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1.
Work ; 70(1): 109-124, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34487009

RESUMO

BACKGROUND: Studies of the social validity of work ability evaluations are rare, although the concept can provide valuable information about the acceptability, comprehensibility and importance of procedures. OBJECTIVE: The aim of this study was to explore clients' perceptions of social validity of work ability evaluations and the following official decisions concerning sickness benefits within the Swedish sickness insurance system. METHODS: This was a longitudinal qualitative study based on interviews with 30 clients on sick leave, analyzed through deductive content analysis. RESULTS: Clients' understanding of the evaluation was dependent on whether the specific tests were perceived as clearly related to the clients' situation and what information they received. For a fair description of their work ability, clients state that the strict structure in the evaluation is not relevant to everyone. CONCLUSION: The work ability evaluations indicate low acceptability due to lack of individual adaptation, the comprehensibility varied depending on the applicability of the evaluation and information provided, while the dimension 'importance' indicated as higher degree of social validity. The official decision about sickness benefits however was considered unrelated to the evaluation results, lacking solid arguments and sometimes contradictory to other stakeholders' recommendations indicating poor social validity.


Assuntos
Seguro , Avaliação da Capacidade de Trabalho , Humanos , Pesquisa Qualitativa , Licença Médica , Previdência Social
2.
Vaccine ; 39(36): 5091-5094, 2021 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-34348844

RESUMO

A two-dose series of the recombinant zoster vaccine (RZV, Shingrix) was licensed by the Food and Drug Administration in 2017 and recommended by the Advisory Committee on Immunization Practices in 2018 for adults in the United States age 50 years and older. Despite the health benefits of shingles vaccination, coverage has remained low, with financial barriers among healthcare providers identified as one potential factor. This study estimates the reimbursement levels for RZV among a large sample of privately insured individuals in the US from the 2018 IBM® MarketScan® Commercial Claims and Encounters database. Of 198,534 claims for an RZV dose, the mean reimbursement was $149. Most claims (83%) exceeded $140, which was the private sector vaccine price reported on the CDC vaccine price list in April 2018. These results can be useful for providers considering procuring RZV and for state immunization programs considering ways to improve vaccination coverage.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Seguro , Adulto , Herpes Zoster/prevenção & controle , Humanos , Pessoa de Meia-Idade , Setor Privado , Estados Unidos , Vacinas Sintéticas
4.
J Manipulative Physiol Ther ; 44(5): 372-377, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34366149

RESUMO

OBJECTIVE: The purpose of this study was to evaluate the relationship between treatment escalation and spinal manipulation in a retrospective cohort of people diagnosed with musculoskeletal disorders of the cervical spine. METHODS: We used retrospective analysis of insurance claims data (2012-2018) from a single Fortune 500 company. After isolating the first episode of care, we categorized 58 147 claims into 7951 unique patient episodes. Treatment escalation included claims where imaging, injection, emergency room, or surgery was present. Modified Poisson regression was used to determine the relative risk of treatment escalation comparing recipients vs nonrecipients of spinal manipulation, adjusted for age, sex, episode duration, and risk scores. RESULTS: The sample was 55% women, with a mean age of 44 years (range, 18-103). Treatment escalation was present in 42% of episodes overall: 2448 (46%) associated with other care and 876 (26%) associated with spinal manipulation. The estimated risk of any treatment escalation was 2.38 times higher in those who received other care than in those who received spinal manipulation (95% confidence interval, 2.22-2.55, P = .001). CONCLUSION: Among episodes of care associated with neck pain diagnoses, those associated with other care had twice the risk of any treatment escalation compared with those associated with spinal manipulation. In the United States, over 90% of spinal manipulation is provided by doctors of chiropractic; therefore, these findings are relevant and should be considered in addressing solutions for neck pain. Additional research investigating the factors influencing treatment escalation is necessary to moderate the use of high-cost and guideline-incongruent procedures in people with neck pain.


Assuntos
Seguro , Manipulação Quiroprática , Manipulação da Coluna , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/terapia , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-34435389

RESUMO

It is unclear that whether Urban and Rural Resident Basic Medical Insurance (URRBMI) is associated with depressive symptoms among middle-aged and older adults. To fulfill this research gap, this study aimed to investigate the association between URRBMI and depressive symptoms among the middle-aged and older adults in China. This data of this study was sourced from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS). Ordinary least squares (OLS) regression models were used to explore the association between URRBMI and depressive symptoms. Instrumental variable (IV) method was employed to address potential endogeneity problem which is caused by reverse causation and omitted variable bias. Propensity score matching (PSM) and doubly robust estimation were employed to conduct robustness checks. We provide robust evidence indicating that participation of URRBMI was significantly correlated with a reduced depression score. Moreover, we find that improving the utilization of inpatient and outpatient care may be important channels through which URRBMI relieved depressive symptoms.


Assuntos
Seguro , Aposentadoria , Idoso , Assistência Ambulatorial , China , Depressão/epidemiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , População Rural , População Urbana
6.
J Health Care Poor Underserved ; 32(3): 1199-1207, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34421025

RESUMO

In the United States, uninsurance remains a major barrier in accessing health care for many citizens and residents. Studies have shown that uninsured patients with many cancers and chronic diseases have worse survival than insured patients. A recent study similarly showed that uninsured patients with gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) have significantly shortened survival. While GEP-NETs are indolent tumors with generally favorable prognosis, comprehensive care involves years of surveillance, imaging, and treatment following resection, all of which carry a large financial burden. In this commentary, we expand on these findings as they relate to insurance-based disparities as well as management and policy implications.


Assuntos
Seguro , Neoplasias Intestinais , Tumores Neuroendócrinos , Neoplasias Pancreáticas , Neoplasias Gástricas , Humanos , Tumores Neuroendócrinos/epidemiologia , Tumores Neuroendócrinos/terapia , Neoplasias Pancreáticas/terapia , Neoplasias Gástricas/terapia , Estados Unidos/epidemiologia
7.
Accid Anal Prev ; 161: 106349, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34411805

RESUMO

Road accidents and vehicular emissions are two significant issues related to road transportation, affecting both human life and the environment. Prior research suggests that driver behavior is a crucial factor in the majority of road crashes and is a significant factor influencing fuel consumption and vehicle emission. Significant improvement in driving behavior can be achieved by providing feedback to drivers about their driving behavior. An increasing interest among researchers to identify risky and non-economical driving maneuvers has led to the development of driver behavior profiling, i.e., rating/categorizing drivers into different categories based on how they drive. To get an insight into different parameters and methodology adopted by researchers for categorizing drivers into different categories, this paper presents a systematic review of studies on driver behavior profiling. In the present paper, PRISMA approach was adopted to shortlist the most relevant studies for systematic review out of 1231 initial studies, which were extracted using the relevant keywords. The findings from our study suggest that the selection of parameters for profiling the driver will depend on the application of the profiling scheme, type of device used for extracting data, and importance of parameter in rating criteria. Further, the findings suggest that significant improvement in driving behavior can be achieved by providing feedback to the drivers about their driving behavior and by implementing usage-based insurance schemes. It is also suggested that future studies shall focus on using smartphone devices for the collection of driver data as smartphones are nowadays easily accessible to everyone.


Assuntos
Condução de Veículo , Seguro , Acidentes de Trânsito/prevenção & controle , Humanos , Assunção de Riscos , Transportes
8.
Traffic Inj Prev ; 22(7): 582-587, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34379535

RESUMO

OBJECTIVE: The Insurance Institute for Highway Safety (IIHS) introduced its side impact ratings test in 2003. Despite manufacturers' improvements to airbags and vehicle structures, 45% of 2018 side crash fatalities on U.S. roadways were in good-rated vehicles, suggesting that more crashworthiness improvements are necessary. Crash trends indicate that the most promising avenue to address the remaining real-world injuries is a higher severity vehicle-to-vehicle test using a barrier to represent a striking sport-utility vehicle (SUV). Laboratory tests comparing striking SUVs with the current IIHS moving deformable barrier (MDB) showed discrepancies in damage patterns and injury measures. The current study outlines the characteristics of a multi-stiffness aluminum honeycomb barrier to represent a modern SUV-striking vehicle in side impact crash tests. METHODS: Barrier size and shape were determined from a series of measurements taken from 21 modern SUVs. Barrier honeycomb stiffness characteristics were derived by comparing the damage profile of six different barrier prototypes against a baseline profile obtained from a high-severity SUV crash into a midsize car. Tests were conducted at 60 km/h with a 1,900 kg MDB. The best honeycomb design was tested against four additional vehicles to ensure it was representative of striking SUVs of different sizes and types. RESULTS: The final barrier has a 1,700-mm width by 600-mm height and 500-mm depth multi-stiffness design, with less stiffness on the top and more stiffness in the lower outside sections compared with the original IIHS barrier. For three struck vehicles, the redesigned barrier matched all performance criteria set by the striking-SUV tests. For two additional struck vehicles, there were some differences in intrusion patterns but overall, these matched the test trends of the striking SUVs. The new barrier in a higher severity test mode resulted in a range of performance for these good-rated vehicles. CONCLUSION: A multi-stiffness aluminum honeycomb barrier was developed to represent the characteristics of striking SUVs in 60 km/h perpendicular side impact crash tests focusing on the occupant compartment. The redesigned barrier differentiates between currently good-rated vehicles, which will promote structural and restraint system improvements to the fleet relevant to the remaining real-world injuries.


Assuntos
Air Bags , Seguro , Ferimentos e Lesões , Acidentes de Trânsito , Alumínio , Humanos , Veículos Automotores
9.
Artigo em Inglês | MEDLINE | ID: mdl-34199008

RESUMO

PURPOSE: to quantify and compare pre- and post-surgical incontinence pad use between men treated with radical prostatectomy (RP) for prostate cancer (PCa) and cancer-free controls, using population-based Austrian insurance claims data. METHODS: Men who underwent RP for treating PCa between 2013-2015 were identified. Cancer-free men ≥45 years with and without benign prostate hyperplasia (BPH) were used as controls. Longitudinal data on ICD-diagnoses, type of surgery, prescribed incontinence pads, and hospitals' surgery volumes were aggregated between 2011-2018 to capture pre- and up to three years post-RP follow-up. Monthly rates of pad use were calculated and compared between RP types and cancer-free controls. RESULTS: A total of 6248 RP patients, 7158 cancer-free men with BPH, and 50,257 cancer-free men without BPH were analyzed. Comparing to pre-RP (0.03, 95%CI: 0.02-0.05), RP resulted in significantly higher rates of prescribed pads (at 3 months: 12.61, 95%CI: 11.59-13.65; 12 months: 6.71, 95%CI: 6.10-7.34; 36 months: 4.91, 95%CI: 3.76-4.62). These rates were also higher than those for cancer free controls (with BPH:0.06, 95%CI: 0.04-0.09; without BPH:0.12, 95%CI: 0.10-0.14). The rate of prescribed pads after surgery continued to decline over time and remained higher among men who underwent minimally invasive RP compared to those who underwent an open procedure. CONCLUSION: Despite progress in surgical techniques, post-RP incontinence remains a prevalent adverse event. The rate of pad usage steadily improved over the first three years post RP. The rate of patients with incontinence needing pads was higher among those who were treated minimally invasive compared to open approach.


Assuntos
Seguro , Neoplasias da Próstata , Áustria , Humanos , Tampões Absorventes para a Incontinência Urinária , Masculino , Pessoa de Meia-Idade , Próstata , Prostatectomia , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/cirurgia
10.
Adv Ther ; 38(9): 4646-4658, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34292518

RESUMO

INTRODUCTION: Alopecia areata (AA) is an autoimmune disorder causing sudden, non-scarring hair loss. There are currently no drugs approved for AA treatment. This study assessed prevalence of comorbidities, treatments, and healthcare costs and resource utilization among patients with AA in the USA. METHODS: Patients diagnosed with AA between January 2011 and December 2018 were identified in IBM MarketScan® Research Databases. Eligible patients had no other hair loss-related disorders and were continuously enrolled with medical and pharmacy benefits at least 12 months before and after AA diagnosis. Descriptive statistics were used to summarize comorbid conditions, treatments related to AA or other autoimmune/inflammatory conditions, and all-cause and AA-specific healthcare costs and resource utilization identified from claims data. RESULTS: A total of 68,121 patients with AA were identified. Mean (SD) age was 40.3 (17.8) years and 61.0% were female. The most common comorbidities included hyperlipidemia (22.4%), hypertension (21.8%), thyroid disorders (13.1%), contact dermatitis or eczema (10.8%), depression (9.5%), and anxiety (8.4%). Comorbid autoimmune diseases included atopic dermatitis (2.8%), psoriasis (2.1%), chronic urticaria (1.5%), and rheumatoid arthritis (1.1%). During the 12-month follow-up period, 37,995 patients (55.8%) were prescribed treatment for their AA or other comorbid autoimmune/inflammatory disease; 44.9% of treated patients were prescribed therapy within 7 days of AA diagnosis. Of patients receiving treatment, 80.3% received topical steroids and 30.0% received oral steroids. Mean (SD) total healthcare costs were $11,241.21 ($43,839.69) for all-causes and $419.12 ($1534.99) for AA. AA-related expenses were driven by outpatient and prescription costs. CONCLUSION: Patients with AA have a high comorbidity burden and lack of treatment. Current AA treatments, including systemic therapies other than oral steroids, were not frequently utilized in this study population. Healthcare costs incurred by patients with AA went beyond AA-related expenses. Longitudinal data are needed to better understand treatment trajectories and the disease burden in patients with AA.


Assuntos
Alopecia em Áreas , Seguro , Adulto , Alopecia em Áreas/tratamento farmacológico , Alopecia em Áreas/epidemiologia , Comorbidade , Feminino , Custos de Cuidados de Saúde , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos
11.
J Affect Disord ; 293: 168-175, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34198032

RESUMO

OBJECTIVE: Previous studies have not investigated the contribution of medical insurance to income-related inequality in depressive symptoms. To fulfill this research gap, this study aimed to assess the contribution of Urban and Rural Resident Basic Medical Insurance (URRBMI) to income-related inequality in depressive symptoms among middle-aged and older adults in China. METHODS: The data of this study was obtained from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS). The data of Particulate Matter 2.5 (PM2.5) concentrations were sourced from Atmospheric Composition Analysis Group. Furthermore, concentration curve and concentration index were employed to measure the extent of income-related inequality in depressive symptoms. Moreover, decomposition method of concentration index was used to quantify the contribution of URRBMI to the income-related inequality in depressive symptoms. RESULTS: The concentration index values of depression occurrence and score were -0.1067 and -0.0712, respectively, indicating pro-rich inequality. The decomposition results reveal that the contribution rate of URRBMI to concentration index of depression occurrence was 18.88%, which indicates that it reduced the pro-rich inequality in depression occurrence. In addition, the contribution rate of URRBMI to concentration index of depression score was 3.55%, indicating that it relieved the pro-rich inequality in depression score. CONCLUSION: This study found pro-rich inequalities in depression occurrence and score which were reduced with the coverage of URRBMI. It is quite necessary to further expand the coverage of URRBMI.


Assuntos
Depressão , Seguro , Idoso , China/epidemiologia , Depressão/epidemiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Fatores Socioeconômicos
12.
Ann Fam Med ; 19(4): 332-341, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34264834

RESUMO

PURPOSE: Although the cost and complexity of managing diabetes is increasing around the world, placing greater burden on patients and their families, the cost of drug regimens prescribed to Chinese patients has not been evaluated. This study was conducted to evaluate the temporal changes in the costs and drugs used for people with diabetes. METHODS: Patients enrolled in Beijing Medical Insurance with outpatient medical records from 2016 through 2018 were included in this study. The outcomes of interest were: (1) the number of outpatient medications, (2) the number of comorbidities diagnosed, (3) the estimated annual cost of the outpatient drug regimen, (4) the drug therapy strategies used for diabetic patients, and (5) the most commonly prescribed classes of drugs. RESULTS: Over the 3-year period, there was a significant decrease (9.0%, P <.001) in the average number of diabetes medications used. Both antiglycemic and non-antiglycemic drug use decreased by 3.6% and 12.9%, respectively. Similarly, for estimated annual costs of medication, an 18.4% (P <.05) decrease was observed, with a gradual decreased from ¥6,868 ($1,059) in 2016 to ¥5,605 ($865) in 2018. CONCLUSION: This is the first large-scale cost analysis of the medical management of diabetes since the implementation of medical insurance in China. Despite the increasing availability of newer, more expensive diabetes drugs, there was a significant reduction in the number of diabetes medications used, that may be due to a more rational approach to optimizing metabolic targets.


Assuntos
Atenção à Saúde/economia , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/economia , Gastos em Saúde/estatística & dados numéricos , Hipoglicemiantes/uso terapêutico , Seguro/estatística & dados numéricos , Pequim , China , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Custos e Análise de Custo , Diabetes Mellitus/epidemiologia , Custos de Medicamentos , Registros Eletrônicos de Saúde , Feminino , Humanos , Hipoglicemiantes/economia , Seguro/economia , Masculino , Atenção Primária à Saúde , Estudos Retrospectivos
13.
Lima; Perú. Ministerio de Salud; 1ra ed; 20210700. 98 p. ilus.
Monografia em Espanhol | MINSAPERÚ | ID: biblio-1282191

RESUMO

El documento contiene: La Política Nacional Multisectorial de Salud al 2030: Perú, País Saludable, El Modelo de Cuidado Integral de Salud por Curso de Vida, Evolución de la rectoría del sector salud: 2016-2021, Redes Integradas de Salud ­ RIS, Financiamiento en salud, Cobertura Universal de Salud - Seguro Integral de Salud, Gestión de riesgos, Derechos en salud: SUSALUD, Trabajando por más salud, Recursos humanos en salud, Agenda Digital del Sector Salud 2020-2025, Medicamentos, Actualización del Plan Esencial de Aseguramiento en Salud PEAS 2021 - DS 023-2021-SA.


Assuntos
Gestão de Riscos , Preparações Farmacêuticas , Reforma dos Serviços de Saúde , Assistência Integral à Saúde , Impactos na Saúde , Desenvolvimento Institucional , Agenda de Prioridades em Saúde , Recursos Humanos , Financiamento da Assistência à Saúde , Cobertura Universal de Saúde , Mão de Obra em Saúde , Política de Saúde , Seguro , Gestão em Saúde
14.
Artigo em Inglês | MEDLINE | ID: mdl-34201528

RESUMO

The COVID-19 epidemic has seriously affected global economic and social development. The extent to which insurance can play a role in preventing and transferring the risk of infectious diseases has become one of the major concerns of the community. This paper first analyzes the main contents of the U.S. Pandemic Risk Insurance Act during the COVID-19 epidemic and its insights to the global audiences. Then, on the basis of the definition of global pandemic, this paper analyzes the great challenges faced by the insurability of the infectious diseases' catastrophe from the regional impact, risk accumulation, correlation with capital markets, and accuracy of catastrophe model, and the insurability of local infectious diseases. Finally, this paper presents the key points of the top-level design of the risk transfer mechanism of infectious disease insurance in China. This paper is informative in understanding the role of insurance in the risk transfer of infectious diseases.


Assuntos
COVID-19 , Seguro , China/epidemiologia , Humanos , Pandemias , SARS-CoV-2
15.
Artigo em Inglês | MEDLINE | ID: mdl-34210019

RESUMO

During the last decade, the use of nanomaterials, due to their multiple utilities, has exponentially increased. Nanomaterials have unique properties such as a larger specific surface area and surface activity, which may result in health and environmental hazards different from those demonstrated by the same materials in bulk form. Besides, due to their small size, they can easily penetrate through the environmental and biological barriers. In terms of exposure potential, the vast majority of studies are focused on workplace areas, where inhalation is the most common route of exposure. The main route of entry into the environment is due to indirect emissions of nanomaterials from industrial settings, as well as uncontrollable releases into the environment during the use, recycling and disposal of nano-enabled products. Accidental spills during production or later transport of nanomaterials and release from wear and tear of materials containing nanomaterials may lead to potential exposure. In this sense, a proper understanding of all significant risks due to the exposure to nanomaterials that might result in a liability claim has been proved to be necessary. In this paper, the utility of an application for smartphones developed for the insurance sector has been validated as a solution for the analysis and evaluation of the emerging risk of the application of nanotechnology in the market. Different exposure scenarios for nanomaterials have been simulated with this application. The results obtained have been compared with real scenarios, corroborating that the use of novel tools can be used by companies that offer risk management in the form of insurance contracts.


Assuntos
Seguro , Nanoestruturas , Nanoestruturas/toxicidade , Nanotecnologia , Medição de Risco , Local de Trabalho
16.
BMC Public Health ; 21(1): 1444, 2021 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-34294053

RESUMO

BACKGROUND: With the rapid growth of the ageing population, the operating burden of China's basic medical insurance fund is becoming increasingly heavy. To counter rapid population ageing and ameliorate a series of problems, China has adjusted its fertility policies several times. On January 1, 2016, the universal two-child policy was implemented. This study analysed the impacts of the adjustment to the fertility policy and potential improvements in fertility intention on the insured population and medical insurance fund sustainability. METHODS: We used an actuarial science method and took the urban and rural residents' basic medical insurance (URRBMI) of China, which covers most urban and rural residents, as an example to build a dynamic forecast model of population growth and a dynamic actuarial model of medical insurance funds. RESULTS: Compared with the original policy, under the current fertility intention (40%) with the universal two-child policy, the ageing of the population structure of URRBMI participants will decline significantly after 2026, and individuals aged 65 and over will account for only 19.01% of the total participants in 2050. The occurrence of the current deficit and accumulated deficit of the URRBMI fund will be postponed for one year to 2022 and 2028, respectively. If fertility intentions continue to rise, the ageing degree of the population structure will decrease, and the deficit would be further delayed. CONCLUSIONS: The universal two-child policy is conducive to improving the degree of overall population ageing, delaying the occurrence of a URRBMI fund deficit, and improving the sustainability of URRBMI funds. If fertility intention increases, the effects would be stronger. However, since the adjustment of the universal two-child policy has a certain time lag, it will take time to demonstrate this impact. Therefore, while actively promoting the universal two-child policy, other measures should be taken, such as improving the fertility desire among couples of childbearing age and reforming medical insurance payment methods.


Assuntos
Administração Financeira , Seguro , Envelhecimento , China , Humanos , Política Pública , População Rural , População Urbana
17.
Artigo em Inglês | MEDLINE | ID: mdl-34300028

RESUMO

The agricultural insurance subsidy policy (AISP) encourages farmers to expand production scale by mitigating production risks. Under the high-input production patterns of traditional agriculture, the implementation of AISP is conducive to increase farmers' income, but it also leads to the destruction of the agricultural environment. Achieving agricultural green development (AGD) has been hindered in China. In this context, this paper attempts to analyze the impact of AISP on farmers' income and the agricultural environment. Based on the panel data of 316 prefecture-level cities from 2003 to 2012 in China, this paper empirically tests the effects of AISP by employing methods such as time-varying difference-in-difference (DID). The results show that AISP has significantly promoted the growth of farmers' incomes but has negatively impacted the agricultural environment. Furthermore, the mechanism analysis shows that the policy effects are realized by affecting the quantity of main productive fixed assets (Mpfa) and grain sown area per capita (Gsa). In addition, the policy effect is heterogeneous in different regions. Therefore, the government should appropriately raise the subsidy standard for farmers who adopt environmental-friendly production patterns. At the same time, the government should give more subsidies to the large grain-producing areas.


Assuntos
Política Fiscal , Seguro , Agricultura , China , Fazendeiros , Humanos
18.
BMJ Open ; 11(7): e043768, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34266835

RESUMO

OBJECTIVE: To assess the association of coprescribed medications for chronic comorbid conditions with clinical dementia in older adults, as indicated by the initiation of a new prescription of antidementia medication (NPADM). DESIGN: Retrospective enumeration cohort study. SETTING: A Japanese city in Tokyo Metropolitan Area. PARTICIPANTS: A total of 42 024 adults aged ≥77 years residing in Kashiwa City, a suburban city of Tokyo Metropolitan Area, who did not have any prscription of antidementia medication from 1 April to 30 June 2012. MAIN OUTCOME MEASURE: The primary outcome was NPADM during follow-up period until 31 March 2015 (35 months). Subjects were categorised into four age groups: group 1 (77-81 years), group 2 (82-86 years), group 3 (87-91 years) and group 4 (≥92 years). In addition to age and sex, 14 sets of medications prescribed during the initial background period (from 1 April 2012 and 31 June 2012) were used as covariates in a Cox proportional hazard model. RESULTS: In a follow-up period of 1 345 457 person-months (mean=32.0±7.5 months, median 35 months), NPADM occurred in 2365 subjects. NPADM incidence at 12 months was 1.9%±0.1% (group 1: 0.9%±0.1%, group 2: 2.1%±0.1%, group 3: 3.2%±0.2% and group 4: 3.6%±0.3%; p<0.0001). In addition to older age and female sex, use of the following medications was significantly associated with NPADM: statins (HR: 0.82, 95% CI 0.73 to 0.92; p=0.001), antihypertensives (HR: 0.80, 95% CI 0.71 to 0.85; p<0.0001), non-steroidal bronchodilators (HR: 0.72, 95% CI 0.58 to 0.88; p=0.002), antidepressants (HR: 1.79, 95% CI 1.47 to 2.18; p<0.0001), poststroke medications (HR: 1.45, 95% CI 1.16 to 1.82; p=0.002), insulin (HR: 1.34, 95% CI 1.01 to 1.78; p=0.046) and antineoplastics (HR: 1.12, 95% CI 1.01 to 1.24; p=0.035). CONCLUSIONS: This retrospective cohort study identified the associations of coprescribed medications for chronic comorbid conditions with NPADM in older adults. These findings would be helpful in understanding the current clinical practice for dementia in real-world setting and potentially contribute to healthcare policymaking. TRIAL REGISTRATION NUMBER: UMIN000039040.


Assuntos
Demência , Seguro , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Demência/tratamento farmacológico , Demência/epidemiologia , Feminino , Humanos , Lactente , Pessoa de Meia-Idade , Estudos Retrospectivos , Tóquio , Adulto Jovem
19.
J Subst Abuse Treat ; 129: 108384, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34080552

RESUMO

OBJECTIVE: To quantify weekly rates of use of buprenorphine for those with employer-based insurance and whether the rate differs based on county-level measures of race, historical fatal drug overdose rate, and COVID-19 case rate. METHODS: We used 2020 pharmaceutical claims for 4.8 million adults from a privately insured population to examine changes in the use of buprenorphine to treat opioid use disorder in 2020 during the onset of the COVID-19 pandemic. We quantified variation by examining changes in use rates across counties based on their fatal drug overdose rate in 2018, number of COVID-19 cases per capita, and percent nonwhite. RESULTS: Weekly use of buprenorphine was relatively stable between the first week of January (0.6 per 10,000 enrollees, 95%CI = 0.2 to 1.1) and the last week of August (0.8 per 10,000 enrollees, 95%CI = 0.4 to 1.3). We did not find evidence of any consistent change in use of buprenorphine by county-level terciles for COVID-19 rate as of August 31, 2020, age-adjusted fatal drug overdose rate, and percent nonwhite. Use was consistently higher for counties in the highest tercile of county age-adjusted fatal drug overdose rate when compared to counties in the lowest tercile of county age-adjusted fatal drug overdose rate. DISCUSSION: Our results provide early evidence that new federal- and state-level policies may have steadied the rate of using buprenorphine for those with employer-based insurance during the pandemic.


Assuntos
Buprenorfina , COVID-19 , Overdose de Drogas , Seguro , Transtornos Relacionados ao Uso de Opioides , Adulto , Buprenorfina/uso terapêutico , Overdose de Drogas/epidemiologia , Humanos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Pandemias , SARS-CoV-2 , Estados Unidos
20.
Int J Pharm Compd ; 25(3): 190-195, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34125708

RESUMO

Risk, which can come from various sources, is the exposure to loss or injury. Included, but not limited to common risks associated by business owners, are natural disasters, accidents, legal liabilities, weather-related events, and criminal activities. Specific to pharmacy is professional liability risk, including physical harm to a patient. This article provides an understanding of some of the risks faced by business owners and pharmacists, transferal of risk to another entity such as an insurance company, and an understanding of the insurance policy itself.


Assuntos
Seguro , Assistência Farmacêutica , Farmácias , Farmácia , Humanos , Responsabilidade Legal , Farmacêuticos
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