Background
Although there is extensive evidence that social interactions within different types of social ties affect fertility decisions and behavior both in western and nonwestern settings, there ...is no available data to evaluate the impact within the Middle Eastern context, leading to difficulty in explaining fully the ways in which interactions in personal networks influence fertility behavior among the region's populations.
Aims
This study aims to explore the mechanisms through which social ties affect fertility decisions in Turkey. We examine various social mechanisms such as social support, social pressure,social influence and social learning to explore how and why these mechanisms exert influence on women's fertility decision‐making processes.
Method
Using semi‐structured interviewing (N = 51),the study draws on mothers' retrospective accounts of the childbearing process and current intentions for higher order births.
Results
Our findings point to the substantial role played by family networks in women's fertility behavior in Turkey. While family and nonfamily network partners stimulate social pressure and social influence respectively, social support exclusively operates through family members. Also, the majority of social learning occurs within the family. Our findings also show how kin and non‐kin network partners operate through these mechanisms and differentially influence specific stages of the fertility process such as the transition to parenthood and parity progression.
Conclusion
The overarching finding of this study is that the personal networks have effects on fertility decisions in Turkey. Our findings pointed to the role of the social and cultural context of the Middle Eastern setting where childbearing is a substantive issue that matters to extended family and the community. An important contribution of this study is that it is the first of its kind to explore social mechanisms vis‐à‐vis fertility decision‐making in the Middle Eastern context and provides a nonwestern and comparative perspective to the research in this area.
To evaluate the cost-effectiveness and budget impact of using standard care (no advanced treatment, NAT) compared with an advanced treatment (AT), dehydrated human amnion/chorion membrane (DHACM), ...when following parameters for use (FPFU) in treating lower extremity diabetic ulcers (LEDUs).
We analysed a retrospective cohort of Medicare patients (2015-2019) to generate four propensity-matched cohorts of LEDU episodes. Outcomes for DHACM and NAT, such as amputations, and healthcare utilisation were tracked from claims codes, analysed and used to build a hybrid economic model, combining a one-year decision tree and a four-year Markov model. The budget impact was evaluated in the difference in per member per month spending following completion of the decision tree. Likewise, the cost-effectiveness was analysed before and after the Markov model at a willingness to pay (WTP) threshold of $100,000 per quality adjusted life year (QALY). The analysis was conducted from the healthcare sector perspective.
There were 10,900,127 patients with a diagnosis of diabetes, of whom 1,213,614 had an LEDU. Propensity-matched Group 1 was generated from the 19,910 episodes that received AT. Only 9.2% of episodes were FPFU and DHACM was identified as the most widely used AT product among Medicare episodes. Propensity-matched Group 4 was limited by the 590 episodes that used DHACM FPFU. Episodes treated with DHACM FPFU had statistically fewer amputations and healthcare utilisation. In year one, DHACM FPFU provided an additional 0.013 QALYs, while saving $3,670 per patient. At a WTP of $100,000 per QALY, the five-year net monetary benefit was $5003.
The findings of this study showed that DHACM FPFU reduced costs and improved clinical benefits compared with NAT for LEDU Medicare patients. DHACM FPFU provided better clinical outcomes than NAT by reducing major amputations, ED visits, inpatient admissions and readmissions. These clinical gains were achieved at a lower cost, in years 1-5, and were likely to be cost-effective at any WTP threshold. Adoption of best practices identified in this retrospective analysis is expected to generate clinically significant decreases in amputations and hospital utilisation while saving money.
To evaluate large propensity-matched cohorts to assess outcomes in patients receiving advanced treatment (AT) with skin substitutes for lower extremity diabetic ulcers (LEDUs) versus no AT (NAT) for ...the management of LEDUs.
The Medicare Limited Dataset (1 October 2015 through 2 October 2018) were used to retrospectively analyse people receiving care for a LEDU treated with AT or NAT (propensity-matched Group 1). Analysis included major and minor amputations, emergency department (ED) visits and hospital readmissions. In addition, AT following parameters for use (FPFU) was compared with AT not FPFU (propensity-matched Group 2). A paired t-test was used for comparisons of the two groups. For comparisons of three groups, the Kruskal-Wallis test was used. A Bonferroni correction was performed when multiple comparisons were calculated.
There were 9,738,760 patients with a diagnosis of diabetes, of whom 909,813 had a LEDU. In propensity-matched Group 1 (12,676 episodes per cohort), AT patients had statistically fewer minor amputations (p=0.0367), major amputations (p<0.0001), ED visits (p<0.0001), and readmissions (p<0.0001) compared with NAT patients. In propensity-matched Group 2 (1131 episodes per cohort), AT FPFU patients had fewer minor amputations (p=0.002) than those in the AT not FPFU group.
AT for the management of LEDUs was associated with significant reductions in major and minor amputation, ED use, and hospital readmission compared with LEDUs managed with NAT. Clinics should implement AT in accordance with the highlighted parameters for use to improve outcomes and reduce costs.
To evaluate the cost-effectiveness of dehydrated human amnion/chorion membrane (DHACM) in Medicare enrolees who developed a venous leg ulcer (VLU).
This economic evaluation used a four-state Markov ...model to simulate the disease progression of VLUs for patients receiving advanced treatment (AT) with DHACM or no advanced treatment (NAT) over a three-year time horizon from a US Medicare perspective. DHACM treatments were assessed when following parameters for use (FPFU), whereby applications were initiated 30-45 days after the initial VLU diagnosis claim, and reapplications occurred on a weekly to biweekly basis until completion of the treatment episode. The cohort was modelled on the claims of 530,220 Medicare enrolees who developed a VLU between 2015-2019. Direct medical costs, quality-adjusted life years (QALYs), and the net monetary benefit (NMB) at a willingness-to-pay threshold of $100,000/QALY were applied. Univariate and probabilistic sensitivity analyses (PSA) were performed to test the uncertainty of model results.
DHACM applied FPFU dominated NAT, yielding a lower per-patient cost of $170 and an increase of 0.010 QALYs over three years. The resulting NMB was $1178 per patient in favour of DHACM FPFU over the same time horizon. The rate of VLU recurrence had a notable impact on model uncertainty. In the PSA, DHACM FPFU was cost-effective in 63.01% of simulations at the $100,000/QALY threshold.
In this analysis, DHACM FPFU was the dominant strategy compared to NAT, as it was cost-saving and generated a greater number of QALYs over three years from the US Medicare perspective. A companion VLU Medicare outcomes analysis revealed that patients who received AT with a cellular, acellular and matrix-like product (CAMP) compared to patients who received NAT had the best outcomes. Given the added clinical benefits to patients at lower cost, providers should recommend DHACM FPFU to patients with VLU who qualify. Decision-makers for public insurers (e.g., Medicare and Medicaid) and commercial payers should establish preferential formulary placement for reimbursement of DHACM to reduce budget impact and improve the long-term health of their patient populations dealing with these chronic wounds.
Support for this analysis was provided by MiMedx Group, Inc., US. JLD, and RAF are employees of MiMedx Group, Inc. WHT, BH, PS, BGC and WVP were consultants to MiMedx Group, Inc. VD, AO, MRK, JAN, NW and GAM served on the MiMedx Group, Inc. Advisory Board. MRK and JAN served on a speaker's bureau. WVP declares personal fees and equity holdings from Stage Analytics, US.
Abstract
Research has shown that interviewers can significantly affect survey respondents’ reported attitudes and behaviors. Several interviewer characteristics have been found to partially explain ...variation in respondents’ answers across interviewers, particularly when questions are related to interviewers’ observable characteristics such as gender, race, and age. However, less is known about if and how interviewers’ religious appearance and religious attitudes affect survey responses and, more specifically, reports about religious attitudes. Collecting accurate information on religious attitudes is important, given the sensitivity of this information across the globe and the growing interest in understanding religious perceptions and misconceptions. This paper is the first to investigate (a) the independent effects and the interplay between interviewers’ religious veil status and interviewers’ religious attitudes on respondents’ reported religious attitudes and (b) the magnitude of the interviewer variance explained by interviewers’ religious characteristics. The data comes from a nationally representative survey of religious and political attitudes in Tunisia carried out in 2013. Data from the survey also includes information about interviewers’ characteristics (including veil status for females) and interviewers’ own religious attitudes based on their responses to the same survey questions asked of respondents. Results showed that respondents interviewed by veiled female interviewers reported greater religiosity than respondents interviewed by unveiled female interviewers. Equally important were interviewers’ religious attitudes, which also independently affected the corresponding attitudes of respondents and explained a substantial percentage of the between-interviewer variance for several outcomes. The effect of interviewers’ attitudes on respondents’ attitudes was not stronger among veiled interviewers. Our investigation also revealed that the effect of interviewers’ attitudes on respondents’ reported attitudes operated somewhat differently for male and female respondents depending on the specific survey items. Future studies are needed to explore the mechanism(s) underlying these effects.
beyond sectarianism in iraq moaddel, mansoor; de jong, julie; dagher, munqith
Contexts,
08/2011, Letnik:
10, Številka:
3
Journal Article
Odprti dostop
During eight years of a U.S.-led occupation, Iraqi attitudes have shifted away from sectarianism and toward a national identity. Coupled with increased support for the separation of politics and ...religion, this shift may pave the road for a functioning national government.
•NURTURE is an ongoing study of nusinersen started in a presymptomatic stage of SMA.•All infants were ≥25 months old, and alive without permanent ventilation.•All infants achieved independent sitting ...and 88% (22/25) were walking alone.•Nusinersen demonstrated durability of effect with a median 2.9 years of follow up.•Nusinersen was well tolerated with no new safety concerns over extended follow up.
Spinal muscular atrophy (SMA) is a neurodegenerative disease associated with severe muscle atrophy and weakness in the limbs and trunk. We report interim efficacy and safety outcomes as of March 29, 2019 in 25 children with genetically diagnosed SMA who first received nusinersen in infancy while presymptomatic in the ongoing Phase 2, multisite, open-label, single-arm NURTURE trial. Fifteen children have two SMN2 copies and 10 have three SMN2 copies. At last visit, children were median (range) 34.8 25.7–45.4 months of age and past the expected age of symptom onset for SMA Types I or II; all were alive and none required tracheostomy or permanent ventilation. Four (16%) participants with two SMN2 copies utilized respiratory support for ≥6 h/day for ≥7 consecutive days that was initiated during acute, reversible illnesses. All 25 participants achieved the ability to sit without support, 23/25 (92%) achieved walking with assistance, and 22/25 (88%) achieved walking independently. Eight infants had adverse events considered possibly related to nusinersen by the study investigators. These results, representing a median 2.9 years of follow up, emphasize the importance of proactive treatment with nusinersen immediately after establishing the genetic diagnosis of SMA in presymptomatic infants and emerging newborn screening efforts.
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