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Other Costs (other + cost)
Selected AbstractsCould interchangeable use of dry powder inhalers affect patients?INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2005D. Price Summary The aim of asthma treatment is optimal disease control. Poor asthma control results in considerable patient morbidity, as well as contributing to the considerable burden placed by the disease on healthcare budgets. There is a need for costs to be carefully scrutinised, with the switching of patients to inhaler devices with lower acquisition costs likely to be increasingly considered. However, before such practice becomes widespread, it is important to establish whether or not this could adversely impact on patients and the level of disease control. For approval to have been given, all marketed inhalers must have satisfied current regulatory requirements for devices. Full preclinical and clinical development programmes are not required when application is made for authorisation to market a new inhaler containing an existing chemical entity, although clinical equivalence testing must be used. Both beneficial and adverse effects should be tested, and the limits of equivalence must be clearly defined, based on therapeutic relevance. It should be noted that equivalence studies are invalid when the end point is not responding (i.e. at the top of the dose,response curve) and when equivalence limits approach or are equal to the magnitude of the drug effect. Approval on the basis of regulations designed to safeguard quality of dry powder inhalers does not mean that devices are interchangeable. When using an inhaler, there are many stages between the patient and the therapeutic effect, involving device design, pharmaceutical performance and patient behaviour. Regulations governing new devices cover only a few of the many factors affecting disease control. Furthermore, clinical trials to assess equivalence may not take into account factors in patient behaviour or variations in patient inhaler technique that may affect use of devices in real-life situations. When assessing the consequences of interchangeable use of dry powder inhalers on healthcare costs, it is important to ensure that the acquisition cost of the devices is not the only cost considered. Other costs that should be considered include the cost of time spent demonstrating to the patient how to use the new device, the cost of additional physician visits to address patient concerns and the management costs if disease control is adversely affected. [source] Cost-comparison of DDT and alternative insecticides for malaria controlMEDICAL AND VETERINARY ENTOMOLOGY, Issue 4 2000K. Walker Summary In anti-malaria operations the use of DDT for indoor residual spraying has declined substantially over the past 30 years, but this insecticide is still considered valuable for malaria control, mainly because of its low cost relative to alternative insecticides. Despite the development of resistance to DDT in some populations of malaria vector Anopheles mosquitoes (Diptera: Culicidae), DDT remains generally effective when used for house-spraying against most species of Anopheles, due to excitorepellency as well as insecticidal effects. A 1990 cost comparison by the World Health Organization (WHO) found DDT to be considerably less expensive than other insecticides, which cost 2 to 23 times more on the basis of cost per house per 6 months of control. To determine whether such a cost advantage still prevails for DDT, this paper compares recent price quotes from manufacturers and WHO suppliers for DDT and appropriate formulations of nine other insecticides (two carbamates, two organophosphates and five pyrethroids) commonly used for residual house-spraying in malaria control programmes. Based on these ,global' price quotes, detailed calculations show that DDT is still the least expensive insecticide on a cost per house basis, although the price appears to be rising as DDT production declines. At the same time, the prices of pyrethroids are declining, making some only slightly more expensive than DDT at low application dosages. Other costs, including operations (labour), transportation and human safety may also increase the price advantages of DDT and some pyrethroids vs. organophosphates and carbamates, although possible environmental impacts from DDT remain a concern. However, a global cost comparison may not realistically reflect local costs or effective application dosages at the country level. Recent data on insecticide prices paid by the health ministries of individual countries showed that prices of particular insecticides can vary substantially in the open market. Therefore, the most cost-effective insecticide in any given country or region must be determined on a case-by-case basis. Regional coordination of procurement of public health insecticides could improve access to affordable products. [source] How ideology shapes the evidence and the policy: what do we know about cannabis use and what should we do?ADDICTION, Issue 8 2010John Macleod ABSTRACT In the United Kingdom, as in many places, cannabis use is considered substantially within a criminal justice rather than a public health paradigm with prevention policy embodied in the Misuse of Drugs Act. In 2002 the maximum custodial sentence tariff for cannabis possession under the Act was reduced from 5 to 2 years. Vigorous and vociferous public debate followed this decision, centred principally on the question of whether cannabis use caused schizophrenia. It was suggested that new and compelling evidence supporting this hypothesis had emerged since the re-classification decision was made, meaning that the decision should be reconsidered. The re-classification decision was reversed in 2008. We consider whether the strength of evidence on the psychological harms of cannabis has changed substantially and discuss the factors that may have influenced recent public discourse and policy decisions. We also consider evidence for other harms of cannabis use and public health implications of preventing cannabis use. We conclude that the strongest evidence of a possible causal relation between cannabis use and schizophrenia emerged more than 20 years ago and that the strength of more recent evidence may have been overstated,for a number of possible reasons. We also conclude that cannabis use is almost certainly harmful, mainly because of its intimate relation to tobacco use. The most rational policy on cannabis from a public health perspective would seem to be one able to achieve the benefit of reduced use in the population while minimizing social and other costs of the policy itself. Prohibition, whatever the sentence tariff associated with it, seems unlikely to fulfil these criteria. [source] Sex, Reproductive Status, and Cost of Tail Autotomy via Decreased Running Speed in LizardsETHOLOGY, Issue 1 2009William E. Cooper Jr Autotomy, voluntary shedding of body parts to permit escape, is a theoretically interesting defense because escape benefit is offset by numerous costs, including impaired future escape ability. Reduced sprint speed is a major escape cost in some lizards. We predicted that tail loss causes decreased speed in males and previtellogenic females, but not vitellogenic females already slowed by mass gain. In the striped plateau lizard, Sceloporus virgatus, adults of both sexes are subject to autotomy, and females undergo large increases in body condition (mass/length) during vitellogenesis. Time required for running 1 m was similar in intact autotomized males and previtellogenic females, but increased by nearly half after autotomy. Vitellogenic females were slower than other lizards when intact, but their speed was unaffected by autotomy. Following autotomy, speeds of all groups were similar. Thus, speed costs of autotomy vary with sex and reproductive condition: decreased running speed is not a cost of autotomy in vitellogenic females or presumably gravid females. Costs of autotomy are more complex than previously known. Speed and other costs might interact in unforseen ways, making it difficult to predict whether strategies to compensate for diminished escape ability differ with reproductive condition in females. [source] Reconfiguring ,post-socialist' regions: cross-border networks and regional competition in the Slovak and Ukrainian clothing industryGLOBAL NETWORKS, Issue 3 2008ADRIAN SMITH Abstract The global garment industry is currently being reshaped in dramatic ways through processes of trade liberalization, delocalization and interfirm and interregional competition. There has been much speculation about the increasing importance of factor (especially labour) costs in fuelling further rounds of de-localization of garment production towards low-cost production locations, such as China and India. However, the extent to which these processes mean the end to garment production in higher factor-cost locations, including those neighbouring the major clothing markets of the USA and the EU, is open to question. In this article we interrogate the interregional shifts in garment sourcing taking place in Europe and its surrounding regions. While factor costs (including labour) are important determinants of the geography of sourcing, a range of other costs (logistical and policy costs) are important in structuring the geographies of global and regional production. Firms in the Slovak Republic are responding to increasing competitive pressures and we assess how trans-border sourcing, subcontracting and FDI are being integrated into strategies to sustain European production networks. We highlight the emergence of cross-border production relocation to Ukraine as one specific strategy. We examine the product specificity of these changes and the ways in which they are embedded within already existing production networks, forms of cross-border contracting and central European trade regimes. In other words, we explore some of the forces that shape the somewhat tentative continuation of garment production for export to EU markets in central Europe despite the ,spectre of China'. [source] Cost-effectiveness of HIV nonoccupational post-exposure prophylaxis in AustraliaHIV MEDICINE, Issue 4 2009D Guinot Objective The aim of the study was to determine the cost-effectiveness of HIV nonoccupational post-exposure prophylaxis (NPEP) in Australia. Methods A retrospective cost analysis of a population-based observational cohort of 1601 participants eligible for NPEP in Australia between 1998 and 2004 was carried out. We modelled NPEP treatment costs and combined them with effectiveness outcomes to calculate the cost per seroconversion avoided. We estimated the cost-utility of the programme, and sensitivity and threshold analysis was performed on key variables. Results The average NPEP cost per patient was A$1616, of which A$848 (52%) was for drugs, A$331 (21%) for consultations, A$225 (14%) for pathology and A$212 (13%) for other costs. The cost per seroconversion avoided in the cohort was A$1 647 476 in our base case analysis, and A$512 410 when transmission rates were set at their maximal values. The cost per quality-adjusted life-year (QALY) was between A$40 673 and A$176 772, depending on the risks of HIV transmission assumed. Conclusions In our base case, NPEP was not a cost-effective intervention compared with the widely accepted Australian threshold of A$50 000 per QALY. It was only cost-effective after receptive unprotected anal intercourse exposure to an HIV-positive source. Although NPEP was a relatively well-targeted intervention in Australia, its cost-effectiveness could be improved by further targeting high-risk exposures. [source] Fallback foods, eclectic omnivores, and the packaging problemAMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 4 2009Stuart A. Altmann Abstract For omnivorous primates, as for other selective omnivores, the array of potential foods in their home ranges present a twofold problem: not all nutrients are present in any food in the requisite amounts or proportions and not all toxins and other costs are absent. Costs and benefits are inextricably linked. This so-called packaging problem is particularly acute during periods, often seasonal, when the benefit-to-cost ratios of available foods are especially low and animals must subsist on fallback foods. Thus, fallback foods represent the packaging problem in extreme form. The use of fallback foods by omnivorous primates is part of a suite of interconnected adaptations to the packaging problem, the commingling of costs and benefits in accessing food and other vital resources. These adaptations occur at every level of biological organization. This article surveys 16 types of potential adaptations of omnivorous primates to fallback foods and the packaging problem. Behavioral adaptations, in addition to finding and feeding on fallback foods, include minimizing costs and requirements, exploiting food outbreaks, living in social groups and learning from others, and shifting the home range. Adaptive anatomical and physiological traits include unspecialized guts and dentition, binocular color vision, agile bodies and limbs, Meissner's corpuscles in finger tips, enlargement of the neocortex, internal storage of foods and nutrients, and ability internally to synthesize compounds not readily available in the habitat. Finally, during periods requiring prolonged use of fallback foods, life history components may undergo changes, including reduction of parental investment, extended interbirth intervals, seasonal breeding or, in the extreme, aborted fetuses. Am J Phys Anthropol 140:615,629, 2009. © 2009 Wiley-Liss, Inc. [source] When exactly can carpal tunnel syndrome be considered work-related?ANZ JOURNAL OF SURGERY, Issue 3 2002Sonja Falkiner Background: Carpal tunnel syndrome (CTS), compression of the median nerve at the wrist, is the most frequently encountered peripheral entrapment neuropathy. Whilst rates of all other work-related conditions have declined, the number of work-related musculoskeletal disorders (which include CTS) has not changed for the past 9 years in the USA. Median days off work are also highest for CTS: 27 compared to 20 for fractures and 18 for amputations. This results in enormous Workers Compensation and other costs to the community. Awareness of CTS as a disorder associated with repeated trauma at work is now so widespread amongst workers that many have diagnosed themselves before being medically assessed, often by means of the Internet. Surprisingly, however, a definite causal relationship has not yet been established for most occupations. Although the quality of research in this area is generally poor, CTS research studies are being used as the basis for acceptance of Workers Compensation claims, substantial expensive ergonomic workplace change and even workplace closures. The fact that the incidence of work-related musculoskeletal disorders has not changed despite these latter measures would suggest that a causal relationship is not proven and that some resources are being misdirected in CTS prevention and treatment. Method: A literature review of 64 articles on CTS was conducted. This included those articles most frequently cited as demonstrating the relationship between CTS and work. Results: Primary risk factors in the development of CTS are: being a woman of menopausal age, obesity or lack of fitness, diabetes or having a family history of diabetes, osteoarthritis of the carpometacarpal joint of the thumb, smoking, and lifetime alcohol intake. In most cases, work acts as the ,last straw' in CTS causation. Conclusion: Except in the case of work that involves very cold temperatures (possibly in conjunction with load and repetition) such as butchery, work is less likely than demographic and disease-related variables to cause CTS. To label other types of work as having caused CTS, therefore, would result in inappropriate allocation of resources. It would also relieve individuals of the responsibility of addressing correctable lifestyle factors and treatable illnesses such as obesity, diabetes, smoking and increased alcohol intake which may have contributed to their CTS more that their work. This results in both avoidable long-term health effects and ongoing costs to the community. [source] Multi-scale sampling and statistical linear estimators to assess land use status and changeAPPLIED VEGETATION SCIENCE, Issue 2 2009D. Rocchini Abstract Question: Multi-temporal analysis of remotely sensed imagery has proven to be a powerful tool for assessment and monitoring of landscape diversity. Here the feasibility of assessing land-use diversity and land-use change was tested at multiple scales and over time by means of statistical linear estimators based on a probabilistic sampling design. Location: The study area (the district of Asciano, Tuscany, Italy) is characterized by erosional forms typical of Pliocene claystone (i.e. calanchi and biancane) that have been subject to the phenomenon of biancane reworking over the past 50 years, mainly owing to the expansion of intensive agriculture. Methods: Cells at two different scales (50 m × 50 m and 10 m × 10 m) were classified by two operators according to a multilevel legend, using 1954 and 2000 aerial photographs. Inter-operator agreement and accuracy were tested by Cohen's K coefficient. Total land cover estimation for each class was carried out using a multistage estimator, while the variance was estimated by means of the Wolter estimator. Field-based information on plant species composition was recorded in order to test for a relationship between land use and plant community composition by anova and indicator species analysis. Results: Agreement between photointerpreters and accuracy were significantly higher than those expected by chance, proving that the approach proposed is reproducible, as long as proper quality assurance methods are used. Our data show that, at the two scales considered (50 m × 50 m and 10 m × 10 m), crops have increased against woodlands and semi-natural areas, the latter showing the highest and significantly different mean species richness. Meanwhile, an increase in the coverage of trees and shrubs was found within the semi-natural areas, probably as a result of secondary succession occurring on typical landscape elements such as biancane. Conclusions: Inferential statistics made it possible to acquire quantitative information on the abundance of land cover classes, allowing formal multi-temporal and multi-scale analysis. Sampling design-based statistical linear estimators were found to be a powerful tool for assessing landscape trends considering both time expenditure and other costs. They make it possible to maintain the same scale of analysis over time series data and to detect both coarse- and fine-grained changes in spatial patterns. [source] | |||||||||||||