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How do central banks identify risks? A survey of indicators

Para los bancos centrales son cruciales el desarrollo y el mantenimiento de un marco de identificación de riesgos que permita la detección temprana de posibles amenazas para la estabilidad financiera y que facilite la aplicación de las políticas más adecuadas. Este documento resume los principales indicadores desarrollados para la identificación de riesgos tanto por parte del Banco de España como por otros bancos centrales y autoridades prudenciales. Así, esta recopilación de indicadores contribuye a mejorar la transparencia y la comunicación del Banco de España en su objetivo de potenciar la estabilidad del sistema financiero. El Banco de España utiliza algunos de estos indicadores en sus tareas regulares de identificación y seguimiento de riesgos, mientras que otros proceden de trabajos de investigación concretos. Este conjunto de medidas puede clasificarse en dos amplias categorías, en función del tipo de riesgo monitorizado: estándar o sistémico. Dada la naturaleza multidimensional del riesgo sistémico, su identificación va más allá de la propia suma de los riesgos estándar presentados en este documento (concretamente, riesgos de crédito, macroeconómico, de mercado, de liquidez y bancario). Este estudio también clasifica los indicadores en función del tipo de segmento institucional donde se originan los riesgos; concretamente, sector público, hogares, sociedades no financieras, bancos, sector financiero no bancario, mercado inmobiliario residencial y mercados financieros. Este trabajo muestra que los indicadores desarrollados y utilizados habitualmente por el Banco de España permiten una monitorización exhaustiva de las vulnerabilidades potenciales. En cualquier caso, el mantenimiento de un sistema de identificación de riesgos requiere una adaptación continua a los nuevos desarrollos teóricos y herramientas econométricas, así como a los nuevos desafíos. En este sentido, actualmente se están desarrollando nuevos indicadores para evaluar los riesgos derivados del cambio climático y los relacionados con los ciberriesgos. Se espera que las necesidades de seguimiento relacionadas con estos riesgos aumenten en el futuro.For central banks, it is crucial to develop and maintain risk identification frameworks that allow them to detect in good time and address potential threats to financial stability with the most appropriate policy tools. This paper reviews the main indicators developed for this purpose by the Banco de España and by other central banks and prudential authorities. In this way, this stocktaking exercise contributes to improving the transparency and effective communication of the financial stability-related tasks carried out at the Banco de España. Some of the indicators are used in regular Banco de España surveillance activities, whereas others pertain to specific research activities. We classify our set of measures into two broad categories depending on the risk monitored: standard or systemic risks. Given the multidimensional nature of systemic risk, its identification goes beyond the sum of the standard risks explored in this paper (namely credit, macroeconomic, market, and liquidity and bank risks). This survey also classifies indicators by the type of institutional segment that triggers risks; namely, sovereigns, households, non-financial corporations, banks, non-bank financial sector, residential real estate and the financial markets. This work shows how the measures developed and regularly used at the Banco de España allow potential vulnerabilities to be comprehensively monitored. Nevertheless, maintaining an adequate risk-identification framework requires continuous adaptation to new theoretical developments and econometric tools, and, more importantly, to emerging challenges. In this respect, there is a current drive to develop new indicators to assess potential risks arising from climate change and those linked to the risk of system-wide cyber incidents. It is expected that the monitoring needs related to these risks will increase in the future

Planning Climate and Global Change Research: A Review of the Draft U.S. Climate Change Science Program Strategic Plan

A draft strategic plan for the Climate Change Science Program (CCSP) was released to the scientific community and the public in November 2002. At the request of the CCSP, the National Academies formed a committee to review this draft strategic plan; the results of this review are reported herein

Strategic plan for integrated care of patients with kidney failure

There is a huge gap between the number of patients worldwide requiring versus those actually receiving safe, sustainable, and equitable care for kidney failure. To address this, the International Society of Nephrology coordinated the development of a Strategic Plan for Integrated Care of Patients with Kidney Failure. Implementation of the plan will require engagement of the whole kidney community over the next 5-10 years

Delivery Practices and Associated Factors among Mothers Seeking Child Welfare Services in Selected Health Facilities in Nyandarua South District, Kenya

<p>Abstract</p> <p>Background</p> <p>A measure of the proportion of deliveries assisted by skilled attendants is one of the indicators of progress towards achieving Millennium Development Goal (MDG) 5, which aims at improving maternal health. This study aimed at establishing delivery practices and associated factors among mothers seeking child welfare services at selected health facilities in Nyandarua South district, Kenya to determine whether mothers were receiving appropriate delivery care.</p> <p>Methods</p> <p>A hospital-based cross-sectional survey among women who had recently delivered while in the study area was carried out between August and October 2009. Binary Logistic regression was used to identify factors that predicted mothers' delivery practice.</p> <p>Results</p> <p>Among the 409 mothers who participated in the study, 1170 deliveries were reported. Of all the deliveries reported, 51.8% were attended by unskilled birth attendants. Among the deliveries attended by unskilled birth attendants, 38.6% (452/1170) were by neighbors and/or relatives. Traditional Birth Attendants attended 1.5% (17/1170) of the deliveries while in 11.7% (137/1170) of the deliveries were self administered. Mothers who had unskilled birth attendance were more likely to have <3 years of education (Adjusted Odds ratio [AOR] 19.2, 95% confidence interval [CI] 1.7 - 212.8) and with more than three deliveries in a life time (AOR 3.8, 95% CI 2.3 - 6.4). Mothers with perceived similarity in delivery attendance among skilled and unskilled delivery attendants were associated with unsafe delivery practice (AOR 1.9, 95% CI 1.1 - 3.4). Mother's with lower knowledge score on safe delivery (%) were more likely to have unskilled delivery attendance (AOR 36.5, 95% CI 4.3 - 309.3).</p> <p>Conclusion</p> <p>Among the mothers interviewed, utilization of skilled delivery attendance services was still low with a high number of deliveries being attended by unqualified lay persons. There is need to implement cost effective and sustainable measures to improve the quality of maternal health services with an aim of promoting safe delivery and hence reducing maternal mortality.</p

Patients' perspectives of care for type 2 diabetes in Bangladesh -a qualitative study

Background: Worldwide, type 2 diabetes affects approximately 220 million people and is the cause of 1.1 million deaths each year, 80% of which occur in low and middle income countries (LMICs). Over the next 20 years, prevalence is expected to double worldwide and increase by 150% in LMICs. There is now a move towards improving care for diabetes. However no information on patients' needs, perceptions and experiences is available, hindering effective and appropriate changes in policy and practice. We developed a study with the objective of understanding patients' experiences of treatment for type 2 diabetes. Methods. During January 2011, we conducted in-depth interviews in five sites across two administrative districts of Bangladesh, purposefully chosen to represent different geographic regions and local demographics In total, we conducted 23 (14 male, 9 female) individual interviews across the 5 sites, to gain insight into patients' understanding of their diabetes and its management. Results: Patients' levels of knowledge and understanding about diabetes and its management is depended on where they received their initial diagnosis and care. Away from specialist centres, patients had poor understanding of the essential of diabetes and its management. No appropriate written or verbal information was available for a significant number of patients, compounded limited knowledge and understanding of diabetes by healthcare professionals. Patients felt that with improved provision of appropriate information they would be able to better understand their diabetes and improve their role in its management. Access to appropriate diagnosis and subsequent treatment was restricted by availability and costs of services. Conclusion: Effective, appropriate and essential healthcare services for diabetes in Bangladesh is extremely limited, a majority of patients receive suboptimal care. Site of diagnosis will impact significantly on the quality of information provided and the quality of subsequent treatments. Although appropriate services are available at some specialist centres, the inability of patients to pay for routine tests and check-ups prevents them from receiving timely diagnoses and appropriate continuity of care. The double burden of communicable diseases and diseases is now a well-recognised. Emphasis must be placed on developing appropriate and effective preventive strategies to address this burden

Effect of Standard Tuberculosis Treatment on Plasma Cytokine Levels in Patients with Active Pulmonary Tuberculosis

CITATION: Riou, C. et al. 2012. Effect of standard tuberculosis treatment on plasma cytokine levels in patients with active pulmonary tuberculosis. PLoS ONE, 7(5): e36886, doi:10.1371/journal.pone.0036886.The original publication is available at http://journals.plos.org/plosoneBackground: Sputum Mycobacterium tuberculosis (Mtb) culture is commonly used to assess response to antibiotic treatment in individuals with pulmonary tuberculosis (TB). Such techniques are constrained by the slow growth rate of Mtb, and more sensitive methods to monitor Mtb clearance are needed. The goal of this study was to evaluate changes in plasma cytokines in patients undergoing treatment for TB as a means of identifying candidate host markers associated with microbiologic response to therapy. Methods: Twenty-four plasma cytokines/chemokines were measured in 42 individuals diagnosed with active pulmonary TB, 52% were HIV co-infected. Individuals, undergoing a 26-week standard TB treatment, were followed longitudinally over 18 months and measurements were associated with HIV status and rates of sputum culture conversion. Results: Plasma concentrations of interferon-inducible protein-10 (IP-10) and vascular endothelial growth factor (VEGF) were significantly reduced upon TB treatment, regardless of HIV status. By the end of treatment, IP-10 concentrations were significantly lower in HIV negative individuals when compared to HIV-positive individuals (p = 0.02). Moreover, in HIV negative patients, plasma VEGF concentrations, measured as early as 2-weeks post TB treatment initiation, positively correlated with the time of sputum conversion (p = 0.0017). No significant changes were observed in other studied immune mediators. Conclusions: These data suggest that VEGF plasma concentration, measured during early TB treatment, could represent a surrogate marker to monitor sputum culture conversion in HIV uninfected individuals.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0036886Publisher's versio