Distortions in a multi-level co-financing system: the case of the agri-environmental programme of Saxony-Anhalt

In this paper we analyse the impact of the EU multi-level cofinancing system on regional policy-making and priority setting taking the case of the agri-environmental programme of Saxony-Anhalt. The implications of several co-financing scenarios are analysed and compared to respective lump-sum transfers using an interactive linear programming approach. The results reveal how regional choices on agri-environmental measures are influenced by the co-financing system leading to distortions. The extent of these distortions depends on the specific regional preferences and restrictions.agri-environmental programmes, co-financing, federalism, interactive programming, policy-making, Agricultural and Food Policy, Environmental Economics and Policy,

Distortions in a Multi-Level Co-Financing System: The Case of the Agri-Environmental Program of Saxony-Anhalt

In this paper we analyze the impact of the EU multi-level co-financing system on regional policy-making and priority setting taking the case of the agri-environmental program of Saxony-Anhalt in Germany. The implications of several co-financing scenarios are analyzed and compared to respective lump-sum transfers using an interactive linear programming approach. The results reveal that regional choices on agri-environmental measures are strongly influenced by the co-financing system leading to distortions. The extent of these distortions depends on the specific regional preferences and restrictions to be considered in the policy-making process.Agri-environmental programs, co-financing, federalism, interactive programming, policy-making, Environmental Economics and Policy, Financial Economics, Food Consumption/Nutrition/Food Safety, C61, H72, Q18,

Programming rural development funds – An interactive linear programming approach applied to the EAFRD program in Saxony-Anhalt

Policies for rural areas have become an important but complex policy field in the European Union`s Common Agricultural Policy. The purpose of this paper is to report on a methodological approach pursued to model the allocation of EAFRD (European Agricultural Fund for Rural Development) funds in Saxony-Anhalt. We show how an interactive programming approach can be developed and used to support our partner Ministry of Agriculture and the Environment. So far, various key elements of the modeling approach have been specified: the definition of all relevant policy measures and funding options, the assessment of impacts on the regional objectives pursued, the definition of relevant lower and upper bounds, and the formulation of co-financing requirements and possibilities. Some first results reveal potentials for policy adjustment. After some more refinements and specifications, the model is to be used interactively with Ministry representatives for scenario calculations to support policy-making and strategy development for rural development in Saxony-Anhalt.rural development, interactive programming, EAFRD, multi-level co-financing, Saxony-Anhalt, Agricultural and Food Policy, Agricultural Finance, Community/Rural/Urban Development, Environmental Economics and Policy, Institutional and Behavioral Economics, Public Economics,

Aspekte der Agrarpolitik 2004

Agricultural and Food Policy, Community/Rural/Urban Development, International Relations/Trade,

Aspekte der Agrarpolitik 2005

Agricultural and Food Policy, Community/Rural/Urban Development, International Relations/Trade,

Co-financing Implications for Regional Policy-Making: A Case Study for the Agri-environmental Programme in Saxony-Anhalt

Financing agri-environmental programmes in the European Union (EU) takes place in a multi-level system with mixed co-financing and shared financial responsibilities. In this paper we analyse how co-financing influences policy-making in regions taking the case of the agri-environmental programme in Saxony-Anhalt. Using an interactive linear programming approach the implications of several co-financing scenarios are analysed. EU co-financing certainly enhances the financial volume for the agri-environmental programme in Saxony-Anhalt; but as regional policy-making is distorted by the scheme of mixed co-financing as compared to unconditional financial transfers, the priorities for measures vary depending on different EU co-financing scenarios.agri-environmental programmes, co-financing, federalism, interactive programming, policy-making, Environmental Economics and Policy,

Executive summary. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK

The European Paediatric Pulmonary Vascular Disease (PVD) Network is a registered, non-profit organisation that strives to define and develop effective, innovative diagnostic methods and treatment options in all forms of paediatric pulmonary hypertensive vascular disease, including specific forms such as pulmonary arterial hypertension (PAH)-congenital heart disease, pulmonary hypertension (PH) associated with bronchopulmonary dysplasia, persistent PH of the newborn, and related cardiac dysfunction. Methods The writing group members conducted searches of the PubMed/MEDLINE bibliographic database (1990-2015) and held five face-to-face meetings with votings. Clinical trials, guidelines, and reviews limited to paediatric data were searched using the terms 'pulmonary hypertension' and 5-10 other keywords, as outlined in the other nine articles of this special issue. Class of recommendation (COR) and level of evidence (LOE) were assigned based on European Society of Cardiology/American Heart Association definitions and on paediatric data only, or on adult studies that included >10% children. Results A total of 9 original consensus articles with graded recommendations (COR/LOE) were developed, and are summarised here. The topics included diagnosis/monitoring, genetics/biomarker, cardiac catheterisation, echocardiography, cardiac magnetic resonance/chest CT, associated forms of PH, intensive care unit/ventricular assist device/lung transplantation, and treatment of paediatric PAH. Conclusions The multipaper expert consensus statement of the European Paediatric PVD Network provides a specific, comprehensive, detailed but practical framework for the optimal clinical care of children with PH

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication