Objective: To investigate the relationship between measures of placement restrictiveness and educational achievement for a sample of emancipated foster youth. Method: Information was collected on 171 ...foster adolescents in Illinois. The permanency plan for each ward was independent living. Three methods were used to calculate the cumulative restrictiveness levels of various living arrangements while in placement. Follow-up information on educational progress was collected at age 21. Results: Two thirds of the youths in less restrictive placements attended postsecondary education, compared to one third who were placed in highly restrictive settings. Overall, nearly 85% of the enrollees in postsecondary education or training programs came from placements rated as low in restrictiveness. Conclusions: Placements rated as low in restrictiveness such as foster family homes and transitional apartments are probably the most effective settings in which to prepare foster wards for independence. Overall, the most useful method for calculating restrictiveness was the Predominant Placement Type formula.
Vouchers are increasingly used as a demand-side subsidy to reduce financial hardship and improve quality of services. Elderly Healthcare Voucher Scheme has been introduced by the Hong Kong Government ...since 2009 to provide subsidy to elderly aged 65 and above to visit ten different types of private primary care providers for curative, preventive and chronic disease management. Several enhancements have been made over the past few years. This paper (as part of an evaluation study of this unique healthcare voucher scheme) aims to assess the long term impact of the voucher scheme in encouraging the use of primary care services.
Two rounds of cross-sectional survey among elderly in Hong Kong were conducted in 2010 and 2016. Propensity score matching and analysis were used to compare changes in perception and usage of vouchers over time.
61.5% of respondents in 2016 agreed "the scheme encourages me to use more private primary care services", a significant increase from 36.2% in 2010. Among those who agreed in 2016, the majority thought the voucher scheme would encourage them to use acute services (90.3%) in the private sector, rather than preventive care (40.3%) and chronic disease management (12.2%). Respondents also reported that their current usual choice of care was visiting "both public and private doctors" (61.9%), representing a significant increase (up from 48.4%) prior to their use of voucher.
The voucher scheme has encouraged the use of more private care services, particularly acute services rather than disease prevention or management of chronic disease. However, there needs to be caution that the untargeted and open-ended nature of voucher scheme could result in supply-induced demand which would affect long term financial sustainability. The dual utilization of health services in both the public and private sector may also compromise continuity and quality of care. The design of the voucher needs to be more specific, targeting prevention and chronic disease management rather than unspecified care which is mainly acute and episodic in order to maximize service delivery capacity as a whole for equitable access in universal health coverage and to contribute to a sustainable financing system.
•Undifferentiated voucher scheme subsidises elderly to visit private primary care providers.•Public services utilisation and voucher-transaction data from a survey cohort were analysed.•Using voucher ...was not associated with a reduction in public services utilization.•Vouchers were mainly used for acute-care rather than disease prevention/chronic disease management.•Voucher design needs to be reconsidered taking the context and goals of health system into account.
To incentivize private primary care utilization and reduce reliance on public healthcare services, Elderly Healthcare Voucher Scheme has been implemented to provide a voucher entitlement to entire older resident population for subsidising their purchase of unspecified primary healthcare services in the private sector. Our study assessed whether voucher usage is associated with reduced utilization of public healthcare services. We retrieved the public healthcare services utilization and voucher transaction data of a survey cohort of 551 participants, who were age eligible for the scheme since 2009, over the period 2009–2015. Our results showed that voucher usage was not associated with reduced utilization of public healthcare services and has encouraged dual utilization of public and private healthcare. It may be due to a generated supply-induced demand and price inflation. The finding suggests the voucher is specifically designed to address the health systems issues to achieve the effective policy objectives. Defining the specific services to be provided and the prices at which they should be offered based on the needs of specified populations is a fundamental design parameter which needs to be incorporated. The alternatives of whether primary care services should be expanded and provided in the public sector or purchased using supply/demand side instruments should be considered taking the context and goals of the health system into account.
Hong Kong's health system comprises parallel and segmented public and private financed and provided sectors, in which access to the limited public primary healthcare has been an issue. This gave the ...government the impetus to implement the Elderly Healthcare Voucher Scheme since 2009, providing Hong Kong resident aged 65 and above an annual entitlement of HK$2,000 to purchase private primary healthcare. This was to reduce the demand for public healthcare and encourage the use of private preventive care and chronic disease management. To evaluate the effectiveness and impact of the voucher scheme, in‐depth understanding from the providers' perspectives on implementation barriers and facilitators was studied. The perspectives of 33 service providers were sought through five focus group discussions and seven telephone interviews between 2016 and 2017. Mixed sampling strategies were used, and the discussion covered three main areas: (a) factors that affect the impact of voucher scheme in bridging the private and public primary healthcare sector; (b) perceived barriers to participation in the voucher scheme and (c) potential enhancement of the voucher scheme. Participants agreed that the voucher scheme encouraged uptake of private primary care for acute episodes, but not for chronic disease management and rehabilitation due to inadequate financial entitlements and the elderly persons’ lack of knowledge on the services covered. Low financial incentives, tedious administrative work and inadequate communications were identified as barriers for enrolment. The voucher scheme has resulted in increased utilisation of private primary healthcare but has not reduced the demand for public primary healthcare. Fundamental questions remain about the scheme's potential role in improving universal health coverage and financial sustainability which are related to the program design and to whether this is the better mechanism, or a complementary mechanism to address some of the more complex health system priorities including better chronic disease management.
Introduction: With the rapid increase in the prevalence of the Internet and/or smartphone usage worldwide in the last decade, engagement in internet gaming and social media may be problematic and may ...lead to negative consequences on mental and physical health among young adults. The main objectives of the present study are (1) to investigate how internet gaming and social media impact on physical activity, sleep quality, quality of life (QoL), and academic performance of university students in Hong Kong and (2) to investigate how physical activity and sleep associate with QoL and academic performance of university students in Hong Kong. Methods: This study employed a longitudinal design with 3-month duration. Hong Kong university students ( n = 15; 4 males; mean age = 26.87 years) completed the questionnaires, wore a device to measure their physical activity and sleep, provided screen time data showing the time usage of applications on gaming and social media categories, and academic transcript for the study. Results: Internet gaming was negatively correlated with physical activity and psychological QoL ( r s = −0.49 to −0.62); social media use was negatively correlated with physical activity and sleep quality ( r s = −0.48 to −0.63); internet gaming and smartphone addiction were negatively correlated with academic performance ( r s = −0.51 to −0.53); physical activity was positively correlated with psychological QoL ( r s = 0.49). Conclusion: The results emphasized that internet gaming and smartphone addiction tend to have negative impact on physical activity, psychological QoL, sleep, and academic performance. The findings may be regarded as a direction for health-care providers to develop and evaluate the intervention to treat the specific type of internet/smartphone overuse.
We investigated whether treatment of mice with established pressure overload-induced heart failure (HF) with the naturally occurring polyphenol resveratrol could improve functional symptoms of ...clinical HF such as fatigue and exercise intolerance. C57Bl/6N mice were subjected to either sham or transverse aortic constriction surgery to induce HF. Three weeks postsurgery, a cohort of mice with established HF (%ejection fraction <45) was administered resveratrol (~450 mg·kg
·day
) or vehicle for 2 wk. Although the percent ejection fraction was similar between both groups of HF mice, those mice treated with resveratrol had increased total physical activity levels and exercise capacity. Resveratrol treatment was associated with altered gut microbiota composition, increased skeletal muscle insulin sensitivity, a switch toward greater whole body glucose utilization, and increased basal metabolic rates. Although muscle mass and strength were not different between groups, mice with HF had significant declines in basal and ADP-stimulated O
consumption in isolated skeletal muscle fibers compared with sham mice, which was completely normalized by resveratrol treatment. Overall, resveratrol treatment of mice with established HF enhances exercise performance, which is associated with alterations in whole body and skeletal muscle energy metabolism. Thus, our preclinical data suggest that resveratrol supplementation may effectively improve fatigue and exercise intolerance in HF patients.
Resveratrol treatment of mice with heart failure leads to enhanced exercise performance that is associated with altered gut microbiota composition, increased whole body glucose utilization, and enhanced skeletal muscle metabolism and function. Together, these preclinical data suggest that resveratrol supplementation may effectively improve fatigue and exercise intolerance in heart failure via these mechanisms.
Chromosome 22q11.2 deletion syndrome is a neurogenetic disorder associated with high rates of schizophrenia and other psychiatric conditions. The authors report what is to their knowledge the first ...large-scale collaborative study of rates and sex distributions of psychiatric disorders from childhood to adulthood in 22q11.2 deletion syndrome. The associations among psychopathology, intellect, and functioning were examined in a subgroup of participants.
The 1,402 participants with 22q11.2 deletion syndrome, ages 6–68 years, were assessed for psychiatric disorders with validated diagnostic instruments. Data on intelligence and adaptive functioning were available for 183 participants ages 6 to 24 years.
Attention deficit hyperactivity disorder (ADHD) was the most frequent disorder in children (37.10%) and was overrepresented in males. Anxiety disorders were more prevalent than mood disorders at all ages, but especially in children and adolescents. Anxiety and unipolar mood disorders were overrepresented in females. Psychotic disorders were present in 41% of adults over age 25. Males did not predominate in psychotic or autism spectrum disorders. Hierarchical regressions in the subgroup revealed that daily living skills were predicted by the presence of anxiety disorders. Psychopathology was not associated with communication or socialization skills.
To the authors’ knowledge, this is the largest study of psychiatric morbidity in 22q11.2 deletion syndrome. It validates previous findings that this condition is one of the strongest risk factors for psychosis. Anxiety and developmental disorders were also prevalent. These results highlight the need to monitor and reduce the long-term burden of psychopathology in 22q11.2 deletion syndrome.
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