Projecting the long-term societal value of a disease-modifying treatment for Alzheimer's disease in the United States.

INTRODUCTION: We estimate societal value of a disease-modifying Alzheimer's disease (AD) treatment that reduces progression by 30% in early stages. METHODS: Using the International Society for Pharmacoeconomics and Outcomes Research value flower as framework, we estimate gross societal value, that is, not including treatment cost, from avoided medical and social care costs, productivity and quality-adjusted life-years (QALY) gains for patients and caregivers, adjusting for severity of disease, value of financial insurance, and value of insurance for currently unafflicted adults with a Markov model. RESULTS: Predicted societal value from 2021 until 2041 is $2.62 trillion for the overall afflicted US population and $986 billion for the 2021 prevalent cohort or $134,418 per person, with valuation of patients' QALY gains (63%) and avoided nursing-home costs (20%) as largest components. Delays in access because of health system capacity constraints could reduce realized value between 52% and 69%. The value of insurance for the unafflicted is $4.52 trillion or $18,399 on average per person. DISCUSSION: With a total of $5.5 trillion, the projected gross societal value of a hypothetical AD treatment is substantial, which may help to put the cost of treatment into perspective.

Impact of built, social, and economic environments on adolescent obesity and related health behaviors.

OBJECTIVE: This study aimed to estimate the effects of the built, social, and economic environments on adolescent obesity and related behaviors. METHODS: Exploiting quasi-exogenous variation in military families' geographic location, this study estimated intent-to-treat models of the association between the assigned installation's county environments and adolescents' (mean age 13.5 years) self-reported and model-corrected BMI, overweight or obesity status, and self-reported diet and exercise. Three indices for the built, social, and economic environments characterized county-level environments (higher value implies more advantageous environments) based on 19 indicators. Multivariate linear and logistic models were estimated on the full sample (N = 1111) and on subsamples with greater exposure based on time (n = 682) and off-installation residence (n = 604). RESULTS: Exposure to more advantageous built environments for more than 2 years was associated with lower probabilities of obesity (-0.18; 95% CI: -0.34 to -0.026) and overweight or obesity (-0.34; 95% CI: -0.56 to -0.12) and was associated with lower BMI z scores (-0.76; 95% CI: -1.45 to -0.02). Results for adolescents living off-installation were similar. More advantageous built environments were also associated with lower consumption of unhealthy foods, but not with physical activity. Social and economic environments were not associated with any outcomes. CONCLUSIONS: The built environment, but not social and economic environments, was a strong predictor of adolescents' BMI, overweight or obesity status, and eating behaviors.

Association of Place With Adolescent Obesity.

Importance: Despite strong evidence linking place and obesity risk, the extent to which this link is causal or reflects sorting into places is unclear. Objective: To examine the association of place with adolescents' obesity and explore potential causal pathways, such as shared environments and social contagion. Design, Setting, and Participants: This natural experiment study used the periodic reassignment of US military servicemembers to installations as a source of exogenous variation in exposure to difference places to estimate the association between place and obesity risk. The study analyzed data from the Military Teenagers Environments, Exercise, and Nutrition Study, a cohort of adolescents in military families recruited from 2013 through 2014 from 12 large military installations in the US and followed up until 2018. Individual fixed-effects models were estimated that examined whether adolescents' exposure to increasingly obesogenic places over time was associated with increases in body mass index (BMI) and probability of overweight or obesity. These data were analyzed from October 15, 2021, through March 10, 2023. Exposure: Adult obesity rate in military parent's assigned installation county was used as a summary measure of all place-specific obesogenic influences. Main Outcomes and Measures: Outcomes were BMI, overweight or obesity (BMI in the 85th percentile or higher), and obesity (BMI in the 95th percentile or higher). Time at installation residence and off installation residence were moderators capturing the degree of exposure to the county. County-level measures of food access, physical activity opportunities, and socioeconomic characteristics captured shared environments. Results: A cohort of 970 adolescents had a baseline mean age of 13.7 years and 512 were male (52.8%). A 5 percentage point-increase over time in the county obesity rate was associated with a 0.19 increase in adolescents' BMI (95% CI, 0.02-0.37) and a 0.02-unit increase in their probability of obesity (95% CI, 0-0.04). Shared environments did not explain these associations. These associations were stronger for adolescents with time at installation of 2 years or longer vs less than 2 years for BMI (0.359 vs. 0.046; P value for difference in association = .02) and for probability of overweight or obesity (0.058 vs. 0.007; P value for difference association = .02), and for adolescents who lived off installation vs on installation for BMI (0.414 vs. -0.025; P value for association = .01) and for probability of obesity (0.033 vs. -0.007; P value for association = .02). Conclusion and Relevance: In this study, the link between place and adolescents' obesity risk is not explained by selection or shared environments. The study findings suggest social contagion as a potential causal pathway.

Burnout, Resilience and Self-Esteem in School Teaching University Students.

Burnout syndrome seems to involve fatigue that is characterised by loss of motivation, lack of energy, and some apathy as a consequence of continued exposure to stress in demanding performance circumstances. BACKGROUND: The goal of the present study is to analyse the relationship between burnout in university students with a degree in Teaching and some variables that may be associated with it such as self-esteem, resilience or age. METHODS: A total of 1547 graduate students enrolled in the career of Teaching in the Faculty of Educational Sciences of the University of Granada, Spain, participated in the study. Of them, 337 (21.8%) were men, 1195 (77.3%) were women, 14 (0.9%) indicated other gender options, and 1 (0%) did not respond to this item. The mean age of the participants was 20.52. RESULTS: The results show that low levels of self-esteem and resilience, are the variables that best predict the increase in burnout in students of Teaching. CONCLUSIONS: Findings are discussed regarding applied implications and the need for future research. Intervention initiatives focused on enhancing personal strengths such as resilience or self-esteem can help students to cope with the stress associated with demanding educational situations and thus reduce the presence of burnout.

Do Sheriff-Coroners Underreport Officer-Involved Homicides?

Introduction: In the United States, each state sets its own standards for its death investigation system. These may require independent medical examiners and coroners or allow for the sheriff to assume the role of coroner. Motivated by the well-established fact that counts of officer-involved homicides in official data sets grossly undercount the number of these incidents, we examine the possibility that different death investigation systems may lead to different death classification outcomes. Methods: To examine the potential differences in officer-involved homicide underreporting by presence of sheriff-coroner and violent death type (gunshot, intentional use of force, pursuit, or other vehicle accident), we compare ratios of incidents from both the Federal Bureau of Investigation's Supplementary Homicide Reports and the restricted Multiple-Cause of Death files from the National Vital Statistics System to the Fatal Encounters data across coroner contexts in California between 2000 and 2018; we quantify differences descriptively and examine bivariate tests of means. Results: We find significantly greater underreporting of officer-involved deaths in sheriff-coroner counties in both official data sets for all incidents compared with non-sheriff-coroner counties, independently of the period considered. These underreporting differences in the National Vital Statistics System are robust to restricting to gunshot and intentional use of force deaths, the type of incident expected to be less prone to misclassification in that data set. Conclusions: Officer-involved death underreporting in sheriff-coroner counties necessitates further scrutiny. Disparities in officer-involved death reporting suggest political pressure may play a role in classifying deaths.

Gender differences in couples' division of childcare, work and mental health during COVID-19.

The current COVID-19 crisis, with its associated school and daycare closures as well as social-distancing requirements, has the potential to magnify gender differences both in terms of childcare arrangements within the household and at work. We use data from a nationally representative sample of the United States from the Understanding Coronavirus in America tracking survey to understand gender differences within households on the impact of the COVID-19 crisis. We study how fathers and mothers are coping with this crisis in terms of childcare provision, employment, working arrangements, and psychological distress levels. We find that women have carried a heavier load than men in the provision of childcare during the COVID-19 crisis, even while still working. Mothers' current working situations appear to have a limited influence on their provision of childcare. This division of childcare is, however, associated with a reduction in working hours and an increased probability of transitioning out of employment for working mothers. Finally, we observe a small but new gap in psychological distress that emerged between mothers and women without school-age children in the household in early April. This new gap appears to be driven by higher levels of psychological distress reported by mothers of elementary school-age and younger children.