Patient choice and private provision decreased public provision and increased inequalities in Scotland: a case study of elective hip arthroplasty.

Background: This is the first research to examine how the policy of patient choice and commercial contracting where NHS funds are given to private providers to tackle waiting times, impacted on direct NHS provision and treatment inequalities. Methods: An ecological study of NHS funded elective primary hip arthroplasties in Scotland using routinely collected inpatient data 1 April 1993-31 March 2013. Results: An increased use of private sector provision by NHS Boards was associated with a significant decrease in direct NHS provision in 2008/09 (P < 0.01) and with widening inequalities by age and socio-economic deprivation. National treatment rate fell from 143.8 (140.3, 147.3) per 100 000 in 2006/07 to 137.8 (134.4, 141.2) per 100 000 in 2007/08. By 2012/13, territorial NHS Boards had not recovered 2006/07 levels of provision; this was most marked for NHS Boards with the greatest use of private sector, namely Fife, Grampian and Lothian. Patients aged 85 years and over or living in the more deprived areas of Scotland appear to have been disadvantaged since the onset of patient choice in 2002. Conclusions: NHS funding of private sector provision for elective hip arthroplasty was associated with a decrease in public provision and may have contributed to an increase in age and socio-economic inequalities in treatment rates.

Reliability and validity of the acquired brain injury challenge assessment (ABI-CA) in children.

PRIMARY OBJECTIVE: The Acquired Brain Injury Challenge Assessment (ABI-CA) was created to fill a measurement gap and evaluate deficits in advanced motor skills in children with acquired brain injury (ABI). Study objectives were to refine ABI-CA response options and evaluate (i) inter-/intra-rater reliability, (ii) concurrent validity and difficulty level in relation to the Community Balance & Mobility Scale (CB&M) and (iii) administration efficiency of the refined ABI-CA. RESEARCH DESIGN: Measurement study. METHODS: Phase I involved ABI-CA revisions. Phase 2 consisted of live-/video-scoring of the ABI-CA with 15 typically-developing (TD) children and 15 with ABI (7-17 years) to assess reliability/validity. RESULTS: The revised 20-item ABI-CA displayed excellent reliability for the entire sample (ICCs > 0.90; 95% CI = 0.92-1.00; SEM ≤ 3.60) and within ABI and TD sub-groups. The ABI-CA and CB&M correlated strongly (r = 0.75, p < 0.0001). The ABI-CA mean score (/100) was 11.3 points lower (p < 0.0001) than the CB&M's mean score (/100). CONCLUSION: The ABI-CA demonstrated excellent reliability and initial evidence of validity. ABI-CA scores were lower overall than the CB&M, indicating the ABI-CA may have greater capacity to evaluate improvements in advanced motor skills in children with ABI. Multi-centre research is needed to confirm the ABI-CA's test-retest reliability and, assuming acceptability, assess responsiveness to change.

Global estimates of shark catches using trade records from commercial markets.

Despite growing concerns about overexploitation of sharks, lack of accurate, species-specific harvest data often hampers quantitative stock assessment. In such cases, trade studies can provide insights into exploitation unavailable from traditional monitoring. We applied Bayesian statistical methods to trade data in combination with genetic identification to estimate by species, the annual number of globally traded shark fins, the most commercially valuable product from a group of species often unrecorded in harvest statistics. Our results provide the first fishery-independent estimate of the scale of shark catches worldwide and indicate that shark biomass in the fin trade is three to four times higher than shark catch figures reported in the only global data base. Comparison of our estimates to approximated stock assessment reference points for one of the most commonly traded species, blue shark, suggests that current trade volumes in numbers of sharks are close to or possibly exceeding the maximum sustainable yield levels.

Homeopathy for anxiety and anxiety disorders: a systematic review of the research.

OBJECTIVE: To conduct a systematic review of the clinical research evidence on homeopathy in the treatment of anxiety and anxiety disorders. METHODS: A comprehensive search of major biomedical databases: MEDLINE, EMBASE, ClNAHL, PsycINFO, Cochrane Library; and of specialist complementary and alternative medicine (CAM) databases: AMED, CISCOM and Hom-Inform was conducted. Efforts were made to identify unpublished and ongoing research using relevant sources and experts in the field. Relevant research was categorised by study type and appraised according to study design. Clinical commentaries were obtained for studies reporting clinical outcomes. RESULTS: Eight randomised controlled studies were identified. The types of anxiety and anxiety disorders studied were test anxiety, generalised anxiety disorder and anxiety related to medical or physical conditions such as cancer or surgical procedures. Single case reports/studies were the most frequently encountered study type but other study types including uncontrolled trials/case series and surveys were also found. No relevant qualitative research was identified. CONCLUSIONS: A comprehensive search demonstrates that the evidence on the benefit of homeopathy in anxiety and anxiety disorders is limited. A number of studies of homeopathy in such conditions were located but the randomised controlled trials report contradictory results, are underpowered or provide insufficient details of methodology. Several uncontrolled and observational studies reported positive results including high levels of patient satisfaction but because of the lack of a control group, it is difficult to assess the extent to which any response is due to homeopathy. Adverse effects reported appear limited to 'remedy reactions' and included temporary worsening of symptoms and reappearance of old symptoms. On the basis of this review it is not possible to draw firm conclusions on the efficacy or effectiveness of homeopathy for anxiety. However, surveys suggest that homeopathy is quite frequently used by people suffering from anxiety. If shown to be effective, it is possible that homeopathy may have benefits in terms of adverse effects and acceptability to patients. Consequently, further investigation is indicated. Future research should be of pragmatic design and include qualitative studies.

Yoga for anxiety: a systematic review of the research evidence.

Between March and June 2004, a systematic review was carried out of the research evidence on the effectiveness of yoga for the treatment of anxiety and anxiety disorders. Eight studies were reviewed. They reported positive results, although there were many methodological inadequacies. Owing to the diversity of conditions treated and poor quality of most of the studies, it is not possible to say that yoga is effective in treating anxiety or anxiety disorders in general. However, there are encouraging results, particularly with obsessive compulsive disorder. Further well conducted research is necessary which may be most productive if focused on specific anxiety disorders.

Homeopathy for depression: a systematic review of the research evidence.

OBJECTIVE: To systematically review the research evidence on the effectiveness of homeopathy for the treatment of depression and depressive disorders. METHODS: A comprehensive search of major biomedical databases including MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Library was conducted. Specialist complementary and alternative medicine (CAM) databases including AMED, CISCOM and Hom-Inform were also searched. Additionally, efforts were made to identify unpublished and ongoing research using relevant sources and experts in the field. Relevant research was categorised by study type and appraised according to study design. Clinical commentaries were obtained for studies reporting clinical outcomes. RESULTS: Only two randomised controlled trials (RCTs) were identified. One of these, a feasibility study, demonstrated problems with recruitment of patients in primary care. Several uncontrolled and observational studies have reported positive results including high levels of patient satisfaction but because of the lack of a control group, it is difficult to assess the extent to which any response is due to specific effects of homeopathy. Single-case reports/studies were the most frequently encountered clinical study type. We also found surveys, but no relevant qualitative research studies were located.: Adverse effects reported appear limited to 'remedy reactions' ('aggravations') including temporary worsening of symptoms, symptom shifts and reappearance of old symptoms. These remedy reactions were generally transient but in one study, aggravation of symptoms caused withdrawal of the treatment in one patient. CONCLUSIONS: A comprehensive search for published and unpublished studies has demonstrated that the evidence for the effectiveness of homeopathy in depression is limited due to lack of clinical trials of high quality. Further research is required, and should include well-designed controlled studies with sufficient numbers of participants. Qualitative studies aimed at overcoming recruitment and other problems should precede further RCTs. Methodological options include the incorporation of preference arms or uncontrolled observational studies. The highly individualised nature of much homeopathic treatment and the specificity of response may require innovative methods of analysis of individual treatment response.

The estimation of potential yield and stock status using life-history parameters.

Using life-history invariants, this paper develops techniques that allow the estimation of maximum sustainable yield and the fishing mortality rate that produces the maximum yield from estimates of the growth parameters, the length at first capture and the steepness of the stock recruitment relationship. This allows sustainable yields and fishing capacity to be estimated from sparse data, such as those available for developing country fisheries.