People adjust to the risks presented by natural disasters in a number of ways; they can move out of harms way, they can self protect, or they can insure. This paper uses Hurricane Andrew, the largest U.S. natural disaster prior to Katrina, to evaluate how people and housing markets respond to a large disaster. Our analysis combines a unique ex post database on the storm’s damage along with information from the 1990 and 2000 Censuses in Dade County, Florida where the storm hit. The results suggest that the economic capacity of households to adjust explains most of the differences in demographic groups’ patterns of adjustment to the hurricane damage. Low income households respond primarily by moving into low-rent housing in areas that experienced heavy damage. Middle income households move away to avoid risk, and the wealthy, for whom insurance and self-protection are most affordable, appear to remain. This pattern of adjustment with respect to income is roughly mean neutral, so an analysis based on measures of central tendency such as median income would miss these important adjustments. Copyright Springer Science + Business Media, LLC 2006Natural hazards, Economic adjustment, Hurricanes,

In our early clinical experience with the absorbable polymer matrix scaffold P4HB, it seemed to provide superior clinical performance and value-based benefit compared with porcine cadaveric biologic mesh.

This research discusses results obtained through formulation and estimation of a dynamic stochastic model that captures individual smoking decision making, health expectations, and longevity over the life cycle. The standard rational addiction model is augmented with a Bayesian learning process about the health marker transition technology to evaluate the importance of personalized health information in the decision to smoke cigarettes. Additionally, the model is well positioned to assess how smoking, and smoking cessation, impacts morbidity and mortality outcomes while taking into consideration the potential for dynamic selection of smoking behaviors. The structural parameters are estimated using rich longitudinal health and smoking data from the Framingham Heart Study: Offspring Cohort. Results suggest that there exists heterogeneity across individuals in the pathways by which smoking effects health. Furthermore, upon smoking, the estimated parameters suggest a positive reinforcement effect and a negative withdrawal effect, both of which encourage future smoking. The paper also presents evidence of health selection in smoking behavior that, when not modeled, may cause an overstatement of the effect of smoking on morbidity and mortality. Finally, personalized health marker information is not found to significantly influence smoking behavior relative to chronic health shocks themselves.

Many public health policies are rooted in findings from medical and epidemiological studies that fail to consider behavioral influences. Using nearly 50 years of data from Framingham Heart Study male participants, we evaluate the longevity consequences of different lifetime smoking patterns by jointly estimating smoking behavior and health outcomes over the life cycle, by richly including smoking and health histories, and by flexibly incorporating correlated unobserved heterogeneity. Unconditional difference-in-mean calculations that treat smoking behaviors as random indicate a 9.3 year difference in age of death between lifelong smokers and nonsmokers; our findings suggest the bias-corrected difference is 4.3 years.

We obtain estimates of associations between statin use and health behaviors. Statin use is associated with a small increase in BMI and moderate (20% to 33%) increases in the probability of being obese. Statin use was also associated with a significant (e.g., 15% of mean) increase in moderate alcohol use among men. There was no consistent evidence of a decrease in smoking associated with statin use, and exercise worsened somewhat for females. Statin use was associated with increased physical activity among males. Finally, there was evidence that statin use increased the use of blood pressure medication and aspirin for both males and females, although estimates varied considerably in magnitude. These results are consistent with the hypothesis that healthy diet is a strong substitute for statins, but there is only uneven evidence for the hypothesis that investments in disease prevention are complementary.

Background:Amniotic membrane is tissue obtained from human placenta rich in cytokines, growth factors, and stem cells that possess the ability to inhibit infection, improve healing, and stimulate regeneration.Methods:A meta-analysis was performed examining randomized controlled trials comparing amniotic tissue products with standard of care in nonhealing diabetic foot ulcers including PubMed, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews.Results:A search of 3 databases identified 596 potentially relevant articles. Application of selection criteria led to the selection of 5 randomized controlled trials. The 5 selected randomized controlled trials represented a total of 311 patients. The pooled relative risk of healing with amniotic products compared with control was 2.7496 (2.05725–3.66524, P < 0.001).Conclusions:The current meta-analysis indicates that the treatment of diabetic foot ulcers with amniotic membrane improves healing rates in diabetic foot ulcers. Further studies are needed to determine whether these products also decrease the incidence of subsequent complications, such as amputation or death, in diabetic patients.

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Study Objectives To examine the cost-effectiveness and potential net monetary benefit of a fully automated digital cognitive behavioral therapy (CBT) intervention for insomnia compared with no insomnia treatment in the United States (US). Similar relative comparisons were made for pharmacotherapy and clinician-delivered CBT (individual and group). Methods We simulated a Markov model of 100,000 individuals using parameters calibrated from the literature including direct (treatment) and indirect costs (e.g., insomnia-related healthcare expenditure, lost workplace productivity). Health utility estimates were converted into quality-adjusted life years (QALYs) and one QALY was worth $50,000. Simulated individuals were randomized equally to one of five arms (digital CBT, pharmacotherapy, individual CBT, group CBT or no insomnia treatment). Sensitivity was assessed by bootstrapping the calibrated parameters. Cost estimates were expressed in 2019 US dollars. Results Digital CBT was cost-beneficial when compared with no insomnia treatment and had a positive net monetary benefit of $681.06 (per individual over 6-months). Bootstrap sensitivity analysis demonstrated that the net monetary benefit was positive in 94.7% of simulations. Relative to other insomnia treatments, digital CBT was the most cost-effective treatment because it generated the smallest incremental cost-effectiveness ratio (-$3,124.73). Conclusions Digital CBT was the most cost-effective insomnia treatment followed by group CBT, pharmacotherapy, and individual CBT. It is financially prudent and beneficial from a societal perspective to utilize automated digital CBT to treat insomnia at a population scale.