Welfare Reform and Health of Immigrant Women and their Children

We investigate the association between the 1996 welfare reform and health insurance, medical care use and health of low-educated, foreign-born, single mothers and their children. We find that welfare reform was associated with an eight to 11.5 percentage points increase in proportion uninsured among low-educated foreign-born, single mothers. We also find that the decline in welfare caseload since 1996 was associated with a 6.5 to 10 percentage points increase in the proportion of low-educated foreign-born, single mothers reporting delays in receiving medical care or receiving no care due to cost and a nine percentage points decline in visits to a health professional in the past 12 months. We do not find any consistent evidence that welfare reform affected the health insurance, medical care utilization and health of children living with single mothers.     

Cardiovascular disease and osteoporosis: balancing risk management

In this narrative review of the current literature, we examine the traditional risk factors and patient profiles leading to cardiovascular disease and osteoporosis. We discuss the interrelationships between risk factors and common pathophysiological mechanisms for cardiovascular disease and osteoporosis. We evaluate the increasing evidence that supports an association between these disabling conditions. We reveal that vascular health appears to have a strong effect on skeletal health, and vice versa. We highlight the importance of addressing the risk benefit of preventative interventions in both conditions. We discuss how both sexes are affected by these chronic conditions and the importance of considering the unique risk of the individual. We show that habitual physical activity is an effective primary and secondary preventative strategy for both cardiovascular disease and osteoporosis. We highlight how a holistic approach to the prevention and treatment of these chronic conditions is likely warranted.     

Crowd-Out and Emergency Department Utilization

When consumers gain Medicaid, their cost of healthcare changes. The direction of this change determines how utilization changes. The previously uninsured see a stark decrease in the price of primary care after gaining public insurance. Due to charity care, they may face an increase in the price of emergency department care. The previously insured see a reduction in emergency department prices and decreased access to primary care. We examine the impact of the prior insurance status of the newly publicly insured on substitution between healthcare. We base our identification on California’s LIHP and ACA Medicaid expansions. One challenge we face is estimating crowd-out. We use machine learning techniques to predict prior insurance status based on observable covariates in cross-sectional data. We find an increase in emergency department utilization caused entirely by those crowded-out whose access to primary care has decreased. We find the opposite utilization patterns for the previously uninsured.     

Sharing and expanding academic and practitioner knowledge in health care

The purpose of this paper is to expand understanding of academic-practitioner knowledge-sharing in the service of enhanced knowledge creation in health care. To this end, we describe the tacit and explicit knowledge of academics and practitioners and how this knowledge exists within their communities of practice. We also discuss benefits of, difficulties with, and some underlying dynamics of academic-practitioner knowledge-sharing. We then propose what might be done, based on appreciation of these dynamics, to foster joint knowledge-sharing and knowledge creation. We illustrate our arguments with examples from health care settings.     

Contracts for primary and secondary care physicians and equity-efficiency trade-offs

We analyse how payment systems for general practitioners (GPs) and hospital specialists affect inequalities in healthcare treatments, referrals, and patient health. We present a model of contracting with two providers, a GP and a hospital specialist, with patients differing in severity and socioeconomic status, and the GP only receiving an informative signal on severity. We investigate four health system configurations depending on whether the GP refers and the specialist treats only high-severity patients or patients with any severity. We show that an increase in the GP fee, which induces GPs to refer only high-severity patients, increases utilitarian welfare but also increases inequities in access to specialist visits. A reduction in the DRG reimbursement to hospital specialists, which induces specialists to treat only high-severity patients, increases utilitarian welfare but also increases inequities in access to specialist visits when the GP refers only high-severity patients.     

医院总会计师的职责与岗位胜任力

分析了医院总会计师的角色与职责,在此基础上提出总会计师要想胜任其医院最高财务负责人的角色,需具备职业品质、专业素质及管理素质三个方面的胜任力,同时对医院总会计师胜任力模型各要素含义进行了分述。     

Population-level intervention and information collection in dynamic healthcare policy

We develop a general framework for optimal health policy design in a dynamic setting. We consider a hypothetical medical intervention for a cohort of patients where one parameter varies across cohorts with imperfectly observable linear dynamics. We seek to identify the optimal time to change the current health intervention policy and the optimal time to collect decision-relevant information. We formulate this problem as a discrete-time, infinite-horizon Markov decision process and we establish structural properties in terms of first and second-order monotonicity. We demonstrate that it is generally optimal to delay information acquisition until an effect on decisions is sufficiently likely. We apply this framework to the evaluation of hepatitis C virus (HCV) screening in the general population determining which birth cohorts to screen for HCV and when to collect information about HCV prevalence.     

Postoperative nausea and vomiting in infants and young children following urologic surgery

This article presents a cohort review of anesthesia-related perioperative outcomes of children undergoing ambulatory urologic surgery using a combination of general and regional anesthesia. We analyzed the charts of 123 patients who underwent hypospadias repair and circumcision between July 1,2006, and January 2, 2009, for cases of postoperative nausea and vomiting. We found the incidence to be quite low. We believe the low incidence may have been related to the prophylactic use of antiemetics along with an opioid-sparing technique for anesthesia care.     

Coronary artery anomalies studied by Doppler echocardiography in infancy and childhood--possibilities and limitations

We investigated infants with Kawasaki disease, congenital coronary artery fistulas and anomalous origin of the left coronary artery from the pulmonary trunc (Bland-White-Garland syndrome) by 2-dimensional and Doppler echocardiography. We describe the systematic approach for visualizing in detail coronary anatomy by two-dimensional echocardiography. Our results suggest that this echocardiographic technique is useful for detecting coronary anomalies and has a great rolbefore angiocardiography especially in sick babies. We recommend performing 2-dimensional echocardiography in the acute and chronic stage of Kawasaki disease for evaluating coronary arterial aneurysms.     

Fruit and Vegetable Consumption and Lung Cancer Risk: A Case-Control Study in Galicia,Spain

Lung cancer has multiple risk factors and tobacco is the main one. Diet plays a role, but no clear effect has been consistently observed for different fruit and vegetable consumption. We aim to assess the association between fruit and vegetable consumption and lung cancer risk through a hospital-based case-control study in Spanish population. We recruited incident lung cancer cases in 2 Spanish hospitals from 2004 to 2008. Controls were individuals attending hospital for trivial surgery. Cases and controls were older than 30 and did not have a neoplasic history. We collected information on lifestyle with special emphases on tobacco and dietary habits. We included 371 cases and 496 controls. We found no protective effect for overall fruit consumption. For green leafy vegetables, the odds ratio (OR) was 0.92 [95% confidence interval (CI) = 0.32–2.69), and for other vegetables the OR was 0.77 (95% CI = 0.40–1.48) for the categories compared. We observed a reduced risk for broccoli and pumpkin intake. Although fruit consumption does not seem to be associated with a lower lung cancer risk, only the frequent consumption of specific green leafy vegetables and other vegetables might be associated with a reduced risk of lung cancer.     

Peer Reviewed: Grading and Reporting Health and Health Disparities

Report cards are widely used in health for drawing attention to performance indicators. We developed a state health report card with separate grades for health and health disparities to generate interest in and awareness of differences in health across different population subgroups and to identify opportunities to improve health. We established grading curves from data for all 50 states for 2 outcomes (mortality and unhealthy days) and 4 life stages (infants, children and young adults, working-age adults, and older adults). We assigned grades for health within each life stage by sex, race/ethnicity, socioeconomics, and geography. We also assigned a health disparity grade to each life stage. Report cards can simplify complex information for lay audiences and garner media and policy maker attention. However, their development requires methodologic and value choices that may limit their interpretation.     

Reactivity and reactions to regulatory transparency in medicine, psychotherapy and counselling

We explore how doctors, psychotherapists and counsellors in the U.K. react to regulatory transparency, drawing on qualitative research involving 51 semi-structured interviews conducted during 2008-10. We use the concept of 'reactivity mechanisms' (Espeland & Sauder, 2007) to explain how regulatory transparency disrupts practices through simplifying and decontextualizing them, altering practitioners' reflexivity, leading to defensive forms of practice. We make an empirical contribution by exploring the impact of transparency on doctors compared with psychotherapists and counsellors, who represent an extreme case due to their uniquely complex practice, which is particularly affected by this form of regulation. We make a contribution to knowledge by developing a model of reactivity mechanisms, which explains how clinical professionals make sense of media and professional narratives about regulation in ways that produce emotional reactions and, in turn, defensive reactivity to transparency.     

Time-inconsistent health behavior and its impact on aging and longevity

We integrate time-inconsistent decision making due to hyperbolic discounting into a gerontologically founded life cycle model with endogenous aging and longevity. Individuals can slow down aging and postpone death by health investments and by reducing unhealthy consumption, conceptualized as smoking. We show that individuals continuously revise their original plans to smoke less and invest more in their health. Consequently, they accumulate health deficits faster and die earlier than originally planned. This fundamental health consequence of time-inconsistency has not been addressed in the literature so far. Because death is endogenous, any attempt to establish the time-consistent first-best solution by manipulating the first order conditions through (sin-) taxes and subsidies is bound to fail. We calibrate the model with U.S. data for an average American in the year 2012 and estimate that time-inconsistent health behavior causes a loss of about 4 years of life. We show how price policy can nudge individuals to behave more healthy such that they actually realize the longevity and value of life planned at age 20.     

Structure,dynamics and function of Leishmania genome: Resolving the puzzle of infection,genetics and evolution?

We review and discuss here the specificity and contribution of genome (re-)arrangement studies for the exploration of genetic diversity among Leishmania. We show how the early molecular karyotyping studies generated an original perception of the genetics and evolution of these Protozoa, while providing some possible explanations on the parasite diverse phenotypes (drug resistance, pathogenicity…). We compare the results with the enormous amount of data provided by the recent genome sequencing projects, so far focused on one strain per genus/species. We highlight the relevance of parallel sequencing of different strains of a same species, now made possible by the new sequencing technologies. We recommend paying a particular attention to variation in gene copy number, a feature showed by the karyotyping studies to be extremely informative.     

Multiple imputation using chained equations: Issues and guidance for practice

Multiple imputation by chained equations is a flexible and practical approach to handling missing data. We describe the principles of the method and show how to impute categorical and quantitative variables, including skewed variables. We give guidance on how to specify the imputation model and how many imputations are needed. We describe the practical analysis of multiply imputed data, including model building and model checking. We stress the limitations of the method and discuss the possible pitfalls. We illustrate the ideas using a data set in mental health, giving Stata code fragments.     

Insiders and business directors on hospital boards and strategic change

Many hospitals are eager to incorporate practices of boards in business organizations. Yet little evidence exists on the desirability of "corporate" board features in hospital settings. We examined the effects of two characteristics of corporate boards--the relative dominance of insiders and of directors with business-related occupations on strategic changes within hospitals. We studied 335 hospitals in California immediately following legislative reforms in 1982. We found that hospital boards with a higher proportion of insiders and business directors made more changes in their mix of services in response to legislative reform. In addition, this relationship held for nonproprietary hospitals but not for proprietary hospitals. Limitations and implications of the results are discussed.     

Re-exploring the early relationship between teenage cigarette and e-cigarette use using price and tax changes

In 2016, the Surgeon General used longitudinal cohort studies to conclude that youth e-cigarette use is strongly associated with cigarette use. We re-evaluate data from the period of time before the writing of the Surgeon General report, using quasi-experimental methods, and reach the opposite conclusion. We study contemporaneous and intertemporal effects of e-cigarette and cigarette price and tax changes. Our price variation comes from 35,000 retailers participating in the Nielsen Retail Scanner data system. We match price and tax variation to survey data on current use of e-cigarettes and cigarettes for over 94,000 students between grades 6 and 12 in the National Youth Tobacco Survey (NYTS) for years 2011–2015. We find evidence that e-cigarettes and cigarettes are same-period economic substitutes. Coefficient estimates (while imprecisely estimated) also suggest potentially large positive effects of past e-cigarette prices on current cigarette use, indicating intertemporal economic substitution. Our findings raise doubts about the conclusion of government-sponsored reports that e-cigarettes and cigarettes are strongly positively associated. We recommend revisiting and possibly amending this conclusion.     

Children's eligibility and coverage: recent trends and a look ahead

We used data from the 1996-2005 Medical Expenditure Panel Survey to track changes in children's public insurance eligibility and coverage. During the 2001-2005 "postexpansion" period, eligibility was approximately constant, while public enrollment increased rapidly and uninsurance declined. Nevertheless, as of 2005, 62 percent of all uninsured children (5.5 million) continued to be eligible but not enrolled. We present detailed estimates of their characteristics by age, income, race/ethnicity, health status, and nativity/citizenship. We also examine the impact of potential changes in SCHIP income thresholds--both an expansion and a rollback--and estimate the number and characteristics of the children potentially affected.     

The future of activity space and health research

We discuss the future of activity space and health research in the context of a recently published systematic review. Our discussion outlines a number of elements for reflection among the research community. We need to think beyond activity space and reconceptualize exposure in era of high volume, high precision location data. We need to develop standardized methods for understanding global positioning system data. We must adopt replicable scientific computing processes and machine learning models. Finally, we must embrace modern notions of causality in order to contend with the conceptual challenges faced by our research field.