What Do the Bingers Drink? Microeconometric Evidence on Negative Externatilities of Alcohol Consumption by Beverage Types

The recent debate on alcohol tax reform and recommendations from the Henry Tax Review in Australia have highlighted the need for quantifying externalities of excessive alcohol consumption by beverage types. This paper presents micro-level information from the Australian National Drug Strategy Household Surveys to examine the association between risky drinking behaviour, drinker characteristics, health and labour market status, and types of alcohol beverages consumed. Drinkers of regular strength beer (RSB) and RTDs in a can (RTDC) have the highest incidences of heavy bingeing, and low alcohol beer and fortified and bottled wine least likely. Bottled spirits (BS), RSB and RTDC are most likely linked to risky behaviour such as property damage and physical abuse under alcohol influence. All three spirit products are overwhelmingly the favourable drinks for the underage and young drinkers. Risky drinking behaviour is not found to be strictly associated with the alcohol strength of the products.Alcohol consumption, alcohol tax, binge drinking, beer, wine and spirits

"Neither we are satisfied nor they"-users and provider's perspective: a qualitative study of maternity care in secondary level public health facilities, Uttar Pradesh, India.

BACKGROUND: Quality of care provided during childbirth is a critical determinant of preventing maternal mortality and morbidity. In the studies available, quality has been assessed either from the users' perspective or the providers'. The current study tries to bring both perspectives together to identify common key focus areas for quality improvement. This study aims to assess the users' (recently delivered women) and care providers' perceptions of care to understand the common challenges affecting provision of quality maternity care in public health facilities in India. METHODS: A qualitative design comprising of in-depth interviews of 24 recently delivered women from secondary care facilities and 16 health care providers in Uttar Pradesh, India. The data were analysed thematically to assess users' and providers' perspectives on the common themes. RESULTS: The common challenges experienced regarding provision of care were inadequate physical infrastructure, irregular supply of water, electricity, shortage of medicines, supplies, and gynaecologist and anaesthetist to manage complications, difficulty in maintaining privacy and lack of skill for post-delivery counselling. However, physical access, cleanliness, interpersonal behaviour, information sharing and out-of-pocket expenditure were concerns for only users. Similarly, providers raised poor management of referral cases, shortage of staff, non-functioning of blood bank, lack of incentives for work as their concerns. DISCUSSION: The study identified the common themes of care from both the perspectives, which have been foundrelevant in terms of challenges identified in many developing countries including India. The study framework identified new themes like management of emergencies in complicated cases, privacy and cost of care which both the group felt is relevant in the context of providing quality care during childbirth in low resource setting. The key challenges identified by both the groups can be prioritized, when developing quality improvement program in the health facilities. The identified components of care can match the supply with the demand for care and make the services truly responsive to user needs. CONCLUSION: The study highlights infrastructure, human resources, supplies and medicine as priority areas of quality improvement in the facility as perceived by both users and providers, nevertheless the interpersonal aspect of care primarily reported by the users must also not be ignored

Intensity-Modulated Radiation Therapy (IMRT) Versus Rapidarc in the Treatment of Carcinoma Left Breast – Finding the Optimal Radiation Therapy Technique

Introduction: This study aimed to evaluate the dosimetric variations and treatment efficacy between intensity-modulated radiotherapy (IMRT) and double-arc RapidArc for irradiation of carcinoma left breast, focusing on adequate target coverage, sparing of organs at risk (OARs), delivered monitor units (MUs) per fraction, and treatment delivery time.Material and Methods: This prospective, observational study was conducted on 30 patients with carcinoma left breast. All these patients were treated with adjuvant radiation therapy.  We generated two plans for each of these patients: IMRT and double-arc RapidArc technique. The target volume and OARs were analyzed using dose-volume histograms (DVHs). The average MUs and the treatment time were used as markers to assess the efficacy of treatment delivery.Results: The planning target volume parameters such as homogeneity and conformity index were similar for all the plans with both techniques. With IMRT, statistically significantly better sparing of I/L lung, heart, C/L breast, C/L lung, and esophagus were achieved as compared to RapidArc. We found that RapidArc resulted in significantly lower MUs (535.05 ± 105.42) than IMRT (913.57 ± 129.35). Treatment delivery time was statistically shorter with RapidArc as compared to IMRT (p=0.001). Conclusion: This study concluded that both IMRT and RapidArc plans have similar target coverage in terms of homogeneity and conformality indexes. Better OARs sparing was noticed with IMRT while RapidArc enabled higher efficacy with lower MUs and shorter treatment delivery time. However, further studies are needed to establish these dosimetric advantages being translated to improvements in the clinical outcomes of these patients

Does bingeing affect earnings?

While excessive drinking is associated with lower earnings through adverse health effects, absenteeism and low productivity, moderate alcohol consumption has been argued to generate positive wage effects. These positive wage premiums are usually expected to arise from the social effect of drinking and the benefcial health consequences of drinking in moderation. Using unit-record data from the Australian National Drug Strategy Household Survey, this paper examines the impact of drinking patterns on individuals’ earnings, controlling for selectivity bias driven by the endogenous relationship between drinking and earnings. In particular, a Multinomial Logit Selectivity model is estimated for four drinking statuses. This study shows that frequent bingeing is associated with reduced earnings whilst non bingers and occasional bingers earn a positive premium over abstainers. Further, a decomposition of the earnings differentials indicates that, across various occupations, abstainers are at least as, if not more, ‘productive’ than drinkers and frequent bingers are less ‘productive’ than non bingers and occasional bingers

Management of lung cancer brain metastasis: An overview

With the improvements in systemic treatment for lung cancer, distant metastasis to sanctuary sites such as brain has become an increasingly more important issue. The management of these patients consists of supportive care and disease-directed treatment. Combined modality treatment (surgical resection or radiosurgery, followed by whole brain radiotherapy) of brain metastases has greatly improved the local control of disease in patients with single lesion, good functional performance status, and controlled extracranial disease as demonstrated in prospective randomized studies. For patients with multiple brain metastases, conventional fractionated whole brain radiotherapy continues to be a standard and efficacious treatment. At present, experience with the use of molecularly targeted tyrosine kinase inhibitors in nonsmall cell lung cancer patients with activating mutations in the epidermal growth factor receptor gene and anaplastic lymphoma kinase gene is growing. However, their effectiveness in patients with brain metastases is not well established. In the arena of targeted therapies, vascular endothelial growth factor pathway inhibitors such as bevacizumab have shown some activity in brain metastases. Further prospective studies are necessary to facilitate selection of patient subpopulation for targeted agents in future studies

Disaggregated econometric estimation of consumer demand response by alcoholic beverage types

The paper presents estimates of price elasticities of demand for 12 disaggregated alcoholic beverages in Australia: premium beer, full strength beer, low alcohol beer and mid-strength beer; red bottled wine, white bottled wine, sparkling wine, cask wine; dark and light ready-to-drink (RTD); and dark and light spirits. These disaggregated categories correspond closely to the commodities of interest to public policymakers with respect to taxation and health policies. The system of demand equations is estimated with Nielsen’s data using a semiflexible Almost Ideal Demand System model in order to impose negative semi-definiteness on the demand parameters. Results indicate elastic own-price elasticities for virtually all commodities. Cross-price elasticities suggest that beverages most linked with negative externalities, namely full strength beer, dark RTD and dark spirits, may need to be taxed jointly. Any proposed tax increase to cask wine may also result in consumers shifting demand to more undesirable beverages. The elasticity estimates are used to illustrate the effect of a hypothetical change towards taxation equalisation based on alcohol content. These elasticities offer crucially needed inputs for analysing any tax change policies