Medical expenditure after marginal cut of cash benefit among public assistance recipients in Japan: natural experimental evidence

BackgroundsIncome reduction in poor households affects healthcare demands for impoverished population. However, the impact of reduced benefits for public assistance recipients, who can use medical services for free, on healthcare costs has not been examined. We hypothesised that marginal cuts in benefits increase recipients’ medical expenditure by extra demand for medical care. We tested this hypothesis using public assistance databases of Japan.MethodsThe study population comprised households in five municipalities receiving public assistance between April 2016 and September 2018. The households have a child aged 12–60 months and receive a monthly child-support income of US$150, which reduces by US$50 when the child turns 36 months of age. Our analysis comprised an age-based sharp regression-discontinuity study.ResultsWe observed 4893 household-months (11 032 person-months). When a firstborn child reached 36 months, their frequency of outpatient visits and healthcare costs by recipients, except for the firstborn child, increased (0.45, 95% CI: 0.30 to 0.61; US$111.2, 95% CI: 20.7 to 201.7), while those of the firstborn child did not increase significantly. The monthly medical expenditure per household increased by US$248.6 (95% CI: 25.4 to 471.7). Inpatient medical costs increased significantly (US$64.3, 95% CI: 8.4 to 120.2).ConclusionsGovernment savings through income reduction were offset by increased medical expenditure. This may be due to recipients’ behavioural change and their worsening health conditions. To prevent excessive medical expenditure, policymakers should consider how income reduction affects the behaviour and health of the impoverished population.

Women with Recurrent Pregnancy Loss More Often Have an Older Brother and a Previous Birth of a Boy: Is Male Microchimerism a Risk Factor?

Known etiologic factors can only be found in about 50% of patients with recurrent pregnancy loss (RPL). We hypothesized that male microchimerism is a risk factor for RPL and aimed to explore whether information on family tree and reproductive history, obtained from 383 patients with unexplained RPL, was supportive of this hypothesis. The male:female sex ratio of older siblings was 1.49 (97:65) in all RPL patients and 1.79 (52:29) in secondary RPL (sRPL) patients, which differed significantly from the expected 1.04 ratio (p = 0.027 and p = 0.019, respectively). In contrast, the sex ratio of younger siblings was close to the expected ratio. Sex ratio of the firstborn child before sRPL was 1.51 (p = 0.026). When combined, 79.1% of sRPL patients had at least one older brother, a firstborn boy, or both. This differed significantly from what we expected based on the distribution of younger siblings and a general 1.04 sex ratio of newborns (p = 0.040). We speculate whether (s)RPL patients possibly acquired male microchimerism from older brother(s) and/or previous birth of boy(s) by transplacental cell trafficking. This could potentially have a detrimental impact on their immune system, causing a harmful response against the fetus or trophoblast, resulting in RPL.

The Bathsheba Affair as a Royal Apology of King Solomon

Analysis of the story of David and Bathsheba in 2 Samuel 11:1–12:25 reveals that it possesses several layers. The report of the second Ammonite War, which represents the initial content of 2 Samuel 11:1–12:31 and serves as the basis of the original Bathsheba Affair story, glorified David as a great warrior and gracious king, who married the widow of his fallen-in-action officer, Uriah the Hittite, and adopted Uriah’s newborn son, Solomon. The later Bathsheba Affair story, written by a pro-Solomonic author during Solomon’s reign, introduced the arbitrary taking of Bathsheba, Uriah the Hittite’s wife, by David before her husband met a natural warrior’s death. According to this version, Bathsheba remained with David in his palace and conceived there. The story demonstrates that Solomon, Bathsheba’s firstborn child, was not Uriah’s son but rather, by claiming direct royal lineage to King David, was David’s legitimate successor to the Throne of Israel. The next three revisions of the story 1) introduced Nathan the Prophet’s accusations against David, presumed to have been written between the late ninth and late eighth centuries B.C.E. by a prophetic author; 2) replaced Solomon with a fictitious firstborn child, written by a Deuteronomistic writer in the exilic period; and 3) introduced David’s second transgression – the murder of Uriah – written by an anti-Davidic author in the post-exilic period.

(Re)claiming Barbara Baynton’s Gothic Creek: An Analysis of Gillian Mears’ Foals’ Bread and Jessie Cole’s Deeper Water

The creek is a threatening site for women in Barbara Baynton’s Bush Studies (1902). The female characters in her stories are routinely represented as vulnerable, drowning, or murdered at the creek, and the slippery banks and murky waters have been established by Baynton as an Australian gothic space where women (and their bodies) are denied agency. Gillian Mears and Jessie Cole are two contemporary writers who challenge Baynton’s representation of the gothic creek. The female protagonists in their most recent Australian gothic novels, Noah in Mears’ Foal’s Bread (2011) and Mema in Cole’s Deeper Water (2014), understand the creek as a subversive site that accommodates alternative female corporeal experiences. While Noah in Foal’s Bread finds body autonomy in her use of the creek as a birthing space for her firstborn child, Mema in Deeper Water experiences body empowerment in her use of the creek as a space of sexual awakening. Though the gothic creek is a fearful site for women in Baynton’s establishing Australian gothic text, Bush Studies, both Foal’s Bread and Deeper Water demonstrate that the contemporary gothic creek is able to (re)negotiated as a site of female body autonomy and empowerment.

First-Time Motherhood Experiences and the Decision to Have a Second Child

Mothers’ experiences with their firstborn child may be relevant for understanding the further growth of families. Dutch women ( N = 795) reported on motherhood experiences during pregnancy and the first year. Direct effect models of mood symptoms, birth expectations, and child negative reactivity, and indirect effect models via parenting self-efficacy were tested to discriminate mothers who had, wanted, were undecided, and did not want a second child at a 2-year follow-up. Results indicated that mothers with two children had higher prenatal parenting self-efficacy and less postnatal trait anxiety compared with those who wanted a second child. There was no evidence for indirect effects of mood symptoms, birth expectations, or negative reactivity on having a second child via parenting self-efficacy. Also, mothers who did not want a second child had more unmet expectations regarding childbirth and, surprisingly, reported less child negative reactivity than other mothers. Implications of these findings are discussed.

Preferences for Sex of Firstborn Child among Primiparous Turkish Women

Sex of the baby is an important fantasy object for pregnant women. The objective of this study was to assess the preferences of women for their infants' sex. In this study, 99 primiparous women were included, and accordance of their desires with the newborns' actual sex and feelings about it were examined. All of the mothers were newly delivered and had healthy newborns (53 girls, 46 boys). Before birth, 49 (49.5%) mothers prefered to have a daughter, 25 (25.3%) mothers prefered to have a son, and 25 (25.3%) mothers reported no preferences about the infant's sex, a statistically significant preference for girls. There was no significant difference in the reported emotions of women according to sex preference and its concordance with infants' actual sex after delivery. It is considered that the timing of the interview might be a strong predictor for this result.