School vouchers are the most contentious form of parental school choice. Vouchers provide government funds that parents can use to send their children to private schools of their choice. Here we examine the empirical question of whether or not a school voucher program in Washington, DC, affected achievement or the rate of high school graduation for participating students. The District of Columbia Opportunity Scholarship Program (OSP) has operated in the nation's capital since 2004, funded by a federal government appropriation. Because the program was oversubscribed in its early years of operation, and vouchers were awarded by lottery, we were able to use the “gold standard” evaluation method of a randomized experiment to determine what impacts the OSP had on student outcomes. Our analysis revealed compelling evidence that the DC voucher program had a positive impact on high school graduation rates, suggestive evidence that the program increased reading achievement, and no evidence that it affected math achievement. We discuss the implications of these findings in light of recent policy developments including the reauthorization of the OSP and the enactment or expansion of more than a dozen school voucher or voucher‐type programs throughout the United States in 2011 and 2012.

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Background: Lack of training among health care providers (HCPs) to safely prescribe opioids is a contributing factor to the opioid crisis. Training and other resources have been developed to educate providers about safe and appropriate opioid prescribing practices.Method: The national survey was conducted with 2000 HCPs representing primary care physicians (PCPs), including family practice, general practice, and internal medicine; specialists (SPs); physician assistants (PAs); and nurse practitioners (NPs), a mix of primary care and specialists. This survey examined exposure to opioid educational information and opioid prescribing.Results: PCPs reported prescribing opioids for chronic pain to significantly more patients compared with other HCP groups. PCPs (89.8%) and NPs (85.5%) reported significantly greater exposure to opioid educational information compared with both SPs (71.9%) and PAs (78.8%). Overall, HCPs had limited knowledge about abuse-deterrent formulations, but PCPs had greater knowledge than other groups. HCPs had an increased likelihood of prescribing opioids to fewer patients in the last 3 months relative to the prior 12 months if they worked in a state or county clinic vs a solo or group practice type (adjusted odds ratio [AOR] = 1.97; 95% confidence interval [CI], 1.12-3.49) and were exposed to more opioid educational information during the last 12 months (AOR = 1.19; 95% CI, 1.06-1.32).Discussion: HCPs' exposure to opioid educational information was associated with less opioid prescribing for chronic pain. Findings indicated a difference in exposure and knowledge gaps across provider groups. More information is needed on the content of opioid educational information provided to HCPs.

Background Cardiovascular disease (CVD) is the leading cause of mortality in western countries and the first cause of mortality in women. Purpose Women generally do not concern about CVD and that represents the main risk for them. Methods Misericordia Hospital, Grosseto, started a Clinic of Health and Gender Medicine on 2017. On the first and third Monday of every month, we evaluate < 60 years patients who are at risk for traditional CVD, depression, early menopause, polycystic ovary, autoimmune and rheumatic disease. On the first visit, medical history, arterial pressure, electrocardiogram, body mass index, waist circumference and lipid profile, were collected. We also supply questionnaires to evaluate diabetes and depression risk by Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9) and food diary. Two weeks later, a multidisciplinary team (cardiologist-diabetologist-nutritionist-gynecologist-psychiatrist and a nurse) evaluates the patients defining the personal risk profile. Results From 2017 to December 2019, 74 females and 7 males belonging to the target population were examined. Age group: <45(61%), 46-50(26%), 51-60(48%), >60(19%). Clinical characteristics: Hypertension: 64%; Obesity 5%; Unknown dyslipidemia 44%; Risk of diabetes: 39%; Gestational diabetes: 5%; Gestational hypertension: 5% CVD risk: 42%; Depression: 33% Autoimmune disease: 30%. From them 60.5% have needed further investigation. Follow-up is going on. Conclusions according with the literature, more than 50% of the cohort was unconsciously at high risk of CVD. So a multidisciplinary approach is needed in order to frame a complex health status. Thus we established collaboration with patients to improve lifestyles as CVD-prevention's tool. Key messages Cardiovascular disease represent often an hidden health problem, especially in women. Multidisciplinary approach is needed to face CVD.