Suchergebnisse

In The Fattening of America, renowned health economist Eric Finkelstein, along with business writer Laurie Zuckerman, reveal how the U.S. economy has become the driving force behind our expanding waistlines. Blending theory, research, and engaging personal anecdotes the authors discuss how declining food costs-especially for high-calorie, low-nutrient foods-and an increasing usage of technology, which make Americans more sedentary, has essentially led us to eat more calories than we burn off.

Purpose.To assess the impact of medication use on improvements in coronary heart disease (CHD) risk among WISEWOMAN participants.Design.Pre-post analysis.Setting.WISEWOMAN projects operating at the local level in 8 states.Subjects.WISEWOMAN participants with baseline and one-year follow-up data with at least one abnormal risk factor at baseline (N = 2385; 24% of women with baseline visits).Intervention.WISEWOMAN provides low-income uninsured women with CHD risk factor screenings, lifestyle interventions, access to medications, and referral services.Measures.One-year changes in blood pressure, cholesterol, and 10-year CHD risk by medication status.Analysis.Regression analysis was used to estimate risk factor changes by medication status (newly medicated women, women medicated at baseline, or not medicated women) and quantify the percentage of improvements in risk factors attributed to medication use.Results.Participants experienced statistically significant improvements in systolic (12.6 mm Hg) and diastolic (9.7 mm Hg) blood pressure, total (25.7 mg/dl) and HDL (4.9 mg/dl) cholesterol, and 10-year CHD risk (11.6%). Medication use was responsible for 4% to 5% of the reduction in blood pressure, 32% of the reduction in total cholesterol, 3% of the increase in HDL cholesterol, and 31% of the reduction in 10-year CHD risk.Conclusions.Some of the improvements in CHD risk factors can be attributed to medication use; however, the majority of improvements are likely driven by a combination of other factors, including screenings, risk factor counseling, and lifestyle interventions.

Purpose. To quantify annual costs attributable to obesity, including both increased medical expenditures and absenteeism, separately for overweight and three categories of obesity (i.e., obesity grades I, II, and III) among men and women with full-time employment. Design. Standard econometric methods were used to separately estimate overweight and obesity-attributable medical expenditures and absenteeism. Setting. The civilian noninstitutionalized population of the United States. Sample. Two nationally representative and publicly available datasets (with response rates of at least 60%) were restricted to participants 18 to 64 years old and employed fulltime for the entire year. The final datasets used to estimate obesity-attributable medical expenditures and absenteeism included 20,329 and 25,427 adults, respectively. Measures. Annual medical expenditures and missed work days due to illness or injury. Analysis Results. Overweight and obesity-attributable costs range from $175 per year for overweight male employees to $2485 per year for grade-II obese female employees. The costs of obesity (excluding overweight) at a firm with 1000 employees are estimated to be $285,000 per year. Conclusions. Obesity results in significant increases in medical expenditures and absenteeism among full-time employees. Approximately 30% of the total costs result from increased absenteeism, and although those with grade-III obesity represent only 3% of the employed population, they account for 21% of the costs due to obesity. These estimates do not consider other potential costs associated with obesity, including disability and presenteeism.

Purpose Financial incentives are a promising approach to enhance weight loss outcomes; however, little guidance exists on the optimal incentive structure. Design Mixed methods. Setting An online weight management trial, combining outcome (i.e., weight loss) and behavioral (i.e., self-weighing, dietary self-monitoring, and steps) incentives over 12 months (up to $665). Subjects 116 participants who completed the incentive preference assessment at the 18-month follow-up visit. Method Response distributions on the form, magnitude, certainty, and target of the incentives and content analysis of the qualitative responses. Results Nearly all (96.6%) participants indicated they liked receiving electronic Amazon gift cards, more so than the alternatives presented. Most participants (81.0%) thought they would have lost a similar amount of weight if the incentives were smaller. Few (18.1%) indicated they would have preferred a lottery structure, but 50.8% indicated the variable incentive schedule was beneficial during the maintenance period. Most (77.6%) felt incentives were most helpful when starting to lose weight. In both phases, most participants (85.3% and 72.4%, respectively) indicated appropriate behaviors were incentivized. Participants had mixed views on whether outcome or behavioral incentives were most motivating. Conclusion There was notable variation in preferences for the magnitude, duration, and timing of incentives; it will be important to examine in future research whether incentive design should be tailored to individual preferences.

Purpose. To quantify the relationship between body mass index (BMI) and rates of medically attended injuries by mechanism (overall, fall, motor vehicle, and sport-related) and by nature (strain/sprain, lower extremity fracture, and dislocations), and between BMI and injury treatment costs. Design. Cross-sectional analysis. Setting. The noninstitutionalized population of the United States. Subjects. The 1999–2000, 2000–2001, and 2001–2002 waves of the Medical Expenditure Panel Survey, a large, nationally representative dataset, were combined to create the analysis sample. The final sample included 42,304 adults. Measures. Medically attended injury rates by mechanism and nature of injury and related treatment costs. Analysis. Logistic regressions were used to separately estimate the odds of sustaining any injury by mechanism or by nature for overweight (25 ≤ BMI ≤ 29.9) and three categories of obese individuals compared with those who were normal weight. A second set of regressions tested whether, given that an injury occurred, obese individuals had greater injury treatment costs. Results. Slightly more than one in five adults sustain an injury each year that requires medical treatment. The odds of sustaining an injury are 15% (overweight) to 48% (Class III obesity) greater among those with excess weight. Conditional on sustaining an injury, BMI did not have a significant impact on injury treatment costs. Conclusion. Our findings show a clear association between BMI and the probability of sustaining an injury. If increasing BMI is causing the rise in injury rates, then the incidence of injuries, including those related to falls, sprains/strains, lower extremity fractures, and joint dislocations, are likely to increase as the prevalence of obesity increases.

We explore differences in perception of national security policies between self‐identified liberals, moderates, and conservatives from a national sample of U.S. adults. Using a discrete choice experiment, we also quantify each group's willingness to trade off select policies in exchange for reduced risk of a 9/11‐style terrorist attack. Relative to other groups, liberals are more likely to view such policies as ineffective and susceptible to government abuse. They also perceive a lower threat of terrorism. All groups are willing to make trade‐offs between civil liberties and risk of a terrorist attack. However, loss of civil liberties affects liberals more than conservatives. (JEL D61, H41, H56)

Background: The greatest risk factor for cardiovascular disease is hypertension, which can be alleviated via diet, exercise, and adherence to medication. Yet, blood pressure control in Nepal is inadequate, which is partly hindered by a lack of evidence-based, low-cost, scalable, and cost-effective cardiovascular disease prevention programmes. The the community-based management of hypertension in Nepal (COBIN) study was a 12-month community-based hypertension management programme of blood pressure monitoring and lifestyle counselling intervention undertaken by female community health volunteers (FCHVs) in Nepal, against usual care, which showed success in reducing blood pressure. Here we aimed to retrospectively quantify the budget impact and cost-effectiveness of the scale-up of the programme. Methods: In this retrospective analysis, we collected participant-level data from the COBIN study; programme delivery cost data from programme administrators from the COBIN study group; and popualtion and other data from WHO, the World Bank, and the Nepalese Government. We estimated costs per participant and total costs of a national scale-up of the COBIN programme focusing on two scenarios: scenario A, delivery of the intervention to only people aged 25–65 years with hypertension; and scenario B, delivery of the intervention to all adults aged 25–65 years regardless of hypertension status. Effectiveness was based on in-trial blood pressure reductions converted to cardiovascular disease disability-adjusted life-years (DALYs) averted. The primary cost-effectiveness measure was incremental cost per averted cardiovascular disease DALY (calculated using the incremental cost-effectiveness ratio [ICER]) from a health system perspective, including programme delivery and incremental medication costs. We did univariate sensitivity analyses of scenario B to assess the effect of uncertainty in key parameter values in our calculations. Findings: From a health system perspective, the first-year budget impact was US$7·1 million in scenario A and $10·8 million in scenario B. With each subsequent year, the costs decreased by approximately 50%. In the base-case cost-effectiveness analysis, from the health system perspective, scenario A resulted in an ICER of $582 per DALY averted and scenario B resulted in an ICER of $411 per DALY averted. The ICER was most sensitive to uncertainty in the number of total avertable cardiovascular disease DALYs in the eligible population. Interpretation: The programme is projected to be highly cost-effective in both scenarios compared with the WHO thresholds for cost-effectiveness for Nepal. For policy makers intending to meet the UN Sustainable Development Goal of reducing premature mortality from non-communicible diseases, this intervention should be considered. Funding: Duke-NUS Medical School, Singapore.

BACKGROUND: The greatest risk factor for cardiovascular disease is hypertension, which can be alleviated via diet, exercise, and adherence to medication. Yet, blood pressure control in Nepal is inadequate, which is partly hindered by a lack of evidence-based, low-cost, scalable, and cost-effective cardiovascular disease prevention programmes. The the community-based management of hypertension in Nepal (COBIN) study was a 12-month community-based hypertension management programme of blood pressure monitoring and lifestyle counselling intervention undertaken by female community health volunteers (FCHVs) in Nepal, against usual care, which showed success in reducing blood pressure. Here we aimed to retrospectively quantify the budget impact and cost-effectiveness of the scale-up of the programme. METHODS: In this retrospective analysis, we collected participant-level data from the COBIN study; programme delivery cost data from programme administrators from the COBIN study group; and popualtion and other data from WHO, the World Bank, and the Nepalese Government. We estimated costs per participant and total costs of a national scale-up of the COBIN programme focusing on two scenarios: scenario A, delivery of the intervention to only people aged 25-65 years with hypertension; and scenario B, delivery of the intervention to all adults aged 25-65 years regardless of hypertension status. Effectiveness was based on in-trial blood pressure reductions converted to cardiovascular disease disability-adjusted life-years (DALYs) averted. The primary cost-effectiveness measure was incremental cost per averted cardiovascular disease DALY (calculated using the incremental cost-effectiveness ratio [ICER]) from a health system perspective, including programme delivery and incremental medication costs. We did univariate sensitivity analyses of scenario B to assess the effect of uncertainty in key parameter values in our calculations. FINDINGS: From a health system perspective, the first-year budget impact was US$7·1 million in ...

BACKGROUND: High blood pressure (BP) is the leading attributable risk for cardiovascular disease (CVD). In rural South Asia, hypertension continues to be a significant public health issue with sub-optimal BP control rates. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering BP among adults with hypertension in rural communities in Bangladesh, Pakistan and Sri Lanka. METHODS/DESIGN: This study is a stratified, cluster randomized controlled trial with a qualitative component for evaluation of processes and stakeholder feedback. The MCI has five components: (1) home health education by government community health workers (CHWs), (2) BP monitoring and stepped-up referral to a trained general practitioner using a checklist, (3) training public and private providers in management of hypertension and using a checklist, (4) designating hypertension triage counter and hypertension care coordinators in government clinics and (5) a financing model to compensate for additional health services and provide subsidies to low income individuals with poorly controlled hypertension. Usual care will comprise existing services in the community without any additional training. The trial will be conducted on 2550 individuals aged ≥40 years with hypertension (with systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, based on the mean of the last two of three measurements from two separate days, or on antihypertensive therapy) in 30 rural communities in Bangladesh, Pakistan and Sri Lanka. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability-adjusted life years averted will be computed. Stakeholders including policy makers, provincial- and district-level coordinators of relevant programmes, physicians, CHWs, key community leaders, hypertensive individuals and family members in the identified clusters will be interviewed. DISCUSSION: The study will provide evidence of the effectiveness and cost-effectiveness of MCI strategies for BP control compared to usual care in the rural public health infrastructure in South Asian countries. If shown to be successful, MCI may be a long-term sustainable strategy for tackling the rising rates of CVD in low resourced countries.