Severe Clotting During Extracorporeal Dialysis Procedures

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73576/1/j.1525-139X.1991.tb00417.x.pd

Access to long-term care after a wealth shock: evidence from the housing bubble and burst

Home equity is the primary self-funding mechanism for long term services and supports (LTSS). Using data from the relevant waves of the Health and Retirement Study (1996-2010), we exploit the exogenous variation in the form of wealth shocks resulting from the value of housing assets, to examine the effect of wealth on use of home health, unpaid help and nursing home care by older adults. We find a significant increase in the use of paid home health care and unpaid informal care but no effect on nursing home care access. We conduct a placebo test on individuals who do not own property; their use of LTSS was not affected by the housing wealth changes. The findings suggest that a wealth shock exerts a positive and significant effect on the uptake of home health and some effect on unpaid care but no significant effect on nursing home care

Kroatien lider under lidenhedens forbandelse

Intet resum

Et barn vokser ud af sine sko

Richard Swartz: Et barn vokser ud af sine sk

Right-to-Work Laws as Economic Freedom: Their Role in Influencing the Geographic Pattern of Manufacturing Jobs, Incomes, and Finances

A large empirical literature has found positive effects from economic freedom on economic outcomes, such as output and per capita economic growth. This study seeks to explain empirically the disparate timing of state manufacturing earnings and employment decline, as well as the shift among states in both manufacturing earnings and manufacturing employment resulting from right-to-work laws, which can be viewed as reflecting labor market freedom and thereby acting as a de facto economic policy. The results of the empirical estimations suggest a marked geographic shift of manufacturing employment and compensation in the U.S. during the 1970 to 2012 time period. The empirical estimations indicate that the regions of the country that have historically represented the manufacturing base have suffered the greatest relative losses in both employment and compensation during this period. In addition to regional location, it appears that right-to-work laws have had the effect of leveling manufacturing employment and compensation levels across the states since 1970. The data analysis suggests that, at least in part due to right-to-work laws, the manufacturing sectors of the states and regions are becoming increasingly similar over time, i.e., manufacturing activity that was once highly concentrated in the Great Lakes, Northeast, and Mideast has now converged significantly, with the outcome that there is little geographic difference in concentration among the eight BEA regions

The Frequency of Withdrawal from Acute Care Is Impacted by Severe Acute Renal Failure

Introduction: In the general intensive care setting, decisions to withdraw life support when patients deteriorate despite aggressive treatment are estimated to occur in 10% of all patients and in 40% of the patients who die. Acute renal failure (ARF) severe enough to necessitate renal replacement therapy (RRT) is associated with in-hospital mortality approximating 50%. Yet the impact of severe ARF on decisions to withdraw treatment has not been previously described. In chronic renal failure patients, voluntary withdrawal from maintenance dialysis occurs in 10%–20% of patients when increasing complications and poor quality of life ensue, and knowing these data facilitates discussions with patients and families. Having similar data for complicated ARF would facilitate decision making for families and caregivers when these difficult situations arise. Methods: All cases of ARF requiring RRT during 2000–2001 at University of Michigan Hospital (n = 383) were entered prospectively into an outcome study at the time RRT was initiated. Comprehensive data collection included demographic and clinical characteristics, outcome and complications, and severity of illness. Additional information for patients who died included cause of death, life-support withdrawal decisions, and the presence of prior advance directives. Results: Overall mortality in severe ARF (i.e., severe enough to require RRT) was 53%. Lifesupport withdrawal occurred in 72% of deaths (compared to 40%–50% reported among general intensive care cases) and was associated with intensive care stay well beyond 2 weeks. Severity of illness, as indicated by modified APACHE III scores, was higher in patients who died than in survivors, but severity of illness was not higher for withdrawal from treatment than death without withdrawal decisions. Life-support withdrawal was not associated with other demographic or clinical characteristics (hospital service, primary admitting diagnosis, ventilator or pressor dependence, sepsis, or initial type of RRT chosen). Prior advance directives were available in 29% of patients overall, but having advance directives did not predict withdrawal from acute treatment. Death occurred within 2 days of withdrawal in more than 90% of cases, emphasizing the severity of underlying illness. Conclusions: Severe ARF reflects the severity of underlying illness, impacts overall survival, and is associated with more frequent withdrawal from aggressive treatment. High severity of illness and prolonged intensive care without improvement beyond 2 weeks presage decisions to withdraw treatment and signal patients and caregivers that death is imminent and that further aggressive care should be reconsidered or limited.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63219/1/jpm.2004.7.676.pd

Access to long term care after a wealth shock: evidence from the housing bubble and burst

Home equity is the primary self-funding mechanism for long term services and supports (LTSS). Using data from the relevant waves of the Health and Retirement Study, we exploit the exogenous variation resulting from the value of housing assets during the Great Recession to examine the effect of housing wealth on use of home health, unpaid help and nursing home care by older adults. Consistent with the idea that individuals consume part of their housing equity during an emergency, we find evidence of a significant increase in the use of paid home health care, nursing home and unpaid informal care. The intensity of unpaid care, however, was not affected. We conduct a placebo test on individuals who do not own property; their use of LTSS was not affected by the housing wealth changes. Taken together, the findings suggest that a housing wealth shock exerts a positive and significant effect on the uptake of home health and nursing home entry and some effect on the probability of unpaid care, but no significant effect on the intensity of unpaid care

Substance Abuse and Welfare Policy at the New Century

Drawing on findings from the SSI Study and other research, this paper takes up various policy questions fundamental to any welfare program for substance abusers. The paper considers the place of disability benefits in the U.S. system of categorical aid and the problems raised by substance abuse for the disability category. It discusses the desirable objectives of a welfare program for substance abusers and the various mechanisms by which they might be achieved. And finally, it considers how any new program might be positioned in the context of categorical aid and American federalism