The Evolution of Inequity in the Access to Health Care in Spain: 1987-2001

This paper reports an analysis of the evolution of income related health inequalities in Spain over the period 1987-2001. We use recently developed methods in order to cardinalise and model self assessed health within a regression framework, decompose the sources of inequality and explain the observed differences between 1987 (one year after the 1986 General Health Act was approved) and 2001 (the latest available representative data on health for the Spanish population). The results show that the period has witnessed a reduction in income related health inequality. The driver of such reduction has been the weakening of the income health gradient, which lends support to the hypothesis that the important health policy reforms implemented over the period have been successful in the objective of reducing socio-economic inequalities in health. Our results also suggest that actions aimed at improving the health of those with low levels of education and of those who are not actively participating in the labor market would lead to further reductions in income related health inequality.

Accès à la thrombolyse lors d'AVC: rôle des secours préhospitaliers et des médecins de premier recours [Access to thrombolysis in stroke: place of the rescue system and of the primary care physician].

Thrombolysis is the most effective treatment improving the outcome of patients suffering from acute stroke. Moreover, its effectiveness increases when administrated as quick as possible after the onset of the first symptoms. Prehospital selection of patients and their immediate transfer to stroke center are the principal factors allowing the practice of thrombolysis within the authorized time frame. On the basis of regional Swiss French data, it seems that patients evaluated by emergency physician and their direct transfer in an acute stroke unit reduces delays and allows for a higher thrombolysis rate.

Primary Care Sensitive Hospitalization: users detect flaws on the access to services

The aim of this study is to analyze and understand the reasons for the occurrence of sensitive hospitalizations in accordance with users. Qualitative study conducted with users who were admitted to Pedreira General Hospital, in São Paulo. The data was collected through semi structured interviews and thereafter, transcribed and processed in the electronic program Alceste. When analyzing the content, the access was seized fundamentally as an empirical category, bringing up problems that later deserved, from the Brazilian Ministry of Health, a specific Program to improve the quality and access to primary care. The hierarchical and pyramidal organization shape from the health system in the city of São Paulo can be one of the important aspects for the access matter and established as an important restricting factor in the primary care role in reducing or even preventing the occurrence of these hospitalizations.

The Vaccine Formulation Laboratory: a platform for access to adjuvants.

Adjuvants are increasingly used by the vaccine research and development community, particularly for their ability to enhance immune responses and for their dose-sparing properties. However, they are not readily available to the majority of public sector vaccine research groups, and even those with access to suitable adjuvants may still fail in the development of their vaccines because of lack of knowledge on how to correctly formulate the adjuvants. This shortcoming led the World Health Organization to advocate for the establishment of the Vaccine Formulation Laboratory at the University of Lausanne, Switzerland. The primary mission of the laboratory is to transfer adjuvants and formulation technology free of intellectual property rights to academic institutions, small biotechnology companies and developing countries vaccine manufacturers. In this context, the transfer of an oil-in-water emulsion to Bio Farma, an Indonesian vaccine manufacturer, was initiated to increase domestic pandemic influenza vaccine production capacity as part of the national pandemic influenza preparedness plan.

Standardized enforcement: Access to justice vs contractual innovation

We model the different ways in which precedents and contract standardization shapethe development of markets and the law. In a setup where more resourceful parties candistort contract enforcement to their advantage, we find that the introduction of astandard contract reduces enforcement distortions relative to precedents, exerting twoeffects: i) it statically expands the volume of trade, but ii) it crowds out the use ofinnovative contracts, hindering contractual innovation. We shed light on the largescale commercial codification occurred in the 19th century in many countries (evenCommon Law ones) during a period of booming commerce and long distance trade.

Tolerance of whitefish embryos to Pseudomonas fluorescens linked to genetic and maternal effects, and reduced by previous exposure.

Juvenile or adult fish can alter their behaviour and rely on an innate and adaptive immune system to avoid/counteract pathogens, while fish embryos have to depend on egg characteristics and may be partly protected by their developing immune system that is building up from a certain age on. We developed an infection protocol that allows testing the reaction of individual whitefish embryos (Coregonus palaea) to repeated exposures to Pseudomonas fluorescens, an opportunistic bacterial fish pathogen. We used a full-factorial in vitro breeding design to separately test the effects of paternal and maternal contributions to the embryos' susceptibility to different kinds of pathogen exposure. We found that a first non-lethal exposure had immunosuppressive effects: pre-exposed embryos were more susceptible to future challenges with the same pathogen. At intermediate and high levels of pathogen intensity, maternal effects turned out to be crucial for the embryos' tolerance to infection. Paternal (i.e. genetic) effects played a significant role at the strongest level of infection, i.e. the embryos' own genetics already explained some of the variation in embryo susceptibility. Our findings suggest that whitefish embryos are largely protected by maternally transmitted substances, but build up some own innate immunocompetence several days before hatching.

The evolution of inequity in the access to health care in Spain: 1987-2001

This paper reports an analysis of the evolution of equity in access to health care in Spain over the period 1987-2001, a time span covering the development of the modern Spanish National Health System. Our measures of access are the probabilities of visiting a doctor, using emergency services and being hospitalised. For these three measures we obtain indices of horizontal inequity from microeconometric models of utilization that exploit the individual information in the Spanish National Health Surveys of 1987 and 2001. We find that by 2001 the system has improved in the sense that differences in income no longer lead to different access given the same level of need. However, the tenure of private health insurance leads to differences in access given the same level of need, and its contribution to inequity has increased over time, both because insurance is more concentrated among the rich and because the elasticity of utilization for the three services has increased too.

Enabling mobile access to digital libraries in digital divide contexts

Digital libraries (DL) have had a tremendous impact on improving the accessibility of scientific and academic publications. In developing countries, they seem to be the great hope, due to the serious existing problems with the traditional publishing and distribution mechanisms and to the potential they have on enabling access to a great panoply of publications. Moreover, accessing digital libraries over mobile devices has the potential of reaching a broader community of users and on helping to bridge the digital divide, since there are very reduced computer and Internet penetration rates in these countries, along with a higher mobile phone usage. For developed countries, accessing digital libraries on the go might also bring important added value. This paper features an analysis of the major issues related to making digital libraries accessible over mobile devices. A specific study on the possibility of using mobile digital libraries in a developing country context is also presented along with a proposal for making DSpace based digital libraries accessible over mobile phones.

Access to a simulator is not enough: the benefits of virtual reality training based on peer-group-derived benchmarks--a randomized controlled trial.

BACKGROUND: Virtual reality (VR) simulators are widely used to familiarize surgical novices with laparoscopy, but VR training methods differ in efficacy. In the present trial, self-controlled basic VR training (SC-training) was tested against training based on peer-group-derived benchmarks (PGD-training). METHODS: First, novice laparoscopic residents were randomized into a SC group (n = 34), and a group using PGD-benchmarks (n = 34) for basic laparoscopic training. After completing basic training, both groups performed 60 VR laparoscopic cholecystectomies for performance analysis. Primary endpoints were simulator metrics; secondary endpoints were program adherence, trainee motivation, and training efficacy. RESULTS: Altogether, 66 residents completed basic training, and 3,837 of 3,960 (96.8 %) cholecystectomies were available for analysis. Course adherence was good, with only two dropouts, both in the SC-group. The PGD-group spent more time and repetitions in basic training until the benchmarks were reached and subsequently showed better performance in the readout cholecystectomies: Median time (gallbladder extraction) showed significant differences of 520 s (IQR 354-738 s) in SC-training versus 390 s (IQR 278-536 s) in the PGD-group (p < 0.001) and 215 s (IQR 175-276 s) in experts, respectively. Path length of the right instrument also showed significant differences, again with the PGD-training group being more efficient. CONCLUSIONS: Basic VR laparoscopic training based on PGD benchmarks with external assessment is superior to SC training, resulting in higher trainee motivation and better performance in simulated laparoscopic cholecystectomies. We recommend such a basic course based on PGD benchmarks before advancing to more elaborate VR training.

Vers un accès à des soins de qualité pour les personnes lesbiennes, gays, bisexuelles et transgenres. [Access to quality primary care for LGBT people].

Cet article propose une approche globale de la santé des personnes lesbiennes, gays, bisexuelles, et transgenres (LGBT), où respect des singularités et non-jugement occupent une position centrale. Il invite à dépasser une vision centrée sur les risques liés au VIH. Pour qui n'a pas connu de questionnement en lien avec son orientation sexuelle ou son identité de genre, il est difficile de concevoir comment la découverte d'une caractéristique identitaire pendant l'enfance peut se transformer sous le regard des autres en un fardeau souvent invisible mais fréquemment associé avec une morbidité émotionnelle et médicale considérable. Cet article pose la question suivante : combien de personnes LGBT ressortent chaque semaine d'une consultation médicale sans avoir eu l'opportunité de bénéficier d'une écoute, d'un soutien et de soins adaptés ? [Abstract] This article offers a comprehensive approach to the health of lesbian, gay, bisexual and transgender (LGBT) people, where respect for diversity and non judgemental care play a central role. It calls for a health and medical vision that goes beyond HIV risk. For those who never had to question their own sexual orientation or gender identity, it is certainly difficult to understand how the discovery of one's identity trait in childhood or early adolescence can be transformed under social pressure into a burden which often remains invisible but is associated with considerable emotional and medical morbidity. This article raises the following question : How many LGBT patients go unnoticed every week, leaving the physician's office without an opportunity to receive appropriate listening, support and care ?

Evidence for a compulsive-like behavior in rats exposed to alternate access to highly preferred palatable food.

Converging evidence suggests that recurrent excessive calorie restriction causes binge eating by promoting behavioral disinhibition and overeating. This interpretation suggests that cognitive adaptations may surpass physiological regulations of metabolic needs after recurrent cycles of dieting and binging. Intermittent access to palatable food has long been studied in rats, but the consequences of such diet cycling procedures on the cognitive control of food seeking remain unclear. Female Wistar rats were divided in two groups matched for food intake and body weight. One group received standard chow pellets 7 days/week, whereas the second group was given chow pellets for 5 days and palatable food for 2 days over seven consecutive weeks. Rats were also trained for operant conditioning. Intermittent access to palatable food elicited binging behavior and reduced intake of normal food. Rats with intermittent access to palatable food failed to exhibit anxiety-like behaviors in the elevated plus maze, but displayed reduced locomotor activity in the open field and developed a blunted corticosterone response following an acute stress across the diet procedure. Trained under a progressive ratio schedule, both groups exhibited the same motivation for sweetened food pellets. However, in contrast to controls, rats with a history of dieting and binging exhibited a persistent compulsive-like behavior when access to preferred pellets was paired with mild electrical foot shock punishments. These results highlight the intricate development of anxiety-like disorders and cognitive deficits leading to a loss of control over preferred food intake after repetitive cycles of intermittent access to palatable food.

The young infant's triangular communication in the family : access to threesome intersubjectivity ? Conceptual considerations and case illustrations

During these last decades, the notion of primary intersubjectivity has gained acceptance among developmentalists and clinicians. But a new challenge is put out to our models by recent findings on the triangular competence of the very young infant, or her capacity to simultaneously communicate with two partners at a time. This discovery raises the question of a collective form of intersubjectivity. Findings on the triangular competence of the 3- to 4-month-old interactions with father and mother in different contexts of the Lausanne trilogue play situation are reviewed and illustrated, with a view to examine whether it is based on a dyadic or triangular program and whether conditions for a threesome form of primary intersubjectivity are fulfilled. The discussion focuses on the revisions of the theory of intersubjectivity, of developmental theory, and of clinical practice these findings call for, pointing toward a three -person psychology too.

Childhood adversity and psychosis: examinig whether the association is due to genetic confounding using a monozygotic twin differences approach

Purpose: To test whether the association between childhood adversity and positive and negative psychotic experiences is due to genetic confounding. Method: Childhood adversity and psychotic experiences were assessed in a sample of 226 twins from the general population. A monozygotic (MZ) twin differences approach was used to assess possible genetic confounding. Results: In the whole sample, childhood adversity was significantly associated with positive (β =.45; SE=.16; p=.008) and negative psychotic experiences (β=.77; SE=.18; p<.01). Within-pair MZ twin differences in exposure to childhood adversity were significantly associated with differences in positive (β =.71; SE=.29; p=.016) and negative psychotic experiences (β =.98; SE=.38; p=.014) in a subsample of 86 MZ twin pairs. Conclusions: Individuals exposed to childhood adversity are more likely to report psychotic experiences. Furthermore, our findings indicate that unique environmental effects of childhood adversity contribute to the development of psychotic experiences.

Networking the unemployed : Can policy interventions facilitate access to employment through informal channels ?

It is widely known that informal contacts and networks constitute a major advantage when searching for a job. Unemployed people are likely to benefit from such informal contacts, but building and sustaining a network can be particularly difficult when out of employment. Interventions that allow unemployed people to effectively strengthen their networking capability could as a result be promising. Against this background, this article provides some hints in relation to the direction that such interventions could take. First, on the basis of data collected on a sample of 4,600 newly-unemployed people in the Swiss Canton of Vaud, it looks at the factors that influence jobseekers' decisions to turn to informal contacts for their job search. The article shows that many unemployed people are not making use of their network because they are unaware of the importance of this method. Second, it presents an impact analysis of an innovative intervention designed to raise awareness of the importance of networks which is tested in a randomized controlled trial setting.