Modeling the effect of information quality on risk behavior change and the transmission of infectious diseases

How the quality of information about the prevalence of an infectious disease affects individuals’ incentives to adopt self-protective actions to reduce the risk of infection is studied using an economic/game-theoretic model of epidemics. In the model, agents make inferences regarding the current prevalence of a disease by observing the health status of a subset of the population. Therefore, the higher the number of agents whose infection status can be observed, the better one’s information about the current prevalence is. In particular, it is assumed that an agent’s estimate of the current prevalence depends on observations of the current health status of other agents and on the agent’s estimate of past prevalence, and that the agent places more weight on the current observations in forming an estimate of the prevailing prevalence when the number of observations increases. It is shown that the likelihood of eradicating an infectious disease through behavioral changes depends critically on the amount of information that individuals have access to, which also determines whether prevalence will be relatively stable or will exhibit cyclical patterns over time. Increasing the amount of information that individuals possess may lower the likelihood of eradication.     

An economic perspective on personalized medicine

The concept of personalized medicine not only promises to enhance the life of patients and increase the quality of clinical practice and targeted care pathways, but also to lower overall healthcare costs through early-detection, prevention, accurate risk assessments and efficiencies in care delivery. Current inefficiencies are widely regarded as substantial enough to have a significant impact on the economies of major nations like the US and China, and, therefore the world economy. A recent OECD report estimates healthcare expenditure for some of the developed western and eastern nations to be anywhere from 10% to 18%, and growing (with the US at the highest). Personalized medicine aims to use state-of-the-art genomic technologies, rich medical record data, tissue and blood banks and clinical knowledge that will allow clinicians and payors to tailor treatments to individuals, thereby greatly reducing the costs of ineffective therapies incurred through the current trial and error clinical paradigm. Pivotal to the field are drugs that have been designed to target a specific molecular pathway that has gone wrong and results in a diseased condition and the diagnostic tests that allow clinicians to separate responders from non-responders. However, the truly personalized approach in medicine faces two major problems: complex biology and complex economics; the pathways involved in diseases are quite often not well understood, and most targeted drugs are very expensive. As a result of all current efforts to translate the concepts of personalized healthcare into the clinic, personalized medicine becomes participatory and this implies patient decisions about their own health. Such a new paradigm requires powerful tools to handle significant amounts of personal information with the approach to be known as “P4 medicine”, that is predictive, preventive, personalized and participatory. P4 medicine promises to increase the quality of clinical care and treatments and will ultimately save costs. The greatest challenges are economic, not scientific.     

Synthetic biology: ensuring the greatest global value

Synthetic biology (SynBio) has tremendous, transformative potential. Like other technologies, it can be used for good or ill. Currently, the structure of the allocation of potential benefits and risks is biased in favor of richer countries. The underlying problem is simple: most risks from SynBio are universal and affect both the rich and the poor with equal force; but benefits from SynBio can be expected to accrue chiefly to the rich. The risk/benefit balance is therefore skewed in a way that may lead to inefficient and unfair decisions. One potential solution is presented in this paper, using the principles that underlie the Health Impact Fund (HIF). The HIF is designed to reward companies based on assessed health impact, no matter where it occurs in the world, so that extending the life of a poor person is as profitable as extending the life of a rich person. This paper considers both the potential benefits and costs of SynBio; examines how the current global pharmaceutical industry is structured; introduces the HIF proposal; and finally explores how the principles underlying the HIF could be used productively with SynBio for global health.     

78例胎盘早剥临床分析

目的：探讨胎盘早剥的诱发因素、手术方式和临床处理方法。方法：采用回顾性病例分析的方法,对2010年6月至2012年1月在我院妇产科接受治疗的78例胎盘早剥患者的临床资料进行统计,分析胎盘早剥的诱因、临床分度及处置原则。结果：诱发因素：妊娠期高血压病占第1位,胎膜早破为第2位,妊娠期合并糖尿病为第3位。此外,羊水过多、妊娠合并子宫肌瘤、外伤等也是引起胎盘早剥的因素。在78例胎盘早剥患者中,重度的有18例,中度的有32例,这50例患者全用采取剖宫产进行处置。另有28例为轻度胎盘早剥,其中6例采用阴道分娩。结论：胎盘早剥以妊娠期高血压、胎膜早破、妊娠期糖尿病为主要发病诱因,中重度胎盘早剥一般用剖宫产终止妊娠,轻度胎盘早剥可部分用阴道分娩。     

儿童过敏性紫癜的临床特点及其肾损害的相关因素分析

摘要目的：总结儿童过敏性紫癜的临床特点,并分析其肾损害的相关因素。方法：选择2006年2月~2012年8月我院小儿科诊治的过敏性紫癜患儿86例,根据是否伴有肾脏损害分为观察组（34例）和对照组（52例）,分析两组患者的一般临床资料,总结儿童过敏性紫癜的临床特点,并探讨导致儿童过敏性紫癜并发肾损害的相关因素。结果：（1）儿童过敏性紫癜的诱因包括感染、过敏、疫苗接种、寄生虫病史及其它原因,其中感染比例最高,占66．28％;首发症状包括紫癜、腹痛及关节痛的一种或多种,其中紫癜比例最高,占59．30％。（2）观察组患儿中年龄≥8Y、皮疹反复≥4w及血FIB升高的比例分别为73．53％（25／34）、52．94％（18／34）和26．47％（9／34）,均显著高于对照组患儿（P〈0．05）,非条件Logistic多元回归分析结果示皮疹反复≥4W及血FⅢ升高为过敏性紫癜患儿发生肾脏损伤的危险因素。结论：儿童过敏性紫癜的主要诱因为感染,典型临床表现为紫癜,皮疹反复芝4w及血FIB升高为过敏性紫癜患儿发生肾脏损伤的危险因素。     

Subtle social cues, explicit incentives and cooperation in social dilemmas

Subtle contextual social cues and the explicit incentive structure of social dilemmas are two important, but fundamentally different classes of determinants of cooperative behavior. The former provides subjective social information regarding the likelihood of attaining mutual cooperation by shaping one's expectations of the cooperative behavior of the interacting party. The latter provides objective, ecological information about the strategic opportunities offered by the situation. In prior research, both classes have generally been studied in isolation, hampering insight into how social judgments and ecological opportunities interact in shaping cooperation. To fill in this gap we set up a repeated mixed-motive game in which we manipulate subtle social cues and the incentive structure of the game simultaneously. We develop the hypothesis that social information is less important in shaping mutual cooperation of two team members when the incentive structure is such that it contains natural synergies. In contrast, when the incentive structure offers no synergy, “rational contracting” is hampered and social cues are essential for mutual cooperation to develop. The evidence we present in this paper is consistent with this hypothesis.     

Incentive design to boost health for juveniles with Medicaid coverage: Evidence from a field experiment

Augmenting incentives for juveniles with separate incentives for parents could boost juvenile efforts to reduce BMI. However, financing a parent incentive by reducing the incentives offered to adolescents could attenuate the juvenile response. In a field experiment, Medicaid-covered juveniles enrolled in a cardiac wellness program were randomly assigned to two groups: juveniles in the focused-incentive group received all earned points; juveniles in the split-incentive group split earned points with a parent. The focused-incentive group was 12.8 percentage points more likely to achieve their stipulated goals compared to the split-incentive group at the end of the 3-month active phase of the program. In contrast, members of the split-incentive group outperformed their peers in the focused-incentive group during the second quarter, and the two incentives structures were equally effective at the year-end session. Additional quasi-experimental data indicates that members of both incentivized groups significantly outperformed (focused-incentive group by 8.48 percentage points and split-incentive group by 11.0 percentage points) a pre-experiment (non-incentivized) set of juveniles enrolled in the same program at year-end.