Health care expenditure for hospital-based delivery care in Lao PDR

<p>Abstract</p> <p>Background</p> <p>Delivery by a skilled birth attendant (SBA) in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs) in Lao PDR.</p> <p>Methods</p> <p>A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed.</p> <p>Results</p> <p>Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD) than for vaginal delivery (59 USD). After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care.</p> <p>Conclusions</p> <p>Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family incomes were able to pay for more non-medical care expenses. The effect of health insurance on service utilization was noted by women and SBAs. To achieve the goal of utilizing delivery care in the hospitals, coverage of health insurance needs to be expanded.</p

The effects of compression on single and multiphase flow in a model polymer electrolyte membrane fuel cell gas diffusion layer

A two-dimensional study of an idealised fibrous medium representing the gas diffusion layer of a PEMFC is conducted using computational fluid dynamics. Beginning with an isotropic case the medium is compressed uni-directionally to observe the effects on single and multiphase flow. Relations between the compression ratio and the permeability of the medium are deduced and key parameters dictating the changes in flow are elucidated. The main conclusions are that whilst compression reduces the absolute permeability of an isotropic medium, the creation of anisotropic geometry results in preferential liquid water pathways. The most important parameter for capillary flow, in uniformly hydrophobic media, is the minimum fibre spacing normal to the flow path. The effect is less pronounced with decreasing contact angle and non-existent for neutrally wettable media

43.先天性肩甲骨高位症(Sprengel病)に対するChigot法による手術治験例(第631回千葉医学会整形外科例会)

A − log10 p from the KEGG, Reactome, or BioCarta GeneSet enrichment (left) and from the TF binding enrichment (right) is compared for five negatively correlated module pairs with the biggest absolute correlation in the nine-dataset experiment. Each one of the two negatively correlated modules is shown on one of the x-axis or y-axis, and each dot corresponds to a KEGG, Reactome, or BioCarta GeneSet (left) or a group of genes composed of a TF and its targets (right). B − log10 p from the KEGG, Reactome, or BioCarta GeneSet enrichment (top) and from the TF binding enrichment (bottom) is compared for module 5 (on the x-axis) and 6 (on the y-axis). Each dot corresponds to a KEGG, Reactome, or BioCarta GeneSet (left) or a group of genes composed of a TF and its targets (right). (PDF 194 kb

On the Critical Effect of the Metal (Mo vs. W) on the [3++2] Cycloaddition Reaction of M3S4 Clusters with Alkynes: Insights from Experiment and Theory

Whereas the cluster [Mo3S4(acac)3(py)3]+ ([1]+, acac=acetylacetonate, py=pyridine) reacts with a variety of alkynes, the cluster [W3S4(acac)3(py)3]+ ([2]+) remains unaffected under the same conditions. The reactions of cluster [1]+ show polyphasic kinetics, and in all cases clusters bearing a bridging dithiolene moiety are formed in the first step through the concerted [3+2] cycloaddition between the C C atoms of the alkyne and a Mo(m-S)2 moiety of the cluster. A computational study has been conducted to analyze the effect of the metal on these concerted [3+2] cycloaddition reactions. The calculations suggest that the reactions of cluster [2]+ with alkynes feature DG values only slightly larger than its molybdenum analogue, however, the differences in the reaction free energies between both metal clusters and the same alkyne reach up to approximately 10 kcal mol¢1, therefore indicating that the differences in the reactivity are essentially thermodynamic. The activation strain model (ASM) has been used to get more insights into the critical effect of the metal center in these cycloadditions, and the results reveal that the change in reactivity is entirely explained on the basis of the differences in the interaction energies Eint between the cluster and the alkyne. Further decomposition of the Eint values through the localized molecular orbital-energy decomposition analysis (LMO-EDA) indicates that substitution of the Mo atoms in cluster [1]+ by W induces changes in the electronic structure of the cluster that result in weaker intra- and inter-fragment orbital interactions

Significant associations of PAI-1 genetic polymorphisms with osteonecrosis of the femoral head

<p>Abstract</p> <p>Background</p> <p>The pathogenesis of osteonecrosis of the femoral head (ONFH) has been implicated in hypofibrinolysis and blood supply interruption. Previous studies have demonstrated that decreased fibrinolytic activity due to elevated plasminogen activator inhibitor-1 (PAI-1) levels correlates with ONFH pathogenesis. The -675 4G/5G single nucleotide polymorphism (SNP rs1799889) in the PAI-1 gene promoter is associated with PAI-1 plasma level. We investigated whether rs1799889 and two other SNPs of the PAI-1 gene (rs2227631, -844 G/A in the promoter; rs11178, +10700 C/T in the 3'UTR) are associated with increased ONFH risk.</p> <p>Methods</p> <p>Three SNPs in PAI-1 were genotyped in 206 ONFH patients and 251 control subjects, using direct sequencing and a TaqMan^®5' allelic discrimination assay. We performed association analysis for genotyped SNPs and haplotypes with ONFH.</p> <p>Results</p> <p>The 4G allele of rs1799889, A allele of rs2227631, and C allele of rs11178 were significantly associated with increased ONFH risk (p = 0.03, p = 0.003, and p = 0.002, respectively). When we divided the population according to gender, an association between the three SNPs and increased risk of ONFH was found only in men. In another subgroup analysis based on the etiology of ONFH, rs2227631 (A allele) and rs11178 (C allele) in the idiopathic subgroup (p = 0.007 and p = 0.021) and rs1799889 (4G allele) and rs11178 (C allele) in the alcohol-induced subgroup (p = 0.042 and p = 0.015) were associated with increased risk of ONFH. In addition, a certain haplotype (A-4G-C) of PAI-1 was also significantly associated with ONFH (p < 0.001).</p> <p>Conclusion</p> <p>Our findings demonstrated that three SNPs (rs1799889, rs2227631, and rs11178) of the PAI-1 gene were associated with ONFH risk. This study also suggests that PAI-1 SNPs may play an important role in ONFH.</p

ACE I/D Gene Polymorphism Can't Predict the Steroid Responsiveness in Asian Children with Idiopathic Nephrotic Syndrome: A Meta-Analysis

The results from the published studies on the association between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism and the treatment response to steroid in Asian children with idiopathic nephrotic syndrome (INS) is still conflicting. This meta-analysis was performed to evaluate the relation between ACE I/D gene polymorphism and treatment response to steroid in Asian children and to explore whether ACE D allele or DD genotype could become a predictive marker for steroid responsiveness. = 0.85; respectively), however, the result for the association of II genotype with SRNS risk was not stable.Our results indicate that D allele or DD homozygous can't become a significant genetic molecular marker to predict the treatment response to steroid in Asian children with INS