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Estimating the cost of smoking to the NHS in England and the impact of declining prevalence
- Christine Callum, Seán Boyle, Amanda Sandford
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- Journal:
- Health Economics, Policy and Law / Volume 6 / Issue 4 / 06 September 2011
- Published online by Cambridge University Press:
- 25 August 2010, pp. 489-508
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- Article
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Smoking cost the National Health Service (NHS) in England in 1996 an estimated £1.4–£1.7 billion. In 1998, in Smoking Kills, the Government outlined an action plan for reducing smoking prevalence. This paper estimates 2006 costs and the impact of declining prevalence. Estimates are derived from costs, service use, and attributable proportions based on current and ex-smokers’ prevalence and relative risk compared with never-smokers. Comparable 1996 costs were estimated by substituting 1996 prevalence. Smoking-attributable hospital admissions cost the NHS an estimated £1 billion in 2006, outpatient attendances cost £190 million, general practitioner (GP) consultations £530 million, practice nurse consultations £50 million and GP prescriptions £900 million; £2.7 billion in total. This represents 5% of adult hospital admission costs, 4% outpatients, 11% GP and 8% practice nurse consultations and 12% of prescription costs. Smoking accounted for 24% of respiratory disease hospital admission costs and 16% of cancer and cardiovascular disease costs (people aged ⩾35 years). The 2006 cost is estimated to be 13% lower than if smoking had remained at 1996 levels. Smoking represents a substantial cost throughout the NHS. Significant savings are associated with a reduction in prevalence, but much of this stems from an earlier phase of the smoking epidemic. Securing future such savings requires further policies to reduce smoking prevalence.
11 - Jaw adductor force and symphyseal fusion
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- By William L. Hylander, Department of Biological Anthropology and Anatomy, Duke University Medical Center, P.O. Box 3170, Durham, NC 27710, USA, Christopher J. Vinyard, Department of Biological Anthropology and Anatomy, Duke University Medical Center, P.O. Box 3170, Durham, NC 27710, USA, Matthew J. Ravosa, Department of Cell and Molecular Biology, Northwestern University Medical School, 303 East Chicago Avenue, Chicago, IL 60611, USA, Callum F. Ross, Department of Anatomical Sciences, School of Medicine, Health Sciences Center, Stony Brook University, Stony Brook, NY 11794-8081, USA, Christine E. Wall, Department of Biological Anthropology and Anatomy, Duke University Medical Center, P.O. Box 3170, Durham, NC 27710, USA, Kirk R. Johnson, Department of Biological Anthropology and Anatomy, Duke University Medical Center, P.O. Box 3170, Durham, NC 27710, USA
- Edited by Fred Anapol, University of Wisconsin, Milwaukee, Rebecca Z. German, University of Cincinnati, Nina G. Jablonski, California Academy of Sciences, San Francisco
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- Book:
- Shaping Primate Evolution
- Published online:
- 10 August 2009
- Print publication:
- 20 May 2004, pp 229-257
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Summary
Introduction
Research over the last 25–30 years has revealed a considerable amount about the basic mechanisms of mammalian mastication (e.g., van Eijden and Turkawski, 2001; Türker, 2002). This progress has been largely due to the development of new experimental procedures and techniques. On the other hand, there has been relatively little emphasis on employing these procedures and techniques so as to facilitate adaptive explanations for the evolution of the mammalian masticatory apparatus (Herring, 1993). It has been our intent over the last several years to do just that (Ross and Hylander, 1996; Hylander et al., 1998, 2000, 2002, 2003; Ravosa et al., 2000; Vinyard et al., 2001, in press a; Wall et al., 2002; Williams et al., 2003). In recent years the functional morphology of the craniofacial region of primates and other mammals has attracted a significant amount of research interest (Weijs, 1994; Ross and Hylander, 1996, 2000; Spencer, 1998; Anapol and Herring, 2000; Daegling and Hylander, 2000; Dechow and Hylander, 2000; Herring and Teng, 2000; Hylander et al., 2000; Lieberman and Crompton, 2000; Ravosa et al., 2000). This is simply because there continue to be many unanswered research questions or problems. One persistent problem that has received a considerable amount of attention is related to the adaptive significance of symphyseal fusion in mammals. As noted by many, the ossification or fusion of the left and right sides of the lower jaw or dentaries has occurred independently in many different mammalian lineages (e.g., Beecher, 1977).