Disease management programs: program intervention, behavior modification, and dosage effect

Disease management programs provide highly personalized self- management support to consumers afflicted with chronic illnesses. Program interventions include the provision of health information, ongoing motivation, and support for behavior change, adherence to pharmacotherapy, development of self-efficacy, and the distribution of self-care tools. Interactions between program and patients are structured and repetitive over time. Consumer behavior change can result in measurable improvements in quality and medical cost savings from postponement or avoidance of preventable complications. We evaluated the impact on cost and quality of a comprehensive Diabetes Disease Management Program (DDMP) across ten US urban markets. A staggered implementation allowed for ten pre–post and five pair-wise comparisons. The DDMP demonstrated significant improvements in six diabetes-related quality indicators, lower cost, and a dose-response with greater than 6 months participation. We conclude that a DDMP improves quality of care and reduce overall medical costs.     

“我们正在寻找中国进口商”

亚洲是我国开展对外经贸合作最主要的对象之一,特别是东盟一巾吲自由贸易区2010年1月1日全面启动以来,中国与亚洲国家经贸合作正变得更广泛而深入。近日,本刊记者集中采访了新加坡、马尔代夫和马来阳砸驻华大使,请他们介绍中国企业在这些国家的发展机会。     

Can medium-scale farms support smallholder commercialisation and improve welfare? Evidence from Nigeria

In spite of mounting evidence about the growth of medium-scale farms (MSFs) across Africa, there is limited empirical evidence on their impact on neighbouring small-scale farms (SSFs). We examine the relationships between MSFs and SSFs, with particular focus on the specific mechanisms driving potential spillover effects. First, we develop a theoretical model explaining two propagating mechanisms: learning effects (training) and cost effects (reduced transactions cost). An empirical application to data from Nigeria shows that SSFs with training from MSFs tend to use higher levels of modern inputs (have higher productivity), and receive higher prices and income. The results also show that purchasing inputs from MSFs reduces the costs of accessing modern inputs and is associated with higher inorganic fertiliser use by SSFs. Our results suggest that the benefits of receiving training and purchasing inputs from MSFs are particularly important for very small-scale producers, operating less than 1 hectare of land. This implies that policies which promote the efficient operation of MSFs and encourage their interaction with SSFs can be an effective mechanism for improving the productivity and welfare of smallholder farms, hence reducing their vulnerability to extreme poverty.     

The role of On‐line communities on the internet for Sustainable Development

For the world to move towards a more sustainable future greater understanding is required about the links between society, reality, business activity, the environment, technology and sustainable development (Welford, 199816). Technological development of the Internet offers the potential, if appropriately utilized, to be an enabler of a more sustainable future. On‐line communications, via the Internet, is driving the evolution of cyber based communities in both domestic and commercial environments. Such changes in international communications are clearly at a relatively early stage of development, which raises many issues of fundamental interest but also concern. Security and control are issues of prime importance to all existing and future participants in cyberspace, due to the direct implications on both freedom and order. The Internet has evolved from a small specialist controlled environment, including both scientists and academic members, to on‐line activity that is currently viewed by many as anarchic in nature. The more recent rise of the World Wide Web (WWW), driven by corporate acceptance and adoption, appears to be pushing towards formalization of both the Internet infrastructure and also applications. In exploring the role of on‐line communities for sustainable development the paper addresses fundamental issues of importance. Copyright © 1999 John Wiley & Sons, Ltd and ERP Environment.     

A production/remanufacture model with returns’ subassemblies managed differently

This paper considers a production-remanufacturing inventory model for a single product, where constant demand is satisfied from the inventory of newly produced and remanufactured items. Although the available models in the literature imply that collected used units (or returns) are disassembled for recovery purposes, these models really do not treat them as such. Contrary, the returns are assumed to be recovered as whole units, perhaps, for simplicity. This assumption may not capture the benefits reaped from product recovery programs. This paper addresses this limitation in the literature and assumes that each unit of a used product is collected and disassembled into components, where these components are sorted into subassemblies, which are fed back into the production-remanufacturing process. The returned subassemblies are remanufactured and reassembled to represent a second source of as-good-as-new units of the end-product. For this multi-component inventory problem, the question that needs to be answered is whether, or not, extreme strategies of either pure remanufacturing or pure production are more economical than a mixed strategy (one that combines both strategies). A mathematical model is developed that accounts for the inventories of subassemblies. The results suggested that not accounting for the disassembled components of a product leads to inappropriate inventory decisions that are not environmentally sound.     

Board gender diversity and dividend policy in Australian listed firms: the effect of ownership concentration

Asia Pacific Journal of Management - We examine the association between board gender diversity and corporate dividend payout. Our results suggest that although board gender diversity impacts...     

Least squares, preliminary test and Stein-type estimation in general vector AR(p) models

In the general vector autoregressive process AR ( p ), multivariate least square estimation (LSE)/maximum likelihood estimation (MLE) of a subset of the parameters is considered when the complementary subset is suspected to be redundant. This may be viewed as a special case of linear constraints of autoregressive parameters. We incorporate this nonsample information in the estimation process and propose preliminary test and Stein-type estimators for the target subset of parameters. Under local alternatives their asymptotic properties are investigated and compared with those of unrestricted and restricted LSE. The dominance picture of the estimators is presented.     

Banks' environmental policy and business outcomes: The role of competition

By integrating the two areas of competition–performance and environment–performance, this research explores if competition matters in the relationship between environmental practices and interest margins in the market. A panel of 458 banks from 74 countries for the period of 2006–2016 is used, and the sample is further divided into developed and developing countries. This paper uses the system Generalized Method of Moments estimator to tackle potential omitted variable bias, endogeneity, and simultaneity issues. Without competition, environmental practices only affect banks in developing countries; however, the results show a significant impact for the full sample, including developed countries, when the competition is taken into consideration, suggesting that competition might play a role in the relationship of environmental practices and interest margins. In the full sample, competition impacts the relationship negatively after a moderate level of competition is reached in the market. The environmental practices in developing countries are prone to competition in the market. In developed countries, the competition is found to be lightly positively moderating the impact of environmental practices on interest margins. Based on these findings, it is recommended that developing countries should have a low or moderate level of competition to encourage environmental practices. For developed countries, however, high competition should be preferred to encourage banks to consider environmental practices as one of their core business strategies. These findings are found robust to different statistical estimators.     

WHO’S THE BOSS? HOUSEHOLD DISTRIBUTION OF POWER IN A NON‐COOPERATIVE FRAMEWORK

When labour market participation influences bargaining power in a household, the male and the female labour supplies can be either positively or negatively related. If negatively related, possibilities include: ‘balance of power’, the complete dominance of one member, and circumstances where inequity persists with incomplete dominance. If effort levels are positively sloped, it is possible to have equilibrium at either high or low effort levels leading to equity. The effects of economic development and wage discrimination are also discussed.     

Economic burden associated with inadequate antidepressant medication management among patients with depression and known cardiovascular diseases: insights from a United States–based retrospective claims database analysis

Abstract

Aims: The current study examined the association between insufficient major depressive disorder (MDD) care and healthcare resource use (HCRU) and costs among patients with prior myocardial infarction (MI) or stroke.

Methods: This was a retrospective study conducted using the MarketScan Claims Database (2010–2015). The date of the first MI/stroke diagnosis was defined as the cardiovascular disease (CVD) index date and the first date of a subsequent MDD diagnosis was the index MDD date. Adequacy of MDD care was assessed during the 90 days following the index MDD date (profiling period) using 2 measures: dosage adequacy (average fluoxetine equivalent dose of ≥20?mg/day for nonelderly and ≥10?mg/day for elderly patients) and duration adequacy (measured as the proportion of days covered of 80% or higher for all MDD drugs). Study outcomes included all-cause and CVD-related HCRU and costs which were determined from the end of the profiling period until the end of study follow-up. Propensity-score adjusted generalized linear models (GLMs) were used to compare patients receiving adequate versus inadequate MDD care in terms of study outcomes.

Results: Of 1,568 CVD patients who were treated for MDD, 937 (59.8%) were categorized as receiving inadequate MDD care. Results from the GLMs suggested that patients receiving inadequate MDD care had 14% more all-cause hospitalizations, 4% more all-cause outpatient visits, 17% more CVD-related outpatient visits, 13% more CVD-related emergency room (ER) visits, higher per patient per year CVD-related hospitalization costs ($21,485 vs. $17,756), higher all-cause outpatient costs ($2,820 vs. $2,055), and higher CVD-related outpatient costs ($520 vs. $434) compared to patients receiving adequate MDD care.

Limitations: Clinical information such as depression severity and frailty, which are potential predictors of adverse CVD outcomes, could not be ascertained using administrative claims data.

Conclusions: Among post-MI and post-stroke patients, inadequate MDD care was associated with a significantly higher economic burden.