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Only Limited Evidence (only + limited_evidence)
Selected AbstractsCardiovascular drugs as antidiabetic agents: evidence for the prevention of type 2 diabetesDIABETES OBESITY & METABOLISM, Issue 7 2008D. P. Macfarlane Given the long-term health consequences and increasing incidence of type 2 diabetes, there is great interest to potentially prevent or delay its onset. Primary prevention studies have demonstrated that intensive exercise and weight reduction, and to a lesser extent certain antidiabetic agents, can reduce new onset diabetes in at-risk individuals. Results from post hoc analyses and secondary end-point outcomes of large randomized controlled trials of cardiovascular drugs suggest that these may also have beneficial effects, reducing the incidence of new onset diabetes in addition to their proven cardiovascular benefits. Multiple meta-analyses confirm that drugs primarily acting on the renin,angiotensin system (RAS) reduce the incidence of diabetes in the populations studied, perhaps via improved insulin sensitivity and/or effects on pancreatic beta cells. However, results from the recent Diabetes REduction Approaches with Medication study specifically failed to show a significant reduction in the incidence of diabetes with ramipril in individuals with abnormal glucose tolerance at baseline. There is only limited evidence that statins improve glucose tolerance, and although beta-blockers tend to have detrimental effects on glucose tolerance, newer agents with vasodilatory properties may confer benefits. With current guidelines, the use of cardiovascular drugs modifying the RAS will increase in at-risk individuals, but at present, they cannot be recommended to prevent diabetes. [source] Initial, habitual and compulsive alcohol use is characterized by a shift of cue processing from ventral to dorsal striatumADDICTION, Issue 10 2010Sabine Vollstädt-Klein ABSTRACT Aims During the development of drug addiction, initial hedonic effects decrease when substance use becomes habitual and ultimately compulsive. Animal research suggests that these changes are represented by a transition from prefrontal cortical control to subcortical striatal control and within the striatum from ventral to dorsal domains of the striatum, but only limited evidence exists in humans. In this study we address this hypothesis in the context of alcohol dependence. Design, setting and participants Non-abstinent heavy social drinkers (n = 21, 5.0 ± 1.5 drinks/day, 13 of them were alcohol-dependent according to DSM-IV) and light social drinkers (n = 10, 0.4 ± 0.4 drinks/day) were examined. Measurements We used a cue-reactivity functional magnetic resonance imaging (fMRI) design during which pictures of alcoholic beverages and neutral control stimuli were presented. Findings In the dorsal striatum heavy drinkers showed significant higher activations compared to light drinkers, whereas light social drinkers showed higher cue-induced fMRI activations in the ventral striatum and in prefrontal areas compared to heavy social drinkers [region of interest analyses, P < 0.05 false discovery rate (FDR)-corrected]. Correspondingly, ventral striatal activation in heavy drinkers correlated negatively with obsessive-compulsive craving, and furthermore we found a positive association between cue-induced activation in the dorsal striatum and obsessive-compulsive craving in all participants. Conclusions In line with our hypothesis we found higher cue-induced activation of the ventral striatum in social compared to heavy drinkers, and higher dorsal striatal activation in heavy drinkers. Increased prefrontal activation may indicate that social drinkers activate cortical control when viewing alcohol cues, which may prevent the development of heavy drinking or alcohol dependence. Our results suggest differentiating treatment research depending on whether alcohol use is hedonic or compulsive. [source] Implementation of the IPPC Directive and its economic impacts: evidence from the EU steel and glass industryENVIRONMENTAL POLICY AND GOVERNANCE, Issue 3 2008Tilmann Rave Abstract This paper aims at assessing the likely economic impacts of different approaches to implementation of Directive 96/61/EC on integrated pollution prevention and control (IPPC) by establishing a conceptual framework and by providing empirical evidence from case studies in the EU electric steel and domestic glass industry. The potential economic implications of the IPPC permitting process are analysed from the point of view of individual plants. Both plant- and sector-specific factors and the institutional and regulatory context of IPPC implementation in different member states are taken into account. The paper finds only limited evidence of any adverse competitiveness impacts arising from IPPC implementation. Copyright © 2008 John Wiley & Sons, Ltd and ERP Environment. [source] Attention Deficit Hyperactivity Disorder and substance use disorders: is there a causal link?ADDICTION, Issue 6 2001Michael T. Lynskey Attention-deficit hyperactivity disorder (ADHD), characterized by restless, inattentive and hyperactive behaviours, is a relatively common childhood disorder that affects approximately 5% of the general population. There has been controversy about whether ADHD increases risks of developing substance use disorders. The available evidence suggests that, in the absence of conduct disorder, ADHD is not associated with an increased risk of substance use problems in males. There is only limited evidence on the role of ADHD in the aetiology of substance use disorders among females. While ADHD has traditionally been considered as a childhood disorder, it may also occur in adults; research needs to examine the extent to which ADHD in adulthood increases the risk of substance use disorders. [source] Developing new measures of welfare state change and reformEUROPEAN JOURNAL OF POLITICAL RESEARCH, Issue 5 2002Francis G. Castles Since the publication of Gøsta Esping,Andersen's The Three Worlds of Welfare Capitalism (Esping,Andersen 1990), which built its typologies on a rich database of detailed programme characteristics, it has been generally accepted that measures of social expenditure are an inferior, and even a misleading, source of information concerning the character of welfare state development. The problem is, however, that the kinds of detailed programme data Esping,Andersen used are not routinely available, while the quality of social expenditure data has been improving rapidly, culminating in the Organisation for Economic Cooperation and Development's (OECD) now regularly updated and highly disaggregated Social Expenditure Database (SOCX). This article explores the possibility of using SOCX to devise measures of the extent, structure and trajectory of welfare state change and reform in 21 OECD countries over the period 1984 to 1997. On the basis of these measures, it suggests that there has been almost no sign of systematic welfare retrenchment in recent years and only limited evidence of major structural transformation or programmatic reorientation. [source] ,Out of Hospital': a scoping study of services for carers of people being discharged from hospitalHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2009Rachel Borthwick BSc (Hons) RM RN Abstract Successive government policies have highlighted the need to inform and involve carers fully in the hospital discharge process. However, some research suggests that many carers feel insufficiently involved and unsupported in this process. This paper summarises a scoping review to identify what the UK literature tells us about the service provision for carers, and its effectiveness, around the time of hospital discharge of the care recipient, and also describes a mapping exercise of the work currently being done by Princess Royal Trust for Carers Centres in England to support carers around the time of hospital discharge. The restriction to UK literature was dictated by the nature of the project; a modest review carried out for a UK-based voluntary sector organization. Fifty-three documents were reviewed, of which 19 papers (representing 17 studies) were reporting on primary research. As only five of these studies actually involved an intervention, it appears there is very little research from the UK which evaluates specific interventions to support carers around the time of hospital discharge of the care recipient. While the mapping exercise showed that in some areas there are services and/or initiatives in place which have been designed to improve the process of discharge for carers, in many places there is still a gap between what policy and research suggest should happen and what actually happens to carers at this time. Even where services and initiatives to support carers through the discharge process exist, there is only limited evidence from research or evaluation to demonstrate their impact on the carer's experience. Further research, both quantitative and qualitative, is required to address these areas and enable commissioners, providers and carers' organizations to work together towards a service in which patients and carers alike receive the support and help they need at this significant time of transition. [source] The Screening Effect of the Private Securities Litigation Reform ActJOURNAL OF EMPIRICAL LEGAL STUDIES, Issue 1 2009Stephen J. Choi Prior research shows that the Private Securities Litigation Reform Act (PSLRA) increased the significance of merit-related factors in determining the incidence and outcomes of securities fraud class actions (Johnson et al. 2007). We examine two possible explanations for this finding: the PSLRA may have reduced the incidence of nonmeritorious litigation, or it may have changed the definition of merit, effectively precluding claims that would have survived and produced a settlement pre-PSLRA. We find no evidence that pre-PSLRA claims that settled for nuisance value would be less likely to be filed under the PSLRA regime. There is evidence, however, that pre-PSLRA nonnuisance claims would be less likely to be filed under the PSLRA regime. The latter result, which we refer to as the screening effect, is particularly pronounced for claims lacking hard evidence of securities fraud or abnormal insider trading. We find only limited evidence of a similar screening effect for case outcomes. [source] Evaluation of the Personal Dental Services (Wave 1) for Lambeth, Southwark and Lewisham Primary Care Trusts , Part 2: Retrospective analyses of treatment and other dental record dataJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2005Helen Best BDS MDS PhD Abstract Aim/Objective, The purpose of the study was to undertake analyses of treatment data for the Personal Dental Services (PDS) of Lambeth, Southwark and Lewisham Primary Care Trusts and relate the analyses to the PDS goals of supporting practitioners deliver appropriate quality dental care and ensuring that appropriate quality safety net services are available for all residents. Method, Analyses of treatment data provided by the Dental Practice Board were undertaken for the post-PDS period (February 1999,March 2003, based on data availability). Analyses of the clinic notes for 1500 patients were also undertaken for the 1 year pre-PDS period (October 1997,September 1998) and post-introduction of the PDS (October 1998,June 2003). Two sets of analyses were undertaken to evaluate trends in treatment claims for the Dental Practice Board data, absolute numbers of each type of treatment claimed each month and change in numbers of types of treatments claimed over time. The clinic notes were used to undertake post-PDS, pre-PDS comparisons of the number of treatment items and grouped treatment item categories undertaken and the number of courses and percentages of private treatment items provided. The following sociodemographic characteristics of the patients were also analysed, age, gender, exemption ,status ,and ,attendance ,status. Results, Overall it was identified that the percentage reduction in the number of treatment items undertaken was 13% (95% CI ,19%, ,7%), post- as compared to the pre-PDS introduction period. On an annual basis it was identified that the percentage reduction in the number of treatment items undertaken per year per patient post-PDS was 4% (95% CI ,6%, ,2%). There were significant variations in the impact of the PDS on the number of treatment items undertaken for different types of patients. A limited number of treatment types changed significantly post- as compared to pre-PDS. The proportion of exempt patients treated did not increase ,post-PDS. Conclusions, It is possible that a less, invasive style of dental treatment was provided during the course of the PDS, however, there was only limited evidence to indicate that dentists practice style changed based on types of treatment categories provided. The PDS provided a limited safety net service for local residents. In setting program goals the nature of quality dental practice requires definition and evaluation should be undertaken on a prospective basis. [source] ADVANCES IN CLINICAL PRACTICE: New endoscopic and surgical treatment options for early esophageal adenocarcinomaJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2010Susan Gan Abstract Although the outcome for advanced stage esophageal cancer is poor, the early detection and treatment of early stage disease is usually associated with a much better outcome. Until recently, esophagectomy has been the treatment of choice in fit patients. However, morbidity is significant, and this has encouraged the development of newer endoscopic treatments that preserve the esophagus. These techniques include ablation and mucosal resection. Promising results are described, and endoscopic methods might provide a reasonable alternative for the treatment of early esophageal cancer. However, follow-up remains short and endoscopic treatment does not deal with potential lymphatic spread. Hence, careful selection is required. Minimally invasive techniques for esophageal resection have also been shown to be feasible, although there is only limited evidence that they reduce postoperative morbidity. Better data are still required to demonstrate improved outcomes from endoscopic treatment and minimally invasive esophagectomy. [source] Psychiatric inpatient care for adults with intellectual disabilities: generic or specialist units?JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 1 2004K. Xenitidis Abstract Background When adults with intellectual disabilities (ID) require a psychiatric admission, general adult mental health units are often used. Specialist units have emerged recently as a care option but there is only limited evidence of their effectiveness. Thus this study aims to describe and evaluate the effectiveness of a specialist inpatient unit and report on the utilization of generic and specialist inpatient services. Method All patients admitted to a specialist ID psychiatric unit were evaluated on admission and immediately after discharge on a number of outcome measures. In addition, they were compared with those admitted to general adult mental health units covering the same catchment area. Results Significant improvements were demonstrated within the specialist unit cohort on measures including psychopathology, global level of functioning, behavioural impairment and severity of mental illness. The specialist unit patients had a longer length of inpatient stay but were less likely to be discharged to out-of-area residential placement. Conclusions Specialist units are an effective care option for this group of people. [source] Economic liberalization and new product enterprises in the newly industrializing countries: an analysis of the Indian experienceJOURNAL OF INTERNATIONAL DEVELOPMENT, Issue 2 2002Homi Katrak This paper examines whether India's recent economic liberalization policies have led to a shift away from the relatively R&D intensive new product enterprises (NPEs) and towards old product enterprises (OPEs). The former type of enterprises had begun production under the earlier protectionist regime and there has been concern whether they will do well under the more competitive liberalized environment. Empirical tests, covering two 6-year periods, 1985,90 and 1991,96, found only limited evidence that the growth in the number of the NPEs had been relatively lower in the post liberalisation period, compared to that of the OPEs. However the NPEs' contribution to the growth of industry output had not decreased in that period. Overall there has been no adverse effect on the NPEs. These results may well be showing that any unfavourable influence of trade liberalisation on the NPEs has been offset by the liberalisation of the imports of technology and also the de-licensing policy. Copyright © 2002 John Wiley & Sons, Ltd. [source] Psychosocial interventions for adolescent cancer patients: a systematic review of the literaturePSYCHO-ONCOLOGY, Issue 7 2009Diana C. M. Seitz Abstract Objective: Both cancer diagnosis and the consequent treatment are particularly challenging for adolescent patients. Adjuvant psychological interventions to reduce cancer-related distress are therefore a fundamental part of a multidisciplinary treatment. Assuming that psycho-oncology has to consider developmentally specific aspects, this review summarizes empirical studies of the efficacy and effectiveness of psychosocial interventions for adolescent cancer patients. Methods: Electronic searches were conducted in four databases. Studies were included only if they were exclusively designed for adolescent cancer patients and incorporated a defined outcome measure to evaluate the effects of the implemented intervention. Results: Only four studies fulfilled the inclusion criteria. One of those studies reported a significant improvement compared with a waitlist control group. The relevant gains were found in the overall level of distress, as well as in additional outcome variables such as knowledge of sexual issues, body image and anxiety about psychosexual issues. The remaining studies revealed no significant changes related to psychological distress and psychosocial functioning. Conclusion: Taken together, the findings point out that there is a lack of intervention research in psycho-oncology with adolescents. So far, there is only limited evidence for the effectiveness of psychosocial interventions to improve coping with cancer-associated problems in adolescent patients. Future research needs to be done in this population. In order to establish more conclusive results, larger samples and interventions particularly designed for adolescent patients ought to be studied. Copyright © 2008 John Wiley & Sons, Ltd. [source] | |||||||||||||