Curvature and turning point of the environmental Kuznets curve in a global economy: the role of governance.

This study explores the role of governance in shaping the environmental Kuznets curve (EKC), especially focusing on its curvature and turning point. The study highlights the role of various governance indicators in the formulation, implementation, and enforcement of environmental regulations. However, the study asserts that since in developing countries poverty, infrastructure, and human development are valued above a clean environment, good governance is less likely to contribute to mitigating pollution in developing countries. Using a panel of 160 countries, the study finds that better governance helps bring down the critical level of per capita income at which the relationship between income and pollution turns negative. Furthermore, the EKC can be shifted downward by improving governance in the respective countries. The study, however, reveals that the dividends of better governance are more pronounced at higher income levels. Since good governance works only when the desired regulations are in place, it is recommended that for poor countries aid packages for governance reforms need to emphasize the enactment of specific environmental regulations. Investment in institutions is expected to yield maximum dividends in such countries that have gained high-income status but are still lacking in institutional development.

Methodological challenges and approaches to improving response rates in population surveys in areas of extreme deprivation.

BACKGROUND: Achieving good response rates to population surveys from hard to reach groups in deprived areas can be challenging. AIM: To explore and compare different approaches to improving response rates in an economically deprived multicultural area. METHOD: Following a lower than anticipated response rate in a pilot study for a postal questionnaire survey of chronic pain (79/653 (12%)), we conducted a second pilot involving a shorter postal survey and separate collection of more detailed information in a waiting room survey. The second postal survey used a shorter questionnaire, telephone data collection from non-responders by study team members rather than telephone reminders from practice receptionists, and involved a nested randomised-controlled trial (RCT) of hand-addressed versus printed-address envelopes. Both pilots involved subjects randomly selected from the practice registers. RESULTS: The second pilot postal survey using shorter questionnaires yielded considerably more responses (240/642 (37%)). Our RCT showed that hand-addressed envelopes achieved a slightly higher response rate although not large enough to justify its use in our main study. The waiting room survey was successful in collecting more detailed data from lengthy questionnaires. CONCLUSION: A range of methods of questionnaire administration may be required when conducting a survey with a hard to reach group in a deprived and ethnically diverse population. Postal and telephone administration can be used to collect a small amount of data. Face-to-face administration and recruitment can be successful for longer questionnaires.

Assessment of treatment outcomes in patients with overactive bladder: importance of objective and subjective measures.

Overactive bladder (OAB) is a highly prevalent symptom syndrome that negatively affects health-related quality of life (HRQL). In clinical practice, the diagnosis and treatment of OAB are largely driven by a patient's reporting of symptoms, often in combination with objective assessment. Thus, OAB provides the opportunity to examine the relations between objective (eg, urodynamic studies, bladder diary variables) and subjective (eg, symptom bother, HRQL) outcomes. We compared objective and subjective results from 27 trials recently evaluated in a systematic review and meta-analysis of antimuscarinic agents used to treat OAB. Many studies demonstrated concurrent improvements in both types of outcomes. However, several reports showed that although pharmacotherapy may reduce micturition frequency or increase bladder capacity, treated patients may not perceive a significant benefit to HRQL. We conclude that objective assessments can help determine the underlying causes of OAB symptoms and assess the effects of treatment, but that these results are not always predictive of subjective outcomes, which are influenced by a patient's priorities and lifestyle, and thus highly individualized. A patient's perception of treatment success should be regarded as an important measure of efficacy because a patient considers the trade-offs between symptom improvement, adverse events, and effects on daily life when assessing overall treatment benefit. We recommend that subjective measures become standard considerations in the initial evaluation and treatment of patients with OAB.