General Practitioners' willingness to pay for continuing medical education in a fee-for-service universal coverage health care system

Background: Sponsoring of physicians meetings by life science companies has led to reduced participation fees but might influence physician's prescription practices. A ban on such sponsoring may increase participation fees. We aimed to evaluate factors associated with physicians' willingness to pay for medical meetings, their position on the sponsoring of medical meetings and their opinion on alternative financing options. Methods: An anonymous web-based questionnaire was sent to 447 general practitioners in one state in Switzerland, identified through their affiliation to a medical association. The questionnaire evaluated physicians' willingness to pay for medical meetings, their perception of a bias in prescription practices induced by commercial support, their opinion on the introduction of a binding legislation and alternative financing options, their frequency of exchange with sales representatives and other relevant socioeconomic factors. We built a multivariate predictor logistic regression model to identify determinants of willingness to pay. Results: Of the 115 physicians who responded (response rate 26%), 48% were willing to pay more than what they currently pay for congresses, 79% disagreed that commercial support introduced a bias in their prescription practices and 61% disagreed that it introduced a bias in their colleagues' prescription practices. Based on the multivariate logistic regression, perception of a bias in peers prescription practices (OR=7.47, 95% CI 1.65-38.18) and group practice structure (OR=4.62, 95% CI 1.34-22.29) were significantly associated with an increase in willingness to pay. Two thirds (76%) of physicians did not support the introduction of a binding legislation and 53% were in favour of creating a general fund administered by an independent body. Conclusion: Our results suggest that almost half of physicians surveyed are willing to pay more than what they currently pay for congresses. Predictors of an increase in physicians' willingness to pay were perception of the influence of bias in peers prescription practices and group practice structure. Most responders did not agree that sponsoring introduced prescribing bias nor did they support the 2 introduction of a binding legislation prohibiting sponsoring but a majority did agree to an independent body that would centrally administer a general fund.

The quality of primary care in a country with universal health care coverage.

BACKGROUND: Standard indicators of quality of care have been developed in the United States. Limited information exists about quality of care in countries with universal health care coverage.OBJECTIVE: To assess the quality of preventive care and care for cardiovascular risk factors in a country with universal health care coverage.DESIGN AND PARTICIPANTS: Retrospective cohort of a random sample of 1,002 patients aged 50-80 years followed for 2 years from all Swiss university primary care settings.MAIN MEASURES: We used indicators derived from RAND's Quality Assessment Tools. Each indicator was scored by dividing the number of episodes when recommended care was delivered by the number of times patients were eligible for indicators. Aggregate scores were calculated by taking into account the number of eligible patients for each indicator.KEY RESULTS: Overall, patients (44% women) received 69% of recommended preventive care, but rates differed by indicators. Indicators assessing annual blood pressure and weight measurements (both 95%) were more likely to be met than indicators assessing smoking cessation counseling (72%), breast (40%) and colon cancer screening (35%; all p < 0.001 for comparisons with blood pressure and weight measurements). Eighty-three percent of patients received the recommended care for cardiovascular risk factors, including > 75% for hypertension, dyslipidemia and diabetes. However, foot examination was performed only in 50% of patients with diabetes. Prevention indicators were more likely to be met in men (72.2% vs 65.3% in women, p < 0.001) and patients < 65 years (70.1% vs 68.0% in those a parts per thousand yen65 years, p = 0.047).CONCLUSIONS: Using standardized tools, these adults received 69% of recommended preventive care and 83% of care for cardiovascular risk factors in Switzerland, a country with universal coverage. Prevention indicator rates were lower for women and the elderly, and for cancer screening. Our study helps pave the way for targeted quality improvement initiatives and broader assessment of health care in Continental Europe.

Parasites of the flatfish Paralichthys adspersus (Steindachner, 1867) (Pleuronectiformes) from northern Chile

Three species of protistan and 22 species of metazoan parasites were obtained from a sample of 179 flatfish, (Paralichthys adspersus) taken-off Antofagasta, northern Chile. Prevalence of infection of seven parasites (Protista: 1, Copepoda: 2, Digenea: 1, Acantocephala: 1, Nematoda: 2) was significantly and positively correlated with host size. Host's sex do not seem to affect prevalence of infection, except for Nybelinia surmenicola, Capillaria sp. and Anisakis sp. (prevalence of infection significantly greater in males than females) and Philometra sp. (prevalence higher in females). Mean abundance is correlated with size in nine species (Protista: 1, Copepoda: 2, Digenea: 3, Acantocephala: 1, Nematoda: 2). Host's sex do not affect mean abundance, except for Cainocreadium sp. and Philometra sp.(mean abundance higher in females) and Nybelinia surmenicola, Capillaria sp. and Anisakis sp. (mean abundance higher in males).

Publicizing insecurity, privatizing security: Chinese wholesalers' surveillance cameras in a Paris suburb

Since the early nineties, several hundreds of Chinese immigrants have settled in what has become known as the 'Chinese wholesalers area'. For the past two years, Chinese wholesalers in Aubervilliers have been calling on public authorities to address the problem of street robberies and violent thefts, which they experience on a daily basis. Yet, they have been encouraged by the authorities to ensure their own protection, by - amongst other things - installing surveillance cameras to film the streets. This is illegal according to French legislation on camera surveillance. Knowing this, why have surveillance cameras been adopted as a solution? This question guides the ethnographic analysis presented here of a situation where the installation of surveillance cameras was locally negotiated by the main actors involved - namely, the wholesalers' representatives and the police.

Cultural relativism in the Universal Periodic Review of the Human Rights Council

This Working Paper aims to offer an up-to-date list of cultural relativist players and arguments with respect to human rights, constituted by China, Viet Nam, Myanmar, Iran, Pakistan, Yemen, Syria, Malaysia and Cuba. This working paper argues that Indonesia, Iraq, Colombia and Mexico are not in the same cultural relativist group of states maintained by renowned scholars, notably Cristina Cerna and Dianne Otto. As such, apart from this form of cultural relativism based on the respect for the self-determination of indigenous peoples and communities, this working paper exposes two different categories of radical cultural relativism based on revolutionary discourse and/or radical Islamism, as well as targets the credibility on the latter two based on the information facilitated by the United Nations (UN) Human Rights Council (HRC) Universal Periodic Review (UPR).