Technical efficiency in primary health care: does quality matter?

The accuracy required in the measurement of output is an issue that has as yet still not been satisfactorily addressed in empirical research on efficiency in primary health care. We exploit information retrieved from a newly constructed database (APEX06) for the Spanish region of Extremadura. The richness of our dataset allows us to consider original synthetic measures of output that take into account both the quantity and the quality of services provided by 85 primary care centres (PCCs) in 2006. We provide evidence that neglecting the issue of properly accounting for the quality of health services can lead to misleading results. Our main finding is that adjusting output for quality influences efficiency analysis in three senses. First, inefficiency now explains relatively more of the deviation from the potential output. Second, the average technical efficiency in the sector is lower, while its dispersion among PCCs is significantly higher. And third, the efficiency ranking of the PCCs is also affected.Primary Health Care; Stochastic Frontier Analysis; Technical Efficiency; Quality

Technological innovations at the onset of the Mid-Pleistocene Climate Transition in high-latitude East Asia

The interplay between Pleistocene climatic variability and hominin adaptations to diverse terrestrial ecosystems is a key topic in human evolutionary studies. Early and Middle Pleistocene environmental change and its relation to hominin behavioural responses has been a subject of great interest in Africa and Europe, though little information is available for other key regions of the Old World, particularly from Eastern Asia. Here we examine key Early Pleistocene sites of the Nihewan Basin, in high-latitude northern China, dating between ∼1.4 to 1.0 million years ago (Ma). We compare stone tool assemblages from three Early Pleistocene sites in the Nihewan Basin, including detailed assessment of stone tool refitting sequences at the ∼1.1 Ma-old site of Cenjiawan. Increased toolmaking skills and technological innovations are evident in the Nihewan Basin at the onset of the Mid-Pleistocene Climate Transition (MPT). Examination of the lithic technology of the Nihewan sites, together with an assessment of other key Palaeolithic sites of China, indicates that toolkits show increasing diversity at the outset of the MPT and in its aftermath. The overall evidence indicates the adaptive flexibility of early hominins to ecosystem changes since the MPT, though regional abandonments are also apparent in high-latitudes, likely owing to cold and oscillating environmental conditions. The view presented here sharply contrasts with traditional arguments that stone tool technologies of China are homogeneous and continuous over the course of the Early Pleistocene.Introduction Results - Stone-tool-knapping skills recorded in the Cenjiawan assemblage - Technological comparisons of the Nihewan Basin assemblages Discussio

Fiscal residua and federalist reform in Italy. Will regional and redistributive policies survive?

This paper criticizes the idea to conceive the fiscal federalist reform in Italy as a tool to empower central-northern regions to retain resources otherwise wasted in the South. We argue that such a view muddles up efficiency and redistribution issues, thus threatening the legitimate inter-regional fiscal flows. To dispute the thesis of excessive transfers to Mezzogiorno regions, we first show that the regional distribution of (both current and capital) government expenditure has systematically penalized the South in the last 15 years. Secondly, for the years 2004-2006, we calculate «benchmark» regional fiscal residua, consistent with the progressive Italian personal taxation (IRPEF), and the announced targets of regional policies (45% of total capital government expenditure to be made in the South). For most centre-northern regions, the actual residua turn out to be lower than the «benchmark» ones.Mezzogiorno, redistribution, inter-governmental relations, federalism, regional development policies

Adenomyosis: Mechanisms and Pathogenesis

Adenomyosis is a common disorder of the uterus, and is associated with an enlarged uterus, heavy menstrual bleeding (HMB), pelvic pain, and infertility. It is characterized by endometrial epithelial cells and stromal fibroblasts abnormally found in the myometrium where they elicit hyperplasia and hypertrophy of surrounding smooth muscle cells. While both the mechanistic processes and the pathogenesis of adenomyosis are uncertain, several theories have been put forward addressing how this disease develops. These include intrinsic or induced (1) microtrauma of the endometrial-myometrial interface; (2) enhanced invasion of endometrium into myometrium; (3) metaplasia of stem cells in myometrium; (4) infiltration of endometrial cells in retrograde menstrual effluent into the uterine wall from the serosal side; (5) induction of adenomyotic lesions by aberrant local steroid and pituitary hormones; and (6) abnormal uterine development in response to genetic and epigenetic modifications. Dysmenorrhea, HMB, and infertility are likely results of inflammation, neurogenesis, angiogenesis, and contractile abnormalities in the endometrial and myometrial components. Elucidating mechanisms underlying the pathogenesis of adenomyosis raise possibilities to develop targeted therapies to ameliorate symptoms beyond the current agents that are largely ineffective. Herein, we address these possible etiologies and data that support underlying mechanisms

Neuro-hormonal effects of physical activity in the elderly.

Thanks to diagnostic and therapeutic advances, the elderly population is continuously increasing in the western countries. Accordingly, the prevalence of most chronic age-related diseases will increase considerably in the next decades, thus it will be necessary to implement effective preventive measures to face this epidemiological challenge. Among those, physical activity exerts a crucial role, since it has been proven to reduce the risk of cardiovascular diseases, diabetes, obesity, cognitive impairment and cancer. The favorable effects of exercise on cardiovascular homeostasis can be at least in part ascribed to the modulation of the neuro-hormonal systems implicated in cardiovascular pathophysiology. In the elderly, exercise has been shown to affect catecholamine secretion and biosynthesis, to positively modulate the renin-angiotensin-aldosterone system and to reduce the levels of plasma brain natriuretic peptides. Moreover, drugs modulating the neuro-hormonal systems may favorably affect physical capacity in the elderly. Thus, efforts should be made to actually make physical activity become part of the therapeutic tools in the elderly. © 2013 Femminella, de Lucia, Iacotucci, Formisano, Petraglia, Allocca, Ratto, DAmico, Rengo, Pagano, Bonaduce, Rengo and Ferrara

Assessment of the radiological impact of a decommissioning nuclear power plant in Italy

The assessment of the radiological impact of a decommissioning Nuclear Power Plant is presented here through the results of an environmental monitoring survey carried out in the area surrounding the Garigliano Power Plant. The levels of radioactivity in soil, water, air and other environmental matrices are shown, in which {\alpha}, {\beta} and {\gamma} activity and {\gamma} equivalent dose rate are measured. Radioactivity levels of the samples from the Garigliano area are analyzed and then compared to those from a control zone situated more than 100 km away. Moreover, a comparison is made with a previous survey held in 2001. The analyses and comparisons show no significant alteration in the radiological characteristics of the area surroundings the plant, with an overall radioactivity depending mainly from the global fallout and natural sources

Assessment of the radiological impact of a decommissioning nuclear power plant in Italy

The assessment of the radiological impact of a decommissioning Nuclear Power Plant is presented here through the results of an environmental monitoring survey carried out in the area surrounding the Garigliano Power Plant. The levels of radioactivity in soil, water, air and other environmental matrices are shown, in which {\alpha}, {\beta} and {\gamma} activity and {\gamma} equivalent dose rate are measured. Radioactivity levels of the samples from the Garigliano area are analyzed and then compared to those from a control zone situated more than 100 km away. Moreover, a comparison is made with a previous survey held in 2001. The analyses and comparisons show no significant alteration in the radiological characteristics of the area surroundings the plant, with an overall radioactivity depending mainly from the global fallout and natural sources.Comment: 13 pages, 6 figures, 2 table