Optimal Health Insurance in the Presence of Risky Health Behaviors *

Abstract In this paper I develop an overlapping generations model that incorporates bad behaviors (such as smoking and unhealthy eating habits that lead to obesity) to investigate the equilibrium effects of different cost sharing mechanisms and excise taxation on bad behaviors and medical expenditures. I show that while higher cost sharing induces individuals to refrain from bad behaviors, it has mixed welfare effects across different individuals. For example, if coinsurance rate is increased by 20 percentage points, smoking prevalence goes down by about 2 percentage points and medical expenditures to GDP ratio slightly declines. Although higher cost sharing increases the overall welfare in the economy, unhealthy individuals are either worse off or have much less welfare gains compared to healthy individuals. The quantitative implications of the model are consistent with the variation in smoking prevalence and excise taxes across tobacco and non-tobacco states

A Primary Leiomyosarcoma of the Thyroid Gland: A Case and Literature Review

Introduction: We want to present a rare case of Primary leiomyosarcoma of the thyroid (PLT) gland and review the literature on PLT including the differential diagnoses, pathology, and alternative treatment strategies.Presentation of Case: A 56-year-old man who underwent left side total thyroidectomy with diagnosis of substernal goiter. On pathologic examination, three different pathology clinics had a common opinion that this was a grade 3 pleomorphic sarcoma of thyroid itself. Positron Emission Tomography (PET/CT) obtained one month after surgery displayed no distant metastases. Loco regional radiotherapy (RT) to the thyroid bed was delivered up to a dose of 59.4 Gray (Gy) in 1.8 Gy daily fractions. PET/CT obtained three months after RT showed bilateral multiple lung metastases without loco regional recurrence. The patient received 6 courses of doxorubicin and cyclophosphamide based chemotherapy. A new PET/CT scan showed only two metabolically active metastases on both lungs. Because of disappearance of small metastases, the patient underwent sequential bilateral metastasectomy in one month interval. Pathology results verified the metastases of PLT. The patient is still alive without any signs of disease 6 years after RT and he is the only long surviving case reported up to now.Conclusion: The treatment protocols for PLT have not been well established yet, because of their rareness and poor prognosis. We believe that our case may be directive for PLT treatment

Liver transplantation: Yesterday, today and tomorrow

With the advances in technical skills, management of postoperative complications and improvements in immunosuppressive drugs, liver transplantation is the standard treatment for many patients with chronic liver disease. Today, shortage of donor organs seems to be the major limiting factor for the application of liver transplantation. This review focuses on five issues that are challenging to clinical practice of liver transplantation and relevant to gastroenterologists. These include living donor liver transplantation, recurrent viral hepatitis, non-heart-beating donors, hepatocellular carcinoma, and ABO incompatible liver transplantation. Living donor and non-heart beating donor transplantations were initiated as a solution to increase the donor organ pool and it is expected that there will be an increase in the number of these donors. Recurrent hepatitis C and hepatocellular carcinoma following liver transplantation are among major problems and ongoing research in these diseases may lead to better outcomes in these recipients

Liver transplantation: Yesterday, today and tomorrow EDITORIAL

With the advances in technical skills, management of postoperative complications and improvements in immunosuppressive drugs, liver transplantation is the standard treatment for many patients with chronic liver disease. Today, shortage of donor organs seems to be the major limiting factor for the application of liver transplantation. This review focuses on five issues that are challenging to clinical practice of liver transplantation and relevant to gastroenterologists. These include living donor liver transplantation, recurrent viral hepatitis, non-heart-beating donors, hepatocellular carcinoma, and ABO incompatible liver transplantation. Living donor and non-heart beating donor transplantations were initiated as a solution to increase the donor organ pool and it is expected that there will be an increase in the number of these donors. Recurrent hepatitis C and hepatocellular carcinoma following liver transplantation are among major problems and ongoing research in these diseases may lead to better outcomes in these recipients

Fish Oil-Containing Lipid Emulsions In Adult Parenteral Nutrition: A Review Of The Evidence

Background. There is evidence from laboratory and animal studies that fish oil-containing intravenous lipid emulsions (FOC-IVLEs) have a beneficial effect on inflammation and the immune response, suggesting a possible clinical benefit. Clinical studies of FOC-IVLEs have reported mixed results. The aim of this review is to present findings from recent randomized controlled clinical trials and other quality clinical studies investigating the effects of administering intravenous fish oil alone or as part of a multilipid emulsion and to examine the quality of these studies in an objective, evidence-based manner. Methods. Studies comparing FOC-IVLEs with other IVLEs in adults were included. Thirty-four clinical studies were evaluated: 19 investigated levels of inflammatory and immune markers as an endpoint; 13 investigated rates of infection or sepsis; 3 investigated clinical outcomes in septic patients; and 29 investigated general clinical outcomes. Results. There was conflicting evidence for a beneficial effect of fish oil on levels of inflammatory and immune markers and some evidence that fish oil decreased the rate of postoperative atrial fibrillation. Studies generally reported few statistical differences in clinical outcomes and rates of infection and sepsis with FOC-IVLEs as compared with other IVLEs. The quality of reporting was generally poor, and the presented evidence for comparisons between FOC-IVLEs and other IVLEs was inconclusive or weak. Conclusions. There is very little high-quality evidence that FOC-IVLEs have a more beneficial effect than other IVLEs on clinical outcomes in adult patients.WoSScopu

Approach To Nutritional Therapy In Patients Who Require Vasopressors General Information And Protocol Proposal

Studies of enteral nutrition (EN) therapy in patients who require vasopressors are limited. Unfortunately, hemodynamically unstable patients or patients receiving vasopressors were mostly excluded from the large randomized controlled trials in nutrition. We aimed to present the protocol by Hacettepe University Adult Hospital Nutrition Support Team as different approaches to EN of these patients.WoSScopu