Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature

BACKGROUND: There has been a growing interest in the role of the private for-profit sector in health service provision in low- and middle-income countries. The private sector represents an important source of care for all socioeconomic groups, including the poorest and substantial concerns have been raised about the quality of care it provides. Interventions have been developed to address these technical failures and simultaneously take advantage of the potential for involving private providers to achieve public health goals. Limited information is available on the extent to which these interventions have successfully expanded access to quality health services for poor and disadvantaged populations. This paper addresses this knowledge gap by presenting the results of a systematic literature review on the effectiveness of working with private for-profit providers to reach the poor. METHODS: The search topic of the systematic literature review was the effectiveness of interventions working with the private for-profit sector to improve utilization of quality health services by the poor. Interventions included social marketing, use of vouchers, pre-packaging of drugs, franchising, training, regulation, accreditation and contracting-out. The search for published literature used a series of electronic databases including PubMed, Popline, HMIC and CabHealth Global Health. The search for grey and unpublished literature used documents available on the World Wide Web. We focused on studies which evaluated the impact of interventions on utilization and/or quality of services and which provided information on the socioeconomic status of the beneficiary populations. RESULTS: A total of 2483 references were retrieved, of which 52 qualified as impact evaluations. Data were available on the average socioeconomic status of recipient communities for 5 interventions, and on the distribution of benefits across socioeconomic groups for 5 interventions. CONCLUSION: Few studies provided evidence on the impact of private sector interventions on quality and/or utilization of care by the poor. It was, however, evident that many interventions have worked successfully in poor communities and positive equity impacts can be inferred from interventions that work with types of providers predominantly used by poor people. Better evidence of the equity impact of interventions working with the private sector is needed for more robust conclusions to be drawn

Glacial vicariance drives phylogeographic diversification in the amphi-boreal kelp Saccharina latissima

Glacial vicariance is regarded as one of the most prevalent drivers of phylogeographic structure and speciation among high-latitude organisms, but direct links between ice advances and range fragmentation have been more difficult to establish in marine than in terrestrial systems. Here we investigate the evolution of largely disjunct (and potentially reproductively isolated) phylogeographic lineages within the amphi-boreal kelp Saccharina latissima s.l. Using molecular data (COI, microsatellites) we confirm that S. latissima comprises also the NE Pacific S. cichorioides complex and is composed of divergent lineages with limited range overlap and genetic admixture. Only a few genetic hybrids were detected throughout a Canadian Arctic/NW Greenland contact zone. The degree of genetic differentiation and sympatric isolation of phylogroups suggest that S. latissima s.l. represents a complex of incipient species. Phylogroup distributions compared with paleo-environmental reconstructions of the cryosphere further suggest that diversification within S. latissima results from chronic glacial isolation in disjunct persistence areas intercalated with ephemeral interglacial poleward expansions and admixture at high-latitude (Arctic) contact zones. This study thus supports a role for glaciations not just in redistributing pre-existing marine lineages but also as a speciation pump across multi-glacial cycles for marine organisms otherwise exhibiting cosmopolite amphi-boreal distributions.Pew Foundation (USA); Portuguese FCT (Fundacao para a Ciencia e a Tecnologia) through program GENEKELP [PTDC/MAR-EST/6053/2014]; Portuguese FCT (Fundacao para a Ciencia e a Tecnologia) through program MARFOR [Biodiversa/0004/2015]; Portuguese FCT (Fundacao para a Ciencia e a Tecnologia) [UID/Multi/04326/2013, SFRH/BPD/88935/2012, SFRH/BPD/111003/2015]; NSERC; FRQNT; Canada Foundation for Innovation; New Brunswick Innovation Foundation; European Union's Seventh Framework Programme [226248]; Danish Environmental Protection Agency within the Danish Cooperation for Environment in the Arctic (DANCEA)info:eu-repo/semantics/publishedVersio

Imaging findings in craniofacial childhood rhabdomyosarcoma

Rhabdomyosarcoma (RMS) is the commonest paediatric soft-tissue sarcoma constituting 3–5% of all malignancies in childhood. RMS has a predilection for the head and neck area and tumours in this location account for 40% of all childhood RMS cases. In this review we address the clinical and imaging presentations of craniofacial RMS, discuss the most appropriate imaging techniques, present characteristic imaging features and offer an overview of differential diagnostic considerations. Post-treatment changes will be briefly addressed

Diagnóstico da disposição final dos resíduos sólidos urbanos na região da Associação dos Municípios do Alto Irani (AMAI), Santa Catarina Diagnosis of the final disposal of urban solid wastes in the region of the Association of the Cities at Alto Irani (AMAI), Santa Catarina State

O objetivo desse estudo foi diagnosticar o destino dos resíduos sólidos urbanos na região da AMAI (SC), composta por catorze municípios. Foram aplicados questionários às prefeituras e realizadas visitas nos municípios para mapear tanto lixões ativos e desativados como aterros controlados e sanitários. Os parâmetros utilizados foram: existência de cercas; tipo de cobertura; retirada dos resíduos antes da cobertura; proximidades com águas superficiais; presença de catadores ou animais; monitoramento e coleta de chorume e gás; distância de moradias e existência de coleta seletiva. A partir da pesquisa, foram localizados vinte e sete lixões desativados, sendo que dezoito deles receberam algum tipo de remediação; porém, em nenhum deles ocorreu de forma padrão. Detectou-se precariedade na remediação nos lixões desativados, pois a simples cobertura com terra não é suficiente, já que o material ali depositado continua poluindo através do chorume produzido. Atualmente, todos os municípios depositam os seus resíduos sólidos urbanos em aterros sanitários localizados em Xanxerê e Xaxim. Dos quatorze municípios, somente um possui coleta seletiva e ainda de forma precária. Atualmente, coleta-se 54,15 ton/dia de resíduos, totalizando-se uma média de 0,610 g/hab.dia de lixo, a um custo de R$1,78/hab para os cofres públicos mensalmente.<br>The aim of this study was to carry out diagnosis about the destination given to the urban solid wastes in AMAI-SC region, which has fourteen cities. It was applied questionnaires to the city halls, and visits to map active and inactive dumps, controlled and sanitary landfill. It was investigated: the existence of fences, monitoring and collecting of gas and leachate, if they were next to the superficial waters, the presence of animals or collectors. It was considered, also, the distance of houses and/or urban mass and information about selective collection. It was found twenty and seven inactive dumps, where eighteen had received treatment. It was detected precariousness in remediation of all inactive dumps, because a single covering with land is not enough, therefore the material put there, keeps polluting through the production of lard and methane gas. Nowadays, all AMAI cities put their urban solid wastes in sanitary landfill found in Xanxerê and Xaxim. Among the fourteen cities, only one has selective collection, and in a precarious way, what reduces the useful life time of landfill, beyond being harmful to the environment. It is collected 54.15 tons/day of wastes, which sums 0.610 g/hab.day of waste, costing R$ 1.78 to the public coffers monthly