Employer-Provided Health Insurance and the Incidence of "Job-Lock": Is There a Consensus?

Several recent developments in health care in the United States include declining health care coverage, particularly that provided by employers, and a noticeable shift in the burden of medical care costs to employees. If these developments cause employees to feel locked into their jobs, optimal job matches in the labor force will not take place. Partly in response, the federal government has passed laws protecting health coverage for workers who switch jobs, with the passage of the Consolidated Omnibus Budget Reconciliation Act of 1986 and later the Health Insurance Portability and Accountability Act in 1996. In this paper we summarize the current literature on the topic and present some findings using the National Health Interview Survey, focusing on the 1997-2003 period. Our findings are consistent with recent assertions that there is some evidence of job-lock. Working Paper 06-5

Essays in Labor Economics: Alcohol Consumption and Socioeconomic Outcomes

Recent studies indicate that alcohol consumption may affect economic outcomes through its effects on health capital and social capital. If, in fact, differences in economic outcomes are causally linked to differences in alcohol consumption, then lack of adequate insight into such connectivity may adversely affect the labor market and retirement outcomes of some groups of individuals in society. In two essays, this dissertation examines the impact of alcohol consumption on wealth at retirement using data from the RAND Health and Retirement Study (HRS) from 1992 through 2002; and the effects of alcohol consumption on employment duration and earnings using the Geocode version of the National Longitudinal Survey of Youth (NLSY1979) micro dataset from 1984 through 1996. This dissertation relies on Grossman\u27s 1972 health capital model. Empirically, the research relies on panel data methods and duration analysis to determine whether differences in economic outcomes can be explained by differences in alcohol consumption. The results indicate that drinking is positively related to improved socioeconomic outcomes as compared to total abstention, when endogeneity has not been taken into account under both duration analysis and panel data methods. When endogeneity is taken into account, alcohol consumption tends to shorten the duration of employment via survival analysis. Also, estimation via instrumental variables approach indicates that the relationship between alcohol consumption and socioeconomic outcomes (retirement wealth and earnings) is rather an inverted U-shaped for some panel data specifications. Moreover, the effects of alcohol consumption on retirement wealth and earnings tend to diminish with instrumental variables approach. These findings did not change even with abstainers partitioned into lifetime abstainers and infrequent or light drinkers (less than one drinking day per week)

The Effects of Natural Resource Conservation on the Development of Fringe Communities around the Barekese Catchment Area

The study sought to assess the effects of nature resource conservation on fringe communities in the Barekese conserved area in Ghana. A sample of 82 household heads was randomly selected from four fringe communities and interviewed to gather the needed primary data. Also focused group discussions were held with farmers, fishers, hunters and chain-saw operator groups in the sampled communities. The findings were that the Barekese catchment area conservation project had resulted in the reduction in farmlands of the people living in the fringe communities. It has also brought about some natural resource use conflicts, poverty and the undermining of livelihood opportunities of the fringe communities. It is therefore recommended that alternative livelihood opportunities, especially nonfarm businesses need to be encouraged and supported by the government and other local authorities among the resource fringe communities to minimize the negative effects of conservation. Active involvement of the fringe communities in the decision making process, before, during and after the conservation, could have engendered local ownership and reduced the antagonistic tendencies from the fringe communities. Keywords: natural resource, conservation, fringe communities, Barekes

Sexual dysfunction among Ghanaian men presenting with various medical conditions

<p>Abstract</p> <p>Background</p> <p>Several medical conditions can affect and disrupt human sexuality. The alteration of sexuality in these medical conditions often hinder effective communication and empathy between the patients and their sexual partners because of cultural attitudes, social norms and negative feelings such as anxiety and guilt. Validated and standardized sexual inventories might therefore help resolve this problem. The objective of this cross-sectional study was to obtain data on the prevalence of male sexual dysfunction (SD) among Ghanaians with various medical conditions residing in Kumasi.</p> <p>Methods</p> <p>The Golombok Rust Inventory of Sexual Satisfaction (GRISS) was administered to 150 Ghanaian men with various medical conditions between 19 and 66 years old (mean ± standard deviation: 40.01 ± 12.32 years) domiciled in the Kumasi metropolis.</p> <p>Results</p> <p>Out of the total 150 questionnaires administered, 105 (70.0%) men returned the questionnaires. Questionnaires from 3 men were incomplete, leaving 102 complete and evaluable questionnaires, indicating a 68.0% response rate. Of the remaining 102 men, 88.2% were married, 70.6% had attained higher education, 88.2% were non-smokers. Whereas 54.9% were engaged in exercise, 61.8% indulged in alcoholic beverages. The prevalence of the various medical conditions include: diabetes (18%), hypertension (24.5%), migraine (11.8%), ulcer (7.8%), surgery (6.9%), STD (3.9) and others (26.5%). The prevalence of SD among the respondents in the study was 59.8%. The highest prevalence of SD was seen among ulcer patients (100%), followed by patients who have undergone surgery (75%), diabetes (70%), hypertension (50%), STD (50%) and the lowest was seen among migraine patients (41.7%).</p> <p>Conclusions</p> <p>SD rate is high among Ghanaian men with medical conditions (about 60%) and vary according to the condition and age.</p

Outbreak of rabies among humans, dogs and livestock, Awutu-Senya East Municipality, Ghana, 2019

Introduction: Rabies is a neglected zoonotic disease caused by the Rabies virus (RABV). Ninety-percent of human rabies are dog-mediated. Globally there are 59,000 human rabies annually. On June 16 2019, a 4-year-old girl from the Awutu-Senya East Municipal of Ghana, died following symptoms of aggression, hyper-salivation and hydrophobia. She had a dog scratch five weeks prior. We confirmed the outbreak, determined its magnitude, identified associated factors and implemented control measures. Methods: We interviewed community members to understand potential exposures to RABV. We reviewed the animal bite records, clinical notes of human rabies cases and initial line-list. We conducted community-based rabies surveillance for animal bites and confirmed RABV by Polymerase Chain Reaction of brain tissue of dead human and animals. We updated the line-list with demographic, exposure, and outcome variables of bite victims. Quantitative data was analyzed descriptively, and findings presented as frequencies and proportions. Results: Overall, 155 dog bites were identified, among which six human rabies deaths were recorded (Attack rate=3.9%). Males were 51.6% (80/155) of bite victims, whiles children 5-14 years constituted 27% (40/147). About 86.5% (134/155) of bites were by unvaccinated dogs, and stray dogs bit 80.6% (125/155) of individuals. Category III bites were 35% (50/141). RABV was isolated from 16.7% (1/6) of human deaths and 30% (3/10) of rabid dog. We suspected rabies infection in a goat. Dogs roamed unattended within communities. Conclusion: This rabies outbreak was dog-mediated. Poor pet ownership and limited vaccination of dogs were associated factors. Mass dog vaccination, prompt post-exposure prophylaxis and risk communication were critical interventions implemented

Prevalence of Potentially Inappropriate Medication Use in Older Adults Using the 2012 Beers Criteria

The Beers list of potentially inappropriate medications (PIMs) provides a key indicator of medication prescribing quality. The criteria were updated in 2012, adding new drugs and assessing evidence strength

Perception of Track and Field Athletes on the Use of Cryotherapy in Injury Management in Ashanti Region of Ghana

The use of cryotherapy in injury management (IM) has been widely studied but report on track and field athletes’ (TFAs) perception in Ghana remains scarce. TFAs in Ashanti region of Ghana habitually sustained acute injuries due to competition stressors that typically affect peak performance like in other contact games. Despite been observed that sustained injuries accomplished cryotherapy treatment, TFAs’ visit to non-clinical therapy nonetheless remain prominent. This cross-sectional study therefore documents the perceptions of TFAs on the use cryotherapy in IM. Ninety five [mean age = 22.26±1.10years, 59 (62.1%) males, 36(37.9%) females] TFAs camped at the Babayara Sports stadium Kumasi in preparation for 11th African Games were purposively sampled. Self-structured and validated instrument on the use of cryotherapy in IM was administered to elicit TFAs perceptions. TFAs perceived the use of cryotherapy in IM as significant [F = 788.884, X2 = 404.192, df = 94, p = .000].Gender influence on TFAs perception of use of cryotherapy in IM was not significantly different. Mainstream significantly professed at least a good feeling (79.0%, X2 = 37.000, p = 000) after receiving cryotherapy treatment. As such, attachement of Physical Therapists to the TFAs training sessions in Ashanti region, provision of enabling environment and equipment to enhance effective IM processes through cryotherapy are strategic approaches advocated.

Modeling screening, prevention, and delaying of Alzheimer's disease: an early-stage decision analytic model

<p>Abstract</p> <p>Background</p> <p>Alzheimer's Disease (AD) affects a growing proportion of the population each year. Novel therapies on the horizon may slow the progress of AD symptoms and avoid cases altogether. Initiating treatment for the underlying pathology of AD would ideally be based on biomarker screening tools identifying pre-symptomatic individuals. Early-stage modeling provides estimates of potential outcomes and informs policy development.</p> <p>Methods</p> <p>A time-to-event (TTE) simulation provided estimates of screening asymptomatic patients in the general population age ≥55 and treatment impact on the number of patients reaching AD. Patients were followed from AD screen until all-cause death. Baseline sensitivity and specificity were 0.87 and 0.78, with treatment on positive screen. Treatment slowed progression by 50%. Events were scheduled using literature-based age-dependent incidences of AD and death.</p> <p>Results</p> <p>The base case results indicated increased AD free years (AD-FYs) through delays in onset and a reduction of 20 AD cases per 1000 screened individuals. Patients completely avoiding AD accounted for 61% of the incremental AD-FYs gained. Total years of treatment per 1000 screened patients was 2,611. The number-needed-to-screen was 51 and the number-needed-to-treat was 12 to avoid one case of AD. One-way sensitivity analysis indicated that duration of screening sensitivity and rescreen interval impact AD-FYs the most. A two-way sensitivity analysis found that for a test with an extended duration of sensitivity (15 years) the number of AD cases avoided was 6,000-7,000 cases for a test with higher sensitivity and specificity (0.90,0.90).</p> <p>Conclusions</p> <p>This study yielded valuable parameter range estimates at an early stage in the study of screening for AD. Analysis identified duration of screening sensitivity as a key variable that may be unavailable from clinical trials.</p

Sexual dysfunction among married couples living in Kumasi metropolis, Ghana

<p>Abstract</p> <p>Background</p> <p>Sexuality and its manifestation constitute some of the most complex of human behaviour and its disorders are encountered in community. Sexual dysfunction is more prevalent in women than in men. While studies examining sexual dysfunction among males and females in Ghana exist, there are no studies relating sexual problems in males and females as dyadic units. This study therefore investigated the prevalence and type of sexual disorders among married couples.</p> <p>Method</p> <p>The study participants consisted of married couples between the ages of 19 and 66 living in the province of Kumasi, Ghana. Socio-demographic information and Golombok-Rust Inventory of Sexual Satisfaction (GRISS) questionnaires were administered to 200 couples who consented to take part in the study. All 28 questions of the GRISS are answered on a five-point (Likert type) scale from "always", through "usually', "sometimes", and "hardly ever", to "never". Responses are summed up to give a total raw score ranging from 28-140. The total score and subscale scores are transformed using a standard nine point scale, with high scores indicating greater problems. Scores of five or more are considered to indicate SD. The study was conducted between July and September 2010.</p> <p>Results</p> <p>Out of a total of 200 married couples, 179 completed their questionnaires resulting in a response rate of 89.5%. The mean age of the participating couples as well as the mean duration of marriage was 34.8 ± 8.6 years and 7.8 ± 7.6 years respectively. The husbands (37.1 ± 8.6) were significantly older (p < 0.0001) than their corresponding wives (32.5 ± 7.9). After adjusting for age, 13-18 years of marriage life poses about 10 times significant risk of developing SD compared to 1-6 years of married life among the wives (OR: 10.8; CI: 1.1 - 49.1; p = 0.04). The total scores (6.0) as well as the percentage above the cut-off (59.2) obtained by the husbands compared to the total score (6.2) and the percentage above cut-off (61.5) obtained by the wives, indicates the likely presence of sexual dysfunction. The prevalence of impotence and premature ejaculation were 60.9% and 65.4% respectively from this study and the prevalence of vaginismus and anorgasmia were 69.3% and 74.9% respectively. The highest prevalence of SD subscales among the men was dissatisfaction with sexual act followed by infrequency, whereas the highest among the women was infrequency followed by anorgasmia. Dissatisfaction with sexual intercourse among men correlated positively with anorgasmia and wife's non-sensuality and infrequency of sex.</p> <p>Conclusion</p> <p>The prevalence of sexual dysfunction in married couples is comparable to prevalence rates in the general male and female population and is further worsened by duration of marriage. This could impact significantly on a couple's self-esteem and overall quality of life.</p

The consequences of delaying insulin initiation in UK type 2 diabetes patients failing oral hyperglycaemic agents: a modelling study

<p>Abstract</p> <p>Background</p> <p>Recent data have shown that type 2 diabetes patients in the UK delay initiating insulin on average for over 11 years after first being prescribed an oral medication. Using a published computer simulation model of diabetes we used UK-specific data to estimate the clinical consequences of immediately initiating insulin versus delaying initiation for periods in line with published estimates.</p> <p>Methods</p> <p>In the base case scenario simulated patients, with characteristics based on published UK data, were modelled as either initiating insulin immediately or delaying for 8 years. Clinical outcomes in terms of both life expectancy and quality-adjusted life expectancy and also diabetes-related complications (cumulative incidence and time to onset) were projected over a 35 year time horizon. Treatment effects associated with insulin use were taken from published studies and sensitivity analyses were performed around time to initiation of insulin, insulin efficacies and hypoglycaemia utilities.</p> <p>Results</p> <p>For patients immediately initiating insulin there were increases in (undiscounted) life expectancy of 0.61 years and quality-adjusted life expectancy of 0.34 quality-adjusted life years versus delaying initiation for 8 years. There were also substantial reductions in cumulative incidence and time to onset of all diabetes-related complications with immediate versus delayed insulin initiation. Sensitivity analyses showed that a reduced delay in insulin initiation or change in insulin efficacy still demonstrated clinical benefits for immediate versus delayed initiation.</p> <p>Conclusion</p> <p>UK type 2 diabetes patients are at increased risk of a large number of diabetes-related complications due to an unnecessary delay in insulin initiation. Despite clear guidelines recommending tight glycaemic control this failure to begin insulin therapy promptly is likely to result in needlessly reduced life expectancy and compromised quality of life.</p