Sunday, January 26, 2020

Benefits of Financial Liberalisation

Benefits of Financial Liberalisation A EUROPEAN POLICY ABSTRACT: This paper extends to test if the short and in the long run. Weak indica- the same short-run increase in cyclical tions are found that this may happen par- volatility arising from financial integration tially due to the anchoring of expectations is observed in this specific sample of â€Å"emerg-provided by the EU Accession, and to the ing markets. This work finds signs that, more robust institutional framework contrary to other emerging markets, this imposed by this process onto the countries in does not happen: for the future Member question. States, financial integration, similarly to the KEY WORDS: Enlargement, European outcome observed in mature market Union, financial liberalization, booms, 81 economies, reduces cyclical volatility both in busts, cycles, volatility. 1. INTRODUCTION Financial and capital flows liberalization can play a fundamental role in increasing growth and welfare. Typically, emerging or developing economies seek foreign savings to solve the inter-temporal savings-investment problem. On the other hand, current account surplus countries seek opportunities to invest their savings. To the extent that capital flows from surplus to deficit countries are well intermediated and, therefore, put to the most productive use, they increase welfare. Liberalization can, however, also be dangerous, as has been witnessed in many past and recent financial, currency and banking crises. It can make countries more vulnerable to exogenous shocks. In particular, if serious macroeconomic imbalances exist in a recipient country, and if the financial sector is weak, be it in terms of risk management, prudential regulation and supervision, large capital flows can easily lead to serious financial, banking or currency crises. A number of recent crises, like those in Ea st Asia, Mexico, Russia, Brazil and Turkey (described, for example, in IMF (2001)), and, to some extent, the Argentinean episode of late 2001, early 2002, have demonstrated the potential risks associated with financial and capital flows liberalization. Central and Eastern Europe has a somewhat different experience, when compared to other emerging regions, concerning the financial liberalization process, as the process there seems to have been much less crisis-prone than in, for instance, Asia or Latin America. This maybe, at least partially, because the current high degree of external and financial liberalization in the Central Eastern European countries (CEECs), beyond questions of economic allocative efficiency, must be understood in terms of the process of Accession to the European Union. The EU integration process implies legally binding, sweeping liberalization measures-not only capital account liberalization, but investment by EU firms in the domestic financial services, and the maintenance of a competitive domestic environment, giving this financial liberalization process strong external incentives (and constraints). Those measures were implemented parallel to the development of a highly sophisticated regulatory and supervis ory structure, again based on EU standards. This whole process happened also with the EUs technical and financial support, through specific programs-like the PHARE one, for these so-called Accession, and the TACIS, for the former Soviet Union ones- and direct assistance from EU institutions, like the European Commission, the European Parliament and the European Central Bank (also, on a very early stage of the transition process, the influence of the IMF in setting up policies and institutions in several countries in the region-an intervention widely considered to haven been successful-was important: see Hallerberg et al., 2002). Additionally, EU membership seems to act as an anchor to market expectations (see Vinhas de Souza and Hà ¶lscher, 2001), limiting the possibilities of self- fulfilling financial crises and regional contagion (see Linne, 1999), which had the observed devastating effects in both Asia and Latin America (even a major event, like the Russian collapse of 1998, had very reduced regional side effects). Several regional episodes of financial systems instability did happen (see Vinhas de Souza, 2002(a) and Vinhas de Souza, 2002(b)), but none with the prolonged negative consequences observed in other region (which was also due to the effective national policy actions undertaken after those episodes). This studys main aim is to expand the Kaminsky and Schmukler database (see Kaminsky and Schmukler, 2003), from now on indicated as KS, to include the Accession and Acceding Countries from Eastern Europe (namely, for Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania , Slovakia and Slovenia). In their original work, KS build an extensive database of external and financial liberalization, which includes both developed countries and countries from emerging regions (but not from Eastern Europe). With that, they create different indexes of liberalization (capital account, banking and stock markets: see Table I below) and using them individually and in an aggregate fashion, test for the effects and causality of this process on financial and real volatility, for the existence of differences between regions, and for the effects of the ordering of the liberalization process. One underlying hypotheses of this work is that the existing regulatory and institutional framework in Eastern Europe, plus a more sustainable set of macro policies, played an important role in enabling liberalization to largely deliver the welfare enhancing outcomes that it is supposed to. Such an â€Å"anchoring role of the European Union in the CEECs, through the process of EU membership, and through the effective imposition of international standards of financial supervision and regulation, may indicate that, beyond multilateral organizations like the IMF or the OECD, a greater, pro-active regional stabilizing role in emerging markets by regional actors, for instance, the United States, or by some regional sub-grouping, like Mercosur, may also be welfare enhancing for other â€Å"emerging regions. 2. CAPITAL ACCOUNT The achieving of capital account liberalization happened rather swiftly in most of the countries in our sample: by the mid 1990s, all bar Bulgaria and Romania had been declared Article VIII compliant (for those two countries, this happened in 1998: see Table II below). One of the main driving forces behind this was the process of European Integration, for which external liberalization is a pre-requisite: in the early to mid-1990s, all the countries had signed Association Agreements with the European Union (frequently preceded by trade liberalization agreements with the EU, also called â€Å"Europe trade agreements, usually with years given to the countries to prepare for their full implementation) and formally applied for EU membership. Another additional factor supporting liberalization was IMF and OECD membership: four of the larger countries in our sample became OECD members during the second half of the 1990s. Another factor to be considered, is the endogenous decision process to liberalize in a sustainable fashion. 3. BANKING SECTOR Financial integration, in the form of the opening up the banking sector to foreign banks, is seen as being positive, on a micro level, as foreign banks are usually better capitalized and more efficient than their domestic counterparts (of course, the domestic banking sector eventually catches-up: for an indication of this process at the ACs, see, among others, Tomova et al., 2003). Also from a macroeconomic perspective, financial integration maybe positive for the Eastern European countries, both for long run growth and, as there are indications that foreign banks do not contract either their credit supply nor their deposit base, in helping to smooth the cycle (see de Haas and Lelyveld, 2003: they find some indication that this is linked to the better capitalization base and prudential ratios, as better capitalized domestic banks behave similarly to foreign banks). Given the bank-centered nature of virtually all the financial systems of the future Member States, this is particularly important for them. In most of the member states, the initial stage of the creation of the two-tier banking system, modeled on the Western European â€Å"universal bank system, was characterized by rather liberal licensing practices and limited supervision policies (aimed at the fast creation of a de novo commercial, private banking sector: see Fleming et al., 1996, Balyozov, 1999, Enoch et al., 2002, Sà ¶rg et al., 2003). This caused a mushrooming of new banks in those countries in the early 1990s. Parallel to this, a series of banking crises, of varied proportions, affected most of those de novo banking systems, due to this lax institutional framework, inherited fragilities from the command economy period (the political need to support state-owned, inefficient industries, with the consequent accumulation of bad loans and also the financing of budget deficits), macroeconomic instability, risky expansion and investment strategies and also sheer inexperience, both from the investor s and from regulators. Progressively, the re-capitalization, privatization and internationalization of the banking system (mostly into the hands of EU financial conglomerates), coupled with the implementation of a more robust, EU-modeled institutional framework, did away with most of those problems. Two of the worst cases where the set of Baltic banking crises and the Bulgarian episode, which are described in more detail below. Other smaller banking crises happened in Estonia in 1994 and 1998, and in Latvia in 1994. Caprio and Klingebiel, 2003, report smaller episodes of â€Å"financial sector distress in the Czech Republic (94-95), Hungary (93), Poland (91-93), Romania (98-00), Slovakia (97) and Slovenia (92-94). The initial proliferation of banks was, quite naturally, followed by a process of consolidation and strengthening-parallel to the privatization of the remnant state-owned components of the financial system- of the banking sector in most of those economies (in Bulgaria, from 81 banks in 1992 to 35 in 2001, in the Czech Republic from 55 in 1995 to 38 in 2001, Estonia, from 42 in 1992 to 7 currently, while Hungary had 33 banks in 2002, showing only a very slight decrease from the early 1990s, Latvia from 56 in 1994 to 23, Lithuania from 27 in 1993 to 13, in Poland from 8 1 in 1995 to 71 in 2001, in Romania from 45 in 1998 to 41 in 2001, in Slovakia from 22 in 2000 to 19 in 2001, and in Slovenia, where the number fell from 25 to 21 during 2001 alone). This consolidation process was frequently led by foreign companies, which now hold the majority of the assets of the banking system in virtually all of them-contrary to the situation in the current EU Member States-bar Slovenia. This process now has a component of regional expansion of the Eastern European banks themselves, or, more precisely in most cases, the regional expansion of Western banks via some of their locally-owned subsidiaries (see Sà ¶rg et al., 2003, ibid). The share of banking assets to GDP, nevertheless, is still far below the Euro area average (which stood at around 265% of GDP by end 2001), compared with 47% in Bulgaria, 136% in the Czech Republic, 72% in Estonia and Latvia, 32% in Lithuania, 63% in Poland, 60% in Hungary, 30% in Romania, 96% in Slovakia and 94% in Slovenia (data also for 2001). Another peculiar feature of the banking system in the region is that foreign currency lending -usually euro-denominated-to residents is very high, especially in the Balti c republics: with 80% of total loans in Estonia, 56% in Latvia and 61% in Lithuania. Also, the Baltic countries have substantial shares of deposits by non-residents, with over 10% in Estonia and Lithuania and close to 5% in Latvia (Latvia, with its close trading ties to Russia, has a particular strategy of selling itself as a stable financial services center to CIS depositors: see IMF, 2003(b), ibid). The supervision system has also substantially improved, and, following recent international-and EU- best practice, is now centered in independent universal supervisory agencies in the most advanced of those countries (Reininger et al., 2002, ibid., estimate that the formal regulatory environment for the Czech Republic, Hungary and Poland is actually above the EU, and that its actual enforcement level is at its average;Liive, 2003, gives a description of the Estonian experience that culminated in the creation of the EFSA -Estonian Financial Supervisory Authority- in January 2002). 3.1 BANKING CRISES IN EASTERN EUROPE The Baltic bank crises were, to different degrees, linked to liquidity difficulties related tolerations with Russia (in the November 1992 Estonian case, by the freezing of assets held by some Estonian banks in their former Moscow headquarters, while the Latvian and Lithuanian episodes of, respectively, March and December 1995, were caused by the drying-up of lucrative trade-financing opportunities with Russia, whose export commodities, at that time, were still below world price levels) and regulatory tightening (Latvia, Lithuania), compounded by the elimination of credit opportunities with the implementation of the Estonian and Lithuanian CBAs (Currency Board Arrangements). In Lithuania, as in Bulgaria, the financing of the budget deficit also played a role. In the Estonian and Latvian cases, around 40% of the assets of the banking system where compromised, in the Lithuanian and Bulgarian cases, around a third. The Bulgarian 1996-1997 crisis eliminated a third of its banking sector, and led the country to hyperinflation (reaching over 2000% in March 1997, see Yotzov, 2002). Its roots lie in the political instability that preceded it (which, on its turn, led to inadequate real sector reform, with state-owned, loss making enterprises being financed via the budget deficit or through arrears with the, at the time, still mostly state-owned part banking sector: those arrears were, in turn, partially monetized by the Bulgarian National Bank -BNB- and the largest state bank, the State Savings Bank -SSB). Periodic foreign exchange crises (March 1994, February 1997) and bank runs (late1995, late 1996, early 1997) were part of this picture. The implementation of tighter supervisory procedures during 1996 (giving the BNB the power to close insolvent banks), and a tightening of policy actually led to more bank runs. A caretaker government in February 1997 (before a newly elected government took power in May) paved the way to longer lasting reform and the implementation of t he CBA, with its tighter budget constraints towards both the government and the banking sector. This reform process happened with the support from multilateral institutionsamely, (namely the IMF). 4. STOCK MARKETS The existence of stock markets is assumed to be beneficial for economic performance. In principle, it provides a way for companies to raise capital at lower costs than through simple banking intermediation, and because it is not as restricted a source of capital as internal financing. Also, it is assumed that the existence of alternative modes of finance may reduce the likelihood of credit crunches caused by problems with the banking sector (see Greenspan, 2000). Additionally, the existence of external ownership is (or was, given the recent problems with market-based governance in the US and the EU, and the shift towards a more regulated environment) assumed to provide better governance for the management of firms. The majority of economic analyses seem to support the position that a diversified financing mix is positive for economic growth and stability. As described in the previous section, all the financial sectors in the Member States are bank-centered, with stock markets playing marginal roles in most of them (and, in some, a very marginal role: in Bulgaria, Slovakia and Romania, their average market capitalization in GDP terms is below 5%: see Figure I below). All of these countries had (re-)established stock markets by the mid-90s (see Table III above). About half of the future Member States used them to drive the initial process of re-privatization, either via mass issues of voucher certificates for residents (the most famous case of this strategy was the Czech Republic), or via IPOs (Initial Public Offerings) re-privatization processes, to lock-in domestic and foreign strategic investors (see Claessens at al., 2000). In the voucher-driven privatization, the initial large number of investors and traded stocks in those stock markets was soon concentrated in a rather limited number of institutional investors-domestic and foreign- and â€Å"blue chip stocks. In the IPO-driven markets, the number of stocks and investors actually tended to increase with time, albeit from a rather concentrated base. Even in the largest ones, nevertheless, market capitalization, as a GDP share, was and remains rather low (see Figure I below), and far below the EU average (around 72% of GDP). Only in the Czech Republic, Estonia, Hungary and Slovenia the average market capitalization is above a 20% GDP share, while in Romania is below 1% in several years. Also, the average market turnover is equally below the one observed in comparable EU economies. Similarly to what is observed in the banking sector, the initial regulatory environment was deliberately lax, and the regulators were plagued by much the same problems of inexperience and limited number of staff and resources. This does not mean that domestic agents in those countries lack access to the financial services supposed to be provided by stock markets: the very process of opening up, the increase in cross-border trade in financial services, the harmonization of rules for capital trading with the EU (including the ongoing efforts of the Lamfalussy Committee towards a single European market for securities: according to the current proposal, small and medium size firms would be able to use a simplified prospectus valid throughout the EU and choose the country of its approval), plus the development of information technology, all imply that is not actually necessary-nor economically optimal, given economies of scale-for each individual country to have its own separate stock market. One must also recall that the current national stock markets in the mature developed economies are themselves the result of process of consolidation-and closing-of smaller regional stock markets (as was observed in Bulgari a in the early 1990s), which still today coexist with larger, dominant national stock exchanges even in some mature markets, like Germany and the US. Nevertheless, the observed tendency of domestic larger companies, with presumed better growth prospects, to list abroad (see Table IV below), due to the obvious cost and liquidity advantages of the larger international stock markets, does seems, on balance, to deprive those stock markets of liquidity (see Claessens at al., 2003). On the other hand, nonresidents seem to play a major role in most of those markets (accounting for 77% of the capitalization in Estonia, 70% in Hungary and half of the free-float capitalization in Lithuania). All the specific questions described above concerning the way those stock exchanges were founded and their later developments, plus their relative smallness and shallowness, affect the dynamics of their stock market indexes (SMI), and are clearly reflected by them (as one may see in Figure II, below). This, coupled with the rather limited duration of the series, may affect their adequacy as proxies of financial cycles. Source: Datastream, modified by the authors. The price indexes here were converted to US Dollars and re-based to a common reference period were they equal 100, May of 1998. The country codings are as described in the Annexes. 5. ESTIMATED INDEXES The construction of the index for this new sample of countries was the core of this work. A comprehensive effort was done to crosscheck the information collected from papers and publications with national sources. Below we present the estimated monthly index, for the period January 1990 to June 2003 (see Figure III). The base data for its construction was collected from IMF and EBRD publications, and then exhaustively verified both with national sources and with works written about the individual countries and the region. This is an index that falls with liberalization, where maximum liberalization equals one and minimum three (in this sense, one could actually see it as an index of financial repression). As an additional robustness check, the year-end value of the index here constructed was regressed on the combined EBRDs yearly indexes of banking sector reform and non-banking financial sector reform. The results from a panel regression with the index constructed here on the LHS and the EBRD index on the RHS yield a coefficient of .60, and correlations among the individual country- specific index series range from -0.91 to -0.35. As one may see from Figure III above, the process of integration and liberalization was almost continuous throughout the 1990s and early 2000s. The spikes in the â€Å"Full Liberalization Index in the early 1990s do not indicate reversals: the merely reflect the entry into the sample of the newly independent Baltic republics. As former members of the Soviet Union, they â€Å"enter the world as highly closed economies, but those countries introduced liberalization reforms almost immediately from the start. After this, a slight increasing trend, that does reflect a mild liberalization reversal, is observed, starting mid-1994 and lasting until early 1997, from when a continuous liberalization trend is observed. Noteworthy here is the fact that virtually none of the obvious candidates for a reversal of liberalization (the 1997 Asian Crisis, the collapse of the Czech monetary arrangement in 1997, the collapse of the Bulgarian monetary arrangement in 1996/97, the 1998 Russian Crisis, the 1999-2001 oil price shocks-as all those economies are highly dependent of imported energy sources) seems to have driven these mild liberalization reversals. Comparing the Full Index constructed here with the one constructed by KS, for similar time samples, one may observe that the ACs start substantially below the average level of other emerging markets- i.e., they are more liberalized, but both the â€Å"entry of the initially less liberalized former Soviet republics, plus continuous liberalization efforts in the emerging market KS set reverse this situation. A similar liberalization reversal trend in both the ACs and the merging market set is observed from early 1994, but it is actually slightly stronger on the ACs sample, until its reversal in 1996. By the end of our sample, the ACs are clearly below the final value for the emerging set in KSs sample. This sort of remarkably fast pattern of the ACs â€Å"leapfroging towards best international practice is also observed in several types of institutional frameworks, like, for instance, monetary policy institutions and instruments (see Vinhas de Souza and Hà ¶lscher, 2001): a process that virtually took decades for Western central banks was compressed in a half a dozen years in the Future Member States. Nevertheless, by the end of the sample, both emerging and ACs are still above the level of mature, developed economies. Analyzing the individual components of the index (see Figure V), one may see that, abstracting again from the initial spikes in the index, which are, as explained above, caused by the addition of new countries to the sample, the 1994/1997 reversal of liberalization was essentially driven by the Financial Sector liberal ization component. As will become clear with the country specific analysis below, this was related, in most cases, to-and here it must be stressed that those were rather limited reversals-to the banking crises that plagued several countries in our sample in the early to mid 1990s. Comparing now the individual components of the Full Index constructed here with the ones from KS, again for emerging and mature economies, it becomes clear that the reversals observed in Figure IV were driven by different sources in the emerging set (increase in capital account restrictions) and ACs set (financial sector): see Figure VI. All the indexes for mature economies are, again as one would expect, substantially lower. One could, in principle, aggregate the countries in our sample in three different groups: rapid liberalizers (the ones that followed a â€Å"big bang early approach, without major reversals: Bulgaria, Estonia, Latvia, Lithuania), consistent liberalizers (the ones that followed a more delayed path, but also without major roll backs: the Czech Republic, Hungary, Poland) and cautious liberalizers (the ones whose liberalization path was either openly inconsistent or downright mistrustful: Romania, Slovakia, Slovenia). 5.1 COUNTRY-BY-COUNTRY LIBERALIZATION PATH. In Bulgaria, virtually no sign of a liberalization reversal is observed, even during the substantial stress experienced by the country during the banks runs of 1996/97 and the ultimate collapse of the floating regime in 1997 (beyond ad hoc restrictive measures adopted by the banks themselves). As in most of the countries in my sample, the stock market is the last one to liberalize, but does so in a faster fashion. Nevertheless, this is in most cases a data quasi-artifact that arises from the later (re-)constitution of the stock exchange itself. In the Czech Republic, a limited reversal of the financial sector liberalization is observed from late1995 to late 1997, namely, via the imposition of limits on banks short-term open positions towards on-residents, as a way to limit the exposure of the financial sector to the inflows brought about by the hard peg and the potential gains with interest rate differentials. After the peg was replaced by the current float regime, this restriction i s duly removed. In Estonia, again, virtually no sign of a liberalization reversal is observed, even during the bank runs of the early 1990s, the unwinding of the 1997 bubble, nor during the 1998 Russian crisis. Again, the stock market is the last one to liberalize, but one more time, this arises from the later constitution of the stock exchange. In Hungary, also no signs of any liberalization reversal are observed. Hungary was an early reformer, introducing some liberalization measures already during the late 1980s, but the profile of its reform path is much more discounted through time, as compared, for instance, with the Baltic countries. In Latvia, a rather limited reversal of the financial sector liberalization is observed from mid 1996all the way to early 2003: resulting from the 1996 banking crisis, specific aggregate lending limits to regions (i.e., limits on exposure to non-OECD countries, bar the other Baltic republics) are imposed. In Lithuania, a limited reversal of the f inancial sector liberalization is observed from early 1998, also resulting from the experienced banking crisis: reserve requirements on deposits on foreign accounts by non-resident are introduced; In Poland, no signs of any liberalization reversal are observed. Similarly to Hungary, the profile of its reform path is much more discounted through time; In Romania, no signs of any liberalization reversal are observed, but the reform path is a decidedly slow and cautious one: at the end of the sample, it has the highest (i.e., less liberalized) score for the â€Å"Full Index of all countries in the sample: 1.60 (see Table V). In Slovakia, no signs of any liberalization reversal are observed. Here, the reform path is characterized by a broad stagnation since the Czechoslovak partition till 1998/1999, when, after a change in the political leadership, reforms are re-started, reaching after that levels similar to the other â€Å"Vise grad countries in a rather quick fashion. In Slovenia, one of the most consistently cautious Member States concerning the advantages of integration and liberalization, reversals are indeed observed in all three indexes, since early 1995in the capital account and financial sector components, and from early 1997 in the stock market one. Since early 1999, with the entry in effect of the EU Association Agreement, across-the-board further (re)liberalization measures have been introduced. 6. FINANCIAL CYCLES AND LIBERALIZATION The financial cycle coding which is used by KS defines cycles as a at least twelve month-long strictly downwards (upwards) movement, followed by a equally upwards (downwards) 12-month movement from the through (peak) of a stock market index, measured in USD, as they should reflect returns from the point of view of an international investor. As described in the stock market section of this work, one must be warned that there are specific factors in the countries in our sample that may affect the effectiveness of a stock market index as an adequate proxy of financial cycles, at least for the sample here considered. Beyond that, these series have a rather limited time extension (our sample covers the 01:1990-06:2003 period). Adapting KS criteria to the limited time dimension of our sample, we use a less stringent definition of â€Å"cycle, the same algorithm as above but with a 3-month window for the cycle (Edwards et al., 2003, use a 6-month window). With this we get 118 observations for all countries in our sample. Of these 118 cycles, 61 are upward, with an average of 7.51 months duration, and 57 are downward, with an average of 8.20 months of duration. 7. CONCLUSION The main aim of this paper was to extend the index developed by Kaminsky and Schmukler, 2003, for a specific sample of countries, namely, the previously centrally planned economies from Central and Eastern Europe, and to perform a similar analysis on them. Our results do lend some support to the basic assumption of this study: in spite of all the limitations of the time series used (their shortness, the fact that they were buffeted by several country-specific and common shocks), a re-estimation of KSs core regressions strongly supports the notion that financial liberalization does generate benefits both in the short and in the long run, measured via the extension of the amplitude of upward cycles and its reduction for downward cycles of stock market indexes. Importantly, these results diverge from KS, as in their work â€Å"emerging markets experience a relative short run increase in the amplitude of downward cycles. Another noteworthy feature is that only minor liberalization rever sals, led by the financial sector component, were observed in the aggregate index. Also, those reversals do not seem to be driven by â€Å"contagion from shocks in other emerging markets (like the Asian or Russian crisis), but reflect country-specific shocks. When considering the individual components of the index separately, again signs of minor reversals in financial sector liberalization are observed, related to temporary reactions to the several banking crisis observed in the region. Concerning the importance of institutions and of the EU Accession, this papers initial assumption was that the mostly positive results above would come about due to the anchoring of expectation provided by the perspective of entry into the EU already by mid-2004 (or 2007, in the case of Bulgaria and Romania) for the countries here analyzed, and by the imposition of a more robust macro and institutional framework by the requirements of the Accession process itself. Signs of this are not found in the KS regressions, perhaps because the liberalization index itself captures the effects of the EU Accession process. Finally, using a different framework than KSs to assess the affects of liberalization on financial, real and nominal volatility, most of the econometric results seem to support the previous ones, but they seem to indicate that the capital account liberalization is the element that most consistently and significantly reduces volatility. On this final section, the majority the econometric results seem to support some specific role for the EU Enlargement process in reducing volatility. Benefits of Financial Liberalisation Benefits of Financial Liberalisation A EUROPEAN POLICY ABSTRACT: This paper extends to test if the short and in the long run. Weak indica- the same short-run increase in cyclical tions are found that this may happen par- volatility arising from financial integration tially due to the anchoring of expectations is observed in this specific sample of â€Å"emerg-provided by the EU Accession, and to the ing markets. This work finds signs that, more robust institutional framework contrary to other emerging markets, this imposed by this process onto the countries in does not happen: for the future Member question. States, financial integration, similarly to the KEY WORDS: Enlargement, European outcome observed in mature market Union, financial liberalization, booms, 81 economies, reduces cyclical volatility both in busts, cycles, volatility. 1. INTRODUCTION Financial and capital flows liberalization can play a fundamental role in increasing growth and welfare. Typically, emerging or developing economies seek foreign savings to solve the inter-temporal savings-investment problem. On the other hand, current account surplus countries seek opportunities to invest their savings. To the extent that capital flows from surplus to deficit countries are well intermediated and, therefore, put to the most productive use, they increase welfare. Liberalization can, however, also be dangerous, as has been witnessed in many past and recent financial, currency and banking crises. It can make countries more vulnerable to exogenous shocks. In particular, if serious macroeconomic imbalances exist in a recipient country, and if the financial sector is weak, be it in terms of risk management, prudential regulation and supervision, large capital flows can easily lead to serious financial, banking or currency crises. A number of recent crises, like those in Ea st Asia, Mexico, Russia, Brazil and Turkey (described, for example, in IMF (2001)), and, to some extent, the Argentinean episode of late 2001, early 2002, have demonstrated the potential risks associated with financial and capital flows liberalization. Central and Eastern Europe has a somewhat different experience, when compared to other emerging regions, concerning the financial liberalization process, as the process there seems to have been much less crisis-prone than in, for instance, Asia or Latin America. This maybe, at least partially, because the current high degree of external and financial liberalization in the Central Eastern European countries (CEECs), beyond questions of economic allocative efficiency, must be understood in terms of the process of Accession to the European Union. The EU integration process implies legally binding, sweeping liberalization measures-not only capital account liberalization, but investment by EU firms in the domestic financial services, and the maintenance of a competitive domestic environment, giving this financial liberalization process strong external incentives (and constraints). Those measures were implemented parallel to the development of a highly sophisticated regulatory and supervis ory structure, again based on EU standards. This whole process happened also with the EUs technical and financial support, through specific programs-like the PHARE one, for these so-called Accession, and the TACIS, for the former Soviet Union ones- and direct assistance from EU institutions, like the European Commission, the European Parliament and the European Central Bank (also, on a very early stage of the transition process, the influence of the IMF in setting up policies and institutions in several countries in the region-an intervention widely considered to haven been successful-was important: see Hallerberg et al., 2002). Additionally, EU membership seems to act as an anchor to market expectations (see Vinhas de Souza and Hà ¶lscher, 2001), limiting the possibilities of self- fulfilling financial crises and regional contagion (see Linne, 1999), which had the observed devastating effects in both Asia and Latin America (even a major event, like the Russian collapse of 1998, had very reduced regional side effects). Several regional episodes of financial systems instability did happen (see Vinhas de Souza, 2002(a) and Vinhas de Souza, 2002(b)), but none with the prolonged negative consequences observed in other region (which was also due to the effective national policy actions undertaken after those episodes). This studys main aim is to expand the Kaminsky and Schmukler database (see Kaminsky and Schmukler, 2003), from now on indicated as KS, to include the Accession and Acceding Countries from Eastern Europe (namely, for Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania , Slovakia and Slovenia). In their original work, KS build an extensive database of external and financial liberalization, which includes both developed countries and countries from emerging regions (but not from Eastern Europe). With that, they create different indexes of liberalization (capital account, banking and stock markets: see Table I below) and using them individually and in an aggregate fashion, test for the effects and causality of this process on financial and real volatility, for the existence of differences between regions, and for the effects of the ordering of the liberalization process. One underlying hypotheses of this work is that the existing regulatory and institutional framework in Eastern Europe, plus a more sustainable set of macro policies, played an important role in enabling liberalization to largely deliver the welfare enhancing outcomes that it is supposed to. Such an â€Å"anchoring role of the European Union in the CEECs, through the process of EU membership, and through the effective imposition of international standards of financial supervision and regulation, may indicate that, beyond multilateral organizations like the IMF or the OECD, a greater, pro-active regional stabilizing role in emerging markets by regional actors, for instance, the United States, or by some regional sub-grouping, like Mercosur, may also be welfare enhancing for other â€Å"emerging regions. 2. CAPITAL ACCOUNT The achieving of capital account liberalization happened rather swiftly in most of the countries in our sample: by the mid 1990s, all bar Bulgaria and Romania had been declared Article VIII compliant (for those two countries, this happened in 1998: see Table II below). One of the main driving forces behind this was the process of European Integration, for which external liberalization is a pre-requisite: in the early to mid-1990s, all the countries had signed Association Agreements with the European Union (frequently preceded by trade liberalization agreements with the EU, also called â€Å"Europe trade agreements, usually with years given to the countries to prepare for their full implementation) and formally applied for EU membership. Another additional factor supporting liberalization was IMF and OECD membership: four of the larger countries in our sample became OECD members during the second half of the 1990s. Another factor to be considered, is the endogenous decision process to liberalize in a sustainable fashion. 3. BANKING SECTOR Financial integration, in the form of the opening up the banking sector to foreign banks, is seen as being positive, on a micro level, as foreign banks are usually better capitalized and more efficient than their domestic counterparts (of course, the domestic banking sector eventually catches-up: for an indication of this process at the ACs, see, among others, Tomova et al., 2003). Also from a macroeconomic perspective, financial integration maybe positive for the Eastern European countries, both for long run growth and, as there are indications that foreign banks do not contract either their credit supply nor their deposit base, in helping to smooth the cycle (see de Haas and Lelyveld, 2003: they find some indication that this is linked to the better capitalization base and prudential ratios, as better capitalized domestic banks behave similarly to foreign banks). Given the bank-centered nature of virtually all the financial systems of the future Member States, this is particularly important for them. In most of the member states, the initial stage of the creation of the two-tier banking system, modeled on the Western European â€Å"universal bank system, was characterized by rather liberal licensing practices and limited supervision policies (aimed at the fast creation of a de novo commercial, private banking sector: see Fleming et al., 1996, Balyozov, 1999, Enoch et al., 2002, Sà ¶rg et al., 2003). This caused a mushrooming of new banks in those countries in the early 1990s. Parallel to this, a series of banking crises, of varied proportions, affected most of those de novo banking systems, due to this lax institutional framework, inherited fragilities from the command economy period (the political need to support state-owned, inefficient industries, with the consequent accumulation of bad loans and also the financing of budget deficits), macroeconomic instability, risky expansion and investment strategies and also sheer inexperience, both from the investor s and from regulators. Progressively, the re-capitalization, privatization and internationalization of the banking system (mostly into the hands of EU financial conglomerates), coupled with the implementation of a more robust, EU-modeled institutional framework, did away with most of those problems. Two of the worst cases where the set of Baltic banking crises and the Bulgarian episode, which are described in more detail below. Other smaller banking crises happened in Estonia in 1994 and 1998, and in Latvia in 1994. Caprio and Klingebiel, 2003, report smaller episodes of â€Å"financial sector distress in the Czech Republic (94-95), Hungary (93), Poland (91-93), Romania (98-00), Slovakia (97) and Slovenia (92-94). The initial proliferation of banks was, quite naturally, followed by a process of consolidation and strengthening-parallel to the privatization of the remnant state-owned components of the financial system- of the banking sector in most of those economies (in Bulgaria, from 81 banks in 1992 to 35 in 2001, in the Czech Republic from 55 in 1995 to 38 in 2001, Estonia, from 42 in 1992 to 7 currently, while Hungary had 33 banks in 2002, showing only a very slight decrease from the early 1990s, Latvia from 56 in 1994 to 23, Lithuania from 27 in 1993 to 13, in Poland from 8 1 in 1995 to 71 in 2001, in Romania from 45 in 1998 to 41 in 2001, in Slovakia from 22 in 2000 to 19 in 2001, and in Slovenia, where the number fell from 25 to 21 during 2001 alone). This consolidation process was frequently led by foreign companies, which now hold the majority of the assets of the banking system in virtually all of them-contrary to the situation in the current EU Member States-bar Slovenia. This process now has a component of regional expansion of the Eastern European banks themselves, or, more precisely in most cases, the regional expansion of Western banks via some of their locally-owned subsidiaries (see Sà ¶rg et al., 2003, ibid). The share of banking assets to GDP, nevertheless, is still far below the Euro area average (which stood at around 265% of GDP by end 2001), compared with 47% in Bulgaria, 136% in the Czech Republic, 72% in Estonia and Latvia, 32% in Lithuania, 63% in Poland, 60% in Hungary, 30% in Romania, 96% in Slovakia and 94% in Slovenia (data also for 2001). Another peculiar feature of the banking system in the region is that foreign currency lending -usually euro-denominated-to residents is very high, especially in the Balti c republics: with 80% of total loans in Estonia, 56% in Latvia and 61% in Lithuania. Also, the Baltic countries have substantial shares of deposits by non-residents, with over 10% in Estonia and Lithuania and close to 5% in Latvia (Latvia, with its close trading ties to Russia, has a particular strategy of selling itself as a stable financial services center to CIS depositors: see IMF, 2003(b), ibid). The supervision system has also substantially improved, and, following recent international-and EU- best practice, is now centered in independent universal supervisory agencies in the most advanced of those countries (Reininger et al., 2002, ibid., estimate that the formal regulatory environment for the Czech Republic, Hungary and Poland is actually above the EU, and that its actual enforcement level is at its average;Liive, 2003, gives a description of the Estonian experience that culminated in the creation of the EFSA -Estonian Financial Supervisory Authority- in January 2002). 3.1 BANKING CRISES IN EASTERN EUROPE The Baltic bank crises were, to different degrees, linked to liquidity difficulties related tolerations with Russia (in the November 1992 Estonian case, by the freezing of assets held by some Estonian banks in their former Moscow headquarters, while the Latvian and Lithuanian episodes of, respectively, March and December 1995, were caused by the drying-up of lucrative trade-financing opportunities with Russia, whose export commodities, at that time, were still below world price levels) and regulatory tightening (Latvia, Lithuania), compounded by the elimination of credit opportunities with the implementation of the Estonian and Lithuanian CBAs (Currency Board Arrangements). In Lithuania, as in Bulgaria, the financing of the budget deficit also played a role. In the Estonian and Latvian cases, around 40% of the assets of the banking system where compromised, in the Lithuanian and Bulgarian cases, around a third. The Bulgarian 1996-1997 crisis eliminated a third of its banking sector, and led the country to hyperinflation (reaching over 2000% in March 1997, see Yotzov, 2002). Its roots lie in the political instability that preceded it (which, on its turn, led to inadequate real sector reform, with state-owned, loss making enterprises being financed via the budget deficit or through arrears with the, at the time, still mostly state-owned part banking sector: those arrears were, in turn, partially monetized by the Bulgarian National Bank -BNB- and the largest state bank, the State Savings Bank -SSB). Periodic foreign exchange crises (March 1994, February 1997) and bank runs (late1995, late 1996, early 1997) were part of this picture. The implementation of tighter supervisory procedures during 1996 (giving the BNB the power to close insolvent banks), and a tightening of policy actually led to more bank runs. A caretaker government in February 1997 (before a newly elected government took power in May) paved the way to longer lasting reform and the implementation of t he CBA, with its tighter budget constraints towards both the government and the banking sector. This reform process happened with the support from multilateral institutionsamely, (namely the IMF). 4. STOCK MARKETS The existence of stock markets is assumed to be beneficial for economic performance. In principle, it provides a way for companies to raise capital at lower costs than through simple banking intermediation, and because it is not as restricted a source of capital as internal financing. Also, it is assumed that the existence of alternative modes of finance may reduce the likelihood of credit crunches caused by problems with the banking sector (see Greenspan, 2000). Additionally, the existence of external ownership is (or was, given the recent problems with market-based governance in the US and the EU, and the shift towards a more regulated environment) assumed to provide better governance for the management of firms. The majority of economic analyses seem to support the position that a diversified financing mix is positive for economic growth and stability. As described in the previous section, all the financial sectors in the Member States are bank-centered, with stock markets playing marginal roles in most of them (and, in some, a very marginal role: in Bulgaria, Slovakia and Romania, their average market capitalization in GDP terms is below 5%: see Figure I below). All of these countries had (re-)established stock markets by the mid-90s (see Table III above). About half of the future Member States used them to drive the initial process of re-privatization, either via mass issues of voucher certificates for residents (the most famous case of this strategy was the Czech Republic), or via IPOs (Initial Public Offerings) re-privatization processes, to lock-in domestic and foreign strategic investors (see Claessens at al., 2000). In the voucher-driven privatization, the initial large number of investors and traded stocks in those stock markets was soon concentrated in a rather limited number of institutional investors-domestic and foreign- and â€Å"blue chip stocks. In the IPO-driven markets, the number of stocks and investors actually tended to increase with time, albeit from a rather concentrated base. Even in the largest ones, nevertheless, market capitalization, as a GDP share, was and remains rather low (see Figure I below), and far below the EU average (around 72% of GDP). Only in the Czech Republic, Estonia, Hungary and Slovenia the average market capitalization is above a 20% GDP share, while in Romania is below 1% in several years. Also, the average market turnover is equally below the one observed in comparable EU economies. Similarly to what is observed in the banking sector, the initial regulatory environment was deliberately lax, and the regulators were plagued by much the same problems of inexperience and limited number of staff and resources. This does not mean that domestic agents in those countries lack access to the financial services supposed to be provided by stock markets: the very process of opening up, the increase in cross-border trade in financial services, the harmonization of rules for capital trading with the EU (including the ongoing efforts of the Lamfalussy Committee towards a single European market for securities: according to the current proposal, small and medium size firms would be able to use a simplified prospectus valid throughout the EU and choose the country of its approval), plus the development of information technology, all imply that is not actually necessary-nor economically optimal, given economies of scale-for each individual country to have its own separate stock market. One must also recall that the current national stock markets in the mature developed economies are themselves the result of process of consolidation-and closing-of smaller regional stock markets (as was observed in Bulgari a in the early 1990s), which still today coexist with larger, dominant national stock exchanges even in some mature markets, like Germany and the US. Nevertheless, the observed tendency of domestic larger companies, with presumed better growth prospects, to list abroad (see Table IV below), due to the obvious cost and liquidity advantages of the larger international stock markets, does seems, on balance, to deprive those stock markets of liquidity (see Claessens at al., 2003). On the other hand, nonresidents seem to play a major role in most of those markets (accounting for 77% of the capitalization in Estonia, 70% in Hungary and half of the free-float capitalization in Lithuania). All the specific questions described above concerning the way those stock exchanges were founded and their later developments, plus their relative smallness and shallowness, affect the dynamics of their stock market indexes (SMI), and are clearly reflected by them (as one may see in Figure II, below). This, coupled with the rather limited duration of the series, may affect their adequacy as proxies of financial cycles. Source: Datastream, modified by the authors. The price indexes here were converted to US Dollars and re-based to a common reference period were they equal 100, May of 1998. The country codings are as described in the Annexes. 5. ESTIMATED INDEXES The construction of the index for this new sample of countries was the core of this work. A comprehensive effort was done to crosscheck the information collected from papers and publications with national sources. Below we present the estimated monthly index, for the period January 1990 to June 2003 (see Figure III). The base data for its construction was collected from IMF and EBRD publications, and then exhaustively verified both with national sources and with works written about the individual countries and the region. This is an index that falls with liberalization, where maximum liberalization equals one and minimum three (in this sense, one could actually see it as an index of financial repression). As an additional robustness check, the year-end value of the index here constructed was regressed on the combined EBRDs yearly indexes of banking sector reform and non-banking financial sector reform. The results from a panel regression with the index constructed here on the LHS and the EBRD index on the RHS yield a coefficient of .60, and correlations among the individual country- specific index series range from -0.91 to -0.35. As one may see from Figure III above, the process of integration and liberalization was almost continuous throughout the 1990s and early 2000s. The spikes in the â€Å"Full Liberalization Index in the early 1990s do not indicate reversals: the merely reflect the entry into the sample of the newly independent Baltic republics. As former members of the Soviet Union, they â€Å"enter the world as highly closed economies, but those countries introduced liberalization reforms almost immediately from the start. After this, a slight increasing trend, that does reflect a mild liberalization reversal, is observed, starting mid-1994 and lasting until early 1997, from when a continuous liberalization trend is observed. Noteworthy here is the fact that virtually none of the obvious candidates for a reversal of liberalization (the 1997 Asian Crisis, the collapse of the Czech monetary arrangement in 1997, the collapse of the Bulgarian monetary arrangement in 1996/97, the 1998 Russian Crisis, the 1999-2001 oil price shocks-as all those economies are highly dependent of imported energy sources) seems to have driven these mild liberalization reversals. Comparing the Full Index constructed here with the one constructed by KS, for similar time samples, one may observe that the ACs start substantially below the average level of other emerging markets- i.e., they are more liberalized, but both the â€Å"entry of the initially less liberalized former Soviet republics, plus continuous liberalization efforts in the emerging market KS set reverse this situation. A similar liberalization reversal trend in both the ACs and the merging market set is observed from early 1994, but it is actually slightly stronger on the ACs sample, until its reversal in 1996. By the end of our sample, the ACs are clearly below the final value for the emerging set in KSs sample. This sort of remarkably fast pattern of the ACs â€Å"leapfroging towards best international practice is also observed in several types of institutional frameworks, like, for instance, monetary policy institutions and instruments (see Vinhas de Souza and Hà ¶lscher, 2001): a process that virtually took decades for Western central banks was compressed in a half a dozen years in the Future Member States. Nevertheless, by the end of the sample, both emerging and ACs are still above the level of mature, developed economies. Analyzing the individual components of the index (see Figure V), one may see that, abstracting again from the initial spikes in the index, which are, as explained above, caused by the addition of new countries to the sample, the 1994/1997 reversal of liberalization was essentially driven by the Financial Sector liberal ization component. As will become clear with the country specific analysis below, this was related, in most cases, to-and here it must be stressed that those were rather limited reversals-to the banking crises that plagued several countries in our sample in the early to mid 1990s. Comparing now the individual components of the Full Index constructed here with the ones from KS, again for emerging and mature economies, it becomes clear that the reversals observed in Figure IV were driven by different sources in the emerging set (increase in capital account restrictions) and ACs set (financial sector): see Figure VI. All the indexes for mature economies are, again as one would expect, substantially lower. One could, in principle, aggregate the countries in our sample in three different groups: rapid liberalizers (the ones that followed a â€Å"big bang early approach, without major reversals: Bulgaria, Estonia, Latvia, Lithuania), consistent liberalizers (the ones that followed a more delayed path, but also without major roll backs: the Czech Republic, Hungary, Poland) and cautious liberalizers (the ones whose liberalization path was either openly inconsistent or downright mistrustful: Romania, Slovakia, Slovenia). 5.1 COUNTRY-BY-COUNTRY LIBERALIZATION PATH. In Bulgaria, virtually no sign of a liberalization reversal is observed, even during the substantial stress experienced by the country during the banks runs of 1996/97 and the ultimate collapse of the floating regime in 1997 (beyond ad hoc restrictive measures adopted by the banks themselves). As in most of the countries in my sample, the stock market is the last one to liberalize, but does so in a faster fashion. Nevertheless, this is in most cases a data quasi-artifact that arises from the later (re-)constitution of the stock exchange itself. In the Czech Republic, a limited reversal of the financial sector liberalization is observed from late1995 to late 1997, namely, via the imposition of limits on banks short-term open positions towards on-residents, as a way to limit the exposure of the financial sector to the inflows brought about by the hard peg and the potential gains with interest rate differentials. After the peg was replaced by the current float regime, this restriction i s duly removed. In Estonia, again, virtually no sign of a liberalization reversal is observed, even during the bank runs of the early 1990s, the unwinding of the 1997 bubble, nor during the 1998 Russian crisis. Again, the stock market is the last one to liberalize, but one more time, this arises from the later constitution of the stock exchange. In Hungary, also no signs of any liberalization reversal are observed. Hungary was an early reformer, introducing some liberalization measures already during the late 1980s, but the profile of its reform path is much more discounted through time, as compared, for instance, with the Baltic countries. In Latvia, a rather limited reversal of the financial sector liberalization is observed from mid 1996all the way to early 2003: resulting from the 1996 banking crisis, specific aggregate lending limits to regions (i.e., limits on exposure to non-OECD countries, bar the other Baltic republics) are imposed. In Lithuania, a limited reversal of the f inancial sector liberalization is observed from early 1998, also resulting from the experienced banking crisis: reserve requirements on deposits on foreign accounts by non-resident are introduced; In Poland, no signs of any liberalization reversal are observed. Similarly to Hungary, the profile of its reform path is much more discounted through time; In Romania, no signs of any liberalization reversal are observed, but the reform path is a decidedly slow and cautious one: at the end of the sample, it has the highest (i.e., less liberalized) score for the â€Å"Full Index of all countries in the sample: 1.60 (see Table V). In Slovakia, no signs of any liberalization reversal are observed. Here, the reform path is characterized by a broad stagnation since the Czechoslovak partition till 1998/1999, when, after a change in the political leadership, reforms are re-started, reaching after that levels similar to the other â€Å"Vise grad countries in a rather quick fashion. In Slovenia, one of the most consistently cautious Member States concerning the advantages of integration and liberalization, reversals are indeed observed in all three indexes, since early 1995in the capital account and financial sector components, and from early 1997 in the stock market one. Since early 1999, with the entry in effect of the EU Association Agreement, across-the-board further (re)liberalization measures have been introduced. 6. FINANCIAL CYCLES AND LIBERALIZATION The financial cycle coding which is used by KS defines cycles as a at least twelve month-long strictly downwards (upwards) movement, followed by a equally upwards (downwards) 12-month movement from the through (peak) of a stock market index, measured in USD, as they should reflect returns from the point of view of an international investor. As described in the stock market section of this work, one must be warned that there are specific factors in the countries in our sample that may affect the effectiveness of a stock market index as an adequate proxy of financial cycles, at least for the sample here considered. Beyond that, these series have a rather limited time extension (our sample covers the 01:1990-06:2003 period). Adapting KS criteria to the limited time dimension of our sample, we use a less stringent definition of â€Å"cycle, the same algorithm as above but with a 3-month window for the cycle (Edwards et al., 2003, use a 6-month window). With this we get 118 observations for all countries in our sample. Of these 118 cycles, 61 are upward, with an average of 7.51 months duration, and 57 are downward, with an average of 8.20 months of duration. 7. CONCLUSION The main aim of this paper was to extend the index developed by Kaminsky and Schmukler, 2003, for a specific sample of countries, namely, the previously centrally planned economies from Central and Eastern Europe, and to perform a similar analysis on them. Our results do lend some support to the basic assumption of this study: in spite of all the limitations of the time series used (their shortness, the fact that they were buffeted by several country-specific and common shocks), a re-estimation of KSs core regressions strongly supports the notion that financial liberalization does generate benefits both in the short and in the long run, measured via the extension of the amplitude of upward cycles and its reduction for downward cycles of stock market indexes. Importantly, these results diverge from KS, as in their work â€Å"emerging markets experience a relative short run increase in the amplitude of downward cycles. Another noteworthy feature is that only minor liberalization rever sals, led by the financial sector component, were observed in the aggregate index. Also, those reversals do not seem to be driven by â€Å"contagion from shocks in other emerging markets (like the Asian or Russian crisis), but reflect country-specific shocks. When considering the individual components of the index separately, again signs of minor reversals in financial sector liberalization are observed, related to temporary reactions to the several banking crisis observed in the region. Concerning the importance of institutions and of the EU Accession, this papers initial assumption was that the mostly positive results above would come about due to the anchoring of expectation provided by the perspective of entry into the EU already by mid-2004 (or 2007, in the case of Bulgaria and Romania) for the countries here analyzed, and by the imposition of a more robust macro and institutional framework by the requirements of the Accession process itself. Signs of this are not found in the KS regressions, perhaps because the liberalization index itself captures the effects of the EU Accession process. Finally, using a different framework than KSs to assess the affects of liberalization on financial, real and nominal volatility, most of the econometric results seem to support the previous ones, but they seem to indicate that the capital account liberalization is the element that most consistently and significantly reduces volatility. On this final section, the majority the econometric results seem to support some specific role for the EU Enlargement process in reducing volatility.

Saturday, January 18, 2020

Thai Environment Support Physical Activity Health And Social Care Essay

Introduction:In older grownups, physical activity is necessary to supply and keep wellness. ( 1 ) Physical environment, a construct of environment which includes both natural characteristics and human concepts, ( 2,3 ) is significantly associated with physical activity engagement within older people. ( 4-8 ) While the significance of physical environment is good recognized, an accurate step to place the specific features of the physical environment in relationship to one ‘s physical activity, with regard to older Thai people ( aged 60 old ages and older ) , presently non good established. Most of the physical environment questionnaires presently being used have been developed in Western states and most of these graduated tables used within all ages. ( 9-12 ) Furthermore, different dependability among urban and rural respondents have been noticed. ( 14 ) Some questionnaires are designed utilizing either neighborhood-focused graduated tables or community-focused graduated table to measure the physical environment ( 5,12,14 ) , whereas others uses both. ( 8,15 ) Prior research has found that facets of physical environment, i.e. safety, traffic volume, street lighting, unattended Canis familiariss, pavements and accessible public diversion installations, influence one ‘s physical activity, ( 5-8 ) whereas other groundss suggest ambiguous consequences. ( 12,14,16 ) These incompatibilities may be related, peculiarly in older grownups, to the type of measuring used to measure the physical environment. The Environmental Supports for Physical Activity Questionnaire ( ESPA ) is a measuring designed to capture and measure the back uping societal and physical environment for physical activity typically performed by all ages. ( 4,17 ) While non all ESPA attributes apply to the aged Thai who live in either urban or rural countries, most properties are closely congruous with this population. In add-on, the coefficient differences between urban and rural respondents of the ESPA were little when compared with other questionnaires. ( 13 ) As a consequence, ESPA was chosen for physical environment appraisal in senior Thai individuals. The differences in geographic characteristics, civilization and forms of life of aged Thais, may be influenced non merely by their vicinity and community environments but besides place environment. Merely over three-quarterss of senior Thais resided in their ain places. ( 18 ) Most spend the bulk of their twenty-four hours in family jobs, household attention activities, horticulture, every bit good as take parting in community groups activities. ( 5-6 ) With progressing age, the place environment and close milieus become the major life infinite where senior citizens perform their mundane activities and spend most of their clip. ( 19 ) Harmonizing to the findings of the preliminary survey in 10 older Thais, place was most often mentioned as a favourite topographic point for prosecuting in physical activity because of safety concerns and convenience. Even though ESPA focuses chiefly on vicinity and community environmental properties, the relationship of place environment and physical a ctivity of older people is still unknown. After obtaining written consent from the writer, the ESPA was translated into Thai by the translation-back interlingual rendition method. ( 20 ) Some points of the ESPA questionnaire were deleted and the questionnaire format reviewed. Deleted points reflected physical activities and topographic points that are unfound in the Thai context. Five pages of the graduated table and assorted types of picks that was thought by the research worker to be hard to reply were besides removed from the questionnaire. Furthermore, a demand exists to measure home-focused graduated table as an facet of the physical environment of aged Thais. The modified ESPA was conceptualized to include three subscales, with the six points functioning as supportive vicinity and community environments, and four new points as supportive of place environment. The new one page questionnaire was named â€Å" Thai Environment Support for Physical Activity in older Tai people ( TESPA ) † . However, if there is low m istake in the appraisal, the account of the relationship between physical environment and physical activity will be raised. For these grounds, the TESPA needs to be validated for the older Thai population.AimThe intent of this survey was to measure TESPA among Thai seniors for dependability and cogency.InstrumentsFour instruments were used to roll up informations. They included: demographic informations questionnaire ; the Chula Mental Test ( CMT ) ; the International Physical Activity Questionnaire – Long signifier ( IPAQ-L ) ; and the TESPA Demographics: The research worker designed a demographic information questionnaire which was used to obtain demographic and socioeconomic informations about each topic. The Chula Mental Test ( CMT ) : The CMT is a 13 points, interview manner, used to mensurate cognitive map of older Tai who have trouble reading and authorship. ( 21 ) Entire tonss indicate cognitive map and scope from 0-19. The cogency and dependability of the CMT was acceptable. ( 21 ) The IPAQ-L: The IPAQ-L assesses the frequence, strength and continuance of all day-to-day physical activity undertaken by five spheres including: work-related activities ; transport-related activities ; domestic jobs ; leisure clip related activities and clip exhausted sitting during the old 7 yearss. ( 22 ) The entire physical activity equals the MET ( metabolic equivalents ) mark, which is the amount of proceedingss spent in each sphere multiplied by the MET value. ( 23 ) Threshold values for the IPAQ-L in this survey included the undermentioned classs: insufficiently active ( & lt ; 600 MET-min/week ) , and sufficient active ( & gt ; 600 Met-min-week ) . ( 24 ) After obtaining written consent from the writer, the IPAQ-L was translated into Thai by the translation-back interlingual rendition method. ( 20 ) The content was validated by three experts in gerontologies and a content cogency index ( CVI ) of 0.96 obtained. The stableness by test-retest over two hebdomads utilizing the S pearman correlativity coefficient of the IPAQ-L was reported to be 0.77 in the pilot survey. The TESPA: the TESPA is composed of 10 points: three vicinity points, three community points, and four place points ( see Table 1 ) . Neighborhood environment is referred to older people ‘s perceptual experiences of support including: features, entree, and barriers to physical activity in an country within a 10-minutes walk from their place. ( 17 ) Community environment support refers to older people ‘s perceptual experiences of convenience and the safe behavior of physical activity in their community within a 20-minutes thrust from their place. ( 17 ) Home environment support is defined as participants ‘ perceptual experiences of convenience and safety, both in and around their place, in relation to their physical activity battle. The Likert graduated table was used to measure physical environment for physical activity. Possible responses were 1 ( strongly disagree ) , 2 ( disagree ) , 3 ( neither agree nor disagree ) , 4 ( agree ) , and 5 ( strongly agree ) . The possible tonss ranged from 10 to 50. Higher tonss indicated a higher degree of sensed physical environment support towards physical activity.MethodThe cross-sectional design was conducted in two stages. Phase I involved quantifying the TESPA that had been implemented during the pilot survey. Phase II included using TESPA to the current survey ; concept cogency was accomplished through usage of confirmatory factor analysis and the known-group method.Phase 1: Quantification of the TESPAValidation and finding of the dependability of TESPA ‘s psychometric belongingss was accomplished. Three geriatric experts determined the content cogency of the TESPA graduated table. When the CVI reached an acceptable value, the pilot survey was conducted. Prior to garnering informations, two research helpers, nursing alumnuss with maestro ‘s grades who had old research experience, were trained to interview participants who met the standards. The research helpers were instructed and tested to corroborate their apprehension of sample standards, definitions, and base constructs of each questionnaire until a satisfactory degree had been reached at the discretion of the research worker. Each research helper and the research worker interviewed 5 samples and inter-rater dependability was assessed. Agreement between the research helpers and the research worker ranged from 78-92 % , with an mean understanding of 87 % . The pilot survey was carried out on October 2008. The purposes were to measure the feasibleness, and to measure psychometric belongingss utilizing TESPA. After obtaining moralss blessing from the IRB, Chulalongkorn University, Thailand, consent was obtained from the managers of two Primary Care Units ( PCU ) , in two small towns ( one located in an urban environment and the other in a rural country ) , in Khon Kaen Province, Thailand. Participants were older Thai people who met the undermentioned inclusion standards ; 60 old ages of age and over, nomadic and cognitively capable of replying inquiries accurately. No wellness jobs or ongoing interventions that would disrupt engagement in physical activity such as holding suffered a recent cardiovascular event ( anterior 6 months ) , nephritic failure, liver cirrhosis, human immunodeficiency virus, major surgery in the last 6 hebdomads, or a history of medicine usage for the bosom or blood vass during the last three months. Fifteen older people from each puting were recruited utilizing purposive sampling. Each possible participant was given an informed consent signifier that explained the intents of the survey, undertakings to be completed and the length of clip needed to finish the interview, every bit good as its benefits, hazards, types of questionnaires they would be asked to reply, and that they could retreat at anytime without reverberations. The participants were interviewed at their places or at a local temple, whichever suited them. A codification figure was assigned to each participant to maintain confidentiality. Furthermore, stableness of dependability of the TESPA was obtained in two hebdomads, whereas internal consistence was assessed at baseline. The participants were preponderantly older ( average age = 70+ 4.19 old ages ) , lived with partner ( 53.3 % ) , employed ( 62.6 % ) , females ( 76.7 % ) , who had an simple instruction ( 80 % ) and a household income of less than 5,000 Baht ( USD 147 ) per month ( 76.7 % ) . A significant proportion ( 63.3 % ) of them had lived in a municipal country for an norm of 44.6 old ages in their ain abode. Although 50 % ( n=15 ) of the participants felt they had a sufficient degree of physical activity, 20 % ( n=6 ) said their physical activity degree was low. Merely 23.3 % ( n=7 ) reported holding no current wellness jobs, and 16.7 % of them were hypertensive. Their most frequent type of physical activity was household-related activities, followed by leisure clip, transportation-related and occupational activities.Phase 2: Measuring the InstrumentPhase II involved finding of the concept cogency of the TESPA. A sample of 320 aged was obtained via multi-stage random trying from 12 small town s in six states of Thailand. One individual from each household was selected utilizing a systematic random trying technique from a list of household names provided by the PCU unit of each small town. None of the selected names were involved in any of anterior pilot surveies. Datas were collected between November 2008 and April 2009. Prior to the interview, the research worker introduced herself, established resonance, explained the intent of the survey, the parts the participants would do, the choice standards and emphasized the confidentiality or namelessness of the information being collected. Potential participants were eligible if they scored & gt ; 15 on the CMT, were able to ambulate without assistive devices and were willing to take part. The interview procedure took about 15-20 proceedingss. A 5 minute remainder was given after completion of each questionnaire. Participants were ab initio asked to finish the questionnaire on personal informations, and the TESPA, followed by the IPAQ-L questionnaires. Each participant were given a hankie for their clip take parting in the interview.Datas analysisDescriptive informations are presented as average + SD. The internal dependability of the graduated table was based on an alpha coefficient greater than o r equal to 0.70 ; ( 25 ) stableness of the graduated table was analyzed by merchandise correlativity coefficient. Reliability of each point, overall dependability, and concept cogency of the graduated table were determined utilizing structural equation mold ( SEM ) . ( 26 ) The known-group technique was conducted utilizing the multivariate analysis of discrepancy, to compare the physical environment of those who reported sufficient physical activity and those who did non. Statistical significance for analyses except SEM was defined as P & lt ; 0.05. SPSS version 17.0 was used.ConsequencesTable 1 depicts participants ‘ age, which ranged from 60 to 94 old ages old. One-half of the participants ( 50.0 % ) age ranged in between 60-69 old ages. The participants were preponderantly females ( 55 % , n=176 ) , and married ( 64.4 % , n=206 ) who had an simple instruction ( 75.6 % , n=242 ) .In add-on, family activities had the highest degree of engagement, followed by transit related activities, leisure, and business, severally.Insert table 1 herePhase 1: Quantification of TESPAThe CVI of the TESPA questionnaire was 0.92. The dependability coefficients and the test-retest dependability of the graduated table were 0.73 and 0.76 severally. Besides, the alpha coefficient of place had the highest value, followed by vicinity and community, severally ( i= 0.83,0.66, and 0.06 ) . The TESPA was culturally appropriate for aged Thais and the processs were followed without any trouble.Phase 2: Measuring the InstrumentThe entire amount tonss of the TESPA ranged from 19.00 to 50.00, with a mean of 34.87 ( SD=6.47 ) . Based on collateral factor analysis, the findings demonstrated that the concept of TESPA was composed of place, vicinity, and community environment subscales. The correlativity among points ranged from 0.02 to 0.77 and the entire graduated table could explicate 61.01 % of the discrepancy of physical environment. The place, vicinity, and community subscale could account for 29.4 % , 19.7 % , and 12.0 % of the discrepancy, severally. The measurement theoretical account testing was designed to gauge which ten points were used as indexs for the theoretical account. Although the original theoretical account was statistically important, th e theoretical account was non consistent with the informations /df= 4.59 and a RMSEA value greater than 0.05 ( = 151.54, df= 33 ; P & lt ; 0.0001 GFI= 0.91 ; RMSEA= 0.06 ; NFI= 0.88 ; CFI= 0.91 ) . Based on alteration indices, mistake covariances were allowed to correlate. The revised measuring theoretical account ( see Figure 1 ) was re-assessed and findings indicated that overall fit indices had improved. The revised theoretical account was fit with the following data/df= 1.33 ( =33.27, df= 25, p=0.13, GFI= 0.98, RMSEA= 0.03, NFI= 0.98, CFI= 0.99 ) . Furthermore, the correlativities between subscales presented significantly low to chair values ( Home-Neighborhood, r=0.51, P & lt ; 0.01 ; Home-Community, r=0.29, P & lt ; 0.01 ; Neighborhood-Community, r=0.38. P & lt ; 0.01 ) .Insert figure 1 hereTable 2 illustrates the burdens with t-values and squared multiple correlativity coefficients among each ascertained variables for the TESPA graduated table. The squared multiple correlativ ities for ascertained variables of the latent variables ranged from 0.02 to 0.92. The R2 of points 2, 3, 4, 5, and 6 were acceptable indexs, but points 1, 7, 8, 9, and 10 which were less than 0.40.Insert Table 2 hereTable 3 shows differences in the TESPA subscale between the two physical activity degree ( P & lt ; 0.05 ) .Insert Table 3 hereDiscussion:Testing of the TESPA measuring provided extra grounds for the cogency and dependability. The findings are discussed in the undermentioned subdivision. The content cogency and concept cogency of the TESPA graduated table were acceptable. Continued support for the concept cogency of the graduated table was besides provided through collateral factor analysis ( LISREL 8.80 pupil edition ) and the known-group method. The TESPA measuring theoretical account demonstrated that all measured sub-scales had important low to high parametric quantity estimations, which were related to their specific concepts and validated the relationships among ascertained variables and their concepts. The known-group technique is an scrutiny of relationships based on theoretical anticipation. ( 27 ) Within the known-group method, the findings demonstrated that all three physical environment all three subscales and entire tonss were significantly correlated with physical activity. This determination indicated that older people who had sufficient degree of physical activity scored significantly higher in each of three factors – supportive place, vicinity , and community environment – than those who did non. The bulk of the seniors sampled have lived in their place for a average 30 old ages ; accordingly, they were familiar with the physical features of their environment in and outside the place. In add-on, engagement in family activities had the highest degree of engagement, followed by transit related activities, leisure, and business, severally. As a ground, senior citizens determine the facets of their physical environment to which they are exposed, and in bend, that physical environment modifies their behaviour. It is possible that the friendly environment contributed to physical activity battle, while unfriendly environments discouraged activity. Therefore, although place environment is restricted by country and instruments, the determination demonstrates that it can be included as an extra facet for supplying physical activity battle. Sing dependability, the TESPA exceeded the coveted standard of 0.70 for new graduated tables, peculiarly ; place subscale had the highest value. However, the dependability for vicinity and community subscale were depicted less than the old survey. ( 13 ) Although the R2 for points 1, 7, 8, 9 and 10 indicated that they were irrelevant for the TESPA graduated table, the measuring theoretical account had a good tantrum with the empirical information. It is the first clip this graduated table has been validated in aged Thais, moreover this survey produced normative informations for comparing in the aged, which were non found in other surveies. Approximately 61 % of the discrepancy in the TESPA graduated table was explained by the 10 points, whereas 39 % of the discrepancy in this graduated table remains unexplained. Matching with the SCT attack, Bandura argues that about all facets of the physical environment can act upon one ‘s determination about physical activity battle. ( 3 ) O wing to the fact that the TESPA measuring includes merely safety, convenience, and handiness ; it is possible that other facets such as policy ( 28 ) may farther lend to physical activity. Extra work is needed to place these yet unidentified facets.Restrictions and recommendations:This survey was limited by homogeneousness of the sample. The bulks of participants were female, married, with low socioeconomic position, and lived in their place. Continued rating of the psychometric belongingss both in other samples and extra new points are recommended. Additionally, the usage of an utilizing nonsubjective measuring should be considered, to further add to the cogency of the findings and confirm the subjective study. However, based on three subscales of the TESPA, use of these factors with cognitive behavioural and policy schemes may promote the aged to increase their physical activity battle. This consequence can widen cognition of the physical environment for physical activity measuring.DecisionsThe TESPA was developed from the modified ESPA and the findings of a qualitative survey of older Thai people. Psychometric rating of the TESPA graduated table, including cogency and dependability, were chiefly satisfactory. Although the testing of the TESPA graduated table represents an initial effort, the consequences of the current survey suggest that the definition of the physical environment should include the place environment, every bit good as vicinity and community environment as these besides contains both incentives and obstructions for older Thai people set abouting physical activity.

Friday, January 10, 2020

The Little-Known Secrets to Cool Personal Essay Topics

The Little-Known Secrets to Cool Personal Essay Topics Even if you crash into a committee member later on, he'll not have any method of connecting your essay (out of the thousands he's read) to you. The essay isn't about camping in any way, but about the fragile character of nature. You are able to also use your own personal experience or the experiences of people that you know as a descriptive introduction to the issue. Some students find it tough to write on themselves, although some find it a lot easier to speak about their private life, in place of exploring an assigned subject. Personal essays are extremely important and odds are that you'll be asked to write them many times in your academic career. To begin with, determine what your choices are. You do it all of the time whenever you are speaking, but whenever you're writing, your ideas could possibly be flowing so fast you neglect to place the periods in. In addition, it is a fantastic place to polish your essay up a nd correct small grammar, spelling and other kinds of mistakes. Why Almost Everything You've Learned About Cool Personal Essay Topics Is Wrong The topic Personal strength usually does not want much research in case you have some experience in writing. The teachers don't always assign the specific topic. Language is made by people together. Ruthless Cool Personal Essay Topics Strategies Exploited There's, obviously, a limit on the range of pages even our finest writers can produce with a pressing deadline, but usually, we can satisfy all the clients seeking urgent assistance. A time you made an extremely good choice. Even in the event the deadline is truly tight, feel free to get hold of our managers. Colleges want a feeling of maturity and introspectionpinpoint the transformation and demonstrate your private growth. Where to Find Cool Personal Essay Topics Following are two or three expository essay topics which may be given to students, as a part of their assignments. Pe rsonal essays are an excellent procedure to get your students writing right at the start of the year. Students lead busy lives and frequently forget about a coming deadline. You are able to even save essays so that you can readily upload the exact same one for multiple scholarship applications. For future students, it's a difficult undertaking to compose their very first personal college essay. The majority of the competitive colleges need a personal statement as part of the admission procedure. No matter the deadline is, bear in mind that we're prepared to assist! Nevertheless, writing a personal essay is a tough thing, it will become much easier when you choose a topic. Then, it is going to be required to choose a topic for your own personal essay, and after it, you will be prepared to compose your paper. Know the sort of essay that you're writing. In that case, then you need to attempt writing narrative essays. One ought to know that a personal essay isn't an objective bit of writing. A personal essay is thought to be one of the most intriguing and engaging varieties of papers. It is a brief essay that is about you. It is called the autobiographical one. The target of including your own personal experiences is to maintain your audience engaged. Describe some tasks which you've accomplished over the last two years that do not have any connection to academic studies. From that point, you will know what kind of structure and organization to use. Try to remember that a high degree of detailing is a feature of all great narrative essay examples. The absolute most difficult decision you've ever faced. Picking a topic for a personal statement is pretty tricky. Get double-use out of your own personal statement. It's important to get the appropriate quantity of data in your article. Another great alternative if you're looking for essay topics for college. To choose which subject you're likely to discuss, it's essential to see the complete collection of good persuasive speech topics from the special area of study. Share an essay on any subject of your pick. Thus, it's critical to compose an attractive paper if you want a simple time in school. Maybe it is a school teacher. Regardless of what piece of writing you are assigned at your institution, the comprehensive paper has to be interesting to read. A museum you truly need to go and visit. If you believe out loud superior than you do on paper, brainstorming with somebody else might be the thing to do! Individuals can still locate your work online and you need to make sure it's written good and mistake free. When you begin to take writing seriously and placing your words available for other people to see you shed a number of that fr eedom. It means a great deal of things.

Wednesday, January 1, 2020

Sepsis Inflammation and White Cell Count Essay - 2255 Words

This is the case study of Mr. Jones, a 65 year old male, who was admitted to the emergency department with persistent cough and episodes of chest pain over the last five days. He appeared to be experiencing worsening dyspnoea, fever and feeling unwell. It was also noted that he had a poor urine output over the last 24 hours. An indwelling catheter was inserted which only obtained 20 mLs of amber urine. Mr. Jones clinical assessment revealed that his Glasgow Coma Score was 11/15. He was opening his eyes to speech, only making inappropriate words and localizes to pain. He was also pyrexial with a temperature of 39.0 ËšC, diaphoretic with hot peripheries, hypotensive BP 90/45 mmHg (MAP 60 mmHg), and tachyopneic at 30breaths/min and†¦show more content†¦Mr. Jones white cell count is elevated and revealed at 1400 mm while his CRP is also raised. Cytokinines are the one of the primary mediators that signal other cells to release additional mediators such as tumour necrosis factor-a (TNF-a) interleukin (IL)-1, IL-6, IL-8, interferon, leukotrienes, histamine, bradykinin, prostaglandins, thromboxane A2, serotonin, nitric oxide, arachidonic acid, platelet-activating factor (PAF), oxygen free radicals and myocardial depressant factor (Munford, 2001:67). If the invading organism is a gram negative bacterium, endotoxins are also released, which further stimulate the production of these inflammatory mediators (Jones Bucher, 1999:134). Tumour necrosis factor (TNF) is responsible for the disruption of the tight junction between endothelial cells which results in an increased permeability to plasma proteins and fluid, which worsens fluid accumulation in the alveoli further impairing gas exchanged (Bersten Soni, 2009:709). TNF comprises of two different molecules, firstly TNFa which leads to programmed cell death in target cells, and when combined with IL-1 which acts on the central nervous system causing lethargy (Marieb, 2004). TNFB stimulates granulocyte activity and B cell proliferation which shows an increase in neutrophil count (Jean- Baptise, 2007:63). Monocytes, macrophages, lymphocytes, astrocytes and endothelial cells secrete IL-1 which promotes fever, anorexia,Show MoreRelatedCauses And Treatment Of Sepsis1573 Words   |  7 Pages‘Sepsis’, a lame man might hear of this word and have no clue or whatsoever of what this is – but in the real world it’s not something to be happy about and has been a major issue in the medical field. Sepsis is a complex condition which doesn’t have a specific definition, diagnosis or treatment but one thing the medical practitioners are specific of is the origin. Sepsis is from a Greek word called â€Å"Sepo† which means â€Å"decay† idiomatically known as â€Å"Blood poisoning† (Steen C., 2009). The medicalRead MoreEvaluation Of Open Reduction And Internal Fixation Of Maxillofacial Fractures1559 Words   |  7 Pagesinflammatory markers in diagnosis and monitoring of treatment of infectious complications in post-operative patients[1-4]. Vario us authors have studied markers including (Total leucocyte count) TLC, CRP(C-reactive protein), AST (Aspartate Transaminase) and ALT (Alanine Transaminase) in patients with SIRS and sepsis [5]. Behaviour of inflammatory markers and their correlation to infection in the postoperative phase have been evaluated in various disciplines of surgery. However, similar studies in maxillofacialRead MoreThe Overwhelming Infection of Septic Shock980 Words   |  4 Pageshypotension, altered coagulation, inflammation, impaired circulation at a cellular level, anaerobic metabolism, changes in mental status and multiple organ failure (as sited in Garretson Malberti, Ignatavicius and Workman (2009), â€Å"sepsis is a widespread infection coupled with a more general criteria: body temperature higher than 380C or lower than 360C, heart rate greater than 90 beats per minute, respiratory rate greater than 20 breaths per minutes, and WBC count greater than 12,000/mm or lowerRead MoreSepsis Is Defined As A Severe Infection1370 Words   |  6 PagesAccording to Elsevier, â€Å"Sepsis is defined as a severe infection that occurs after bacteremia of gram-negative bacilli (most common) or gram-p ositive cocci. Septic shock is mediated by a complex interaction of hormonal and chemical substances through an immune system response to bacterial endotoxins†. http://pageburstls.elsevier.com/books/978-0-323-09137-4/id/B9780323091374000059_p16455. Sepsis occurs when the body becomes infected with an infection that takes over the entire circulatory system andRead MoreSepsis : A Systemic And Response Of The Immune System1244 Words   |  5 PagesSepsis Sepsis is a systemic over response of the immune system, due to an infection that the body tries to fight. This leads to reduced blood flow to vital organs such as the kidneys and the heart, which often results in multiple organ failure with the possibility of death. Sepsis can develop into septic shock which is the point where the patient’s blood pressure drops to a dangerous level due to the presence of bacteria in the body. Patients diagnosed with sever sepsis have a 20-30% chance of deathRead MoreSepsis Early Detection and Treatment1132 Words   |  5 PagesRunning Head: SEPSIS DETECTION AND TREATMENT Sepsis Early Detection and Treatment Steven H. Gregory Chamberlain College of Nursing March28, 2009 Sepsis Early Detection and Treatment Severe Sepsis affects 750,000 Americans and causes more than 200,000 deaths annually. Sepsis is a complex condition that results from an infectious process that represents the bodys response to infection and involves systemic inflammatory and cellular events that result in altered circulation and coagulationRead MoreSepsis5688 Words   |  23 PagesRunning Head: Sepsis 1 Sepsis: A Clinical Case Study Example Conestoga College Running Head: Sepsis 2 Abstract Sepsis is an inflammatory systemic response to infection. The symptoms are produced by the host’s defense systems rather than by the invading pathogens (Schouten et al., 2008). Sepsis is a frequent cause of admission to intensive care units (ICUs) and it is one of the leading causes of death among hospitalized patients (Alberti et al., 2003). It is a public healthRead MoreAppendicitis Case Study1950 Words   |  8 PagesIn the absence of surgical facilities, intravenous antibiotics are used to delay or avoid the onset of sepsis; it is now recognized that many cases will resolve when treated non-operatively. In some cases the appendicitis resolves completely; more often, an inflammatory mass forms around the appendix. This is a relative contraindication to surgery. APPENDICITIS Appendicitis is inflammation of the appendix. It is thought that appendicitis begins when the opening from the appendix into the cecumRead MoreA Short Note On Chronic Inflammatory Disease And Its Effect On The Body s Immune System1567 Words   |  7 PagesSLE is a chronic inflammatory disease that occurs when your body’s immune system attacks your own tissues and organs. There are different body systems effected such as joints, skin, blood cells, brain, kidneys, heart and lungs. Some may have only a few joints affected, where others may have multiple joints affected. The small joints of the hands and feet tend to be the most common affected. Joint stiffness is common and is usually worse in the morning. Mild joint swelling may occur but severe arthritisRead MoreSymptoms And Treatment Of Sepsis2113 Words   |  9 PagesIntroduction Sepsis is a potentially life-threatening complication caused by the body’s response to an infection. Our immune system protects us against threats, which include viruses, bacteria and parasites that cause infectious diseases. Our immune system responds by triggering an inflammatory response to bacteria in the blood. However, with sepsis the response is massive and the inflammation that occurs can cause a ripple effect of changes that may lead to damage of multiple organ systems, causing