Emerging Adults with Chronic Illness Pursuing and Enhancing Leisure

The purpose of this study is to develop an understanding of the adjustment process undertaken by emerging adults living with a chronic illness in their pursuit and enjoyment of leisure. A theoretical focus is placed on the processes of selection, optimization, and compensation. Semi-structured interviews were conducted with 27 participants who have a chronic illness. Participants’ experiences were rooted much more in triumph rather than loss. Selection was influenced by a consideration of uncertainty, a desire to avoid potential embarrassment, and an acceptance or rejection of constraints. Three types of approaches that helped them optimize their leisure experience involved participants shaping their perspectives about leisure and life, enhancing resources to make leisure possible, and by living through pain and discomfort. Responding to challenges that might otherwise limit their participation or enjoyment in leisure, participants prepared for possible incidents, received support from others, and confronted negative situations.     

Macroeconomic costs to large scale disruptions of food production: The case of foot- and-mouth disease in the United States

We forecast the economic consequences of a widespread contamination of the food system based on a hypothetical outbreak of foot-and-mouth disease (FMD). Since the immediate effect on the livestock sector could affect the entire supply chain and US livestock, meat and dairy exports, we measure these impacts using GTAP, a multi-region, multi-sector computable general equilibrium (CGE) model of the global economy. The immediate “shocks” to the US livestock, raw milk and other animal products sectors indirectly affect all sectors of the economy, as well as international markets and trade. We decompose these effects due to each component of the initial shocks, and estimate the importance of these shocks to the national food system for the Mid-Atlantic Region using IMPLAN. Our GTAP results indicate that losses to the USA economy would be about $11.7 billion, and with the ripple effect throughout the rest of the world including beneficiary nations (Argentina, Brazil, Latin America, Australia and New Zealand) and losers (Canada, Mexico, European Union) would be 14.1 billion. We estimate the proportion of the domestic impact affecting the Mid-Atlantic Region. Based on a regional input–output model of that region, we estimate that total losses in value added are nearly $800 million; losses in labor income total about $565 million; and there are job losses of just over 12 thousand.     

The Economics of Controlling Insect-Transmitted Plant Diseases

A framework is developed to analyze a spatially dependent economically significant pest problem emanating from a source and spreading via a carrier such as an insect. Transmission and/or source control to combat the pest or disease problem are explored. Alternative assumptions about the effectiveness of transmission control and the feasibility and costs, both social and private, of reduction of the pest population at the source are examined in an application of the model to controlling Pierce's disease in California wine grapes.     

Behavioral Incentives, Equilibrium Endemic Disease, and Health Management Policy for Farmed Animals

The article develops a dynamic capital valuation model in which farms can act with farm-varying cost to increase the probability of avoiding an infectious endemic animal disease. Multiple endemic disease equilibria can exist, and the one with the largest set of action takers is socially optimal. Costly capital markets are shown to be a factor in determining the extent of disease. Frictions, such as dealing with a veterinary public health bureaucracy, can enhance social welfare by encouraging precautionary biosecurity actions. Technical innovations can reduce social welfare, and a disease indemnification scheme is also studied. Suggestions for empirical implementation are provided.     

Natural Resource Booms and Inequality: Theory and Evidence*

We develop a theory, in the context of a two‐sector growth model in which learning‐by‐doing drives growth, to explain the time path of income inequality following natural resource booms in resource‐rich countries. Under the condition of a relatively unskilled labor intensive non‐traded sector, inequality falls immediately after a boom, and then increases steadily over time until the initial impact of the boom disappears. Using data for 90 countries between 1965 and 1999, we find evidence in support of the theory, especially for oil and mineral booms. We also find that uncertainty about future commodity prices increases long‐run inequality.     

新闻报刊中疾病隐喻表达的ICM分析

疾病隐喻中的许多表达方式都是由其他概念域的语言映射而来,是人类隐喻认知的结果。新闻报刊中与疾病相关的隐喻表达方式主要可归纳为战争隐喻、恶魔隐喻和自然灾害隐喻几种。对疾病隐喻表达做理想化认知模型(ICM)分析,探讨疾病隐喻的认知理据和分布特征,能够为人们认知疾病隐喻现象提供新的视角。     

小议公路路基病害的分析与防治

路基是道路的基础,更是保证路面质量的关键。然而,在现实中,由于需要反复承受各种荷载和自然因素的作用,会导致路基的形状、边坡坡度发生改变,严重影响了路面的质量和稳定性。由于所处地区的差异,产生的路基病害也是多种多样的,最常见有边坡崩塌、滑塌,路基变形等,产生的原因涉及土质、人为的破坏、养护和管理等因素。彻底的控制路基病害的产生是不现实的,因此,只能找出其产生的原因并做好防范,采取一系列切实可行的措施,将其产生的可能性降到最低程度。本文论述了不同地区公路路基病害的主要类型及其危害,分析了其产生的原因,并提出了一些切实可行的防治措施,切实保障路面质量和稳定性。     

大病医疗保障“湛江模式”的成效、经验与启示

基于医疗保障城乡一体化改革,湛江的大病医疗保障采取商业保险与社会保险结合的模式,通过商业健康保险机构与政府部门合作运营管理大病医疗保障,显著降低了城乡居民发生灾难性医疗支出的比例;其发挥市场机制为城乡居民提供医疗保障的政策理念和政府与商业保险机构分工协作、共担风险、共同运营管理的经验做法．具有普遍借鉴意义。大病医疗保障“湛江模式”也存在“一刀切”式的经济补偿标准有悖公平、“保重大疾病、保高额住院医疗费”的重点未能反映“大病风险”的本质以及缴费水平的差距不大、商业健康保险机构参与深度和广度不够等不足。大病医疗保障是“特惠型”的保障制度,保障水平需要与经济社会发展水平相适应,应全面考量大病风险损失,分类评估家庭大病风险承受能力,充分发挥商业健康保险机构的大病风险管理职能,并根据大病风险损失的严重程度实施差异化补偿标准,避免家庭发生灾难性医疗支出。     

A retrospective study to assess the epidemiological and economic burden of pneumococcal diseases in adults aged 50 years and older in Taiwan

Objective:

Invasive pneumococcal disease (IPD) and pneumococcal pneumonia cause substantial morbidity and mortality worldwide. This retrospective study was conducted to estimate the disease burden from pneumococcal disease in older adults in Taiwan from a health insurer’s perspective.

Methods:

Data for the years 2002–2009 from patients aged ≥50 years with insurance records indicating pneumococcal meningitis, pneumococcal bacteremia, or hospitalized or outpatient pneumonia were obtained from the National Health Insurance Research Database in Taiwan. Admission data for inpatients, visit data for outpatients, and associated costs were extracted from the database to estimate the incidence, case fatality rates, and direct and indirect costs of pneumococcal disease episodes. These data were applied to the estimated population of Taiwan in 2010 to provide an estimated disease burden for a single year from the payer perspective.

Results:

The average incidence per 100,000 person years was 2.4 for IPD, 278.8 for hospitalized pneumococcal pneumonia, and 1376.4 for outpatient pneumococcal pneumonia. The average case fatality rate was 12.3% for IPD and 10.0% for hospitalized pneumonia. Hospitalized pneumonia accounted for over 90% of direct medical costs. The incidence of hospitalized pneumococcal pneumonia per 100,000 person years was 84.4 for adults of 50–64 years, 313.1 for adults of 65–74 years, 820.3 for adults of 75–84 years, and 1650.9 for adults of 85+ year of age. In 2010, it was estimated there were over 113,000 episodes of pneumococcal disease, causing almost 2000 deaths, with direct medical costs of more than NT$3.4 billion annually.

Conclusions:

Pneumococcal disease is a significant cause of mortality and excess healthcare expense among the elderly in Taiwan. Disease burden in older adults increases with advancing age.     

Cost effectiveness analysis of a next generation risk assessment score for cardiovascular disease

Objectives:

The goal of this study is to determine the cost-effectiveness of MIRISK VP, a next generation coronary heart disease risk assessment score, in correctly reclassifying and appropriately treating asymptomatic, intermediate risk patients.

Study design:

A Markov model was employed with simulated subjects based on the Multi-Ethnic Study of Atherosclerosis (MESA). This study evaluated three treatment strategies: (i) practice at MESA enrollment, (ii) current guidelines, and (iii) MIRISK VP in MESA.

Methods:

The model assessed patient healthcare costs and outcomes, expressed in terms of life years and quality-adjusted life years (QALYs), over the lifetime of the cohort from the provider and payer perspective. A total of 50,000 hypothetical individuals were used in the model. A sensitivity analysis was conducted (based on the various input parameters) for the entire cohort and also for individuals aged 65 and older.

Results:

Guiding treatment with MIRISK VP leads to the highest net monetary benefits when compared to the ‘Practice at MESA Enrollment’ or to the ‘Current Guidelines’ strategies. MIRISK VP resulted in a lower mortality rate from any CHD event and a modest increase in QALY of 0.12–0.17 years compared to the other two approaches.

Limitations:

This study has limitations of not comparing performance against strategies other than the FRS, the results are simulated as with all models, the model does not incorporate indirect healthcare costs, and the impact of patient or physician behaviors on outcomes were not taken into account.

Conclusions:

MIRISK VP has the potential to improve patient outcomes compared to the alternative strategies. It is marginally more costly than both the ‘Practice at MESA Enrollment’ and the ‘Current Guidelines’ strategies, but it provides increased effectiveness, which leads to positive net monetary benefits over either strategy.