Managed competition in health care in the Netherlands and Germany: Theoretical foundation, empirical findings and policy conclusions

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Will covid-19 be eradicated?

In this paper I want to define the meaning of “eradication”, explain the history of various diseases that have been eradicated, and compare and contrast them to covid-19, to answer the question of “Will covid-19 be eradicated”

Private health insurance in social health insurance countries: Market outcomes and policy implications

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On the degradation behavior of magnesium, magnesium hydroxide derived coatings and magnesium containing layered double hydroxides with regard to medical applications

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Viruses in nondisinfected drinking water from municipal wells and community incidence of acute gastrointestinal illness.

BackgroundGroundwater supplies for drinking water are frequently contaminated with low levels of human enteric virus genomes, yet evidence for waterborne disease transmission is lacking.ObjectivesWe related quantitative polymerase chain reaction (qPCR)-measured enteric viruses in the tap water of 14 Wisconsin communities supplied by nondisinfected groundwater to acute gastrointestinal illness (AGI) incidence.MethodsAGI incidence was estimated from health diaries completed weekly by households within each study community during four 12-week periods. Water samples were collected monthly from five to eight households per community. Viruses were measured by qPCR, and infectivity assessed by cell culture. AGI incidence was related to virus measures using Poisson regression with random effects.ResultsCommunities and time periods with the highest virus measures had correspondingly high AGI incidence. This association was particularly strong for norovirus genogroup I (NoV-GI) and between adult AGI and enteroviruses when echovirus serotypes predominated. At mean concentrations of 1 and 0.8 genomic copies/L of NoV-GI and enteroviruses, respectively, the AGI incidence rate ratios (i.e., relative risk) increased by 30%. Adenoviruses were common, but tap-water concentrations were low and not positively associated with AGI. The estimated fraction of AGI attributable to tap-water-borne viruses was between 6% and 22%, depending on the virus exposure-AGI incidence model selected, and could have been as high as 63% among children < 5 years of age during the period when NoV-GI was abundant in drinking water.ConclusionsThe majority of groundwater-source public water systems in the United States produce water without disinfection, and our findings suggest that populations served by such systems may be exposed to waterborne viruses and consequent health risks

Aging, Pensions and Long-term Care: What, Why, Who, How?; Comment on “Financing Long-term Care: Lessons From Japan”

Japan has been aging faster than other industrialized nations, and its experience offers useful lessons to others. Japan has been willing to expand its welfare state with a long-term care (LTC) insurance to finance home care and nursing home care for frail elderly. As Ikegami shows, it created new facilities and expanded specialized staffing for home care, developed a country-wide assessment system and shifted responsibilities between the central and local authorities over that assessment and the determination of co-payments for LTC. Faced with rapid growth in demand for LTC, the government felt the need for new cost control measures. The Japanese experience illustrates that new social policies take time to develop. There is often a need to adjust. But there are also other lessons. The main one is that there is no direct relation between the degree of population aging and total health spending. While aging requires adjustments in the organization of care, and expanding LTC for frail elderly, international studies show there is no need to worry about the ‘unaffordability’ of aging. In this commentary, we have framed four “What, Why, Who, and How” questions about LTC to (re-)define the borderlines between public and private responsibilities for the range of activities for which some (but certainly not all) frail elderly as well as many non-elderly require support in daily life

Water mass circulation and variability in the subpolar North Atlantic

This study focuses on estimating the variability in the formation of Upper and classical Labrador Sea Water (ULSW and LSW). Both are formed by winterly convection and spread into the world ocean as part of the cold limb of the thermohaline circulation. Analyses are based on a large-scale hydrography/tracer data set from the years 1997, 1999, and 2001. Horizontal fields of water mass layer thickness and mean concentrations of chlorofluorcarbon (CFC) have been constructed to determine the CFC inventory of each water mass and to infer water mass formation rates. The years 1997-2001 showed a significant increase in the CFC inventory of ULSW, while the inventory of classical LSW reduced. During 1997-1999 formation of ULSW was strong (6.9-9.2 Sv). From 1999 to 2001 the ULSW formation rate reduced to 3.7-4.0 Sv. LSW formation was absent during these four years. Historical hydrographic data from the Labrador Sea have been used to compare water mass properties of ULSW and LSW on longer time scales. Time series indicate strong variability and a significant anti-correlation of ULSW and LSW formation. Coinciding with weakening convection the density surface that separates ULSW from classical LSW shifted to greater depths. Water layer lying on top of LSW revealed an increasing stratification which is presumably strengthened by warm and saline water intruding from the West Greenland Current into the interior Labrador Sea. Time series of sea surface fluxes indicated a change in the atmospheric conditions after 1995/96. The convection activity at that time was, however, sufficient to ventilate the ULSW layer. Analyses of deep and bottom water properties provided evidence for the existence of export pathways in the Newfoundland Basin that are additional to the Deep Western Boundary Current (DWBC). LSW spreading time scales point to a fast spreading in the DWBC (1-2 years from the Labrador Sea to 43°N) and a slow spreading in the interior Newfoundland Basin (3-6 years)

Guiding dilemmas and principles informing psychotherapeutic work with African refugees in South Africa.

Abstract Therapists seeing refugee populations often struggle with the traditional boundaries of psychotherapy and conventional wisdom’s about therapeutic goals and practice. The social, political and cultural context of the therapeutic work throws up dilemmas and constraints that need to be better understood in working with these marginalized clients, particularly those in uncontaining environments such as South Africa. Although many refugees experience serious mental health problems and adjustment difficulties, the context in which treatment is offered impacts on the type of psychotherapeutic intervention and therapist stance that is optimal or possible. This study discusses presenting strengths, dilemmas and possible guiding therapeutic principles that arose from in-depth semi-structured interviews with 8 interviewees (4 psychotherapists and 4 refugee clients) concerning their experiences of conducting and being in medium term psychotherapy, looking at similarities and differences in observations. In accordance with the literature, this study found that the main descriptions of psychological distress discussed by the refugee clients included those caused by past trauma and those that were a response to current experiences. The prevalence of these symptoms stresses the importance of psychological intervention. The strengths of psychotherapy noted by refugee clients included: the preparation for psychotherapy through psycho-social workshops, attaining of both emotional and general support, the psych-social approach used by many of the therapists and the importance of foundational elements of psychotherapy, such as the relationship. This research project found that experiencing a containing therapeutic space was possible due to what refugees coined ‘the professionalism of the therapists’. Therapists raised such issues such as having to step out of the conventional therapist role, having to deal with the impact of the horror stories described by refugees, struggles to identify appropriate therapeutic approaches, difficulties in assisting refugees to establish sustainable support networks and not meeting refugees’ expectations that they will be ‘fully healed’ through therapy. Possible guiding therapeutic principles, such as working within the supportive framework of a two phased integrative framework, are also discussed. The study found that ideally speaking, therapists and refugee clients are more supported if therapy is offered as part of a multidimensional and multidisciplinary approach

Degradation rates and products of pure magnesium exposed to different aqueous media under physiological conditions

As magnesium and many of its alloys are a promising class of degradable implant materials, a thorough understanding of their degradation under physiological conditions is a key challenge in the field of biomaterial science. In order to increase the predictive power of in vitro studies, it is necessary to imitate the in vivo conditions, track the decomposition process and identify the products that form during the degradation pathway. In this in vitro study, slices of pure magnesium were exposed to Hank's Balanced Salt Solution (HBSS), Dulbecco's Modified Eagle Medium (DMEM) and simulated body fluid (SBF), respectively, under cell culture conditions, which included CO2 gassing. The series were repeated with supplements of fetal bovine serum (FBS), added to the respective media. Degradation rates, osmolality and pH were found to vary with the choice of medium and supplementation with proteins. In order to identify the crystalline degradation products, the crusts formed on the specimens were investigated via X-ray diffraction (XRD) measurements. As expected, brucite, Mg(OH)2, was found among the degradation products; interestingly, nesquehonite, Mg(HCO3)(OH)·2H2O, was found to be the dominant degradation product in this study. The experimental data are well in accordance with solubility calculations