Third-party payer systems are consistently associated with health care cost escalation. Taiwan’s single-payer, universal coverage National Health Insurance (NHI) adopted global budgeting (GB) to ...achieve cost control. This study captures ophthalmologists’ response to GB, specifically service volume changes and service substitution between low-revenue and high-revenue services following GB implementation, the subsequent Bureau of NHI policy response, and the policy impact. De-identified eye clinic claims data for the years 2000, 2005, and 2007 were analyzed to study the changes in Simple Claim Form (SCF) claims versus Special Case Claims (SCCs). The 3 study years represent the pre-GB period, post-GB but prior to region-wise service cap implementation period, and the post-service cap period, respectively. Repeated measures multilevel regression analysis was used to study the changes adjusting for clinic characteristics and competition within each health care market. SCF service volume (low-revenue, fixed-price patient visits) remained constant throughout the study period, but SCCs (covering services involving variable provider effort and resource use with flexibility for discretionary billing) increased in 2005 with no further change in 2007. The latter is attributable to a 30% cap negotiated by the NHI Bureau with the ophthalmology association and enforced by the association. This study demonstrates that GB deployed with ongoing monitoring and timely policy responses that are designed in collaboration with professional stakeholders can contain costs in a health insurance–financed health care system.
To identify the impact of dietary intake and activity level on postpartum weight change.
White (
n = 121) and black (
n = 224) women, 7–12 months postpartum, participating in the Special Supplemental ...Feeding Program for Women, Infants, and Children were assessed for dietary intake, activity level, body weight, and other maternal characteristics.
For both black and white women, the most important variables in predicting postpartum weight loss were pre-pregnancy weight, gestational weight gain, parity, and prenatal exercise. After these factors were controlled, race predicted that black women retained 6.4 lb more than white women. These results may be due to the finding that black women reported significantly higher mean energy intake (2039 versus 1552 kcal,
P < .001), higher percent fat in diet (41 versus 38%,
P < .001), and significantly lower amounts of prenatal and postpartum activity.
Higher energy intake and lower activity levels in black postpartum mothers compared with white mothers may contribute to the significantly higher rates of obesity found in black mothers. This study suggests the need for intervention strategies in the prenatal and postpartum periods to help those at risk of retaining weight gained during pregnancy.
The long-term effects of a 12- and 26-day residential weight control program on weight change were determined in 187 men and women, 1 to 5 years after treatment. Subjects completed a paper/pencil ...questionnaire assessing current diet, weight control techniques, exercise behaviors, behavior modification techniques, binge eating, and dieting behavior. General linear modeling was used to investigate the association between behaviors maintained posttreatment and current weight among subjects who demonstrated behaviors indicative of binge traits (BT) and nonbinge traits (NBT). Results indicate that dissimilar variables are predictive of weight change in the BT and NBT groups. Engaging in exercise behaviors and reduced attempts at dieting lead to greater weight loss in NBT individuals. The use of preplanning techniques was found to be indicative of greater weight loss in BT individuals. These findings suggest the importance of identifying individuals who indulge in binge-eating behaviors prior to intervention in order to deliver the appropriate treatment methods.
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In order to evaluate outcomes among former participants in a residential weight loss program, attendees were surveyed from 1 to 5 years post-intervention. A total of 187 respondents were studied for ...weight changes and behavioral practices. Diet practices were assessed by number of servings per day using the Food Guide Pyramid recommendations as a guideline for indicating fruit and vegetable intake. Exercise behaviors were measured in frequency, duration, and intensity, and a weighted score was computed to obtain units for describing physical activity. Maintaining a 10% weight loss from the program entry weight, consuming five or more servings per day of fruits and/or vegetables (5-a-day) and maintaining an “active” level of physical activity were included in criteria for describing intervention success. Those meeting two of the three criteria were categorized as “successful,” which included 35.8% of the study population. Because each of these behaviors (5-a-day, active lifestyle, and modest weight loss maintenance) result in independent risk reduction, it is recommended that future weight loss intervention evaluations expand the criteria for describing successful impacts and outcomes to include not only weight maintenance, but also physical activity and diet compliance behaviors.
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Estimating exposure to contaminants emitted into workroom air is essential for worker protection. Although contaminant concentrations are often not spatially uniform within workrooms, many methods ...for estimating exposure do not adequately account for this variability. Here the impact of temperature differences within a room on spatial contaminant distribution was studied. Tracer gas (99.5% propylene) concentrations were monitored automatically at 144 sampling points with a photoionization detector. One wall was chosen to represent a building's external wall and was heated or cooled to simulate summer or winter conditions. Experiments were preformed at two flow rates (5.5 and 3.3 m3 min−1) and six thermal conditions (isothermal, three summer conditions and two winter conditions). For 5.5 m3 min−1 and all thermal conditions, the coefficient of variation (CV) ranged from 0.34 to 0.45 and the normalized average concentrations were similar. For 3.3 m3 min−1, winter conditions produced greater spatial variability of concentration (CV = 0.72 and 1.10) than isothermal or summer conditions (CV range = 0.29–0.34). Tests simulating winter conditions suggest that the resulting stable temperature structure inhibited the dilution of the tracer and enhanced its segregation in the lower portion of the room, especially for the lower flow rate (3.3 m3 min−1). Therefore, not explicitly addressing thermal effect in exposure modeling may impact the estimated accuracy and precision when used for rooms that are non-isothermal and not well mixed. These findings also have implications for air monitoring. Dispersion patterns for different thermal conditions were found to be substantially different, even when the mean concentrations were nearly the same. Thus, monitoring data from a single season should not be taken as representative of the entire year, when summer and winter conditions create temperature gradients in a room.
Methods for estimating airborne contaminant concentrations at specific locations within enclosed spaces, such as mathematical models and computational fluid dynamics (CFD), often are validated ...against directly measured concentrations. However, concentration variation with time introduces uncertainty into the measured concentration. Failure to determine monitoring time requirements can lead to errors in quantifying representative concentrations, which are likely to be attributed to errors in the method being validated. In the current study, to obtain the representative concentrations at multiple locations with a direct reading instrument, we used the standard deviation ratio (SDR) method to determine the required minimum monitoring time within a specified precision limit. To demonstrate the use of the SDR approach in constructing precision confidence intervals, tracer gas concentrations at nine sampling locations in an experimental room were measured to obtain population parameters. Three flow rates of 0.9, 3.3 and 5.5 m(3) min(-1) were employed and contaminant concentrations were measured using a photoionization analyser. Monitoring time requirements varied substantially with location within the room and were strongly dependent upon the flow rate of air through the room. The proposed method would be very useful for industrial hygienists and indoor air researchers who sometimes need to obtain several hundred measured concentrations for validation purposes or to perform tests under repeatable conditions in enclosed spaces. This study also showed that the proposed method can be used to devise efficient indoor monitoring strategies.
A model for forage yield with adequate details for leaf area, biomass, nutrients, and hydrology would be valuable for making management decisions. The objectives of this study were to develop Alamo ...switchgrass (Panicum virgatum L.) parameters for the Agricultural Land Management Alternatives with Numerical Assessment Criteria (ALMANAC) model and demonstrate its accuracy across a wide range of environments. Derived plant parameters included potential leaf area index (LAI), potential biomass growth per unit intercepted light, optimum nutrient concentrations, and growth responses to temperature. The model's simulated yields accounted for 79% of the variability in measured yields for one-cut and two-cut harvest systems from six diverse sites in Texas in 1993 and 1994. Simulated yields for three locations differed in sensitivity to potential LAI, heat units to maturity, radiation use efficiency (RUE), and soil depth. The ALMANAC model shows promise as a management tool for this important forage and bioenergy crop.
Demographic, attitudinal, and behavioral differences were assessed among 9th through 12th grade African American adolescents to determine characteristic differences among high, medium, and low ...participators in a nonmandatory school and community-based sexual risk reduction project. Results show that individuals who are part of larger households are more likely to participate in after-school programs, and respondents who reported higher performance in school were more likely to be participants. In partial support of the Health Belief Model, various health threats were associated with participation, including having contracted a sexually transmitted disease at some time in the past, and among females, having been pregnant. Implications are discussed.
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49.
ABSTRACTS Morrow, James R., Jr; Garcia, Anne W.; Zakrajsek, Jennifer S. ...
Measurement in physical education and exercise science,
09/2000, Volume:
4, Issue:
3
Journal Article
Peer reviewed
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50.
ABSTRACTS Morrow, James R., Jr; Garcia, Anne W.; Zakrajsek, Jennifer S. ...
Measurement in physical education and exercise science,
20/9/1/, Volume:
4, Issue:
3
Journal Article
Peer reviewed
Full text
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BFBNIB, DOBA, FSPLJ, GIS, IJS, IZUM, KILJ, KISLJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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