Enrollee Mix, Treatment Intensity, and Cost in Competing Indemnity and HMO Plans

We examine why managed care plans are less expensive than traditional indemnity insurance plans. Our database consists of the insurance experiences of over 200,000 state and local employees in Massachusetts and their families, who are insured in a single pool. Within this group, average HMO costs are 40 percent below those of the indemnity plan. We evaluate cost differences for 8 conditions representing over 10 percent of total health expenditures. They are: heart attacks, cancers (breast, cervical, colon, prostate), diabetes (type I and II), and live births. For each condition, we identify the portions of the cost differential arising from differences in treatment intensity, enrollee mix, and prices paid for the same treatment. Surprisingly, treatment intensity differs hardly at all between the HMOs and the indemnity plan. That is, relative to their fee-for-service competitor, HMOs do not curb the use of expensive treatments. Across the 8 conditions, roughly half of the HMO cost savings is due to the lower incidence of the diseases in the HMOs. Virtually all of the remaining savings come because HMOs pay lower prices for the same treatment.

Scoping review on interventions to improve adherence to reporting guidelines in health research

Objectives The goal of this study is to identify, analyse and classify interventions to improve adherence to reporting guidelines in order to obtain a wide picture of how the problem of enhancing the completeness of reporting of biomedical literature has been tackled so far. Design Scoping review. Search strategy We searched the MEDLINE, EMBASE and Cochrane Library databases and conducted a grey literature search for (1) studies evaluating interventions to improve adherence to reporting guidelines in health research and (2) other types of references describing interventions that have been performed or suggested but never evaluated. The characteristics and effect of the evaluated interventions were analysed. Moreover, we explored the rationale of the interventions identified and determined the existing gaps in research on the evaluation of interventions to improve adherence to reporting guidelines. Results 109 references containing 31 interventions (11 evaluated) were included. These were grouped into five categories: (1) training on the use of reporting guidelines, (2) improving understanding, (3) encouraging adherence, (4) checking adherence and providing feedback, and (5) involvement of experts. Additionally, we identified lack of evaluated interventions (1) on training on the use of reporting guidelines and improving their understanding, (2) at early stages of research and (3) after the final acceptance of the manuscript. Conclusions This scoping review identified a wide range of strategies to improve adherence to reporting guidelines that can be taken by different stakeholders. Additional research is needed to assess the effectiveness of many of these interventionsPeer ReviewedPostprint (author's final draft

In the age of ‘liquid modernity’: self-initiated expatriates in Crete, their multi-generational families and the community

In this paper, we aim to broaden and deepen the current debate on expatriation in business and management discourse, and especially self-initiated expatriation. Following Bauman’s [Liquid Modernity (2000), Cambridge: Polity; Liquid Love, On the Frailty of Human Bonds (2003), Cambridge: Polity] critique of postmodern society and, employing an anthropological lens, we examine work-related expatriation as set within a wider life context. Whereas conventional expatriation research focus is on the workplace, the focus of this study is the wider community. We take a longitudinal approach demonstrating the essential fluid nature of expatriation in general, self-initiated expatriation in particular. We show the importance of multi-generational links as overall critical considerations in effecting decisions to move or stay; we also show how over time, changes in circumstances, career plans and demands of significant others, drive the expatriate agenda. We pay particular attention to nontraditional expatriates and issues of health and disability in the extended family. Finally, we document the importance of the wider family and of the community in the process of adjustment and in engendering a sense of belonging

Is the relationship among outcome variables shown in randomized trials?

BACKGROUND: Randomized controlled trials (RCTs) often have more than one primary outcome and frequently have secondary and harm outcomes. Comparison of outcomes between study arms is the primary focus of RCTs, but there are times when the relation between outcomes is important, such as determining whether an intermediate outcome and a clinical outcome have a strong association. We sought to determine how often reports of RCTs depict the relations among outcomes at the individual patient level and, for those studies that use composite outcomes, how often the relations between component elements are depicted. METHODS: We selected 20 general, specialty and subspecialty medical journals with high impact factors that publish original clinical research. We identified every RCT in the 2011 and 2012 issues and randomly selected 10 articles per journal. For each article we recorded the number of outcomes, the number of composite outcomes and how often the relations between outcomes or elements of composite outcomes were portrayed. RESULTS: All but 16 of the 200 RCTs had more than one outcome. Thus, outcomes could have been related in 92% of studies, but such relations were only reported in 2 (1%). A total of 33 (17%) investigations measured a composite outcome, 32 of which showed data for each component. None, however, showed cross-tabulation of the components. CONCLUSIONS: Readers are rarely shown the relation between outcomes. Mandatory posting of datasets or requirements for detailed appendices would allow readers to see these cross-tabulations, helping future investigators know which outcomes are redundant, which provide unique information and which are most responsive to changes in the independent variables. While not every relationship between outcomes requires depiction, at present such information is seldom portrayed

crisscrossing Science Episode 015: Myosin, How Muscles Move

In this episode, Chris Gaiser (professor of biology at Linfield College) and Mike Crosser (professor of physics at Linfield College) invite David Altman (associate professor of physics at Willamette University) into the studio to discuss his research into different forms of a protein called myosin. In cells, there are chains of molecules called actin that criss-cross throughout the cell. Myosin is able to grab onto the actin and pull, causing different forms of work to happen. For instance, bundles of myosin are the cause for muscles to contract. In other examples, myosin can carry cargo through the cell. Gaiser and Crosser discuss these uses, as well as how Altman is able to study the properties of myosin

LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD : a systematic review and meta-analysis

Acknowledgments The meta-analysis work was performed by Guruprasad Rao KS and Sharanbasappa Durg of Molecular Connections (P) Ltd, Bangalore, India, under the guidance of the manuscript authors and Novartis Pharma AG (Basel, Switzerland). Medical writing assistance was provided by Colette O’Sullivan, PhD, of Scriva Medical Communications Ltd, a professional medical writer funded by Novartis. Development of the manuscript was supported by Novartis Pharma AG (Basel, Switzerland). The authors received no compensation related to the development of the manuscript.Peer reviewedPublisher PD

Missed medical appointments during shifts to and from daylight saving time

Transitions into and out of Daylight Saving Time (DST) can provide insights into how a minor change to a regular sleep–wake cycle can inadvertently affect health. We examined the relationship between DST and missed medical appointments. Using a large dataset, the proportion of missed appointments were examined prior and post spring and autumn clock changes. As predicted, the number of missed medical appointments significantly increased following the spring (forward) clock change and the week of the clock change. This trend was reversed following the transition out of DST. The implications of scheduling appointments around DST to increase attendance are discussed