Adopting the euro in Hungary: expected costs, benefits and timing

Accession to the Economic and Monetary Union is one of the most important steps in Hungary's European integration, which will entail abandoning the national currency and adopting the euro as domestic legal tender. For Hungary as a new member state in the EU, introduction of the euro will not be an option but an obligation. Nevertheless, new EU members will have some leeway to set the date of adopting the euro1. Therefore, it is useful to analyse the likely costs and benefits of joining the euro area for Hungary and to define the choice of medium-term economic policy strategy in the light of the results of this analysis. The National Bank of Hungary would like to contribute to the formulation of an economic policy strategy by issuing this volume, which contains a cost-benefit analysis of the likely effects of the country's joining the euro area. This analysis is confined strictly to the economic benefits and costs of introducing the euro and is not intended to examine its other possible impacts, including, for example, the implications for politics and national security. Adopting the euro will likely have a permanent impact on Hungarian economic growth. This impact will become evident through numerous channels. Bank staff have attempted to quantify and sum up the extent of this impact transmitted through the various channels. The findings of this analysis suggest that the introduction of the euro will bring about significant net gains in growth. However, welfare is influenced not only by the level and rate of GDP growth, but their stability as well. A widely fluctuating national income will produce lower welfare than a more stable one, even if on average the two income levels are identical. For this reason, it is important to examine whether joining the euro area will increase or mitigate the volatility of business cycles. In other words, the key question is whether Hungary and the euro area form an optimum currency area, that is whether the monetary policy of the euro area is capable of adequately substituting independent Hungarian monetary policy in smoothing out cyclical fluctuations. In the findings of this analysis, the euro area seems to be in most respects at least as optimal a currency area for Hungary as for less developed euro area member countries.currency union, convergence, monetary policy, fiscal policy.

Conative Dysfunction in Schizophrenia: A New Empirically-Derived Framework

Conative dysfunction, defined as deficits in performing motivated or volitional action leading to the functional outcome of reduced goal-directed activity (RGDA), is explored as a fundamental and highly impairing aspect of schizophrenia. It is proposed that conative dysfunction is multifaceted and may take different forms within different individuals. Although many such factors have already been studied in schizophrenia, this has been done in a piecemeal fashion, not permitting comparisons among multiple forms of conative dysfunction to determine which ones are most impacted by the disorder or which may cluster within individuals. Thus, the heterogeneity and interrelationships between these factors has not been adequately assessed. A broad range of motivational and volitional tests, representing aspects of conative functioning drawn from a variety of fields including personality, neuropsychology, motivational psychology and psychopathology are administered to a sample of schizophrenia outpatients. Several of these have not previously been examined in the context of schizophrenia. Three research questions are addressed, including; 1) whether distinct conative “types,” characterized by separable dysfunctions, exist; 2) whether some conative functions are more impacted than others in schizophrenia, and whether this depends upon the between-individual variability addressed in question one; and 3) which conative factors are most predictive of poor functional outcomes (i.e., RGDA) in schizophrenia. These questions are addressed via 1) cluster analysis, 2) a series of profile analyses, and 3) a series of regression analyses. Findings support the existence of two distinct patterns of conative dysfunction within schizophrenia, each associated with a set of specific characteristics. One cluster is characterized by difficulty energizing (an executive function subserved by the superior medial prefrontal cortex) and reduced reward sensitivity, while the other is characterized by increased punishment sensitivity, boredom proneness, and various self-reported cognitive, volitional and emotional pathologies, in the context of intact motivation. Distinct aspects of conative dysfunction in each cluster contribute significantly to RGDA, especially boredom propensity, reward sensitivity, intrinsic motivation, and various executive functions. Comparisons are drawn between each cluster and existing clinical typologies. Implications of each of these findings for future research, clinical assessment and intervention are discussed

Examination of Acute Care Nurses Ability to Engage in Patient Education Related to Physical Activity as a Health Behavior

Physical activity is important for management and prevention of chronic disease. The current physical activity guidelines recommend engaging in physical activity for at least 30 minutes per day on at least 5 days a week. Acute care settings may present opportunities for patient education about physical activity. PURPOSE: The purpose of this study was to examine the ability of acute care nurses to engage in patient education regarding physical activity as a health behavior. Additionally, this study examined the influence of level of nurse training, age, personal physical activity and years of experience on these outcomes. METHODS: Nurses from an academic medical center (N=194) were surveyed. Knowledge of current physical activity guidelines, rank of importance of physical activity as a patient care activity and a healthy lifestyle behavior, and confidence to counsel patients about physical activity were queried. RESULTS: Of nurses queried, 32.5% reported days per week and 83% reported minutes per day to engage in physical activity consistent with current guidelines. Physical activity counseling was ranked least important of ten patient care activities and fifth as a healthy lifestyle behavior. The majority of nurses (51%) felt some degree of confidence to counsel patients regarding physical activity. Baccalaureate level nurses were more likely to be consistent with physical activity guidelines than master’s level nurses. Nurses <25 years of age were more current in knowledge of physical activity guidelines than nurses ≥41 years of age. Nurses who exercised were more likely to report knowing current physical activity guidelines. Reported time spent counseling patientsregarding physical activity averaged 6 minutes per patient per day. CONCLUSION: Acute care nurses are counseling patients regarding physical activity although it is ranked least important of ten patient care activities. Future research should include studying: a variety of patient populations; other hospital settings; objective measures of evaluation; and nurses’ training regarding physical activity

Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial

Objective To evaluate the impact of telling patients their estimated spirometric lung age as an incentive to quit smoking.Design Randomised controlled trial.Setting Five general practices in Hertfordshire, England.Participants 561 current smokers aged over 35.Intervention All participants were offered spirometric assessment of lung function. Participants in intervention group received their results in terms of "lung age" (the age of the average healthy individual who would perform similar to them on spirometry). Those in the control group received a raw figure for forced expiratory volume at one second (FEV1). Both groups were advised to quit and offered referral to local NHS smoking cessation services.Main outcome measures The primary outcome measure was verified cessation of smoking by salivary cotinine testing 12 months after recruitment. Secondary outcomes were reported changes in daily consumption of cigarettes and identification of new diagnoses of chronic obstructive lung disease.Results Follow-up was 89%. Independently verified quit rates at 12 months in the intervention and control groups, respectively, were 13.6% and 6.4% (difference 7.2%, P=0.005, 95% confidence interval 2.2% to 12.1%; number needed to treat 14). People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group. Cost per successful quitter was estimated at 280 pound ((euro) 365, $556). A new diagnosis of obstructive lung disease was made in 17% in the intervention group and 14% in the control group; a total of 16% (89/561) of participants.Conclusion Telling smokers their lung age significantly improves the likelihood of them quitting smoking, but the mechanism by which this intervention achieves its effect is unclear.Trial registration National Research Register N0096173751

The Association of Health Literacy with Self-care Agency in Older Adults in Jamaica

Older adults are the fastest growing segment of the population in Jamaica. With an increase from 10% (252,225) of the total Jamaican population in 1995 to 11% (279,051) in 2005, the rate is expected to rise to 25% by 2025. Thus, it will be critically important to understand factors that may contribute to health maintenance, disease prevention, and wellness promotion. Two such factors – not studied extensively in this country - are health literacy and self-care. The purposes of this study were to (a) generate health literacy profile data with the newly-developed Health Literacy Questionnaire for community-dwelling older adults in Jamaica and (b) determine whether relationships exist among aspects of health literacy and self-care practices while controlling for potential socio-demographic influences. The research design was cross-sectional and correlational; multistage sampling and a survey were used. The Health Literacy Questionnaire measures nine aspects of health literacy (e.g., gathering, reading, and understanding health information, social support, and healthcare provider and system engagement). Self-care was measured with an established scale, Appraisal of Self-care Agency Scale. A sample of 200 community-dwelling elders 60 years and older completed the survey. Because the Health Literacy Questionnaire is new, there are no published normative data. There was variation is scores across the nine aspects of health literacy, and among the highest scores were those for social support and active engagement with healthcare providers. Scores for self-care were relatively high, with 84% of the sample scoring in the high perceived capacity range (based on an established cut off score). As predicted, there was a strong positive correlation between health literacy and self-care. Regression analysis revealed three of the health literacy scales - critical appraisal, social support and ability to engage the healthcare provider - to be statistically significant predictors for self-care after controlling for education, region, health status, age, and sex. It seems reasonable to conclude that gains in health literacy can facilitate improvements in older adults’ self-care ability. Nurses can play pivotal roles in this by assessing health literacy, providing education and information, and, particularly, fostering genuine understanding. Key words: older adult, community dwelling, health literacy, self-care, self-care agenc

Chapter 4: Spain

Spain has suffered a lot from the current crisis and is the first large economy that may find itself in need of fiscal rescue. If this happens it may prove quite damaging to the euro. Yet, since the mid-1990s, Spain was a champion of growth and fiscal stability; its unemployment had fallen rapidly to the levels that prevailed in the rest of the European Union. This chapter discusses the reasons why such a virtuous initial situation deteriorated so sharply since the start of the crisis. Was this just bad luck or were the booming years just a mirage?