Health and health expenditures in adjusting and non-adjusting countries

The focus of this study is on the impact of World Bank structural adjustment operations on health expenditures and outcomes. We compare trends and levels of real per capita public spending on health, private consumption (which is the resource base for private health expenditures), and groupings child mortality indicators in four groups of countries. These are: (i) countries that started to borrow for the adjustment process early--Early Adjustment Lending (EAL) countries, (ii) Other Adjustment Lending (OAL) countries, (iii) Non-Adjustment Lending countries whose economies grew during the period 1985-1990 (NAL+), and (iv) Non-Adjustment Lending countries whose economies did not grow (NAL-). The NAL- group provides a 'counterfactual' for comparison with the two groups of adjusting countries. The results show that the fear about possible declines in health care spending in adjusting countries is unwarranted for EAL countries, that is those countries that started the adjustment process early and took it seriously. Government spending on health care increased on average for this group of countries, as did private consumption levels. Government health care expenditures also continued to increase in OAL countries, but mixed GDP growth performance has left little room for increased private spending. However, those countries that showed negative growth in the late eighties and did not start an adjustment process, fared worse throughout: real per capita public health care spending declined during the late eighties and increased less than in the other countries during 1989-1993, while private consumption has declined steadily. The trends in child mortality indicators show tremendous and continuing progress during the past two or three decades with few discernible differences among the four country groupings.     

A meta-analysis of infant outcomes after breech delivery

OBJECTIVE: To estimate the risks of neonatal morbidity and mortality associated with a trial of labor and with elective cesarean for the term breech infant. DATA SOURCES: Using the terms "breech," "malpresentation," and "external cephalic version," we used the MEDLINE and Health Planning and Administration data bases to search the English-language literature from January 1981 to June 1993. The search was supplemented with a review of the reference lists of key articles and text chapters. METHODS OF STUDY SELECTION: We included randomized trials or cohort studies that specified selection criteria for a vaginal delivery, provided detailed outcome data, and allowed for analysis by intended mode of delivery. DATA EXTRACTION AND SYNTHESIS: Nine studies met the inclusion criteria. We pooled the weighted results from these studies to estimate the risks of birth injuries and perinatal death, and the risk differences between trial of labor and no trial of labor groups. The pooled risk for any injury was 1.00% after a trial of labor and 0.09% after elective cesarean. For any injury or death, the risk was 1.23% after a trial of labor and 0.09% after elective cesarean. The risk differences for injury and injury or death were 0.89 and 1.10%, respectively. These are significantly different from zero, suggesting an increased risk of injury and injury or death after a trial of labor. CONCLUSION: When management decisions are made, the potential increased risk of neonatal morbidity after a trial of labor should be considered along with the increased maternal risk from cesarean delivery.     

Health economic issues relevant to countries with aging populations

This article investigates the health economic impacts of aging populations, using scenario techniques and economic systems analysis. Age-related data on hospital utilization and health care expenditure are linked with demographic models for Germany from 1990 to 2040. Findings indicate that the demographic component may not play a major role in determining long-term trends as compared with other, not yet fully elucidated components of utilization and expenditure, both of which are the result of the interplay between supply and demand in health care, and of interactions with the general economy. This acts as a deterrent against the use of simple extrapolations of current indicators (or their trends), but more adequate theoretical economic models are still lacking.     

Health learning materials support in South Africa compared with other developing countries

An investigation was carried out in to thyroid hormones (TSH, T3, T4) and lipid parameters (total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride) in 136 adolescents (94 femals, average age 13 years). An iodine deficiency (grade II-II) with respect to the daily urine excretion per 1,73 m2 BSA was found in 75%. With few exceptions the serum levels of TSH and T4 were in the normal range. In 36% of the patients we noticed compensatory elevated T3 levels. Correlations between thyroid hormones TSH, T4, renal iodine excretion and the volume of thyroid glands were not detectable, only T3 showed a dignificant positive correlation to the thyroid gland volume. The average values of lipids in patients were found to be higher than in normals. We consider the changed lipids as a sign of a disturbed efficacy of thyroid hormones. The regional insufficient iodine supply causes goiters and to a high degree the observed hyperchole-sterolemia, too. Our results underline the necessity of a common iodine salt prophylaxis as well as the treatment of "harmless" goiters in puberty.     

The effect of the Utah Prepaid Mental Health Plan on structure, process, and outcomes of care

Capitation reduced Medicaid costs but had limited effects on most measures of process and outcome. Clients under capitation with the poorest mental health at baseline performed more poorly over time on some measures.     

Health personnel requirements, service delivery, and national policy: A conversation with Thomas D. Hatch.

Topics discussed include the configuration of the Health Resources and Services Administration and one of its units, the Bureau of Health Professions; expansion of the number of health professionals through grants to schools and student assistance; funding opportunities for psychologists in prevention, geriatrics, and health psychology; determining personnel shortage in mental health areas; interprofessional rivalries between physicians and nonphysicians; defining the boundaries of roles/competence for health care professionals. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of widowhood on physical and mental health, health behaviors, and health outcomes: The Women's Health Initiative.

This study examined whether widowhood was associated with physical and mental health, health behaviors, and health outcomes using a cross-sectional (N=72,247) and prospective (N=55,724) design in women aged 50-79 years participating in the Women's Health Initiative observational study (85.4% White). At baseline, married women reported better physical and mental health and generally better health behaviors than widowed women. Whereas women who remained married over the 3-year period showed stability in mental health, recent widows experienced marked impairments and longer term widows showed stability or slight improvements. Both groups of widows reported more unintentional weight loss over the 3-year period. Changes in physical health and health behaviors were inconsistent, with generally small effect sizes. Findings underscore the resilience of older women and their capacity to reestablish connections, but point to the need for services that strengthen social support among women who have difficulty during this transition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health Care, National Health Insurance, and Psychology.

The role of psychologists as health care providers and the parameters of reimbursement for health care services are timely and controversial issues. A landmark decision was reached in this controversy in the 1980 appeal of a Virginia suit by clinical psychologists in which the court ruled that Blue Shield's refusal to directly reimburse psychologists was a violation of antitrust law. Thus, the requirement that psychologists bill through physicians was not upheld. In recent years a specific aspect of this controversy involved psychologists' roles in potential national health insurance programs. A limited study (appearing in the "National Register of Health Services Providers in Psychology" 1976-1978) of clinical psychologists' attitudes toward national health insurance suggests that Congress and psychologists may have disparate views. In addition to favoring national health insurance, over 85% of psychologists surveyed responded that consumers would benefit from such a program with mental health coverage. Only 16% agreed that such a program would constitute a subsidy of the rich by the poor (Albee, 1977). Several areas of conflicting or confusing responses in this study may reflect legitimate reasons for concern by Congress regarding institution of national health insurance. Belief that providers would benefit from mental health coverage in a national health insurance program was shared by 80% of respondents. Ninety-five percent of respondents identified the inclusion or exclusion of clinical psychologists in such a national health insurance as affecting the future of the profession. Curiously, over 50% of respondents agreed that primary care physicians should be reimbursed for mental health services, although such physicians have received no formal training in psychological services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Survey of nurse anesthesia practice, education, and regulation in 96 countries

Reconstitution of the p53-dependent apoptotic pathway by gene transfer of a recombinant wild-type p53 minigene leads to rapid apoptotic cell death in breast and other cancer cell types expressing null or mutant p53. Tumour cells expressing wild-type p53 have been reported to be more resistant to this treatment strategy, presumably as a result of mutations in downstream regulators of p53-dependent apoptotic signalling. The MCF-7 breast cancer cell line is representative of this class of tumour cell. Our recent observation of a p53-dependent apoptotic response following adenovirus-mediated HSV thymidine kinase gene transfer and gancyclovir treatment led us to reexamine recombinant p53 cytotoxicity in MCF-7 cells. Infection with a recombinant adenovirus expressing wild-type p53 resulted in a dramatic increase in p53 protein levels and was accompanied by an increase in p21WAF/CIP1 protein levels and G1 arrest within 24 hours post-infection. A significant decrease in MCF-7 cell viability was first observed at 5 days post-infection and coincided with the appearance of morphological and biochemical changes consistent with apoptotic cell death. By day 7 post-treatment, cell viability decreased to 45% and clonogenic survival was reduced to 12% of controls. The results demonstrate that persistent, high level expression of recombinant p53 can induce programmed cell death in MCF-7 cells. While the mechanism by which p53 overexpression overcomes the defect in downstream apoptotic signalling is not clear, our data suggests that this treatment strategy may be beneficial for the class of tumour cells represented by the MCF-7 cell line.