The Magnitude and Nature of Risk Selection in Employer-Sponsored Health Plans

Most existing studies of risk selection in the employer-sponsored health insurance market are case studies of a single employer or of an employer coalition in a single market. We examine risk selection in the employer-sponsored market by applying a switcher' methodology to a national, panel data set of enrollees in employer-sponsored health plans. We find that people who switched from a non-HMO to an HMO plan used 11 percent fewer medical services in the period prior to switching than people who remained in the non-HMO plan, and that this relatively low use persists once they enroll in an HMO. Furthermore, people who switch from an HMO to a non-HMO plan used 18 percent more medical services in the period prior to switching than those who remained in an HMO plan. HMOs would most likely continue to experience favorable risk selection if employers adjusted health plan payments based on enrollees' gender and age because the selection appears to occur based on enrollee characteristics that are difficult to observe such as preferences for medical care and health status.

The ISCIP Analyst, Volume VIII, Issue 4

This repository item contains a single issue of The ISCIP Analyst, an analytical review journal published from 1996 to 2010 by the Boston University Institute for the Study of Conflict, Ideology, and Policy

The ISCIP Analyst, Volume VII, Issue 20

This repository item contains a single issue of The ISCIP Analyst, an analytical review journal published from 1996 to 2010 by the Boston University Institute for the Study of Conflict, Ideology, and Policy

Playshops: Workshop series exploring play

Playshops was a collaborative project between OCAD University research labs, faculty, and Symon Oliver of ALSO Collective. Expanding on the conventional model of academic workshops, Playshops incorporated both theory and practice in an attempt to investigate methods of play and how they relate to research and innovation. The workshop itself was composed of practice-based exercises followed by discussion periods. The documentation, and post-workshop writing was gathered and designed into the Playshops publication. The publication can be read cover to cover as a conventional book; however, the signatures fold out into posters that relate to the individual exercises on play

Do children with recurrent abdominal pain grow up to become adolescents who control their weight by fasting?:Results from a UK population-based cohort

Objective Gastrointestinal (GI) problems are common in eating disorders, but it is unclear whether these problems predate the onset of disordered eating. Recurrent abdominal pain (RAP) is the most prevalent GI problem of childhood, and this study aimed to explore longitudinal associations between persistent RAP (at ages 7 and 9) and fasting for weight control at 16. Method The Avon Longitudinal Study of Parents and Children (ALSPAC) is a UK population cohort of children. Childhood RAP was reported by mothers and defined as RAP 5+ (5 pain episodes in the past year) in our primary analysis, and RAP 3+ (3 pain episodes) in our sensitivity analysis. Fasting for weight control was reported by adolescents at 16. We used logistic regression models to examine associations, with adjustments for potential confounders. Results After adjustments, we found no association between childhood RAP 5+ and adolescent fasting for weight control at 16 (OR 1.30 (95% Confidence Intervals [CI] 0.87, 1.94) p = .197). However, we did find an association between RAP 3+ and later fasting, in the fully adjusted model (OR 1.50 [95% CI 1.16, 1.94] p = .002), and after excluding those with pre‐existing anxiety (OR 1.52 [95% CI 1.17, 1.97] p = .002). Discussion Our findings suggest a possible independent contribution of RAP to later risk of fasting for weight control, and RAP should be enquired about in the assessment of eating disorders. However, frequency of childhood abdominal pain (as captured by ALSPAC) may be less important to long‐term outcomes than functional impairment

The predictive value of childhood recurrent abdominal pain for adult emotional disorders, and the influence of negative cognitive style. Findings from a cohort study

Background Recurrent abdominal pain (RAP) in childhood is common, with no explanatory pathology identified in the majority of cases. Previous studies have consistently demonstrated an association between childhood RAP and later emotional distress disorders. The aim of this study was to replicate this finding through the analysis of a large dataset, and explore how a negative style of thinking could potentially influence this relationship. Methods The Avon Longitudinal Study of Parents and Children (ALSPAC) is a population cohort of children born in the Avon area of the UK, between 1991±1992. Data on childhood RAP was collected via maternal reports at 3, 4, 7 and 9 years. Mood, anxiety and cognitive style were measured at age 18. We controlled for various confounding factors, including maternal anxiety and the child's pre-existing psychopathology. Logistic regression models were used to examine associations, and moderation effects of cognitive style were analysed using likelihood ratios. Results Experiencing RAP at any one time-point is associated with an increased odds of depression and/or anxiety disorder at 18 (OR = 1.41, 95% CI 1.09±1.83). We found a dose-response relationship and each additional marker of RAP was associated with a 26% (CI: 7% to 47%) increase in risk of having a mood and/or anxiety disorder. Individuals who attribute adversity to global, stable or personal factors were at amplified risk. Conclusions Childhood RAP predicts depression and anxiety disorders at 18 and should be targeted for early intervention. Individuals with a negative cognitive style may be particularly vulnerable, suggesting that cognitive interpretations of physical symptoms could play an important role in long-term health outcomes.</p

Factors influencing the implementation of fall-prevention programmes: a systematic review and synthesis of qualitative studies

BACKGROUND: More than a third of people over the age of 65 years fall each year. Falling can lead to a reduction in quality of life, mortality, and a risk of prolonged hospitalisation. Reducing and preventing falls has become an international health priority. To help understand why research evidence has often not been translated into changes in clinical practice, we undertook a systematic review and synthesis of qualitative research in order to identify what factors serve as barriers and facilitators to the successful implementation of fall-prevention programmes. METHODS: We conducted a review of literature published between 1980 and January 2012 for qualitative research studies that examined barriers and facilitators to the effective implementation of fall-prevention interventions among community-dwelling older people and healthcare professionals. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality according to predefined criteria. Findings were synthesised using meta-ethnography. RESULTS: Of the 5010 articles identified through database searching, 19 were included in the review. Analysis of the 19 studies revealed limited information about the mechanisms by which barriers to implementation of fall-prevention interventions had been overcome. Data synthesis produced three overarching concepts: (1) practical considerations, (2) adapting for community, and (3) psychosocial. A line of argument synthesis describes the barriers and facilitators to the successful implementation of fall-prevention programmes. These concepts show that the implementation of fall-prevention programmes is complex and multifactorial. This is the first systematic review and synthesis of qualitative studies to examine factors influencing the implementation of fall-prevention programmes from the perspectives of both the healthcare professional and the community-dwelling older person. CONCLUSIONS: The current literature on barriers and facilitators to the implementation of fall-prevention programmes examines a variety of interventions. However, the ways in which the interventions are reported suggests there are substantial methodological challenges that often inhibit implementation into practice. We recommend that successful implementation requires individuals, professionals, and organisations to modify established behaviours, thoughts, and practice. The issues identified through this synthesis need to be fully considered and addressed if fall-prevention programmes are to be successfully implemented into clinical practice.National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West of EnglandEuropean Regional Development FundEuropean Social Fund Convergence Programme for Cornwall and the Isles of Scill

Inhibition of Voltage-Gated Hv1 Channel by Guanidine Derivatives

This repository item contains a single issue of The ISCIP Analyst, an analytical review journal published from 1996 to 2010 by the Boston University Institute for the Study of Conflict, Ideology, and Policy