Matching in Rural Producer Organizations

Using a rich dataset from West Africa we study the determinants of membership in rural producer organizations (RPO). We ...nd that on average it is the more fortunate members of rural society who belong in RPOs. In Senegal, the dominant criteria are land ownership. In Burkina Faso it is economic status and family ties with village authorities. Ethnicity also plays a role: RPO membership is less likely for ethnic groups that traditionally emphasize livestock raising. We also look for evidence of assortative matching along multiple dimensions. To this e¤ect we develop an original methodology based on dyadic regressions. We ...nd robust evidence of assortative matching by physical and ethnic proximity as well as by wealth and social status.keywords: matching;group membership;rural producer organizations;Africa

Errors in Variables and the Empirics of Economic Growth

We examine cross-sectional empirical evidence on the determinants of economic growth in light of an instrumental variables estimator, based on sample moments of order higher than two, which does not require extraneous instruments and which remains consistent, under quite reasonable assumptions, when measurement errors affect the explanatory variables. We focus on several in‡fluential papers — Barro (1991), Mankiw, Romer, and Weil (1992), Sachs and Warner (1997a), Easterly and Levine (1997), Levine and Zervos (1998)— and find that many of their results are “fragile”. We argue that the application of our estimator to cross-sectional empirical studies of the determinants of growth yields important insights which may qualify previous findings in the literature, especially given the errors in variables problems which are known to plague commonly used cross-sectional datasets.errors in variables;economic growth

Matching in Rural Producer Organizations

Using a rich dataset from West Africa we study the determinants of membership in rural producer organizations (RPO). We …nd that on average it is the more fortunate members of rural society who belong in RPOs. In Senegal, the dominant criteria are land ownership. In Burkina Faso it is economic status and family ties with village authorities. Ethnicity also plays a role: RPO membership is less likely for ethnic groups that traditionally emphasize livestock raising. We also look for evidence of assortative matching along multiple dimensions. To this e¤ect we develop an original methodology based on dyadic regressions. We …nd robust evidence of assortative matching by physical and ethnic proximity as well as by wealth and social status.keywords: matching, group membership, rural producer organizations, Africa

Errors in Variables and the Empirics of Economic Growth

We examine cross-sectional empirical evidence on the determinants of economic growth in light of an instrumental variables estimator, based on sample moments of order higher than two, which does not require extraneous instruments and which remains consistent, under quite reasonable assumptions, when measurement errors affect the explanatory variables. We focus on several in‡fluential papers — Barro (1991), Mankiw, Romer, and Weil (1992), Sachs and Warner (1997a), Easterly and Levine (1997), Levine and Zervos (1998)— and find that many of their results are “fragile”. We argue that the application of our estimator to cross-sectional empirical studies of the determinants of growth yields important insights which may qualify previous findings in the literature, especially given the errors in variables problems which are known to plague commonly used cross-sectional datasets.errors in variables, economic growth

Matching in Rural Producer Organizations

Using a rich dataset from West Africa we study the determinants of membership in rural producer organizations (RPO). We ...nd that on average it is the more fortunate members of rural society who belong in RPOs. In Senegal, the dominant criteria are land ownership. In Burkina Faso it is economic status and family ties with village authorities. Ethnicity also plays a role: RPO membership is less likely for ethnic groups that traditionally emphasize livestock raising. We also look for evidence of assortative matching along multiple dimensions. To this e¤ect we develop an original methodology based on dyadic regressions. We ...nd robust evidence of assortative matching by physical and ethnic proximity as well as by wealth and social status

Reliability of health-related quality-of-life assessments made by older adults and significant others for health states of increasing cognitive impairment

Background: Older adults are encouraged by many organizations to engage in advance care planning in the event of decisional incapacity. Planning for future health care often involves anticipating health-related quality of life (HRQoL) in states of reduced cognitive functioning. No study has yet examined whether anticipated HRQoL is stable over time. The accuracy with which significant others can predict how an older adult envisions HRQoL in a future state of cognitive impairment is also unknown. We investigated the extent to which health-related quality-of-life ratings made by older adults and designated proxies for health states of increasing cognitive impairment are consistent over time and agree with each other. Methods: Results are based on HRQoL ratings made on a 5-point Likert scale by 235 community-based elder-proxy dyads on three occasions. Ratings were obtained for the older adult’s current health state as well as under the assumption that he/she had a mild to moderate stroke, incurable brain cancer or severe dementia. Data were analyzed using both traditional approaches (e.g., intraclass correlation coefficients, Bland-Altman plots) and the theory of generalizability. Results: We found ratings to be reasonably consistent over time and in good agreement within dyads, even more so as implied cognitive functioning worsened. Across health states, ratings over time or within elder-proxy dyads were no more than one category apart in over 87% of cases. Using the theory of generalizability, we further found that, of the two facets investigated, rater had a greater influence on score variability than occasion. Conclusions: These findings underscore the importance of discussing health-related quality-of-life issues during advance care planning and involving designated proxies in the discussion to enhance their understanding of the role that HRQoL should play in actual decision-making situations. Medical decision-making may be influenced by healthcare providers’ and family members’ assessments of an incapacitated patient’s health-related quality of life, in addition to that of the designated proxy. Future studies should investigate whether these two groups of individuals share the views of the patient and the designated proxy on anticipated HRQo

Should medical assistance in dying be extended to incompetent patients with dementia? : research protocol of a survey among four groups of stakeholders from Quebec, Canada

Background: Alzheimer's disease and related disorders affect a growing number of people worldwide. Quality of life is generally good in the early stages of these diseases. However, many individuals fear living through the advanced stages. Such fears are triggering requests for medical assistance in dying (MAiD) by patients with dementia. Legislation was recently passed in Canada and the province of Quebec allowing MAiD at the explicit request of a patient who meets a set of eligibility criteria, including competence. Some commentators have argued that MAiD should be accessible to incompetent patients as well, provided appropriate safeguards are in place. Governments of both Quebec and Canada are currently considering whether MAiD should be accessible through written requests made in advance of loss of capacity. Objective: Aimed at informing the societal debate on this sensitive issue, this study will compare stakeholders' attitudes towards expanding MAiD to incompetent patients with dementia, the beliefs underlying stakeholders' attitudes on this issue, and the value they attach to proposed safeguards. This paper describes the study protocol. Methods: Data will be collected via a questionnaire mailed to random samples of community-dwelling seniors, relatives of persons with dementia, physicians, and nurses, all residing in Quebec (targeted sample size of 385 per group). Participants will be recruited through the provincial health insurance database, Alzheimer Societies, and professional associations. Attitudes towards MAiD for incompetent patients with dementia will be elicited through clinical vignettes featuring a patient with Alzheimer's disease for whom MAiD is considered towards the end of the disease trajectory. Vignettes specify the source of the request (from the patient through an advance request or from the patient's substitute decision-maker), manifestations of suffering, and how close the patient is to death. Arguments for or against MAiD are used to elicit the beliefs underlying respondents' attitudes. Results: The survey was launched in September 2016 and is still ongoing. At the time of submission, over 850 respondents have returned the questionnaire, mostly via mail. Conclusions: This study will be the first in Canada to directly compare views on MAiD for incompetent patients with dementia across key stakeholder groups. Our findings will contribute valuable data upon which to base further debate about whether MAiD should be accessible to incompetent patients with dementia, and if so, under what conditions

Promoting advance planning for health care and research among older adults: A randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making.</p> <p>Methods/Design</p> <p>Dyads (<it>n </it>= 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled <it>My Preferences </it>that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about <it>My Preferences</it>. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.</p> <p>Discussion</p> <p>This study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.</p> <p>Trial Registration</p> <p><a href="http://www.controlled-trials.com/ISRCTN89993391">ISRCTN89993391</a></p

Utilité du méthylphenidate pour la réadaptation après un accident vasculaire cérébral

Malgré une baisse de mortalité reliée à l'A.V.C. (accident vasculaire cérébral), la morbidité demeure élevée avec des séquelles physiques, intellectuelles et émotionnelles importantes pour les individus atteints. Malheureusement, il n'existe, après l'établissement du dommage cérébral, aucune approche pharmacologique efficace pour améliorer le sort de ces personnes. Depuis une dizaine d'années, des expériences chez l'animal suggèrent que l'amphétamine peut accélérer la récupération fonctionnelle après une lésion corticale. Une seule étude clinique a été réalisée avec I’amphétamine et les quatre sujets traités ont semblé connaître, quelques jours après l'AVC, une amélioration plus rapide de leur hémiplégie que ceux traités par placebo. Nous avons voulu vérifier si les mêmes bénéfices pouvaient être obtenus par un traitement avec méthylphénidate (Ritalin), un psychostimulant semblable à l'amphétamine mais plus utilisé en clinique, chez des victimes d'AVC à une période plus tardive de leur réadaptation. En utilisant le modèle animal ayant servi à démontrer cet effet amphétaminique, nous avons vérifié, dans un premier temps, si le méthylphenidate possède un effet semblable à celui de l'amphétamine sur la récupération motrice après une lésion du cortex sensori-moteur. Nos expériences ont confirmé cette hypothèse tout en mettant en évidence un effet beaucoup plus marqué lorsqu'il y a stimulation motrice en plus du traitement pharmacologique. Dans un deuxième temps, nous avons réalisé un essai clinique randomisé, à double insu et contrôlé par placebo avec méthylphénidate (25 mg/jour pendant sept jours) auprès de 11 victimes d'AVC durant leur phase de réadaptation. Nous n'avons observé à ce stade aucun effet sur la récupération motrice. Par contre, les sujets traités ont semblé présenter moins d'apathie et une meilleure motivation à leur traitement. Malheureusement, les résultats ne sont pas statistiquement significatifs et nous n'avons pu démontrer, en raison de l'hétérogénéité des sujets, un gain fonctionnel supérieur chez le groupe traité. Les résultats de ce projet pilote nous laissent cependant croire en l'utilité potentielle du méthylphénidate chez les sujets plus apathiques d'autant plus que ce traitement n'a engendré aucun effet secondaire significatif