Redirecting resources to community based services : a concept paper

A legacy of the command economy in Central and Eastern Europe and the former Soviet Union is a social protection system that emphasizes institutional care for vulnerable individuals. It has been well established that in many cases institutionalization can be more expensive per client served and produce inferior welfare outcomes than more inclusive approaches designed to support individuals within their families and communities. But countries seeking to change the model of services face a number of financial constraints, including redirecting resources away from institutions. How can countries develop the new programs in an affordable manner? How should they change the financing flows to support the new options, without putting the burden of financing on the vulnerable themselves? The objective of this paper is to provide a framework to help countries re-orient their financing systems for social care. The paper first reviews key concepts in social care financing and then applies them to the problem of changing social care models in ECA countries.Banks&Banking Reform,Public Sector Economics,Health Economics&Finance,Environmental Economics&Policies,Governance Indicators

Time course of bone loss in patients with anorexia nervosa

Objective: To evaluate the time course of bone mineral density (BMD) in women with anorexia nervosa (AN) during two years of follow-up. Methods: We prospectively studied 51 female with AN aged 18-38 years, and forty age-matched healthy women (19-34 years). BMD was measured in lumbar spine (LS), femoral neck (FN) and total hip (TH) by DXA. Results: At baseline, weight, body mass index, and lumbar and hip BMD were significantly (p<0.001) lower in AN patients than in controls. Patients who gain weight showed a significant increase in BMD at FN (+1.6%; p<0.05), and TH (+4.4%; p<0.05) and lower non significant changes in LS (+1.3%). Weight at entry, and percent change of weight were significant determinants (p<0.05) of the variability in percent change of BMD at FN and TH, whereas weight at entry was the main determinant of bone modifications at lumbar spine. Conclusions: Our data emphasize the influence of weight gain in recovery of bone mass in AN patients, especially at the hip

Factors accounting for the association between anxiety and depression, and eczema: the Hordaland health study (HUSK)

<p>Abstract</p> <p>Background</p> <p>The association between anxiety and depression, and eczema is well known in the literature, but factors underlying this association remain unclear. Low levels of omega-3 fatty acids and female gender have been found to be associated with both depression and eczema. Somatization and health anxiety are known to be associated with anxiety and depression, further, somatization symptoms and health anxiety have also been found in several dermatological conditions. Accordingly, omega-3 fatty acid supplement, female gender, somatization and health anxiety are possible contributing factors in the association between anxiety and depression, and eczema. The aim of the study is to examine the relevance of proposed contributing factors for the association between anxiety and depression, and eczema, including, omega-3 fatty acid supplement, female gender, health anxiety and somatization.</p> <p>Methods</p> <p>Anxiety and depression was measured in the general population (n = 15715) employing the Hospital Anxiety and Depression Scale (HADS). Information on eczema, female gender, omega-3 fatty acid supplement, health anxiety and somatization was obtained by self-report.</p> <p>Results</p> <p>Somatization and health anxiety accounted for more than half of the association between anxiety/depression, and eczema, while the other factors examined were of minor relevance for the association of interest.</p> <p>Conclusions</p> <p>We found no support for female gender and omega-3 fatty acid supplement as contributing factors in the association between anxiety/depression, and eczema. Somatization and health anxiety accounted for about half of the association between anxiety/depression, and eczema, somatization contributed most. The association between anxiety/depression, and eczema was insignificant after adjustment for somatization and health anxiety. Biological mechanisms underlying the mediating effect of somatization are yet to be revealed.</p