105 research outputs found
Predicting the UK Equity Premium with Dividend Ratios: An Out-Of-Sample Recursive Residuals Graphical Approach
The purpose of this paper is to evaluate the ability of dividend ratios to predict the UK equity premium. Specifically, we apply the Goyal and Welch (2003) methodology to equity premia derived from the UK FTSE All-Share index. This approach provides a powerful graphical diagnostic for predictive ability. Preliminary in-sample univariate regressions reveal that the UK equity premium contains an element of predictability. Moreover, out-of-sample the considered models outperform the historical moving average. In contrast to similar work on the US, the graphical diagnostic then indicates that dividend ratios are useful predictors of excess returns. Finally, Campbell and Shiller (1988) identities are employed to account for the time-varying properties of the dividend yield and dividend growth processes. It is shown that by instrumenting the models with the identities, forecasting ability can be improved.
Go Back to the Beginning: Career Development and the Challenges of Transitioning From the Military to Civilian Employment
This chapter examines the transition challenges facing military personnel to
moving to civilian employment, a major issue for nations like the USA that have
large armed forces. For such personnel, they seek to establish a career after a period
of service and often without the credentials required for existing or future job
vacancies. This chapter discusses the challenges of career transition from military
to civilian employment, largely in the context of the US-based literature. The
chapter proceeds to outline the range of obstacles to transition and then considers
remedial measures to support transition ranging from pre transition to post transition
support programs
Generation of domains for the Equine Musculoskeletal Rehabilitation Outcome Score: Development by Expert Consensus
Efficiency, ownership and financial structure in European banking
Purpose – This paper aims to compare the cost efficiencies across bank-and market-based EU countries for the different groups of commercial, savings and co-operative banks; and between listed and non-listed banking institutions. In addition, it attempts to determine any potential implications for bank efficiency originating from differences in financial structure. Design/methodology/approach – Efficiency scores are estimated using the Battese and Coelli's time-varying stochastic frontier approach. The classification of bank- and market-based financial systems is based on the World Bank's Financial Structure Database. Findings – On the whole the results reject the agency theory hypothesis that managers of privately-owned banks are more cost efficient than those of mutual banking institutions because of capital market devices as it is found that mutual banks operating in EU-15 countries are significantly more cost efficient than commercial banks. Furthermore, results are mixed concerning the financial structure hypothesis that in developed financial systems bank efficiency should not be statistically different across bank-vs market-based economies. Research limitations/implications – The analysis suggests that differences in cost efficiency across bank types can often be explained by the prevailing financial system in each economy. Practical implications – The evidence illustrates the national diversity of corporate governance systems in Europe and can be important to policy makers who are concerned with the full integration of the European financial system. Originality/value – To the best of the authors’ knowledge, there are no previous similar empirical works for the EU banking sector. Such a study has important policy implications especially due to the fact that the EU banking sector is experiencing profound structural changes and a full integration has not yet been achieved
Impact of multimorbidity count on all-cause mortality and glycaemic outcomes in people with type 2 diabetes: a systematic review protocol
Introduction: Type 2 diabetes (T2D) is a leading health priority worldwide. Multimorbidity (MM) is a term describing the co-occurrence of two or more chronic diseases or conditions. The majority of people living with T2D have MM. The relationship between MM and mortality and glycaemia in people with T2D is not clear.
Methods and analysis: Medline, Embase, Cumulative Index of Nursing and Allied Health Complete, The Cochrane Library, and SCOPUS will be searched with a prespecified search strategy. The searches will be limited to quantitative empirical studies in English with no restriction on publication date. One reviewer will perform title screening and two review authors will independently screen the abstract and full texts using Covidence software, with disagreements adjudicated by a third reviewer. Data will be extracted using a using a Population, Exposure, Comparator and Outcomes framework. Two reviewers will independently extract data and undertake the risk of bias (quality) assessment. Disagreements will be resolved by consensus. A narrative synthesis of the results will be conducted and meta-analysis considered if appropriate. Quality appraisal will be undertaken using the Newcastle-Ottawa quality assessment scale and the quality of the cumulative evidence of the included studies will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. This protocol was prepared in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines to ensure the quality of our review.
Ethics and dissemination: This review will synthesise the existing evidence about the impact of MM on mortality and glycaemic outcomes in people living with T2D and increase our understanding of this subject and will inform future practice and policy. Findings will be disseminated via conference presentations, social media and peer-reviewed publication
Stepping Up Telehealth: Using telehealth to support a new model of care for type 2 diabetes management in rural and regional primary care
Our proposal is to pilot the feasibility and acceptability of a telehealth intervention to enhance care in rural general practice for people with out-of-target Type 2 Diabetes (T2D). Our research program builds on the UK Medical Research Council framework in developing a model of care intervention that is well matched to the setting of General Practice and to the experiences and priorities of patients. We undertook an exploratory qualitative study, leading to the development of a practice-based intervention that we pilot tested for feasibility and acceptability before undertaking a larger pilot and a cluster RCT. We based our work on Normalisation Process Theory (NPT), a sociological theory of implementation, which describes how new practices become incorporated into routine clinical care as a result of individual and collective work. NPT suggested that our model of care intervention would need to be patient centred and include all members of the multidisciplinary diabetes team, including Endocrinologist, RN-CDE General Practitioners (GP), and generalist Practice Nurses (PNs). All of these groups are involved in the �work� of insulin initiation.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy
General Practice Management of Type 2 Diabetes: 2016–18
[Extract] Diabetes is a national health priority. The Australian National Diabetes Strategy 2016–2020was released by the Australian Government in November 2013. The number of people with type 2 diabetes is growing, most likely the result of rising overweight and obesity rates, lifestyle and dietary changes, and an ageing population. Within 20 years, the number of people in Australia with type 2 diabetes may increase from an estimated 870,000 in 2014, to more than 2.5 million.1The most socially disadvantaged Australians are twice as likely to develop diabetes. If left undiagnosed or poorly managed, type 2 diabetes can lead to coronary artery disease (CAD), stroke, kidney failure, limb amputations and blindness. The early identification and optimal management of people with type 2 diabetes is therefore critical. General practice has the central role in type 2 diabetes management across the spectrum, from identifying those at risk right through to caring for patients at the end of life. These guidelines give up-to-date, evidence-based information tailored for general practice to support general practitioners (GPs) and their teams in providing high-quality management.1In the development of the 2016–18 edition of General practice management of type 2 diabetes, The Royal Australian College of General Practitioners (RACGP) has focused on factors relevant to current Australian clinical practice. The RACGP has used the skills and knowledge of your general practice peers who have an interest in diabetes management and are members of the RACGP Specific Interests Diabetes Network. This publication has been produced in accordance with the rules and processes outlined in the RACGP’s conflict of interest (COI) policy. The RACGP’s COI policy is available at www.racgp.org.au/support/policies/organisationalThis edition represents 19 years of a successful relationship between the RACGP and Diabetes Australia. We acknowledge the support of the RACGP Expert Committee – Quality Care, the Medical Education and Scientific Committee of Diabetes Australia, and RACGP staff in the development of these guideline
Multimorbidity, mortality, and HbA1c in type 2 diabetes: a cohort study with UK and Taiwanese cohorts
Background:
There is emerging interest in multimorbidity in type 2 diabetes (T2D), which can be either concordant (T2D related) or discordant (unrelated), as a way of understanding the burden of disease in T2D. Current diabetes guidelines acknowledge the complex nature of multimorbidity, the management of which should be based on the patient’s individual clinical needs and comorbidities. However, although associations between multimorbidity, glycated haemoglobin (HbA1c), and mortality in people with T2D have been studied to some extent, significant gaps remain, particularly regarding different patterns of multimorbidity, including concordant and discordant conditions. This study explores associations between multimorbidity (total condition counts/concordant/discordant/different combinations of conditions), baseline HbA1c, and all-cause mortality in T2D.
Methods and findings:
We studied two longitudinal cohorts of people with T2D using the UK Biobank (n = 20,569) and the Taiwan National Diabetes Care Management Program (NDCMP) (n = 59,657). The number of conditions in addition to T2D was used to quantify total multimorbidity, concordant, and discordant counts, and the effects of different combinations of conditions were also studied. Outcomes of interest were baseline HbA1c and all-cause mortality. For the UK Biobank and Taiwan NDCMP, mean (SD) ages were 60.2 (6.8) years and 60.8 (11.3) years; 7,579 (36.8%) and 31,339 (52.5%) were female; body mass index (BMI) medians (IQR) were 30.8 (27.7, 34.8) kg/m2 and 25.6 (23.5, 28.7) kg/m2; and 2,197 (10.8%) and 9,423 (15.8) were current smokers, respectively. Increasing total and discordant multimorbidity counts were associated with lower HbA1c and increased mortality in both datasets. In Taiwan NDCMP, for those with four or more additional conditions compared with T2D only, the mean difference (95% CI) in HbA1c was −0.82% (−0.88, −0.76) p < 0.001. In UK Biobank, hazard ratios (HRs) (95% CI) for all-cause mortality in people with T2D and one, two, three, and four or more additional conditions compared with those without comorbidity were 1.20 (0.91–1.56) p < 0.001, 1.75 (1.35–2.27) p < 0.001, 2.17 (1.67–2.81) p < 0.001, and 3.14 (2.43–4.03) p < 0.001, respectively. Both concordant/discordant conditions were significantly associated with mortality; however, HRs were largest for concordant conditions. Those with four or more concordant conditions had >5 times the mortality (5.83 [4.28–7.93] p <0.001). HRs for NDCMP were similar to those from UK Biobank for all multimorbidity counts. For those with two conditions in addition to T2D, cardiovascular diseases featured in 18 of the top 20 combinations most highly associated with mortality in UK Biobank and 12 of the top combinations in the Taiwan NDCMP. In UK Biobank, a combination of coronary heart disease and heart failure in addition to T2D had the largest effect size on mortality, with a HR (95% CI) of 4.37 (3.59–5.32) p < 0.001, whereas in the Taiwan NDCMP, a combination of painful conditions and alcohol problems had the largest effect size on mortality, with an HR (95% CI) of 4.02 (3.08–5.23) p < 0.001. One limitation to note is that we were unable to model for changes in multimorbidity during our study period.
Conclusions:
Multimorbidity patterns associated with the highest mortality differed between UK Biobank (a population predominantly comprising people of European descent) and the Taiwan NDCMP, a predominantly ethnic Chinese population. Future research should explore the mechanisms underpinning the observed relationship between increasing multimorbidity count and reduced HbA1c alongside increased mortality in people with T2D and further examine the implications of different patterns of multimorbidity across different ethnic groups. Better understanding of these issues, especially effects of condition type, will enable more effective personalisation of care
Associations between multimorbidity and glycaemia (HbA1c) in people with type 2 diabetes: cross-sectional study in Australian general practice
Objectives: To explore the prevalence of multimorbidity as well as individual and combinations of long-term conditions (LTCs) in people with type 2 diabetes (T2D) attending Australian general practice, using electronic health record (EHR) data. We also examine the association between multimorbidity condition count (total/concordant(T2D related)/discordant(unrelated)) and glycaemia (glycated haemoglobin, HbA1c).
Design: Cross-sectional study.
Setting: Australian general practice.
Participants: 69 718 people with T2D with a general practice encounter between 2013 and 2015 captured in the MedicineInsight database (EHR Data from 557 general practices and >3.8 million Australian patients).
Primary and secondary outcome measures: Prevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%).
Results: Mean (SD) age 66.42 (12.70) years, 46.1% female and mean (SD) HbA1c 7.1 (1.4)%. More than 90% of participants with T2D were living with multimorbidity. Discordant conditions were more prevalent (83.4%) than concordant conditions (69.9 %). The three most prevalent discordant conditions were: painful conditions (55.4%), dyspepsia (31.6%) and depression (22.8%). The three most prevalent concordant conditions were hypertension (61.4%), coronary heart disease (17.1%) and chronic kidney disease (8.5%). The three most common combinations of conditions were: painful conditions and hypertension (38.8%), painful conditions and dyspepsia (23.1%) and hypertension and dyspepsia (22.7%). We found no associations between any multimorbidity counts (total, concordant and discordant) or combinations and HbA1c.
Conclusions: Multimorbidity was common in our cohort of people with T2D attending Australian general practice, but was not associated with glycaemia. Although we did not explore mortality in this study, our results suggest that the increased mortality in those with multimorbidity and T2D observed in other studies may not be linked to glycaemia. Interestingly, discordant conditions were more prevalent than concordant conditions with painful conditions being the second most common comorbidity. Better understanding of the implications of different patterns of multimorbidity in people with T2D will allow more effective tailored care
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