Evaluation of a self-management programme for congestive heart failure patients: design of a randomised controlled trial

BACKGROUND: Congestive heart failure (CHF) has a substantial impact on care utilisation and quality of life. It is crucial for patients to cope with CHF adequately, if they are to live an acceptable life. Self-management may play an important role in this regard. Previous studies have shown the effectiveness of the 'Chronic Disease Self-Management Program' (CDSMP), a group-based cognitive behavioural programme for patients with various chronic conditions. However, the programme's effectiveness has not yet been studied specifically among CHF patients. This paper presents the design of a randomised controlled trial to evaluate the effects of the CDSMP on psychosocial attributes, health behaviour, quality of life, and health care utilisation of CHF patients. METHODS/DESIGN: The programme is being evaluated in a two-group randomised controlled trial. Patients were eligible if they had been diagnosed with CHF and experienced slight to marked limitation of physical activity. They were selected from the Heart Failure and/or Cardiology Outpatient Clinics of six hospitals. Eligible patients underwent a baseline assessment and were subsequently allocated to the intervention or control group. Patients allocated to the intervention group were invited to attend the self-management programme consisting of six weekly sessions, led by a CHF nurse specialist and a CHF patient. Those allocated to the control group received care as usual. Follow-up measurements are being carried out immediately after the intervention period, and six and twelve months after the start of the intervention. An effect evaluation and a process evaluation are being conducted. The primary outcomes of the effect evaluation are self-efficacy expectancies, perceived control, and cognitive symptom management. The secondary outcome measures are smoking and drinking behaviour, Body Mass Index (BMI), physical activity level, self-care behaviour, health-related quality of life, perceived autonomy, symptoms of anxiety and depression, and health care utilisation. The programme's feasibility is assessed by measuring compliance with the protocol, patients' attendance and adherence, and the opinions about the programme. DISCUSSION: A total number of 318 patients were included in the trial. At present, follow-up data are being collected. The results of the trial become clear after completion of the data collection in January 2007. TRIAL REGISTRATION: Trialregister () ISRCTN88363287

An Interest Stabilisation Mechanism to Unburden the ECB

Following the twin crises of sovereign debt and COVID-19, the ECB risks being stuck in a situation of fiscal dominance, in which monetary policy is subordinated to the needs of finance ministers. A strong post-COVID-19 recovery may increase inflationary pressures, requiring a shift towards a less accommodative monetary policy stance. A tightening of monetary policy may, however, lead to a widening of interest rate spreads and new bond market tensions in the euro area. This article argues that the credibility of the ECB is undermined if it is perceived as aiming to close interest spreads. Interest spreads between euro countries arising from fiscal concerns should be a matter of fiscal policy, not monetary policy. The establishment of an interest stabilisation mechanism would allow the ECB to restore monetary dominance and to focus on maintaining price stability.</p

Variations Across Canadian Regions in the Sensitivity to U.S. Monetary Policy

Vector autoregression, Impulse response function, Monetary policy, Canadian regional employment, C32, E52, F42, R1,

Asymmetric monetary policy effects in EMU

This paper develops a semi-structural modelling approach to study asymmetric monetary transmission in Europe. A system of dynamic equations containing reaction functions for monetary policy as well as output gap and inflation equations is simultaneously estimated for France, Germany and Italy. We find asymmetries on the demand side in the strength of interest rate transmission and on the supply side in the effects of the output gap on inflation. The responses are similar in Germany and Italy and generally stronger than in France. Out-of-sample tests do not find a structural break in the transmission mechanisms prior to the establishment of the European Monetary Union.

K2-288Bb: a small temperate planet in a low-mass binary system discovered by citizen scientists

Observations from the Kepler and K2 missions have provided the astronomical community with unprecedented amounts of data to search for transiting exoplanets and other astrophysical phenomena. Here, we present K2-288, a low-mass binary system (M2.0 ± 1.0; M3.0 ± 1.0) hosting a small (R p = 1.9 R ⊕), temperate (T eq = 226 K) planet observed in K2 Campaign 4. The candidate was first identified by citizen scientists using Exoplanet Explorers hosted on the Zooniverse platform. Follow-up observations and detailed analyses validate the planet and indicate that it likely orbits the secondary star on a 31.39-day period. This orbit places K2-288Bb in or near the habitable zone of its low-mass host star. K2-288Bb resides in a system with a unique architecture, as it orbits at &gt;0.1 au from one component in a moderate separation binary (a proj ~ 55 au), and further follow-up may provide insight into its formation and evolution. Additionally, its estimated size straddles the observed gap in the planet radius distribution. Planets of this size occur less frequently and may be in a transient phase of radius evolution. K2-288 is the third transiting planet system identified by the Exoplanet Explorers program and its discovery exemplifies the value of citizen science in the era of Kepler, K2, and the Transiting Exoplanet Survey Satellite

Will the Euro Bring Economic Crisis to Europe?

This paper is part of a project financed by The Jerome Levy Economics Institute of Bard College, Annandale-on-Hudson, NY, to which they are grateful for their generous financial support. The initial introduction of the euro has, against many expectations, been accompanied by a decline in the value of the euro (notably vis--vis the dollar and sterling). It has also been introduced at a time of high levels of unemployment within most of the European Union (EU). This paper explores how the economies of the EU may suffer from the introduction of the euro, specifically from the policy and institutional arrangements within which the euro is embedded. It is the argument of this paper that the eurozone will face considerable economic difficulties. These difficulties will take a number of forms, but we focus on two rather different aspects which could qualify for the term crisis. First, the euro has been launched with high levels of unemployment (of the order of 10 percent of the work force) a