Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries

Objectives To examine Medicare health care spending and health services utilization among high-need population segments in older Mexican Americans, and to examine the association of frailty on health care spending and utilization. Methods Retrospective cohort study of the innovative linkage of Medicare data with the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) were used. There were 863 participants, which contributed 1,629 person years of information. Frailty, cognition, and social risk factors were identified from the H-EPESE, and chronic conditions were identified from the Medicare file. The Cost and Use file was used to calculate four categories of Medicare spending on: hospital services, physician services, post-acute care services, and other services. Generalized estimating equations (GEE) with a log link gamma distribution and first order autoregressive, correlation matrix was used to estimate cost ratios (CR) of population segments, and GEE with a logit link binomial distribution was applied to estimate odds ratios (OR) of healthcare use. Results Participants in the major complex chronic illness segment who were also pre-frail or frail had higher total costs and utilization compared to the healthy segment. The CR for total Medicare spending was 3.05 (95% CI, 2.48–3.75). Similarly, this group had higher odds of being classified in the high-cost category 5.86 (95% CI, 3.35–10.25), nursing home care utilization 11.32 (95% CI, 3.88–33.02), hospitalizations 4.12 (95% CI, 2.88–5.90) and emergency room admissions 4.24 (95% CI, 3.04–5.91). Discussion Our findings highlight that frailty assessment is an important consideration when identifying high-need and high-cost patients.

Young adult drug interventions: a social marketing systematic review and research agenda

Purpose This paper aims to report on the first comprehensive, social marketing systematic review of interventions targeting illicit drug use by young adults. Design/methodology/approach A total of 3,169 papers were screened, with 20 relevant empirical studies meeting the eligibility criteria for the systematic review. These were analysed according to Andreasen’s (2002) and NSMC’s (2006) social marketing benchmarks. Findings The findings provide evidence regarding the efficacy of behavioural and clinical interventions targeting individuals and groups, including motivational, life skills training, cognitive behavioural therapy, comprehensive health and social risk assessments and buprenorphine treatment interventions. Further, results evidence that there is yet to be an intervention which has implemented the full marketing mix, and limited studies have used the social marketing benchmarks of exchange and competition. Originality/value To the best of the authors’ knowledge, this study is the first to conduct a comprehensive systematic review and provide key recommendations outlining the potential for social marketing to support the improved uptake and efficacy of interventions. A research agenda is also put forward to direct future social marketing scholarship in the area of young adult drug interventions.

Risk factors for early TB treatment interruption among newly diagnosed patients in Malaysia

TB treatment interruption has resulted in delayed sputum conversion, drug resistance, and a high mortality rate and a prolonged treatment course, hence leading to economic and psychosocial affliction. To date, there are limited studies investigating the physico-social risk factors for early treatment interruptions. This prospective multicenter cohort study aimed to investigate the risk factors for early treatment interruption among new pulmonary tuberculosis (TB) smear-positive patients in Selangor, Malaysia. A total of 439 participants were recruited from 39 public treatment centres, 2018–2019. Multivariate Cox proportional hazard analyses were performed to analyse the risk factors for early treatment interruption. Of 439 participants, 104 (23.7%) had early treatment interruption, with 67.3% of early treatment interruption occurring in the first month of treatment. Being a current smoker and having a history of hospitalization, internalized stigma, low TB symptoms score, and waiting time spent at Directly Observed Treatment, Short-course centre were risk factors for early treatment interruption. An appropriate treatment adherence strategy is suggested to prioritize the high-risk group with high early treatment interruption. Efforts to quit smoking cessation programs and to promote stigma reduction interventions are crucial to reduce the probability of early treatment interruption.

Social Dimensions of Roma Marginalization

The paper aims to analyze aspects of Roma marginalization, by identifying and assessing the dimensions of social needs within a compact Roma community, located in a marginalized urban area. The effects of the economic crisis and the COVID-19 pandemic increase inequalities regarding the economic and social situation. The major challenge is to reduce the risk of poverty, especially among families with children, people with disabilities and chronic diseases, but also the social exclusion of people at social risk, based on accurate measurements of social phenomena. The community profile indicates the social status of the inhabitants, which provides a picture of the degree of marginalization and social exclusion of Roma. Thus, the study was conducted by constructing a questionnaire as a research tool, which summarizes the results of the activity of information collection and processing, both based on statistical methods and percentage analysis. The problems faced by marginalized Roma communities are low participation in education, early school leaving, difficult transition to tertiary education, lack of adult skills, low skills among vulnerable people in the labor market, low access to services, poor health and housing. Measures for early detection of situations of social risk and intervention lead to positive effects in preventing marginalization and social exclusion.

Risk Information in Non-Financial Disclosure

This paper aims to research the topics related to risk included in non-financial disclosure (NFD) of companies listed on the Warsaw Stock Exchange (WSE) and explore factors that influence the risk topics ratio in NFD. We applied a content analysis using topic modeling to discover latent risk topics in NFD. Next, with Ward’s clustering, we identified four groups of companies with a homogenous risk topic mixture. For causal analysis, to explain the differences in risk topics ratio, we used qualitative comparative analysis (QCA), which allowed us to obtain three paths (variable configurations) leading to the high ratio of risk topics in NFD. Our results suggest that companies disclosing risk information extensively in their NFDs concentrate almost solely on social risk matters. In contrast, companies talking briefly about environmental and social (E&S) risk prepare their NFDs with a more balanced distribution of E&S topics and their financial implication. In general, the companies’ exposure to E&S risk and the use of NFD standards and guidelines as well as the type of NFD impact the space dedicated to risk information. This paper contributes to academics and regulators, filling the gap about risk disclosure in the NFD, identifying the nature of corporate risk disclosures, and upgrading research about determinants of risk information in non-financial disclosure.

Expansion of Planted Forests: The Risk of Pesticides Mixtures

Planted forests include forests established through human planting or deliberate seeding. They are systems that offer us timber and non-timber forest products and ecosystem services, such as wildlife protection, carbon sequestration, soil, and watershed maintenance. Brazil has 7.6 million hectares of planted forests, with 72% of the total area occupied by Eucalyptus spp. A favorable climate and management and genetic improvement research are the main factors responsible for high productivity. In recent years, the expansion of planted areas has been accompanied by the commercial release of several pesticides, mainly herbicides. A recent change in the Brazilian legislation allows mixing phytosanitary products in a spray tank, having a new approach to managing pests, diseases, and weeds. Antagonism is the main risk of tank mixes, and to reduce the dangers associated with this practice, we review all products registered for growing Eucalyptus. This literature review aims to identify the effects of product mixtures registered for Eucalyptus reported for other crops. In addition, environmental and social risk assessment has been widely adopted to export wood and cellulose, making the results of this review an indispensable tool in identifying the nature and degree of risks associated with pesticides. The results classify the effects of the mixtures as an additive, antagonistic or synergistic. The use of pesticide tank mixtures has the potential for expansion. However, there are still challenges regarding variations in the effects and applications in different climatic conditions. Therefore, studies that prove efficient mixtures for the forest sector are essential and the training of human resources.

Gamified Virtual Environment and Interaction Design for Activities of Daily Living Training

Ludic games and gamification processes can extend functional skills in players as they integrate different intelligences and stimulate the cognitive, perceptual, and motor activities. Play can facilitate the work of occupational therapist since provides better cooperation of the patient, besides helping in its development, increasing its behavioral repertoire, mainly in the accomplishment of activities of daily living. This chapter addresses these issues, discussing the design of a gamified virtual environment that helps occupational therapists to develop the potential of children and adolescents with mild, moderate, and severe neuropsychomotor disorder. For that, the authors present an investigation of the use of a gamified virtual environment and interaction devices in the training of activities of daily living. As result, they note that games as assistive technology can encourage the integration of education, rehabilitation, and habilitation of people in situations of vulnerability and social risk, providing access and inclusion through playful and challenging activities.

Determining Consumer Purchase Intention Toward Counterfeit Luxury Goods Based on the Perceived Risk Theory

This study aims to understand the impact of financial, psychological, and social risk dimensions on attitude and intention to purchase counterfeit luxury goods. Data were collected through a questionnaire conducted with 116 Angolan consumers and were treated with structural equation modeling. The results revealed that only financial risk and social risk were influential in attitude toward counterfeit luxury goods. Attitude had a significant influence on the intention to purchase counterfeit luxury goods. The research contributes to the literature because there has been no previous study in an African country that seeks to understand the purchase intention of counterfeit luxury goods according to risk perception theory. On the other hand, this study is one of the few to report that social risk perception positively impacts attitudes towards counterfeit luxury goods.