Comparison of Health Care Worker Satisfaction Before vs After Implementation of a Communication and Optimal Resolution Program in Acute Care Hospitals.

This case-control study investigates the association between a communication and optimal resolution program to address unexpected adverse patient outcomes and measures of health care worker satisfaction.

Students choosing fat-free chocolate milk during school lunch consume more calories, total sugar, protein, minerals and vitamins at lunch.

OBJECTIVE: To examine how milk consumption varies by milk choice and measure the association of milk choice on the nutritional and energetic content of National School Lunch Program (NSLP) lunches. DESIGN: An observational plate waste study using the Digital Photography of Foods Method. SETTING: Data were collected from two suburban South Carolina schools in one district during February and March 2013. PARTICIPANTS: Totally, 968 NSLP lunches selected by 619 kindergarten to fifth grade students. RESULTS: Most students chose chocolate milk (75 %). A multinomial logit model indicated milk choice varied significantly by sociodemographic characteristics. An ordinary least square regression indicated that consumption rates of low-fat white milk were 8·5 % lower than fat-free chocolate milk (P = 0·039) and milk consumption rates varied statistically by sociodemographic characteristics. Ordinary least square regressions found that the consumption of energies and nutrients from NSLP lunches varied with sociodemographic characteristics and milk choice; students selecting chocolate milk consumed 58 more energies (P < 0·001) and 10 more grams of total sugar (P < 0·001) than students selecting low-fat white milk from their NSLP lunches. Students consumed statistically similar energies and nutrients from the non-milk components of their meals. CONCLUSIONS: Students selecting chocolate milk consumed more energies and nutrients from their NSLP lunches with the increases in consumption attributed to the milk component of the meal. The findings have implications for recent changes to NSLP guidelines that allow schools to offer both low-fat and fat-free flavoured milk, reversing the previous ban on low-fat flavoured milk under the Healthy, Hunger-Free Kids Act.

Selection and consumption of lunches by National School Lunch Program participants.

The Healthy, Hunger-Free Kids Act of 2010 requires schools participating in the National School Lunch Program (NSLP) to offer a variety of healthy food options each day. Using digital photography data collected from two suburban elementary schools in the spring of 2013, we examine NSLP participant's selection and consumption of all five NSLP lunch components ((1) milk, (2) vegetable, (3) fruit, (4) meat/meat alternate (MA), and (5) grain). We use logit regressions to analyze the selection of the various lunch components by race/ethnicity, gender, grade, and household income level. In addition, ordinary least squares regressions are used to analyze the selection and consumption of calories contained in the chosen lunch and by lunch component. Selection and consumption varied by race, ethnicity, gender, and eligibility for free or reduced-price lunch. For example, black students consumed fewer calories than white students, black and Hispanic students consumed fewer calories from milk than white students, and free and reduced-price lunch eligible students consumed more calories from milk and fewer calories from grains. Using National Health and Nutrition Examination Survey (NHANES) data, we determine that school lunches are an important part of school-day food intake for NSLP participants. These results provide guidance for making changes within a cafeteria's offerings to increase the selection of healthy foods.

Screening for a Chronic Disease: A Multiple Stage Duration Model with Partial Observability.

We estimate a dynamic multi-stage duration model to investigate how early detection of diabetes can delay the onset of lower extremity complications and death. We allow for partial observability of the disease stage, unmeasured heterogeneity, and endogenous timing of diabetes screening. Timely diagnosis appears important. We evaluate the effectiveness of two potential policies to reduce the monetary costs of frequent screening in terms of lost longevity. Compared to the status quo, the more restrictive policy yields an implicit value for an additional year of life of about $50,000, while the less restrictive policy implies a value of about $120,000.

Caregiving and elderly health in Mexico.

Using the National Mexican Health and Aging Study panel dataset, the authors estimate the effect of having informal care on the probability of dying and on the change in elderly health over a two-year period. Three measures of functional health were used: self-reported health, activities of daily living, and instrumental activities of daily living. We develop an empirical strategy that relies on the panel structure of the dataset to sort out the possible correlation between unobservable characteristics that affect both elderly health and an individual's decision to provide informal care. Our findings suggest that informal care provided by daughters reduces the probability of dying. In addition, informal care provided by daughters reduces the probability of having a decline in activities of daily living and instrumental activities of daily living, while it has no effect on the observed changes in self-reported health status. The protective effect of informal care provided by sons is not statistically significant for any health outcomes. A discussion of the policy options to increase elderly health and to improve the role of caregivers is included.

Maternal Employment, Migration, and Child Development.

We analyze the roles of and interrelationships among school inputs and parental inputs in affecting child development through the specification and estimation of a behavioral model of household migration and maternal employment decisions. We integrate information on these decisions with observations on child outcomes over a 13-year period from the NLSY. We find that the impact of our school quality measures diminish by factors of 2 to 4 after accounting for the fact that families may choose where to live in part based on school characteristics and labor market opportunities. The positive statistical relationship between child outcomes and maternal employment reverses sign and remains statistically significant after controlling for its possible endogeneity. Our estimates imply that when parental responses are taken into account, policy changes in school quality end up having only minor impacts on child test scores.

Determinants of gender differences in health among the elderly in Latin America.

This paper identifies the main gender differences in health and socio-economic characteristics of the elderly in four Latin American cities. Using locally weighted regressions as well as a flexible model specification that treats age non-parametrically, we investigate whether these unadjusted gender gaps in health are due to gender differences in the distribution of age and other explanatory variables. Interestingly, for all cities, the analyses show a gender gap in health in favour of males at each age. The gaps are larger when one uses functional impairment in mobility and personal self-care as indicators of an individual's health instead of self-reported health. Furthermore, controlling for demographic characteristics, baseline health and the availability of family support do little to change the disadvantage for women in measured health outcomes. Controlling for socio-economic variables does, however, reduce most of the gender differences in health.

Living arrangements and the role of caregivers among the elderly in Latin America.

Using the SABE(1) data set, this paper describes the support that the elderly receive from family members, siblings, friends and the community where they live in four Latin American cities. It also reports the activities that the elderly do for their family members. In the four distinct cities included in the study, we find similar trends in terms of living arrangements, the role of caregivers and the type of activities that elderly people provide for their family members. Our findings indicate the elderly without any support tend to be in better health and socio-economic conditions than elderly persons with family or community support; this is likely because healthier individuals need less assistance. Surprisingly, most of the elderly without any help from family members do not receive support from the community either. Daughters inside the household are the most likely caregivers and receive most assistance from the elderly in return. The exchange of services and activities within the household reflects the higher gains that female caregivers receive from taking care of elderly relatives, or the lower wages and consequently their lower cost of providing care. Among the providers of money, sons and daughters share similar characteristics. A significant number of caregivers are in the productive years of their life. A discussion of the policy options to increase elderly health and to improve the role of caregivers is included.

Within- and between-person variation in nutrient intakes of Russian and U.S. children differs by sex and age.

Within- and between-person variation in nutrient intake has been characterized in different adult populations, but little is known of country, age, or sex differences among children. The objectives of this study were as follows: 1) to describe the mean intake, within- and between-individual CV and variance ratios of nutrient intake among children ages 9-18 y old in Russia and the United States in 1996; 2) to compare the age and sex-related differences in nutrient intake variance within and between countries; and 3) to hypothesize about the feasibility of using within-individual variance estimates from one nationally representative sample to adjust the usual intake distributions in another nationally representative sample. Mean intakes of all nutrients except magnesium were significantly higher among U.S. children (P < 0.001); within-person variation was higher among the U.S. children, possibly indicating greater access to a wide array of foods. Strong differentials existed in variance components by sex in both countries, although not in the same direction, and differed by age in U.S. girls. Ratios of within- to between-person variance in 8 of 11 nutrients were lower among Russian (range: 0.9-1.6) than U.S. children (range: 1.4-1.7), suggesting that day-to-day bias may not affect Russian dietary recalls as strongly as in the United States. Researchers are encouraged to use these estimates to conduct sensitivity analyses of usual intake distributions in their own data when multiple days of data collection are not feasible.

A flexible approach for estimating the effects of covariates on health expenditures.

Our estimation strategy uses sequences of conditional probability functions, similar to those used in discrete time hazard rate analyses, to construct a discrete approximation to the density function of an outcome of interest conditional on exogenous explanatory variables. Once the conditional density function has been constructed, we can examine expectations of arbitrary functions of the outcome of interest and evaluate how these expectations vary with observed exogenous covariates. We demonstrate the features and precision of the conditional density estimation method (and compare it to other commonly used methods) through Monte Carlo experiments and an application to health expenditures using the RAND Health Insurance Experiment data. Overall, we find that the approximate conditional density estimator provides accurate and precise estimates of derivatives of expected outcomes for a wide range of types of explanatory variables.