Controlling Costs and Increasing Access to Prescription Drugs: State and Federal Solutions

Spending on health care in the United States continues to increase rapidly, consuming a greater share of the total economy each year. Over the past decade, prescription drug spending has been the fastest growing component of health care expenditures both nationwide and in Washington state. The federal government, state governments, individuals and employers all pay for prescription drugs, and everyone is affected by rising costs. While it is true that overall drug prices have gone up, and in many cases at more than triple the rate of inflation, price increases alone do not account for the drastic increase in spending on pharmaceuticals. The three biggest cost drivers, in order, are:1) the average person fills more prescriptions than ever before (increased utilization),2) new classes of drugs arrive on the market in high demand and at high prices, and3) pharmaceutical companies hike prices on existing drugs. Double-digit increases in total prescription drug costs create two interrelated problems. First, higher prices mean less access for uninsured individuals, and often a difficult choice for the poor: to treat or eat? Second, increased drug spending forces state governments to face a similar choice: to continue funding drug coverage for seniors, the disabled and others at escalating prices and pay for it by cutting teacher salaries, raising taxes, and underfunding firehouses, or to roll back drug benefits and eligibility for already vulnerable groups? While Congress has thus far failed to pass Medicare prescription drug or generic drug legislation, and the executive branch has taken a hands-off approach, the states have taken the lead in designing innovative policies to reduce manufacturer prices and expand access to necessary drugs. Legislation in Washington state, debated in 2002 and expected to be reintroduced in 2003, would allow the state to evaluate the benefits and costs of various and competing prescription drugs, negotiate price discounts for the best-value drugs, and pass the savings on to those who lack prescription drug coverage. Allowing the state to shop smarter is a sensible, near-term way for Washington to address the related problems of access and cost. Furthermore, an emerging consensus among states may drive more fundamental policy changes at the federal level

Temporal Stability in a Marine-Freshwater Stickleback Cline

Populations that live along an environmental gradient (i.e., location of gradual change in environmental factors over space) will adapt to local conditions, thereby creating a trait gradient; also called a cline. We replicated a study by Vines et al. (2016) in Bonsall Creek which studied how five traits evolved along the gradient (i.e., the shape and position of their clines). We found that two of the five traits showed consistent patterns across time; armor traits that experienced loss. The temporal instability in non-armor traits suggests that the environmental conditions that generate selection for those traits are more variable through time

THE CHALLENGES TO THE IMPLEMENTATION OF ADMINISTRATION FOR CHILDREN AND FAMILIES MEMORANDUM: FOSTER CARE AS A SUPPORT TO FAMILIES

The purpose of this study was to assess what challenges, if any, there are to implementing the best practices as indicated in IM 20-06. IM 20-06 shifts the role of resource parents (aka foster parents) from being solely a support for the children, to a support for the entire family, including the biological parents. This represents a major child welfare culture shift. It was unknown if the IM information and recommendations were effectively disseminated to all foster care agencies. Interviews were conducted with foster agency case workers with open-ended questions about their beliefs about the relationships between resource parents and biological parents (the parental sets), how frequently they should communicate if at all, and what trainings and supports all parties are receiving regarding developing and maintaining these relationships. Analysis of the interviews indicates that social workers in local foster family agencies (FFA) have not been trained nor are they supported in the practices outlined in the IM. The implications of this means there has not been adequate dissemination of this information and it has not become local policy yet. Further, there are consequences of continued lower reunification rates than necessary by not creating these policies. Recommendations in order to assess the challenges with the implementation and of the IM include conducting interviews in areas that have incorporated the IM and have developed policies and programs. Additionally, addressing the realization of it locally is recommended

Relationship education and marital satisfaction in newlywed couples: A propensity score analysis.

The purpose of this study was to investigate whether premarital relationship education and characteristics of relationship education in a community sample of newlywed couples predicted marital trajectories over 27 months. Newlywed couples (N = 191) completed measures of marital satisfaction 9 times over 27 months, and prior to marriage they provided information about relationship education and demographic, personal, and relationship risk factors for marital distress. Propensity scores (i.e., the probability of receiving relationship education) were estimated using the marital distress risk factors, and used to derive a matched sample of 72 couples who participated in relationship education and 86 couples who did not. Multilevel analyses of the propensity score matched sample (n = 158) indicated that wives who participated in relationship education had declines in marital satisfaction while wives who did not receive relationship education maintained satisfaction over time. Furthermore, the more hours of relationship education the couple participated in, the less steeply their marital satisfaction declined. Findings indicate that participation in community-based relationship education may not prevent declines in marital satisfaction for newlywed couples. A possible explanation is that the quality of relationship education available to couples is generally poor and could be greatly improved by inclusion of empirically based relationship information and skills training that are known to lead to stronger marriages

A Focused Review of Multidimensional Well-Being Assessments

Introduction: Interest in the topic of well-being continues to grow and has resulted in the creation of a variety of well-being assessments. However, each assessment often brings its own terminology, theories, definitions, and dimensions. This creates a muddled research base that produces inconsistencies in the field of well-being. Therefore, the aim of this review was to identify assessments that measure multiple dimensions of well-being, catalogue and group the dimensions into categories, and develop definitions for the categories based on the conceptualizations in the literature. In doing so, the dimensionality of well-being portrayed in the literature can be better understood. Methods: Web of Science, MEDLINE, and PsycINFO were used to search for journal articles with the key words well-being, wellbeing, and wellness from 1990 to 2020. Two researchers independently reviewed the search results and obtained 30 articles that met the selection criteria for a total of 26 assessments of well-being. From these 26 well-being assessments, 205 dimensions were identified and cataloged. Two researchers sorted the dimensions into categories first based on similar labels, then by definition. Descriptions of the categories were created from the dimensions. Results: The 205 well-being dimensions fit into 12 categories: physical, social, spiritual, emotional, environment, mental / intellectual, occupational, energy, achievement, engagement, purpose, and capability. Most assessments centered around 4 primary categories: social (present in 80% of assessments), emotional (77%), physical (69%), and capability (54%); no measure had dimensions in all 12 categories. The energy category provided a unique measure of well-being meriting further investigation. Conclusions: The literature on the measurement of well-being continues to grow, creating a multitude of assessments from which to choose. There has yet to be a broad multidimensional measure that captures all 12 well-being categories utilized disjointly in the well-being literature. This review provides a better understanding of the dimensions currently in use in the measurement of well-being. Further research is warranted to corroborate these findings and investigate how well-being measurement can be improved

Businesswomen in Small Town Nebraska

Social and economic changes during the past two decades have contributed to a substantial increase in the number of women participating in the American work force. The women\u27s movement, for example, has increased the social acceptability of married women working outside the home and has raised single and married women\u27s professional expectations and opportunities. From an economic perspective, inflation has probably motivated more married women to seek employment, and, at least until the past few years, the American economy has been healthy enough to provide jobs for most of them

Novel Imaging Tools Reveal the Dynamics of the Myocardial Growth Hormone Secretagogue Receptor in Heart Disease and Heart Failure

Heart disease (HD) is the leading cause of mortality worldwide. Currently, diagnosis is based on clinical features, imaging, and circulating cardiac biomarkers. Cardiac imaging technologies, such as echocardiography and cardiac magnetic resonance imaging (cMRI), enable the non-invasive detection of changes in heart function. Although these modalities can detect changes in structure and anatomy, it is usually at later stages, where prevention may not be possible. In conjunction with imaging, circulating biomarkers of heart failure (HF), notably B-type natriuretic peptide (BNP) and cardiac troponin I and T, can be detected with increased levels in the blood. These biomarkers are associated with other comorbidities and may not be specific to cardiac tissue. Thus, there is a critical need to develop imaging agents to detect the biochemical and molecular changes that precede gross structural changes in HD. There is evidence that the growth hormone secretagogue receptor (GHSR) and its ligand ghrelin, could be a potential molecular imaging target where expression is increased in HF. The purpose of my work was to characterize GHSR as a biomarker for the underlying biological mechanisms involved in heart disease and heart. To characterize GHSR in end stage HF and valvular HD in humans, I used quantitative fluorescence microscopy with a custom far-red ghrelin analog to evaluate changes in the ghrelin-GHSR system and its downstream signalling. In this way, the ghrelin-GHSR system was elevated in HF and showed specific regional changes in HD. The ghrelin-GHSR system was correlated to heart function through left ventricular ejection fraction in HF while this system correlates regionally in only the left atrium in HD and no correlations are present in healthy tissue. Therefore, the ghrelin-GHSR system shows scalability from healthy to HD to HF. After characterization of ghrelin-GHSR in the human heart, I evaluated this system using ­in vivo imaging techniques to track the heart after a myocardial infarction in canines. A novel molecular imaging agent demonstrated a unique binding pattern in the heart before and after a myocardial infarction. This binding pattern did not simply reflect cardiac perfusion showing specificity and correlated strongly with histological analysis of this system in the heart showing sensitivity. Therefore, I identified a novel in vivo imaging agent to bind specifically and selectively in the canine heart. In summary, my thesis describes the characterization of the changes in the myocardial ghrelin-GHSR system using novel imaging agents in situ and in vivo. These findings have important clinical application for the early detection of HD