bluuebunny/crossref_metadata_2025_split huggingface dataset:
Loss of distal 11q is associated with DNA repair deficiency and reduced sensitivity to ionizing radiation in head and neck squamous cell carcinoma
Authors: Parikh Rahul A. , White Jason S. , Huang Xin , Schoppy David W. , Baysal Bora E. , Baskaran Rajasekaran , Bakkenist Christopher J. , Saunders William S. , Hsu Lih‐Ching , Romkes Marjorie , Gollin Susanne M. 
Published: May 2007

AbstractAbout 45% of head and neck squamous cell carcinomas (HNSCC) are characterized by amplification of chromosomal band 11q13. This amplification occurs by a breakage‐fusion‐bridge (BFB) cycle mechanism. The first step in the BFB cycle involves breakage and loss of distal 11q, from FRA11F (11q14.2) to 11qter. Consequently, numerous genes, including three critical genes involved in the DNA damage response pathway, MRE11A, ATM, and H2AFX are lost in the step preceding 11q13 amplification. We hypothesized that this partial loss of genes on distal 11q may lead to a diminished DNA damage response in HNSCC. Characterization of HNSCC using fluorescence in situ hybridization (FISH) revealed concurrent partial loss of MRE11A, ATM, and H2AFX in all four cell lines with 11q13 amplification and in four of seven cell lines without 11q13 amplification. Quantitative microsatellite analysis and loss of heterozygosity studies confirmed the distal 11q loss. FISH evaluation of a small series of HNSCC, ovarian, and breast cancers confirmed the presence of 11q loss in at least 60% of these tumors. All cell lines with distal 11q loss exhibited a diminished DNA damage response, as measured by a decrease in the size and number of γ‐H2AX foci and increased chromosomal instability following treatment with ionizing radiation. In conclusion, loss of distal 11q results in a defective DNA damage response in HNSCC. Distal 11q loss was also unexpectedly associated with reduced sensitivity to ionizing radiation. Although the literature attributes the poor prognosis in HNSCC to 11q13 gene amplification, our results suggest that distal 11q deletions may be an equally significant factor. © 2007 Wiley‐Liss, Inc.
Discounting and health benefits
Authors: Parsonage Michael , Neuburger Henry 
Published: May 2007

AbstractThis paper argues that non‐monetary health benefits should not be discounted at the same rate as variables expressed in monetary terms. It argues instead that the appropriate discount rate should be at or close to zero. It explores the various influences of rising income, age and pure time preference on the relative value of current and future health states. It examines various arguments advanced to justify the current practice of discounting health benefits at the same rate as monetary costs. These include uncertainty and delay. The article concludes with an analysis of the likely impact of adopting a zero discount rate on the ranking of health interventions.
Fairness and feasibility in national health care systems
Authors: Pauly Mark V. 
Published: May 2007

AbstractThe issue of National Health Care reform has been discussed from many different perspectives. One of the most fundamental justifications for such reform is based on the notion of horizontal equity. The motivation for equity in medical services use contrasts with the the seeming lack of concern for equity in financing. Proposed policy remedies often involve transfers through taxation, though the effects of government taxation often reduce the efficiency of publicly financed health insurance. Further, the effects of heterogeneous preferences complicate the assessment of optimal medical service consumption levels. Ethical justification aside, this paper addresses the notion of fairness in the provision of medical care from an economic perspective. It suggests policies which might be most suitable in achieving such a goal. A paradoxical result of these considerations of fairness is that unequal insurance coverage is requisite to ensure more equal utilization of medical services by the population. The concept of fairness is then developed into a bottom up system of equity in the medical market.
Quality assurance in Canada: What are the health professions doing?
Authors: Kushner Carol 
Published: May 2007

AbstractAlthough quality assurance (QA) programming in Canada is still at an early stage of development, health professionals are increasingly being called upon to substantiate the value of the services they provide. A body of research showing wide variations in the rates of service provision and significant amounts of inappropriate care have convinced many policy makers about the need to improve quality in the Canadian health system. Recent and severe economic pressures on provincial government funders could foster a more rational approach to resource allocation, including the consideration that better quality care is more efficient care.The bulk of health care in Canada is delivered in the private offices of practitioners, where quality assurance programming is relatively undeveloped. Although some licensing organizations do conduct proactive routine audits of their members' practices, a national survey, based on self‐report, indicated that most of these programmes do not conform to recommendations found in the quality assurance literature.Although there have been some new initiatives in Canadian QA, it remains to be seen how these will influence the evolution of quality assurance programming conducted by Canada's health professions.
Management of human resources in health care: The Canadian experience
Authors: Adams Orvill 
Published: May 2007

AbstractEach of Canada's ten provinces has a publicly administered system of health insurance, funded by provincial and federal taxes, that is accessible to all citizens and covers all medically necessary services provided by physicians and hospitals. Canadians spend an estimated 9.2 percent of their gross national product on health care (about 2.8 percentage points below US spending), of which three quarters is public‐sector spending. According to the Organization for Economic Cooperation and Development, Canada's health status is equal to or better than that of the United States, despite lower per capita health spending.About seven percent of the Canadian labour force works in health care, and attempts to introduce coordinated planning of human resources in health care have not as yet proceeded far. The predominant policy issue here is the supply and the role of physicians. It has been argued that entrenching within the system the fee‐for‐service method of paying physicians has created a disincentive to the delegation of responsibility to health personnel other than doctors.It is also argued that introduction of government‐run health insurance provided the opportunity for human resource planning, but that the decision by governments to act only as the payer resulted in ad‐hoc planning approaches.However, governments' concern over health care costs has led to a more direct role by them in the planning of the human resources in health. They are re‐examining the autonomy and jurisdictional rights of the professions that deliver health care to Canadians.
Are increases in cigarette taxation regressive?
Authors: Borren Pim , Sutton Matthew 
Published: May 2007

AbstractUsing the latest published data from Tobacco Advisory Council surveys, this paper re‐evaluates the question of whether or not increases in cigarette taxation are regressive in the United Kingdom. The extended data set shows no evidence of increasing price‐elasticity by social class as found in a major previous study. To the contrary, there appears to be no clear pattern in the price responsiveness of smoking behaviour across different social classes. Increases in cigarette taxation, while reducing smoking levels in all groups, fall most heavily on men and women in the lowest social class. Men and women in social class five can expect to pay eight and eleven times more of a tax increase respectively, than their social class one counterparts. Taken as a proportion of relative incomes, the regressive nature of increases in cigarette taxation is even more pronounced.
Equity and efficiency in Italian health care
Authors: Paci Pierella , Wagstaff Adam 
Published: May 2007

AbstractHealth care finance and provision in Italy is unusual by international standards: public financing relies heavily on both general taxation and social insurance, and although the vast majority of expenditure is publicly financed, the majority of care is provided by the private sector. The system suffers, however, from a chronic failure to control expenditures and its record on perinatal and infant mortality is poor. Hospitals in Italy have a low bed‐occupancy rate by international standards and the per diem system of reimbursing private hospitals encourages unduly long stays. Costs per inpatient day are high by international standards, but costs per admission are close to the OECD average. Ambulatory care costs are extremely low, but this appears to be due to the fact that GPs see so many patients that their role is inevitably mainly administrative. Consumption of medicines is extremely high, but because the cost per item is low, expenditure per capita is not unduly high. Despite the emphasis on social insurance, the financing system appears to be progressive. There is evidence of inequalities in health in Italy, and some evidence that health care is not provided equally to those in the same degree of need.
Recruitment methods for screening programmes: The price of high compliance
Authors: Torgerson D. J. , Donaldson C. , Garton M. J. , Reid D. M. , Russell I. T. 
Published: May 2007

AbstractHigh population compliance is seen as a prerequisite for an equitable screening service. To achieve high compliance fixed appointments are usually advocated. However, the costs of achieving high compliance have not previously been described. To assess the costs of achieving high compliance we have used a randomised trial of two common appointment methods: 800 women aged 45‐49 living within 20 miles of Aberdeen were selected at random from the Community Health Index. They were randomly assigned to receive one of two letters—one offering a fixed appointment, the other inviting them to telephone to make an appointment.For a defined population fixed appointments achieved high compliance but only by reducing the opportunities for screening; for every 100 women screened, 110 additional women were denied the opportunity of a screening test. In contrast the open letters of invitation achieved efficiency by increasing the number of women screened with given resources within a larger population. Thus for screening services with fixed budgets, high compliance is achieved only by screening fewer people.
Trends in the structure, productivity, effectiveness and unit costs of the hospital and community health services workforce in England: 1979–1991
Authors: Cutler Peter 
Published: May 2007

AbstractIn this paper it is shown that there have been significant structural changes in the composition of the Hospital and Community Health Services (HCHS) workforce over the 1980s. The number of doctors, nurses and other medical professionals has grown at the expense of support staff such as ancillaries and maintenance workers. The number of agency and contract staff has risen rapidly, partly offsetting the loss of directly‐employed support staff.Changes in the workforce have been compared with changes in activity, as measured by the cost‐weighted activity index. According to this measure labour productivity has grown by a compound rate of 1.9% annually. Adjusting the labour force index for the wage bill of each group reveals productivity growth of 1.5%. The effectiveness of treatment, as proxied by the decline in avoidable perinatal mortality, has grown by 3.4% annually.Unit labour costs have fallen over the period at an average annual rate of 0.3%. The trend conceals wide fluctuations, with labour costs falling slowly during the first half of the decade, and rising strongly during the second half. Medical professionals benefited disproportionately from wage increases in comparison with other HCHS groups during the mid to late 1980s.
Income transfers and the labour market participation of disabled individuals in the UK
Authors: O'Donnell Owen 
Published: May 2007

AbstractData from the OPCS Disability Survey are used to model the labour force participation of disabled individuals. The model is an endogenous switching regression and estimation is by the two stage probit procedure. The estimates are used to simulate the impact of Disability Working Allowance, introduced in April 1992, on the participation rate of the disabled population.
Generalizability of valuations on health states collected with the EuroQolc‐questionnaire
Authors: Essink‐Bot Marie‐Louise , Stouthard Marlies E. A. , Bonsel Gouke J. 
Published: May 2007

AbstractProblem: Non‐response and non‐usable response were found in population surveys on valuation of health states. If non‐response is selective regarding valuations, then generalization of the resulting values to the whole survey population is not permitted. This could limit the use of empirical utility values in resource allocation in health care.Methods: Response behaviour of a sample of 1400 from the Dutch general population to the mailed EuroQolc‐questionnaire was analyzed by four methods. I. Phoning resolute non‐respondents; II. comparison of zip code characteristics of respondents and non‐respondents (because individual data on background characteristics were not available for the non‐respondents); III. analysis of response over time (wave‐analysis); IV: comparison of background variables of successful (less than two valuations missing) and unsuccessful respondents, combined with analysis of the effect of these background variables on valuations.Results: No indications for selective non‐response were found, although the phenomenon appeared hard to investigate. The successful response came from a slightly younger and better educated subsample. However, a general influence of age and educational level on valuations could not be shown. This finding is consistent with the literature.Conclusion: Although the existence of selective non‐response cannot be excluded, its relevance can be considered to be small. This finding is encouraging for the use of empirical utility values in allocative decisions.
A cost function analysis of residential services for adults with a learning disability
Authors: Shiell Alan , Pettipher Catherine , Raynes Norma , Wright Ken 
Published: May 2007

AbstractSuccessive UK governments have pursued a policy of community care for people with learning disabilities which, in the past ten years, has led to a marked change in the nature of residential provision. Research evidence on the costs and quality of alternative forms of community provision is inconclusive and contradictory. It is therefore timely to consider whether or not community residential facilities have delivered the expected quality of service at appropriate cost. The paper presents the results of a cost function analysis of a random stratified sample of staffed community facilities in England excluding London.Both costs and quality of care were found to vary greatly amongst community residential facilities. The most important factors explaining differences in cost were case‐mix factors relating to client age, dependency and length of stay. Facility characteristics such as the type of building, the internal layout and the structural quality were not significant. Quality of service measures such as the extent to which care‐regimes were client orientated and made use of local community services were positively and significantly associated with costs. Type of provider had no impact on costs independent of differences in case‐mix and quality of care with the exception of the private for profit sector which appeared less expensive than other agencies.The shortcomings of the methods and implications of these findings for policy makers are discussed.
Have procompetitive changes altered hospital provision of indigent care?
Authors: Campbell Ellen S. , Ahern Melissa W. 
Published: May 2007

AbstractIn the past decade alone there have been numerous changes in the financial and competitive environment of hospitals in the United States. Some examples include the advent of Medicare's Prospective Payment System, growth in managed care options, relaxation of states' Certificate of Need (CON) regulations, and court cases questioning the tax‐exempt status of nonprofit hospitals. In this paper we attempt to reveal how hospitals alter their provision of care to the poor in a more cost conscious and competitive environment. Using hospital data from the State of California for the fiscal years ending in 1983 and 1987, estimates explaining uncompensated care commitments are presented. In particular, this study illustrates how hospitals under different ownership control varied their provision of uncompensated care over the period studied on average and by profitability level. Other factors, such as hospital location, teaching status, medicare patient load, and contractual adjustments, are also included in the analysis. A number of interesting trends are detected. Moreover, the results are found to be compatible with a quid pro quo hypothesis which states that hospital regulators reward large uncompensated care providers with profitable CON licenses.
Reduced list costings: Examination of an informed short cut in mental health research
Authors: Knapp M. , Beecham J. 
Published: May 2007

AbstractThe demands for cost information in health services are many and various but the supply of such information is less than might be expected and is compounded by the expense of undertaking costs research. This paper examines a short cut to mental health research which, if certain rules and conventions are obeyed, can still produce valid costs data. By distilling evidence from previous research a reduced list of services is identified which accounts for the greater part of the total costs of care packages. By concentrating on these key services, 94 per cent of the total costs of care were predicted for discharged long‐stay patients and no less than 91 per cent for people supported by community psychiatric nurses. The results suggest that this reduced list method can work well where the aim is to obtain broad orders of magnitude for the costs of care. By reducing the resources required for research, the approach could expand the current costs information base and move towards meeting the pressing practice demands for costs data.
Monitoring health in Sweden: On the rationale for working environment regulations
Authors: Lyttkens Carl Hampus 
Published: May 2007

AbstractThe quality of the working environment affects the health status of a population. In the absence of government intervention this quality would be determined by market forces, but the market outcome is generally not accepted. Instead public policy attempts to carefully monitor the level of occupational hazards, which are invariably subject to regulation in industrialized countries. However, this study demonstrates that the welfare implications of this monitoring of health are not self‐evident. In the presence of a tax on labour and, for example, a tax‐financed social insurance system, it is shown that market forces may lead either to excessive or to sub‐optimal investments in injury prevention. Both private and (local) public safety goods are considered.
Is malaria control a priority? Evidence from Nepal
Authors: Mills Anne 
Published: May 2007

AbstractThe research reported here assessed the value of malaria control through a cost‐effectiveness study of the vertically‐organized malaria control programme in Nepal. It presents a methodological framework for analysing cost‐effectiveness which includes resource‐saving consequences as well as health consequences. The methods used to collect data on control costs, cases and deaths prevented, treatment costs averted and production gains are described and the assumptions required by the analysis are made explicit. A variety of cost‐effectiveness ratios are calculated, sensitivity analysis applied and the policy implications of the results considered. The results from Nepal are compared to estimates for parasitic disease and other health programmes in other countries: it is concluded that the Nepalese programme appears no less cost‐effective than many other health interventions. It can also be justified by reference to the population groups benefiting from malaria control.
Measuring utility values for QALYs: Two methodological issues
Authors: Smith Richard , Dobson Matthew 
Published: May 2007

AbstractTwo methodological concerns in utility estimation, the development of health state descriptions (scenarios) and the interpretation of interval scale anchor points, are examined in the context of disease‐specific cost utility analyses (CUA). It is contended that results in CUA can be fundamentally biased by: (i) how the information presented in a scenario is generated; and (ii) the researcher's ‘definition’ of anchor points, when these are used as bounds to the interval scale. A number of recommendations are made, in particular for a more explicit reporting of these issues in CUA, to facilitate greater consistency in the application of utility measurement techniques.
Appraising the use of contingent valuation: A note in response
Authors: Fox‐Rushby Julia 
Published: May 2007

AbstractThis paper reviews the guidelines and recommendations propounded by Morrison and Gyldmark in relation to the use of contingent valuation (CV) to value health states. The issues raised are: that QALYs may not be sufficiently sensitive to changes in health thus requiring the use of CV formulation; the questionable practice of reinterpreting monetary values; and the possibility of income bias. It is concluded that further empirical research, at least, is needed to verify whether this approach should be rejected in favour of quality adjusted life years (QALYs) or healthy year equivalents (HYEs).
Cost‐effectiveness of endoscopic surgery
Authors: Cuschieri A. 
Published: May 2007

AbstractEndoscopic surgery is a rapidly defusing treatment approach subject to continual technological advance. It offers great potential for economic benefits as well as health gains, but as shown in the article in this issue by Kesteloot and Penninckx, the relative cost of open versus endoscopic surgery is a quite complex issue. The main factors influencing the costs and effectiveness of endoscopic surgery are reviewed and the need for more and better evaluation studies highlighted.
Persons vs years: Two ways of eliciting implicit weights
Authors: Olsen Jan Abel 
Published: May 2007

AbstractThe paper presents two methods for eliciting individuals' implicit weights to be attached to health benefits which extend over time. The first is a person‐trade‐off type which implies that social weights are attached to years with improved health when these are distributed between different groups of people. The second method is based on time‐trade‐off which yields private weights to succeeding years with improved health for oneself. Emphasis is placed on methodological issues, but some preliminary results obtained from small samples are also presented.