Consumer Demand for Health Information on the Internet

The challenges consumers face in acquiring and using information are a defining feature of health care markets. In this paper, we examine demand for health information on the Internet. We find that individuals in poor health are more likely than those in better health to use the Internet to search for health information and to communicate with others about health and health care. We also find that individuals facing a higher price to obtain information from health care professionals are more likely to turn to the Internet for health information. Our findings indicate that demand for consumer health information depends on the expected benefits of information and the price of information substitutes.

Self-Regulatory Depletion Increases Emotional Reactivity in the Amygdala

The ability to self-regulate can become impaired when people are required to engage in successive acts of effortful self-control, even when self-control occurs in different domains. Here, we used functional neuroimaging to test whether engaging in effortful inhibition in the cognitive domain would lead to putative dysfunction in the emotional domain. Forty-eight participants viewed images of emotional scenes during functional magnetic resonance imaging in two sessions that were separated by a challenging attention control task that required effortful inhibition (depletion group) or not (control group). Compared to the control group, depleted participants showed increased activity in the left amygdala to negative but not to positive or neutral scenes. Moreover, whereas the control group showed reduced amygdala activity to all scene types (i.e. habituation), the depletion group showed increased amygdala activity relative to their pre-depletion baseline; however this was only significant for negative scenes. Finally, depleted participants showed reduced functional connectivity between the left amygdala and ventromedial prefrontal cortex during negative scene processing. These findings demonstrate that consuming self-regulatory resources leads to an exaggerated neural response to emotional material that appears specific to negatively valenced stimuli and further suggests a failure to recruit top–down prefrontal regions involved in emotion regulation

Cost of inpatient rehabilitation care in the Department of Veterans Affairs

Abstract—We investigated the determinants of inpatient rehabilitation costs in the Department of Veterans Affairs (VA) and examined the relationship between length of stay (LOS) and discharge costs using data from VA and community rehabilitation hospitals. We estimated regression models to identify patient characteristics associated with specialized inpatient rehabilitation costs. VA data included 3,535 patients discharged from 63 facilities in fiscal year 2001. We compared VA costs to community rehabilitation hospitals using a sample from the Uniform Data System for Medical Rehabilitation of 190,112 patients discharged in 1999 from 697 facilities. LOS was a strong predictor of cost for VA and non-VA hospitals. Functional status, measured by Functional Independence Measure (FIM) scores at admission, was statistically significant but added little explanatory value after controlling for LOS. Although FIM scores were associated with LOS, FIM scores accounted for little variance in cost after controlling for LOS. These results are most applicable to researchers conducting cost-effectiveness analyses.average costs, billing, charges, cost, health economics, micro-cost methods, reimbursement, rehabilitation, VA, veterans

Energy Harvesting from Atmospheric Variations - Theory and Test

The last two decades have offered a dramatic rise in the use of digital technologies such as wireless sensor networks that require small isolated power supplies. Energy harvesting, a method to gather energy from ambient sources including sunlight, vibrations, heat, etc., has provided some success in powering these systems. One of the unexplored areas of energy harvesting is the use of atmospheric temperature variations to obtain usable energy. This paper investigates an innovative device to extract energy from atmospheric variations using ethyl chloride filled mechanical bellows. The apparatus consists of a bellows filled with ethyl chloride working against a spring in a closed and controlled environment. The bellows expand/contract depending upon the ambient temperature and the energy harvested is calculated as a function of the bellows’ length. The experiments showed that 6 J of energy may be harvested for a 23 degree Celsius change in temperature. The numerical results closely correlated to the experimental data with a deviation of 1%. In regions with high diurnal temperature variation, such an apparatus may yield approximately 250 uW depending on the ambient temperature range

A Study of Selected Demographic Factors Associated With Changes in Age Structure in the Population of South Dakota From 1960-1970

A study of the population profile for South Dakota for 1960 and 1970 was made to determine: (1) the changes that transpired in the composition 0£ the population for the age categories 0-4, 0-14, 15-34, 35-64, 65+ and 75+; (2) the variation in the changes observed in the selected age categories when controlled according to residence, sex and race differentials; and (3) the extent to which changes in the basic demographic components of migration, fertility and mortality are associated with changes in the age interval 0-4. Each county in South Dakota was employed as the unit of analysis, and census and vital data were aggregated and tabulated. General changes by number and percent in South Dakota\u27s population from 1960 to 1970 by size, urban-rural distribution, expected natural increase and net migration were determined and analysed [sic] by state, county and planning district. Similarly, changes in number and rates for vital events reported for South Dakota from 1960 and 1970 were determined and compared. Changes in the population were determined according to age and such selected differentials as planning district, urban-rural residence, sex and race. The association between a set of demographic variables and the declines in the number of children under five from 1960 to 1970 for the State was hypothesized and analysed [sic] using a step-wise least squares multi-variate linear equation. The major findings and conclusions were: 1. South Dakota from 1960 to 1970 declined in population, continued previous patterns of rural depopulation, urbanization and net outmigration, experienced increases in nuptuality, and recorded declines in fertility and child mortality. Variations in losses appeared associated with such factors as large urban centers, reservation Indian populations, and adjacency to State private and public colleges and universities. 2. Changes by age categories varied considerably, the largest loss occurring in interval 0-4, the largest gain in the 15-34 young adult group, and other increases occurring in age intervals 65+ and 75+. These gains appeared associated with the advance of cohorts from younger age intervals to these age categories during the decade. 3. Population redistribution from rural to urban centers was experienced in all age categories, the sex ratio declined markedly in the age dependent population, and the number of non-whites in proportion to whites increased in all categories except 75+. Urban communities appeared to have greater ability to attract selectively newcomers and to retain population levels than did rural places and farm areas. Changes in the age-sex composition of the population appeared associated with differential mortality and fertility and with selective migration

Cost data in implementation science: categories and approaches to costing

A lack of cost information has been cited as a barrier to implementation and a limitation of implementation research. This paper explains how implementation researchers might optimize their measurement and inclusion of costs, building on traditional economic evaluations comparing costs and effectiveness of health interventions. The objective of all economic evaluation is to inform decision-making for resource allocation and to measure costs that reflect opportunity costs-the value of resource inputs in their next best alternative use, which generally vary by decision-maker perspective(s) and time horizon(s). Analyses that examine different perspectives or time horizons must consider cost estimation accuracy, because over longer time horizons, all costs are variable; however, with shorter time horizons and narrower perspectives, one must differentiate the fixed and variable costs, with fixed costs generally excluded from the evaluation. This paper defines relevant costs, identifies sources of cost data, and discusses cost relevance to potential decision-makers contemplating or implementing evidence-based interventions. Costs may come from the healthcare sector, informal healthcare sector, patient, participant or caregiver, and other sectors such as housing, criminal justice, social services, and education. Finally, we define and consider the relevance of costs by phase of implementation and time horizon, including pre-implementation and planning, implementation, intervention, downstream, and adaptation, and through replication, sustainment, de-implementation, or spread

Use of the Internet for health information by the chronically ill

Introduction: Chronic conditions are among the leading causes of death and disability in the United States. The Internet is a source of health information and advice for individuals with chronic conditions and shows promise for helping individuals manage their conditions and improve their quality of life. Methods: We assessed Internet use for health information by people who had one or more of five common chronic conditions. We conducted a national survey of adults aged 21 and older, then analyzed data from 1980 respondents who had Internet access and who reported that they had hypertension, diabetes, cancer, heart problems, and/or depression. Results: Adjusted rates for any Internet use for health information ranged from 33.8% (heart problems only) to 52.0% (diabetes only). A sizable minority of respondents — particularly individuals with diabetes — reported that the Internet helped them to manage their condition themselves, and 7.9% said information on the Internet led them to seek care from a different doctor. Conclusion: Use of the Internet for health information by chronically ill patients is moderate. Self-reported effects on choice of treatment or provider are small but noteworthy

The Costs of an Outreach Intervention for Low-Income Women With Abnormal Pap Smears

INTRODUCTION: Follow-up among women who have had an abnormal Papanicolaou (Pap) smear is often poor in public hospitals that serve women at increased risk for cervical cancer. This randomized controlled trial evaluated and compared the total cost and cost per follow-up of a tailored outreach intervention plus usual care with the total cost and cost per follow-up of usual care alone. METHODS: Women with an abnormal Pap smear (n = 348) receiving care at Alameda County Medical Center (Alameda County, California) were randomized to intervention or usual care. The intervention used trained community health advisors to complement the clinic's protocol for usual care. We assessed the costs of the intervention and the cost per follow-up within 6 months of the abnormal Pap smear test result. RESULTS: The intervention increased the rate of 6-month follow-up by 29 percentage points, and the incremental cost per follow-up was $959 (2005 dollars). The cost per follow-up varied by the severity of the abnormality. The cost per follow-up for the most severe abnormality (high-grade squamous intraepithelial lesion) was$681, while the cost per follow-up for less severe abnormalities was higher. CONCLUSION: In a health care system in which many women fail to get follow-up care for an abnormal Pap smear, outreach workers were more effective than usual care (mail or telephone reminders) at increasing follow-up rates. The results suggest that outreach workers should manage their effort based on the degree of abnormality; most effort should be placed on women with the most severe abnormality (high-grade squamous intraepithelial lesion)

Socially Excluded Individuals Fail to Recruit Medial Prefrontal Cortex for Negative Social Scenes

Converging behavioral evidence suggests that people respond to experiences of social exclusion with both defensive and affiliative strategies, allowing them to avoid further distress while also encouraging re-establishment of positive social connections. However, there are unresolved questions regarding the cognitive mechanisms underlying people\u27s responses to social exclusion. Here, we sought to gain insight into these behavioral tendencies by using functional magnetic resonance imaging (fMRI) to examine the impact of social exclusion on neural responses to visual scenes that varied on dimensions of sociality and emotional valence. Compared to socially included participants, socially excluded participants failed to recruit dorsomedial prefrontal cortex (dmPFC), a brain region involved in mentalizing, for negative social scenes. Moreover, following social exclusion, dmPFC demonstrated a linear effect of valence, with greater activity to positive social scenes compared to negative social scenes. These results suggest that, following social exclusion, people display a preference for mentalizing about positive social information and tend to avoid negative aspects of their social world