Trends and Regional Variation in Hospital Mortality, Length of Stay and Cost in Hospital of Ischemic Stroke Patients in Alberta Accompanying the Provincial Reorganization of Stroke Care.

OBJECTIVES: This study aimed to evaluate the trends and regional variation of stroke hospital care in 30-day in-hospital mortality, hospital length of stay (LOS), and 1-year total hospitalization cost after implementation of the Alberta Provincial Stroke Strategy. METHODS: New ischemic stroke patients (N = 7632) admitted to Alberta acute care hospitals between 2006 and 2011 were followed for 1 year. We analyzed in-hospital mortality with logistic regression, LOS with negative binomial regression, and the hospital costs with generalized gamma model (log link). The risk-adjusted results were compared over years and between zones using observed/expected results. RESULTS: The risk-adjusted mortality rates decreased from 12.6% in 2006/2007 to 9.9% in 2010/2011. The regional variations in mortality decreased from 8.3% units in 2008/2009 to 5.6 in 2010/2011. The LOS of the first episode dropped significantly in 2010/2011 after a 4-year slight increase. The regional variation in LOS was 15.5 days in 2006/2007 and decreased to 10.9 days in 2010/2011. The 1-year hospitalization cost increased initially, and then kept on declining during the last 3 years. The South and Calgary zones had the lowest costs over the study period. However, this gap was diminishing. CONCLUSIONS: After implementation of the Alberta Provincial Stroke Strategy, both mortality and hospital costs demonstrated a decreasing trend during the later years of study. The LOS increased slightly during the first 4 years but had a significant drop at the last year. In general, the regional variations in all 3 indicators had a diminishing trend.

Physical activity and health outcomes: evidence from Canada.

Health production models include participation in physical activity as an input. We investigate the relationship between participation in physical activity and health using a bivariate probit model. Participation is identified with an exclusion restriction on a variable reflecting sense of belonging to the community. Estimates based on data from Cycle 3.1 of the Canadian Community Health Survey indicate that participation in physical activity reduces the reported incidence of diabetes, high blood pressure, heart disease, asthma, and arthritis as well as being in fair or poor health. Increasing the intensity above the moderate level and frequency of participation in physical activity appears to have a diminishing marginal impact on adverse health outcomes. Our results provide support for guidelines about engaging in exercise regularly to achieve health benefits.

Air quality and employee performance in teams: Evidence from the NFL.

Emerging research documents the impact of poor air quality on employee performance in a number of settings, including sport. Unlike other settings, sports teams have limited ability to influence previously scheduled games, making air quality exogenous to unobservable factors affecting game outcomes. We link play-level data from National Football League (NFL) games to data from air quality monitoring stations located near NFL stadiums. Results using data from about 90,000 offensive plays in 900 NFL games indicate that yards gained per offensive play increase with PM2.5 concentration. Defensive players are relatively more affected by air quality than offensive players.

Monetary Cost of the MyPlate Diet in Young Adults: Higher Expenses Associated with Increased Fruit and Vegetable Consumption.

BACKGROUND: Cost is a commonly reported barrier to healthy eating. This is a secondary research analysis designed to examine the food expenditures of young adults on a university campus following the United States Department of Agriculture (USDA) MyPlate guidelines for fruits and vegetables. METHODS: Meal receipts and dietary intake were recorded weekly. Anthropometrics and clinical assessments were recorded before intervention. Researchers rated compliance based on the participant's dietary food log, receipt matching, food pictures, and reports during weekly 1-hour consultations. RESULTS: Fifty-three young adults (18-30 years old) at-risk of, or diagnosed with, metabolic syndrome (MetS) were enrolled in the study, with 10 excluded (n = 43) from analyses due to enrollment in a fixed cost university campus dining meal plan. A two sample t-test assessed differences in food costs and regression analysis determined associations between food cost and diet compliance while controlling for confounding factors of age, sex, and body mass index (BMI). Diet compliant subjects (n = 38) had higher weekly food cost at $95.73 compared to noncompliant subjects (n = 5) who spent $66.24 (p=0.01). A regression analysis controlling for age, sex, BMI, and geographical region also indicated cost differences based on diet compliance (p < 0.0001). CONCLUSION: Results indicate an ∼$29.00 per week increase in food cost when eating the recommended amount of fruit and vegetables. These findings can contribute to research incentive design, program planning cost, and determining effective interventions to improve diet in this population.

Analysis of healthcare financing, supply and utilisation trends in the new EU countries.

The EU expanded in 2004 to include eight transition countries, i.e. Central and Eastern European (CEE) and newly independent states of the former Soviet Union, and two other CEE countries are scheduled to join the EU in 2007. Each of these countries has undertaken substantial healthcare reform efforts over the past 15 years. The paths of healthcare reform are diverse for a number of reasons including differences in initial economic, political and structural conditions. The objective of this article is to evaluate the process and preliminary outcomes of healthcare reform in the new EU and candidate countries by analysing trends in aggregate financing, supply and utilisation indicators using data drawn from the WHO Health for All database. The analysis is done in the context of an analytical framework built around common healthcare reform themes. The key reform measures examined include implementing social insurance systems, implementing payment systems that promote efficiency, and removal of excess capacity. The trend analysis highlights the importance of the economic, political and social context in driving the direction and pace of healthcare reform. For example, the transition to social insurance systems was smoother in countries with stronger economies and political commitment to reform. Policies aimed at improving the efficiency of the healthcare system, reducing utilisation and reducing excess capacity were met with some success in all of the countries. However, the reform effort continues as the countries are still addressing the initial challenges of insufficient funding, informal payments, excess capacity and inefficiencies in the provision of healthcare.

Sport participation and subjective well-being: instrumental variable results from German survey data.

BACKGROUND: A major policy goal of many ministries of sport and health is increased participation in sport to promote health. A growing literature is emerging about the benefits of sport participation on happiness. A challenge in establishing a link between sport participation and happiness is controlling for endogeneity of sport participation in the happiness equation. METHODS: This study seeks to establish causal evidence of a relationship between sport participation and self reported happiness using instrumental variables (IV). RESULTS: IV estimates based on data from a 2009 population survey living in Rheinberg, Germany indicate that individuals who participate in sport have higher life happiness. The results suggest a U-shaped relationship between age and self-reported happiness. Higher income is associated with greater self-reported happiness, males are less happy than females, and single individuals are less happy than nonsingles. CONCLUSIONS: Since the results are IV, this finding is interpreted as a causal relationship between sport participation and subjective well-being (SWB). This broader impact of sport participation on general happiness lends support to the policy priority of many governments to increase sport participation at all levels of the general population.