Effects of changes in short-term human cognition on reported healthcare utilisation.

Growing empirical evidence indicates that financial anxiety causes reductions in short-term cognitive capacity. Results from urban communities in Delhi, India show sizable differences in the number of health events recalled between the poor and non-poor respondents over experimentally controlled recall periods. One explanation for this recall difference is 'poor memory'. Such results provide additional reasons for healthy skepticism of the accuracy of self-reported health survey data. The present research identifies which forms of cognitive capacity are related to health event recall and assesses the roles of poverty and illiteracy as mediating variables. Results indicate that underreporting of health events among the poor in rural Kenya is not solely due to 'poor memory'. Data used comes from a repeated cross-sectional study conducted in Samburu county, Kenya over 10-months between 2017-2018. This period coincided with the ending of a protracted and severe drought in East Africa. The results presented in the current study confirm the poor and non-poor distinction, but provide a more detailed cognitive explanation for such results. Reflective throught, as measured by fluid intelligence and heuristic use, is shown to be good predictors of fever recall among relatively poor rura communities in central Kenya.

The role of short-term changes in cognitive capacity on economic expenditure among Kenyan agro-pastoralists.

The increased exposure of pastoralist communities in East Africa to climatic shocks has focused attention on the resilience of these communities. Although many social scientists directly or indirectly infer versions of homo-economic agents, increasing evidence in development behavioral economics, indicates that such assumptions may be misplaced. Despite on-going advances in the science concerning the effects of stress on dynamic changes in short-term cognitive capacity, there remains limited understanding of the effects of changes in cognitive capacity on economic decision making. The present research empirically evaluates the drivers of short-term changes in cognitive capacity-cognitive ability and heuristic use-and its effect on crop and livestock expenditure among predominantly poor Kenyan agro-pastoralists. Three rounds of cognition and survey data from Samburu, Kenya is analysed. The primary data was collected at the end of the 2015-16 East African drought and covers an 11-month period between October 2016 and September 2017. Dynamic panel estimation, employing maximum likelihood, is used on balanced and unbalanced data. Results indicate that fluid intelligence and heuristic use, along with literacy and stressors, affect crop expenditure. Perceptions of scarcity, relative to prior expectations, are also identified as an important determinant of short-term changes in cognitive ability. These results underscore the importance of better understanding the effects of short-term changes in cognitive capacity on economic expenditure among the poor.

Variable Cognition in ABM Decision-Making: An Application to Livestock Vaccine Choice.

Modeling realistic human decision-making is an important feature of good policy design processes. The use of an agent-based modeling framework allows for quantitative human decision-models that assume fully rational agents. This research introduces a dynamic human decision-making sub-model. The parameterisation of human memory and "rationality" in a decision-making model represents an important extension of decision-making in ABMs. A data driven model of herd movement within a dynamic natural environment is the context for evaluating the cognitive decision-making model. The natural and human environments are linked via memory and rationality that affect herdsmen decision-making to vaccinate cattle using a once-for-life vaccine (Rift Valley fever) and an annual booster vaccine (Contagious Bovine Pleuropneumonia). The simulation model uses environmental data from Samburu county, Kenya from 2004 to 2015. The cognitive parameters of memory and "rationality" are shown to successfully differentiate between vaccination decisions that are characterized by annual and once-for-life choices. The preliminary specifications and findings from the dynamic cognition-pastoralist agent-based model (PastoralScape) indicate that the model offers much to livestock vaccination modeling among small-scale herders.

Information sharing and willingness-to-pay for CBPP vaccine in rural Kenya.

The study estimates cattle owners' willingness-to-pay (WTP) for Contagious Bovine Pleuropneumonia (CBPP) vaccine in Samburu county, Kenya. Of particular policy relevance, the study presents findings on WTP for i) improved access to vaccines and ii) timely access to disease-risk information. The mean price for a CBPP vaccine was estimated at KES 66 (USD 0.64). This price relates to a CBPP vaccine that requires a 1.8 h commute, cattle owners' receipt of timely information that the CBPP disease risk is low-moderate and the vaccine lowers the risk of either tail-drop or post-vaccine abortion. The conditional WTP for mean travel duration and high-risk information are similar at KES 53.9 and KES 51.5. The marginal effect on demand for a 1 h additional travel duration and provision of CBPP disease risk information was estimated as a 1.5 per cent reduction and 2.3 increase. The results of this study indicate that cattle owners value greater levels of knowledge concerning the changing risk profile of CBPP in their community and improved access to CBPP vaccination services. Enhanced engagement with cattle owners concerning CBPP would likely result in a greater utilisation of available CBPP vaccines, conditional on the perceived CBPP disease risk.

Government doctor absenteeism and its effects on consumer demand in rural north India.

Government doctor absenteeism from their public posts is a sizable problem across developing economies. The consumer demand estimation for outpatient fever treatment presented in this paper investigates the interrelationship between government doctor absenteeism and the large informal healthcare sector. Using a counterfactual framework, this paper estimates treatment effect of eliminating government doctor absenteeism. The effects are measured by changes to the market share of government Bachelor of Medicine and Bachelor of Surgery (MBBS) providers and resulting own-price elasticities of demand for government MBBS providers and unqualified providers. Modelling incorporates patients expected health outcomes by provider via the use of a qualitative measure of word-of-mouth recommendations. Results indicate that eliminating government MBBS provider absenteeism in North India would increase utilisation of government outpatient fever treatments from 18% to 50%.

Informal healthcare sector and marginalized groups: Repeat visits in rural North India.

The interrelationship between the public and private sectors, and formal and informal healthcare sectors effects market-level service quality, pricing behaviour and referral networks. However, health utilisation analysis of national survey data from many low and middle income countries is constrained by the lack of disaggregated health provider data. This study is concerned with the pattern of repeat outpatient consultations for a single episode of fever from public and private qualified providers and private unqualified providers. Cross-sectional survey data from 1173 adult respondents sampled from three districts within India's most populous state-Uttar Pradesh is analysed. Data was collected during the monsoon season-September to October-in 2012. Regression analysis focuses on the pattern of repeats visits for a single episode of mild-sever fever as the dependent variable. Results show that Women and Muslims in rural north India are more likely to not access healthcare, and if they do, consult with low quality unqualified outpatient healthcare providers. For fever durations of four or more days, men are more likely to access unqualified providers compared to women. Results of the current study supports the literature that women's utilisation of outpatient healthcare for communicable illnesses in LMICs is often less than men. A relative lack of access to household resources explains why fever duration parameter estimates for women and men differ.

Stated Choice design comparison in a developing country: recall and attribute nonattendance.

BACKGROUND: Experimental designs constitute a vital component of all Stated Choice (aka discrete choice experiment) studies. However, there exists limited empirical evaluation of the statistical benefits of Stated Choice (SC) experimental designs that employ non-zero prior estimates in constructing non-orthogonal constrained designs. This paper statistically compares the performance of contrasting SC experimental designs. In so doing, the effect of respondent literacy on patterns of Attribute non-Attendance (ANA) across fractional factorial orthogonal and efficient designs is also evaluated. The study uses a 'real' SC design to model consumer choice of primary health care providers in rural north India. A total of 623 respondents were sampled across four villages in Uttar Pradesh, India. METHODS: Comparison of orthogonal and efficient SC experimental designs is based on several measures. Appropriate comparison of each design's respective efficiency measure is made using D-error results. Standardised Akaike Information Criteria are compared between designs and across recall periods. Comparisons control for stated and inferred ANA. Coefficient and standard error estimates are also compared. RESULTS: The added complexity of the efficient SC design, theorised elsewhere, is reflected in higher estimated amounts of ANA among illiterate respondents. However, controlling for ANA using stated and inferred methods consistently shows that the efficient design performs statistically better. Modelling SC data from the orthogonal and efficient design shows that model-fit of the efficient design outperform the orthogonal design when using a 14-day recall period. The performance of the orthogonal design, with respect to standardised AIC model-fit, is better when longer recall periods of 30-days, 6-months and 12-months are used. CONCLUSIONS: The effect of the efficient design's cognitive demand is apparent among literate and illiterate respondents, although, more pronounced among illiterate respondents. This study empirically confirms that relaxing the orthogonality constraint of SC experimental designs increases the information collected in choice tasks, subject to the accuracy of the non-zero priors in the design and the correct specification of a 'real' SC recall period.

Revenue effects of practice nurse-led care for chronic diseases.

OBJECTIVE: To determine the economic feasibility in Australian general practices of using a practice nurse (PN)-led care model of chronic disease management. METHODS: A cost-analysis of item numbers from the Medicare Benefit Schedule (MBS) was performed in three Australian general practices, one urban, one regional and one rural. Patients (n =254; >18 years of age) with chronic conditions (type 2 diabetes, hypertension, ischaemic heart disease) but without unstable or major health problems were randomised into usual general practitioner (GP) or PN-led care for management of their condition over a period of 12 months. After the 12-month intervention, total MBS item charges were evaluated for patients managed for their stable chronic condition by usual GP or PN-led care. Zero-skewness log transformation was applied to cost data and log-linear regression analysis was undertaken. RESULTS: There was an estimated A$129 mean increase in total MBS item charges over a 1-year period (controlled for age, self-reported quality of life and geographic location of practice) associated with PN-led care. The frequency of GP and PN visits varied markedly according to the chronic disease. CONCLUSIONS: Medicare reimbursements provided sufficient funding for general practices to employ PNs within limits of workloads before the new Practice Nurse Incentive Program was introduced in July 2012.

Metabolic acidosis and other determinants of hemoglobin-oxygen dissociation in severe childhood Plasmodium falciparum malaria.

Metabolic acidosis is a common complication of severe malaria caused by Plasmodium falciparum. The factors contributing to the acidosis were assessed in 62 children with severe falciparum malaria (cases) and in 29 control children who had recently recovered from mild or moderate malaria. The acidosis was largely caused by the accumulation of both lactic and 3-hydroxybutyric acids. The determinants of oxygen release to the tissues were also examined; although there was no difference between cases and controls in respect of 2,3-bisphosphoglycerate and mean corpuscular hemoglobin concentration, there was a marked increase in P(50) in the cases, caused by pyrexia, low pH, and base deficit. There was substantial relative or actual hypoglycemia in many cases. The relationship of these observations to therapeutic strategy is discussed.

Multicomponent analysis of encapsulated marine oil supplements using high-resolution 1H and 13C NMR techniques.

Multicomponent high-resolution 1H and 13C NMR analysis has been employed for the purpose of detecting and quantifying a wide range of fatty acids (as triacylglycerols or otherwise) in encapsulated marine cod liver oil supplements. The 1H NMR technique provided quantitative data regarding the docosahexaenoic acid content of these products, which serves as a valuable index of fish oil quality, and a combination of both 1H and 13C spectroscopies permitted the analysis of many further components therein, including sn-1 monoacylglycerols, sn-1,2 and -1,3 diacylglycerol adducts, together with a range of minor components, such as trans-fatty acids, free glycerol and cholesterol, and added vitamins A and E. The identities of each of the above agents were confirmed by the application of two-dimensional 1H-1H spectroscopies. The NMR techniques employed also uniquely permitted determinations of the content of nonacylglycerol forms of highly unsaturated (or other) fatty acids in these products (i.e., ethyl esters), and therefore served as a means of distinguishing "natural" sources of cod liver oils from those subjected to chemical modification to and/or supplementation with synthetic derivatives such as ethyl docosahexaenoate or eicosopentaenoate. The analytical significance and putative health effects of the results acquired are discussed.

Fetal programming of perivenous glucose uptake reveals a regulatory mechanism governing hepatic glucose output during refeeding.

Increased hepatic gluconeogenesis maintains glycemia during fasting and has been considered responsible for elevated hepatic glucose output in type 2 diabetes. Glucose derived periportally via gluconeogenesis is partially taken up perivenously in perfused liver but not in adult rats whose mothers were protein-restricted during gestation (MLP rats)-an environmental model of fetal programming of adult glucose intolerance exhibiting diminished perivenous glucokinase (GK) activity. We now show that perivenous glucose uptake rises with increasing glucose concentration (0-8 mmol/l) in control but not MLP liver, indicating that GK is flux-generating. The data demonstrate that acute control of hepatic glucose output is principally achieved by increasing perivenous glucose uptake, with rising glucose concentration during refeeding, rather than by downregulation of gluconeogenesis, which occurs in different hepatocytes. Consistent with these observations, glycogen synthesis in vivo commenced in the perivenous cells during refeeding, MLP livers accumulating less glycogen than controls. GK gene transcription was unchanged in MLP liver, the data supporting a recently proposed posttranscriptional model of GK regulation involving nuclear-cytoplasmic transport. The results are pertinent to impaired regulation of hepatic glucose output in type 2 diabetes, which could arise from diminished GK-mediated glucose uptake rather than increased gluconeogenesis.