Your Choice : Weight Management in Primary Care

The aims of this intervention are 1) To be a targeted intervention: BMI >30 or > 28 for patients with comorbidities provided with support to lose weight. 2) To help patients achieve weight loss (with an initial 5% goal over the 12 week intervention period) 3) To establish primary care weight management services in thecounty 4) To train the primary care workforce in weight managementintervention 5)To help patients make sustainable lifestyle changes in terms ofhealthy eating and physical activity 6)To ensure an appropriate exit strategy was in place

Evaluation of the Birmingham My Choice Adult Weight Management Programme

The aims of this intervention are: To reduce adult obesity levels To improve access to weight management services in primary care. To improve access to weight management services for areas with high BME populations or poor access to commercial weight loss providers To improve diet and nutrition, promote healthy weight and increase levels of physical activity in overweight or obese patients. To support patients to make lifestyle changes to enable them to lose weight

Wie wirkt Pluralität auf individuelle Religiosität? Eine Konfrontation von Wissenssoziologie und Rational Choice

Interdisziplinär konzipiert, zeigt dieses Buch in historischer und gegenwartsbezogener Perspektive die Komplexität und den Facettenreichtum des religiösen Pluralismus auf, der unsere gesellschaftliche Wirklichkeit zunehmend bestimmt. Die hier dokumentierten religionswissenschaftlichen, soziologischen, rechtlichen und philosophischen Zugänge sind dabei behilflich, sich mit Religion und ihrer weltweit wachsenden gesellschaftlichen Relevanz auseinander zu setzen. Die Beiträge zeigen, wie der Herausforderung des Religionspluralismus im europäischen und außereuropäischen Raum begegnet wird und welche große Bandbreite an Themen hierbei zu Tage tritt.

Scoring Methods for Ordinal Multidimensional Forced-Choice Items

In most psychological tests and questionnaires, a test score is obtained bytaking the sum of the item scores. In virtually all cases where the test orquestionnaire contains multidimensional forced-choice items, this traditionalscoring method is also applied. We argue that the summation of scores obtained with multidimensional forced-choice items produces uninterpretabletest scores. Therefore, we propose three alternative scoring methods: a weakand a strict rank preserving scoring method, which both allow an ordinalinterpretation of test scores; and a ratio preserving scoring method, whichallows a proportional interpretation of test scores. Each proposed scoringmethod yields an index for each respondent indicating the degree to whichthe response pattern is inconsistent. Analysis of real data showed that withrespect to rank preservation, the weak and strict rank preserving methodresulted in lower inconsistency indices than the traditional scoring method;with respect to ratio preservation, the ratio preserving scoring method resulted in lower inconsistency indices than the traditional scoring method

Freedom of choice of specialist physicians is important to Swiss resident: a cross-sectional study.

QUESTION UNDER STUDY: To assess how important the possibility to choose specialist physicians is for Swiss residents and to determine which variables are associated with this opinion. METHODS: This cross-sectional study used data from the 2007 Swiss population-based health survey and included 13,642 non-institutionalised adults who responded to the telephone and paper questionnaires. The dependent variable included answers to the question "How important is it for you to be able to choose the specialist you would like to visit?" Independent variables included socio-demographics, health and past year healthcare use measures. Crude and adjusted logistic regressions for the importance of being able to choose specialist physicians were performed, accounting for the survey design. RESULTS: 45% of participants found it very important to be able to choose the specialist physician they wanted to visit. The answers "rather important", "rather not important" and "not important" were reported by 28%, 20% and 7% of respondents. Women, individuals in middle/high executive position, those with an ordinary insurance scheme, those reporting ≥2 chronic conditions or poorer subjective health, or those who had had ≥2 outpatient visits in the preceding year were more likely to find this choice very important. CONCLUSIONS: In 2007, almost half of all Swiss residents found it very important to be able to choose his/her specialist physician. The further development of physician networks or other chronic disease management initiatives in Switzerland, towards integrated care, need to pay attention to the freedom of choice of specialist physicians that Swiss residents value. Future surveys should provide information on access and consultations with specialist physicians.

Mate choice evolution, dominance effects, and the maintenance of genetic variation.

Female mate choice influences the maintenance of genetic variation by altering the mating success of males with different genotypes. The evolution of preferences themselves, on the other hand, depends on genetic variation present in the population. Few models have tracked this feedback between a choice gene and its effects on genetic variation, in particular when genes that determine offspring viability and attractiveness have dominance effects. Here we build a population genetic model that allows comparing the evolution of various choice rules in a single framework. We first consider preferences for good genes and show that focused preferences for homozygotes evolve more easily than broad preferences, which allow heterozygous males high mating success too. This occurs despite better maintenance of genetic diversity in the latter scenario, and we discuss why empirical findings of superior mating success of heterozygous males consequently do not immediately lead to a better understanding of the lek paradox. Our results thus suggest that the mechanisms that help maintain genetic diversity also have a flipside of making female choice an inaccurate means of producing the desired kind of offspring. We then consider preferences for heterozygosity per se, and show that these evolve only under very special conditions. Choice for compatible genotypes can evolve but its selective advantage diminishes quickly due to frequency-dependent selection. Finally, we show that our model reproduces earlier results on selfing, when the female choice strategy produces assortative mating. Overall, our model indicates that various forms of heterozygote-favouring (or variable) female choice pose a problem for the theory of sexual ornamentation based on indirect benefits, rather than a solution.

Good genes drive female choice for mating partners in the lek-breeding European treefrog.

Investigating the mechanisms underlying female mate choice is important for sexual-selection theory, but also for population-genetic studies, because distinctive breeding strategies affect differently the dynamics of gene diversity within populations. Using field-monitoring, genetic-assignment, and laboratory-rearing methods, we investigated chorus attendance, mating success and offspring fitness in a population of lek-breeding tree-frogs (Hyla arborea) to test whether female choice is driven by good genes or complementary genes. Chorus attendance explained approximately 50% of the variance in male mating success, but did not correlate with offspring fitness. By contrast, offspring body mass and growth rate correlated with male attractiveness, measured as the number of matings obtained per night of calling. Genetic similarity between mating partners did not depart from random, and did not affect offspring fitness. We conclude that females are able to choose good partners under natural settings and obtain benefits from the good genes, rather than compatible genes, their offspring inherit. This heritability of fitness is likely to reduce effective population sizes below values previously estimated.

Subjective health assessments and active labor market participation of older men: evidence from a semiparametric binary choice model with nonadditive correlated individual-specific effects

We use panel data from the U. S. Health and Retirement Study, 1992-2002, to estimate the effect of self-assessed health limitations on the active labor market participation of older men. Self-assessments of health are likely to be endogenous to labor supply due to justification bias and individual-specific heterogeneity in subjective evaluations. We address both concerns. We propose a semiparametric binary choice procedure that incorporates nonadditive correlated individual-specific effects. Our estimation strategy identifies and estimates the average partial effects of health and functioning on labor market participation. The results indicate that poor health plays a major role in labor market exit decisions.

Patients' and physicians' preferences for type 2 diabetes mellitus treatments in Spain and Portugal: a discrete choice experiment.

OBJECTIVE To assess Spanish and Portuguese patients' and physicians' preferences regarding type 2 diabetes mellitus (T2DM) treatments and the monthly willingness to pay (WTP) to gain benefits or avoid side effects. METHODS An observational, multicenter, exploratory study focused on routine clinical practice in Spain and Portugal. Physicians were recruited from multiple hospitals and outpatient clinics, while patients were recruited from eleven centers operating in the public health care system in different autonomous communities in Spain and Portugal. Preferences were measured via a discrete choice experiment by rating multiple T2DM medication attributes. Data were analyzed using the conditional logit model. RESULTS Three-hundred and thirty (n=330) patients (49.7% female; mean age 62.4 [SD: 10.3] years, mean T2DM duration 13.9 [8.2] years, mean body mass index 32.5 [6.8] kg/m(2), 41.8% received oral + injected medication, 40.3% received oral, and 17.6% injected treatments) and 221 physicians from Spain and Portugal (62% female; mean age 41.9 [SD: 10.5] years, 33.5% endocrinologists, 66.5% primary-care doctors) participated. Patients valued avoiding a gain in bodyweight of 3 kg/6 months (WTP: €68.14 [95% confidence interval: 54.55-85.08]) the most, followed by avoiding one hypoglycemic event/month (WTP: €54.80 [23.29-82.26]). Physicians valued avoiding one hypoglycemia/week (WTP: €287.18 [95% confidence interval: 160.31-1,387.21]) the most, followed by avoiding a 3 kg/6 months gain in bodyweight and decreasing cardiovascular risk (WTP: €166.87 [88.63-843.09] and €154.30 [98.13-434.19], respectively). Physicians and patients were willing to pay €125.92 (73.30-622.75) and €24.28 (18.41-30.31), respectively, to avoid a 1% increase in glycated hemoglobin, and €143.30 (73.39-543.62) and €42.74 (23.89-61.77) to avoid nausea. CONCLUSION Both patients and physicians in Spain and Portugal are willing to pay for the health benefits associated with improved diabetes treatment, the most important being to avoid hypoglycemia and gaining weight. Decreased cardiovascular risk and weight reduction became the third most valued attributes for physicians and patients, respectively.

Understanding the hierarchy governance choice of some wineries in Brazil - case study of 3 Brazilian wineries

ABSTRACT This study aims to contribute towards understanding the multiple factors, which influence firm's governance decisions. To identify some of these factors, three cases in the Brazilian wine industry were analyzed: Miolo located in Vale dos Vinhedos (South of Brazil) and in Vale do Rio São Francisco (Northeast of Brazil); Don Laurindo located in Vale dos Vinhedos; and ViniBrasil located in Vale do Rio São Francisco. For the most part, all three firms procure the grapes they use for their wine production in-house. Only Miolo purchases an insignificant amount of grapes outside of its production. By Brazilian standards, these regions have a long tradition of grape production and it is not difficult to purchase sufficient quantity of grapes to produce wine. However, the wineries are concerned also about the quality of the grapes they use and purchasing high-quality grapes might be critical issue. On the other hand, the quality of grapes is easily measured and the cost to buy in the market is cheaper than producing in-house. Furthermore, also the level of asset specificity present in the grape-grower-wine-producer transaction seems, by itself, insufficient to justify the use of hierarchical governance forms. Then, the aim of the article is to analyze the reasons why these wineries largely rely on hierarchy governance forms to procure their grape-inputs. What explains their use of hierarchy governance, given that both asset specificity and measurement problems appear to be relatively low?

Information overload, choice deferral, and moderating role of need for cognition: Empirical evidence

ABSTRACT Choice deferral due to information overload is an undesirable result of competitive environments. The neoclassical maximization models predict that choice avoidance will not increase as more information is offered to consumers. The theories developed in the consumer behavior field predict that some properties of the environment may lead to behavioral effects and an increase in choice avoidance due to information overload. Based on stimuli generated experimentally and tested among 1,000 consumers, this empirical research provides evidence for the presence of behavioral effects due to information overload and reveals the different effects of increasing the number of options or the number of attributes. This study also finds that the need for cognition moderates these behavioral effects, and it proposes psychological processes that may trigger the effects observed.