The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR''s

Impacts, adaptation and vulnerability to global environmental change: challenges and pathways for an action-oriented research agenda for middle-income and low-income countries

The socio-economic impacts of environmental stresses associated with global environmental change depend to a large extent on how societies organize themselves. Research on climate-related societal impacts, vulnerability and adaptation is currently underdeveloped, prompting international global environmental change research institutions to hold a series of meetings in 2009–2010. One of these aimed at identifying needs in middle-income and low-income countries (MLICs), and found that effective responses to the challenge of reducing vulnerability and enhancing adaptation will drive research and policy into challenging and innovative areas of research. Producing impacts, vulnerability and adaptation knowledge requires greater inclusion of MLIC researchers and a rethinking of the research structures, institutions and paradigms that have dominated global change research to date. Scientific literature discussed in this article suggests that governance issues need to become central objects of empirically based, detailed, multiscalar and action-oriented research, and that this needs to address the politically sensitive and seemingly intractable issue of reducing global inequities in power and resource distribution. The scientific literature suggests that without effective action in those directions, current trends toward greater inequality will continue to both reflect and intensify global environmental threats and their impact