The chicken or the egg? Endogeneity in labour market participation of informal carers in England

Around 14% of the UK labour force has informal care responsibilities and almost everyone in society will be an informal carer in their lifetime. A well-known fact in the small economic literature on informal care is the apparent negative relation between care responsibilities and labour market participation. Yet, caring and labour market participation may be endogenous. Using an instrumental variable approach and panel data techniques and employing data from the British Household Panel Study from 1991 to 2002, this paper shows that not accommodating for endogeneity in the labour market participation equation may significantly overestimate the impact care exhibits on the employment decision of informal carers. Moreover, it is shown that a negative impact on employment only applies to some care-types. Policy implications are derived.     

The pharmaceutical industry in scandal: Mercury or Aesculapius?

During the last decade public sympathy for the pharmaceutical industry has gradually been eroded because of excessive protectionism and profit margins. Its reputation as a healthy, profitable and prosperous industry has recently been seriously damaged by several errors of judgement. Data from early trials proved to be less positive than expected. The responsible drug manufacturers decided to cover the results up. So far the pharmaceutical industry has managed to weather the criticism, but recently a multitude of damaging data was published by an unexpected outsider. Angell, a former editor in chief of one of the most respected, peer-reviewed medical journals in the world, the New England Journal of Medicine, decided to collect such data and to analyze them critically. She also used this analysis to draw up recommendations for improving of what she regarded as an unhealthy situation. The book gained bestseller status on the American market and received much praise from reviewers. Although quickly denounced by the industry as controversial and excessively negative, it contains a lot of data, opinions and conclusions that also apply directly to the European situation.     

Testing for Helicobacter pylori in primary care: trouble in store?

STUDY OBJECTIVE: To assess the role of testing for Helicobacter pylori in the management of dyspeptic patients in primary care. DESIGN: Selective review of literature frequently quoted to support use of H pylori testing. MAIN RESULTS: Testing for H pylori and referral of only positive cases for endoscopy aims to reduce the number of "unnecessary" endoscopies. Patients with negative results may receive short-term reassurance and subsequently place fewer demands on health services. However, studies to date have only assessed this practice in secondary care settings. Given the relatively high prevalence of both dyspepsia and H pylori infection, the transfer of this practice to primary care may lead to a paradoxical increase in endoscopy referrals. Identification of H pylori and prescribing of eradication treatment also aims to reduce endoscopy referrals. No primary care trials have yet assessed this approach. Given that fewer than one in four of dyspeptic patients have peptic ulceration, a high proportion may fail to respond to eradication treatment and subsequently require referral for endoscopy. The longer term clinical and psychosocial sequelae of treating or labelling patients with an infection associated with gastric cancer remain unknown. CONCLUSIONS: Given uncertainty concerning the possible adverse effects of H pylori testing in primary care, we suggest a moratorium on its use in this setting until results from relevant clinical trials become available.

 

     

The sick building syndrome: a chicken and egg situation?

Objectives: To examine the temporal relationship and specificity between self-reports on the indoor environment at work and symptoms that are traditionally connected with the sick building syndrome (SBS). Methods: This questionnaire study used a prospective full panel design as regards self-reports on exposure and outcome. At the baseline, the sample comprised 2,164 adults selected randomly from the general population. Of these 1,402, who were still working and living in the same place, completed a second questionnaire a year later. Health measures were symptoms that are traditionally connected with the SBS, as well as some “dummy” symptoms that hardly can be causally related to the indoor environment. The associations between self-reports on the indoor environment and these symptom groups were assessed both in cross-sectional and longitudinal analyses, the latter examining the normal direction that exposure leads to symptoms as well as the reverse order: that symptoms lead to perceived exposure. Results: In cross-sectional analyses, the indoor environment factors were associated equally with SBS symptoms and with “dummy” symptoms. In longitudinal analyses, only few of the indoor environment factors predicted the development of any of the symptom groups. However, both the SBS symptoms and the “dummy” symptoms were risk factors for beginning to report exposures in the indoor environment. Conclusions: Symptoms predict future reports on exposures in the indoor environment indicating that it is difficult to determine what existed first: the outcome or the exposure. In addition, the perceived indoor environment is associated not only with the traditional SBS symptoms, but also with symptoms that cannot be physiologically linked to the indoor environment. These results suggest that there is a risk of reporting bias when assessing non-specific symptoms. Thus, many of the associations found in previous cross-sectional studies on SBS symptoms and indoor environment factors may possibly be explained by reporting bias.     

The role of clinical engineers in hospitals: essential or expedient?

This article explores the capabilities of those technicians and clinical engineers who manage biomedical equipment. Equipment technicians maintain the equipment in hospitals and may participate in some basic equipment management. Clinical engineers, on the other hand, may augment this management effort in equipment-intensive hospitals by designing the specifications and procedures needed to integrate equipments into properly working systems and to maintain them under local conditions. In addition, clinical engineers can improve equipment management by providing an engineering viewpoint to such areas as technology assessment, computer applications, quality improvement, and in-service education.     

The closure of rural hospitals in Saskatchewan: method or madness?

On April 14, 1993 the Minister of Health of the Province of Saskatchewan announced the closure of 52 of the 112 small hospitals using the criteria of: size, utilization for two consecutive years and distance to the nearest-neighbouring hospital. Amazingly, that government was re-elected. This study compared two models of reasons for hospital closure: the government criteria; and historical population, resource, and utilization factors, gathered for the year prior to closure and a decade earlier. Of the 112 small hospitals in Saskatchewan, the 10 hospitals in the frontier area were not included. Hospitals in the settled part of the province were divided into two distinct zones. The Northern zone, with 53 hospitals is characterized by rich dark soil and prosperous trade centres and the Southern zone, with 49 hospitals is characterized by light brown sandy soil and oil and gas exploration centres. Two discriminant models were developed. The government model consisted of size, two years of utilization and distance. The historical model consisted of population, resource, and utilization factors for the years 1981/1982 and 1991/1992. The dependent variable for both models was hospital status (open = 1 and closed = 0). The government model accurately predicted 91.18% of the closure decisions. The historical model had a classification accuracy of 95.10% for the whole of settled Saskatchewan, 96.23% for the Northern zone, and 95.92% for the Southern zone. The historical model was more accurate than the government model. Closing a hospital is a sad event. The manner in which the government closed nearly half of the small hospitals in Saskatchewan and gained re-election is an important account of responsible public policy. The historical model developed to examine this story takes public policy one step further in that it is possible for governments to recognize signals that indicate when communities should undertake orderly transitions in the operation of their health services facilities.     

What goes wrong at a disaster or major incident?

From a receiving hospital's perspective a major incident is 'an accident about to happen'. The potential for chaos is present at every phase. This short paper describes in a chronological fashion the common traps and pitfalls and how to avoid them.     

The preterm infant: Breast or bottle?

The long term survival of preterm infants has greatly improved in the last decade. Clinicians have consequently been able to concentrate more on their optimal nutrition and this has led to a controversy regarding the best milk for these infants. Current theory and practice suggests that the fastest growth and the best energy retention is obtained if a highly modified preterm formula milk is used. Banked mature human breast milk appears nutritionally inadequate and has no proven advantages. The use of fresh mothers' own milk merits further investigation, although its widespread use will usually be impractical.     

Converging skills in healthcare: The perfect storm or the perfect opportunity?

This editor's letter was completed before hurricane Sandy made landfall and her destruction was known. Our hearts go out to those who have suffered losses from the storm and we remember you in our thoughts and prayers.     

The Medical Ethics Committee: dinosaur or phoenix?

Just when managed care is forcing providers to confront new ethical dilemmas, ethics committees are preoccupied with formal compliance programs. A proposal for renewal.     

The new reproductive technology: problem or solution?

New reproductive technologies, such as in vitro fertilisation, have been the subject of heated debate among academics, medical ethicists and policy makers. This paper examines the literature of physicians, infertile consumers of the technology and feminist critics, and argues that differences in the meaning of procreation are at the root of the debate. Physicians see it as a sphere of professional intervention; consumers focus on genetic transmission; and feminist critics see procreation as a locus for struggle over women's autonomy. Given these different meanings of procreation, empirical data and logical arguments will not resolve the conflict over reproductive technology.