Using Economic Evaluation to Hasten Health Equity

Achieving health equity has proven elusive for two reasons. First, most research has focused on changing the behavior of individuals; however, policies that address socioeconomic factors or change the context to facilitate healthy decisions tend to be more effective. Second, health disparity science and evidence are not consistently used to guide policymakers, even those seeking health equity. In this perspective, we discuss economic evaluation tools that researchers can use to assist decision-makers in conducting research or evaluating policy: self-reported health-related quality-of-life surveys and cost–benefit analysis evaluations informed with the willingness to pay for research and analyses

Psychological Health Influences of Legal-Marriage and -Partnerships on Same-Sex Couples

This chapter explores whether Californians in same-sex legal marriages and partnerships reported lower levels of psychological distress than other adult Californians after the 2008 California Supreme Court Decision that legalized same-sex marriage. We pooled 10 years of California Health Interview Survey (CHIS) data and employ a T1-T2 design to approximate a time series design. Dependent variables include overall self-related health, psychological distress, and household income. Independent variables include sexual identity and same-sex spouse. Bi-variate analyses compared self-reported mental and physical health between the two periods. We found decreased reports of poorer health and increased reports of very good health among gay men and lesbian women with legal spouses. Psychological distress decreased for legally coupled gay men and lesbians while increased slightly among unpartnered lesbian women and gay men. Household income increased among coupled lesbian women and gay men and decreased among others. Our project demonstrated positive health influences for Californians with legal same-sex spouses. We recommend future research projects that explore whether and how same- and opposite-sex marriage benefits health, well-being, and prosperity, and for marital status survey questions that are inclusive of sexual and gender identities and elicit the sex/gender of a respondent’s spouse

The association between an established Chief Experience Officer role and hospital patient experience scores

The healthcare industry is currently reacting to multiple stakeholders demanding improvements to the patient experience. Some healthcare organizations are implementing new management structures, i.e., the role of Chief Experience Officer (CXO). This study statistically reviewed descriptors associated with hospitals that have and have not created and filled the role of CXO and, more importantly, measured the association between the CXO role and results of patients’ perceptions of their experience of care as measured by publicly reported Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) results. This study was conducted utilizing data gather on hospitals in three states, California, Florida, and New York. The results of the study yield insight into the organization characteristics of hospitals and the market factors associated with those hospitals that have filled the CXO role. Hospitals with a formal CXO role are larger, more likely to be for profit, and operate in metro areas of these states with higher per capita income. In addition, hospitals that have a formal CXO role are also more likely to have higher HCAHPS scores as determined by the patient recommendation question as well as the hospital overall rating question included in the HCAHPS survey. Experience Framework This article is associated with the Culture & Leadership lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this len

An Ethical Analysis of Contemporary Healthcare Practices and Issues

The purpose of this analysis is to examine specific segments of healthcare policy and practice, applying various ethical perspectives. We examine the economic and political influences that surround ethical behavior in health services, as well as how practitioners, patients, and families respond and act as a result of such influences. We then delve into the fundamental principles that guide ethical behavior by medical practitioners, including the Hippocratic Oath and vows of medical professionalism. Further, we analyze disparities in healthcare provisions based on gender, race, and ethnicity. Ethical theory is weaved into each of these sections, as the philosophical and ethical writings of prominent scholars illuminate how the conditions of contemporary healthcare administration are affected by the injustices and political influences that pervade the entire health services industry

Nutritional properties of the invasive lionfish: A delicious and nutritious approach for controlling the invasion

Lionfish, Pterois volitans and P. miles, are native to the Indo-Pacific and have recently invaded the Western Atlantic Ocean. Strategies for control of this invasion have included limited removal programs and promotion of lionfish consumption at both local and commercial scales. We demonstrate that lionfish meat contains higher levels of healthy n-3 fatty acids than some frequently consumed native marine fish species. Mean lionfish fillet yield was 30.5% of the total body wet weight, a value that is similar to that of some grouper and porgy species. A sensory evaluation indicated that lionfish meet the acceptability threshold of most consumers

Altered Host Immunity, Human T Lymphotropic Virus Type I Replication, and Risk of Adult T-Cell Leukemia/Lymphoma: A Prospective Analysis from the ATL Cohort Consortium

Background: Adult T-cell leukemia/lymphoma (ATL) is a rare and often fatal outcome of infection with human T-lymphotropic virus type I (HTLV-I). Altered host immunity in HTLV-I carriers has been postulated as a risk factor for ATL, but is not well understood. Methods: We prospectively examined well-validated serologic markers of HTLV-I pathogenesis and host immunity in 53 incident ATL cases and 150 carefully matched asymptomatic HTLV-I carriers from eight population-based studies in Japan, Jamaica, the United States and Brazil. We used multivariable conditional logistic regression, conditioned on the matching factors (cohort/race, age, sex, and sample collection year), to evaluate the biomarkers’ associations with ATL in all subjects and by years (≤5, >5) from blood draw to ATL diagnosis. Results: In the pooled population, above-median soluble interleukin-2-receptor-alpha levels (sIL2R, v. ≤ median; odds ratio (OR), 95% confidence interval (CI)=4.08, 1.47-11.29) and anti-Tax seropositivity (anti-Tax; OR, 95% CI=2.97, 1.15-7.67), which indicate T cell activation and HTLV-I replication, respectively, were independently associated with an increased ATL risk. Above-median total immunoglobulin E levels (v. ≤ median; OR, 95% CI=0.45, 0.19-1.06), which indicate type 2 (B cell) activation, predicted a lower ATL risk. The sIL2R and anti-Tax associations with ATL were stronger in samples collected ≤5 years pre-diagnosis. Conclusions: The biomarker profile predictive of ATL risk suggests a role for heightened T cell activation and HTLV-I replication and diminished type 2 immunity in the etiology of ATL in HTLV-I carriers. Translation of these findings to clinical risk prediction or early ATL detection requires further investigation. Acknowledgements: This abstract is presented on behalf of the ATL Cohort Consortium

Genome-wide interaction study of a proxy for stress-sensitivity and its prediction of major depressive disorder

Individual response to stress is correlated with neuroticism and is an important predictor of both neuroticism and the onset of major depressive disorder (MDD). Identification of the genetics underpinning individual differences in response to negative events (stress-sensitivity) may improve our understanding of the molecular pathways involved, and its association with stress-related illnesses. We sought to generate a proxy for stress-sensitivity through modelling the interaction between SNP allele and MDD status on neuroticism score in order to identify genetic variants that contribute to the higher neuroticism seen in individuals with a lifetime diagnosis of depression compared to unaffected individuals. Meta-analysis of genome-wide interaction studies (GWIS) in UK Biobank (N = 23,092) and Generation Scotland: Scottish Family Health Study (N = 7,155) identified no genome-wide significance SNP interactions. However, gene-based tests identified a genome-wide significant gene, ZNF366, a negative regulator of glucocorticoid receptor function implicated in alcohol dependence (p = 1.48x10-7; Bonferroni-corrected significance threshold p < 2.79x10-6). Using summary statistics from the stress-sensitivity term of the GWIS, SNP heritability for stress-sensitivity was estimated at 5.0%. In models fitting polygenic risk scores of both MDD and neuroticism derived from independent GWAS, we show that polygenic risk scores derived from the UK Biobank stress-sensitivity GWIS significantly improved the prediction of MDD in Generation Scotland. This study may improve interpretation of larger genome-wide association studies of MDD and other stress-related illnesses, and the understanding of the etiological mechanisms underpinning stress-sensitivity