Search

Child mortality rates (0–4 years) between 1979 and 2010 and poverty were shown to be significantly worse in five of the six English-speaking countries than in the other 15 western nations suggesting that in these countries children are relatively disadvantaged.

Objectives To test the hypothesis that the USA healthcare system was superior to the NHS and 17 other Western countries in reducing feasible mortality rates over the period 1979–2005. Design Economic inputs into healthcare, GDP health expenditure (GDPHE) were compared with clinical outputs, i.e. total ‘adult’ (15–74 years) and ‘older’ (55–74 years) mortality rates based upon three-year average mortality rates for 1979–81 vs. 2003–2005. A cost-effective ratio was calculated by dividing average GDPHE into reduced mortality rates over the period. Setting Nineteen Western countries’ mortality rates compared between 1979–2005. Participants Mortality of people by age and gender. Main outcome measures A cost-effective ratio to measure efficiency and effectiveness of healthcare systems in reducing mortality rates. Chi-square tested any differences between the USA, UK and other Western countries. Results Input: The USA had the highest current and average GDPHE; the UK was 10th highest but joint 16th overall, still below the Western countries’ average. Output: Every country's mortality rate fell substantially; but 15 countries reduced their mortality rates significantly more than the US, while UK ‘adult’ and ‘older’ mortality rates fell significantly more than 12 other countries. Cost-effectiveness: The USA GDPHE: mortality rate ratio was 1:205 for ‘adults’ and 1:515 for ‘older’ people, 16 Western countries having bigger ratios than the US; the UK had second greatest ratios at 1:593 and 1:1595, respectively. The UK ratios were >20% larger than 14 other countries. Conclusions In cost-effective terms, i.e. economic input versus clinical output, the USA healthcare system was one of the least cost-effective in reducing mortality rates whereas the UK was one of the most cost-effective over the period.

Background Intradermal capsaicin is a human pain model that produces reliable pain and sensitization. This model facilitates controlled testing of analgesic efficacy via a crossover design while minimizing confounding variables in clinical pain states and retaining sufficient power with small samples. Methods To determine the lowest dose of capsaicin that produces consistent neurosensory measures, we administered 0.1, 1, 10, or 100 μg to healthy volunteers in a blinded manner ( N = 19). Pain scores were recorded at 0, 5, 10, 15, and 60 minutes on a visual analog scale from 0 to 100. Areas and intensities of mechanical allodynia (foam brush stimulus) and pinprick hyperalgesia (von Frey test) were quantified at 15 and 60 minutes, as were flare areas. Results Capsaicin produced dose-dependent increases in spontaneous pain ( p = .013), the area and intensity of mechanical allodynia ( p = .006 and p < .001, respectively), the area and intensity of pinprick hyperalgesia ( p = .010 and p = .014, respectively), and the flare area ( p = .010). The 10 μg dose produced greater spontaneous pain than the 1 μg dose ( p = .017). The 100 μg dose produced greater spontaneous pain than the 10 μg, but the difference was not statistically significant. Conclusion The 10 and 100 μg capsaicin doses produced robust pain measures across a range of modalities, and lower doses produced minimal effects. Whereas most studies use 100 μg, using a lower dose is reasonable and may facilitate detection of subtle analgesic effects—particularly with nonopioid analgesics—and drugs can be tested in lower doses, minimizing adverse side effects.

Objective Every Western nation expends vast sums on health, especially for cancer; thus, the question is how efficient is the UK in reducing adult (55–74) cancer mortality rates and total mortality rates (TMR) compared to the other Western nations in the context of economic-input to health, the percentage of Gross-Domestic-Product-expenditure-on-Health. Design WHO mortality rates for baseline 3 years 1989–1991 and 2008–2010 were analysed, and confidence intervals determine any significant differences between the UK and other countries in reducing the mortalities. Efficiency ratios are calculated by dividing reduced mortality over the period by the average % of national income. Setting Twenty-one similar socio-economic Western countries. Participants The 21 countries’ general population. Main outcome measures Cancer mortality rates, total mortality rates Gross Domestic Product and Efficiency Ratios. Results Economic Input: In 1980, UK national income was 5.6% and the European average was 7.1%. By 2010, UK national income was 9.4% being equal 17th of 21 averaging 7.1% over the period. Europe’s 1980–2010 average of 8.4% yields a UK to Europe ratio of 1:1.18. Clinical output 1989–2010: UK Cancer Mortality Rates was the sixth highest, but equal sixth biggest fall, significantly greater than 14 other countries. UK Total Mortality Rates was the fifth highest but third biggest decline, significantly greater than 17 countries. UK’s cancer Efficiency Ratios is largest at 1:301 and second biggest for Total Mortality Rates at 1.1341; the USA ratios were 1:152 and 1:525, respectively. Conclusions UK reduced mortalities indicate that the NHS achieves proportionally more with relatively less, but UK needs to match European average Gross-Domestic-Product-expenditure-on-Health to meet future challenges.