Employer-funded health care and labor markets: an insider’s view

This session will explore the impact of the U.S. health care system on U.S. labor markets. ; Why do employers believe that rising health care costs are a major cause for concern when economists insist that workers are the ones who actually bear the costs? What are the implications of large health care liabilities for the long-run viability of U.S. employers? How do rising health care costs affect employment and compensation decisions and labor mobility? Do behavioral insights shed any light on these issues?Health care reform

Deprivation as an outcome determinant in emergency medical admissions

Background: Deprivation in the general population predicts mortality. We have investigated its relevance to an acute medical admission, using a database of all emergency admissions to St James’ Hospital, Dublin, over a ten year period (2002-2011). <p/>Methods: All emergency admissions, based on geocoding of residence, were allocated to a Small Area Health Research Unit (SAHRU) division, with a corresponding deprivation index. We then examined this index as a univariate (unadjusted) and independent (adjusted) predictor of 30-day in-hospital mortality. <p/>Results: The 30-day in-hospital mortality, over the 10 year period was higher, for those in the upper half of the deprivation distribution (9.6% vs 8.6%: p = 0.002). Indeed, there was a stepwise increase in 30-day mortality over the quintiles of deprivation from 7.3% (Quintile 1) to 8.8%, 10.0%, 10.0% and 9.3% respectively. Univariate logistic regression of the deprivation indices (quintiles) against outcome showed an increased risk (p = 0.002) of a 30-day death with OR’s respectively (compared with lowest deprivation quintile) of 1.23 (95% CI 1.07, 1.40), 1.41 (95% CI 1.24, 1.60), 1.41 (95% CI 1.24, 1.61) and 1.30 (95% CI 1.14, 1.48). The deprivation index was an independent predictor of outcome in a model when adjusted for illness severity and co-morbidity. The fully adjusted OR for a 30-day death was increased by 31% (p=0.001) for patients in the upper half of the deprivation index distribution (OR 1.31: 95% CI 1.20, 1.44). <p/>Conclusion: Deprivation independently of co-morbidity or acute illness severity is a powerful outcome predictor in acute medical admissions

Physical activity patterns in a nationally representative sample of adults in Ireland

Original article can be found at: http://journals.cambridge.org/ Copyright - the authors. DOI: 10.1079/PHN2001192Objective To evaluate habitual levels of physical activity in a nationally representative sample of adults in Ireland. Design Cross-sectional survey using a self-administered questionnaire. Usual levels of work, recreational and household activities were evaluated in relation to anthropometric, demographic and socio-economic characteristics. The amount and intensity of all activities were quantified by assigning metabolic equivalents (METS) to each activity. Setting Republic of Ireland and Northern Ireland, 1997–1999. Subjects Random sample of 1379 adults aged 18–64 years. Results Men were approximately twice as active in work and recreational activity (139.7 ± 83.9 METS) as women (68.5 ± 49.8 METS; P 28kg m−2) or obese (BMI > 30kg m−2). Fewer obese subjects reported higher levels of work and leisure activities. However, a higher percentage of obese women reported participation in the higher levels of household activities. Participation rates in recreational activities were low. Walking was the most important leisure activity of both men (41%) and women (60%). In terms of hours per week spent in vigorous physical activity, men were more active than women, professional and skilled non-manual women were more active than women in other social classes, and younger subjects (aged 18–35 years) were more active than older subjects. Conclusions The holistic approach used in the assessment of physical activity in this study has revealed important and subtle differences in the activity patterns of men and women. Failure to fully characterise the respective activity patterns of men and women could lead to ill-informed public health policy aimed at promoting and sustaining lifetime habits of physical activity. The results suggest that simple population-focused programmes to promote physical activity are unlikely to offer the same chance of long-term success as more sensitive and individualised strategies.Peer reviewe

A target repurposing approach identifies N-myristoyltransferase as a new candidate drug target in filarial nematodes

Myristoylation is a lipid modification involving the addition of a 14-carbon unsaturated fatty acid, myristic acid, to the N-terminal glycine of a subset of proteins, a modification that promotes their binding to cell membranes for varied biological functions. The process is catalyzed by myristoyl-CoA:protein N-myristoyltransferase (NMT), an enzyme which has been validated as a drug target in human cancers, and for infectious diseases caused by fungi, viruses and protozoan parasites. We purified Caenorhabditis elegans and Brugia malayi NMTs as active recombinant proteins and carried out kinetic analyses with their essential fatty acid donor, myristoyl-CoA and peptide substrates. Biochemical and structural analyses both revealed that the nematode enzymes are canonical NMTs, sharing a high degree of conservation with protozoan NMT enzymes. Inhibitory compounds that target NMT in protozoan species inhibited the nematode NMTs with IC50 values of 2.5-10 nM, and were active against B. malayi microfilariae and adult worms at 12.5 µM and 50 µM respectively, and C. elegans (25 µM) in culture. RNA interference and gene deletion in C. elegans further showed that NMT is essential for nematode viability. The effects observed are likely due to disruption of the function of several downstream target proteins. Potential substrates of NMT in B. malayi are predicted using bioinformatic analysis. Our genetic and chemical studies highlight the importance of myristoylation in the synthesis of functional proteins in nematodes and have shown for the first time that NMT is required for viability in parasitic nematodes. These results suggest that targeting NMT could be a valid approach for the development of chemotherapeutic agents against nematode diseases including filariasis

Study of a small solar probe /sunblazer/. part ii- spacecraft and payload design progress report, jul. 1, 1964 - jun. 30, 1965

Design considerations for Sunblazer solar probe and payloa

'HeART of Stroke (HoS)', a community-based Arts for Health group intervention to support self-confidence and psychological well-being following a stroke: protocol for a randomised controlled feasibility study

Introduction Over 152 000 people in the UK have strokes annually and a third experience residual disability. Low mood also affects a third of stroke survivors; yet psychological support is poor. While Arts for Health interventions have been shown to improve well-being in people with mild-to-moderate depression post-stroke, their role in helping people regain sense of self, well-being and confidence has yet to be evaluated. The main aim of this study is to explore the feasibility of conducting a pragmatic multicentre randomised controlled trial to assess the effectiveness and cost-effectiveness of an Arts for Health group intervention (‘HeART of Stroke’ (HoS)) for stroke survivors. HoS is a 10-session artist-facilitated group intervention held in the community over 14 weeks. It offers a non-judgemental, supportive environment for people to explore sense of self, potentially enhancing well-being and confidence. Methods and analysis Sixty-four people, up to 2 years post-stroke, recruited via secondary care research staff or community stroke/rehabilitation teams in two UK centres will be randomised to either HoS plus usual care or usual care only. Self-reported outcomes, measured at baseline and approximately 5 months postrandomisation, will include stroke-related, well-being, mood, self-esteem, quality of life and process measures. Analyses will focus on estimating key feasibility parameters (eg, rates of recruitment, retention, intervention attendance). We will develop outcome and resource use data collection methods to inform an effectiveness and cost-effectiveness analysis in the future trial. Interviews, with a sample of participants, will explore the acceptability of the intervention and study processes, as well as experiences of the HoS group. Ethics and dissemination National Health Service (NHS), Research and Development and University ethical approvals have been obtained. Two peer-reviewed journal publications are planned plus one service user led publication. Findings will be disseminated at key national conferences, local stakeholder events and via institutional websites.This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0212-27054)

Assessing Safety Risk Management Performance in Chinese Subway Construction Projects: A Multistakeholder Perspective

The rapid development of subway projects in China presents significant safety risks to those involved. Building on the previous empirical research that identified and classified the safety risks of these projects, the aim of this paper is to assess the safety risk management performance in Chinese subway construction projects from a multistakeholder perspective. Questionnaire surveys and semistructured interviews were conducted with three hundred and ninety-nine and eight construction professionals, respectively, who worked on subway construction projects in southeast China. The results indicate that the top five areas of safety risk management performance are related to construction plan development, management of high-risk construction works, hazard identification and communication, government-related factors, and client-related factors. In contrast, the bottom five areas of safety risk management performance are related to engineering consultant-related factors, the site's natural environment and weather conditions, regular tests, machine calibration and maintenance, site construction schedule, and construction preparedness. The relationship between this safety risk management performance and the perceived importance of each risk factor is also reported, identifying priority areas for improvements on these projects. These findings contribute new conceptual insights to the paucity of research on the safety risk management performance of Chinese subway construction projects from a multistakeholder perspective. The results also provide new practical insights for policymakers and project managers to help them develop more effective and focused strategies to further improve the safety performance of these major projects

A qualitative study of mothers’ perceptions of weaning and the use of commercial infant food in the United Kingdom

Background: Commercially produced infant food has a different taste profile and nutritional content to homemade baby food and its consumption is now very widespread. This change in early food experience may lead to a reduced dietary variety and a decreased microbial load exposure.Objective: The purpose of this study was to gain insight into parental perceptions of complementary feeding, specifically opinions of commercially produced baby food, using qualitative research methods. Methods: Four focus group discussions took place (n = 24), with mothers of infants aged 4-7 months. Half of participants were first time mothers and a third had experience weaning infants with symptoms of cows' milk allergy. Participants were prompted with questions about complementary feeding and shown several different products to stimulate discussion. Results: Thematic analysis of focus groups indicated that three distinctive groups of mothers exis