Involvement of Ministries of Health in Health Service Coverage Decisions: Is England an Aberrant Case?

This article examines the involvement of ministries of health in making health service coverage decisions in Denmark, England, France and Germany. The study aims to inform debate in England about the feasibility of reducing perceived ministerial and bureaucratic ‘interference’ in decisions affecting the National Health Service, based on interviews with senior government officials and other health system stakeholders. Ministries of health differ in their involvement in health system governance and coverage decisions (‘the benefits package’), reflecting differences in institutional arrangements. In all four countries, organizations at arm's length or independent from government are either involved in providing technical advice to the ministry of health or have been mandated to take these decisions themselves. However, ministries of health occasionally intervene in the decision‐making process or ignore the advice of these organizations. The Department of Health in England is not an aberrant case, at least in relation to coverage decisions. Indeed, ministries of health in Denmark and France play a larger role in making these decisions. Public pressure, often amplified by the media, is a shared reason for ministerial and ministry involvement in all four countries. This dynamic may thus limit the feasibility of attempts to further separate the NHS from both the Department of Health and wider political pressures.     

Identifying the most successful dose (MSD) in dose-finding studies in cancer

For a dose finding study in cancer, the most successful dose (MSD), among a group of available doses, is that dose at which the overall success rate is the highest. This rate is the product of the rate of seeing non-toxicities together with the rate of tumor response. A successful dose finding trial in this context is one where we manage to identify the MSD in an efficient manner. In practice we may also need to consider algorithms for identifying the MSD which can incorporate certain restrictions, the most common restriction maintaining the estimated toxicity rate alone below some maximum rate. In this case the MSD may correspond to a different level than that for the unconstrained MSD and, in providing a final recommendation, it is important to underline that it is subject to the given constraint. We work with the approach described in O'Quigley et al. [Biometrics 2001; 57(4):1018-1029]. The focus of that work was dose finding in HIV where both information on toxicity and efficacy were almost immediately available. Recent cancer studies are beginning to fall under this same heading where, as before, toxicity can be quickly evaluated and, in addition, we can rely on biological markers or other measures of tumor response. Mindful of the particular context of cancer, our purpose here is to consider the methodology developed by O'Quigley et al. and its practical implementation. We also carry out a study on the doubly under-parameterized model, developed by O'Quigley et al. but not     

A parallel analysis of individual and ecological data on residential radon and lung cancer in south-west England

Parallel individual and ecological analyses of data on residential radon have been performed using information on cases of lung cancer and population controls from a recent study in south-west England. For the individual analysis the overall results indicated that the relative risk of lung cancer at 100 Bq m⁻³ compared with at 0 Bq m⁻³ was 1.12 (95% confidence interval (0.99, 1.27)) after adjusting for age, sex, smoking, county of residence and social class. In the ecological analysis substantial bias in the estimated effect of radon was present for one of the two counties involved unless an additional variable, urban–rural status, was included in the model, although this variable was not an important confounder in the individual level analysis. Most of the methods that have been recommended for overcoming the limitations of ecological studies would not in practice have proved useful in identifying this variable as an appreciable source of bias.     

Revisiting the model of creative destruction: St. Jacobs,Ontario, a decade later

Ten years ago, the model of creative destruction was developed to predict the fate of communities that base their development on the commodification of rural heritage (Mitchell, C.J.A., 1998. Entrepreneurialism, commodification and creative destruction: a model of post-modern community development. Journal of Rural Studies 14, 273–286). Its application to the village of St. Jacobs, Canada, demonstrated that entrepreneurial investment had fostered the creation of a setting for aestheticized consumption. In this paper we demonstrate that creative destruction has continued to unfold in the village over the course of the past decade. The evolutionary path taken is assessed in light of current literature on rural space. It is concluded that to fully understand the transformative process, one must integrate the demands of myriad sub-cultures, whose social relations, ideologies and actions will contribute to the development of a contested landscape of consumption. This finding necessitates that modifications be made to the model and its various stages. The most significant is recognition that the “heritage-scape” is an interim state of landscape change; one that displaces the productivist landscape of the industrial period, and precedes the creation of the “neo-productivist” leisure-scape of post-industrialism. Whether or not such a “final” state is achieved is dictated by the power struggle that inevitably arises amongst sub-cultures engaged in the transformation of rural space.     

Cell Phone Survey Feasibility in The U.S.: Sampling and Calling Cell Numbers Versus Landline Numbers

In 2004, we conducted a nationwide dual frame survey of landlineand cell phone numbers to evaluate the feasibility of includingcell phone numbers in a random digit dial telephone survey.Households with both landline and cell phones were eligiblefor selection in both samples. This article describes our designand data collection methods; compares the results from the twosamples (with an emphasis on operational characteristics); andpresents the outcomes of two experimental manipulations designedto improve the cell phone response rate.     

Assessing the Playing Field: A Prospective Longitudinal Study of Internet Sports Gambling Behavior

Internet gambling is growing rapidly, as is concern about its possible effect on the public’s health. This paper reports the results of the first prospective longitudinal study of actual Internet sports gambling behavior during eight study months. Data include recorded fixed-odds bets on the outcome of sporting contests and live-action bets on the outcome of events within contests for 40,499 Internet sports gambling service subscribers who enrolled during February 2005. We tracked the following primary gambling behaviors: daily totals of the number of bets made, money bet, and money won. We transformed these variables into measures of gambling involvement. We analyzed behavior for both fixed-odds and live-action bets. The median betting behavior of the 39,719 fixed-odds bettors was to place 2.5 bets of €4 (approximately $5.3 US) every fourth day during the median 4 months from first to last bet. This typical pattern incurred a loss of 29% of the amount wagered. The median betting behavior of the 24,794 live-action bettors was to place 2.8 wagers of €4 every fourth day during the median duration of 6 weeks at a loss of 18% of the amount wagered. We also examined the behavior of empirically determined groups of heavily involved bettors whose activity exceeded that of 99% of the sample.     

Is Work-Family Policy Use Related to the Gendered Division of Housework?

Researchers have proposed that work-family policy use may either reinforce or challenge the existing gendered division of labor within couples, but results from prior studies have been inconclusive. Using data from a regional survey of work and family life, we extend this research by focusing on how housework is divided within couples and by differentiating between traditionally female- and male- typed housework tasks. Results show that among dual-earning women, policy use is not related to share of female- or male-typed tasks. Among dual-earning men, policy use is positively related to share of female-typed tasks and negatively related to share of male-typed tasks. These findings suggest that work-family policy use does not reinforce the gendered division of housework.