Beneficiary Groups Research Articles

MEANS OF CLASS ACTION LAWSUIT AS AN ALTERNATIVE AND SOLUTION FOR RECOVERING STATE AND COMMUNITY FINANCIAL LOSSES IN CORRUPTION DIRECT CASH ASSISTANCE VILLAGE FUNDS

The purpose of this study was to analyze the means of class action lawsuits that can be used as an alternative to recovering state losses and community losses as direct victims of Village Fund Direct Cash Assistance budget corruption. This type of research is normative legal research, namely looking at law from the point of view of norms which of course is prescriptive, using an analytical descriptive approach, namely describing the position of law as it is now. The legal materials used are primary legal materials, secondary legal materials, and tertiary legal materials obtained through library research, so that deeper analysis and understanding can be carried out so that there is a strengthening of the legal basis to produce good legal analysis. The collected legal materials were then analyzed using qualitative analysis techniques. The results of the study show that the use of class action lawsuits can be used as an alternative to recover state losses and community losses due to acts of corruption in the Village Direct Cash Assistance budget. Class action facilities are far more effective and efficient in efforts to eradicate corruption which do not burden the state budget, compared to enforcing criminal law through the criminal justice system (police, prosecutors, courts, and correctional institutions). In addition, the implementation of the execution of the return of compensation through class action facilities is more accommodative and equivalent because the legal interests of the injured stakeholder, in this case, the State and the people of the Direct Cash Assistance (Bantuan Langsung Tunai/BLT) Fund Beneficiary Group, can both be restored.

Association of BCC Module Roll-Out in SHG meetings with changes in complementary feeding and dietary diversity among children (6-23 months)? Evidence from JEEViKA in Rural Bihar, India.

Child dietary diversity is very low across rural communities in Bihar. Based on the experience of behavior change communication (BCC) module roll out in self-help group (SHG) sessions in rural Bihar, this study aims to assess the impact of the intervention on child dietary diversity levels in the beneficiary groups. The study is based on a pre-post study design whereby child dietary diversity is examined for a sample of 300 children (6-23 months old from 60 village organizations) during both pre-intervention as well as post-intervention phase. The latter consists of two types of group viz. a) children whose mothers were directly exposed to BCC module in SHGs sessions and b) those who were non-participants but may have indirect exposure through spillovers of BCC activities. Econometric analysis including logistic regression as well as propensity score matching techniques are applied for estimating the changes in dietary diversity in the post-intervention phase. During the pre-intervention phase, 19% of the children (6-23 months) had adequate dietary diversity (eating from at least 4 out of 7 different food groups) and this increased to 49% among the exposed group and to 28% among the non-exposed group in the post-intervention phase. The exposed group have an odds ratio of 3.81 (95% CI: 2.03, 7.15) for consuming diverse diet when compared to the pre-intervention group. The propensity score matching analysis finds a 33% average treatment effect on the treated (ATT) for the group participating in BCC sessions at SHG events. BCC roll out among SHG members is an effective mode to increase dietary diversity among infants and young children. The impact on child dietary diversity was significantly higher among mothers directly exposed to BCC modules. The BCC module also improved knowledge and awareness levels on complementary feeding and child dietary diversity.

Coverage Parity And Racial And Ethnic Disparities In Mental Health And Substance Use Care Among Medicare Beneficiaries.

Many older Americans do not receive needed care for mental health and substance use disorders (MHSUD), and there are substantial racial and ethnic disparities in receipt of this care across the lifespan. Medicare introduced cost-sharing parity for outpatient MHSUD care during the period 2010-14, reducing beneficiaries' out-of-pocket share of MHSUD spending from 50percent to 20percent. Among traditional Medicare beneficiaries ages sixty-five and older, we examined changes in MHSUD use and spending during the period 2008-18 for low-income beneficiaries with the cost-sharing reduction versus a control group of beneficiaries with free care throughout the study period among Black, Hispanic, Asian, and American Indian/Alaska Native versus White beneficiaries. Among older Medicare beneficiaries, overall use of MHSUD services increased during this period. For White beneficiaries, MHSUD cost-sharing parity was associated with an increased likelihood of having specialty MHSUD visits and medication use and a reduced likelihood of having unmonitored MHSUD medication use and MHSUD emergency department visits and hospitalizations. However, cost-sharing parity was associated with smaller or no gains in MHSUD services use for racial and ethnic minority beneficiaries compared with White beneficiaries, thus widening racial and ethnic disparities in MHSUD care.

Фільтри при наданні соціальної допомоги працездатному населенню: можливості інституціалізації

The purpose of the article was to study the social protection of the able-bodied population in the context of the systematization of filters when determining the target group of beneficiaries with an outline of the ways of further reforming social protection with the optimization of the filtering process. In the process of researching legal acts that regulate social protection, we discovered the following filters, which are used to screen out applicants and form an address group of aid recipients: insurance case; conditionality of social assistance; financial capacity of a person or a family; a person's participation in the mandatory State social insurance; participation in active employment programs; tying the amount of assistance to social standards and/or the presence of previous uniform contributions to the mandatory State social insurance, taking into account insurance experience and the amount of wages. As a result of the study, debatable aspects were revealed in the formation of the population filtering process from the standpoint of defining the target group of persons. In order to institutionalize the system of social protection of the able-bodied population, the following proposals have been formulated: the assessment of a person's financial capacity should be based on fair social standards; the system of social protection for able-bodied persons should be built by encouraging them to make social contributions, to be a member of the mandatory State social insurance; mandatory participation of able-bodied persons in employment programs to support their competitiveness on the labor market, formation of motivation for social participation in social-labor relations in order to help a person get out of the status of a beneficiary; simplification of procedures and restrictions that hinder the receipt of assistance; in some types of aid, its conditionality should be strengthened to improve the quality of human capital formation; strengthening supervision and application of relevant norms regarding informal employment, in particular through better coordination of actions of relevant government structures; conducting social awareness campaigns regarding the negative consequences of informal employment for social protection.

Public Utility Services in Poland and Belarus

The text deals with the definition of public services and their scope in Belarus and Poland. As a result of the conducted research, it was found that it is difficult to accept one criterion indicating that the given services are public. A permanent criterion of non-payment for the services provided cannot be accepted, as there are public services which are paid for. A wide group of beneficiaries may indicate that it is a service or product of general interest. A comparison of the scope and services of public utility in Belarus and in Poland shows their wider scope present in Belarus. The aim of the study is to investigate: − whether the scope of public utility has evolved in the last thirty years, after the political transformation that took place in Poland and Belarus, − what scope of public utility services is provided by the public administration in Poland and Belarus, − whether services of general interest can be provided by private entrepreneurs in these two States. Conducting the research required the use of a comparative research method aimed at comparing the legal regulations regarding the conduct of activities in the field of public utility in Poland and in Belarus. The historical-legal method was also used to show the evolution of the scope of public utility services through the change of legal regulations.

Subjective scope of the right to compensation for real property left beyond the current borders of the Republic of Poland: Compensation for legal persons?

The right to compensation for real property left beyond the current borders of the Republic of Poland has been granted by virtue of the Act of 8 July 2005 on the Exercise of the Right to Compensation for Property Left Beyond the Current Borders of the Republic of Poland (the so-called “Bug River Act”). The Act fulfils the commitments made by Poland in 1944 in the so-called Republican Pacts, which guaranteed Polish citizens compensation for loss of real property as a result of migrations caused by the change of the Polish eastern border. The solutions adopted in the Act are aimed at definitive settlement of the commitments made several decades ago. One of the issues that has always aroused the most controversy was how to determine the beneficiaries of the right to compensation (previously called the “right to classification”). Despite a rich body of jurisprudence of administrative courts, this issue still remain ambiguous. Questions appear, inter alia, as to whether a legal person is entitled to a compensation. This article is an attempt to present how the lawmaker has approached this group of beneficiaries over the years, whether the right to compensation was granted to legal persons and whether they are entitled to compensation under the currently applicable laws.

Experiences of Applying Electronic School Management in A Number of Countries and the Possibility of Benefiting from Them

The aim of the research is to showcase the experiences of some countries in the application of school electronic management and the possibility of getting benefits from them at the local level. The researcher used the comparative approach by presenting the experiences of some Arab and foreign countries in applying and analyzing electronic studying of school management and how to get benefits from them. The researcher clarified the concept of electronic management, its importance, objectives and motives for its application in schools. The researcher reviewed the experiences of some foreign countries in the application of electronic school management, such as the experience of (the United States of America, Singapore, France) and conducted a comparative analysis between them, as well as the experience of some Arab countries in this field as the experience of (Saudi Arabia, the Emirates, Egypt) and applied a comparative analysis between them. The researcher concluded the following: There is a need for scientific and realistic planning gradually according to the stages of the process of applying electronic school management, the existence of a clear comprehensive strategy that falls under the e-government strategy for the qualitative transition from traditional school management to electronic, the formation of positive trends for individuals and institutions towards technology, training administrative and educational cadres and the beneficiary groups of students and parents for the application of electronic school management, ensuring the involvement of the private sector and local community institutions to invest in the services provided, providing the basic requirements in the application (financial, human, administrative) considering the privacy of the country.

Social Security for Vulnerable Workers in Aceh Province: Lessons from the Covid-19 Pandemic

Conditions for vulnerable workers whose living conditions are uncertain have worsened since the beginning of the COVID-19 pandemic. This study investigates the social assistance programs available to these workers and analyzes the beneficiaries and distribution flow of social assistance during the pandemic in Aceh Province, Indonesia. The data were obtained from agencies in Aceh and vulnerable workers themselves, with a total of 100 respondents. A descriptive qualitative method is used in this study. From the results of the field survey, the distribution of [what does JPS stand for?] (JPS) assistance in Aceh was carried out in the form of non-cash assistance that meets basic needs in 2020, and then in 2021 the distribution of JPS Covid-19 assistance was cash transferred directly by the Aceh Provincial Office to beneficiaries, through a cooperating bank account. There was no change in the expenditures of the beneficiary group (which in this case was vulnerable workers) during the pandemic, but there was a change in income.

Systematic Review of Inclusive Musical Practices in Non-Formal Educational Contexts

Inclusive musical practices for social transformation and inclusion have been developed since the end of the 20th century. These experiences promote equality and social justice. The objective of this work is to classify and describe the scientific production around inclusive musical practices in non-formal education contexts. A systematic review based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was developed between December 2021 and January 2022. The review finally included 36 studies, extracted from the databases: SCOPUS, ERIC and WOS. The inclusion and exclusion criteria were limited by language (English and Spanish) and type of scientific production (peer-reviewed articles and book chapters) without limiting the years of publication. The data extraction was carried out based on the following categories: beneficiary group, type of experience, country or geographical area of impact, group or musical gender with which it works, age or ages of the group. The growing interest of society towards these practices in the last five years is confirmed. It is also identified that the two most studied population groups are people with disabilities and at risk of exclusion.

Cultural cognition, effective communication, and security: Insights from intercultural trainings for law enforcement officers in Poland

AbstractEconomic migration, international mobility and refugee crises have brought about both risks and opportunities. Alongside the socio-economic and cultural potential to capitalize on they have generated challenges that need to be addressed. In such an increasingly globalized and diverse world, intercultural competences have become strategic resources underpinning the concept of democratic citizenship and social integration. The objectives of the present article are thus two-fold: firstly we want to explore the concept of cultural cognition and highlight the importance of intercultural and diversity awareness, and, secondly, we intend to present and discuss the results of intercultural training sessions for uniformed services conducted within the “Open Lodz” project (Otwarta Łódź POWR.03.01.00-IP.08-00-3MU/18) (2019-2022) coordinated by the University of Lodz in collaboration with the Marek Edelman Dialogue Center in Łódź, the Municipal Police, the City of Lodz Office and the City Guard in Łódź. The project was aimed at enhancing foreigners’ quality of life and functioning in Poland. With this goal in view project activities, addressed at two groups of beneficiaries, namely foreign nationals and frontline workers (police, city guard officers, and municipal clerks) focused on improving communication skills (linguistic and cultural competences)

The Influences of Various Factors and Interest Demands on Linpan Landscape Evolution in the Chengdu Plain: A Qualitative Study Based on Oral Histories

Traditional rural homegarden agroforestry systems in the Chengdu Plain of China are often referred to as “Linpan” in Chinese, which integrates the landscape of ecological functions and human production activities. In recent years, due to the influences of urbanization and the aging population, the Linpan landscape has changed dramatically. Clarifying the factors which influence Linpan landscape evolution is a critical way to improve rural landscape renovation. Through oral history interviews, the deep-seated factors driving the evolution of the Linpan landscape form from 1949 to 2020 are explored using the grounded theory. The results show that in the process of Linpan landscape evolution, beneficiary groups, the material basis, and cultural characteristics are the prerequisites for changing the Linpan settlement landscape. The demand of production and life and government-led behavior are the two main influencing factors, and landscape change is the final result. The demand of production and life from the residents is the primary internal driving force of landscape change, while government-led behavior is the main external driving force of settlement development and evolution. The nature of the main driving forces behind the evolution of the Linpan landscape in the Chengdu Plain can be divided into three stages. (1) From 1949 to 1980, it was characterized as a balancing of government forces and social forces. (2) From 1981 to 1993, it was characterized by social forces suppressing government forces. (3) From 1994 to 2020, it was characterized as a stalemate between the government and social forces. From the perspective of the evolution of the Linpan settlement landscape, the traditional Linpan form and settlement layout have been unable to meet the new requirements of the rural social and economic transition period. They are facing the challenges of rural reconstruction and rural revitalization. In the future, village and town planning and the design of new settlements need to comprehensively consider the demands of different interest groups.

Evaluation and Effectiveness of River Training Works with Special Focus on Tinau River in Rupandehi District of Nepal

Flood in Tinau River is very common since past decades. It has damaged several houses, cultivated land and live stocks in the past and continues till the date. Hundreds of hectares of cultivated lands have been deposited with sand and debris making the land unsuitable for farming. The governments of Nepal and local bodies have been launching projects for flood control. Various types of structures were built in the past. Millions of Nepalese Rupees have been invested for river training works. However, the river training works is not functioning well. This study was conducted during the period from March 2019 to April 2020. The objective of this study is to evaluation the effectiveness of river training works with especial focus on Tinau River in Rupandehi district of Nepal. Field observation, in-depth interview, focus group discussion and questionnaire survey were the major tools used for the field investigation. The study found that the extraction of river bed materials and unmanaged catchment area are also the causes of the ineffectiveness of the river training works. It also includes lack of monitoring and supervision, socio-political pressure and lack of enforcement of law and policies. Similarly, some other causes are inadequate co-ordination between line agencies, inadequate plan and policies and lack of awareness are the minor causes of ineffective river training works. Furthermore, inadequate maintenance of built up structures, irresponsible of beneficiary group, unmanaged population growth at catchment area were also found causes behind sustainability of the river training works. The study would like to suggest that the river bed extraction should be conducted in a balanced way. And, hydrological, geological and geotechnical studies should be conducted in detail before design of the river training structures.

A CONCEPTUAL FRAMEWORK FOR DIGITAL LIBRARY AND THAT APPLY TO THE ENGINEERING EDUCATION AT HIGHER LEARNING INSTITUTION

This study aims to take a theoretical look at the arena of digital libraries. To that end, it is necessary to investigate the requirements of a digital library to establish in the departments of higher learning institutions in Bangladesh. Similarly, this study looks at the level of necessity, especially in engineering programs such as Civil Engineering, from an economic perspective. This is a precautious measure during an emergency period (state of affairs in-country) and contributes to the Sustainable Teaching and Learning (STL) in higher learning institutions for effectiveness and efficiency in developing human skill resources. For this study, a digital library for Civil Engineering is proposed to develop at the higher learning institution. The outcome of this study may apply to the discipline of Civil Engineering at International Islamic University Chittagong (IIUC) as a pilot program and then focus on diversified areas such as structure, materials, and construction; transportation; geotechnical; environment; and water resources. There are several exceptional features of the digital library. This library will address specific learning and content needs for several different beneficiary groups; the collections will exploit contemporary multimedia techniques to encourage active online STL library collections, which will focus on learning outcomes for lifelong groups. As an integral part of the digital library, a hosting portal is needed to develop to provide easy access to the collections in highlighted diversified areas.

Which indicator should be used? A comparison between the incidence and intensity of catastrophic health expenditure: using difference-in-difference analysis

BackgroundCatastrophic health expenditure (CHE) represents out-of-pocket payment as a share of household income. Most previous studies have focused on incidence aspects when assessing health policy effects. However, because CHE incidence is a binary variable, the effect of the health policy could not accurately be evaluated. On the contrary, the intensity of CHE is a continuous variable that can yield completely different results from previous studies. This study reassesses the coverage expansion plan for four serious diseases using the intensity of CHE in Korea.MethodsWe used the Korea Health Panel Study from 2013 to 2015 to conduct the analysis. The study population is households with chronic diseases patients. We divided the population into two groups: the policy beneficiary group, i.e., households with a patient of any of the four serious diseases, and the non-beneficiary group. A difference-in-difference model was employed to compare the variation in the intensity and incidence of CHE between the two groups. We defined the incidence of CHE as when the ratio of out-of-pocket medical expenses to household income is more than a threshold of 10%, and the intensity of CHE is the height of the ratio subtracting the threshold 10%.ResultsThe increased rate of CHE intensity in households with four serious diseases was lower than that in households with other chronic diseases. The interaction term, which represents the effect of the policy, has a significant impact on the intensity but not on the incidence of CHE.ConclusionsCHE indicators should be applied differently according to the purpose of policy evaluation. The incidence of CHE should be used as the final achievement indicator, and the intensity of CHE should be used as the process indicator. Furthermore, because CHE has an inherent characteristic that is measured by the ratio of household income to medical expenses, to lower this, a differential out-of-pocket maximum policy for each income class is more appropriate than a policy for strengthening the coverage for specific diseases.

A Sick Benefit Scheme Reduces Unmet Healthcare Needs: An Natural Experiment in Seoul

Abstract South Korea experiences four times more unmet healthcare needs than OECD countries (11.6% and 2.6% respectively). Unmet healthcare needs are caused by the double burden of direct and indirect costs including income loss, and OECD countries operate a sickness benefit scheme to resolve sudden loss of pay. Seoul introduced the first sickness benefit system, Seoul-Type Paid Sick Leave Support (hereinafter Seoul Sick Leave), for self-employed national healthcare insurance subscribers to reduce the rate of unmet healthcare needs. By comparing the amount of increasing medical expenses between the beneficiary and non-beneficiary before (2018) and after (2019-2020) the introduction of the system, the study was intended to confirm the reduced unmet healthcare needs. This study used data from the National Health Information Database (NHID) and the difference in differences (DID) analytic framework. 96 and 121 patients were included in benefit and non-benefit cohorts, respectively. As a result, the beneficiary group’s expenses were smaller than those of the non-beneficiary group (coef.=-1.24, p = 0.026). However, the beneficiary group had a greater amount of increase in hospitalization expenses before and after the introduction than the non-beneficiary group did (coef.=1.66, p = 0.005). Our finding showed that the Seoul Sick Leave helped the precarious workers as they were able to use inpatient services when they needed. If it is to be scaled up to the national level, it should be applied all people to enhance universal health insurance in Korea. Key messages • Identified the effectiveness of the first sickness benefit system as it helped the precarious workers as they were able to use inpatient services when they needed. • By financially supporting them, the Seoul Sick Leave support can achieve health promotion through early detection and treatment.

Rare disease curative care expenditure-financing scheme-health provider–beneficiary group analysis: an empirical study in Sichuan Province, China

BackgroundRare diseases impose a heavy economic burden on patients’ families and society worldwide. This study used the samples from Sichuan Province in China to estimate the curative care expenditure (CCE) of ten rare diseases, for supporting the prioritization of rare disease health policies.MethodsMulti-stage cluster sampling method was adopted to investigate 9714 rare disease patients from 1556 medical institutions in Sichuan Province. Based on the System of Health Accounts 2011, this study estimated the total CCE of 10 rare diseases, financing schemes, and their allocation among different medical institutions and groups of people.ResultsIn 2018, the total CCE of the ten rare diseases was $19.00 million, the three costliest rare diseases were Hemophilia ($4.38 million), Young-onset Parkinson’s disease ($2.96 million), and Systemic Sclerosis ($2.45 million). Household out-of-pocket expenditure (86.00% for outpatients, 41.60% for inpatients) and social health insurance (7.85% for outpatients; 39.58% for inpatients) were the main sources of financing CCE. The out-of-pocket expenditures for patients with Young-onset Parkinson’s disease, Congenital Scoliosis, and Autoimmune Encephalitis accounted for more than 60% of the total CCE. More than 80% of the rare disease CCE was incurred in general hospitals. The 40–59 age group accounted for the highest CCE (38.70%) while men spent slightly more (55.37%) than women (44.64%).ConclusionsAs rare disease treatment is costly and household out-of-pocket expenditure is high, we suggest taking steps to include rare disease drugs in the National Reimbursement Drug List and scientifically re-design insurance coverage. It is also necessary to explore a multi-tiered healthcare security system to pay for the CCE of rare diseases and reduce the economic burden on patients.

Micro-financial institutions and processes of women empowerment in Zambia

This study explores microfinancial institutions (MFIs) and processes that shape (dis)empowerment among women operating in informal business settings in Zambia, drawing from a schema that integrates multi-dimensional, multi-level, and dynamic understandings of livelihoods specifically how MFIs shape prospects of ‘stepping-up,’ ‘stepping-out,’ or ‘hanging-out.’ We used questionnaires group discussions, and multi-level interviews to draw lessons from women linked to the main branch of Vision Fund Zambia. We explored policy and institutional processes shaping micro-finance, processes of inclusion or exclusion, and implications for livelihood pathways as indicators of empowerment. Results show MFIs enhance social networks and connections between and among women beneficiaries, facilitating cooperation, access to additional finance, exchange of information, and innovation among group members (stepping up). Access to financial capital (loans) improved livelihood activities, permitting investments into immediate business activities as well as wider investments into agriculture (stepping out) but these remain minimal and unsustainable. Meanwhile, we find a general lack of business knowledge and financial management skills among beneficiaries, limiting the extent to which access to finance can lead to sustained transformative changes across beneficiary groups. Whereas coordination mechanisms and processes of inclusion and exclusion processes exist, policy and institutional processes themselves remain vague about micro-level processes for accessing finance and empowerment. As a result, most beneficiaries were merely hanging in, trapped in the financial arrangement and debt. An argument is made that rather than frame empowerment of marginalized groups as apolitical, and primarily within financial capital lens – which we acknowledge remains important – MFIs should consider multi-dimensional elements that altogether shape effective forms of livelihoods and women empowerment.

Annual health care costs among Medicare Beneficiaries with essential tremor

IntroductionEssential tremor (ET) is one of the most common neurological disorders, affecting an estimated 2.2% of the entire US population. Despite its high prevalence and associated morbidity and mortality, there are no published data on the medical costs associated with ET care. MethodsThis is a retrospective secondary data analysis using the 5% Medicare claims data from 2016 to study age-eligible Medicare beneficiaries diagnosed with ET (diagnostic code G250) relative to a propensity score-matched group of comparison beneficiaries without ET (27,081 in each arm). Comparisons were matched within age strata and on the full set of Charlson comorbidity indicators, race, and sex. We examined encounter-level costs (amounts paid) and total annual costs of care (in constant $2021 dollars) adjusting for age, sex, race/ethnicity, provider specialty, setting, and the most common comorbidities, using a generalized linear model. ResultsThe final sample included 54,162 total beneficiaries, with an average age of 75, 65% female and 94% Non-Hispanic White. On average, Medicare beneficiaries with at least one outpatient or physician office visit with an ET diagnosis have $1068 (95% CI: $981, $1154) in additional direct medical care expenditures per year relative to statistically similar comparison beneficiaries of the same age. Across the population, we predicted aggregated additional spending attributable to ET among Medicare beneficiaries between $1.5 billion and $5.4 billion per year. ConclusionThe estimated direct medical costs among Medicare beneficiaries with an ET diagnosis aggregated to the population-level are non-trivial. These data begin to fill a gap in knowledge.

CLL-410 Adherence and Discontinuation Among Medicare Beneficiaries Initiating Venetoclax versus BTKis for Relapsed/Refractory Chronic Lymphocytic Leukemia

Compelling clinical trial data for BCL2 (i.e., venetoclax) and BTK inhibitors (BTKis) have led to a paradigm shift in chronic lymphocytic leukemia (CLL) treatment. However, contemporary real-world studies evaluating venetoclax and BTKis remain limited, with real-world adherence and discontinuation in patients treated with venetoclax versus BTKis uncertain. To compare real-world venetoclax versus BTKis treatment patterns in older adults with relapsed/refractory (R/R) CLL. We performed a retrospective claims-based study using 2015-2019 100% Medicare Parts A/B/D, identifying fee-for-service Medicare beneficiaries aged ≥66 years newly initiating venetoclax between 1/1/2016 and 12/31/2018. From the remaining individuals during the same period, we also identified patients newly initiating a BTKi. Treatment outcomes in the 12-month post-index period included adherence (proportion of days covered [PDC] ≥0.80) and discontinuation (evidence of a 90-day consecutive gap in treatment [sensitivity analyses: 60- and 120-day gaps]). Logistic regressions controlling for differences in sociodemographic and clinical characteristics between the two study groups were used to estimate adjusted outcomes. We identified 711 and 1,566 mutually exclusive groups of beneficiaries initiating venetoclax and BTKi, respectively. Compared to BTKi initiators, those initiating venetoclax tended to be slightly younger (mean age 75.6 [SD 6.0] vs. 77.6 [SD 6.9] years, P<0.001) but had poorer clinical characteristics (for example, 39.4% vs. 30.4% with ≥8 comorbidities [P<0.001] and 51.5% vs. 42.5% with any hospitalization in the 12-months pre-index [P<0.001]). Beneficiaries initiating venetoclax had a higher unadjusted rate of adherence (57.9% vs. 47.3%, P<0.001) and a lower unadjusted rate of discontinuation at 12 months compared to BTKi (32.8% vs. 45.1%, P<0.001). Sensitivity analyses using a 60- and 120-day gap showed similar results. After risk adjustment, the venetoclax group had even higher adherence (61.9% vs. 45.4%, P<.0001) and lower discontinuation when compared to the BTKi group (28.5% vs. 47.4%, P<0.001). In this large, real-world study utilizing national Medicare data, older heavily pre-treated adults with R/R CLL initiating venetoclax had higher rates of adherence and lower rates of discontinuation relative to those initiating BTKis, despite poorer clinical characteristics. These favorable real-world venetoclax results are encouraging and support the goal of developing well-tolerated novel combinations for older adults.

Making Nutritious Diets More Affordable: Findings from a Cost of Diet Assessment in West Singhbhum, Jharkhand, India

Background: India bears a disproportionate burden of undernutrition. Access to an affordable, nutritious diet is one of the critical challenges. There is a need to assess the cost of a nutritious diet and find ways to understand and minimise the affordability gap through a comprehensive approach.&#x0D; Objective: The present study was conducted in the West Singhbhum district of Jharkhand, India. Its objective was to find out the cost of various diets, and their affordability, based on households’ accounting for their total food expenditure, and assessing the coverage of essential governments’ nutrition-specific interventions to use a model for suggesting ways to minimise the affordability gap. We also estimate the potential impact of nutrition-sensitive programmes on household food affordability.&#x0D; Methodology: The study employed the Cost of the Diet (CotD) methodology, a mixed-method, cross-sectional assessment, where the research team conducted surveys in 16 markets, 12 focus group discussions (FGDs) and 96 individual interviews (IDIs). Additionally, 434 household-level surveys were conducted to understand income, expenditure patterns in the localities and uptake of key nutrition-sensitive interventions. Secondary information from the 68th round of the National Sample Survey 2012 were used to assess rural Jharkhand’s non-food expenditure (NFE). Data were analysed primarily using the Save the Children’s Cost of the Diet software version 2.5.2.&#x0D; Results: The cost of the diet increased with an increase in the diet quality – from a basic energy-only diet costing INR 33,892 ($505.85)[1] per year for a standard household with 6 members to a food-habit nutritious diet (FHAB) costing INR 70,627 ($1054.13) per year. More than half of the sampled households could not afford a nutritious diet. The poorest quartile was spending 56.8% of income on food, compared to 33.7% for the richest quintile.&#x0D; Conclusion: The cost of a FHAB diet should be used as a benchmark to track the progress of beneficiary groups in upcoming socio-economic assessments. Changes in the affordability gap should be observed to assess whether new initiatives have worked. Optimal coverage of existing nutrition-specific and nutrition-sensitive programmes has the potential to reduce the cost of a FHAB nutritious diet by up to 30%.&#x0D; [1] $1=INR 67 (The exchange rate at the time of data collection, December 2019)