Inequalities in reproductive, maternal, newborn and child health in Vietnam: a retrospective study of survey data for 1997-2006

Background: Vietnam has achieved considerable success in economic development, poverty reduction, and health over a relatively short period of time. However, there is concern that inequalities in health outcomes and intervention coverage are widening. This study explores if inequalities in reproductive, maternal, newborn and child health and nutrition changed over time in Vietnam in 1997-2006, and if inequalities were different depending on the type of stratifying variable used to measure inequalities and on the type of outcome studied. Methods: Using data from four nationally representative household surveys conducted in 1997-2006, we study inequalities in reproductive, maternal, newborn and child health and nutrition outcomes and intervention coverage by computing concentration indices by living standards, maternal education, ethnicity, region, urban/rural residence, and sex of child. Results: Inequalities in maternal, newborn and child health persisted in 1997-2006. Inequalities were largest by living standards, but not trivial by the other stratifying variables. Inequalities in health outcomes generally increased over time, while inequalities in intervention coverage generally declined. The most equitably distributed interventions were family planning, exclusive breastfeeding, and immunizations. The most inequitably distributed interventions were those requiring multiple service contacts, such as four or more antenatal care visits, and those requiring significant support from the health system, such as skilled birth attendance. Conclusions: Three main policy implications emerge. First, persistent inequalities suggest the need to address financial and other access barriers, for example by subsidizing health care for the poor and ethnic minorities and by support from other sectors, for example in strengthening transportation networks. This should be complemented by careful monitoring and evaluation of current program design and implementation to ensure effective and efficient use of resources. Second, greater inequalities for interventions that require multiple service contacts imply that inequalities could be reduced by strengthening information and service provision by community and village health workers to promote and sustain timely care-seeking. Finally, larger inequalities for interventions that require a fully functioning health system suggest that investments in health facilities and human resources, particularly in areas that are disproportionately inhabited by the poor and ethnic minorities, may contribute to reducing inequalities

The Axl-Regulating Tumor Suppressor miR-34a Is Increased in ccRCC but Does Not Correlate with Axl mRNA or Axl Protein Levels

High expression of the receptor tyrosine kinase Axl is associated with poor prognosis in patients with Renal Cell Carcinoma (RCC), the most common malignancy of the kidney. The miR-34a has been shown to directly regulate Axl in cancer cells. The miR-34a is a mediator of p53-dependent tumor suppression, and low expression of miR-34a has been associated with worse prognosis in several cancers. Our aim was to elucidate whether miR-34a or the other members of the miR-34 family (miR-34b/c) regulate Axl in RCC

Towards the acoustic estimation of jellyfish abundance

Acoustic target strengths (TSs) of the 2 most common large medusae, Chrysaora hysoscella and Aequorea aequorea, in the northern Benguela (off Namibia) have previously been estimated (at 18, 38 and 120 kHz) from acoustic data collected in conjunction with trawl samples, using the ‘comparison method’. These TS values may have been biased because the method took no account of acoustic backscatter from mesozooplankton. Here we report our efforts to improve upon these estimates, and to determine TS additionally at 200 kHz, by conducting additional sampling for mesozooplankton and fish larvae, and accounting for their likely contribution to the total backscatter. Published sound scattering models were used to predict the acoustic backscatter due to the observed numerical densities of mesozooplankton and fish larvae (solving the forward problem). Mean volume backscattering due to jellyfish alone was then inferred by subtracting the model-predicted values from the observed water-column total associated with jellyfish net samples. Zooplankton-corrected echo intensity/jellyfish density data pairs were in close agreement with linear relationships determined previously from uncorrected data. Small sample sizes precluded recalculation of TS, but nonparametric pair-wise tests failed to detect any significant differences between echo intensities for jellyfish densities observed in the present study and echo intensities predicted for those densities by density–intensity relationships arising from the previous study. Previous linear density–intensity relationships had y-axis intercepts greater than zero. On the assumption that the positive intercepts were due to backscatter from unsampled mesozooplankton, new TS relationships were calculated from downward-adjusted density–intensity relationships. New values agreed closely with TS estimates determined elsewhere using single-target echo detection techniques. Given that estimates of jellyfish TS appear robust, it should now be feasible to identify jellyfish acoustically at sea and to assess their abundance, even in the presence of mixed mesozooplankton assemblages