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The objective of this study is to determine the physical evaluations and assessment tools used by a group of Canadian healthcare professionals treating adults with spasticity.
Methods:
A cross-sectional web-based 19-question survey was developed to determine the types of physical evaluations, tone-related impairment measurements, and assessment tools used in the management of adults with spasticity. The survey was distributed to healthcare professionals from the Canadian Advances in Neuro-Orthopedics for Spasticity Congress database.
Results:
Eighty study participants (61 physiatrists and 19 other healthcare professionals) completed the survey and were included. Nearly half (46.3%, 37/80) of the participants reported having an inter- or trans-disciplinary team managing individuals with spasticity. Visual observation of movement, available range of motion determination, tone during velocity-dependent passive range of motion looking for a spastic catch, spasticity, and clonus, and evaluation of gait were the most frequently used physical evaluations. The most frequently used spasticity tools were the Modified Ashworth Scale, goniometer, and Goal Attainment Scale. Results were similar in brain- and spinal cord-predominant etiologies. To evaluate goals, qualitative description was used most (37.5%).
Conclusion:
Our findings provide a better understanding of the spasticity management landscape in Canada with respect to staffing, physical evaluations, and outcome measurements used in clinical practice. For all etiologies of spasticity, visual observation of patient movement, Modified Ashworth Scale, and qualitative goal outcomes descriptions were most commonly used to guide treatment and optimize outcomes. Understanding the current practice of spasticity assessment will help provide guidance for clinical evaluation and management of spasticity.
More than half of the current members of the US Congress served in their state legislature prior to holding federal office. We quantify the relationship between state legislative service and career progression to Congress. Using close elections for exogenous assignment of political experience across otherwise similar candidates, we show that serving in the state legislature more than doubles an individual's probability of eventually contesting a Congressional seat relative to a similar candidate who lost in a comparable election; it also doubles the individual politician's probability of eventually winning a Congressional seat. State legislatures thus create national politicians out of otherwise marginal political entrants. We then show that the effect of state legislative service on career progression is larger in more professionalized legislatures, highlighting the role of institutions in facilitating political career progression. Our results hold important implications for representation and accountability, and confirm that prevailing institutions can affect political selection via career progression.
To assess the mental health of pregnant women, with reference to anxiety, depression and obsessive-compulsive (OC) symptoms, during the COVID-19 pandemic.
Methods:
A cross-sectional survey was conducted in Ireland during the third wave of the pandemic between February and March 2021. Psychiatric, social and obstetric information was collected from pregnant women in a Dublin maternity hospital, alongside self-reported measures of mental health status.
Results:
Of 392 women responding, 23.7% had anxiety, scoring >9 for GAD-7 (7-item generalised anxiety disorder), 20.4% had depression, scoring >9 for PHQ-9 (9-item depression screening tool: Patient health questionnaire) and 10.3% had obsessive-compulsive disorder (OCD), scoring >13 for Yale–Brown obsessive-compulsive scale symptom checklist (Y-BOCS). Amongst self-reported OCD symptoms, there was a preponderance for obsessions rather than compulsions. Of 392 women, 36.2% described their mental health as worse during the pandemic, most frequently describing symptoms of anxiety and sleep disturbance. When analysed against test scores, self-reported worsening of mental health was significantly associated with higher scores on the GAD-7, PHQ-9 and Y-BOCS scales. The three scores were positively interrelated. Poor mental health scores were associated with self-reported strain in relationship with the baby’s father, and current or previous history of mental illness.
Conclusion:
This study found high levels of depression, anxiety and OC symptoms amongst pregnant women during COVID-19. This highlights the vulnerability of this group to mental illness and the importance of enhanced screening and support during pandemics.
By
Stefan Dercon, former Chief Economist, Department for International Development (DFID), UK; Professor of Economic Policy, Oxford University, UK,
Stephen A. O'connell, former Chief Economist, United States Agency for International Development (USAID); Gil and Frank Mustin Professor of Economics, Swarthmore College, Pennsylvania, USA
The Sustainable Development Goals (SDGs) provide an extraordinary vision of what global development should look like between now and 2030. Starting with the concept of sustainability, the SDGs go far beyond the Millennium Development Goals (MDGs) to incorporate a set of environmental and social-justice priorities that require national action at all levels of income. As agreed by 193 signatory nations at the September 2015 United Nations General Assembly, the 2030 Agenda for Sustainable Development (https://sustainabledevelopment.un.org/post2015/ transformingourworld) is meant to be universal, indivisible, and interlinked. In conventional development arenas like extreme poverty and hunger the SDGs also inspire, doubling down on the MDGs by defining success in absolute rather than relative terms. Global partners target an end to poverty in all its forms, for example, rather than a 50 percent reduction in extreme-poverty headcount ratios.
The UN's drive for universal norms and targets involved widespread public debate and painstaking negotiations and compromises between national governments. The process was simultaneously more transparent and much more difficult and convoluted than when the MDGs emerged from behind closed doors a decade and a half ago. Some widening in the scope of commitments was inevitable and also desirable, to accommodate sustainability goals and build a truly global coalition. But there was also widespread awareness as negotiations proceeded that fewer goals might allow for greater success. By the latter standard, the 2030 Agenda is daunting. With 17 global goals and 169 highly ambitious targets, the Agenda seems in danger of departing not just in scope but also in coherence from the elegant eight goals and 17 targets of the MDGs.
In practice, therefore, a great deal remains on the table in terms of shaping global action. This is true not just in the conventional sense of identifying costeffective approaches to individual targets but also in the deeper sense of operationalizing – and unavoidably, prioritizing – targets at the national and global levels. This book makes a vital contribution to what should be a collective effort to prioritize.
The period from 1960 to 2000 was one of remarkable growth and transformation in the world economy. Why did most of Sub-Saharan Africa fail to develop over this period? Why did a few small African economies succeed spectacularly? The Political Economy of Economic Growth in Africa, 1960–2000 is by far the most ambitious and comprehensive assessment of Africa's post-independence economic performance to date. Volume 1 examines the impact of resource wealth and geographical remoteness on Africa's growth and develops a new dataset of governance regimes covering all of Sub-Saharan Africa. Separate chapters analyze the dominant patterns of governance observed over the period and their impact on growth, the ideological formation of the political elite, the roots of political violence and reform, and the lessons of the 1960–2000 period for contemporary growth strategy.
By
Paul Collier, Professor of Economics University of Oxford,
Jan Willem Gunning, Professor of Development Economics Free University of Amsterdam,
Stephen A. O'Connell, Professor of Economics Swarthmore College,
Benno J. Ndulu, Advisor to the Vice President Africa region of the World Bank
Our analysis has been retrospective: Africa's economic growth over the period 1960–2000. The primary purpose in understanding Africa's past is to help guide its future. Our main conclusion from our review of Africa's past has been that while its opportunities were atypically difficult, its politics evolved in such a way that it largely failed to harness them. The politics was transmitted into the economy through syndromes: growth-constraining packages of policies, institutions, and behavior.
In this chapter we look forward. Opportunities, as we define them, are geographical characteristics and hence, for better or for worse, there is little one can do to change them. Africa can, however, make much better use of its opportunities and, where opportunities are adverse, mitigate their economic impact. We consider in turn the three big opportunity groups that we have used throughout the study – landlocked and resource-scarce, resource-rich, and coastal and resource-scarce countries. For each we ask two types of question. First, what proximately is needed in order for opportunities to be harnessed? For example, landlocked Africa needs better transport infrastructure. Second, what are the political underpinnings that would enable such proximate changes to be made and sustained? For example, what political structures would provide the incentive for neighboring countries to maintain the transport corridors that landlocked countries need?
As background, we stress four major lessons from our analysis of Africa's experience.
Growth depends upon the interaction of opportunities and choices. A country, or an entire region, may fail to grow either because there are no opportunities, or because choices are made that preclude opportunities being taken. The stark phenomenon we are trying to understand is that for forty years Africa stagnated while other developing regions grew. This chapter attempts to explain this alarming phenomenon in terms of the distinctive opportunities open to the region and the distinctive choices which were made.
Before explanation comes description. The comparison of regional growth rates must surely seem a straightforward matter. In fact, especially for Africa, it is sensitive to apparently arcane choices. To date, in our view scholars have invariably got these choices wrong and so we must begin with a brief discussion of these issues.
The basic unit for reporting GDP and its growth is the nation: regional figures on GDP are built up from these observations at the level of the nation. The most widely cited regional growth rates come from the World Economic Outlook (WEO) of the IMF and the Global Economic Prospects (GEP) of the World Bank. In both cases, the regional figures are half-way houses on the road to estimates of the growth of global GDP. Necessarily, in such an approach, the growth rates of regional and global GDP are simply arrived at from the total level of GDP and its comparison with the previous year.
By
Paul Collier, Professor of Economics University of Oxford,
Robert H. Bates, Eaton Professor of the Science of Government Harvard University,
Anke Hoeffler, research officer at the CSAE University of Oxford,
Stephen A. O'Connell, Professor of Economics Swarthmore College
We have seen that Africa's geography has distinctively shaped its opportunities. Two-thirds of Africa's population live in countries that are either dominated by natural resource wealth, or are landlocked and resource-scarce. Both of these conditions are difficult to cope with, and both are far more common in Africa than in other parts of the developing world. In this chapter we suggest that not only have Africa's opportunities been shaped by its geography, but that to a significant extent so have its choices.
Policy choices do not lend themselves to quantitative analysis: they are highly multifaceted with no obvious procedure for aggregation, and they are often continuous but ordinal, lying on the qualitative spectrum better–worse. In addition, individual variables often measure policy outcomes rather than policy settings: they become endogenous to growth. We have reduced this complexity to a manageable set of “syndromes” – patterns of policy choice that are plausibly causally prior to growth outcomes and that an economist would expect to be seriously dysfunctional for growth. This simplification has naturally come at the price of a substantial loss of information. However, as we saw in chapter 2, the syndromes are associated with a substantial part of Africa's growth shortfall. If this association is causal, which we shall investigate, then the loss of information is not overly severe, at least in terms of the impact of policies on growth. Attention then properly shifts to explaining policy choices, and here the syndrome structure provides a powerful focal point for analysis.
A collaborative effort of the African Economic Research Consortium (AERC), Harvard University, and Oxford University, the Growth Project was designed to produce the first comprehensive assessment by African research economists of the growth experience of Sub-Saharan Africa (SSA) in the post-independence period. At the core of the project is a tight integration of country-level research with global econometric evidence on economic growth. In this chapter we provide the building blocks of this approach and a perspective on the lessons it produced. The themes introduced here are developed in detail throughout this volume and in the accompanying volume 2 of country studies. In the course of our analysis we provide a road map to the remaining chapters of this synthesis volume.
Economic growth in Africa, 1960–2000
Africa's growth record appears in table 1.1, which focuses on the period from 1960 to 2000 and applies to all developing countries with continuous data. The post-1960 period corresponds closely to the era of political sovereignty in SSA (table 1.2). It is also by far the most intensively studied period in the global growth econometrics literature, reflecting the availability of comparable cross-country data on the contemporary nation-states of the developing world.
Simple cross-country averages suggest, at best, a story of modest progress. Human development indicators (HDIs) showed a decided improvement over the forty-year period, and real GDP per capita rose by 60 percent.
But, on a deeper look, the record is profoundly unsettling.