How do patient characteristics influence informal payments for inpatient and outpatient health care in Albania: Results of logit and OLS models using Albanian LSMS 2005

Abstract Background Informal payments for health care are common in most former communist countries. This paper explores the demand side of these payments in Albania. By using data from the Living Standard Measurement Survey 2005 we control for individual determinants of informal payments in inpatient and outpatient health care. We use these results to explain the main factors contributing to the occurrence and extent of informal payments in Albania. Methods Using multivariate methods (logit and OLS) we test three models to explain informal payments: the cultural, economic and governance model. The results of logit models are presented here as odds ratios (OR) and results from OLS models as regression coefficients (RC). Results Our findings suggest differences in determinants of informal payments in inpatient and outpatient care. Generally our results show that informal payments are dependent on certain characteristics of patients, including age, area of residence, education, health status and health insurance. However, they are less dependent on income, suggesting homogeneity of payments across income categories. Conclusions We have found more evidence for the validity of governance and economic models than for the cultural model.</p

COMPARE LAAO: Rationale and design of the randomized controlled trial "COMPARing Effectiveness and safety of Left Atrial Appendage Occlusion to standard of care for atrial fibrillation patients at high stroke risk and ineligible to use oral anticoagulation therapy"

Contains fulltext : 252137.pdf (Publisher’s version ) (Open Access)BACKGROUND: Left atrial appendage occlusion (LAAO) provides an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). In patients with a long-term or permanent contraindication for OAC randomized controlled trial (RCT) data is lacking. STUDY OBJECTIVES: To assess the efficacy and safety of LAAO in AF patients who are ineligible to use OAC. The co-primary efficacy endpoint is (1) time to first occurrence of stroke (ischemic, hemorrhagic, or undetermined) and (2) time to first occurrence of the composite of stroke, transient ischemic attack (TIA), and systemic embolism (SE). The primary safety endpoint is the 30-day rate of peri-procedural complications. STUDY DESIGN: This is a multicenter, investigator-initiated, open-label, blinded endpoint (PROBE), superiority-driven RCT. Patients with AF, a CHA₂DS₂-VASc score ≥2 for men and ≥3 for women and a long-term or permanent contraindication for OAC will be randomized in a 2:1 fashion to the device- or control arm. Patients in the device arm will undergo percutaneous LAAO and will receive post-procedural dual antiplatelet therapy (DAPT) per protocol, while those in the control arm will continue their current treatment consisting of no antithrombotic therapy or (D)APT as deemed appropriate by the primary responsible physician. In this endpoint-driven trial design, assuming a 50% lower stroke risk of LAAO compared to conservative treatment, 609 patients will be followed for a minimum of 1 and a maximum of 5 years. Cost-effectiveness and budget impact analyses will be performed to allow decision-making on reimbursement of LAAO for the target population in the Netherlands. SUMMARY: The COMPARE LAAO trial will investigate the clinical superiority in preventing thromboembolic events and cost-effectiveness of LAAO in AF patients with a high thromboembolic risk and a contraindication for OAC use. NCT TRIAL NUMBER: NCT04676880

The Dutch health insurance reform: switching between insurers, a comparison between the general population and the chronically ill and disabled

Background: On 1 January 2006 a number of far-reaching changes in the Dutch health insurance system came into effect. In the new system of managed competition consumer mobility plays an important role. Consumers are free to change their insurer and insurance plan every year. The idea is that consumers who are not satisfied with the premium or quality of care provided will opt for a different insurer. This would force insurers to strive for good prices and quality of care. Internationally, the Dutch changes are under the attention of both policy makers and researchers. Questions answered in this article relate to switching behaviour, reasons for switching, and differences between population categories. Methods: Postal questionnaires were sent to 1516 members of the Dutch Health Care Consumer Panel and to 3757 members of the National Panel of the Chronically ill and Disabled (NPCD) in April 2006. The questionnaire was returned by 1198 members of the Consumer Panel (response 79%) and by 3211 members of the NPCD (response 86%). Among other things, questions were asked about choices for a health insurer and insurance plan and the reasons for this choice. Results: Young and healthy people switch insurer more often than elderly or people in bad health. The chronically ill and disabled do not switch less often than the general population when both populations are comparable on age, sex and education. For the general population, premium is more important than content, while the chronically ill and disabled value content of the insurance package as well. However, quality of care is not important for either group as a reason for switching. Conclusion: There is increased mobility in the new system for both the general population and the chronically ill and disabled. This however is not based on quality of care. If reasons for switching are unrelated to the quality of care, it is hard to believe that switching influences the quality of care. As yet there are no signs of barriers to switch insurer for the chronically ill and disabled. This however could change in the future and it is therefore important to monitor changes.

Physicochemical characterization of must and wine Moscato Giallo from grapevines grown under plastic overhead cover

O objetivo deste trabalho foi avaliar a influência da cobertura de plástico sobre as características físico-químicas do mosto e do vinho da cultivar Moscato Giallo. Na safra 2006, um experimento em delineamento completamente casualizado foi realizado em vinhedo com cobertura de plástico impermeável, e sem cobertura como controle. De cada vinhedo, três microvinificações (20 L) foram elaboradas. Foram realizadas avaliações físico-químicas quanto ao: mosto – oBrix, açúcares redutores, densidade, acidez total, ácido tartárico, ácido málico e pH; e vinho – densidade, graduação alcoólica, acidez total, acidez volátil, pH, extrato seco, açúcares redutores, cinzas, I 420, compostos voláteis e minerais. O mosto das videiras cobertas apresentou maior rendimento, porém, menor concentração de açúcares pelo fato de a maturação das uvas ter-se atrasado. Como conseqüência, os vinhos do cultivo protegido tiveram menor graduação alcoólica, embora tenham sido beneficiados pela sanidade das uvas, com a redução de acetato de etila e acidez volátil. O microclima da cobertura também restringiu a concentração de alguns minerais no vinho, principalmente P e K. A cobertura beneficiou a qualidade enológica, porém requer atraso na data de colheita, para as uvas atingirem adequada maturação fisiológica e tecnológica.The objective of this work was to evaluate the plastic overhead cover (POC) effect on must and wine composition of the cultivar Moscato Giallo. In 2006 vintage, it was performed a completely randomly designed experiment, in a vineyard covered with an impermeable plastic cloth, and without covering as control. From each vineyard, three microvinification (20 L) were elaborated. Physico-chemical analysis were performed for: musts – oBrix, reducer sugar contents, density, total acidity, tartaric acid, malic acid and pH; and wines – density, alcohol degree, acidity, volatile acidity, pH, dry extract, reducer sugar contents, ashes, I 420, volatile compounds and minerals. The must of the covered vineyard presented higher yield, but lower sugar content, due to delay on ripening. As consequence, the POC wines showed lower alcohol degree, but with the benefit of a lower ethyl-acetate and volatile acidity levels. The POC microclimate also caused a decrease of some minerals (mainly P and K) in the wines. POC improved the enological quality, however, this demands delay in the harvest date to achieve the adequate physiological and technological maturation of grapes