Paying for health care in Vietnam: extending voluntary health insurance coverage

This discussion paper aims to synthesise a variety of reports and research projects conducted by the International Programme at the Centre for Health Economics, concerning the Vietnamese health system, over the past 4 years. In particular it focuses on the development of the state voluntary health insurance scheme which is the subject of a current DFID-funded research project. Previous work conducted by the members of the International Programme includes an investigation into the impact of economic reforms on the health system, an evaluation of the impact of user charges on access to health services amongst the poor, and a report providing an analysis of the state health insurance programme. The aim of the current research project is to analyse the experience of voluntary health insurance to date, making recommendations to policy-makers on its future development. A large household survey will form part of the investigations. The paper presents the situation to date, highlighting major developments, successes and failures, and the main challenges facing the scheme. The research project started in July 1998 and is due to be completed in March 2000.GDP, health insurance

Unofficial payments for acute state hospital care in Kazakhstan. A model of physician behaviour with price discrimination and vertical service differentiation

We consider a discriminatory pricing and service differentiation model where: a)state physicians exploit their monopoly position and adjust quality to the unofficial payment made, and b)patients, perceiving state provision as poor, pay unofficially to improve it. Applying OLS and probit analysis to survey data on patients discharged from Almaty City hospitals, and using admission wait, length of stay (LOS) and a subjective categorical variable as quality measures. Unofficial payments are positively associated with surgical admission wait and the subjective quality of care while negatively associated with hospital LOS. Evidence suggests that price discrimination and service differentiation takes place in Kazakhstan.transition economies, unofficial or informal payments for health care, length of stay, ordered probit and marginal effects

NEET young people and the labour market: working on the margins

This paper is based on findings from a longitudinal study of twenty young people who have spent significant periods of time categorised as NEET (not in education, employment or training). Drawing on three years of ethnographic research conducted across two local authorities in the north of England, it focuses on the lived experience of a set of young people as they move between various sites of exclusion and participation in the labour market. Central to the paper are the experiences of three individuals and their attempts to begin work in the retail, care and catering industries. The paper illustrates a range of tensions between the aspirations of young people and the opportunities open to them. It provides a critical insight into some of the conditions which characterise work on the fringes of the labour market and the inter-play between these and the attitudes, values and dispositions of the young people taking part in the research. The paper’s findings challenge popular discourses about young people on the margins of participation and pose questions about the articulation between education, work and training for those seeking to enter the labour market

Statistical methods and applications to animal breeding

This thesis comprises a collection of 39 research papers divided into three groups. The first group discusses the development of statistical methods, especially novel methods of variance component estimation, with general application. The second group examines the potential use of statistical methods in animal breeding studies, ranging from the construction of new experimental designs to the analysis of non-normal data. The third group reports on studies on animal breeding data in beef and dairy cattle.Group I is entitled "Statistical methods, including variance component estimation, with general application". The major theme of this group is the estimation of variance components. Some previous work based on methods for balanced data, gave rise to methods that were neither unique nor efficient and other methods gave results that are inconsistent with the analysis of variance for balanced data. A method was introduced, now known as REML (Residual Maximum Likelihood) that unifies the area. The method was introduced for the analysis of incomplete block designs with unequal block size but was found to have important applications in the analysis of groups of similar trials, time-series and animal breeding. Papers investigating REML estimation for multivariate data, time-series and detecting outliers are included. The relationship of REML to other methods is elucidated, especially for balanced and partially balanced designs. Computational strategies are discussed.The last two papers in the group illustrate a method of analysis of dial lei crosses that involves using multiple copies of the data. This idea of using multiple copies was shown also to be useful in the analysis of rectangular lattice designs and in the interpretation of some recently introduced neighbour analyses of field trials.The next group of papers, Group II, report on "Application of statistical methods to animal breeding studies". The work on variance components has some application in animal breeding and I have built on these links. Four papers consider efficient designs for estimation of genetic parameters, including designs for estimating heritability from data on two generations of data, for estimating maternal genetic variances, for estimating parent-offspri ng regression and for estimating multivariate genetic parameters. These designs can lead to substantial reductions in the variances of the estimates of the parameters, compared with classical designs, halving variances in some cases. Other papers have shown how to efficiently estimate heritability from unbalanced data, both from two generations of data and from more than two generations.Often in animal breeding experiments animals used as parents are not selected at random, but selected on phenotypic measurements, perhaps of relatives. This can cause bias in some methods of estimation. On the other hand REML estimates can take account of the selection process. Selection experiments and the estimation of realised heritability are discussed.REML estimation has found widespread acceptance by animal breeders, partly because some quantities arising in the methods were terms that animal breeders use in evaluating animals. It was shown how to improve one method of evaluation and methods of evaluating sires were reviewedSome work is included on multivariate evaluation. It is shown how the complex multivariate calculations can be reduced to simpler univariate calculations using a canonical transformation, how results on selection indices can be used to interpret multivariate predictions. A simple interpretation of quadratic selection indices is given.Other work considered some parallel problems with non-normal data. In particular for binary data, estimation of heritability, optimal designs for estimation of heritability and prediction of breeding values. It was shown how to estimate genotype frequencies using generalised linear model methods and > h? suggested how to evaluate animals worth and estimate genetic parameters when the data fits a generalised linear model.The last group, Group III, is entitled "Experimental studies". These include reports on a long term study of evaluation of breeds and cross-breeding in beef cattle in Zambia. The section also examines the genetic relationship between meat and milk production in British Friesian cattle. The validity of models used in dairy sire evaluation are investigated including the heterogeneity of heritability of milk yield at different levels of production and the use of a novel model for taking account of environmental variation within herds.GROUP I: STATISTICAL METHODS INCLUDING VARIANCE COMPONENT ESTIMATE WITH GENERAL APPLICATION01. R. THOMPSON. 1969. Iterative estimation of variance components for non-orthogonal data. Biometrics 25, 767-773. || 02. H.D. PATTERSON and R. THOMPSON. 1971. Recovery of inter-block information when block sizes are unequal. Biometrika 58, 545-554. || 03. H.D. PATTERSON and R. THOMPSON. 1975. Maximum likelihood estimation of components of variance. Proceedings of the 8th International Biometric Conference. Ed. L.C.A. Corsten and T. Postelnicu, 199-207. || 04. R. THOMPSON. 1980. Maximum likelihood estimation of variance components. Math. Operationsforsh. Statist. ljU 545-561. || 05. R. THOMPSON. 1978. The estimation of variance and covariance components with an application when records are subject to culling. Biometrics 29, 527-550. || 06. L.R. SCHAEFFER, J.W. WILTON and R. THOMPSON. 1978. Simultaneous estimation of variance and covariance components from multitrait mixed model equations. Biometrics 34, 199-208. || 07. D.M. COOPER and R. THOMPSON. 1977 . A note on the estimation of the parameters of the autoregressive-moving average process. Biometrika 64, 625-628. || 08. R. THOMPSON. 1985. A note on restricted maximum likelihood estimation with an alternative outlier model. J.R. Statist. Soc. B 47, 53-55. || 09. R. THOMPSON. 1975. A note on the W transformation. Technometrics J7, 511-512. || 10. R. THOMPSON and K. MEYER. 1986. Estimation of variance components : what is missing in the EM algorithm? J. Statist. Comput. Simul. 24 215-230. || 11. D.L. ROBINSON, R. THOMPSON and P.G.N. DIGBY. REML. 1982. A program for the analysis of non-orthogonal data by restricted maximum likelihood. COMPSTAT 1982, II. Eds. H. Cassinus, P. Ettinger and J.R. Mattieu. Physica-Verlag, Wien 231-232. || 12. R. THOMPSON. 1983. Dial lei crosses, partially balanced incomplete block designs with triangular association schemes and rectangular lattices. GENSTAT newsletter JJ3, 16-32. || 13. R. THOMPSON. 1984. The use of multiple copies of data in forming and interpreting analysis of variance. Experimental design, Statistical Methods and Genetic Statistics. Ed. K. Hinkelmann. Marcel Dekker, New York, 155-174.GROUP II: APPLICATION OF STATISTICAL METHODS TO ANIMAL BREEDING STUDIES14. R. THOMPSON. 1976. The estimation of maternal genetic variances. Biometrics 32 903-917. || 15. R. THOMPSON. 1976. Design of experiments to estimate heritability when observations are available on parents and offspring. Biometrics 32 283-304. || 16. W.G. HILL and R. THOMPSON. 1977. Design of experiments to estimate parent-offspring regression using selected parents. Anim. Prod. 24, 163-168. || 17. N.D. CAMERON and R. THOMPSON. 1986. Design of multivariate selection experiments to estimate genetic parameters. Theor. Appl. Genet. 72, 466-476. || 18. R. THOMPSON. 1977. The estimation of heritability with unbalanced data. I. Observations available on parents and offspring. Biometrics 33, 485-495. || 19. R. THOMPSON. 1977. The estimation of heritability with unbalanced data. II. Data available on more than two generations. Biometrics 33, 495-504. || 20. R. THOMPSON. 1977. The estimation of heritability with unbalanced data. III. Unpublished Appendices, 1-17. || 21. R. THOMPSON. 1976. Estimation of quantitative genetic parameters. Proceedings of the International Conference on Quantitative Genetics. Ed. 0. Kempthorne, E. Pollak and T. Bailey. Iowa State University press, Ames, Iowa, 639-657. (vii) || 22. W.G. HILL and R. THOMPSON. 1978. Probabilities of non-positive definite between group or genetic covariance matrices. Biometrics 34, 429-439. || 23. K. MEYER and R. THOMPSON. 1984. Bias in variance and covariance component estimators due to selection on a correlated trait. Z. Tierzucht. Zuchtungsbiol. 101, 33-50. || 24. R. THOMPSON. 1976. Relationship between the cumulative different and best linear unbiased predictor methods of evaluating bulls. Anim. Prod. 23^, 15-24. || 25. R. THOMPSON. 1979. Sire Evaluation. Biometrics 35, 339-353. || 26. R. THOMPSON. 1986. Estimation of realised heritability in a selected population using mixed model methods. Genet. Sel. Evol . 475-484. || 27. R. THOMPSON. 1972. The maximum likelihood approach to the estimate of liability. Anim. Hum. Genet. 36, 221-231. || 28. R. THOMPSON, B.J. McGUIRK and A.R. GILMOUR. 1985. Estimating the heritability of all-or-none and categorical traits by offspring-parent regression. Z. Tierzucht. Zuchtungsbiol. 102, 342-354. || 29. J.L. FOULLEY, D. GIANOLA and R. THOMPSON. 1983. Prediction of genetic merit from data on binary and quantitative variates with an application to calving difficulty, birth weight and pelvic opening. Genet. Sel. Evol. 15, 401-424. || 30. R. THOMPSON and R.J. BAKER. 1981. Composite link functions in generalised linear models. J.R. Statist. Soc. B. 30, 125-131. || 31. R. THOMPSON. 1980. A note on the estimation of economic values for selection indices. Anim. Prod. 31, 115-117.GROUP III: EXPERIMENTAL STUDIES32. W. THORPE, D.K.R. CRUICKSHANK and R. THOMPSON. 1980. Genetic and evironmental influences on beef cattle production in Zambia. Factors affecting weaner production from Angoni, Barotse and Boran dams. Anim. Prod. 30, 217-234. || 33. W. THORPE, D.K.R. CRUICKSHANK and R. THOMPSON. 1980. Genetic and environmental influences on beef cattle production in Zambia. 2. Sire weights for age of purebred and reciprocally crossbred progeny. Anim. Prod. 30, 235-243. || 34. W. THORPE, D.K.R. CRUICKSHANK and R. THOMPSON. 1980. Genetic and environmental influences on beef cattle production in Zambia. 3. Carcass characteristics of purebred and reciprocally crossbred progeny. Anim. Prod. 30, 245-252. || 35. W. THORPE, D.C.K. CRUICKSHANK and R. THOMPSON. 1982. Genetic and environmental influences on beef cattle in Zambia. 4. Weaner production from purebred and reciprocally crossbred progeny. Anim. Prod. 33, 165-177. || 36. W. THORPE, D.K.R. CRUICKSHANK and R. THOMPSON. 1979. The growth and carcass character!- sti cs of crosses of Hereford and Friesian with Angoni, Barotse and Boran cattle in Zambia. J. Agric. Sci., Camb. 93, 423-430. || 37. I.L. MASON, V.E. VIAL and R. THOMPSON. 1972. Genetic parameters of beef characteristics and the genetic relationship between meat and milk production in British Friesian cattle. Anim. Prod. 135-148. || 38. W.G. HILL, M.R. EDWARDS, M-K A. AHMED and R. THOMPSON. 1983. Heritability of milk yield and composition at different levels and variability of production. Anim. Prod. 36, 59-68. || 39. V.P.S. CHAUHAN and R. THOMPSON. 1986. Dairy sire evaluation using a "rolling months" model. Z. Tierzucht. Zuchtungsbiol 103, 321-333

Influence of Marianismo on Colorectal Cancer Screening Behavior Among Hispanic Women in the United States

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer death in the United States (U.S).1 Although early detection and treatment can reduce CRC-related morbidity and mortality, almost twothirds of patients are diagnosed with advanced stage disease indicating non-adherence to recommended screening guidelines.1 Indeed, less than half of individuals over 50 years of age get screened at recommended intervals.2 More specifically, lower rates of CRC screening exist among these groups: those identifying as being of Hispanic origin, the uninsured, disabled individuals, and women.3 In a 2011 report from the National Center on Health Statistics capturing the impact of socioeconomic status (SES) on the health of the nation, only 47% of Hispanic or Latino respondents reported any colorectal cancer screening procedure (2010) compared to 59% of all adults, ages 50 – 75 years, regardless of race.3 Evidence suggests that screening for CRC can reduce CRC mortality rates.5 The malignant form of CRC develops from a benign polyp that can be detected through screening methods.5 The primary screening methods for CRC include the fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy and the recommended screening intervals for each include one year, five years, and ten years, respectively.6 Despite strong evidence supporting the benefits of CRC screening and resulting reduction in mortality, low rates of screening among at-risk individuals will result in a projected 50,830 deaths from the disease this year.7 With such an enormous burden caused by a potentially preventable disease, the U.S Department of Health and Human Services (DHHS) has established goals and objectives to increase CRC screening via its Healthy People 2020 initiative. From 2008 2 to 2010, DHHS reported an increase in CRC screenings from 52.1 to 59.1 percent. By 2020, DHHS aims to increase screening to a rate of 70.5 percent.4 To improve CRC screening rates, especially among populations where screening rates are lower, we need to increase our understanding of what factors influence screening among these populations.5 DHHS noted that the burden of CRC disease is distributed unequally among poor and ethnic and racial minorities because of multiple factors, including language or cultural differences with healthcare providers.2 This language barrier, known as limited English proficiency (LEP), has been documented in the literature as a barrier to CRC screening among differing subgroups of Spanishspeaking Latinos.8 For example, in a study analyzing data from the Medical Expenditure Panel Survey (MEPS) aimed at understanding patient-provider communication and language barriers influencing CRC screening, non-English speaking patients experienced less than half the likelihood of being screened for CRC than did the English-speaking patients.9 In a cross-sectional study analyzing the factors associated with CRC screening disparities observed between Whites and Hispanic national origin subgroups, authors note that the variations in health behaviors may be as great among individuals within major racial/ethnic groups.10 Therefore, analyzing cultural barriers within a specific ethnic group could help us understand how to reduce those barriers. Specifically, understanding cultural barriers could result in the creation of personally-tailored interventions.10 In a systematic literature review highlighting interventions published from 1950 to September of 2010 aimed at the improvement of CRC-related care among racial and ethnic minorities, researchers found that interventions involving patient 3 education by phone or in-person contact, combined with patient navigation, leads to improvements in CRC screening rates among minority populations.11 Furthermore, promotoras, or trusted members of Hispanic communities vested in the promotion of health, have been used to improve the health of Hispanic populations since the 1960’s.12 Acting as a bridge between the health care system and members of Hispanic communities in the U.S, promotoras have led many public health interventions.12,13 For example, in a recent quasi-experimental study evaluating a promotora-led intervention on CRC-related perceptions and communications among Hispanics in the Lower Yakima Valley of Washington State, researchers found a significant increase in the percentage of participants who asked their doctors for a CRC screening test after promotora-led intervention at follow-up.12 One cultural element observed as having a negative influence on CRC screening among Mexican males is Machismo.14 Evolving during the 19th century after Latin American countries asserted their independence from prior Spanish rule, Machismo was initially formed as a concept that defined male dominance over women and can be described as the “attitudes and identities associated with masculinity” seen among Hispanic men.14,15 This cultural factor is still prevalent among Hispanic males today and has been documented as a particular barrier to seeking preventative health care measures. Recently, a qualitative study investigated the influence of Machismo on CRC screening rates among two different subgroups of Hispanic men: first-generation Mexicans and Hispanos residing in New Mexico.14 Individuals identifying as being Hispano in this study trace their ancestry back to 16th century Spanish colonists who arrived in New Mexico and consider themselves “pure blooded” Spanish conquistadors.14 This 4 qualitative study found Machismo to be an inhibiting factor only for Mexican men.14 Mexican men felt that getting a colonoscopy was “embarrassing”, and Machismo, rather than a concrete personality trait, was found to be a trait exhibited during particular situations in Mexican men.14 The evolution of Machismo has had a contrasting effect on the cultural identities of Hispanic women, in some instances leading them to develop a submissive and inferior identity to their male counterparts.15 This cultural characteristic exhibited among some Latin women is termed Marianismo. Less well-known than Machismo, Marianismo is a term used to imply the “idealized view of femininity based on the image of Mary, the Virgin Mother”.15,16 Women that exhibit the Marianismo characteristic pride themselves on being a good wife and mother and remain “respectful and dependent” on their husband.17 This ideology of gender roles has resulted in the belief that “women are the weaker sex” among Latin men and women in countries where Machismo and Mariansmo are prominent.15 In middle-class Latin America, women exhibiting Marianismo are exclusively identified with the home, tied to the domestic responsibilities and are discouraged from working outside the home.18 This aspect of Marianismo may cause women that exhibit these characteristics to be economically and socially vulnerable.18Although research has been conducted and evaluated on Machismo as a barrier to CRC screening for Hispanic men, Marianismo and its effect on Hispanic women to seek CRC screening has not yet been evaluated. As Hispanic women have migrated to the U.S and have acculturated to the U.S environment, many of these women may still face cultural oppression by continuing “to adhere to their traditional patriarchal culture.”15 One result of this adherence to culture may be that many Hispanic women still 5 remain in the household as a homemaker, and in result may feel that because they are not bringing home an income, seeking primary health care services is not their choice. This situation may keep them a “vulnerable and disenfranchised population” in terms of healthcare.15 Studies have been conducted to understand the implications of Machismo exhibited among Hispanic men surrounding topics such as breast cancer survivorship and HIV prevention.17,19 For example, in a mixed-methods design study investigating the perspectives of a group of low-income Chilean women regarding HIV, Machismo and Marianismo were found to be major barriers to HIV prevention.17 Socio-cultural aspects of Machismo and Marianismo include the inability of women to make personal decisions; this study resulted in these aspects impacting low-income Chilean women to seek HIV preventative actions.17 In a qualitative cross-sectional study investigating the cultural, social, and healthcare system factors that impact quality of life and survivorship of a group of immigrant Latina breast cancer survivors in the metropolitan District of Columbia, researchers found that many women with male partners exhibiting Mashismo noted “their male partners had difficulty demonstrating support and coping with the emotional aspects of having a spouse with a cancer diagnosis”.19 Being that there has been little research investigating the role of Marianismo on preventative health screening behaviors among Hispanic women, this study seeks to understand whether Marianismo influences the CRC screening behaviors of Hispanic women ages 50 and older in the U.S.15 Specifically, data from the 2012 Behavioral Risk Factor Surveillance Survey (BRFSS) will be analyzed to compare Hispanic women ages 50 and older exhibiting Marianismo characteristics and Hispanic women ages 50 and older not exhibiting 6 Marianismo characteristics. Marianismo characteristics will be distinguished by three reported demographic characteristics: marital status (being married), employment status (being a homemaker), and primary language spoken (Spanish)

Predictions of the atmospheric composition of GJ 1132b

GJ 1132 b is a nearby Earth-sized exoplanet transiting an M dwarf, and is amongst the most highly characterizable small exoplanets currently known. In this paper we study the interaction of a magma ocean with a water-rich atmosphere on GJ 1132b and determine that it must have begun with more than 5 wt% initial water in order to still retain a water-based atmosphere. We also determine the amount of O2 that can build up in the atmosphere as a result of hydrogen dissociation and loss. We find that the magma ocean absorbs at most ~10% of the O2 produced, whereas more than 90% is lost to space through hydrodynamic drag. The most common outcome for GJ 1132 b from our simulations is a tenuous atmosphere dominated by O2, although for very large initial water abundances atmospheres with several thousands of bars of O2 are possible. A substantial steam envelope would indicate either the existence of an earlier H2 envelope or low XUV flux over the system's lifetime. A steam atmosphere would also imply the continued existence of a magma ocean on GJ 1132 b. Further modeling is needed to study the evolution of CO2 or N2-rich atmospheres on GJ 1132 b.Comment: 14 pages, 11 figures, accepted at Ap

Plant biosecurity preparedness plan for U.S. agricultural producers (2006)

"Eden : Extension Disaster Education Network""The author thanks the professionals of Purdue University's Cooperative Extension Service for generously sharing sections of their May 2004 document entitled Rural Security Planning: Protecting Family, Friends, and Farm [Document Number PPP-64]. EDEN also thanks the following technical reviewers: Wayne C. Bailey, Ph.D., MU Extension, Plant Sciences, College of Agriculture, Food and Natural Resources, University of Missouri; David E. Baker, CSP, MU Extension, College of Agriculture, Food and Natural Resources, University of Missouri; Abigail Borron, Extension Disaster Education Network, Purdue University; Steve Cain, Extension Disaster Education Network, Purdue University; Eric Evans, MU Extension, Fire and Rescue Training Institute, University of Missouri; Fred Fishel, Ph.D., MU Extension, Integrated Pest Management, Plant Sciences, University of Missouri; Dale Langford, Extension and Agricultural Information, University of Missouri; James Stack, Ph.D., Plant Pathology, Kansas State University; Laura Sweets, Ph.D., Plant Pathology, University of Missouri."Developed by EDEN as part of its online Plant Biosecurity Management Course for Extension Professionals."New 3/06/2M

Novel Coronavirus Outbreak in Wuhan, China, 2020: Intense Surveillance Is Vital for Preventing Sustained Transmission in New Locations.

The outbreak of pneumonia originating in Wuhan, China, has generated 24,500 confirmed cases, including 492 deaths, as of 5 February 2020. The virus (2019-nCoV) has spread elsewhere in China and to 24 countries, including South Korea, Thailand, Japan and USA. Fortunately, there has only been limited human-to-human transmission outside of China. Here, we assess the risk of sustained transmission whenever the coronavirus arrives in other countries. Data describing the times from symptom onset to hospitalisation for 47 patients infected early in the current outbreak are used to generate an estimate for the probability that an imported case is followed by sustained human-to-human transmission. Under the assumptions that the imported case is representative of the patients in China, and that the 2019-nCoV is similarly transmissible to the SARS coronavirus, the probability that an imported case is followed by sustained human-to-human transmission is 0.41 (credible interval [0.27, 0.55]). However, if the mean time from symptom onset to hospitalisation can be halved by intense surveillance, then the probability that an imported case leads to sustained transmission is only 0.012 (credible interval [0, 0.099]). This emphasises the importance of current surveillance efforts in countries around the world, to ensure that the ongoing outbreak will not become a global pandemic

Adult Students of Color in Predominately White Classrooms

This study explored the experiences of adult students of color in predominately white classrooms. My aims were to (a) better understand their educational experiences, (b) share their stories in their respective voices, and (c) conduct a secondary level of data analysis that examined issues of race, class, power, and privilege