence for the efficacy of rituximab in each condition was reviewed, and the cost of treatment was calculated. Results: A total of 101 cases of off-label rituximab use were analyzed. The median age of the patients involved was 53 [interquartile range (IQR) 37.5-68.0] years; 55.4 % were women. The indications for prescribing rituximab were primarily hematological diseases (46 %), systemic connective tissue disorders (27 %), and kidney diseases (20 %). Available evidence supporting rituximab treatment for these indications mainly came from individual cohort studies (53.5 % of cases) and case series (25.7 %). The short-term outcome (median 3 months, IQR 2-4 months) was a complete response in 38 % of cases and partial response in 32.6 %. The highest short-term responses were observed for systemic lupus erythematosus and membranous glomerulonephritis, and the lowest was for neuromyelitis optica, idiopathic thrombocytopenic purpura, and miscellaneous indications. Some response was maintained in long-term follow-up (median 23 months IQR 12-30months) in 69.2%of patients showing a short-term response. Median cost per patient was 5,187.5 (IQR 5,187.5-7,781.3). Conclusions: In our study, off-label rituximab was mainly used for the treatment of hematological, kidney, and systemic connective tissue disorders, and the response among our patient cohort was variable depending on the specific disease. The level of evidence supporting the use of rituximab for these indications was low and the cost was very high. We conclude that more clinical trials on the off-label use of rituximab are needed, although these may be difficult to conduct in some rare diseases. Data from observational studies may provide useful information to assist prescribing in clinical practice.

Differences in seasonal price patterns among second home rentals and hotels: Empirical evidence and practical implications

Hotels and second home rentals are two of the most important tourist accommodation options in Spain. In terms of seasonality, almost all previous studies have analysed tourism demand from the point of view either of total arrivals or the number of tourists lodged in a single accommodation type (hotels, rural accommodation, etc). However, there are no studies focusing on price seasonality orcomparing seasonality among different accommodation types. By using seasonality indicators and a price index constructed by means of hedonic methods, this paper aims to shed some light on seasonal pricing patterns among second home rentals and hotels. The paper relies on a 2004 database of 144 hotels and 1,002 apartments on the Costa Brava (northeast Spain). The results show that prices for second home rentals display a smoother seasonal pattern than hotels due to reduced price differences between shoulder (May and October) and peak periods (August)

Forest Transition in Madagascar's Highlands: Initial Evidence and Implications

Madagascar is renowned for the loss of the forested habitat of lemurs and other species endemic to the island. Less well known is that in the highlands, a region often described as an environmental "basket-case" of fire-degraded, eroded grasslands, woody cover has been increasing for decades. Using information derived from publically available high- and medium-resolution satellites, this study characterizes tree cover dynamics in the highlands of Madagascar over the past two decades. Our results reveal heterogeneous patterns of increased tree cover on smallholder farms and village lands, spurred by a mix of endogenous and exogenous forces. The new trees play important roles in rural livelihoods, providing renewable supplies of firewood, charcoal, timber and other products and services, as well as defensible claims to land tenure in the context of a decline in the use of hillside commons for grazing. This study documents this nascent forest transition through Land Change Science techniques, and provides a prologue to political ecological analysis by setting these changes in their social and environmental context and interrogating the costs and benefits of the shift in rural livelihood strategies.