Advocacy coalitions involved in California's menu labeling policy debate: Exploring coalition structure, policy beliefs, resources, and strategies.

Advocacy coalitions often play an important role in the state health policymaking process, yet little is known about their structure, composition, and behavior. In 2008, California became the first state to enact a menu labeling law. Using the advocacy coalition framework, we examine different facets of the coalitions involved in California's menu labeling policy debate. We use a qualitative research approach to identify coalition members and explore their expressed beliefs and policy arguments, resources, and strategies by analyzing legislative documents (n = 87) and newspaper articles (n = 78) produced between 1999 and 2009. Between 2003 and 2008, six menu labeling bills were introduced in the state's legislature. We found the issue received increasing media attention during this period. We identified two advocacy coalitions involved in the debate-a public health (PH) coalition and an industry coalition. State organizations acted as coalition leaders and participated for a longer duration than elected officials. The structure and composition of each coalition varied. PH coalition leadership and membership notably increased compared to the industry coalition. The PH coalition, led by nonprofit PH and health organizations, promoted a clear and consistent message around informed decision making. The industry coalition, led by a state restaurant association, responded with cost and implementation arguments. Each coalition used various resources and strategies to advance desired outcomes. PH coalition leaders were particularly effective at using resources and employing advocacy strategies, which included engaging state legislators as coalition members, using public opinion polls and information, and leveraging media resources to garner support. Policy precedence and a local policy push emerged as important policymaking strategies. Areas for future research on the state health policymaking process are discussed

X-ray Observations of Distant Optically Selected Cluster

We have measured fluxes or flux limits for 31 of the 79 cluster candidates in the Palomar Distant Cluster Survey (PDCS) using archival ROSAT/PSPC pointed observations. Our X-ray survey reaches a flux limit of $\simeq 3 \times 10^{-14}$ erg s$^{-1}$ cm$^{-2}$ (0.4 - 2.0 keV), which corresponds to luminosities of $L_x\simeq 5 \times 10^{43}$ erg s$^{-1}$ ($H_o$ = 50 km s$^{-1}$ Mpc$^{-1}$, $q_o$ = ${1/2}$), if we assume the PDCS estimated redshifts. Of the 31 cluster candidates, we detect six at a signal-to-noise greater than three. We estimate that $2.9^{+3.3}_{-1.4}$ (90% confidence limits) of these six detections are a result of X-ray emission from objects unrelated to the PDCS cluster candidates. The net surface density of X-ray emitting cluster candidates in our survey, $1.71^{+0.91}_{-2.19}$ clusters deg$^{-2}$, agrees with that of other, X-ray selected, surveys. It is possible, given the large error on our contamination rate, that we have not detected X-ray emission from any of our observed PDCS cluster candidates. We find no statistically significant difference between the X-ray luminosities of PDCS cluster candidates and those of Abell clusters of similar optical richness. This suggests that the PDCS contains objects at high redshift similar to the low redshift clusters in the Abell catalogs. We show that the PDCS cluster candidates are not bright X-ray sources, the average luminosity of the six detected candidates is only $\bar{L_x}=0.9\times10^{44}$ erg s$^{-1}$ (0.4-2.0 keV). This finding is in agreement with previous X-ray studies of high redshift, optically selected, rich clusters of galaxies.Comment: 19 pages, LaTeX with AAS Preprint Macros (v. 4), 3 embedded postscript figures, 3 Seperate Tables using aj_pt4.sty, Accepted by the Astronomical Journal for November 199

A feral family on our doorstep

A family was discovered living in isolation in the Free State region of South Africa. Certain members of this family, (the mother and three sons and a daughter) displayed primitive and ape-like behaviour, prompting the local and international press to refer to them as a feral family. The affected members of the family are presented as a case study describing how the family became isolated, their response to outside intervention and eventually how the family was “discovered”. Clinical presentations are also documented as well as the therapeutic interventions used. After evaluation, the affected members of the family were shown to have various degrees of mental retardation. The words ‘feral' and ‘neglect' are defined and certain similar documented cases of feral children discovered previously in other regions are mentioned. The etiology of the condition is explored, discussing the effects of the environment on various aspects of neural development in children, especially referring to the lack of neuro-stimulation and other insults to the brain during the critical phase of brain plasticity. Cognitive deficits, poor mastery of language and decrease in brain size are often found in feral children. The role of a child's genetic predisposition and a paucity of environmental stimulation is also explained in the article. South African Psychiatry Review Vol. 9(4) 2006: 231-23

The Economic Impact of Payer Policies after the Rx-to-OTC Switch of Second-Generation Antihistamines* *Preliminary results of this analysis were presented at the 9th annual HMO Research Network Conference April 1-2, 2003

AbstractObjectiveAs a result of the over-the-counter (OTC) introduction of loratadine, health plans have been struggling to determine the best policy to incorporate this change within their existing drug benefit structure for second-generation antihistamines (SGA). The objective of this study was to examine the economic impact of payer policies in response to the Rx-to-OTC switch of loratadine.Study DesignDecision analysis was used to model the budgetary impact and cost-effectiveness of four policies for SGA benefits for the managed care organization (MCO), employer, and Medicaid perspectives separately.Patients and MethodsOutcomes included direct medical costs and lost productivity (employers only), discounted, quality-adjusted life-years (QALYs) saved because of amelioration of allergic rhinitis symptoms and avoidance of unintentional injuries associated with the use of first-generation antihistamines (FGA). Bayesian probabilistic sensitivity analysis was conducted using second-order Monte Carlo simulation.ResultsProviding limited OTC and second-tier prescription benefits would cost approximately $0.13 and$0.30 compared to third-tier prescription benefits for employers and MCOs, respectively, and would save Medicaid $.02 per member per month (PMPM). Providing limited coverage for OTC loratadine while retaining second-tier prescription benefits for SGA was the optimal policy for a willingness to pay below$26,200 per QALY for all payers.ConclusionsOffering second-tier prescription and limited OTC benefits provides greater effectiveness and is not significantly more expensive PMPM than discontinuation. Some of the drug savings from limiting coverage of prescription SGA may be attenuated by the cost of lost productivity and direct medical expenditures due to unintentional injuries associated with increased FGA use in addition to the increased cost of therapeutic substitutes