Showing papers by "RAND Corporation published in 2007"
TL;DR: Dementia prevalence estimates from this first nationally representative population-based study of dementia in the USA to include subjects from all regions of the country can provide essential information for effective planning for the impending healthcare needs of the large and increasing number of individuals at risk for dementia as the population ages.
Abstract: Aim: To estimate the prevalence of Alzheimer’s disease (AD) and other dementias in the USA using a nationally representative sample. Methods: The Aging, Demographics, and Memory Study sample was composed of 856 individuals aged 71 years and older from the nationally representative Health and Retirement Study (HRS) who were evaluated for dementia using a comprehensive in-home assessment. An expert consensus panel used this information to assign a diagnosis of normal cognition, cognitive impairment but not demented, or dementia (and dementia subtype). Using sampling weights derived from the HRS, we estimated the national prevalence of dementia, AD and vascular dementia by age and gender. Results: The prevalence of dementia among individuals aged 71 and older was 13.9%, comprising about 3.4 million individuals in the USA in 2002. The corresponding values for AD were 9.7% and 2.4 million individuals. Dementia prevalence increased with age, from 5.0% of those aged 71–79 years to 37.4% of those aged 90 and older. Conclusions: Dementia prevalence estimates from this first nation
1,746 citations
TL;DR: The SURVIVE trial as mentioned in this paper was a randomized, double-blind trial comparing the efficacy and safety of intravenous levosimendan or dobutamine in 1327 patients with acute decompensated heart failure who required inotropic support.
Abstract: ContextBecause acute decompensated heart failure causes substantial morbidity and mortality, there is a need for agents that at least improve hemodynamics and relieve symptoms without adversely affecting survival.ObjectiveTo assess the effect of a short-term intravenous infusion of levosimendan or dobutamine on long-term survival.Design, Setting, and PatientsThe Survival of Patients With Acute Heart Failure in Need of Intravenous Inotropic Support (SURVIVE) study was a randomized, double-blind trial comparing the efficacy and safety of intravenous levosimendan or dobutamine in 1327 patients hospitalized with acute decompensated heart failure who required inotropic support. The trial was conducted at 75 centers in 9 countries and patients were randomized between March 2003 and December 2004.InterventionsIntravenous levosimendan (n = 664) or intravenous dobutamine (n = 663).Main Outcome MeasureAll-cause mortality at 180 days.ResultsAll-cause mortality at 180 days occurred in 173 (26%) patients in the levosimendan group and 185 (28%) patients in the dobutamine group (hazard ratio, 0.91; 95% confidence interval, 0.74-1.13; P = .40). The levosimendan group had greater decreases in B-type natriuretic peptide level at 24 hours that persisted through 5 days compared with the dobutamine group (P<.001 for all time points). There were no statistical differences between treatment groups for the other secondary end points (all-cause mortality at 31 days, number of days alive and out of the hospital, patient global assessment, patient assessment of dyspnea at 24 hours, and cardiovascular mortality at 180 days). There was a higher incidence of cardiac failure in the dobutamine group. There were higher incidences of atrial fibrillation, hypokalemia, and headache in the levosimendan group.ConclusionDespite an initial reduction in plasma B-type natriuretic peptide level in patients in the levosimendan group compared with patients in the dobutamine group, levosimendan did not significantly reduce all-cause mortality at 180 days or affect any secondary clinical outcomes.Trial Registrationclinicaltrials.gov Identifier: NCT00348504
899 citations
TL;DR: How residents in low-income, minority communities use public, urban neighborhood parks and how parks contribute to physical activity are studied to find public parks are critical resources for physical activity in minority communities.
Abstract: Objectives. Parks provide places for people to experience nature, engage in physical activity, and relax. We studied how residents in low-income, minority communities use public, urban neighborhood parks and how parks contribute to physical activity.Methods. In 8 public parks, we used direct observation to document the number, gender, race/ethnicity, age group, and activity level of park users 4 times per day, 7 days per week. We also interviewed 713 park users and 605 area residents living within 2 miles of each park.Results. On average, over 2000 individuals were counted in each park, and about two thirds were sedentary when observed. More males than females used the parks, and males were twice as likely to be vigorously active. Interviewees identified the park as the most common place they exercised. Both park use and exercise levels of individuals were predicted by proximity of their residence to the park.Conclusions. Public parks are critical resources for physical activity in minority communities. B...
863 citations
TL;DR: Pharmacy benefit design represents an important public health tool for improving patient treatment and adherence and increased cost sharing is highly correlated with reductions in pharmacy use, but the long-term consequences of benefit changes on health are still uncertain.
Abstract: ContextPrescription drugs are instrumental to managing and preventing chronic disease. Recent changes in US prescription drug cost sharing could affect access to them.ObjectiveTo synthesize published evidence on the associations among cost-sharing features of prescription drug benefits and use of prescription drugs, use of nonpharmaceutical services, and health outcomes.Data SourcesWe searched PubMed for studies published in English between 1985 and 2006.Study Selection and Data ExtractionAmong 923 articles found in the search, we identified 132 articles examining the associations between prescription drug plan cost-containment measures, including co-payments, tiering, or coinsurance (n = 65), pharmacy benefit caps or monthly prescription limits (n = 11), formulary restrictions (n = 41), and reference pricing (n = 16), and salient outcomes, including pharmacy utilization and spending, medical care utilization and spending, and health outcomes.ResultsIncreased cost sharing is associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of therapy. For each 10% increase in cost sharing, prescription drug spending decreases by 2% to 6%, depending on class of drug and condition of the patient. The reduction in use associated with a benefit cap, which limits either the coverage amount or the number of covered prescriptions, is consistent with other cost-sharing features. For some chronic conditions, higher cost sharing is associated with increased use of medical services, at least for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia. While low-income groups may be more sensitive to increased cost sharing, there is little evidence to support this contention.ConclusionsPharmacy benefit design represents an important public health tool for improving patient treatment and adherence. While increased cost sharing is highly correlated with reductions in pharmacy use, the long-term consequences of benefit changes on health are still uncertain.
791 citations
TL;DR: Adult Decision-Making Competence appears to be a distinct construct relevant to adults' real-world decisions and less likely to report negative life events indicative of poor decision making, as measured by the Decision Outcomes Inventory.
Abstract: The authors evaluated the reliability and validity of a set of 7 behavioral decision-making tasks, measuring different aspects of the decision-making process The tasks were administered to individuals from diverse populations Participants showed relatively consistent performance within and across the 7 tasks, which were then aggregated into an Adult Decision-Making Competence (A-DMC) index that showed good reliability The validity of the 7 tasks and of overall A-DMC emerges in significant relationships with measures of socioeconomic status, cognitive ability, and decision-making styles Participants who performed better on the A-DMC were less likely to report negative life events indicative of poor decision making, as measured by the Decision Outcomes Inventory Significant predictive validity remains when controlling for demographic measures, measures of cognitive ability, and constructive decision-making styles Thus, A-DMC appears to be a distinct construct relevant to adults' real-world decisions
756 citations
TL;DR: The prevalence of clinically severe obesity is increasing at a much faster rate among adults in the USA than is the prevalence of moderate obesity, consistent with the public health idea that the population weight distribution is shifting, which disproportionately increases extreme weight categories.
717 citations
TL;DR: It is found that, overall, immigrants have lower rates of health insurance, use less health care, and receive lower quality of care than U.S. populations; however, there are differences among subgroups.
Abstract: Immigrants have been identified as a vulnerable population, but there is heterogeneity in the degree to which they are vulnerable to inadequate health care. Here we examine the factors that affect immigrants’ vulnerability, including socioeconomic background; immigration status; limited English proficiency; federal, state, and local policies on access to publicly funded health care; residential location; and stigma and marginalization. We find that, overall, immigrants have lower rates of health insurance, use less health care, and receive lower quality of care than U.S.-born populations; however, there are differences among subgroups. We conclude with policy options for addressing immigrants’ vulnerabilities.
683 citations
TL;DR: Deficits in the quality of care provided to children appear to be similar in magnitude to those previously reported for adults and strategies to reduce these apparent deficits are needed.
Abstract: Methods We assessed the extent to which care processes recommended for pediatric outpatients are delivered. Quality indicators were developed with the use of the RAND– UCLA modified Delphi method. Parents of 1536 children who were randomly selected from 12 metropolitan areas provided written informed consent to obtain medical records from all providers who had seen the children during the 2-year period before the date of study recruitment. Trained nurses abstracted these medical records. Composite quality scores were calculated by dividing the number of times indicated care was documented as having been ordered or delivered by the number of times a care process was indicated. Results On average, according to data in the medical records, children in the study received 46.5% (95% confidence interval [CI], 44.5 to 48.4) of the indicated care. They received 67.6% (95% CI, 63.9 to 71.3) of the indicated care for acute medical problems, 53.4% (95% CI, 50.0 to 56.8) of the indicated care for chronic medical conditions, and 40.7% (95% CI, 38.1 to 43.4) of the indicated preventive care. Quality varied according to the clinical area, with the rate of adherence to indicated care ranging from 92.0% (95% CI, 89.9 to 94.1) for upper respiratory tract infections to 34.5% (95% CI, 31.0 to 37.9) for preventive services for adolescents. Conclusions Deficits in the quality of care provided to children appear to be similar in magnitude to those previously reported for adults. Strategies to reduce these apparent deficits are needed.
584 citations
TL;DR: This study uses a simple computer simulation model to compare several alternative frameworks for decision making under uncertainty and finds that robust strategies may be preferable to optimum strategies when the uncertainty is sufficiently deep and the set of alternative policy options is sufficiently rich.
Abstract: Many commentators have suggested the need for new decision analysis approaches to better manage systems with deeply uncertain, poorly characterized risks Most notably, policy challenges such as abrupt climate change involve potential nonlinear or threshold responses where both the triggering level and subsequent system response are poorly understood This study uses a simple computer simulation model to compare several alternative frameworks for decision making under uncertainty -- optimal expected utility, the precautionary principle, and three different approaches to robust decision making -- for addressing the challenge of adding pollution to a lake without triggering unwanted and potentially irreversible eutrophication The three robust decision approaches -- trading some optimal performance for less sensitivity to assumptions, satisficing over a wide range of futures, and keeping options open -- are found to identify similar strategies as the most robust choice This study also suggests that these robust decision approaches offer a quantitative, decision analytic framework that captures the spirit of the precautionary principle while addressing some of its shortcomings Finally, this study finds that robust strategies may be preferable to optimum strategies when the uncertainty is sufficiently deep and the set of alternative policy options is sufficiently rich
492 citations
TL;DR: The authors attempted to measure the risk for subsequent cardiovascular morbidity in men with prostate cancer who received androgen deprivation therapy and found that the risk was higher in men who received ADT with a history of cardiovascular disease.
Abstract: BACKGROUND. The use of androgen deprivation therapy (ADT) in the treatment of men with prostate cancer has risen sharply. Although cardiovascular disease is the most common reason for death among men with prostate cancer who do not die of the disease itself, data regarding the effect of ADT on cardiovascular morbidity and mortality in men with prostate cancer are limited. In the current study, the authors attempted to measure the risk for subsequent cardiovascular morbidity in men with prostate cancer who received ADT. METHODS. A cohort of newly diagnosed men in a population-based registry who were diagnosed between 1992 and 1996 were identified retrospectively. A total of 22,816 subjects were identified after exclusion criteria were applied. Using a multivariate model, the authors calculated the risk of subsequent cardiovascular morbidity in men with prostate cancer who were treated with ADT, as defined using Medicare claims. RESULTS. Newly diagnosed prostate cancer patients who received ADT for at least 1 year were found to have a 20% higher risk of serious cardiovascular morbidity compared with similar men who did not receive ADT. Subjects began incurring this higher risk within 12 months of treatment. However, Hispanic men were found to have a lowered risk for cardiovascular morbidity. CONCLUSIONS. ADT is associated with significantly increased cardiovascular morbidity in men with prostate cancer and may lower overall survival in men with low-risk disease. These data have particular relevance to decisions regarding the use of ADT in men with prostate cancer in settings in which the benefit has not been clearly established. For men with metastatic disease, focused efforts to reduce cardiac risk factors through diet, exercise, or the use of lipid-lowering agents may mitigate some of the risks of ADT. Cancer 2007;110:1493–500. � 2007 American Cancer Society.
491 citations
01 Dec 2007
TL;DR: In this article, the authors compared the benefits in fracture reduction and the harms from adverse events (AE) among and within the various classes of treatment for low bone density for vertebral, non-vertebral, hip, and radial fractures.
Abstract: This Comparative Effectiveness Review (CER) compares the benefits in fracture reduction and the harms from adverse events (AE) among and within the various classes of treatment for low bone density. Our outcomes of interest for measuring benefits are vertebral, non-vertebral, hip, and radial fractures. The studies collect vertebral fracture outcomes in one of two ways. In some studies, all participants undergo radiography at pre-determined intervals. Other studies use clinical criteria, i.e. whether a fracture has been diagnosed by a clinician during the time interval. Trials that radiograph all participants will by nature detect more fractures. However the higher detection rate will apply to both treatment and placebo groups. Thus, the relative differences found should be similar that found in studies that use clinical criteria.
TL;DR: Clinicians need to carefully screen for substance abuse and mental health disorders in candidates for opioid therapy and facilitate appropriate treatment of these disorders.
Abstract: A central question in prescribing opioids for chronic non-cancer pain (CNCP) is how to best balance the risk of opioid abuse and dependence with the benefits of pain relief. To achieve this balance, clinicians need an understanding of the risk factors for opioid abuse, an issue that is only partially understood. We conducted a secondary data analysis of regional VA longitudinal administrative data (years 2000-2005) for chronic users of opioids for CNCP (n=15,160) to investigate risk factors for the development of clinically recognized (i.e., diagnosed) opioid abuse or dependence among these individuals. We analyzed four broad groups of possible risk factors: (i) non-opioid substance abuse disorders, (ii) painful physical health disorders, (iii) mental health disorders, and (iv) socio-demographic factors. In adjusted models, a diagnosis of non-opioid substance abuse was the strongest predictor of opioid abuse/dependence (OR=2.34, p<0.001). Mental health disorders were moderately strong predictors (OR=1.46, p=0.005) of opioid abuse/dependence. However, the prevalence of mental health disorders was much higher than the prevalence of non-opioid substance abuse disorders (45.3% vs. 7.6%) among users of opioids for CNCP, suggesting that mental health disorders account for more of the population attributable risk for opioid abuse than does non-opioid substance abuse. Males, younger adults, and individuals with greater days supply of prescription opioids dispensed in 2002 were more likely to develop opioid abuse/dependence. Clinicians need to carefully screen for substance abuse and mental health disorders in candidates for opioid therapy and facilitate appropriate treatment of these disorders.
TL;DR: A new analytic method is described, based on robust decision making, for suggesting narrative scenarios that emerge naturally from a decision analytic framework that can communicate quantitative judgments about uncertainty as well as support a well-defined decision process without many drawbacks of current approaches.
Abstract: Scenarios play a prominent role in policy debates over climate change, but questions continue about how best to use them. We describe a new analytic method, based on robust decision making, for suggesting narrative scenarios that emerge naturally from a decision analytic framework. We identify key scenarios as those most important to the choices facing decision makers and find such cases with statistical analysis of datasets created by multiple runs of computer simulation models. The resulting scenarios can communicate quantitative judgments about uncertainty as well as support a well-defined decision process without many drawbacks of current approaches. We describe an application to long-term water planning in California.
TL;DR: Comorbid PTSD among depressed patients is associated with increased illness burden, poorer prognosis, and delayed response to depression treatment, and Providers should consider recommending psychotherapeutic interventions for depressed patients with PTSD.
Abstract: Compared to those with depression alone, depressed patients with posttraumatic stress disorder (PTSD) experience more severe psychiatric symptomatology and factors that complicate treatment. To estimate PTSD prevalence among depressed military veteran primary care patients and compare demographic/illness characteristics of PTSD screen-positive depressed patients (MDD-PTSD+) to those with depression alone (MDD). Cross-sectional comparison of MDD patients versus MDD-PTSD+ patients. Six hundred seventy-seven randomly sampled depressed patients with at least 1 primary care visit in the previous 12 months. Participants composed the baseline sample of a group randomized trial of collaborative care for depression in 10 VA primary care practices in 5 states. The Patient Health Questionnaire-9 assessed MDD. Probable PTSD was defined as a Primary Care PTSD Screen ≥ 3. Regression-based techniques compared MDD and MDD-PTSD+ patients on demographic/illness characteristics. Thirty-six percent of depressed patients screened positive for PTSD. Adjusting for sociodemographic differences and physical illness comorbidity, MDD-PTSD+ patients reported more severe depression (P < .001), lower social support (P < .001), more frequent outpatient health care visits (P < .001), and were more likely to report suicidal ideation (P < .001) than MDD patients. No differences were observed in alcohol consumption, self-reported general health, and physical illness comorbidity. PTSD is more common among depressed primary care patients than previously thought. Comorbid PTSD among depressed patients is associated with increased illness burden, poorer prognosis, and delayed response to depression treatment. Providers should consider recommending psychotherapeutic interventions for depressed patients with PTSD.
TL;DR: Patients’ unmet concerns can be dramatically reduced by a simple inquiry framed in the SOME form, and both the learning and implementation of the intervention require very little time.
Abstract: Context
In primary, acute-care visits, patients frequently present with more than 1 concern. Various visit factors prevent additional concerns from being articulated and addressed.
TL;DR: Nurse working conditions were associated with all outcomes measured and will most likely promote patient safety, and future researchers and policymakers should consider a broad set of working condition variables.
Abstract: Background:System approaches, such as improving working conditions, have been advocated to improve patient safety. However, the independent effect of many working condition variables on patient outcomes is unknown.Objective:To examine effects of a comprehensive set of working conditions on elderly p
Journal Article•
TL;DR: The greatest impediment to estimating the cost of productivity lost to illness is the lack of established and validated methods for monetization.
Abstract: The greatest impediment to estimating the cost of productivity lost to illness is the lack of established and validated methods for monetization. The issues raised in this review are intended to stimulate future research to validate and improve such methods.
TL;DR: A lower likelihood of disorders in neighborhoods with a greater presence of stress-buffering mechanisms is found, and cross-level interactions revealed that violence-exposed individuals in high crime neighborhoods are vulnerable to depressive/anxiety disorders.
TL;DR: Three experiments explored whether expectancy-violating partners engender "threat" responses in perceivers while multiple measures were assessed, including cardiovascular reactivity, task performance, appraisals, and behavior.
Abstract: Individuals who violate expectations increase uncertainty during social interactions. Three experiments explored whether expectancy-violating partners engender “threat” responses in perceivers. Participants interacted with confederates who violated or confirmed expectations while multiple measures were assessed, including cardiovascular reactivity, task performance, appraisals, and behavior. In Experiments 1 and 2, participants interacted with White or Latino confederates who described their family backgrounds as either high or low socioeconomic status. In Experiment 3, participants interacted with Asian or White confederates who spoke with expected accents or southern accents. Participants interacting with expectancy-violating partners (e.g., Asians with southern accents) exhibited cardiovascular responses consistent with threat, poorer task performance, and manifested negative and defeat-related behavior. Implications for decreasing prejudicial responses via uncertainty reduction are discussed.
TL;DR: The demand for scientific evidence on non-pharmaceutical public health interventions for influenza is pervasive, and present policy recommendations must rely heavily on expert judgment.
Abstract: In an influenza pandemic, the benefit of vaccines and antiviral medications will be constrained by limitations on supplies and effectiveness. Non-pharmaceutical public health interventions will therefore be vital in curtailing disease spread. However, the most comprehensive assessments of the literature to date recognize the generally poor quality of evidence on which to base non-pharmaceutical pandemic planning decisions. In light of the need to prepare for a possible pandemic despite concerns about the poor quality of the literature, combining available evidence with expert opinion about the relative merits of non-pharmaceutical interventions for pandemic influenza may lead to a more informed and widely accepted set of recommendations. We evaluated the evidence base for non-pharmaceutical public health interventions. Then, based on the collective evidence, we identified a set of recommendations for and against interventions that are specific to both the setting in which an intervention may be used and the pandemic phase, and which can be used by policymakers to prepare for a pandemic until scientific evidence can definitively respond to planners' needs. Building on reviews of past pandemics and recent historical inquiries, we evaluated the relative merits of non-pharmaceutical interventions by combining available evidence from the literature with qualitative and quantitative expert opinion. Specifically, we reviewed the recent scientific literature regarding the prevention of human-to-human transmission of pandemic influenza, convened a meeting of experts from multiple disciplines, and elicited expert recommendation about the use of non-pharmaceutical public health interventions in a variety of settings (healthcare facilities; community-based institutions; private households) and pandemic phases (no pandemic; no US pandemic; early localized US pandemic; advanced US pandemic). The literature contained a dearth of evidence on the efficacy or effectiveness of most non-pharmaceutical interventions for influenza. In an effort to inform decision-making in the absence of strong scientific evidence, the experts ultimately endorsed hand hygiene and respiratory etiquette, surveillance and case reporting, and rapid viral diagnosis in all settings and during all pandemic phases. They also encouraged patient and provider use of masks and other personal protective equipment as well as voluntary self-isolation of patients during all pandemic phases. Other non-pharmaceutical interventions including mask-use and other personal protective equipment for the general public, school and workplace closures early in an epidemic, and mandatory travel restrictions were rejected as likely to be ineffective, infeasible, or unacceptable to the public. The demand for scientific evidence on non-pharmaceutical public health interventions for influenza is pervasive, and present policy recommendations must rely heavily on expert judgment. In the absence of a definitive science base, our assessment of the evidence identified areas for further investigation as well as non-pharmaceutical public health interventions that experts believe are likely to be beneficial, feasible and widely acceptable in an influenza pandemic.
TL;DR: Correlated physical and mental health summary scores for the SF-36 and SF-12 derived from an obliquely rotated factor solution should be used along with the uncorrelated summary scores.
Abstract: Background: The SF-36 and SF-12 summary scores were derived using an uncorrelated (orthogonal) factor solution. We estimate SF-36 and SF-12 summary scores using a correlated (oblique) physical and mental health factor model. Methods: We administered the SF-36 to 7,093 patients who received medical care from an independent association of 48 physician groups in the western United States. Correlated physical health (PCSc) and mental health (MCSc) scores were constructed by multiplying each SF-36 scale z-score by its respective scoring coefficient from the obliquely rotated two factor solution. PCS c 12 and MCS c -12 scores were estimated using an approach similar to the one used to derive the original SF-12 summary scores. Results: The estimated correlation between SF-36 PCSc and MCSc scores was 0.62. There were far fewer negative factor scoring coefficients for the oblique factor solution compared to the factor scoring coefficients produced by the standard orthogonal factor solution. Similar results were found for PCSc-12, and MCSc-12 summary scores. Conclusion: Correlated physical and mental health summary scores for the SF-36 and SF-12 derived from an obliquely rotated factor solution should be used along with the uncorrelated summary scores. The new scoring algorithm can reduce inconsistent results between the SF-36 scale scores and physical and mental health summary scores reported in some prior studies. (Subscripts C = correlated and UC = uncorrelated)
TL;DR: In this paper, it is shown that the population parameter values of a model can also influence the χ2 and lead to erroneous decisions about model acceptance/rejection, based on the examination of hypothetical population factor analytic models.
Posted Content•
TL;DR: A nearly 1-percentage-point drop in 7-day mortality for patients at age 65 is estimated, equivalent to a 20% reduction in deaths for this severely ill patient group, and the mortality gap persists for at least 9 months after admission.
Abstract: The health insurance characteristics of the population changes sharply at age 65 as most people become eligible for Medicare. But do these changes matter for health? We address this question using data on over 400,000 hospital admissions for people who are admitted through the emergency room for "non-deferrable" conditions -- diagnoses with the same daily admission rates on weekends and weekdays. Among this subset of patients there is no discernible rise in the number of admissions at age 65, suggesting that the severity of illness is similar for patients on either side of the Medicare threshold. The insurance characteristics of the two groups are much different, however, with a large jump at 65 in the fraction who have Medicare as their primary insurer, and a reduction in the fraction with no coverage. These changes are associated with significant increases in hospital list chargers, in the number of procedures performed in hospital, and in the rate that patients are transferred to other care units in the hospital. We estimate a nearly 1 percentage point drop in 7-day mortality for patients at age 65, implying that Medicare eligibility reduces the death rate of this severely ill patient group by 20 percent. The mortality gap persists for at least two years following the initial hospital admission.
TL;DR: There is a substantial decrease in school participation following a parent death and a smaller drop before the death (presumably due to pre-death morbidity), suggesting that estimates based on cross-sectional data are biased toward zero.
Abstract: AIDS deaths could have a major impact on economic development by affecting the human capital accumulation of the next generation. We estimate the impact of parent death on primary school participation using an unusual five-year panel data set of over 20,000 Kenyan children. There is a substantial decrease in school participation following a parent death and a smaller drop before the death (presumably due to pre-death morbidity). Estimated impacts are smaller in specifications without individual fixed effects, suggesting that estimates based on cross-sectional data are biased toward zero. Effects are largest for children whose mothers died and, in a novel finding, for those with low baseline academic performance.
TL;DR: This paper outlines the theoretical structure of coalitions in parliamentary bodies, sketching out their application to the United States Congress, the United Nations Security Council, or any such body in which the acquisition of power is the payoff.
Abstract: In parliamentary bodies coalitions turn out to be either all-powerful or ineffectual. Conflicts which have such outcomes have been called simple games. This paper outlines their theoretical structure, sketching out their application to the United States Congress, the United Nations Security Council, or any other such body in which the acquisition of power is the payoff.
TL;DR: In this paper, a multinomial logit model of transitions from wage and salary employment to self-employment, retirement or not working is presented, and the impact of health on transitions to self employment is highlighted.
TL;DR: The effects on subsequent violence of gang joining at age 14 are studied while controlling for measured characteristics of boys prior to age 14 and the possible impact of failing to adjust for an important but unmeasured covariate is examined using sensitivity analysis.
Abstract: In a nonrandomized or observational study, propensity scores may be used to balance observed covariates and trajectory groups may be used to control baseline or pretreatment measures of outcome. The trajectory groups also aid in characterizing classes of subjects for whom no good matches are available and to define substantively interesting groups between which treatment effects may vary. These and related methods are illustrated using data from a Montreal-based study. The effects on subsequent violence of gang joining at age 14 are studied while controlling for measured characteristics of boys prior to age 14. The boys are divided into trajectory groups based on violence from ages 11 to 13. Within trajectory group, joiners are optimally matched to a variable number of controls using propensity scores, Mahalanobis distances, and a combinatorial optimization algorithm. Use of variable ratio matching results in greater efficiency than pair matching and also greater bias reduction than matching at a fixed ratio. The possible impact of failing to adjust for an important but unmeasured covariate is examined using sensitivity analysis.
TL;DR: The quality of care, measured according to whether patients were offered recommended services, increases as a patient's number of chronic conditions increases.
Abstract: BACKGROUND There is emerging concern that the methods used to measure the quality of care unfairly penalize providers caring for patients with multiple chronic conditions. We therefore sought to study the relationship between the quality of care and the number of medical conditions a patient has. METHODS We assessed measurements of the quality of medical care received in three cohorts of community-dwelling adult patients in the Community Quality Index study, the Assessing Care of Vulnerable Elders study, and the Veterans Health Administration project (7680 patients in total). We analyzed the relationship between the quality of care that patients received, defined as the percentage of quality indicators satisfied among those for which patients were eligible, and the number of chronic medical conditions each patient had. We further explored the roles of characteristics of patients, use of health care (number of office visits and hospitalizations), and care provided by specialists as explanations for the observed relationship. RESULTS The quality of care increased as the number of medical conditions increased. Each additional condition was associated with an increase in the quality score of 2.2% (95% confidence interval [CI], 1.7 to 2.7) in the Community Quality Index cohort, of 1.7% (95% CI, 1.1 to 2.4) in the Assessing Care of Vulnerable Elders cohort, and of 1.7% (95% CI, 0.7 to 2.8) in the Veterans Health Administration cohort. The relationship between the quality of care and the number of conditions was little affected by adjustment for the difficulty of delivering the care recommended in a quality indicator and for the fact that, because of multiple conditions requiring the same care, a patient could be eligible to receive the same care process more than once. Adjustment for characteristics of patients, use of health care, and care provided by specialists diminished the relationship, but it remained positive. CONCLUSIONS The quality of care, measured according to whether patients were offered recommended services, increases as a patient's number of chronic conditions increases.
TL;DR: Noncoverage (lack of access to the Internet) appears to be of greater concern than nonresponse (unwillingness to participate given access) for representation in Internet surveys of persons 50 years old and older in the US.
TL;DR: In this paper, the authors investigated the ways in which terrorism is linked to education and poverty using data culled from Hamas and Palestinian Islamic Jihad (PIJ) documentary sources, and presented a statistical analysis of the determinants of participation in terrorist activities by members of the Hamas and PIJ between the late 1980s and May 2002.
Abstract: This paper investigates the ways in which terrorism is linked to education and poverty using data newly culled from Hamas and Palestinian Islamic Jihad (PIJ) documentary sources. The paper presents a statistical analysis of the determinants of participation in terrorist activities by members of the Hamas and PIJ between the late 1980s and May 2002. The resulting evidence suggests that both higher education and standard of living are positively associated with participation in Hamas or PIJ and with becoming a suicide bomber, while being married significantly reduces the probability of participation in terrorist activities.