Effect of specificity of health expenditure questions in the measurement of out-of-pocket health expenditure: evidence from field experimental study in Ghana.

BACKGROUND: The effect of number of health items on out-of-pockets (OOPs) has been identified as a source of bias in measuring OOPs. Evidence comes mostly from cross-sectional comparison of different survey instruments to collect data on OOPs. Very few studies have attempted to validate these questionnaires, or distinguish bias arising from the comprehensiveness of the OOPs list versus specificity of OOPs questions. OBJECTIVES: This study aims to estimate biases arising from the specificity of OOPs questions by comparing provider and household's information. METHODS: A generic questionnaire to collect data on household's OOPs was developed following the nomenclature proposed in division 6 of the classification of household final consumption 2018. The four categories within such division are used to set the comprehensiveness of the OOPs list, the specificity within each category was tailored to the design of the nationally representative living standard survey in Ghana where a field experiment was conducted to test the validity of different versions. Households were randomised to 11, 44 or 56 health items. Using data from provider records as the gold standard, we compared the mean positive OOPs, and estimated the mean ratio and variability in the ratio of household expenditures to provider data for the individual households using the Bland-Altman method of assessing agreement. FINDINGS: We found evidence of a difference in the overall mean ratio in the specificity for OOPs in inpatient care and medications. Within each of these two categories, a more detailed disaggregation yielded lower OOPs estimates than less detailed ones. The level of agreement between household and provider OOPs also decreased with increasing specificity of health items. CONCLUSION: Our findings suggest that, for inpatient care and medications, systematically decomposing OOPs categories into finer subclasses tend to produce lower OOPs estimates. Less detailed items produced more accurate and reliable OOPs estimates in the context of a rural setting.

Effects of an email delivered cognitive behavioral therapy for insomnia in college students.

PURPOSE: This study aimed to examine the effect of an email delivered version of Cognitive Behavioral Therapy for Insomnia (CBT-I) in college students with insomnia. DESIGN AND METHODS: The study used a two-group pre- and postdesign (N = 63). The intervention group received 6 weekly, email-delivered CBT-I sessions, and the comparison group received a link to a student wellness website for healthy sleep information. FINDINGS: The intervention group demonstrated significant improvement in attitudes toward sleep, sleep quality, sleep hygiene, and daytime sleepiness from pretest to posttest. Furthermore, the intervention group showed more positive outcomes, compared to the comparison group at the posttest. PRACTICE IMPLICATIONS: An email-delivered sleep intervention is a feasible and easy-to-use tool that nurses can utilize to promote sleep quality among college students.

Background noise disrupts host-parasitoid interactions.

The soundscape serves as a backdrop for acoustic signals dispatched within and among species, spanning mate attraction to parasite host detection. Elevated background sound levels from human-made and natural sources may interfere with the reception of acoustic signals and alter species interactions and whole ecological communities. We investigated whether background noise influences the ability of the obligate parasitoid Ormia ochracea to locate its host, the variable field cricket (Gryllus lineaticeps). As O. ochracea use auditory cues to locate their hosts, we hypothesized that higher background noise levels would mask or distract flies from cricket calls and result in a decreased ability to detect and navigate to hosts. We used a field manipulation where fly traps baited with playback of male cricket advertisement calls were exposed to a gradient of experimental traffic and ocean surf noise. We found that increases in noise amplitude caused a significant decline in O. ochracea caught, suggesting that background noise can influence parasitoid-host interactions and potentially benefit hosts. As human-caused sensory pollution increases globally, soundscapes may influence the evolution of tightly co-evolved host-parasitoid relationships. Future work should investigate whether female cricket phonotaxis towards males is similarly affected by noise levels.

Effects of Experimental Anthropogenic Noise Exposure on the Reproductive Success of Secondary Cavity Nesting Birds.

Artificial nest boxes are critical nesting sites for secondary cavity-nesting birds; however, they are often placed near roadways and in urban areas that experience noise pollution and other human-caused stressors. Recent correlative studies document both negative and positive influences of noise pollution on reproductive success. Additionally, observational studies have not determined which stage of the breeding process is most vulnerable to noise pollution-settlement, incubation, and/or provisioning. Here, we controlled for possible effects from non-random settlement and eliminated potential effects of roadways, such as collisions and chemical and light pollution, by experimentally introducing traffic noise into nest boxes after clutch initiation in two secondary-cavity nesting bird species. We found no evidence for an influence of noise on clutch size, brood size, number of fledglings, or overall nest success in western bluebirds (Sialia mexicana). In contrast, we found that ash-throated flycatcher (Myiarchus cinerascens) nests exposed to noise had lower reproductive success than quiet nests due to higher rates of abandonment at the incubation stage. Our results match recent research demonstrating that ash-throated flycatchers avoid energy-sector noise in their nest placement and, when they do nest in noise, experience stress hormone dysregulation and fitness costs. The lack of a response among western bluebirds differs from reported declines in reproductive success due to exposure to energy-sector noise; however, the absence of a response matches the response seen in other species using an in-box noise playback experiment. These results suggest that in-box noise exposure experiments may be appropriate for assessing noise impacts at the nest, and through some pathways (e.g., direct effects of noise on nestlings), but do not capture other ways in which noise can negatively affect birds during the breeding season that may ultimately cause declines in fitness. Additionally, although manipulative experiments that examine the influence of a single anthropogenic stressor on a single life stage can help reveal causal pathways, urban and other human-dominated environments are characterized by many stressors and future studies should seek to understand how noise interacts with other stressors to impact birds and other wildlife. Finally, in light of mounting evidence demonstrating declines in reproductive success due to noise, our results suggest that nest box placement near roads may be counterproductive to efforts to bolster population densities of some species.