School starting age and long-run health in the United States.

School starting age has been shown to have long-run effects that persist throughout adolescence and into adulthood. Using variation from state-level school starting age laws in the United States, we find that males who are older when they enter school are more likely to have higher levels of self-reported health later in life. We are largely able to rule out education and labor market outcomes as significant channels for this finding. Building from the previous studies that have found conflicting evidence on the effect of school starting age on educational attainment and labor market outcomes in the United States, we find that school starting age decreases the likelihood of high school completion among males but has no significant effect for females. We do not find that labor market outcomes are affected by school starting age.

Effect of expectancy and personality on cortical excitability in Parkinson's disease.

Our previous studies in Parkinson's disease have shown that both levodopa and expectancy of receiving levodopa reduce cortical excitability. We designed this study to evaluate how degree of expectancy and other individual factors modulate placebo response in Parkinson's patients. Twenty-six Parkinson's patients were randomized to 1 of 3 groups: 0%, 50%, and 100% expectancy of receiving levodopa. All subjects received placebo regardless of expectancy group. Subjects completed the NEO-Five Factor Inventory, General Perceived Self-Efficacy Scale, and Perceived Stress Scale. Cortical excitability was measured by the amplitude of motor-evoked potential (MEP) evoked by transcranial magnetic stimulation. Objective physical fatigue of extensor carpi radialis before and after placebo levodopa was also measured. Responders were defined as subjects who responded to the placebo levodopa with a decrease in MEP. Degree of expectancy had a significant effect on MEP response (P < .05). Subjects in the 50% and 100% expectancy groups responded with a decrease in MEP, whereas those in the 0% expectancy group responded with an increase in MEP (P < .05). Responders tended to be more open to experience than nonresponders. There were no significant changes in objective physical fatigue between the expectancy groups or between responders and nonresponders. Expectancy is associated with changes in cortical excitability. Further studies are needed to examine the relationship between personality and placebo effect in Parkinson's patients. © 2013 Movement Disorder Society.

The impact of health reform on the Medicare Advantage program: realigning payment with performance.

The Affordable Care Act enacts a new payment system for private health plans available to Medicare beneficiaries through the Medicare Advantage (MA) program. The system, which is being phased in through 2017, aims to (1) reduce the excess pay­ments received by private plans relative to per capita spending in traditional Medicare, and (2) reward plans that earn high performance ratings. Using 2009 data, this issue brief pres­ents analysis of the distributional impact on MA plan payments of these new policies as if they had been fully implemented in that year. We find that, when the polices [sic] are in place, they will bring overall MA plan payments nationwide down from 114 percent to 102 per­cent of what spending would have been for the same enrollees if they had been enrolled in traditional Medicare. While payments will vary across the nation, high-performing MA plans stand to benefit from this new arrangement.

Defining health diplomacy: changing demands in the era of globalization.

CONTEXT: Accelerated globalization has produced obvious changes in diplomatic purposes and practices. Health issues have become increasingly preeminent in the evolving global diplomacy agenda. More leaders in academia and policy are thinking about how to structure and utilize diplomacy in pursuit of global health goals. METHODS: In this article, we describe the context, practice, and components of global health diplomacy, as applied operationally. We examine the foundations of various approaches to global health diplomacy, along with their implications for the policies shaping the international public health and foreign policy environments. Based on these observations, we propose a taxonomy for the subdiscipline. FINDINGS: Expanding demands on global health diplomacy require a delicate combination of technical expertise, legal knowledge, and diplomatic skills that have not been systematically cultivated among either foreign service or global health professionals. Nonetheless, high expectations that global health initiatives will achieve development and diplomatic goals beyond the immediate technical objectives may be thwarted by this gap. CONCLUSIONS: The deepening links between health and foreign policy require both the diplomatic and global health communities to reexamine the skills, comprehension, and resources necessary to achieve their mutual objectives.

Medicare Advantage in the era of health reform: progress in leveling the playing field.

Payments to private Medicare Advantage (MA) plans have exceeded Medicare fee-for-service (FFS) costs since those payments were increased by the Medicare Modernization Act of 2003 (MMA). Payments to MA plans in 2010 exceeded average costs in FFS Medicare nationally by 8.9 percent, a total of $8.9 billion. While these extra payments are substantial, they represent a decrease relative to 2009, when MA payments were 13.0 percent, or $11.4 billion, greater than FFS costs. The decrease in MA payments relative to FFS costs, while mostly resulting from policy decisions and other factors not directly related to the health reform law, begins to shift MA payments toward levels mandated in the provisions that are set to go into effect in 2012.

Reading the news on Twitter: Source and item memory for social media in younger and older adults.

BACKGROUND: Social media content is well-remembered, possibly because of its personal relevance and gossipy nature. It is unclear whether the mnemonic advantage of social media extends to a population less familiar with these platforms and whether knowing the content is from social media sources influences memory. This study examined how the presentation of news-like content in social media affected both item and source memory across two age groups. Younger adults (n = 42) and older adults (n = 32) studied tweets and news headlines that appeared in the format of Twitter posts or CNN headlines - these items were designed to be either congruent (e.g., tweets formatted as Twitter posts) or incongruent (e.g., tweets formatted as CNN headlines). RESULTS: For item memory, both age groups correctly recognized tweets more than headlines. Source identification was more accurate when format and content were congruent than incongruent. Signal detection analyses indicated that the source advantage for congruent items was largely driven by a bias to select the format that matched the content's original source and that this tendency was stronger in older adults. CONCLUSIONS: These results replicate previous literature on the mnemonic advantage of social media content. Although both younger and older adults remembered the content of social media better than the content of news sources, older adults were more sensitive than younger adults to congruency effects in source memory. These findings suggest that older adults rely more on their prior knowledge of conventional language and style in traditional and social media.

Medicare Advantage reforms: comparing House and Senate bills.

The Medicare Advantage (MA) program, which enables Medicare beneficiaries to enjoy private health plan coverage, is a major element of the current health care reform discussion on Capitol Hill--in large part because payments to MA plans in 2009 are expected to run at least $11 billion more than traditional Medicare would have cost. While the pending Senate and House bills both endeavor to reduce these extra MA payments, their approaches are different. The bills also differ on other aspects of reforming the MA program, such as plans' allowable geographic areas, their risk-adjustment systems and reporting requirements, their potential bonuses for achieving high-quality care and providing good management, and their beneficiary protections. This issue brief compares the above and other provisions in the House and Senate bills, which have a common overall goal to improve the value that Medicare obtains for the dollars it spends

Centella asiatica triterpenes for diabetic neuropathy: a randomized, double-blind, placebo-controlled, pilot clinical study.

BACKGROUND: Diabetic neuropathy (DN), a common complication of diabetes mellitus, results from hyperglycemia, poor microcirculation and attendant nerve damage. Currently available treatments relieve symptoms, but do not modify the neurodegeneration underlying DN. Centella asiatica (CA) triterpenes improved microcirculation in earlier clinical studies, and showed neurotropic effects in preclinical models suggesting a potential disease modifying effect in DN. This 52-week, randomized, double-blind, placebo-controlled trial examined the effects of CAST, a standardized CA extract containing triterpenes, on neuropathy symptoms in Type II diabetic subjects. PATIENTS AND METHODS: The study enrolled patients with a history of Type II diabetes, with evidence of symptomatic symmetrical DN with total symptom score (TSS) ≥4, and stable HbA1c level <8. The primary outcome measure was TSS, which assessed intensity and frequency of parasthesia, numbness, pain and burning symptoms self-reported by patients. Secondary measures were nerve conduction, neurological impairment score, and quantitative sensory testing. RESULTS: Comparing CAST (n=21) and Placebo (n=22) groups, significant reductions from baseline for TSS (p<0.01) and paresthesia (p<0.01) were seen only in CAST treated groups. Numbness increased from baseline only in the Placebo group (p<0.05) and was significantly higher than for the CAST group (p<0.001). Burning sensation was reduced in both groups (p<0.01). Plasma triterpene levels in patients treated with CAST mirrored neurotropic concentrations in vitro. CONCLUSIONS: CAST is a potential oral treatment for diabetic neuropathy, as it is well tolerated and effective in reducing the severity of DN symptoms in patients with Type II diabetes.

Using modafinil to treat fatigue in Parkinson disease: a double-blind, placebo-controlled pilot study.

BACKGROUND: Fatigue is a major nonmotor symptom in Parkinson disease(PD). It is associated with reduced activity and lower quality of life. OBJECTIVE: To determine if modafinil improves subjective fatigue and physical fatigability in PD. METHODS: Nineteen PD patients who reported significant fatigue in the Multidimensional Fatigue Inventory (MFI) participated in this 8-week study. Subjects took their regular medications and were randomly assigned to the treatment group (9 subjects, modafinil 100-mg capsule BID) or placebo group (10 subjects). We used the MFI to measure subjective fatigue and used finger tapping and intermittent force generation to evaluate physical fatigability. Subjects also completed the Epworth Sleepiness Scale (ESS) and the Center of Epidemiological Study-Depression Scale. RESULTS: There were no significant differences at baseline and at 1 month in finger tapping and ESS between the modafinil and placebo groups. At 2 months, the modafinil group had a higher tapping frequency (P<0.05), shorter dwell time (P<0.05), and less fatigability in finger tapping and tended to have lower ESS scores (P<0.12) than the placebo group. However, there was no difference between groups over time for any dimension of the MFI . CONCLUSIONS: This small study demonstrated that although modafinil may be effective in reducing physical fatigability in PD, it did not improve fatigue symptoms.