Analysis of four studies in a comparative framework reveals: health linkage consent rates on British cohort studies higher than on UK household panel surveys

Background: A number of cohort studies and longitudinal household panel studies in Great Britain have asked for consent to link survey data to administrative health data. We explore commonalities and differences in the process of collecting consent, achieved consent rates and biases in consent with respect to socio-demographic, socio-economic and health characteristics. We hypothesise that British cohort studies which are rooted within the health sciences achieve higher consent rates than the UK household longitudinal studies which are rooted within the social sciences. By contrast, the lack of a specific health focus in household panel studies means there may be less selectivity in consent, in particular, with respect to health characteristics. Methods: Survey designs and protocols for collecting informed consent to health record linkage on two British cohort studies and two UK household panel studies are systematically compared. Multivariate statistical analysis is then performed on information from one cohort and two household panel studies that share a great deal of the data linkage protocol but vary according to study branding, survey design and study population. Results: We find that consent is higher in the British cohort studies than in the UK household panel studies, and is higher the more health-focused the study is. There are no systematic patterns of consent bias across the studies and where effects exist within a study or study type they tend to be small. Minority ethnic groups will be underrepresented in record linkage studies on the basis of all three studies. Conclusions: Systematic analysis of three studies in a comparative framework suggests that the factors associated with consent are idiosyncratic to the study. Analysis of linked health data is needed to establish whether selectivity in consent means the resulting research databases suffer from any biases that ought to be considered

The European economy in 1998 and 1999: An update

A. Situation and Prospects for the European Economy 3 I. Slower Growth of the World Economy 3 II. Weaker Expansion of the European Economy 5 III. Economic Policy 7 B. Country Reports 9 I. Germany: Upturn Continues Despite Financial Turbulence 9 II. Confidence Still High in France, Though Off Its Peak 9 III. Downturn in the UK Economy 10 IV. Italy: A Fragile Recovery 1

The European economy in 1999 and 2000: Report

World economic growth this year is likely to remain as weak as in 1998, despite a gradual acceleration in the course of the year. The volume of world trade is estimated to have fallen significantly in the latter half of last year, and to date there are few signs of a rapid recovery. However, there are indications of improved investor sentiment in a number of emerging market economies, and the monetary authorities in many industrial economies have lowered shortterm interest rates significantly since last autumn. In the absence of further financial market turmoil, a modest global recovery is expected to develop this year, led by improved prospects for the Asian economies. World GDP is expected to rise by 3 per cent in 2000, after growth of 2V4 per cent this year (Table 1). The industrial economies as a group are not expected to contribute significantly to the overall rebound. The economy of the United States has remained much stronger than expected, but could experience a soft landing next year, particularly if the Federal Reserve decides to tighten monetary policy. Activity in Japan may at best stabilise next year after two years of declining GDP, with many firms continuing to have excess capacity, and domestic demand expected to remain weak. The continuing weakness of Japan will help to keep the upturn in the emerging markets within bounds. Growth should pick up in Western Europe over the next eighteen months, helped by the present relaxed monetary conditions. However, a recovery this year remains far from assured, with activity likely to be particularly weak in Germany and Italy. The present, historically low, rate of inflation in the industrial world may rise slightly, partly as a result of some recovery in world prices for primary commodities, recently in particular for oil. In the euro area, import prices will also rise as a result of the recent depreciation of the euro against the dollar. The continued strength of the dollar can be partly attributed to the very strong performance of the American economy compared with the European economy, and to the rising interest rate differentials with Europe. We expect that developments in the opposite direction will weaken the dollar again. Section VI of this report illustrates a scenario with a more substantial weakening in the aftermath of a collapse in equity prices. The Western European economy has been strongly affected by the adverse developments in the crisis regions. This has depressed industrial production significantly over the past year. The prospects for Europe are heavily dependent on the timing and extent to which these effects fade away. The American economy has been a strong engine for world economic growth up to now, but there are several imbalances that may lead to a slowdown over the next eighteen months. This could have a substantial impact on the European economy

The European economy in 1998 and 1999

World economic activity remains relatively robust, although the Asian crisis casts a shadow over the picture. The rate of growth of world trade has slowed down since last fall, but is expected to remain above its trend level. International price developments remain quite moderate. Oil prices have declined substantially, and are among the lowest of the decade. Inflationary pressures are also limited in the industrial countries, as capacity constraints are not yet significant there and excess supply has materialized worldwide. The industrial countries show a sustained growth rate between 2Vi and 3 per cent on average. However, the combination of strong growth and low inflation is the result of divergent developments between countries. • The US economy has been until recently particularly buoyant, as strong domestic demand has more than offset the dampening effect of falling exports to Asia. The Japanese economy remains in the doldrums. The threat of a deflation has recently prompted a substantial stimulation programme aiming at preventing a further deterioration of confidence. \^ Economic growth in Asia has been-severely_ restricted, in particular in the ASEAN countries and Korea, although extensive rescue operations have brought the situation in the worst hit countries more or less under control. The impact on the European countries is as yet rather limited, as negative trade effects are largely compensated for by beneficial effects of lower imported inflation and lower interest rates. Thus Western Europe is in a position to sustain the recovery that began in mid-1996. Prospects have been strengthened as uncertainties associated with the implementation of the EMU have now been dissipated. The time has now come to begin to view the EMU countries as a single entity from the viewpoint of economic management, even if differences persist in many fields

The European economy in 1998 and 1999

World economic activity remains relatively robust, although the Asian crisis casts a shadow over the picture. The rate of growth of world trade has slowed down since last fall, but is expected to remain above its trend level. International price developments remain quite moderate. Oil prices have declined substantially, and are among the lowest of the decade. Inflationary pressures are also limited in the industrial countries, as capacity constraints are not yet significant there and excess supply has materialized worldwide. The industrial countries show a sustained growth rate between 2Vi and 3 per cent on average. However, the combination of strong growth and low inflation is the result of divergent developments between countries. • The US economy has been until recently particularly buoyant, as strong domestic demand has more than offset the dampening effect of falling exports to Asia. The Japanese economy remains in the doldrums. The threat of a deflation has recently prompted a substantial stimulation programme aiming at preventing a further deterioration of confidence. \^ Economic growth in Asia has been-severely_ restricted, in particular in the ASEAN countries and Korea, although extensive rescue operations have brought the situation in the worst hit countries more or less under control. The impact on the European countries is as yet rather limited, as negative trade effects are largely compensated for by beneficial effects of lower imported inflation and lower interest rates. Thus Western Europe is in a position to sustain the recovery that began in mid-1996. Prospects have been strengthened as uncertainties associated with the implementation of the EMU have now been dissipated. The time has now come to begin to view the EMU countries as a single entity from the viewpoint of economic management, even if differences persist in many fields. --

The European economy in 1999 and 2000: Report

World economic growth this year is likely to remain as weak as in 1998, despite a gradual acceleration in the course of the year. The volume of world trade is estimated to have fallen significantly in the latter half of last year, and to date there are few signs of a rapid recovery. However, there are indications of improved investor sentiment in a number of emerging market economies, and the monetary authorities in many industrial economies have lowered shortterm interest rates significantly since last autumn. In the absence of further financial market turmoil, a modest global recovery is expected to develop this year, led by improved prospects for the Asian economies. World GDP is expected to rise by 3 per cent in 2000, after growth of 2V4 per cent this year (Table 1). The industrial economies as a group are not expected to contribute significantly to the overall rebound. The economy of the United States has remained much stronger than expected, but could experience a soft landing next year, particularly if the Federal Reserve decides to tighten monetary policy. Activity in Japan may at best stabilise next year after two years of declining GDP, with many firms continuing to have excess capacity, and domestic demand expected to remain weak. The continuing weakness of Japan will help to keep the upturn in the emerging markets within bounds. Growth should pick up in Western Europe over the next eighteen months, helped by the present relaxed monetary conditions. However, a recovery this year remains far from assured, with activity likely to be particularly weak in Germany and Italy. The present, historically low, rate of inflation in the industrial world may rise slightly, partly as a result of some recovery in world prices for primary commodities, recently in particular for oil. In the euro area, import prices will also rise as a result of the recent depreciation of the euro against the dollar. The continued strength of the dollar can be partly attributed to the very strong performance of the American economy compared with the European economy, and to the rising interest rate differentials with Europe. We expect that developments in the opposite direction will weaken the dollar again. Section VI of this report illustrates a scenario with a more substantial weakening in the aftermath of a collapse in equity prices. The Western European economy has been strongly affected by the adverse developments in the crisis regions. This has depressed industrial production significantly over the past year. The prospects for Europe are heavily dependent on the timing and extent to which these effects fade away. The American economy has been a strong engine for world economic growth up to now, but there are several imbalances that may lead to a slowdown over the next eighteen months. This could have a substantial impact on the European economy. --

The European economy in 1998 and 1999: An update

A. Situation and Prospects for the European Economy 3 I. Slower Growth of the World Economy 3 II. Weaker Expansion of the European Economy 5 III. Economic Policy 7 B. Country Reports 9 I. Germany: Upturn Continues Despite Financial Turbulence 9 II. Confidence Still High in France, Though Off Its Peak 9 III. Downturn in the UK Economy 10 IV. Italy: A Fragile Recovery 11 --

Identity and difference - re-thinking UK South Asian entrepreneurship

Purpose: This paper, which is part of a larger study, discusses from an ethno-cultural perspective, the notion of self-identification and difference pertaining to first and second-generation South Asian male entrepreneurs. In essence, previous studies have not explored this dimension to any sufficient depth. Therefore, evidence is unclear as to how ethno-culture has informed entrepreneurial identity and difference. Design/methodology/approach: Adopting a phenomenological research paradigm, 42 semi-structured interviews were conducted with first and second-generation Sikh and Pakistani Muslim male entrepreneurs in Greater London. A typology of second-generation entrepreneurs is developed and a research agenda proposed. Findings: First-generation respondents regard the UK as home, and do not suffer from shifts in identity. These particular respondents identify themselves as Sikh, or Pakistani Muslim, or a Businessman. However, the second-generation identify themselves via three distinct labels. Here respondents stress their ethnicity by using Hyphenated British identities, or hide their ethnicity behind the term a Normal Businessman, or appear opportunists by using ethnicity as a resource to espouse a True Entrepreneurial identity. Research limitations/implications: The research environment within the Greater London area where the respondents are located may not be as generalisible when compared with other parts of the UK. Originality/value: This paper offers a unique insight into self-prescribed identity and difference noted among London’s ethnic entrepreneurs

Automated imaging technologies for the diagnosis of glaucoma: a comparative diagnostic study for the evaluation of the diagnostic accuracy, performance as triage tests and cost-effectiveness (GATE study)

BACKGROUND: Many glaucoma referrals from the community to hospital eye services are unnecessary. Imaging technologies can potentially be useful to triage this population. OBJECTIVES: To assess the diagnostic performance and cost-effectiveness of imaging technologies as triage tests for identifying people with glaucoma. DESIGN: Within-patient comparative diagnostic accuracy study. Markov economic model comparing the cost-effectiveness of a triage test with usual care. SETTING: Secondary care. PARTICIPANTS: Adults referred from the community to hospital eye services for possible glaucoma. INTERVENTIONS: Heidelberg Retinal Tomography (HRT), including two diagnostic algorithms, glaucoma probability score (HRT-GPS) and Moorfields regression analysis (HRT-MRA); scanning laser polarimetry [glaucoma diagnostics (GDx)]; and optical coherence tomography (OCT). The reference standard was clinical examination by a consultant ophthalmologist with glaucoma expertise including visual field testing and intraocular pressure (IOP) measurement. MAIN OUTCOME MEASURES: (1) Diagnostic performance of imaging, using data from the eye with most severe disease. (2) Composite triage test performance (imaging test, IOP measurement and visual acuity measurement), using data from both eyes, in correctly identifying clinical management decisions, that is 'discharge' or 'do not discharge'. Outcome measures were sensitivity, specificity and incremental cost per quality-adjusted life-year (QALY). RESULTS: Data from 943 of 955 participants were included in the analysis. The average age was 60.5 years (standard deviation 13.8 years) and 51.1% were females. Glaucoma was diagnosed by the clinician in at least one eye in 16.8% of participants; 37.9% of participants were discharged after the first visit. Regarding diagnosing glaucoma, HRT-MRA had the highest sensitivity [87.0%, 95% confidence interval (CI) 80.2% to 92.1%] but the lowest specificity (63.9%, 95% CI 60.2% to 67.4%) and GDx had the lowest sensitivity (35.1%, 95% CI 27.0% to 43.8%) but the highest specificity (97.2%, 95% CI 95.6% to 98.3%). HRT-GPS had sensitivity of 81.5% (95% CI 73.9% to 87.6%) and specificity of 67.7% (95% CI 64.2% to 71.2%) and OCT had sensitivity of 76.9% (95% CI 69.2% to 83.4%) and specificity of 78.5% (95% CI 75.4% to 81.4%). Regarding triage accuracy, triage using HRT-GPS had the highest sensitivity (86.0%, 95% CI 82.8% to 88.7%) but the lowest specificity (39.1%, 95% CI 34.0% to 44.5%), GDx had the lowest sensitivity (64.7%, 95% CI 60.7% to 68.7%) but the highest specificity (53.6%, 95% CI 48.2% to 58.9%). Introducing a composite triage station into the referral pathway to identify appropriate referrals was cost-effective. All triage strategies resulted in a cost reduction compared with standard care (consultant-led diagnosis) but with an associated reduction in effectiveness. GDx was the least costly and least effective strategy. OCT and HRT-GPS were not cost-effective. Compared with GDx, the cost per QALY gained for HRT-MRA is £22,904. The cost per QALY gained with current practice is £156,985 compared with HRT-MRA. Large savings could be made by implementing HRT-MRA but some benefit to patients will be forgone. The results were sensitive to the triage costs. CONCLUSIONS: Automated imaging can be effective to aid glaucoma diagnosis among individuals referred from the community to hospital eye services. A model of care using a triage composite test appears to be cost-effective