The EU’s mixed record: human rights and democracy promotion in the former Soviet Union

The EU has engaged in democracy and human rights promotion in the countries of the former Soviet Union since the 1990s. Tinatin Tsertsvadze assesses the successes and failures of the EU’s strategy and some of the key challenges it faces in making further progress

The fading rose of Georgia's revolution: will elections bring fresh hope?

Georgia’s Rose Revolution of 2003 signalled the beginning of a new era for the former Soviet Union Republic. The triumphant new political elite, headed by President Mikheil Saakashvili, vowed to establish a democratic state characterised by respect for human rights, a corruption-free government and a functioning market economy seeking integration with Europe and eventual EU membership. In this new CEPS Commentary, authors Hrant Kostanyan and Tika Tsertsvadze note that almost a decade after the revolution, Georgia is a state in which overreliance on political personalities, as opposed to democratic state institutions, has remained the norm. And the personality credited with leading Georgia to the path of democracy may end up undermining the very process he once started

Evaluation of effectiveness of public expenditures in psychiatric healthcare treatments in Georgia

Health care system in Georgia appears to be one of the important priority of the country during last decade and varies within 9-11%. With regard to health care costs, mental health sector, share its funds within 2%. Although mental health financing and resource distribution are characterized by a growing tendency in Georgia, effective allocation of funds directed for psychiatric treatment remains underestimated. Evidence based government policies imply to offer differentiated services for people with mental health problems and are based on cost-effectiveness analysis. Contemporary studies with the cost/benefit/effectiveness analysis, confirm the effectiveness of community services intervention. In particular, under the same expenditures, community services can make far more positive results by improving the quality of life of people with mental disorders rather than ordinary hospital services. Nowadays, costs for the inpatient services are three times higher compared to the ambulance treatments in Georgia. Taking into view the fact that the country spends 100 times less funds in financing of mental healthcare policies then developed countries and 12 times less than Eastern European countries, choosing appropriate policy which remains adequate ratio between treatment approaches on the bases of cost-effective studies arises in the political agenda. Investing funds in community services means taking out the same amount of funds from in patient, which is already scarce and significantly lower in comparison with the similar indicators in other countries. Thus, giving preferences to inpatient or outpatient services seems to be problematic without analyzing appropriate data and comparing benefit received from funding one treatment policy to the losses of another treatment policy as a result of finance reducing

Community-onset sepsis and its public health burden : protocol of a systematic review

Background: Sepsis is a life-threatening condition and major contributor of public health and economic burden in the industrialised world. The heterogeneity, absence of more specific definition, and difficulties in accurate diagnosis lead to great variability in the estimates of sepsis incidence. There has been uncertainty regarding the incidence and risk factors attributable to community-onset as opposed to hospital-acquired sepsis. Community-onset sepsis has distinct host characteristics, risk factors, pathogens, and prognosis. A systematic assessment of recent evidence is warranted in light of secular changes in epidemiology, pathogens, and the uncertainties around the incidence and risk factors of community-onset sepsis. This protocol describes a systematic review which aims to synthesise the recent empirical evidence on the incidence and risk factors of community-onset sepsis, severe sepsis, and septic shock in high-income countries. Methods/design: English-language publications of cohort and case-control studies reporting incidence and risk factors of community-onset sepsis will be eligible for inclusion. MEDLINE and Embase databases will be searched from 2002 and onwards. References of relevant publications will be hand-searched. Two reviewers will independently screen titles/abstracts and full texts as well as extract data and appraise the risk of bias of included studies. The data extractions and risk of bias assessments will be cross-checked. Any disagreements will be resolved via consensus. The data on incidence and risk factors of sepsis will be organised and synthesised in text, tables, and forest plots. The evidence will be pooled given sufficient data and degree of similarity across study populations, exposures, and outcomes. The heterogeneity will be assessed through visual inspection of forest plots, Chi-square-based p value, and I (2) statistic. The sources of heterogeneity will be explored via subgroup analysis. Discussion: Timeliness and accuracy of diagnosis of sepsis are both crucial aspects for improving the patient's outcome. The findings of this review will be discussed with a view to better inform future recommendations on improving public-facing campaigns, timely presentation, and diagnosis of sepsis in the community. The review will also discuss gaps in evidence and highlight future research and policy-making avenues for improving public health planning. Systematic review registration: PROSPERO CRD42015023484

Mikroökonomische Beschäftigungseffekte des Hamburger Modells zur Beschäftigungsförderung

"Das Hamburger Modell zur Beschäftigungsförderung zielt darauf ab, Arbeitslose mit geringen Verdienstmöglichkeiten und schlechten Arbeitsmarktchancen durch zeitlich befristete Zuschüsse, die sowohl den Teilnehmern an der Maßnahme als auch den Arbeitgebern gewährt werden, in den regulären Arbeitsmarkt zu integrieren. Der Beitrag vergleicht auf der Basis eines Propensity Score Matching den Arbeitsmarkterfolg von Arbeitslosen, die eine Förderung erhalten haben, mit dem Arbeitsmarkterfolg derjenigen, die keine Förderung erhalten haben. Die Ergebnisse sprechen für einen über den Förderungszeitraum anhaltenden Beschäftigungseffekt des Hamburger Kombilohnmodells. Eine mögliche Erklärung für diesen längerfristigen positiven Arbeitsmarkteffekt der temporären Zuschüsse könnte darin bestehen, dass die Teilnehmer während der Maßnahme zusätzliche Erfahrungen sammeln und ihre Produktivität steigt. Eine zweite Erklärung besteht darin, dass durch die Zuschüsse die auf der Arbeitnehmer- und auf der Arbeitgeberseite anfallenden Fixkosten, die mit dem Beschäftigungsverhältnis verbunden sind, effektiv gesenkt werden." (Autorenreferat, IAB-Doku)Kombilohn - Erfolgskontrolle, Arbeitslosigkeitsbekämpfung, Lohnsubvention, Langzeitarbeitslose, berufliche Reintegration, Beschäftigungseffekte, Lohnkostenzuschuss, Hamburg, Bundesrepublik Deutschland

A systematic review of economic models used to assess the cost-effectiveness of strategies for identifying latent tuberculosis in high-risk groups

Timely diagnosis and treatment of latent tuberculosis infection (LTBI) through screening remains a key public health priority. Although globally it is recommended to screen people at high risk of developing TB, the economic evidence underpinning these recommendations is limited. This review critically appraised studies that had used a decision-analytical modelling framework to estimate the cost-effectiveness of interferon gamma release assays (IGRAs) compared to tuberculin skin test (TST) for detecting LTBI in high risk populations. A systematic review of economic models used to assess the cost-effectiveness of strategies for identifying latent tuberculosis in high-risk groups (PDF Download Available). Available from: https://www.researchgate.net/publication/301759613_A_systematic_review_of_economic_models_used_to_assess_the_cost-effectiveness_of_strategies_for_identifying_latent_tuberculosis_in_high-risk_groups [accessed May 27, 2016]

Total hip replacement for the treatment of end stage arthritis of the hip : a systematic review and meta-analysis

Background: Evolvements in the design, fixation methods, size, and bearing surface of implants for total hip replacement (THR) have led to a variety of options for healthcare professionals to consider. The need to determine the most optimal combinations of THR implant is warranted. This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip. Methods: A comprehensive literature search was undertaken in major health databases. Randomised controlled trials (RCTs) and systematic reviews published from 2008 onwards comparing different types of primary THR in patients with end stage arthritis of the hip were included. Results: Fourteen RCTs and five systematic reviews were included. Patients experienced significant post-THR improvements in Harris Hip scores, but this did not differ between impact types. There was a reduced risk of implant dislocation after receiving a larger femoral head size (36 mm vs. 28 mm; RR = 0.17, 95% CI: 0.04, 0.78) or cemented cup (vs. cementless cup; pooled odds ratio: 0.34, 95% CI: 0.13, 0.89). Recipients of cross-linked vs. conventional polyethylene cup liners experienced reduced femoral head penetration and revision. There was no impact of femoral stem fixation and cup shell design on implant survival rates. Evidence on mortality and complications (aseptic loosening, femoral fracture) was inconclusive. Conclusions: The majority of evidence was inconclusive due to poor reporting, missing data, or uncertainty in treatment estimates. The findings warrant cautious interpretation given the risk of bias (blinding, attrition), methodological limitations (small sample size, low event counts, short follow-up), and poor reporting. Long-term pragmatic RCTs are needed to allow for more definitive conclusions. Authors are encouraged to specify the minimal clinically important difference and power calculation for their primary outcome(s) as well CONSORT, PRISMA and STROBE guidelines to ensure better reporting and more reliable production and assessment of evidence

When and how to update systematic reviews

Governments, funding agencies, academic institutions, and health care policy makers are increasingly investing in the design, development, and dissemination of systematic reviews (SRs) to inform clinical practice guidelines, ethical guidance of clinical research, and health care practice and policy. SRs need to be sensitive to the dynamic nature of new evidence, such as published papers. The emergence of new evidence over time may undermine the validity of conclusions and recommendations in any given SR and subsequent practice guideline. This issue has only started to be more seriously considered during the last decade or so. Now it is clear that the use of out-dated evidence can lead to a waste of resources, provision of redundant, ineffective or even harmful health care. The author of this dissertation and his colleagues conducted and published three empirical studies and two conceptual articles (in six peer-reviewed journal publications), which addressed the methodologic aspects of when and how to update SRs. This PhD project provides a summary of these publications. The work described herein has had a significant impact on raising awareness and initiating new research efforts for keeping SRs up-to-date. Publication 1 proposed the first formal definition of what constitutes an update of a SR. The article presented distinguishing features of an updated vs. not updated or a new review. Publication 2 (or Publication 3) systematically reviewed methods, techniques, and strategies describing when and how to update SRs (Study #1). Publication 4, an international survey (Study #2), identified and described updating practices and policies of organisations involved in the production and commission of SRs. Publication 5 reviewed the knowledge and efforts in updating SRs and provided guidance for authors and SR groups as to when and how to update comparative effectiveness reviews produced by the Agency for Healthcare Research and Quality’s (AHRQ) Evidence-based Practice Centres (EPCs) throughout North America. Publication 6 (Study #3) described the development, piloting, and feasibility of a surveillance system to assess the need for updating comparative effectiveness reviews produced by the AHRQ’s EPC Program. This surveillance method has proved to be an efficient approach for prioritising SRs with respect to updating need

Universal school-based prevention programs for alcohol misuse in young people

Background Alcohol misuse in young people is cause of concern for health services, policy makers, prevention workers, criminal justice system, youth workers, teachers, parents. This is one of three reviews examining the effectiveness of (1) school-based, (2) family-based, and (3) multi-component prevention programs. Objectives To review evidence on the effectiveness of universal school-based prevention programs in preventing alcohol misuse in school-aged children up to 18 years of age. Search strategy Relevant evidence (up to 2002) was selected from the previous Cochrane review. Later studies, to July 2010, were identified from MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Project CORK, and PsycINFO. Selection criteria Randomized trials evaluating universal school-based prevention programs and reporting outcomes for alcohol use in students 18 years of age or younger were included. Two reviewers screened titles/abstracts and full text of identified records. Data collection and analysis Two reviewers extracted relevant data independently using an a priori defined extraction form. Risk of bias was assessed. Main results 53 trials were included, most of which were cluster-randomised. The reporting quality of trials was poor, only 3.8% of them reporting adequate method of randomisation and program allocation concealment. Incomplete data was adequately addressed in 23% of the trials. Due to extensive heterogeneity across interventions, populations, and outcomes, the results were summarized only qualitatively.Six of the 11 trials evaluating alcohol-specific interventions showed some evidence of effectiveness compared to a standard curriculum. In 14 of the 39 trials evaluating generic interventions, the program interventions demonstrated significantly greater reductions in alcohol use either through a main or subgroup effect. Gender, baseline alcohol use, and ethnicity modified the effects of interventions. Results from the remaining 3 trials with interventions targeting cannabis, alcohol, and/or tobacco were inconsistent. Authors' conclusions This review identified studies that showed no effects of preventive interventions, as well as studies that demonstrated statistically significant effects. There was no easily discernible pattern in characteristics that would distinguish trials with positive results from those with no effects. Most commonly observed positive effects across programs were for drunkenness and binge drinking. Current evidence suggests that certain generic psychosocial and developmental prevention programs can be effective and could be considered as policy and practice options. These include the Life Skills Training Program, the Unplugged program, and the Good Behaviour Game. A stronger focus of future research on intervention program content and delivery context is warranted. PLAIN LANGUAGE SUMMARY Psychosocial and Development Alcohol Misuse Prevention in Schools can be effective We conducted a Cochrane systematic review of 53 well-designed experimental studies that examined the effectiveness of school-based universal programs for the prevention of alcohol misuse in young people. The studies were divided into two major groups based on the nature of the prevention program: 1) programs targeting specifically prevention or reduction of alcohol misuse and 2) generic programs with wider focus for prevention (e. g., other drug use/abuse, antisocial behavior). In the review we found studies that showed no effects of the preventive program, as well as studies that demonstrated statistically significant effects. There was no easily discernible pattern in program characteristics that would distinguish studies with positive results from those with no effects. Most commonly observed positive effects across programs were for drunkenness and binge drinking. In conclusion, current evidence suggests that certain generic psychosocial and developmental prevention programs can be effective and could be considered as policy and practice options. These include the Life Skills Training Program, the Unplugged program, and the Good Behaviour Game