Natural Experimental Design Research Articles

THE IMPACT OF EARTHQUAKE ON CHILD TEST SCORE

Natural disasters always affect different aspects of individual life. They affect almost every part of life, such as the emotional, economic, physical, social, and environmental aspects. Children are believed to be very vulnerable to disasters. The increasing frequency of disasters and the intensity of their destruction motivate an analysis of the impacts of disasters, especially on education, for children. This paper uses a micro level survey data set from the Indonesian Family Life Survey (IFLS) which covers approximately 83% of the Indonesian population within the survey area. The main objective of this paper is to examine the effects of earthquakes on students’ performance, measured by their child test scores. This type of disaster was chosen because of its intensity, as measured by the percentage of people killed, and the percentage of people evacuated. Moreover, we also investigate the children who took the test immediately after the earthquake and compare their scores with those whose tests were a year after the earthquake. Arguably an earthquake is an exogenous event, so we use the exogenous variation of earthquake as a natural experiment design to estimate the effect of earthquakes on child test scores. A Difference in Difference model (DiD) can be used for estimating if a certain group is exposed to the causal variable of interest, such as an earthquake, and other groups are not. The results confirm that child test scores are significantly affected by earthquakes.

The short-term impact of the alcohol act on alcohol-related deaths and hospital admissions in Scotland: a natural experiment.

Background and aimThe introduction of the Alcohol Act in Scotland on 1 October 2011, which included a ban on multi‐buy promotions, was probably associated with a fall in off‐trade alcohol sales in the year after its implementation. The aim of this study was to test if the same legislation was associated with reduced levels of alcohol‐related deaths and hospital admissions in the 3‐year period after its introduction.DesignA natural experiment design using time–series data to assess the impact of the Alcohol Act legislation in Scotland. Comparisons were made with unexposed populations in the rest of Great Britain.SettingScotland with comparable data obtained for geographical control groups in other parts of Great Britain.ParticipantsFor alcohol‐related deaths, a total of 17 732 in Scotland and 88 001 in England and Wales throughout 169 4‐week periods between January 2001 and December 2013 and for alcohol‐related hospital admissions, a total of 121 314 in Scotland and 696 892 in England throughout 182 4‐week periods between January 2001 and December 2014.MeasurementsDeaths and hospital admissions in Scotland and control groups that were wholly attributable to alcohol for consecutive 4‐week periods between January 2001 and December 2014. Data were obtained by age, sex and area‐based socio‐economic position.FindingsThere was no evidence to suggest that the Alcohol Act was associated with changes in the overall rate of alcohol‐related deaths [incidence rate ratio (IRR) = 0.99, 95% confidence interval (CI) = 0.91–1.07)] or hospital admissions (IRR = 0.98, 95% CI = 0.95–1.02) in Scotland. In control group analyses, the pseudo intervention variable was not associated with a change in alcohol‐related death rates in England/Wales (IRR = 0.99, 95% CI = 0.95–1.02), but was associated with an increase in alcohol‐related hospital admission rates in England (IRR = 1.05, 95% CI = 1.03–1.07). In combined models, the interaction analysis did not provide support for a ‘net effect’ of the legislation on alcohol‐related deaths in Scotland compared with England/Wales (IRR 0.99, 95% CI = 0.95–1.04), but suggested a net reduction in hospital admissions for Scotland compared with England (IRR = 0.93, 95% CI = 0.87–0.98).ConclusionThe implementation of the Alcohol Act in Scotland has not been associated clearly with a reduction in alcohol‐related deaths or hospital admissions in the 3‐year period after it was implemented in October 2011.

Availability of Low-Fat Milk and Produce in Small and Mid-Sized Grocery Stores After 2014 WIC Final Rule Changes, Tennessee.

IntroductionThe 2007 Interim Rule mandated changes to food packages in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) for implementation by 2009. The 2014 Final Rule required additional changes, including increasing the cash value voucher for fruits and vegetables from $6 to $8 for children by June 2014, and allowing only low-fat (1%) or nonfat milk for mothers and children aged 2 to 4 years by October 2014. This study evaluated the effect of the 2014 Final Rule changes on the food environment of small and mid-sized WIC-authorized grocery stores.MethodsWe analyzed secondary data using a natural experimental design to compare the percentage of shelf space for low-fat and nonfat milk and the number of fresh fruit and vegetable varieties in stock before and after the changes. We collected observational data on 18 small and mid-sized WIC-authorized grocery stores in Nashville, Tennessee, using the Nutrition Environment Measures in Store tool in March 2014 and February 2016.ResultsThe mean percentage of shelf space occupied by low-fat and nonfat milk increased from 2.5% to 14.4% (P = .003), primarily because of an increase in the proportion of low-fat milk (P = .001). The mean number of fresh fruit and vegetable varieties increased from 24.3 to 27.7 (P = .01), with a significant increase for vegetables (P = .008) but not fruit.ConclusionAvailability of low-fat milk and variety of fresh vegetables increased after the Final Rule changes in the observed stores. Future research should examine outcomes in other cities.

The intervention effect of local alcohol licensing policies on hospital admission and crime: a natural experiment using a novel Bayesian synthetictime-series method

BackgroundControl of alcohol licensing at local government level is a key component of alcohol policy in England. There is, however, only weak evidence of any public health improvement. We used...

The role of religious norms, trust, importance of attributes and information sources in the relationship between religiosity and selection of the Islamic bank

PurposeThis paper aims to examine the assumption used in previous studies that all Muslims adopt and believe the same law on the prohibition of bank interest and to investigate the indirect effect of religiosity on customers’ decision for using Islamic banking services.Design/methodology/approachThis study uses an exploratory approach and the natural experimental design with seemingly causal models. A total of 363 questionnaires were distributed to three groups of bank customers, i.e. Islamic banks customers, conventional banks customers and customers of both banks (121 respondents in each group).FindingsThe results show that the role of religiosity in the customers’ decision for using the Islamic banking services depends on religious norms variable. Religiosity affects the decision of customers in the traditional group, but it does not have any effect for the contemporary group. Other findings suggest that religiosity indirectly affects the decision for using the Islamic banks through intervening variables of trust and information source.Originality/valueThis is the first paper to investigate the relationship between religiosity and customers’ decision for using the Islamic banking services by considering the religious norm variable. This paper also examines indirect affects of religiosity to the Islamic banks’ choice through intervening variables of trust and information source.

Anxiety and depression are associated with long-term outcomes of hepatocellular carcinoma: A nationwide study of a cohort from Taiwan

Objectives: A natural experimental design was coupled with propensity score matching to assess the risks of anxiety and depression and to assess the longitudinal effects of anxiety and depression on healthcare utilisation and mortality in hepatocellular carcinoma (HCC) patients.Methods: This nationwide population-based cohort study retrospectively analysed 7304 patients treated for HCC during 1996–2010. Generalised estimating equations were used to estimate differences-in-differences models for examining the effects of anxiety and depression disorders.Results: Independent risk factors for anxiety and depression in the HCC patients were female gender (hazard ratio (HR) 1.45; P < 0.001), Charlson co-morbidity index score (HR 1.12; P = 0.005), and liver cirrhosis (HR 1.35; P = 0.004). Anxiety and depression (differences-in-differences value) had a significant (P < 0.001) positive net effect on number of physician visits. Furthermore, the mean overall survival time was 83.4 months (SD 5.4 months) in the anxiety/depression group and 65.4 months (SD 4.8 months) in the non-disorder group. Additionally, the overall survival rate was significantly higher in the anxiety/depression group compared to the non-disorder group during the study period (P = 0.003).Conclusions: Anxiety disorders and depression disorders are associated with a significantly increased overall survival rate in HCC patients. However, further studies are needed to investigate this association.

A natural experimental study of the protective effect of home ownership on household food insecurity in Canada before and after a recession (2008-2009).

Home ownership as opposed to renting is associated with lower rates of food insecurity, the latter being a marker of household economic deprivation associated with adverse health outcomes. It is unclear whether this relationship persists during a major economic decline, or whether different subgroups of home owners are equally protected. The 2008-2009 recession in Canada was tied to events in the United States related to inappropriate mortgage financing; the impact of the recession on food insecurity among home owners may identify policies to mitigate recessionary outcomes. We used a before-and-after natural experimental design using data from the Canadian Community Health Survey (CCHS) cycles 2007/2008 (pre-recession) and 2009/2010 (post-recession) with information on household food insecurity, home ownership versus renting, and socio-demographics. Applying multivariable logistic regression, we examined changes in household food insecurity by housing tenure and sex over the period. Pre-recession, food insecurity affected 3.3% of home owners and 17.1% of renter households. Among home owners, the risk of food insecurity increased post-recession by 10%, which was not statistically significant. Post-recession, and with adjustment, although renters' higher absolute risk of food insecurity persisted, male-respondent home owners experienced the highest rate of increase in food insecurity prevalence by subgroup (OR = 1.26, 95% CI: 1.06-1.50) versus renters (OR = 1.17, 95% CI: 1.05-1.29). Housing policies in Canada protected most home owners from precarity during the 2008-2009 economic recession; however, male-respondent home owners exhibited a unique economic vulnerability during this time. Implications of Canadian home ownership policies are discussed in light of differential vulnerability of home owner groups.

Naturalistic Experimental Designs as Tools for Understanding the Role of Genes and the Environment in Prevention Research.

Before genetic approaches were applied in experimental studies with human populations, they were used by animal and plant breeders to observe, and experimentally manipulate, the role of genes and environment on specific phenotypic or behavioral outcomes. For obvious ethical reasons, the same level of experimental control is not possible in human populations. Nonetheless, there are natural experimental designs in human populations that can serve as logical extensions of the rigorous quantitative genetic experimental designs used by animal and plant researchers. Applying concepts such as cross-fostering and common garden rearing approaches from the life science discipline, we describe human designs that can serve as naturalistic proxies for the controlled quantitative genetic experiments facilitated in life sciences research. We present the prevention relevance of three such human designs: (1) children adopted at birth by parents to whom they are not genetically related (common garden approach); (2) sibling designs where one sibling is reared from birth with unrelated adoptive parents and the other sibling is reared from birth by the biological mother of the sibling pair (cross-fostering approach); and (3) in vitro fertilization designs, including egg donation, sperm donation, embryo donation, and surrogacy (prenatal cross-fostering approach). Each of these designs allows for differentiation of the effects of the prenatal and/or postnatal rearing environment from effects of genes shared between parent and child in naturalistic ways that can inform prevention efforts. Example findings from each design type are provided and conclusions drawn about the relevance of naturalistic genetic designs to prevention science.

The effects of a three-year integrated Olympic education programme on adolescents’ prosocial behaviours

The concept of Olympic education and its use of moral education to shape the development of personality have received insufficient empirical support. The aim of this study was to examine the effects of an integrated Olympic education programme on the development of prosocial behaviour in adolescents. A natural experimental research design was applied in this study. The pre-test sample included 411 adolescents (aged 13–14) who were randomly selected from schools that had begun to apply an integrated Olympic education programme, along with 430 adolescents from schools without an Olympic education programme. The post-test sample included 381 students from schools implementing the Olympic education programme and 402 students from schools without an Olympic education programme. The revised prosocial tendencies measure was administered to the participants at pre- and post-test time points to assess changes in prosocial behaviour and specifically on six types of prosocial behaviour: public, anonymous, dire, emotional, compliant, and altruistic. The analyses showed significant improvements in prosocial behaviour in adolescents from schools that had implemented an integrated Olympic education programme. Changes in prosocial behaviour following the implementation of an integrated Olympic education programme were observed for the compliant, altruistic, and dire types of prosocial behaviour. In conclusion, these findings suggest that an integrated Olympic education programme effectively encourages prosocial behaviour in adolescents. This study expands our understanding of the efficiency of implementing an Olympic education programme in schools. We suggest that future research should investigate the behavioural changes in students of different ages from perspective of both teachers and students.

Reeves et al. Respond to "Harnessing Housing Natural Experiments".

We appreciate the interest our study (1), which took advantage of a natural experiment design to better ascertain causality than conventional observational studies could, has generated. In their accompanying commentary, Bentley et al. (2) suggest that misclassification of depression symptoms (e.g., someone with depression reporting that they are not depressed) may explain our findings if misclassification rates changed due to the reduction in the Local Housing Allowance, one component of the United Kingdom's Housing Benefit (HB) for people in the private rental sector. Misclassification can bias estimated effects in 2 ways. First, if misclassification is nondifferential over time, it will dilute associations, tending to underestimate effect sizes. This is likely to result from measurement error. Second, differential misclassification can impact the direction of findings. This can occur, for example, if the reduction in the HB itself leads to changes in how people report symptoms of depression. This is what Bentley et al. suggest may have happened and generated a spurious correlation. Is there evidence to suggest that HB reductions affected how people reported depression in the Annual Population Survey? We do not find any. It also seems highly unlikely. The main reason is that, according to one evaluation (3), 85% of those affected by the policy were unaware that they had lost income due to the reduction in the HB. Moreover, 75% of this same sample did not know how the HB was calculated (3). It is possible that the remaining 15% changed how they responded, but it is difficult to imagine why people would change the way they responded to 1 specific survey question because of this administrative change in how the HB is calculated. Nevertheless, to address this possibility, we further investigated whether changes occurred in people's responses about other subjectively assessed health problems, which could similarly have had misclassification bias but which would not plausibly have been affected by the HB reform. These health outcomes therefore served as “falsification tests” for the possibility of misclassification. The self-reported measures were “chest or breathing problems, asthma, bronchitis”; “severe disfigurement, skin conditions, allergies”; and “other health problems or disabilities” (see our Web Appendix (1), available at http://aje.oxfordjournals.org/). Each is ambiguous, open to subjective interpretation, and therefore possibly also subject to time-varying misclassification; but unlike mental health, none of these are associated with HB reform (Table 1). If the reduction in the HB changed how people responded to surveys about self-reported health problems, then it only affected this single response (depression) to this 1 question (health). Our finding seems much more likely to have been a real mental health effect. Table 1. Estimates of the Difference in Difference for Various Subjective Measures of Health Among Private Renters in the United Kingdom (Matching Model) Between April 2009 and March 2013a Of course, as Bentley et al. note (2), even a strong natural experiment design cannot rule out potential misclassification bias. We agree. Yet, our evidence consistently suggests that any such bias is likely to have been nondifferential with respect to our hypothesis, leading to conservative estimates of the causal effect. Time-varying differential misclassification is always possible, but in this instance it is highly unlikely.

Federal Civil Litigation as an Instrument of Police Reform: A Natural Experiment Exploring the Effects of the Floyd Ruling on Stop-And-Frisk Activities in New York City

Stop-and-frisk has emerged as a popular crime control tactic in American policing. Though stop-and-frisk has a long, established legal history, the recent experiences in many jurisdictions demonstrate a strong disconnect between principle and practice. Arguably, stop-and-frisk has become the next iteration of a persistent undercurrent in racial injustice in American policing, perhaps best demonstrated by the recent police killings of Eric Garner, Michael Brown, and Freddie Gray — all during stop-and-frisk encounters. Recent events have facilitated a national dialogue on police accountability and police reform, and federal civil litigation has been central to that discussion. Although federal court relief can be pursued through a variety of avenues (most frequently by individuals or class actions under 42 U.S.C. § 1983 or by the U.S. Department of Justice pursuant to 42 U.S.C § 14141), very little research has examined the impact of federal civil litigation on unconstitutional police practices. The current study examines the New York City confluence of racial injustice in policing, misuse of stop-and-frisk by officers, and federal civil litigation designed to precipitate police reform. Authors employ a natural experimental design to conduct a year-to-year comparison of stop-and-frisk activities and outcomes conducted by the NYPD in 2011, during the height of their stop-and-frisk program, and 2014, one year after a federal court deemed the program unconstitutional and ordered reforms. Results show substantial improvement in stop-and-frisk practices following the federal civil litigation, including reduced prevalence and geographic concentration, as well as increased rates of arrest and weapon and contraband seizures. Moreover, crime continued to decline in New York as the NYPD reformed its stop-and-frisk program. Even though racial disparities in those subjected to stops by the NYPD persist, the overall findings show positive progress in New York and highlight the role of federal civil litigation as an instrument of police reform.

Causal Empiricism in Quantitative Research

Quantitative analysis of causal effects in political science has trended toward the adoption of “causal empiricist” approaches. Such approaches place heavy emphasis on causal identification through experimental and natural experimental designs and on characterizing the specific subpopulations for which effects are identified. This trend is eroding the position of traditional regression studies as the prevailing convention for quantitative causal research in political science. This essay clarifies what is at stake. I provide a causal empiricist critique of conventional regression studies, a statement of core pillars of causal empiricism, and a discussion of how causal empiricism and theory interact. I propose that the trend toward causal empiricism should be welcomed by a broad array of political scientists. The trend fits into a broader push to reimagine our discipline in terms of collective research programs with high standards for evidence and a research division of labor.

Early diversion and empowerment policing: evaluating an adult female offender triage project

ABSTRACTThis paper provides an evaluation of a police pilot early-diversion scheme for adult females who were arrested for low-severity offences using a natural experiment design. The intervention is novel in that it diverts arrestees to a women’s centre for assistance to address their criminogenic needs rather than process them through the criminal justice system. The intervention is timely and attractive given its rehabilitative features and its potential for reducing demand on the criminal justice system through community resolution. The study found a promising effect of the intervention on rates of rearrest and daily risk of rearrest over a 12-month follow-up period, but a higher frequency of rearrest among those of the intervention group who were rearrested. The findings are discussed in relation to the political context, theoretical background and police performance and the gendered dynamics of offending.

Benefits of smoking bans on preterm and early-term births: a natural experimental design in Switzerland

BackgroundBirth outcomes are relevant for future children's heath. Capitalising on a natural experimental design in Switzerland, we evaluated how regional smoking bans introduced at different time points affected birth outcomes,...

Effects and Factors Related to Adherence to A Diabetes Pay-for-Performance Program: Analyses of a National Health Insurance Claims Database

ObjectivesTo compare the effects of a diabetes pay-for-performance (P4P) program on diabetes-related/nondiabetes-related healthcare utilization/expenses between participants who adhered to the program and those who did not, and explore factors related to program adherence. DesignA secondary data analysis with a natural experimental design. SettingTaiwan's National Health Insurance claims database (2001–2011) of newly diagnosed patients with diabetes in 2001 was used for the analyses. ParticipantsThe database under analyses contained 119,970 patients who were newly diagnosed with diabetes in 2001. Longitudinal data from 2001 to 2011 were obtained. A sample of 5592 patients who were enrolled in the diabetes P4P program during 2003–2006 was identified. After a 3-year follow-up of the enrolled patients, 2647 (47.3%) of them adhered to the program. To minimize the differences between the characteristics of the patients who adhered to the program and those who did not, propensity score matching was adopted. A total of 5294 patients (adherence: 2647 vs nonadherence: 2647) were included for analyses. MeasurementsWe estimated utilization/expenses of healthcare services for both groups at 6 time points and applied t tests to test each utilization and expense of healthcare services between the 2 groups. A repeated-measures analysis of variance was applied to examine changes in the annual diabetes-related healthcare service expenses and total annual expenses by group. Logistic regression models were used to examine factors related to program adherence. Covariates included participant age, gender, diabetes-related complications, Charlson Comorbidity Index, Continuity of Care Index, time since diagnosis of diabetes, hospitalization in the previous year, and location receiving healthcare services. ResultsTotal annual healthcare expenses spent by the adherence group were significantly lower than those of the nonadherence group. Gender, continuity of care, time since diagnosis of diabetes, hospitalizations in the previous year, and location receiving healthcare services were factors related to program adherence. ConclusionsLong-term, beneficial effects of the diabetes P4P program might have been present if patients had adhered to the program. Interventions and strategies which could improve program adherence and continuity of care are suggested to achieve optimal disease control and clinical outcomes.

HOUSEHOLD EXPENDITURE IN RESPONSE TO NATURAL DISASTERS

Natural disasters have increased in their frequency, and the intensity of their destruction over the last ten years in Indonesia. Households usually respond to these difficulties by cutting their consump-tion, especially for non-essential goods. Arguably natural disasters are exogenous events, so this paper uses the exogenous variation from natural disasters as a natural experiment design to estimate the effect of disasters on household expenditure. When a certain group is exposed to the causal variable of interest, such as a disaster, and other groups are not, the Difference In Difference model (DID) can be used for estimation. Using a micro level survey data set from the Indonesian Family Life Survey (IFLS) which covers approximately 83 percent of the Indonesian population within the survey area, this paper examines the effects of natural disasters on household expenditure. This paper also examines whether there are any different impacts from different types of disasters. The finding is there are no significant effects of disasters on total household expenditure for households living in disaster regions, whether they are affected directly or not by the disaster.Keywords: natural disasters, household expenditure, DID, natural experiment

Impact of offering cycle training in schools upon cycling behaviour: a natural experimental study.

BackgroundEngland’s national cycle training scheme, ‘Bikeability’, aims to give children in England the confidence to cycle more. There is, however, little evidence on the effectiveness of cycle training in achieving this. We therefore examined whether delivering Bikeability was associated with cycling frequency or with independent cycling.MethodsWe conducted a natural experimental study using information on children aged 10–11 years participating in the nationally-representative Millennium Cohort Study. We identified Cohort participants whose schools had offered Bikeability in 2011–2012 using operational Bikeability delivery data (children in London excluded, as delivery data not available). Our natural experimental design capitalised on the fact that Cohort participants were surveyed at different times during 2012 and were also offered Bikeability at different times during 2012. This allowed us to compare cycling levels between children whose schools delivered Bikeability before their survey interview (‘intervention group’, N = 2563) and an otherwise comparable group of children whose schools delivered Bikeability later in the year (‘control group’, N = 773). Parents reported whether their child had completed formal cycle training; their child’s cycling frequency; whether their child ever made local cycling trips without an adult; and other child and family factors. We used Poisson regression with robust standard errors to examine whether cycling behaviour differed between the intervention and control groups.ResultsChildren whose school had offered Bikeability were much more likely to have completed cycle training than the control group (68 % vs. 28 %, p < 0.001). There was, however, no evidence that delivering Bikeability in school was associated with cycling more often (49.0 % cycling at least once per week in the intervention group vs. 49.6 % in the control group; adjusted risk ratio 0.99, 95 % CI 0.89, 1.10). There was likewise no evidence of an association with cycling independently (51.5 % in the intervention group vs. 50.1 % in the control group; adjusted risk ratio 0.97, 95 % CI 0.89, 1.06).ConclusionsOffering high-quality cycle training free at the point of delivery in English schools encourages children to do cycle training, but we found no evidence of short-term effects on cycling frequency or independent cycling. Future evaluation should investigate longer-term effects on these and other stated Bikeability objectives such as increasing cycling safety.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-016-0356-z) contains supplementary material, which is available to authorized users.

The Effects of Election Proximity on Participatory Shirking: The Staggered‐Term Chamber as a Laboratory

This study discusses a downside of electoral pressure. As elections approach, legislators reduce their effort in legislative activities, albeit while increasing their efficiency. To show this, we propose a new, natural experimental design exploiting staggered legislative election calendars to identify the effect of approaching elections. Two‐way natural blocking improves the balance of pretreatments and an instrumental variable approach addresses noncompliance by retirees. Our analysis of the Japanese House of Councillors demonstrates that legislators up for election show up in the chamber less often than those not facing election; however, when they do show up and speak, they tend to speak longer.

The role of trade and investment liberalization in the sugar-sweetened carbonated beverages market: a natural experiment contrasting Vietnam and the Philippines.

BackgroundTrade and investment liberalization may facilitate the spread of sugar-sweetened carbonated beverages (SSCBs), products associated with increased risk factors for obesity, type II diabetes, and cardiovascular diseases (Circulation 121:1356–1364, 2010). Apart from a limited set of comparative cross-national studies, the majority of analyses linking liberalization and the food environment have drawn on case studies and descriptive accounts. The current failure of many countries to reverse the obesity epidemic calls for investigation into both individual and systemic factors, including trade and investment policies.MethodsUsing a natural experimental design we tested whether Vietnam’s removal of restrictions on foreign direct investment (FDI) subsequent to its accession to the World Trade Organization in 2007 increased sales of SSCBs compared with a matched country, the Philippines, which acceded in 1995. Difference-in-difference (DID) models were used to test pre/post differences in total SSCB sales and foreign company penetration covering the years 1999–2013.ResultsFollowing Vietnam’s removal of restrictions on FDI, the growth rate of SSCB sales increased to 12.1 % per capita per year from a prior growth rate of 3.3 %. SSCB sales per capita rose significantly faster pre- and post-intervention in Vietnam compared with the control country the Philippines (DID: 4.6 L per annum, 95 % CI: 3.8 to 5.4 L, p < 0.008). Vietnam’s increase in SSCBs was primarily attributable to products manufactured by foreign companies, whose annual sales growth rates rose from 6.7 to 23.1 %, again unmatched within the Philippines over this period (DID: 12.3 %, 95 % CI: 8.6 to 16.0 %, p < 0.049).ConclusionsGrowth of SSCB sales in Vietnam, led by foreign-owned companies, significantly accelerated after trade and investment liberalization.

Comparison of standardized versus individualized caloric prescriptions in the nutritional rehabilitation of inpatients with anorexia nervosa.

Sparse research informs how caloric prescriptions should be advanced during nutritional rehabilitation of inpatients with anorexia nervosa (AN). This study compared the impact of a standardized caloric increase approach, in which increases occurred on a predetermined schedule, to an individualized approach, in which increases occurred only following insufficient weight gain, on rate, pattern, and cumulative amount of weight gain and other weight restoration outcomes. This study followed a natural experiment design comparing AN inpatients consecutively admitted before (n = 35) and after (n = 35) an institutional change from individualized to standardized caloric prescriptions. Authors examined the impact of prescription plan on weekly weight gain in the first treatment month using multilevel modeling. Within a subsample remaining inpatient through weight restoration (n = 40), multiple regressions examined the impact of caloric prescription plan on time to weight restoration, length of hospitalization, maximum caloric prescription, discharge BMI, and incidence of activity restriction and edema. There were significant interactions between prescription plan and quadratic time on average weekly weight gain (p = .03) and linear time on cumulative weekly weight gain (p < .001). Under the standardized plan, patients gained in an accelerated curvilinear pattern (p = .04) and, therefore, gained cumulatively greater amounts of weight over time (p < .001). Additionally, 30% fewer patients required activity restriction under the standardized plan. Standardized caloric prescriptions may confer advantage by facilitating accelerated early weight gain and lower incidence of bedrest without increasing the incidence of refeeding syndrome.