Public perceptions on national health insurance: Moving towards universal health coverage in South Africa

Background. Since 1994, considerable progress has been made in  transforming the South African health care system, implementing  programmes that improve the health of the population, and improving  access to health care services. However, amid escalating health care costs disparities continue to exist between the public and private health sectors. The implementation of a national or social health insunmce remains elusive despite three government-appointed committees on the matter.Method and objective. This paper reports on the findings of a national probability household sample of the South African population, drawn as part of the 2005 HIV I AIDS national survey, to gauge public opinion on universal health care coverage. The perceptions of South Africans were assessed on selected health care affordability and financing issues.Results. The majority support efforts to contain medicine costs and one-third are of the opinion that the country can provide everyone with all the needed health care and medical services. A l<1rge percentage of participants thought it more important to provide improved health care coverage even if it meant raising taxes, while a small percentage said it is better to hold down taxes despite lack of access to health care for some South Africans. Almost a quarter of participants were unable to comment on questions posed to them, indicating the need for improved public  education and communication.Conclusion. The study provides important insights into public opinion on key policy issues. However, greater public awareness is needed to ensure an informed debate, while the design of a universal national health insurance scheme must take into account both the current context and public opinion

Public perceptions on national health insurance : moving towards universal health coverage in South Africa

Background. Since 1994, considerable progress has been made in transforming the South African health care system, implementing programmes that improve the health of the population, and improving access to health care services. However, amid escalating health care costs disparities continue to exist between the public and private health sectors. The implementation of a national or social health insurance remains elusive despite three government-appointed committees on the matter. Method and objective. This paper reports on the findings of a national probability household sample of the South African population, drawn as part of the 2005 HIV / AIDS national survey, to gauge public opinion on universal health care coverage. The perceptions of South Africans were assessed on selected health care affordability and financing issues. Results. The majority support efforts to contain medicine costs and one-third are of the opinion that the country can provide everyone with all the needed health care and medical services. A large percentage of participants thought it more important to provide improved health care coverage even if it meant raising taxes, while a small percentage said it is better to hold down taxes despite lack of access to health care for some South Africans. Almost a quarter of participants were unable to comment on questions posed to them, indicating the need for improved public education and communication. Conclusion. The study provides important insights into public opinion on key policy issues. However, greater public awareness is needed to ensure an informed debate, while the design of a universal national health insurance scheme must take into account both the current context and public opinion. South African Medical Journal Vol. 96(9) 2006: 814-81

Formation continue et parcours professionnels : entre aspirations des salariés et contexte de l’entreprise

« Levier déterminant de la compétitivité des entreprises », « élément structurant de la sécurisation des parcours des personnes », instrument de « liberté de choisir son avenir professionnel », la formation continue est érigée en solution privilégiée pour le marché du travail. Les enjeux de la crise ouverte par la pandémie du Covid 19 pourraient bien aussi se décliner en termes de formation continue, notamment autour des besoins de reconversion. Pourtant, concilier les besoins des entreprises avec les aspirations professionnelles des personnes ne va pas de soi. Les travaux présentés dans cet ouvrage collectif, réalisés dans le cadre du premier groupe d’exploitation du Dispositif d’enquêtes couplées sur les formations et les itinéraires des salariés (Defis), éclairent, chacun à sa façon et sous des angles variés, les multiples enjeux de la formation continue. Ils questionnent la formation des salariés en lien avec leurs aspirations et les parcours professionnels. Ils tentent également de mieux comprendre la manière dont les différentes configurations productives et le contexte des entreprises peuvent influencer leurs pratiques de formation, de recrutement et autres modes d’acquisition des compétences. Conçu comme un lieu d’échanges et de dialogue pluridisciplinaire autour des données Defis, le groupe d’exploitation a réuni des chercheurs issus du Céreq, des universités ou laboratoires CNRS et autres organismes publics. Leurs appartenances disciplinaires sont variées (économie, sociologie, gestion, sciences de l’éducation) et les méthodologies mobilisées associent parfois une approche qualitative à l’analyse des données quantitatives

Factors associated with receipt of adequate antenatal care among women in Rwanda: A secondary analysis of the 2019-20 Rwanda Demographic and Health Survey.

BackgroundEvery year, antenatal care (ANC) remains a life-saving health intervention for millions of pregnant women worldwide. Yet, many pregnant women do not receive adequate ANC, particularly in sub-Saharan Africa. The study aimed to determine the factors associated with the receipt of adequate ANC among pregnant women in Rwanda.MethodsA cross-sectional study was conducted using the 2019-2020 Rwanda Demographic and Health Survey data. The study included women aged 15-49 years who had a live birth in the previous five years (n = 6,309). Descriptive statistics and multivariable logistic regression analyses were performed.ResultsOverall, 27.6% of participants received adequate ANC. The odds of receiving adequate ANC were higher among those in the middle household wealth index (AOR 1.24; 1.04, 1.48) and rich index (AOR 1.37; 1.16, 1.61) compared to those in the poor wealth index category. Similarly, having health insurance was positively associated with receiving adequate ANC (AOR 1.33; 1.10, 1.60). The odds of receiving adequate ANC were lower among urban dwellers compared to rural (AOR 0.74; 0.61, 0.91); for women who wanted pregnancy later (AOR 0.60; 0.52, 0.69) or never wanted pregnancy (AOR 0.67; 0.55, 0.82) compared to those who wanted pregnancy; for women who perceived distance to a health facility as a big problem (AOR 0.82; 0.70, 0.96) compared to those that did not; and for women whose ANC was provided by nurses and midwives (AOR 0.63; 0.47, 0.8), or auxiliary midwives (AOR 0.19; 0.04, 0.82) compared to those who received ANC from doctors.ConclusionThe prevalence of women who receive adequate ANC remains low in Rwanda. Effective interventions to increase access and utilization of adequate ANC are urgently needed to further improve the country's maternal and child health outcomes

A Brittle Constitutive Law for Long‐Term Tectonic Modeling Based on Sub‐Critical Crack Growth

International audienceAdequate representations of brittle deformation (fracturing and faulting) are essential ingredients of long‐term tectonic simulations. Such models commonly rely on Mohr‐Coulomb plasticity coupled with prescribed softening of cohesion and/or friction with accumulated plastic strain. This approach captures fundamental properties of brittle failure, but is overly sensitive to empirical softening parameters that cannot be determined experimentally. Here we design a brittle constitutive law that captures key processes of brittle deformation, and can be straightforwardly implemented in standard geodynamic models. In our Sub‐Critically‐Altered Maxwell (SCAM) flow law, brittle failure begins with the accumulation of distributed brittle damage, which represents the sub‐critical lengthening of tensile micro‐cracks prompted by slip on pre‐existing shear defects. Damage progressively and permanently weakens the rock's elastic moduli, until cracks catastrophically interact and coalesce up to macroscopic failure. The model's micromechanical parameters can be fully calibrated against rock deformation experiments, alleviating the need for ad‐hoc softening parameters. Upon implementing the SCAM flow law in 2‐D plane strain simulations of rock deformation experiments, we find that it can produce Coulomb‐oriented shear bands which originate as damage bands. SCAM models can also be used to extrapolate rock strength from laboratory to tectonic strain rates, and nuance the use of Byerlee's law as an upper bound on lithosphere stresses. We further show that SCAM models can be upscaled to simulate tectonic deformation of a 10‐km thick brittle plate over millions of years. These features make the SCAM rheology a promising tool to further investigate the complexity of brittle behavior across scales

Prevalence of Psychoactive Substance Consumption in People With Obesity

International audienceOBJECTIVE:The aim of this study was to evaluate the prevalence and the kind of psychoactive substances consumed by people with obesity.METHODS:Patients were included at their first visit for bariatric surgery. Socio-demographic characteristics, anxiety, depressive disorders and psychoactive substance consumption were assessed. The prevalence of psychoactive substance consumption was compared to that of the general population reported by the French National Institute of Prevention and Health Education.RESULTS:One hundred (100) patients were consecutively recruited: 60 women (mean age 41 ± 14 years) and 40 men (mean age 46 ± 13 years). Sixty-seven percent of subjects consumed alcohol. Consumption rates of cannabis (21% vs. 10%), cocaine (7.0% vs. 0.8%) and amphetamine (6.0% vs. 0.3%) were significantly (p < .0001) higher in people with obesity than in the general population.CONCLUSIONS:People with obesity have an excess risk of amphetamine, cocaine and cannabis consumption. This consumption may increase the risk of cardiovascular and psychiatric morbidity and should therefore be detected before surgery

Role of Vγ9vδ2 T lymphocytes in infectious diseases

The T cell receptor Vγ9Vδ2 T cells bridge innate and adaptive antimicrobial immunity in primates. These Vγ9Vδ2 T cells respond to phosphoantigens (pAgs) present in microbial or eukaryotic cells in a butyrophilin 3A1 (BTN3) and butyrophilin 2A1 (BTN2A1) dependent manner. In humans, the rapid expansion of circulating Vγ9Vδ2 T lymphocytes during several infections as well as their localization at the site of active disease demonstrates their important role in the immune response to infection. However, Vγ9Vδ2 T cell deficiencies have been observed in some infectious diseases such as active tuberculosis and chronic viral infections. In this review, we are providing an overview of the mechanisms of Vγ9Vδ2 T cell-mediated antimicrobial immunity. These cells kill infected cells mainly by releasing lytic mediators and pro-inflammatory cytokines and inducing target cell apoptosis. In addition, the release of chemokines and cytokines allows the recruitment and activation of immune cells, promoting the initiation of the adaptive immune response. Finaly, we also describe potential new therapeutic tools of Vγ9Vδ2 T cell-based immunotherapy that could be applied to emerging infections

Follow-Up of Alcohol Consumption After Liver Transplantation: Interest of an Addiction Team?

International audienceBACKGROUND:Alcohol relapses after liver transplantation (LT) constitute a critical issue. Because there is no widely accepted definition of LT, its prevalence varies from 7 to 95% across studies. Only a severe relapse, the frequency of which is estimated to be 11 to 26%, decreases life expectancy after 5 years of LT and requires specific care. To improve the early identification of alcohol consumption among transplanted patients, liver transplant teams may be helped by input from an addiction team. Nevertheless, added benefit of involvement by addiction specialists in treating posttransplant patients has not been demonstrated. Thus, the aim of this study was to compare the evaluation of the alcohol consumption after LT performed routinely during the transplant consultation or obtained from a specific addiction consultation.METHODS:This was a prospective single-site study. Patients were seen consecutively by their hepatologist and by an addiction specialist, and they completed the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Thus, the patient's alcohol status was assessed using 3 different sources of information: the hepatologist's interview, the AUDIT-C score, and the addiction specialist visit.RESULTS:One hundred forty-one patients were consecutively evaluated. Alcohol consumption was identified by the hepatologist in 31 patients (21.9%), in 52 (36.8%) using the AUDIT-C questionnaire, and in 58 (41.1%) by the addiction specialist. The 31 patients concerned reported an average of 6.5 alcohol units/wk to the transplant physician, a number which was significantly greater (p = 0.001) by 8.6 units/wk when they were interviewed by the addiction specialist.CONCLUSIONS:This study highlights the clinical utility of a systematic addiction consultation among liver transplant patients, irrespective of the reason for transplantation

Macrophages and γδ T cells interplay during SARS-CoV-2 variants infection

International audienceIntroduction The emergence of several SARS-CoV-2 variants during the COVID pandemic has revealed the impact of variant diversity on viral infectivity and host immune responses. While antibodies and CD8 T cells are essential to clear viral infection, the protective role of innate immunity including macrophages has been recognized. The aims of our study were to compare the infectivity of different SARS-CoV-2 variants in monocyte-derived macrophages (MDM) and to assess their activation profiles and the role of ACE2 (Angiotensin-converting enzyme 2), the main SARS-CoV-2 receptor. We also studied the ability of macrophages infected to affect other immune cells such as γδ2 T cells, another partner of innate immune response to viral infections. Results We showed that the SARS-CoV-2 variants α-B.1.1.7 (United Kingdom), β-B.1.351 (South Africa), γ-P.1 (Brazil), δ-B.1.617 (India) and B.1.1.529 (Omicron), infected MDM without replication, the γ-Brazil variant exhibiting increased infectivity for MDM. No clear polarization profile of SARS-CoV-2 variants-infected MDM was observed. The β-B.1.351 (South Africa) variant induced macrophage activation while B.1.1.529 (Omicron) was rather inhibitory. We observed that SARS-CoV-2 variants modulated ACE2 expression in MDM. In particular, the β-B.1.351 (South Africa) variant induced a higher expression of ACE2, related to MDM activation. Finally, all variants were able to activate γδ2 cells among which γ-P.1 (Brazil) and β-B.1.351 (South Africa) variants were the most efficient. Conclusion Our data show that SARS-CoV-2 variants can infect MDM and modulate their activation, which was correlated with the ACE2 expression. They also affect γδ2 T cell activation. The macrophage response to SARS-CoV-2 variants was stereotypical