6 research outputs found
Moving to Mellow: How the New Medical Marijuana Policy at the U.S. Department of Veterans Affairs Fits into the Growing Effort to Legalize Pot in America
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Structural adjustment and subsistence industry: artisanal gold mining in Ghana
Since the implementation of Ghana's national Structural Adjustment Programme (SAP), policies associated with the programme have been criticized for perpetuating poverty within the country's subsistence economy. This article brings new evidence to bear on the contention that the SAP has both fuelled the uncontrolled growth of informal, poverty-driven artisanal gold mining and further marginalized its impoverished participants. Throughout the adjustment period, it has been a central goal of the government to promote the expansion of large-scale gold mining through foreign investment. Confronted with the challenge of resuscitating a deteriorating gold mining industry, the government introduced a number of tax breaks and policies in an effort to create an attractive investment climate for foreign multinational mining companies. The rapid rise in exploration and excavation activities that has since taken place has displaced thousands of previously-undisturbed subsistence artisanal gold miners. This, along with a laissez faire land concession allocation procedure, has exacerbated conflicts between mining parties. Despite legalizing small-scale mining in 1989, the Ghanaian government continues to implement procedurally complex and bureaucratically unwieldy regulations and policies for artisanal operators which have the effect of favouring the interests of established large-scale miners
Effect of Advanced Access Scheduling on Processes and Intermediate Outcomes of Diabetes Care and Utilization
BACKGROUND
The impact of open access (OA) scheduling on chronic disease care and outcomes has not been studied.
OBJECTIVE
To assess the effect of OA implementation at 1 year on: (1) diabetes care processes (testing for A1c, LDL, and urine microalbumin), (2) intermediate outcomes of diabetes care (SBP, A1c, and LDL level), and (3) health-care utilization (ED visits, hospitalization, and outpatient visits).
METHODS
We used a retrospective cohort study design to compare process and outcomes for 4,060 continuously enrolled adult patients with diabetes from six OA clinics and six control clinics. Using a generalized linear model framework, data were modeled with linear regression for continuous, logistic regression for dichotomous, and Poisson regression for utilization outcomes.
RESULTS
Patients in the OA clinics were older, with a higher percentage being African American (51% vs 34%) and on insulin. In multivariate analyses, for A1c testing, the odds ratio for African-American patients in OA clinics was 0.47 (CI: 0.29-0.77), compared to non-African Americans [OR 0.27 (CI: 0.21-0.36)]. For urine microablumin, the odds ratio for non-African Americans in OA clinics was 0.37 (CI: 0.17-0.81). At 1 year, in adjusted analyses, patients in OA clinics had significantly higher SBP (mean 6.4 mmHg, 95% CI 5.4 – 7.5). There were no differences by clinic type in any of the three health-care utilization outcomes.
CONCLUSION
OA scheduling was associated with worse processes of care and SBP at 1 year. OA clinic scheduling should be examined more critically in larger systems of care, multiple health-care settings, and/or in a randomized controlled trial