bluuebunny/crossref_metadata_2025_split huggingface dataset:
An analysis of three national health insurance proposals in Sub‐Saharan Africa
Authors: Vogel Ronald J. 
Published: May 2007

AbstractThe financing and/or provision of health insurance by government has a theoretical basis: it stems from market failure in the private health insurance market; and, from externalities in the consumption of health care by the poor. Government health insurance, or national health insurance (NHI) may be analysed by using five criteria: who are the beneficiaries?; efficiency effects; the equity of financing; the level of administrative costs; and, political acceptability. In the last five years, Ghana, Zimbabwe and Nigeria have each considered proposals for NHI. However, each proposal shows design flaws, when analysed in the light of the five criteria above. This article first considers types of health insurance in Sub‐Saharan Africa, and why NHI, with cost recovery as an essential component, might be desirable. A following section present an outline of the NHI proposals in Ghana, Zimbabwe and Nigeria and points out the design flaws. A final section builds upon the theoretically‐good aspects of the three proposals, and considers some alternate approaches to NHI that these three countries and other countries in the Sub‐Sahara might want to consider.
A price to pay, part 2: The impact of user charges in the Volta region of Ghana
Authors: Waddington Catriona , Enyimayew K. A. 
Published: May 2007

AbstractThis paper looks at what happened in Ghana following increases in government health service charges in 1983 and 1985. A combination of analysis of records, interviews and discussion with community groups was used.Utilization in rural areas was affected drastically by the substantial increase of 1985. The effect on urban utilization was less extreme and less durable. The age composition of users changed. After the 1985 increase, proportionately more of the 15‐45 age group used the government services—this was particularly at the expense of the over‐45s. The population was obviously concerned with the cost of health care, but were even more concerned about the quality of care and receiving value‐for‐money. They were unwilling to pay if drug supplies were unreliable or staff behaved unpleasantly.Some problems were encountered with implementing the policy of charges. Many facilities did not spend the revenue to which they were entitled—an interesting point, as the existence of the skill to spend money is often tacitly assumed!Charges also had significant indirect resource consequences. Reduced utilization freed up staff time which should be used to provide other services, particularly preventive ones. This opportunity has not, as yet, been exploited.Fee revenue can be dangerously attractive, particularly if it is administratively more accessible than general government allocations. There is a danger that revenue collection becomes a disproportionately important evaluative criterion in a system which is, after all, ultimately intended to improve health status.
An income‐weighted international average for comparative analysis of health expenditures
Authors: Getzen Thomas E. , Poullier Jean‐Pierre 
Published: May 2007

AbstractData from 17 countries across 28 years are used to estimate an international health expenditure function based on real per capita GNP. Actual and expected spending levels are compared for 24 countries. Between 1960 and 1987, it has been rare for health expenditure in any country to be more than ± 20 per cent from the projected value. The norm is for spending to rise at 1.5 times the growth rate of GDP. Two countries appear to display significant anomalies. Spending in the United Kingdom is consistently 15–25 per cent below normal for all years, and Danish expenditure has declined from 7 to 6 per cent of GDP since 1975.
Health for all nigerians: Some revolutionary management dimensions
Authors: Lambo Eyitayo 
Published: May 2007

AbstractHealth For All by the Year 2000, usually referred to as HFA/2000, is a goal that has been accepted by most nations of the world. PHC is the strategy designed to achieve this laudable goal. In Nigeria, there is no doubt that remarkable strides have been made to achieve the goal of HFA/2000 in recent years. However, in order to fully realise this goal, some further revolutionary management steps are needed. This article first examines the progress on HFA made so far in Nigeria; and then, discusses some management initiatives that need to be taken or accelerated to be able to reach that desirable destination.
Management development for primary health care: A framework for analysis
Authors: Cassels Andrew , Janovsky Katja 
Published: May 2007

AbstractStrengthening management has been widely promoted as a critical component of any strategy concerned with improving the implementation of primary health care (PHC). Management development programmes are, however, subject to conflicting demands and differing expectations. The situation is confounded by the wide diversity of strategies subsumed under the heading of management development, and the confusing nature of much of the terminology currently in use. This article presents a simple conceptual framework that can guide analysis and help programme planners review the options, opportunities and limitations of management development programmes. The framework presented examines management development from three different perspectives: the approach adopted; the outcomes expected; and the process of expansion, extension and adaptation.Our analysis of management development strategies allows us to reach some conclusions in areas where there is a degree of consensus. In countries where there is a mismatch between the strategies of PHC and the organizational structures through which they are to be implemented, management development has a role to play in effecting change. Its potential to do so is limited by powerful social, political, economic and organizational forces. Therefore, the capacity to critically analyse the context in which change is planned, emerges as a key element in programme design. We argue that there is no one best approach to management development, and the design of strategies will be contingent on a variety of factors. We do, however, reaffirm the view that where organizational structures and conditions do not support the implementation of PHC strategies, intervention through training alone is almost certain to be inadequate. To be effective, a more comprehensive programme will be required. Finally, the article points to a number of unresolved issues in areas where there is either controversy, lack of clarity or limited experience.
Hospital role delineation: The technology and the politics
Authors: Duckett Stephen 
Published: May 2007

AbstractRegulated health systems are under increasing pressure to improve the efficiency of their hospital provision. One approach is to have more coordinated hospital provision through hospital role delineation. This short communication proposes the use of Diagnosis Related Groups as part of the role delineation process. However, the role delineation process is not solely a technical one: it requires a blend of technical and political decisions. Political aspects of the role delineation process are also reviewed.
Managing the unmanageable: Public hospital systems
Authors: Boufford Jo Ivey 
Published: May 2007

AbstractThere are significant challenges to those who work in large public health care delivery systems: political imperatives; resource constraints; sometimes rigid personnel systems; and, the reality that everything occurs in a public forum. The fact that many nations are reviewing and, in some instances, restructuring their national health care systems, has added to the complexity and feeling of continual turbulence experienced by their managers. State run systems like that in the United Kingdom are introducing market forces to increase effectiveness and value for money; while market systems, like that in the United States, are increasing regulatory interventions to achieve the kind of cost control available to countries with large public systems which operate with global budgets.Public hospitals in the United States offer examples of public institutions operating in a highly competitive market environment. A decade of management changes undertaken to enhance the efficiency and effectiveness of the New York City Health and Hospitals Corporation (HHC), the largest public hospital system in the United States, is presented as a case study of public health services and public management in a market environment.
Preliminary spectral characterization of snow in a high altitude tropical glacier and potential effects of impurities in snow on albedo of tropical glaciers
Authors: Sicart Jean Emmanuel , Arnaud Yves 
Published: May 2007

AbstractThis paper presents some preliminary measurements of snow spectral reflectance on the tropical Bolivian Zongo glacier. Measurements show a correct agreement with theoretical spectral albedo of pure snow in the near infrared region, but lower values in the visible region (by 10–20%) probably due to aerosols contained in snow. Impurity contents ranged from 10 to 100 ppmw in one‐week‐old snow collected from the Zongo glacier, but measurements are scarce. Large amounts of snowfall partly compensate the proximity of dust sources in mid‐latitude glaciers, whereas on outer‐tropical glaciers precipitations are not abundant and are very seasonal, and sources of aerosols are proximate. Copyright © 2007 John Wiley & Sons, Ltd.
Individual and joint use of statins and low‐dose aspirin and risk of colorectal cancer: A population‐based case–control study
Authors: Hoffmeister Michael , Chang‐Claude Jenny , Brenner Hermann 
Published: May 2007

AbstractRecent research has drawn attention to protective effects of statins on colorectal cancer (CRC) and possible joint effects with other drugs. Because statins are often administered in combination with low‐dose aspirin for the prevention of cardiovascular disease, the aim of our study was to investigate individual and combined effects of statins and low‐dose aspirin on CRC risk. We assessed use of statins and low‐dose aspirin in 540 cases with histologically confirmed incident CRC and 614 control subjects in a population‐based case–control study in Germany. Multiple logistic regression was used to estimate the impact of regular use of either low‐dose aspirin or statins, and of both drugs combined on CRC risk. We found modest risk reduction of CRC for regular use of low‐dose aspirin (adjusted odds ratio 0.77, 95% confidence interval 0.55–1.07) and a stronger association with regular use of statins (OR 0.65, 95% CI 0.43–0.99) or use of both drugs (OR 0.63, 95% CI 0.36–1.10). Combined use of low‐dose aspirin and statins was associated with risk reduction by 62% after 5 or more years (OR 0.38, 95% CI 0.15–0.97). Combinational chemoprevention with low‐dose aspirin and statins might provide stronger risk reduction than either of the single drugs after at least 5 years use, but confirmation is needed, preferably in prospective cohort studies and eventually by randomized controlled trials. © 2007 Wiley‐Liss, Inc.
Fat and meat intake and prostate cancer risk: The multiethnic cohort study
Authors: Park Song‐Yi , Murphy Suzanne P. , Wilkens Lynne R. , Henderson Brian E. , Kolonel Laurence N. 
Published: May 2007

AbstractDietary fat and meat as potential risk factors for prostate cancer have been the focus of many epidemiologic investigations, and findings from recent studies in particular have been inconsistent. Therefore, we examined the association between these exposures and prostate cancer risk in the Multiethnic Cohort Study. The analyses included 82,483 men in Hawaii and Los Angeles aged ≥45, who completed a detailed quantitative food frequency questionnaire in 1993–1996. During the follow‐up period of 8 years, a total of 4,404 incident cases, including 1,278 nonlocalized or high‐grade cancer cases, were identified. Cox proportional hazard models were used to estimate relative risks of prostate cancer after adjustment for time on study, ethnicity, family history of prostate cancer, education, body mass index, smoking status and energy intake. Intake of different types of fat (total, saturated, monounsaturated or polyunsaturated), n‐6 fatty acid, cholesterol, various meats, and fats from meat showed no association with overall prostate cancer risk or with nonlocalized or high‐grade prostate cancer. Furthermore, we found little evidence of any relation of fat and meat intake with prostate cancer risk within any of the 4 racial/ethnic groups (African Americans, Japanese Americans, Latinos and Whites). There was a suggestion of a protective effect of n‐3 fatty acid intake that was limited to Latinos and Whites. However, overall, our findings from a large cohort study of ethnically diverse population give no indication that intake of fat and meat substantially affects prostate cancer risk. © 2007 Wiley‐Liss, Inc.
Racial differences in clinical and pathological associations with PhIP‐DNA adducts in prostate
Authors: Tang Deliang , Liu Jason J. , Bock Cathryn H. , Neslund‐Dudas Christine , Rundle Andrew , Savera Adnan T. , Yang James J. , Nock Nora L. , Rybicki Benjamin A. 
Published: May 2007

AbstractAfrican–American men have a higher dietary intake of 2‐amino‐1‐methyl‐6‐phenylimidazo[4,5‐b]pyridine (PhIP), which is the most abundant heterocyclic amine in cooked meats and is carcinogenic in rat prostate through the formation of DNA adducts. To determine the clinical and demographic factors associated with PhIP‐DNA adduct levels, the biologically effective dose of PhIP in human prostate, we immunohistochemically measured PhIP‐DNA adducts in a study of 162 Caucasian and 102 African–American men who underwent radical prostatectomy for prostate cancer. A strong correlation between PhIP‐DNA adduct levels in prostate tumor and adjacent non‐tumor cells was observed (ρ = 0.62; p < 0.0001); however, non‐tumor cells had significantly higher adduct levels compared with tumor (0.167 optical density (OD) units ± 0.043 vs. 0.104 OD ± 0.027; p < 0.0001). Race was not associated with PhIP‐DNA adduct levels in either tumor or non‐tumor cells, but race‐specific associations were observed. In prostate tumor and non‐tumor cells, tumor volume had the strongest association with PhIP‐DNA adducts in Caucasians, whereas in African–Americans prostate volume was most strongly associated with adduct levels in tumor cells and advanced Gleason grade had the strongest association in non‐tumor cells. In race interaction models, while the only statistically significant interaction was between African–American race and advanced Gleason grade in non‐tumor cells (β = 0.029; p = 0.02), in tumor cells we observed opposite effects by race (positive for African–Americans, negative for Caucasians) for older age and high PSA levels at diagnosis. In conclusion, while PhIP‐DNA adduct levels in prostate cells do not vary significantly by race, our results suggest that PhIP exposure may have stronger effects on prostate tumor differentiation in African–American men. © 2007 Wiley‐Liss, Inc.
Thermographic assessment of tumor growth in mouse xenografts
Authors: Song Chengli , Appleyard Virginia , Murray Karen , Frank Tim , Sibbett Wilson , Cuschieri Alfred , Thompson Alastair 
Published: May 2007

AbstractIn human breast tumors, a 1–2°C increase in skin surface temperature is usually observed at the periphery; it has been proposed that this change is due to the hypervascularity and increased blood flow resulting from tumor‐associated angiogenesis. Here we tested the hypothesis that thermal imaging might represent a useful adjunctive technique in monitoring the growth dynamics of human tumor xenografts. Xenografts were established in immunocomprised nude mice using MDA‐MB‐231 or MCF7 breast cancer cells. We exploited the inherent noncontact and noninvasive advantages of infrared thermography to detect skin surface temperature changes. Continuous thermographic investigation was performed to detect and monitor tumor growth in vivo and high resolution digital images were analyzed to measure the tumor temperature dynamics. In contrast to the skin temperature increases associated with human breast cancer, a consistent temperature decrease was found in the xenograft mice. In one case, a smaller secondary tumor, otherwise undetectable, was clearly evident by thermal imaging. The tumors were cooler than the surrounding tissue with a maximum temperature reduction of 1.5°C for MDA‐MB‐231 tumor and 3°C for MCF7 tumors observed on day 14. In addition, the temperature of the xenograft tumors decreased progressively as they grew throughout the observation period. It was demonstrated that thermographic imaging could detect temperature changes as small as 0.1°C on the skin surface at an early stage of tumor development. The findings of the study indicate that thermographic imaging might have considerable potential in monitoring human tumor xenografts and their response to anticancer drugs. © 2007 Wiley‐Liss, Inc.
Impact of HER2 and EGFR gene status on gefitinib‐treated patients with nonsmall‐cell lung cancer
Authors: Soh Junichi , Toyooka Shinichi , Ichihara Shuji , Fujiwara Yoshiro , Hotta Katsuyuki , Suehisa Hiroshi , Kobayashi Naruyuki , Ichimura Kouichi , Aoe Keisuke , Aoe Motoi , Kiura Katsuyuki , Date Hiroshi 
Published: May 2007

AbstractWe previously examined the relationship between epidermal growth factor receptor (EGFR) status and clinical outcomes of nonsmall‐cell lung cancer (NSCLC) patients treated with gefitinib. In our study, we additionally examined HER2 status and investigate the impact of genetic status as predictors in Japanese NSCLC patients treated with gefitinib. The HER2 copy number status was determined by fluorescence in situ hybridization assay and mutation of HER2 exon 20 was determined by direct sequencing in 74 patients to investigate the relationship between molecular statuses including HER2 and EGFR and the clinical outcomes of patients treated with gefitinib. The high HER2 copy number was identified in 32 (43.2%) of 74 NSCLC patients and no HER2 exon 20 mutations were found. The high HER2 copy number was significantly associated with the sensitivity to gefitinib (p = 0.0045) and a prolonged progression‐free survival (PFS) (p = 0.0089) in a univariate analysis, but not in a multivariate analysis. Multivariate analyses exhibited that the drug‐sensitive EGFR mutation was an independent predictive factor of a better sensitivity to gefitinib (OR = 41.9, p = 0.002), prolonged overall survival (HR = 0.32, p = 0.019) and PFS (HR = 0.31, p = 0.0045). The high EGFR copy number might have a weak association with better response and prognosis without statistical significance. In conclusion, the drug‐sensitive EGFR mutation, rather than HER2 and EGFR copy numbers, is a determinant of favorable clinical outcomes in gefitinib‐treated patients with NSCLC, although the high HER2 copy number, to some extent, may influence the gefitinib effect. © 2007 Wiley‐Liss, Inc.
The role of trophinin, an adhesion molecule unique to human trophoblasts, in progression of colorectal cancer
Authors: Harada Oi , Suga Tomoaki , Suzuki Takefumi , Nakamoto Katsuaki , Kobayashi Motohiro , Nomiyama Tetsuo , Nadano Daita , Ohyama Chikara , Fukuda Michiko N. , Nakayama Jun 
Published: May 2007

AbstractTrophinin is a unique adhesion molecule expressed by human trophoblastic cells. Its activity and in vivo expression pattern implicate trophinin in the initial attachment of trophectoderm cells to maternal epithelia. Subsequent to apical adhesion, trophoblasts aggressively invade maternal tissue to form the placenta, a process resembling tumor invasion. Here, we report that trophinin is expressed in tumors from 64% of colon cancer patients (n = 50) and high trophinin expression is closely associated with poor prognosis. To determine the link between trophinin expression and malignancy, colon adenocarcinoma SW480 cells were stably transfected with trophinin. An invasion assay showed that trophinin‐expressing SW480 cells were more invasive than mock‐transfected cells. Microarray analysis comparing SW480 cells transfected with trophinin with mock‐transfected cells identified high‐mobility group box 1 (HMGB1) as the most significantly elevated transcript. Immunohistochemical analysis of tumors from the colorectal cancer patients confirmed positive correlation of HMGB1 protein expression in the nucleus to trophinin expression in tumor. HMGB1 and its ligand RAGE (the receptor for advanced glycation end product) proteins were coexpressed in 65.6% of trophinin‐positive patients (n = 32). These results suggest that trophinin promotes invasion through a mechanism involving HMGB1/RAGE. © 2007 Wiley‐Liss, Inc.
Response of Aquatic Leaf Associated Microbial Communities to Elevated Leachate DOC: A Microcosm Study
Authors: Schlief Jeanette , Mutz Michael 
Published: May 2007

AbstractIn Central Europe climate change will increase summer droughts, which cause both, premature leaf fall and fragmentation of small streams during summer and early autumn. As a consequence dissolved organic carbon (DOC) leached from leaves will be dispersed into pools with long water residence time. A microcosm experiment was performed to test the effect of high concentrations of leachate DOC and the relative importance of labile and refractory leachate compounds on leaf associated microbial parameters. In microcosms leaf discs colonized in a stream were exposed to high concentrations of either leaf leachate, glucose or tannic acid. Leaf associated respiration, fungal sporulation, leaf mass loss and fungal biomass (ergosterol) were measured during a 3 weeks experimental period and compared to control without DOC amendment. The results imply that depending on source and composition elevated leachate DOC may have variable effects on microbial mediated litter decomposition. Our findings suggest reduced microbial decomposition rates in pools of fragmented streams receiving premature leaf fall. (© 2007 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
Detritus Processing in Tri‐Trophic Food Chains: a Modelling Approach
Authors: Alemanno Sara , Mancinelli Giorgio , Basset Alberto 
Published: May 2007

AbstractWe present a model describing the fluxes of matter and energy through a detritus‐based aquatic community. The model is based on the investigation of the decomposition of Phragmites australis in a Southern Italian coastal lagoon (Lake Alimini Grande). It reproduces the behaviour of the detritus‐based system by simulating processes of microbial growth and macroinvertebrate colonization in a specific patch of detritus. Specifically, the macroinvertebrate colonization is seen as a dynamic process in which individuals move towards the patch according to resource availability. The good agreement between simulated and experimental data suggests that the behaviourally‐based mechanism of invertebrate colonization characterising our model provides an effective description of the decomposition patterns observed in nature. (© 2007 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)