Importance of out-of-pocket costs for adult patients with atopic dermatitis in France.

BACKGROUND: Currently, few studies investigated the economic burden of atopic dermatitis (AD) in adult patients and specifically the estimation of out-of-pocket costs. Patients with skin disorders primarily use comfort care to ease dryness, itch or pain, and the costs of comfort care are not subject to any reimbursement from mandatory or complementary insurance. OBJECTIVE: The purpose of this study was to measure the medical and non-medical expenses paid by the patient. METHODS: Eczema Cohort Longitudinal Adults was a non-interventional study that aimed to assess the burden of AD in terms of quality of life and financial consequences. A self-assessment questionnaire was distributed to adult patients who were cared in four French hospitals. Patients were asked to list the resources consumed for the treatment of AD during the last 12 months and to estimate the corresponding amount of money they had to pay out of their own pockets. The severity of AD was subjected to a stratification based on the PO-SCORAD score. RESULTS: A total of 1024 patients answered the questionnaire: 31.9% with severe AD, 40.4% with moderate AD and 27.6% with mild AD. The mean annual out-of-pocket cost was €462.1 for severe AD and €247.4 for moderate AD. Emollients were the most commonly used product: 74.4% for an average out-of-pocket cost of €151.4. The out-of-pocket costs increased significantly with the severity: 27% of patients with severe AD declared having bought specially textured clothes, while 19% of patients with moderate AD reported the same. The corresponding mean out-of-pocket costs were €162 and €91, respectively. CONCLUSION: The amount of out-of-pocket costs for patients with AD for essential medical and non-medical expenses is relatively high, compared to the average out-of-pocket cost for French households. Integration of these essential resources into the list of reimbursed products and services appears necessary for a better coverage of AD.

Education, HIV, and Early Fertility: Experimental Evidence from Kenya.

A seven-year randomized evaluation suggests education subsidies reduce adolescent girls' dropout, pregnancy, and marriage but not sexually transmitted infection (STI). The government's HIV curriculum, which stresses abstinence until marriage, does not reduce pregnancy or STI. Both programs combined reduce STI more, but cut dropout and pregnancy less, than education subsidies alone. These results are inconsistent with a model of schooling and sexual behavior in which both pregnancy and STI are determined by one factor (unprotected sex), but consistent with a two-factor model in which choices between committed and casual relationships also affect these outcomes.

Cost-effectiveness of the non-pneumatic anti-shock garment (NASG): evidence from a cluster randomized controlled trial in Zambia and Zimbabwe.

BACKGROUND: Obstetric hemorrhage is the leading cause of maternal mortality, particularly in low resource settings where delays in obtaining definitive care contribute to high rates of death. The non-pneumatic anti-shock garment (NASG) first-aid device has been demonstrated to be highly cost-effective when applied at the referral hospital (RH) level. In this analysis we evaluate the incremental cost-effectiveness of early NASG application at the Primary Health Center (PHC) compared to later application at the RH in Zambia and Zimbabwe. METHODS: We obtained data on health outcomes and costs from a cluster-randomized clinical trial (CRCT) and participating study hospitals. We translated health outcomes into disability-adjusted life years (DALYs) using standard methods. Econometric regressions estimated the contribution of earlier PHC NASG application to DALYs and costs, varying geographic covariates (country, referral hospital) to yield regression models best fit to the data. We calculated cost-effectiveness as the ratio of added costs to averted DALYs for earlier PHC NASG application compared to later RH NASG application. RESULTS: Overall, the cost-effectiveness of early application of the NASG at the primary health care level compared to waiting until arrival at the referral hospital was $21.78 per DALY averted ($15.51 in added costs divided by 0.712 DALYs averted per woman, both statistically significant). By country, the results were very similar in Zambia, though not statistically significant in Zimbabwe. Sensitivity analysis suggests that results are robust to a per-protocol outcome analysis and are sensitive to the cost of blood transfusions. CONCLUSIONS: Early NASG application at the PHC for women in hypovolemic shock has the potential to be cost-effective across many clinical settings. The NASG is designed to reverse shock and decrease further bleeding for women with obstetric hemorrhage; therefore, women who have received the NASG earlier may be better able to survive delays in reaching definitive care at the RH and recover more quickly from shock, all at a cost that is highly acceptable.

Impact of cost sharing on quality improvement and profits under uncertain demand: The case of a textile and garment supply chain.

The study explores the strategic pricing and quality improvement decisions under uncertain demand in a three-layer textile and garment supply chain. According to whether the fabric manufacturer (FM) invests in quality or not and whether the garment manufacturer (GM) or garment retailer (GR) is willing to share the costs or not, five game models are constructed to investigate the impact of different members' cost sharing on the optimal decisions and profits. By conducting a theoretical and numerical analysis, we find that: (1) The GM's or GR's cost sharing plays a positive effect on the quality improvement, as for whose cost sharing performs better in improving the quality depending on the proportion of cost sharing, and the quality improvement is highest with both members share the costs simultaneously. (2) The FM receives the highest profit when both members share the costs simultaneously, however, whose cost sharing is more profitable for the FM is also related to the proportion of cost sharing; in short, the FM always benefits from the cost sharing, no matter one member does this or two members do this. (3) The GM (GR) gains the highest profit when only the GR (GM) shares the costs, and the results indicate that if one member has shared the costs, whether the other member engaging in cost sharing could benefit the former depending on their proportions. Specifically, when the GM (GR) chooses to share the costs and the proportion is relatively low, the GR(GM) joining in cost sharing is beneficial to the former; otherwise, is harmful.

"Money talks, bullshit walks" interrogating notions of consumption and survival sex among young women engaging in transactional sex in post-apartheid South Africa: a qualitative enquiry.

BACKGROUND: Transactional sex is believed to be a significant driver of the HIV epidemic among young women in South Africa. This sexual risk behaviour is commonly associated with age mixing, concurrency and unsafe sex. It is often described as a survival- or consumption-driven behaviour. South Africa's history of political oppression as well as the globalization-related economic policies adopted post-apartheid, are suggested as the underlying contexts within which high risk behaviours occur among Black populations. What remains unclear is how these factors combine to affect the particular ways in which transactional sex is used to negotiate life among young Black women in the country.In this paper we explore the drivers of transactional sex among young women aged 16-24, who reside in a peri-urban community in South Africa. We also interrogate prevailing constructions of the risk behaviour in the context of modernity, widespread availability of commodities, and wealth inequalities in the country. METHODS: Data were collected through 5 focus group discussions and 6 individual interviews amongst young women, men, and community members of various age groups in a township in the Western Cape, South Africa. FINDINGS: Young women engaged in transactional sex to meet various needs: some related to survival and others to consumption. In this poverty-stricken community, factors that created a high demand for transactional sex among young women included the pursuit of fashionable images, popular culture, the increased availability of commodities, widespread use of global technologies, poverty and wealth inequalities. Transactional sex encounters were characterized by sexual risk, a casual attitude towards HIV, and male dominance. However, the risk behaviour also allowed women opportunities to adopt new social roles as benefactors in sexual relationships with younger men. CONCLUSION: Transactional sex allows poor, young women to access what young people in many parts of the world also prioritize: fashionable clothing and opportunities for inclusion in popular youth culture. In the context of high HIV prevalence in South Africa, strategies are needed that present young women with safer economic gateways to create and consume alternative symbols of modernity and social inclusion.

Apparel Consumption and Embodied Experiences of Gay Men and Transgender Women in India: Variety and Ambivalence, Fit Issues, LGBT-Fashion Brands, and Affordability.

The purpose of this study was to explore Indian LGBT individuals' apparel consumption practices and embodied experiences related to fashion, style, and the body. Specifically, our research questions were these: What are Indian LGBT individuals' experiences like when navigating the fashion system, and how do they experience their own embodiment in what they wear and how they appear? A qualitative, phenomenological approach was used to answer the research questions. Three gay men and seven transgender women responded to a solicitation for participation and completed a semistructured interview. In our data analysis, we established four themes that relate to two larger areas of emphasis: embodiment and the fashion system. Regarding embodiment, participants related many experiences with their bodies, including (a) variety and ambivalence with bodily practices and (b) difficulty with clothing fit. The other themes centered around knowledge and desires related to the fashion system. Within the fashion system, participants expressed (a) fashion brand awareness and a need for LGBT-centered brands and (b) affordability as a barrier to clothing purchase. Overall, the essence of fashioning one's body as a transgender woman or gay man in India is that, while there has been a significant amount of gender oppression in India, these participants were interested in and desired gender-neutral or LGBT-focused brands.

Keystone actors do not act alone: A business ecosystem perspective on sustainability in the global clothing industry.

Global industries are typically dominated by a few disproportionately large and influential transnational corporations, or keystone actors. While concentration of economic production is not a new phenomenon, in an increasingly interconnected and globalized world, the scale of the impacts of keystone actors on diverse social-ecological systems continues to grow. In this article, we investigate how keystone actors in the global clothing industry engage in collaboration with a variety of other organizations to address nine interrelated biophysical and socioeconomic sustainability challenges. We expand on previous theoretical and empirical research by focusing on the larger business ecosystem in which keystone actors are embedded, and use network analysis to assess the contributions of different actor types to the architecture of the ecosystem. This systemic approach to the study of keystone actors and sustainability challenges highlights an important source of influence largely not addressed in previous research: the presence of organizations that occupy strategic positions around keystone actors. Such knowledge can help identify governance strategies for advancing industry-wide transformation towards sustainability.

Athleisure: A qualitative investigation of a multi-billion-dollar clothing trend.

Clothes play a ubiquitous, yet under-appreciated social role. In the context of body image, clothes may both reflect and facilitate wearers' ideals and anxieties about their physical appearance. Athleisure, referring to athletic-inspired workout apparel that explicitly accentuates wearers' physiques, is a hitherto unexamined clothing trend worth tens of billions of dollars annually (and growing) in the United States consumer market alone. We conducted the first qualitative examination of athleisure by interviewing 20 women who regularly wore athleisure. Four master themes emerged from the data: (1) the athleisure lifestyle, (2) the conditional nature of athleisure, (3) athleisure embodiment, and (4) athleisure-linked cognitive dissonance. Our results suggest that wearing athleisure communicates to others an adherence to the lifestyles depicted in fitspiration - a class of social media imagery that glorifies thin-fit bodies. Participants articulated that athleisure encouraged them to feel more confident and athletic; athleisure also emphasized the women's physiques, and whether they aligned with the thin-fit ideal. Thus, the act of wearing athleisure motivated participants to engage in fitspiration-based activities. Given the (a) massive public demand for athleisure, and (b) industry projections for continued growth in athleisure spending, our findings compel additional research on the connections between clothing and body image.

Report of the human body louse (Pediculus humanus) from clothes sold in a market in central Italy.

BACKGROUND: Pediculus humanus, the human body louse, is widespread where overcrowding and lack of hygiene are present, in areas of the world affected by poverty, war, famine and presence of refugees. It has recently been considered re-emerging among homeless populations in developed countries. In Italy, it was last reported in 1945. Pediculus humanus is a vector of highly relevant human pathogens. METHODS: In October 2018, a woman found small insects on a T-shirt bought second-hand in a local street market in a village 35 km south of Rome (central Italy). Insects were identified both morphologically and by molecular analysis. Moreover, they were analyzed molecularly for the presence of Rickettsia prowazekii, Borrelia recurrentis, Bartonella quintana, Coxiella burnetii and Yersinia pestis. RESULTS: Morphological and molecular analyses of the insects identified them as 26 lice (12 females, 10 males and 4 nymphs) of the species P. humanus. Many nits were found on the T-shirt seams. DNA of the investigated pathogens was not detected in any of the lice. CONCLUSIONS: The exceptionality of the described case lies both in the report of P. humanus from a country where it had not been reported since 1945, and in its finding from second-hand clothes for sale in a market, constituting a potential source of infection for people buying this type of goods. The question arises, how did adults and nits of P. humanus infest clothes for sale on a market stall in a country where it had not been reported for decades. Given that the body louse requires frequent blood meals to survive and develop, its arrival on clothes imported from abroad is highly improbable. Hence, it must be presumed that people infected with the human body louse are present in Italy. This report points out a serious regulatory problem regarding the management of second-hand clothes prior to sale and, more generally, of controls in street markets.

Household saving during pregnancy and facility delivery in Zambia: a cross-sectional study.

Financial barriers cause many women in low- and middle-income countries to deliver outside of a health facility, contributing to maternal and neonatal mortality. Savings accrued during pregnancy can increase access to safe delivery services. We investigated the relationship between household saving during pregnancy and facility delivery. A cross-section of 2381 women who delivered a child in the previous 12 months was sampled from 40 health facility catchment areas across eight districts in three provinces in Zambia in April and May of 2016. During a household survey, women reported on their perceptions of the adequacy of their household savings during their recent pregnancy. Households were categorized based on women's responses as: did not save; saved but not enough; and saved enough. We estimated crude and adjusted associations between perceived adequacy of savings and facility delivery. We also explored associations between savings and expenditures on delivery. Overall, 51% of women surveyed reported that their household saved enough for delivery; 32% reported saving but not enough; and 17% did not save. Household wealth was positively associated with both categories of saving, while earlier attendance at antenatal care was positively associated with saving enough. Compared with women in households that did not save, those in households that saved but not enough (aOR 1.63; 95% CI: 1.17, 2.25) and saved enough (aOR 2.86; 95% CI: 2.05, 3.99) had significantly higher odds of facility delivery. Both categories of saving were significantly associated with higher overall expenditure on delivery, driven in large part by higher expenditures on baby clothes and transportation. Our findings suggest that interventions that encourage saving early in pregnancy may improve access to facility delivery services.

The crowding-out effects of tobacco and alcohol where expenditure shares are low: analyzing expenditure data for Taiwan.

In this paper, we used data from the 2004 Survey of Family Income & Expenditure of Taiwan to show that the problem of the crowding-out effects of tobacco and alcohol in a country with low expenditure can still be serious. Most studies that have investigated this issue have focused on developing countries with a high expenditure share on tobacco or alcohol, and have often overlooked the effects in countries with a low expenditure on such goods. After controlling for the endogeneity of tobacco and alcohol expenditure, and the possibility that households with a zero expenditure on tobacco and alcohol may result from a corner solution rather than abstention, we found that the lowest income households are still most vulnerable to tobacco and alcohol expenditures despite an overall low expenditure in Taiwan. Even higher income households may suffer a lower standard of living due to such expenditure. In addition, some goods and services may be perceived differently by households with different levels of income and this may be caused by the difference in composition across broad expenditure categories. Our results suggest that the government ought to tackle the problem of smoking and drinking outside the realm of health, since these expenditures may harm the country's standard of living even when there is high income.

Crowding out effect of tobacco expenditure and its implications on household resource allocation in India.

This paper examines whether spending on tobacco crowds out expenditure on basic needs and whether it has implications on nutrition intake and household resource allocation in India. The paper uses a household sample survey from India for the year 1999--2000. A system of quadratic conditional Engel curves was estimated for a set of 10 broad groups of commodities. The results suggest that tobacco consuming households had lower consumption of certain commodities such as milk, education, clean fuels and entertainment which may have more direct bearing on women and children in the household than on men suggesting possible 'gender effects' and biases in the allocation of goods and services within the household. Tobacco spending was also found to have negative effects on per capita nutrition intake. The nature of crowding out was found to be similar in low- and high-income households.

The Women's Recovery from Sternotomy (WREST) study: design of a randomized trial of a novel undergarment for early use after sternotomy.

BACKGROUND: Clinicians who work with women poststernotomy often suggest that they wear a supportive brassiere to ameliorate pain, discomfort, and potential wound complications. There is no empirical evidence that supports this practice. METHODS: Despite methodological challenges, a clinical trial is currently underway to investigate the efficacy of early use of a novel undergarment after sternotomy. Women (N = 430) having first time sternotomy in 9 Canadian centers will be randomized to receive either the usual care of the institution or early use of a novel undergarment. Follow-up is planned over 12 postoperative weeks. Coprimary outcomes are pain, discomfort, and return to function. Wound healing is a secondary outcome. An economic evaluation substudy is also underway. CONCLUSIONS: The WREST Study is a unique ongoing trial examining the efficacy of a novel undergarment in reducing women's pain and enhancing their comfort and return to function. The findings of the trial and its economic substudy will enable health care providers to make rational evidence-based clinical decisions regarding women's early care after sternotomy.

Price sensitivity and innovativeness for fashion among Korean consumers.

Price sensitivity is how consumers react to price levels and to price changes. Consumer innovativeness is a tendency to welcome and to adopt new products. Researchers (e.g., R. E. Goldsmith & S. J. Newell, 1997) consider innovative consumers relatively more price insensitive than other consumers, so there should be a negative correlation between measures of these constructs. The results of the present study supported the psychometric soundness of a self-report measure of price sensitivity among 860 Korean consumers and replicated earlier findings of the negative correlation between the 2 constructs.

Provision and decontamination of uniforms in the NHS.

AIM: To ascertain the provision and decontamination of uniforms within a cross-section of NHS trusts in the UK and to compare policies regarding their use. METHOD: A questionnaire was circulated to 170 NHS trust infection control teams in the UK. Eighty-six (51 per cent) responses were received, which represented 101 NHS trusts. RESULTS: Less than half of the trusts (47 per cent) provide adequate numbers of uniforms to allow a clean uniform per shift. Only 26 per cent had adequate on-site staff changing facilities and 65 per cent did not launder uniforms. The majority of nursing staff (91 per cent) were compelled, by a combination of these factors, to launder their uniforms at home. Few were provided with any guidance on how to do this safely. CONCLUSION: There is an urgent need for minimum standards to be set for the provision of uniforms, laundering and changing facilities, to minimise the potential for spread of healthcare-associated infections.