This thesis estimates the treatment effect of inflation targeting adoption on inflation, inflation variability, output, and output variability for 25 explicit inflation targeting countries. I implement the propensity score matching methodology that takes into account the problems of non-experimental nature, such as selection bias or selection on observable, and allows me to effectively mimic properties of randomized experiment and compute unbiased treatment effect estimates. I introduce a variety of propensity score matching methods that were recently developed in the treatment effect literature, including Nearest Neighbor, Radius matching, Kernel matching, and Inverse Probability Weighting. The results indicate that both industrial and developing inflation targeting countries exhibit lower inflation levels and at the same time higher output growth than non-targeting countries. The estimates are however in most cases statistically insignificant. Moreover, it appears that both industrial and developing countries achieve combination of lower inflation variability and output variability compared to non-targeting countries. Nonetheless, majority of the estimates are again statistically insignificant. The results are to a small extent sensitive to the choice of propensity score matching method. Radius matching with tight calipers (r=0.005, r=0.001) tends to provide the most reliable estimates. Balancing properties of the models are reasonable and compared to the previous research the standardised biases are quantitatively better.

Independent and supplementary prescribing are the two main forms of non-medical prescribing (NMP) that have been practised in the UK since 2006. Most available studies have qualitatively investigated the impact of NMP, especially in primary care. This may be due to the fact that prescriptions are issued mainly by general practitioners in primary care. This PhD thesis aimed at investigating the clinical effectiveness of independent pharmacist and diabetes specialist nurse (DSN) prescribers in the management of patients with type 2 diabetes at outpatient clinics in hospitals. A literature review was firstly conducted to explore the current research on NMP around the world and the UK. A systematic review of the previously published randomised control trials (RCT) and non-RCT studies that focused on prescribing interventions of nurses and pharmacist was also conducted to explore the impact of their prescribing interventions in treating type 2 diabetes using HbA1c level as the primary outcome. A programme of work of three retrospective comparative database analytical studies was then carried out to investigate the impact of independent NMPs in type 2 diabetes care. This programme of work used electronic medical records of patients attending outpatient clinics of diabetes centres in two teaching hospitals in Manchester; one employed an independent pharmacist and the other employed DSN prescribers. A group of subjects seen by an NMP in place of a doctor during the study period were the study group and the control group were those who seen only by doctors. The primary outcome was the average yearly change of HbA1c amongst the two groups. Secondary outcomes were yearly change of total cholesterol, blood pressure and serum creatinine as well as body mass index. Five statistical models, which included multivariable regression, propensity score matching and sensitivity analyses, were utilised to control for confounding effects, and the nature of selection bias in the retrospectively comparative effectiveness research using secondary database resources. A total of 330 patients seen by a team including a pharmacist versus 975 by doctors only between January 2006 and January 2013 at one site; and 656 by a team including DSNs versus 3,746 patients seen by doctors only between January 2007 to December 2013 at the other. The studies found both prescribing pharmacists and DSNs are capable of achieving at least non-inferior improvements in diabetes outcome compared to doctors. The pharmacist achieved a mean 0.01% reduction in HbA1c level versus doctors who achieved slight increase (p<0.4). DSNs also achieved a mean 0.07% reduction compared to doctors. However, after adjustment with multivariate and propensity score as well as with propensity score matching, there were no significant differences between the two groups. These findings were consistent with the findings in the systemic review. Although an RCT is the only method that by definition would produce unbiased treatment effects, the use of propensity score methods here, have reduced the potential for bias that may remain unaccounted for in multivariate models without propensity scores. Adjusting for propensity scores using two different methods also gives more confidence that the results are as unbiased as possible. Nonetheless, caution in generalising the results is necessary because of the retrospective nature of the studies and deficiencies in the database used.

Studier visar att strokesjukvården i Sverige har en ojämn kvalitet. Denna studie syftar till att vidare undersöka möjliga ojämlikheter i strokevården. I uppsatsen undersöktes huruvida födelseland påverkar hur patienter som insjuknat i stroke skattar sin hälsa, nöjdhet med vården och nedstämdhet. Därtill jämfördes två statistiska metoder som kan hantera skillnader i patientsammansättning (t.ex. ålder och andra bakgrundsfaktorer), vilka var multipel logistisk regression och propensity score matching följt av konditionell logistisk regression. Båda metoderna gav signifikanta resultat. Resultatet visade att det är troligare att uppskatta sin allmänna hälsa som dålig, vara missnöjd med vården och vara nedstämd ofta eller ständigt för patienter födda utanför Sverige jämfört med de födda i Sverige, oberoende av vilken metod som användes. Propensity score matching visade större påverkan av födelseland på de undersökta responsvariablerna jämfört med multipel logistisk regression. Däremot var resultaten från multipel logistisk regression mer precisa.

<p>This dissertation investigates whether dual credit students' academic performance in subsequent university courses is comparable to that of non-dual-credit students. The study uses data from a Midwest regional public university over a ten-year period and employs propensity score matching and proportional odds ordinal logistic regression to create balanced comparison groups and analyze the results. The findings indicate that students who completed the prerequisite course as dual credit have similar grades in subsequent university courses as those who completed the prerequisite course as a university student. The study also identifies significant predictors of academic performance in subsequent university courses, such as sex, historically underserved groups status, high school GPA, and course subject, regardless of dual credit status. However, first-generation status, SAT scores, and the time between courses are not statistically significant predictors. These results suggest that dual credit students are as prepared for subsequent university courses as non-dual-credit students. Nevertheless, academic outcomes differ based on certain factors, which should be considered when designing student success initiatives and allocating resources.</p>

OBJECTIVES: We examined the association between exclusive breastfeeding, early introduction of feeding formula, early weaning, and asthma in children aged six months to five years in a sample of non-institutionalized US children using a propensity score approach. METHODS: Our study used data from the National Survey of Children's Health (2012-2018) of 3,820 children with physician-diagnosed asthma aged 6 months to 5 years. Propensity score matching (PSM) was applied to control selection bias with age, sex, race, birth weight, Federal Poverty Level, parent's education, and parent smoking history used as covariates in PSM. The total number in the matched sample was 6,904 (3,452 non-asthmatics; 3,452 asthmatics). Matched and unmatched samples were analysed using the χ test and multiple logistic regression. RESULTS: Exclusive breastfeeding was protective against asthma in the pre-matching (AOR 0.72; 95% CI: 0.54-0.97; p = 0.03) and post-matching (AOR 0.66; 95% CI: 0.55-0.81; p < 0.001) samples. Formula feeding before 6 months was associated with asthma in unmatched (AOR 1.38; 95% CI: 1.15-1.66; p < 0.001) and matched (AOR 1.31; 95% CI: 1.16-1.47; p < 0.001) sample. Early weaning before 6 months was associated with asthma in unmatched (AOR 1.62; 95% CI: 1.35-1.54; p < 0.001) and matched sample (AOR 1.37; 95% CI: 1.23-1.54; p < 0.001). CONCLUSION: Public health systems should continue to recommend the implementation of the World Health Organization exclusive breastfeeding guideline in developed countries. Asthma interventions in children under two years should continue to emphasize exclusive breastfeeding to reduce the incidence of infant asthma.

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京都大学 / 新制・課程博士 / 博士(農学) / 甲第23964号 / 農博第2513号 / 新制||農||1093(附属図書館) / 学位論文||R4||N5399(農学部図書室) / 京都大学大学院農学研究科生物資源経済学専攻 / (主査)教授 梅津 千恵子, 教授 浅見 淳之, 准教授 三谷 羊平 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DFAM

Well-being is fundamental for health. However, health and well-being are under threat by increased prevalence of depression and physical inactivity. Interaction with the natural environment may prevent these critical health issues, as research has shown that walking outdoors contributes to better well-being than walking indoors. The aim of this thesis was to investigate outdoor group walks as a potential public health intervention to enhance positive mental and emotional well-being, reduce stress, and foster resilience. This thesis evaluated Walking for Health, a national group walking programme in England using a nonexperimental, longitudinal design. Individuals who did (Group Walkers) and did not (Non-Group Walkers) take part in outdoor group walks completed two online questionnaires about their mental and emotional well-being, and covariates. To gain a broader understanding of how outdoor group walks may contribute to positive well-being, integrations were proposed between the Attention Restoration Theory and the psycho-evolutionary model, and the theories of coping and resilience. Findings show that Group Walkers had greater mental well-being and positive affect, and less negative affect, depression and perceived stress than Non-Group Walkers. Group walking had no affect on social well-being, connectedness to nature or resiliency. Outdoor group walk participation affected positive well-being through a decrease in perceived stress, and an increase in physical activity. Group Walkers demonstrated resilience against adversity on negative affect. No evidence of resilience from outdoor group walks was found for mental well-being, positive affect or depression. Group walks in farmland and green corridor environments may further boost mental well-being, and reduce negative affect and perceived stress, when compared to group walks in the urban environment. This research suggests that outdoor group walks are effective at improving mental and emotional well-being, and could be a useful public health intervention to reduce stress and foster resilience. Implications for theory are discussed.

This thesis consists of four self-contained papers. Essay I (with Linuz Aggeborn): Fluoridation of the drinking water is a public policy whose aim is to improve dental health. Although the evidence is clear that fluoride is good for dental health, concerns have been raised regarding potential negative effects on cognitive development. We study the effects of fluoride exposure through the drinking water in early life on cognitive and non-cognitive ability, education and labor market outcomes in a large-scale setting. We use a rich Swedish register dataset for the cohorts born 1985-1992, together with drinking water fluoride data. To estimate the effects, we exploit intra-municipality variation of fluoride, stemming from an exogenous variation in the bedrock. First, we investigate and confirm the long-established positive relationship between fluoride and dental health. Second, we find precisely estimated zero-effects on cognitive ability, non-cognitive ability and education for fluoride levels below 1.5 mg/l. Third, we find evidence that fluoride improves later labor market outcomes, which indicates that good dental health is a positive factor on the labor market. Essay II: I study the associations between cognitive and non-cognitive abilities and mortality using a population-wide dataset of almost 700,000 Swedish men born between 1950 and 1965. The abilities were measured at the Swedish military enlistment at age 18-20. In addition, I investigate if income and education are good proxies for the abilities. The results suggest that both cognitive and non-cognitive abilities are strongly associated with mortality, but that non-cognitive ability is a stronger predictor. The associations are only partly mediated through income and education. For middle and high income earners and individuals with a college education there are no associations with mortality. However, for low income earners and individuals without a college education, both abilities are strongly associated with mortality. The associations are mainly driven by the bottom of the distributions. Essay III (with Matz Dahlberg, Kevin Mani and Anders Wanhainen): We examine how health information affects individuals' well-being using a regression discontinuity design on data from a screening program for an asymptomatic disease, abdominal aortic aneurysm (AAA). The information provided to the individuals is guided by the measured aorta size and its relation to pre-determined levels. When comparing individuals that receive information that they are healthy with those that receive information that they are in the risk zone for AAA, we find no effects. However, when comparing those that receive information that they have a small AAA, and will be under increased surveillance, with those who receive information that they are in the risk zone, we find a weak positive effect on well-being. This indicates that the positive information about increased surveillance may outweigh the negative information about worse health. Essay IV: I estimate the effect of SSRI antidepressants on the risk of mortality for myocardial infarction (MI) patients using Propensity Score Matching on individual health variables such as pharmaceutical drug prescription, patient history and severity of the MI. The effect of antidepressants on mortality is a heavily debated topic. MI patients have an elevated risk of developing depression, and antidepressants are among the most common treatments for depression and anxiety. However, there are indications that some classes of antidepressants may have drug-induced cardiovascular effects and could be harmful for individuals with heart problems, but there is a lack of large-scale studies using credible identification strategies. My findings indicate no increased risk of two-year mortality for MI patients using SSRI. The results are stable for several specifications and robustness checks.

INTRODUCTION: Medicare Part D provides prescription drug coverage to seniors through a benefit plan with a major deductible inserted in the middle. It is important to study the extent to which this structure affects seniors’ adherence to prescription medications. Therefore, this study had the following objectives: (1) To identify characteristics of beneficiaries reaching and not reaching the coverage gap, (2) To study the entry and exit times from the coverage gap, (3) To study the impact of a complete gap in coverage on beneficiaries’ adherence to prescription medications, (4) To study the impact of a partial gap in coverage on beneficiaries’ adherence to prescription medications METHODS: This was a retrospective quasi-experimental analysis with matched control groups using a nationally representative sample of Part D enrollees from 2008 Centers for Medicare and Medicaid (CMS) datasets. Adherence to each oral medication taken for one or more of the seven pre-defined therapeutic classes before and after reaching the coverage gap was measured using the Medication Possession Ratio (MPR). Appropriate statistical tests for significance were performed for each analysis RESULTS: A quarter of our sample (24.42%) reached the coverage gap in 2008. Most of the beneficiaries reaching the coverage gap did so by end of September. Those reaching the coverage gap and losing all coverage experienced significantly greater reductions in adherence (3% more for beta-blockers to 9% more for oral anti-diabetic agents), compared to those not reaching the coverage gap. A considerable proportion of beneficiaries stopped taking medications in both the groups and the proportion of beneficiaries considered adherent also dropped in both the groups during the coverage gap period. CONCLUSIONS: Medicare Part D beneficiaries face significant barriers to adherence and this is especially highlighted among those reaching the coverage gap. Interventions to improve adherence in this group should target all beneficiaries, especially those with several chronic conditions.