The growth and development of the modern Egyptian financial sector

This thesis focuses on the Egyptian financial sector during the period between the Egyptian Revolution of 1952 and the late 1980's. This was a period during which the country's political leaders sought to administer the economy by a variety of different means, all of which had a marked impact on the manner in which the financial sector was able to operate. An attempt is made to assess the nature of the changes to which the sector was subject, the manner in which the changes shaped financial operations and the potential of the sector to contribute to the removal, or alleviation of some of the problems faced by Egypt today. The techniques employed in pursuit of these objectives are various, concentrating initially on an examination of the 'ideal' role of the 'ideal' financial sector, the path of sectoral development commonly charted within the developing world, and some of the problems faced typically by financial sectors in the wake of such historic developmental experience. The thesis then goes on to discuss Egypt in particular - the background of foreign commercial banking which characterised the sector before the Revolution, and the impact of Gamal Abd al-Nasser's reforms - Egyptianisation, sequestration, nationalisation and central planning. President Sadat's Open Door Economic Policy is also examined. This leads to an assessment of economic conditions today. The activities of the sector are then discussed along with the regulatory environment imposed by the Central Bank and the government. The main findings of this study, discussed in the penultimate chapter, suggest that whilst the financial sector has undoubtedly grown and developed, the general political, social and economic environment in which it has had to operate has prevented it from realising fully its potential. Liquidity stands in excess of 130%, and this in itself points to a lack of both confidence and perceived investment opportunities. Suggested areas of reform to enhance financial performance and improve confidence are described, reflecting the opinions of a range of financiers and others working in Egypt today

The development of basic health services in Papua New Guinea, with particular reference to the Southern Highlands Province

The process of underdevelopment in Papua New Guinea is bringing rapid change for the mass of people as more areas are incorporated into the export oriented cash economy, with disruption of social and economic formations, growing inequality and deepening dependency. This is despite national objectives emphasising more equal development based on the needs of the rural majority. Health services have grown within the framework of underdevelopment and are characterised by an imported clinical model, hospital bias and inequality. The 1974-1978 health plan attempted, unsuccessfully, to reverse trends to urban, curative services and to develop basic rural services using the aid post system in particular. Aid post provision began after the second world war but has, until recently, suffered from relative neglect. Attempts to plan more effectively, and recent decentralisation, may provide the basis for the development of services following a primary health care approach. However, redistribution of resources to the rural majority remains problematic. The Southern Highlands province ranks lowest on most health indicators; as in the majority of rural areas morbidity and mortality patterns indicate the need for primary health care. The distribution and utilisation of health services within the province reflect the national situation, with emphasis on hospital and health centre treatment. Provincial objectives include spatial redistribution of health facilities to improve access and the pursuit of primary health care, focussed on aid posts. Among a number of problems found with aid posts, the orientation and attitudes of orderlies may be inimical to the community development approach of primary health care. The massive, externally-funded, economic development project in the province epitomises the dilemmas of change in the country. For health, as for so much in contemporary Papua New Guinea, the question is whether change will bring development or the extension of underdevelopment

The development of basic health services in Papua New Guinea, with particular reference to the Southern Highlands Province

The process of underdevelopment in Papua New Guinea is bringing rapid change for the mass of people as more areas are incorporated into the export oriented cash economy, with disruption of social and economic formations, growing inequality and deepening dependency. This is despite national objectives emphasising more equal development based on the needs of the rural majority. Health services have grown within the framework of underdevelopment and are characterised by an imported clinical model, hospital bias and inequality. The 1974-1978 health plan attempted, unsuccessfully, to reverse trends to urban, curative services and to develop basic rural services using the aid post system in particular. Aid post provision began after the second world war but has, until recently, suffered from relative neglect. Attempts to plan more effectively, and recent decentralisation, may provide the basis for the development of services following a primary health care approach. However, redistribution of resources to the rural majority remains problematic. The Southern Highlands province ranks lowest on most health indicators; as in the majority of rural areas morbidity and mortality patterns indicate the need for primary health care. The distribution and utilisation of health services within the province reflect the national situation, with emphasis on hospital and health centre treatment. Provincial objectives include spatial redistribution of health facilities to improve access and the pursuit of primary health care, focussed on aid posts. Among a number of problems found with aid posts, the orientation and attitudes of orderlies may be inimical to the community development approach of primary health care. The massive, externally-funded, economic development project in the province epitomises the dilemmas of change in the country. For health, as for so much in contemporary Papua New Guinea, the question is whether change will bring development or the extension of underdevelopment

Practitioner perspectives on strategies to promote longer-term benefits of acupuncture or counselling for depression: a qualitative study

Background: Non-pharmacological interventions for depression may help patients manage their condition. Evidence from a recent large-scale trial (ACUDep) suggests that acupuncture and counselling can provide longer-term benefits for many patients with depression. This paper describes the strategies practitioners reported using to promote longer-term benefits for their patients. Methods: A qualitative sub-study of practitioners (acupuncturists and counsellors) embedded in a randomised controlled trial. Using topic guides, data was collected from telephone interviews and a focus group, altogether involving 19 counsellors and 17 acupuncturists. Data were audio recorded, transcribed verbatim and analysed using thematic content analysis. Results: For longer-term impact, both acupuncturists and counsellors encouraged insight into root causes of depression on an individual basis and saw small incremental changes as precursors to sustained benefit. Acupuncturists stressed the importance of addressing concurrent physical symptoms, for example helping patients relax or sleep better in order to be more receptive to change, and highlighted the importance of Chinese medicine theory-based lifestyle change for lasting benefit. Counsellors more often highlighted the importance of the therapeutic relationship, emphasising the need for careful “pacing” such that the process and tools employed were tailored and timed for each individual, depending on the “readiness” to change. Our data is limited to acupuncture practitioners using the principles of traditional Chinese medicine, and counsellors using a humanistic, non-directive and person-centred approach. Conclusions: Long-term change appears to be an important focus within the practices of both acupuncturists and counsellors. To achieve this, practitioners stressed the need for an individualised approach with a focus on root causes

Validity of single item responses to short message service texts to monitor depression:an mHealth sub-study of the UK ACUDep trial

BACKGROUND: An increasing number of research designs are using text messaging (SMS) as a means of self-reported symptom and outcome monitoring in a variety of long-term health conditions, including severity ratings of depressed mood. The validity of such a single item SMS score to measure latent depression is not currently known and is vital if SMS data are to inform clinical evaluation in the future. METHODS: A sub-set of depressed participants in the UK ACUDep trial submitted a single SMS text score (R-SMS-DS) between 1 and 9 on how depressed they felt around the same time as completing the PHQ-9 depression questionnaire on paper at 3 months follow-up of the trial. Exploratory categorical data factor analysis (EFA) was used to ascertain the alignment of R-SMS-DS scores with the factor structure of the PHQ-9. Any response bias with regard to age or gender was assessed by differential item functioning (DIF) analysis. RESULTS: Depression scores based on the PHQ-9 and R-SMS-DS at 3 months were available for 337 participants (74 % female; mean age: 42 years, SD = 11.1), 213 of which completed the two outcomes within 6 days of each other. R-SMS-DS scores aligned with the underlying latent depression of the PHQ-9 (factor loading of 0.656) and in particular its affective rather than somatic dimension. The R-SMS-DS score was most strongly correlated with depressed mood (r = 0.607), feeling bad about oneself (r = 0.588) and anhedonia (r = 0.573). R-SMS-DS responses were invariant with respect to gender (p = 0.302). However, there was some evidence for age related response bias (p = 0.031), with older participants being more likely to endorse lower R-SMS-DS scores than younger ones. CONCLUSIONS: The R-SMS-DS used in the ACUDep trial was found to be a valid measure of latent affective depression with no gender related response bias. This text message item may therefore represent a useful assessment and monitoring tool meriting evaluation in further research. For future study designs we recommend the collection of outcome data by new health technologies in combination with gold standard instruments to ensure concurrent validity

The Silver Lining of Heart Disease: What Type of Patients Will Be More Likely to Experience It?

After successfully coping with a life threatening event, people tend to look at the brighter side of life.York's Knowledge Mobilization Unit provides services and funding for faculty, graduate students, and community organizations seeking to maximize the impact of academic research and expertise on public policy, social programming, and professional practice. It is supported by SSHRC and CIHR grants, and by the Office of the Vice-President Research & Innovation. [email protected] www.researchimpact.c

Drive time to cardiac rehabilitation: at what point does it affect utilization?

<p>Abstract</p> <p>Background</p> <p>A 30 minute drive time threshold has often been cited as indicative of accessible health services. Cardiac rehabilitation (CR) is a chronic disease management program designed to enhance and maintain cardiovascular health, and geographic barriers to utilization are often cited. The purpose of this study was to empirically test the drive time threshold for CR utilization.</p> <p>Methods</p> <p>A prospective study, using a multi-level design of coronary artery disease outpatients nested within 97 cardiologists. Participants completed a baseline sociodemographic survey, and reported CR referral, enrollment and participation in a second survey 9 months later. CR utilization was verified with CR sites. Geographic information systems were used to generate drive times at 60, 80 and 100% of the speed limit to the closest CR site from participants' homes, to take into consideration various traffic conditions. Bivariate analysis was used to test for differences in CR referral, enrollment and degree of participation by drive time. Logistic regression was used to test drive time increments where significant differences were found.</p> <p>Results</p> <p>Drive times were generated for 1209 outpatients. Overall, CR referral was verified for 523 (43.3%) outpatients, with verified enrollment for 444 (36.7%) participating in a mean of 86.4 ± 25.7% of prescribed sessions. There were significant differences in CR referral and enrollment by drive time (ps < .01), but not degree of participation. Logistic regression analysis (ps < .001) revealed that the drive time threshold at 80% of the posted speed limit for physician referral may be 60 minutes (OR = .26, 95% CI: 0.13-0.55), and the threshold for patient CR enrollment may also be 60 minutes (OR = .11, 95% CI: 0.04-0.33).</p> <p>Conclusions</p> <p>Physicians may be taking geography into consideration when referring patients to CR. Empirical consideration also reveals that patients are significantly less likely to enroll in CR where they must drive 60 minutes or more to the closest program. Once enrolled, distance has no significant effect on degree of participation.</p

A Systematic Evaluation of the Impact of STRICTA and CONSORT Recommendations on Quality of Reporting for Acupuncture Trials

Background: We investigated whether there had been an improvement in quality of reporting for randomised controlled trials of acupuncture since the publication of the STRICTA and CONSORT statements. We conducted a before-and-after study, comparing ratings for quality of reporting following the publication of both STRICTA and CONSORT recommendations. Methodology and Principal Findings: Ninety peer reviewed journal articles reporting the results of acupuncture trials were selected at random from a wider sample frame of 266 papers. Papers published in three distinct time periods (1994–1995, 1999–2000 and 2004–2005) were compared. Assessment criteria were developed directly from CONSORT and STRICTA checklists. Papers were independently assessed for quality of reporting by two assessors, one of whom was blind to information which could have introduced systematic bias (e.g. date of publication). We detected a statistically significant increase in the reporting of CONSORT items for papers published in each time period measured. We did not, however, find a difference between the number of STRICTA items reported in journal articles published before and 3 to 4 years following the introduction of STRICTA recommendations. Conclusions and Significance: The results of this study suggest that general standards of reporting for acupuncture trials have significantly improved since the introduction of the CONSORT statement in 1996, but that quality in reporting detail

Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions

Objective: To identify potentially effective complementary approaches for musculoskeletal (MSK)–mental health (MH) comorbidity, by synthesising evidence on effectiveness, cost-effectiveness and safety from systematic reviews (SRs). Design: Scoping review of SRs. Methods: We searched literature databases, registries and reference lists, and contacted key authors and professional organisations to identify SRs of randomised controlled trials for complementary medicine for MSK or MH. Inclusion criteria were: published after 2004, studying adults, in English and scoring &gt;50% on Assessing the Methodological Quality of Systematic Reviews (AMSTAR); quality appraisal checklist). SRs were synthesised to identify research priorities, based on moderate/good quality evidence, sample size and indication of cost-effectiveness and safety. Results: We included 84 MSK SRs and 27 MH SRs. Only one focused on MSK–MH comorbidity. Meditative approaches and yoga may improve MH outcomes in MSK populations. Yoga and tai chi had moderate/good evidence for MSK and MH conditions. SRs reported moderate/good quality evidence (any comparator) in a moderate/large population for: low back pain (LBP) (yoga, acupuncture, spinal manipulation/mobilisation, osteopathy), osteoarthritis (OA) (acupuncture, tai chi), neck pain (acupuncture, manipulation/manual therapy), myofascial trigger point pain (acupuncture), depression (mindfulness-based stress reduction (MBSR), meditation, tai chi, relaxation), anxiety (meditation/MBSR, moving meditation, yoga), sleep disorders (meditative/mind–body movement) and stress/distress (mindfulness). The majority of these complementary approaches had some evidence of safety—only three had evidence of harm. There was some evidence of cost-effectiveness for spinal manipulation/mobilisation and acupuncture for LBP, and manual therapy/manipulation for neck pain, but few SRs reviewed cost-effectiveness and many found no data. Conclusions: Only one SR studied MSK–MH comorbidity. Research priorities for complementary medicine for both MSK and MH (LBP, OA, depression, anxiety and sleep problems) are yoga, mindfulness and tai chi. Despite the large number of SRs and the prevalence of comorbidity, more high-quality, large randomised controlled trials in comorbid populations are needed