Системы здравоохранения в действии: Кыргызстан

Система здравоохранения Кыргызстана предоставляет гарантированный государством пакет услуг, однако существуют значительные пробелы в охвате населения, а объем финансируемой государством помощи ограничен. Большинство пациентов вынуждены вносить сооплату за стационарное лечение, в то время как государство покрывает всего 50% так называемой базисной цены ограниченного списка (около 70) лекарственных средств. Государственные расходы на здравоохранение сократились, при этом увеличивается доля государственных расходов, направляемых в другие сектора. Частные расходы заполнили образовавшийся дефицит финансирования, и в настоящее время чуть более половины расходов на здравоохранение оплачивается из собственных средств. Сильная зависимость от платежей из собственных средств граждан может привести к катастрофическим и разорительным расходам на здравоохранение. Текущие реформы в области управления государственными финансами призваны обеспечить более рациональное и эффективное расходование государственных средств. Несмотря на усилия по обеспечению доступа к услугам здравоохранения, остаются заметные различия в обеспечении сельских и городских районов, а также барьеры, связанные со стоимостью и пробелами в обязательном медицинском страховании. В целом, Кыргызстан сталкивается с серьезными проблемами в области здравоохранения как в плане инфекционных, так и неинфекционных заболеваний. До пандемии COVID-19 ожидаемая продолжительность жизни росла, но все еще остается одной из самых низких в Европейском регионе ВОЗ

Participation in a Mobile App Survey to Collect Expenditure Data as Part of a Large-Scale Probability Household Panel: Coverage and Participation Rates and Biases

This paper examines non-response in a mobile app study designed to collect expenditure data. We invited 2,383 members of the nationally representative Understanding Society Innovation Panel in Great Britain to download an app to record their spending on goods and services: participants were asked to scan receipts or report spending directly in the app every day for a month. We examine coverage of mobile devices and participation in the app study at different stages of the process. We use data from the prior wave of the panel to examine the prevalence of potential barriers to participation, including access, ability and willingness to use different mobile technologies. We also examine bias in who has devices and in who participates, considering socio-demographic characteristics, financial position and financial behaviours. While the participation rate was low, drop out was also low: over 80% of participants remained in the study for the full month. The main barriers to participation were access to, and frequency of use of mobile devices, willingness to download an app for a survey, and general cooperativeness with the survey. We found extensive coverage bias in who has and does not have mobile devices, and some bias in who participates conditional on having a device. In the full sample, biases remain in who participates in terms of socio-demographic characteristics and financial behaviours. Crucially, however, we observe no biases for several key correlates of spending

The impact of variation in the device used to measure grip strength on the identification of low muscle strength: Findings from a randomised cross-over study

Grip strength is commonly used to identify people with low muscle strength. It is unclear what impact the type of dynamometer used to measure grip strength has on the identification of low muscle strength so we aimed to assess this. Study participants were 118 men and women aged 45-74y from a randomised, repeated measurements cross-over study. Maximum grip strength was assessed using four hand-held dynamometers (Jamar Hydraulic; Jamar Plus+ Digital; Nottingham Electronic; Smedley) in a randomly allocated order. EWGSOP2 cut-points were applied to estimate prevalence of low muscle strength for each device. Agreement between devices was compared. Prevalence of low muscle strength varied by dynamometer ranging between 3% and 22% for men and, 3% and 15% for women. Of the 13 men identified as having low muscle strength by at least one of the four dynamometers, only 8% were identified by all four and 54% by just one. Of the 15 women classified as having low muscle strength by at least one of the four dynamometers, only 7% were identified by all four and 67% by only one. Variation in the measures of grip strength acquired by different hand-held dynamometers has potentially important implications when identifying low muscle strength

A review of new technologies and data sources for measuring household finances: Implications for total survey error

We review process generated data sources and new technologies that could be used to improve the measurement of household finances. The sources include data generated by financial aggregator services, customer loyalty programmes, credit/debit card transactions, and credit rating agencies. The technologies include scanning of barcodes or shopping receipts and smartphone applications. For each of the data sources and technologies, we review what, if anything, is known about (i) the content of what can be measured, (ii) examples of research for which these data have been used, (iii) whether the data have been used as free-standing data sources or linked to probability sample surveys, and (iv) the quality of the data regarding representativeness and measurement quality. The review is structured around an adapted version of the Total Survey Error framework we have developed for evaluating these new data sources, and concludes with a discussion of implications for survey practice and research needs

Immunoglobulin G; structure and functional implications of different subclass modifications in initiation and resolution of allergy.

IgE and not IgG is usually associated with allergy. IgE lodged on mast cells in skin or gut and basophils in the blood allows for the prolonged duration of allergy through the persistent expression of high affinity IgE receptors. However, many allergic reactions are not dependent on IgE and are generated in the absence of allergen specific and even total IgE. Instead, IgG plasma cells are involved in induction of, and for much of the pathogenesis of, allergic diseases. The pattern of IgG producing plasma cells in atopic children and the tendency for direct or further class switching to IgE are the principle factors responsible for long-lasting sensitization of mast cells in allergic children. Indirect class switching from IgG producing plasma cells has been shown to be the predominant pathway for production of IgE while a Th2 microenvironment, genetic predisposition, and the concentration and nature of allergens together act on IgG plasma cells in the atopic tendency to undergo further immunoglobulin gene recombination. The seminal involvement of IgG in allergy is further indicated by the principal role of IgG4 in the natural resolution of allergy and as the favourable immunological response to immunotherapy. This paper will look at allergy through the role of different antibodies than IgE and give current knowledge of the nature and role of IgG antibodies in the start, maintenance and resolution of allergy

Different Fish-Eating Habits and Cytokine Production in Chronic Urticaria with and without Sensitization against the Fish-Parasite Anisakis simplex

Background:Anisakis simplexsensitization has been associated with acute, but also with chronic urticaria.The objective of this study is to characterize chronic urticaria with (CU+) and without sensitization (CU-) againstthe ubiquitous fish parasiteA. simplexin a transversal and longitudinal evaluation.Methods:16 CU+ and 22 CU- patients were included and assessed for Urticaria activity score (UAS), fish-eating habits by standardized questionnaire and cytokine production (assessed by flow cytometric bead-basedarray) of peripheral blood mononuclear cells after stimulation withA. simplexextract or Concanavalin A (ConA). Patients were randomly put on a fish-free diet for three months and UAS, as well as cytokine productionwere again assessed. A difference of"1 in UAS was defined as improvement.Results:There was no difference in UAS in both groups.Anisakisinduced IL-2, IL-4 and IFN-γproduction washigher in CU+. Con A induced IL-6 and IL-10 production was higher in CU+. CU+ was associated with highertotal fish intake, whereas CU- was associated with oily fish intake. The correlation of UAS was positive with oilyfish, but negative with total fish intake.There was a better UAS-based prognosis in CU+ without diet. Improvement was associated with higher ConA induced IL-10!IFN-γas well as IL-10!IL-6 ratios. Further, previous higher oily fish intake was associated withimprovement.Conclusions:Our data confirm the different clinical and immunological phenotype of CU+. Our results show acomplex relationship between fish-eating habits, cytokine production and prognosis, which could have impor-tant consequences in dietary advice in patients with CU. When encounteringA. simplexsensitization, patientsshould not be automatically put on a diet without fish in order to reduce contact withA. simplexproductsThe study was funded by grants from Fundación Sociedad Española de Alergología e Inmunología Clínica (SEAIC) 2009 and Fundación Mutua Madrileña 2009, SpainS