Girls for Sale? Child Sex Ratio and Girl Trafficking in India

ABSTRACT

Illegal trafficking of girls results from their disadvantageous position in society, often reflected by preference for sons and neglect of daughters. India has both higher levels of illegal trafficking of girls and abnormal child sex ratios in favor of boys. This paper examines if the skewed sex ratio in India is associated with trafficking of girls. Using panel data from twenty-nine Indian states from 1980 to 2011, the study finds that a 100-unit increase in the child sex ratio is associated with a 0.635 percent increase in girl trafficking. Further, the association is heterogeneous by women’s empowerment, crime against women, and party rule in the state, and the association between the child sex ratio and trafficking of girls is stronger and larger in magnitude in states with greater women’s empowerment. Overall, it appears the results are driven both by greater reporting and a greater incidence of illegal girl trafficking.     

Healthcare costs associated with nephrology care in pre-dialysis chronic kidney disease patients

Abstract

Objective:

To compare the healthcare costs of pre-dialysis chronic kidney disease (CKD) patients cared for in a nephrology clinic setting versus other care settings.

Methods:

An analysis of health claims between 01/2002 and 09/2007 from the Ingenix Impact Database was conducted. Inclusion criteria were ≥18 years of age, ≥1 ICD-9 claim for CKD, and ≥1 estimated glomerular filtration rate (eGFR) value of <60?mL/min/1.73?m². Patients were classified in the nephrology care cohort if they were treated in a nephrology clinic setting at least once during the study period. Univariate and multivariate analyses were conducted to compare average annualized healthcare costs of patients in nephrology care versus other care settings.

Results:

Among the 20,135 patients identified for analysis, 1,547 patients were cared for in a nephrology clinic setting. Nephrology care was associated with lower healthcare costs with an unadjusted cost savings of $3,049 ($11,303 vs. $14,352, p?=?0.0014) and a cost ratio of 0.8:1 relative to other care settings. After adjusting for covariates, nephrology care remained associated with lower costs (adjusted cost savings: $2,742, p?=?0.006).

Limitations:

Key limitations included potential inaccuracies of claims data, the lack of control for patients’ ethnicity in the calculation of eGFR values, and the presence of potential biases due to the observational design of the study.

Conclusions:

The current study demonstrated that pre-dialysis CKD patients treated in nephrology clinics were associated with significantly lower healthcare costs compared with patients treated in other healthcare settings.     

Adalimumab,etanercept, and infliximab utilization patterns and drug costs among rheumatoid arthritis patients

Abstract

Objectives:

To evaluate the utilization patterns of the anti-tumor necrosis factor (anti-TNF) agents Humira (adalimumab), Enbrel (etanercept), and Remicade (infliximab) in patients with rheumatoid arthritis (RA) and compare medication costs during the first year of treatment. (Humira is a registered trademark of Abbott Laboratories, IL; Enbrel is a registered trademark of Immunex Corporation, CA; and Remicade is a registered trademark of Janssen Biotech, Inc., PA).

Methods:

This retrospective analysis of medical and pharmacy claims included patients who were aged ≥18 years, had ≥2 RA diagnosis codes, and had ≥365 days of persistence with the index anti-TNF. Patients excluded had claims for anti-TNF agents within 6 months before the index date. Refill patterns for adalimumab and etanercept, number of infliximab infusions, time between infusions, and dose per infusion were analyzed for 12 months. Direct anti-TNF medication costs were compared among anti-TNFs for the initial treatment year.

Results:

Infliximab-treated patients (n?=?457) were significantly older than adalimumab- (n?=?337) or etanercept-treated patients (n?=?902). Time between refills was longer than recommended for 28% and 30% of adalimumab and etanercept refill periods, respectively. Potential cumulative time without therapy was 33 days for adalimumab and 43 days for etanercept. Statistically significant differences in mean per-patient anti-TNF medication costs for the first year were reported for adalimumab, etanercept, and infliximab ($14,991, $13,361, and $18,139, respectively; p?<?0.0001); however, a cost assessment using labeled dosing of the anti-TNF agents with optimal treatment compliance yielded comparable annual medication costs.

Limitations:

This analysis only evaluated utilization patterns for selected anti-TNF agents and was not inclusive of other medications that patients may have been using for RA. Absolute patient adherence could not be assessed due to lack of information on how patients were self-administering adalimumab and etanercept or if samples of the agents were made available.

Conclusions:

This study identified gaps in patients’ refills compared with prescriber recommendations. The infliximab-treated group had infusion patterns consistent with prescribing information. Potential clinical and economic implications of dose attenuation with adalimumab and etanercept should be explored further.     

On the efficiency of the negligence rule

The three versions of the negligence rule discussed in the literature differ regarding whether a negligent injurer is liable for the entire loss or only for the incremental loss; or regarding whether negligence is defined as failure to take at least due care or failure to take a cost‐justified precaution. It is shown in the paper that the incremental version with untaken precaution notion of negligence is not efficient; not even for the unilateral case. The paper also establishes, for the bilateral case, the efficiency of the incremental version with the shortfall‐from‐due‐care way of defining negligence.     

The Route Matters: Poverty and Inequality among Lone-Mother Households in Russia

Using the case of Russia, this paper takes issue with the stereotype of lone mothers as the poorest women in society, with the most disadvantaged children. Analysis of the Russian Longitudinal Monitoring Survey suggests there is enormous diversity in the material circumstances and livelihoods of lone mothers. Complementing the diversity of lone mothers' experiences is the finding that women who live with male partners, but who are responsible economically for their households, face problems much like those of lone mothers. The structural inequities that result from combining paid labor with unpaid care and childrearing have particularly adverse consequences for lone mothers and for women who bear the brunt of maintaining their households. While this analysis emphasizes the different aspects of the falsely homogenizing category “lone mother,” it also recognizes the structural disadvantages shared by lone mothers and other women in Russia today.     

Lone Mothers: What is to be done?

This Dialogue presents the views of four authors, from the US, the UK, and Norway, on the best policies to help lone mothers. Lone mothers face an inevitable dilemma in allocating their time between earning income and caring for their children. The low-earning capacity of women in an unequal labor market exacerbates the problem, causing material hardship for many lone mothers and their families. The policy solutions proposed lie along a spectrum, ranging from those that seek to enable all lone mothers to take employment to those that aim to let mothers choose whether to take employment or care for their children themselves. Other policies discussed concern ways to value and support caregiving, improve the low-wage labor market for women, and provide a set of income supports that would both boost income and provide time to care for children.     

Merit and Evaluation Models for Managers in the National Health System： An Empirical Study

The national health system （NHS） complexity increase requires a review of the managerial human resources evaluation and recruiting methods, considering that nowadays doctors need to improve not just their clinical capabilities, but also managerial competences. At this end it is important to develop performances control models and to identify appropriate results indicators, with the aim of introducing an effective doctors selection system for managerial roles. The paper considers the Italian situation and tests the current evaluation and selection methods, by analysing the literature and the existing legislation and by interviewing experts. Moreover, in order to reach an innovative model, complex organizations have been taken into account as benchmarks. Three different categories of experts have been interviewed and texted： national health care organizations managers, companies managers, and business consultants. The 137 interviewed experts have been asked about four main questions concerning the evaluation for hiring managers as chief medical director, department director, and head of complex units. The conducted research suggests four different options in order to evaluate and to select heads of complex unit for the most strategic roles. By consequence, the analysis shows that required characteristics must be managerial attitudes as well as clinical capabilities.     

Is health care a necessity or a luxury? Evidence from urban China

This article uses a smooth transition regression (STR) model to research the income elasticity of the health care expenditure of China’s urban residents in the 1990–2013 period. The results demonstrate that if the real income of China’s urban residents that lags a period is taken as a transition variable, urban residents’ health expenditure follows an LSTR1 nonlinear two-regime model. Here, the income elasticity of health care expenditure of China’s urban residents is 1.4919 in 1990–2002 and 1.2216 in 2003–2013. Overall, the income elasticity of health care of China’s urban residents is greater than 1, indicating that health care is a luxury.     

Reorganizing School Lunch for a More Just and Sustainable Food System in the US

Public school lunch programs in the United States are contested political terrains shaped by government agencies, civil society activists, and agri-food companies. The particular organization of these programs has consequences for public health, social justice, and ecological sustainability. This contribution draws on political economy, critical food studies, and feminist economics to analyze the US National School Lunch Program, one of the world's oldest and largest government-sponsored school lunch programs. It makes visible the social and environmental costs of the “heat-and-serve” economy, where widely used metrics consider only the speed and volume of service as productive work. This study demonstrates that such a narrow understanding of the labor of lunch devalues care and undercuts the potential for school food provisioning to promote ecological and feminist goals. Further, it proposes a “high road” alternative and outlines an agenda for reorganizing school food provisioning to maximize care in all its dimensions.     

Purchasing natural personal care products in the era of fake news? The moderation effect of brand trust

Natural personal care products are gaining popularity due to their benefits in terms of health and well-being. However, consumers are wary of these products and are guided by the fake news circulating about them. Since natural product consumption offers several personal and environmental benefits, it would be worthwhile to understand consumers’ tendency to let fake news influence their consumption decisions. Accordingly, the current study examined the association of fake news and purchasing behaviour towards natural personal care products, utilising Stimulus-Organism-Behaviour-Consequence (SOBC) as the theoretical framework. The study proposed openness to change as the stimulus, perceived benefits and perceived risks as organismic internal states, purchase intentions as the behaviour, and the propensity of believing and acting on fake news as the consequence, which is further associated with system trust. The model was tested by analysing data collected from 390 existing consumers, considering the moderation effect of brand trust and controlling the effect of age and gender. The findings confirmed that openness to change is associated with perceived benefits and risks. Furthermore, perceived benefits and system trust are associated with purchase intentions, which are, in turn, associated with the propensity of believing and acting on fake news. The study presents several novel contributions to theory and practice.