Paying their way: health financing mechanisms in Zambia

Health services in many low-income countries charge user fees. These payments may deter the poorest people from seeking treatment. Zambia has tried two alternatives to user fees: prepayment and discount cards. How do these schemes affect equity in the use of health services?sch_iihpub375pu

Factors associated with seasonal influenza vaccine uptake among children in Japan

BackgroundSeasonal influenza vaccine was once part of the routine immunization schedule that is routinely offered to all children in Japan, but it is now excluded from the schedule. This study aimed to investigate factors influential to parents’ decision to have their children receive seasonal influenza vaccine, as well as types of seasonal influenza vaccine information that is given to parents.MethodsWe conducted a cross-sectional online survey of 555 participants who have at least one child younger than 13 years of age. Respondents were asked to categorize the history of influenza vaccination of their youngest child as either ‘annual’ , ‘sometimes’ , or ‘never’. Participants were also asked about potentially influential factors in their decision to have their children receive a seasonal influenza vaccine.ResultsA total of 75% of respondents answered that their youngest child had received a seasonal influenza vaccine, and 57% of respondents answered that their child receives the vaccine every year. The higher income group was more likely than the lowest income group to have a history of influenza vaccine uptake. A recommendation from a pediatrician or school/nursery to have their child vaccinated was also positively associated with a history of influenza vaccine uptake. The most common reason for a pediatrician’s recommendation was ‘it leads to milder symptoms if infected’.ConclusionsThe main finding of the study is a significant association between household income and influenza vaccination of the youngest child in the household. We also found that cost could be a barrier to vaccinating children in low income households and that information from pediatricians and schools/nurseries could motivate parents to have their children vaccinated

Assessing frontline HIV service provider efficiency using data envelopment analysis: a case study of Philippine social hygiene clinics (SHCs)

AbstractBackground:Globally, local and frontline HIV service delivery units have been deployed to halt the HIV epidemic.However, with the limited resources, there is a need to understand how these units can deliver their optimumoutputs/outcomes efficiently given the inputs. This study aims to determine the efficiency of the social hygieneclinics (SHC) in the Philippines as well as to determine the association of the meta-predictor to the efficiencies.Methods:In determining efficiency, we used the variables from two data sources namely the 2012 Philippine HIVCosting study and 2011 Integrated HIV Behavioral and Serologic Surveillance, as inputs and outputs, respectively.Various data management protocols and initial assumptions in data matching, imputation and variable selection,were used to create the final dataset with 9 SHCs. We used data envelopment analysis (DEA) to analyse theefficiency, while variations in efficiencies were analysed using Tobit regression with area-specific meta-predictors.Results:There were potentially inefficient use of limited resources among sampled SHC in both aggregate and keypopulations. Tobit regression results indicated that income was positively associated with efficiency, while HIVprevalence was negatively associated with the efficiency variations among the SHCs.Conclusions:We were able to determine the inefficiently performing SHCs in the Philippines. Though currentlyinefficient, these SHCs may adjust their inputs and outputs to become efficient in the future. While there wereindications of income and HIV prevalence to be associated with the efficiency variations, the results of this casestudy may only be limited in generalisability, thus further studies are warranted

Establishment and Evaluation of a New Chemiluminescent Enzyme Immunoassay for Carcinoembryonic Antigen Adapted to the Fully Automated ACCESS® System

Peer Reviewe

Health impact assessment of PM2.5-related mitigation scenarios using local risk coefficient estimates in 9 Japanese cities

Previous studies have highlighted the negative effects of PM2.5 on mortality, expressed in terms of attributable deaths and life years lost. However, there are very few studies assessing the health impacts of air pollution in terms of economic burden/benefits. This study assessed the health impact of two hypothetical interventions among sex- and age-specific risk populations using a robust risk estimation and economic valuation process. We utilized the sex- and age-stratified daily all-cause mortality together with the daily PM2.5 of the 9 Japanese cities from 2002 to 2008 in estimating the relative risks. The estimated risks were then utilized for the economic valuation of co-benefits/burden with respect to the two hypothetical PM2.5-related mitigation scenarios, in comparison to status quo, namely: i) decrease to Japanese standards, and ii) decrease to WHO standards. Impact of these interventions on health were assessed using the following HIA metrics: attributable mortality, attributable years life lost, and environmental health impact. A 10-μg/m3 increase in PM2.5 would increase the risk by 0.52% (95% CI: −0.91% to 1.99%) for all-cause mortality, with varying risk estimates per subgroup. High economic burdens were estimated at status quo, with particularly distinct burden difference for age-specific mortality; 0.40 trillion yen (0–64 y.o.) and 1.50 trillion yen (>64 y.o.). If stricter standards, relative to status quo, were to be enforced, i.e. WHO standard, there is a potential to yield economic benefits in the same risk population; 0.26 trillion yen (0–64 y.o.) and 0.98 trillion yen (>64 y.o.). We did not observe any substantial difference with the burden and benefit related to sex-specific mortality. Using the estimated local risk coefficients complemented with the valuation of the risks, policymaking entities will have the opportunity to operate their own HIA to assess the relevant air pollution-related health impacts

Rho-ROCK Expression Predicts the Prognosis in Patients with T3/T4 Gastric Cancer

A small GTPase Rho protein and an effector ROCK have significant roles in cancer adhsion, metastasis, invasion, angiogenesis and cell mortality. We investigated the expressions of RhoA protein and ROCK-1 protein in 100 patients with macroscopically T3/T4 gastric cancer immunohistochemically. The expression of RhoA was detected in gastric cancer specimens from 39 patients and that of ROCK-1 in specimens from 30 patients. The clinicopathological characteristics of 21 tumors with co-expression of RhoA and ROCK-1 proteins (Rho/ROCK ON) were compared with those of the 79 remaining tumors (Rho/ROCK OFF). The percentage of lymph node metastasis positive cases in the Rho/ROCK ON group (81%) was higher than that in the Rho/ROCK OFF group (66%), but the difference was not significant (P = 0.183). However, the prognosis of the 21 patients with Rho/ROCK ON was significantly poorer than that of the 79 with Rho/ROCK OFF (P = 0.006). Our results indicate that the evaluation of the protein expression of RhoA and ROCK-1 is useful for predicting the prognosis in patients with T3/T4 gastric cancer

Community Trial on Heat Related-Illness Prevention Behaviors and Knowledge for the Elderly

This study aims to explore whether broadcasting heat health warnings (HHWs), to every household and whether the additional home delivery of bottled water labeled with messages will be effective in improving the behaviors and knowledge of elderly people to prevent heat-related illness. A community trial on heat-related-illness-prevention behaviors and knowledge for people aged between 65 and 84 years was conducted in Nagasaki, Japan. Five hundred eight subjects were selected randomly from three groups: heat health warning (HHW), HHW and water delivery (HHW+W), and control groups. Baseline and follow-up questionnaires were conducted in June and September 2012, respectively. Of the 1524 selected subjects, the 1072 that completed both questionnaires were analyzed. The HHW+W group showed improvements in nighttime AC use (p = 0.047), water intake (p = 0.003), cooling body (p = 0.002) and reduced activities in heat (p = 0.047) compared with the control, while the HHW group improved hat or parasol use (p = 0.008). An additional effect of household water delivery was observed in water intake (p = 0.067) and cooling body (p = 0.095) behaviors. HHW and household bottled water delivery improved heat-related-illness-prevention behaviors. The results indicate that home water delivery in addition to a HHW may be needed to raise awareness of the elderly

Cytokeratin-Positive Cells in Lymph Nodes in Which Metastases Are Undetectable by Conventional Histological Staining in Advanced Gastric Cancer

Detection of occult metastases in lymph nodes by immunostaining is becoming of increasing interest as a way to improve the accuracy of predicting the prognosis for patients with gastric cancer. Immunohistochemical detection of cytokeratin (CK) is recognized as the most sensitive method for identification of cancerous epithelial cells. In this study, lymph nodes were stained for CK in an effort to detect micrometastases and the clinical implications of the results were examined. We immunostained sections from a total of 1,198 lymph nodes from 25 totally gastrectomized patients with T3 or T4 gastric cancer who had been diagnosed as having no nodal involvement by conventional hematoxylin-eosin (HE) staining. Eighty (6.7%) of 1,198 lymph nodes from 15 (60%) of the 25 patients were immunostained with a CK-specific monoclonal antibody. CK-positive cells were more frequent in patients with macroscopic types of 3,4 and 5 gastric cancer. Patients with nodes that were both HE-negative and CK-negative had the best postoperative survival, followed by patients with HE-negative and CK-positive nodes and, finally, by patiof micrometastases in lymph nodes is a reliable indicator of the prognosis of patients with advanced gastric cancer

The PI3K-Akt Pathway in SN-38-Induced Apoptosis in Human Gastric Cancer Cell Lines

SN-38, an active metabolite of a topoisomerase I inhibitor, CPT-11, exhibits a cytotoxic effect by inducing apoptosis in cancer cells. Phosphatidylinositol-3-OH kinase (PI3K)-Akt signaling is known to protect a variety of cells from apoptosis. The relationship between resistance to SN-38-induced apoptosis and the PI3K-Akt pathway in human gastric cancer cells is unknown. Here, we did an investigation using two gastric cancer cell lines, MKN1 and MKN45. Cell viability was determined by sodium 3'-[1-(phenylaminocarbonyl)-3,4-tetrazolium]-bis(4-methoxy-6-nitro) benzene sulfonic acid hydrate (XTT) assay. Apoptosis was confirmed by fluorescence microscopy using Hoechst 33342 staining. Expression levels of phospho-Akt (pAkt) were determined by Western blotting. After being treated with SN-38, the populations of sub-G1 cells were induced by flow cytometry in 36.8% of MKN45 cells more frequently than in 13.5% of MKN1 cells. SN-38 inhibited the expression of pAkt dose-dependently in MKN45 cells, but not in MKN1 cells. In MKN1 cells, an additional pretreatment with the PI3K inhibitor, LY294002, led to the inhibition of pAkt expression and induced apoptosis. The results suggested that SN-38 induces apoptosis by decreasing PI3K-Akt survival signaling, the anti-apoptotic signals, in human gastric cancer cells. Akt inhibitor might be a useful anti-tumor agent in combination with CPT-11