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Assessing the effect of the 2001-06 Mexican health reform: an interim report card.

Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over 7 years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, we used a wide range of datasets to assess the effect of this reform on different dimensions of the health system. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affiliates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.

Delivery of Health Care↗

Randomised, controlled, community-level HIV-prevention intervention for sexual-risk behaviour among homosexual men in US cities. Community HIV Prevention Research Collaborative.

BACKGROUND: Community-level interventions may be helpful in population-focused HIV prevention. If members of populations at risk of HIV infection who are popular with other members can be engaged to advocate the benefits of behaviour change to peers, decreases in risk behaviour may be possible. We assessed a community-level intervention to lower the risk of HIV infection, focusing on men patronising gay bars in eight small US cities. METHODS: We used a randomised community-level field design. Four cities received the intervention and four control cities did not. Participants were men from each city who went to gay bars. Men completed surveys about their sexual behaviour on entering the bars during 3-night periods at baseline and at 1-year follow-up. In the control cities, HIV educational materials were placed in the bars. In the intervention cities, we recruited popular homosexual men in the community and trained them to spread behaviour-change endorsements and recommendations to their peers through conversation. FINDINGS: Population-level of risk behaviour decreased significantly in the intervention cities compared with the control cities at 1-year follow-up, after exclusion of surveys completed by transients and men with exclusive sexual partners in a city-level analysis, in the intervention cities we found a reduction in the mean frequency of unprotected anal intercourse during the previous 2 months (baseline 1.68 occasions; follow-up 0.59: p = 0.04) and an increase in the mean percentage of occasions of anal intercourse protected by condoms (baseline 44.7%; follow-up 66.8%, p = 0.02). Increased numbers of condoms taken from dispensers in intervention-city bars corroborated risk-behaviour self-reports. INTERPRETATION: Popular and well-liked members of a community who systematically endorse and recommend risk-reduction behaviour can influence the sexual-risk practices of others in their social networks. Natural styles of communication, such as conversations, brought about population-level changes in risk behaviour.

Adult↗

Isihlambezo: utilization patterns and potential health effects of pregnancy-related traditional herbal medicine.

Isihlambezo is a herbal decoction used by many Zulu women in South Africa as a preventative health tonic during pregnancy. Though the practice is cited by ethnographers and medical practitioners, few studies have focused on specific elements of isihlambezo use and preparation. Moreover, though some evidence exists suggesting negative effects of its ingestion, the maternal-fetal health impact and toxicity of isihlambezo have not been adequately studied. We examined two aspects of this traditional antenatal health practice: (1) the potential impact of urbanization and access to Western clinic-based care on popularity and utilization patterns of isihlambezo, and (2) the potential maternal-fetal health effects of its use. Interviews were conducted among rural and urban women in clinic and non-clinic settings regarding socio-behavioral aspects of isihlambezo use. The pharmacology of certain plant ingredients of isihlambezo was investigated through laboratory assays, literature review, and interviews with traditional healers. There were significant differences by area of interview in nearly all aspects of isihlambezo use examined. Though isihlambezo was most popular among urbanites and clinic non-attenders, it was considered an important antenatal health care alternative by the majority of women surveyed. Mixing traditional and clinic-based antenatal care was also strongly advocated. Pharmacological analysis suggested the possibility of both therapeutic and harmful consequences of isihlambezo. It was suggested that the following factors might contribute the popularity of isihlambezo among urban women: high cost and inferior quality of clinic care, use of isihlambezo as a means of adapting to urbanization-related stress, and socio-cultural transition.

Adolescent↗

Antifungal activity of extracts from medicinal plants used by First Nations Peoples of eastern Canada.

From literature describing medicinal usage of plants by First Nations Peoples in eastern Canada, 18 eastern Canadian plants were selected and tested for their antifungal activities. Eight randomly selected tropical plants were also tested for comparative purposes. Four groups of plants were obtained: popular antimicrobial-remedy (n=6), popular non-antimicrobial-remedy (n=6), random temperate (n=6) and random tropical (n=8). Extracts from these plants were tested in disk assays as growth inhibitors of six fungi known to be opportunistic human pathogens (Saccharomyces cerevisiae, Cryptococcus neoformans, Candida albicans, Aspergillus fumigatus, Microsporum gypseum and Trichophyton mentagrophytes). Of the four plant groups tested, extracts from the popular antimicrobial-remedy group were significantly more effective at inhibiting fungal growth based on both overall antifungal activity and number of fungal species inhibited.

Antifungal Agents↗

Ethnobotanical survey in the Palestinian area: a classification of the healing potential of medicinal plants.

An ethnobotanical survey was carried out in the West Bank to evaluate the relative efficacy of the plants used to treat skin diseases and prostate cancer. A total number of 102 informants, 30 years and older and either native born or had been living in the West Bank for more than 30 years, were interviewed using a previously prepared questionnaire. Of about 165 plant species mentioned by the informants, 63 (38.1%) were mentioned by three or more informants. On the basis of their primary uses, 21 of these plants were reported to relieve skin disorders, 17 for urinary system disorders, 16 for gastric disorders, nine for cancer and prostate disorders, eight for arthritis, five for respiratory problems, and five for other ailments. Indices on fidelity levels (FLs), relative popularity level (RPL), and rank-order priority (ROP) were calculated. Plants were classified in two groups: 'popular' (RPL=1) or 'unpopular' (RPL<1). The following plant species were classified as popular in this study: Teucrium polium, Matricaria aurea, Urtica pilulifera, Paronychia argentea, Petroselinum sativum, and Salvia fruticosa. The remaining 57 species were classified as 'unpopular'. Fifty-nine plants were claimed to be effective against cancer and prostate disorders, which include Arum dioscorides, U. pilulifera, Allium sativum, Viscum cruciatum, and Allium cepa.

Adult↗

Quadrature subunits in directionally selective simple cells: spatiotemporal interactions.

I explore here whether linear mechanisms can explain directional selectivity (DS) in simple cells of the cat's striate cortex, a question suggested by a recent upswing in popularity of linear DS models. I chose a simple cell with a space-time inseparable receptive field (RF), i.e. one that shows gradually shifting latency across space, as the RF type most likely to depend on linear mechanisms of DS. However, measured responses of the cell to a moving bar were less modulated, and extended over a larger spatial region than predicted by two different popular "linear" models. They also were more DS in exhibiting a higher ratio of total spikes for the preferred direction. Each of the two models used for comparison has a single "branch" with a single spatiotemporally inseparable linear filter followed by a threshold, hence, a- "1-branch" model. Nonlinear interactions between pairs of bars in a 2-bar linear superposition test of the cell also disagreed in time-course with those of the 1-branch models. The only model whose 1-bar and 2-bar predictions matched the measured cell (including a complete "4-branch" motion energy model that matches complex cells) has two branches that differ in phase by about 90 deg, i.e. in quadrature. Each branch has its own threshold that helps define the preceding spatiotemporal unit as a subunit even after the outputs of the two branches are summed. As subunit phases differ by only 90 deg, flashing bar responses of the 2-subunit model are similar to those of the 1-subunit model. Therefore, the number of subunits is hidden from view when testing with a conventional stationary bar. In summary, movement responses and nonlinear interactions between pairs of bars in the measured cell matched those of the 2-subunit model, while they disagreed with the popular 1-subunit model. Thus, multiple nonlinear subunits appear to be necessary for DS, even in simple cortical cells.

Animals↗

Learned helplessness in social situations.

Helplessness in social situations was conceptualized as the perceived inability to surmount rejection, as revealed by causal attributions for rejection. Although current research on children's social adjustment emphasizes differences in social skills between popular and unpopular children or behavioral intervention as an aid for withdrawn children, the present study explores responses to rejection across popularity levels. The results show that individual differences in attributions for rejection are related to disruption of goal-directed behavior following rejection. As predicted, the most severe disruption of attempts to gain social approval (withdrawal and perseveration) was associated with the tendency to emphasize personal incompetence as the cause of rejection, regardless of popularity level. The findings suggest that cognitive mediators of overt social behavior and ability to solve problems when faced with difficulties need to be considered in the study of children's social relations.

Achievement↗

Social contagion of binge eating.

A social psychological account of the acquisition of binge eating, analogous to the classic social psychological work, "Social Pressures in Informal Groups" (Festinger, Schachter, & Back, 1950), is suggested and tested in two college sororities. In these sororities, clear evidence of group norms about appropriate binge-eating behavior was found; in one sorority, the more one binged, the more popular one was. In the other, popularity was associated with binging the right amount: Those who binged too much or too little were less popular than those who binged at the mean. Evidence of social pressures to binge eat were found as well. By the end of the academic year, a sorority member's binge eating could be predicted from the binge-eating level of her friends (average r = .31). As friendship groups grew more cohesive, a sorority member's binge eating grew more and more like that of her friends (average r = .35). The parsimony of a social psychological account of the acquisition of binge eating behavior is shown. I argue that there is no great mystery to how bulimia has become such a serious problem for today's women. Binge eating seems to be an acquired pattern of behavior, perhaps through modeling, and appears to be learned much like any other set of behaviors. Like other behaviors, it is under substantial social control.

Adult↗

Adolescent girls' and boys' weight-related health behaviors and cognitions: associations with reputation- and preference-based peer status.

In this study, the authors examined associations between preference- and reputation-based peer status and weight-related behaviors and cognitions for both adolescent boys and girls. Sociometric measures of peer like-ability and peer-perceived popularity, as well as self-reported measures of body size, dieting behavior, and weight-related cognitions were collected from a sample of 441 adolescents in Grades 11 and 12. Results revealed weight-related cognitions for girls (concerning obesity) and boys (concerning musculature/fitness). Peer-perceived popularity, but not like-ability, was significantly associated with both boys' and girls' body size and dieting. Lower levels of popularity were associated with heavier body shapes for girls and with both thin and heavier body shapes for boys. Findings suggest that peer status is an important source of social reinforcement associated with weight-related behaviors and cognitions.

Adolescent↗

Relation of emotion-related regulation to children's social competence: a longitudinal study.

The differential relations of children's emotion-related regulation (i.e., effortful control and impulsivity) to their personality resiliency, adult-rated popularity, and social competence were examined in children who were 4.5-7.9 years old and who were remeasured 2 years later. Parents and teachers reported on all constructs, and children's attentional persistence was observed. Structural equation modeling was used to test the mediating role of resiliency on the relations between regulation/control and popularity using two-wave longitudinal data. The results provide some evidence of the mediating role of resiliency in the relations between effortful control and popularity, provide some evidence of bidirectional effects, and also buttress the view that emotional regulation should be differentiated into effortful and reactive forms of control.

Adaptation, Psychological↗

Foods and drinks at four daily time intervals in a group of young children.

This study provides information about snacks and drinks regularly consumed by a group of 2139 4-year-old children. Data were collected through a simple questionnaire completed at interview. Findings were related to caries levels measured at clinical examination 6 months later. Results confirmed that nearly all children had one or more snacks or drinks on most days. The most popular time for these was mid-afternoon. Sweet biscuits and fruit were the most popular snack foods and diluted fruit squash and milk the most popular drinks. Caries, as expressed in mean dmft, increased significantly with increasing number of intakes.

Child, Preschool↗

Fat, plain, but not friendless: self-esteem and peer acceptance of obese pre-adolescent girls.

OBJECTIVES: Poor self-esteem is assumed, but not consistently found, in obese children and adolescents. The aims of this study were a detailed analysis of body weight influences on self-esteem and peer acceptance in pre-adolescent girls. DESIGN: A cross-sectional comparison of girls in four weight (body mass index [BMI]) groups; underweight (< 10%), normal weight (10-85%), overweight (85-95%), and obese (> 95%). MEASURES: Assessments of body weight and height, body shape preference, self-esteem and peer nominations of popularity and attractiveness were collected from 313 girls aged 9y. RESULTS: Obese and overweight girls had significantly lower physical appearance and athletic competence self-esteem than their normal weight peers. Body weight had no impact on girls' rated importance of self-esteem domains. Heavier girls were significantly less likely to be peer nominated as pretty, but did not differ in their popularity. CONCLUSIONS: Prior to adolescence, physical appearance rather than global self-esteem is affected by overweight, and popularity preserved. Further research is required into the mechanisms of peer influence, and its consequences, in obese and overweight young adolescents.

Body Constitution↗

Fluoride concentrations in three types of commercially packed tea drinks in Taiwan.

Tea is a popular drink around the world. It is also one of the major sources of fluoride intake. The objectives of this study were to assess fluoride concentrations in popular non-, semi-, and full-fermented tea drinks sold on the Taiwan market. Concentration differences among three types of commercially available tea drinks (tea leaf, tea bag, and packaged tea beverage) were explored. Several influential factors in intake concentrations were evaluated. The acute threshold intake (ATI) and allowable daily intake (ADI) of those tea drinks were also estimated. For each commercial type, samples from the most popular tea in one particular fermentation degree (non, semi, and full) were randomly purchased and analyzed for fluoride concentrations. Fluoride levels in different rounds of tea, in different containers, and with different ratios of water and tea leaf were also assessed. In total, 132 tea samples were analyzed. The mean fluoride concentrations in leaf tea without the first round, leaf tea with the first round, bagged tea, and packaged tea were 7.04, 7.79, 5.37, and 25.7 mg/l, respectively. Most of the intake concentrations in those samples exceeded 4 mg/l F, the lower bound of fluoride levels reported in the literatures to be associated with a lower IQ in children and a higher risk of bone fracture. Fluoride concentrations in packaged tea were the highest among the three types of commercially available tea. For studied leaf and bagged tea, almost a constant amount of fluoride was infused from the same amount of tea leaf regardless of the water volume. Besides this, making tea with glass or pottery tea makers would not affect fluoride intake concentrations. Acute intoxication is unlikely to occur. However, tea lovers in high fluoride content areas shall consider limit their consumption of tea drinks to avoid potential chronic effects.

Administration, Oral↗

Complementary and alternative medicine use among patients attending a hospital dermatology clinic in Taiwan.

BACKGROUND: Recent studies have indicated that complementary and alternative medicine (CAM) has been gaining popularity around the world. Previous studies showed that CAM use was common among dermatology patients in Western nations. This study presents the prevalence and types of CAM use among a group of patients in a dermatology clinic in Taiwan. METHODS: A convenient sample of 198 patients was recruited from the dermatology clinic of Show Chwan Memorial Hospital in Changhua City, Taiwan. Each patient completed a standardized questionnaire. Chi-square tests were used to compare the demographic characteristics of those who did and did not use CAM. Logistic regression analyses were performed to determine the strength of association between correlate variables and CAM use. RESULTS: Forty-one per cent of subjects had used CAM to treat their dermatological conditions. Subjects in the younger (< 30 years) and older (> 50 years) age groups were more likely to use CAM than those in the 30-50-year age group. Those that participated in religious or social groups were more likely to use CAM. CAM users felt a more negative impact of their dermatological conditions on daily living, relationships, emotional well-being and physical health. CONCLUSIONS: As in Western nations, CAM use is prevalent among dermatology patients in Taiwan: not only the traditionally popular Chinese CAM, but also Western CAM. With CAM being popular in the younger age group, dermatologists will likely encounter more CAM users in the future. Because some CAM may produce serious side-effects, dermatologists need to help and guide patients to assess the benefits and dangers of using CAM to treat dermatological conditions.

Adult↗

Selected factors influencing self-concept among hospitalized Chinese school-age children with a chronic illness.

A correlational descriptive study was conducted to investigate self-concept and selected influencing factors among hospitalized Chinese school-age children with a chronic illness. The purposive sample was composed of 122 school-age children with chronic illnesses, such as nephrotic syndrome, leukemia, and congenital heart disease, who were admitted to three major teaching hospitals in Shanghai City. The children's medical records, demographic forms, and the Piers-Harris Self-concept Scale (PHSCS) were used to collect the data. Descriptive statistics, and stepwise multiple regression were used to analyze the data utilizing the SPSS program (SPSS Inc, Chicago, IL, USA). The results of this study showed that the majority of hospitalized Chinese school-age children with a chronic illness had at least an average level of self-concept. Academic achievement (grade point average) was a strong predictor of self-concept, as are most of its subconcepts, including social behavior, academic competence, and physical appearance and attributes. Age was a significant predictor of overall self-concept, social behavior, and popularity subconcept. Sex was a significant predictor of self-concept subconcepts such as social behavior, anxiety, and popularity. Duration of illness was a significant predictor of physical appearance and attributes. In addition, the type of illness was a significant predictor of popularity. It can be concluded that the importance of school education should be emphasized by hospital and school nurses for the purpose of helping such children build a positive self-concept concerning their age, sex, academic achievement, type of illness, and duration of illness. Recommendations for further research have been suggested.

Adolescent↗

Cutaneous side effects of alternative therapy.

Unconventional, complementary, and alternative therapies have become very popular forms of therapy and the predictions are that their popularity will continue to soar in the future. They are often perceived as being "natural" and therefore harmless, devoid of side effects, and without unpleasant consequences. The fact is that although their risks might be less than those of conventional drugs, side effects of this therapy can and do occur and must be considered as being a relevant factor in using such methods. It is to be expected that their numbers will increase in the future because of their growing popularity and because of continuing efforts to intensify their activity and therapeutic efficacy. Therefore, now more than ever, dermatologists should be familiar with all possible side effects, risks, and toxic, allergic, and possible mutagenic reactions. This article provides fundamental and vital information for practicing dermatologists.

Complementary Therapies↗

Intraperitoneal blood missed on a FAST examination using portable ultrasound.

Bedside ultrasonography is rapidly gaining popularity in the evaluation of emergency patients. Several manufacturers have developed hand-held ultrasound machines that make the technology easy to transport and available in settings where such diagnostic tests were previously unobtainable. The miniaturization of equipment often means compromises and no studies exist comparing the high quality imaging capabilities of larger conventional ultrasound units to hand-held machines on actual patients. We present 3 cases in which intra-abdominal fluid stripes, important markers of intraperitoneal bleeding, were not visible with a popular hand-held unit, but were identified with a larger mobile ultrasound machine. These findings should caution emergency physicians to be aware of this limitation along with the many advantages of these new and popular hand-held ultrasound units.

Adolescent↗

[Cemented total hip arthroplasty in Germany--an update].

AIM: The results of a national survey from 1998 had shown at the time that only around 10 % of orthopaedic surgeons in Germany had strictly implemented modern cementing techniques in total hip arthroplasty (THA). The same study was repeated 5 years later to evaluate the current situation and to determine whether modern cementing techniques have become more popular. METHODS: A detailed, slightly modified questionnaire regarding cement and bone preparation, cementing techniques on acetabulum and femur, and implant types was sent to 572 German orthopaedic and trauma hospitals, as well as to visiting surgeons with an interest in THA. In total, 293 questionnaires were available for evaluation and statistical analysis. RESULTS: Palacos bone cement remained the most widely used cement (> 90 %). The mixing times given varied significantly. Vacuum mixing systems had become more popular (67.9 %). In the femur 81.8 % of the surgeons attempted to preserve cancellous bone and 57.2 % used pulsatile lavage (jet-lavage). Retrograde cement application via a cement gun was done in 71.1 %. Cement restrictors were used in more than 95 %. Only two-thirds of the surgeons implemented sustained cement pressurisation and preferred a cement mantle thickness > 2mm (64 %). Only 16.9 % made multiple small acetabular keyholes and 48.6 % used jet-lavage. In 73.1 % no cement gun was used and in 68.3 % the cement was applied at high viscosity. Manual cement pressurisation was done in 58.1 %. The Muller straight stem device remained the most popular implant. For only 5 of the over 50 stem designs implanted have long-term results been published as yet. Only 10.6 % of surgeons/centres performed > 20 and almost 50 % implanted > 100 cemented THAs/year. CONCLUSION: The results of this survey demonstrated that, in comparison to 1998, the current state of cemented THA, in particular cementing technique has significantly improved. Future emphasis should be on continued surgeon education and training, as the operative, i. e., cementing techniques are of utmost importance for long-term success.

Arthroplasty, Replacement, Hip↗