Predicting healthcare expenditure by multimorbidity groups

Objectives

This article has two main purposes. Firstly, to model the integrated healthcare expenditure for the entire population of a health district in Spain, according to multimorbidity, using Clinical Risk Groups (CRG). Secondly, to show how the predictive model is applied to the allocation of health budgets.

AN EDUCATIONAL AND COUNSELING PROGRAM FOR PHENYLKETONURIC ADOLESCENT GIRLS AND THEIR PARENTS

Since adolescent girls with phenylketonuria are in need of informed counseling, parents and their phenylketonuric daughters were invited to five successful group meetings at Children's Hospital Medical Center in Boston. During these sessions the staff reviewed general aspects of the disorder, dealth with particular problems of adolescence, and focused primarily on the complexities relating to maternal phenylketonuria. Subsequent lively discussions allowed the participants to express their feelings and concerns relative to these issues. The information conveyed will assist parents and their daughters in realistic planning for the future.     

Relations Between Depression Level and Conflict Resolution Styles,Marital Adjustments of Patients With Major Depression and Their Spouses

The objective of this study was to determine to relations between the depression level and the conflict resolution styles, marital adjustments of the depressed patients and to analyze the conflict resolution styles, marital adjustments of both the patients and their spouses as the possible predictors of depression levels. The research comprised 113 patients with major depression and their spouses. While there was a negative correlation between depression scores and positive and subordination conflict resolution styles subscales of the patients, there was a positive correlation between the depression scores and negative conflict resolution style subscale. Negative correlation was observed between the depression and marital adjustment scores of patients (p < 0.05). The conflict resolution styles and marital adjustment of depressed patients and their spouses are predictors of depression in patients.     

POINT OF VIEW

No abstract available for this article.     

Social Adjustment of Women With and Without a Substance-Abusing Partner

Little normative information is available about the psychosocial functioning of women who have a substance-abusing intimate partner. This study examined whether the social adjustment of women who indicate that they have a substance-abusing partner (n=69) is compromised relative to that of women who indicate that their partner does not abuse substances (n=68). Women with a substance-abusing partner reported compromised social adjustment relative to a comparison sample both overall and in five of six life domains (work, social/leisure, primary relationship, parental, family). Results suggest the potential benefit of expanding the focus of research and treatment to include effects and outcomes for these women and to influence treatment-related policy.     

Dynamically adjustable foot-ground contact model to estimate ground reaction force during walking and running

Human dynamic models have been used to estimate joint kinetics during various activities. Kinetics estimation is in demand in sports and clinical applications where data on external forces, such as the ground reaction force (GRF), are not available. The purpose of this study was to estimate the GRF during gait by utilizing distance- and velocity-dependent force models between the foot and ground in an inverse-dynamics-based optimization. Ten males were tested as they walked at four different speeds on a force plate-embedded treadmill system. The full-GRF model whose foot-ground reaction elements were dynamically adjusted according to vertical displacement and anterior-posterior speed between the foot and ground was implemented in a full-body skeletal model. The model estimated the vertical and shear forces of the GRF from body kinematics. The shear-GRF model with dynamically adjustable shear reaction elements according to the input vertical force was also implemented in the foot of a full-body skeletal model. Shear forces of the GRF were estimated from body kinematics, vertical GRF, and center of pressure. The estimated full GRF had the lowest root mean square (RMS) errors at the slow walking speed (1.0 m/s) with 4.2, 1.3, and 5.7% BW for anterior–posterior, medial–lateral, and vertical forces, respectively. The estimated shear forces were not significantly different between the full-GRF and shear-GRF models, but the RMS errors of the estimated knee joint kinetics were significantly lower for the shear-GRF model. Providing COP and vertical GRF with sensors, such as an insole-type pressure mat, can help estimate shear forces of the GRF and increase accuracy for estimation of joint kinetics.     

Plan responses to diagnosis-based payment: Evidence from Germany’s morbidity-based risk adjustment

Many competitive health insurance markets adjust payments to participating health plans according to their enrollees’ risk − including based on diagnostic information. We investigate responses of German health plans to the introduction of morbidity-based risk adjustment in the Statutory Health Insurance in 2009, which triggers payments based on “validated” diagnoses by providers. Using the regulator’s data from office-based physicians, we estimate a difference-in-difference analysis of the change in the share and number of validated diagnoses for ICD codes that are inside or outside the risk adjustment but are otherwise similar. We find a differential increase in the share of validated diagnoses of 2.6 and 3.6 percentage points (3–4%) between 2008 and 2013. This increase appears to originate from both a shift from not-validated toward validated diagnoses and an increase in the number of such diagnoses. Overall, our results indicate that plans were successful in influencing physicians’ coding practices in a way that could lead to higher payments.     

可调式CT扫描多功能头托的设计

结合实际工作及临床经验,设计了一款可调式CT扫描多功能头托。该头托集角度调整及显示装置、头托升降装置及自锁装置为一体,具有一托多用、方便快捷的优点,可解决头颅CT扫描过程中需不断换用不同头托及调整扫描机架角度等繁琐的操作问题,进而在保证良好CT图像质量的前提下节省扫描时间。     

Daily mood and sleep: reciprocal relations and links with adjustment problems

Children's sleep problems are common and associated with increased risk for adjustment problems. We examined daily links between children's sleep and mood, using a daily diary method and actigraphy. We also tested children's daily mood as a mediator of relations among sleep and children's broader internalizing and externalizing symptoms. A community sample of 142 children (mean age = 10.69 years; 57% girls; 69% European American, 31% African American) and their parents participated. For 1 week, children wore actigraphs and parents completed a daily telephone interview about their child's mood. Following the week of actigraphy, mothers and fathers reported on their child's adjustment. Multi‐level models indicated within‐person relations between children's mood and subsequent sleep fragmentation (indicated by increased activity) and sleep latency, and between‐person relations between sleep latency and subsequent mood on the next day. Significant indirect effects were found such that a more negative daily mood (aggregated across diary days) mediated relations between poor sleep efficiency and longer sleep latency and parent‐reported internalizing and externalizing symptoms. Findings extend previous research by highlighting disruptions to children's daily mood as a potential mechanism linking sleep problems to children's mental health.