Matching comprehensive health insurance reimbursements to their real costs: the case of antenatal care visits in a region of Peru.

BACKGROUND: Prepaid contributory systems are increasingly being recognized as key mechanisms in achieving universal health coverage in low and middle-income countries. Peru created the Seguro Integral de Salud (SIS) to increase health service use amongst the poor by removing financial barriers. The SIS transfers funds on a fee-for-service basis to the regional health offices to cover recurrent cost (excluding salaries) of pre-specified packages of interventions. We aim to estimate the full cost of antenatal care (ANC) provision in the Ventanilla District (Callao-Peru) and to compare the actual cost to the reimbursement rates provided by SIS. METHODS: The economic costs of ANC provision in 2011 in 8 of the 15 health centres in Ventanilla District were estimated from a provider perspective and the actual costs of those services covered by the SIS fee of $3.8 for each ANC visit were calculated. A combination of step-down and bottom-up costing methodologies was used. Sensitivity analysis was conducted to test the uncertainty around estimated parameters and model assumptions. Results are reported in 2011 US$. RESULTS: The total economic cost of ANC provision in all 8 health centres was $569,933 with an average cost per ANC visit of$31.3 (95 % CI $29.7-$33.5). Salaries comprised 74.4 % of the total cost. The average cost of the services covered by the SIS fee was $3.4 (95$3.0-$3.8) per ANC visit. Sensitivity analysis showed that the probability of the cost of an ANC visit being above the SIS reimbursed fee is 1.4 %. CONCLUSION: Our analysis suggests that the fee reimbursed by the SIS will cover the cost that it supposed to cover. However, there are significant threats to medium and longer term sustainability of this system as fee transfers represent a small fraction of the total cost of providing ANC. Increasing ANC coverage requires the other funding sources of the Regional Health Office (DIRESA) to adapt to increasing demand

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Palestinian Prisoners and the Right to Health the Israeli Systematic Violations Against the Right to Health

The idea of this research came as a result of the increasing number of health problems among the Palestinian prisoners, and as a result of the Israeli attempts in legitimizing the grave violations against Palestinian prisoners, since the Israeli government passed and ratified many laws that directly violate Palestinian prisoners' rights, and especially the right to health. This research aims to show the responsibility of Israel under international law, and how it tries to remove the legal status of the Palestinian prisoners. This project adopted both quantitative and qualitative methods to conduct the research since they complement each other for the various aspects of this research. In the qualitative approach, reports and international treaties will be used. As for quantitative, statistics and surveys from Addameer will be used. These surveys are filled by prisoners during the lawyers’ first visits, and they include direct specific questions about the ill-treatment, and torture that they might have/ might have not experienced. The methodological approach of this project includes: - 1) Analysis of the primary documents. 2) Primary source: Such as reports published by organizations and institutions. The reports would act as a database for the research, for they include statistics, laws, procedures, etc. 3) Analysis of the secondary sources: The secondary sources used in this research are books, journals, reports, and articles. 4) Interviews: The interviews will be held with former prisoners who have been detained in Israeli prisons, and with people who have experience with the mechanisms that Israel uses in the lawmaking process. This research is expected to conclude that Palestinian prisoners' right to health is deliberately violated by the prison administration and the Israeli judicial system. Also, it's expected that this research will explore how the judicial system in Israel deals with the grave violations of prisoners' right to health. The hypothesis of this research is trying to prove how the Israeli military and judicial system are biased and do not comply with the international treaties and agreements that Israel has signed and ratified. The significance of this research is to show how Palestinian prisoners' right to health is systematically violated, and what are the methods that Israel uses in its violation. The most challenging part of this research is to prove that Israeli violations are systematic

The Importance of the Sanctions Movement in South Africa to its Liberation

Background: The key factor in pushing a nation to fight for their freedom is having their rights turned into privileges, this research will work in understanding how that was the case for South Africa, and how similar the Palestinian struggle is to it. This research was motivated by the similarity of the case of South Africa and the case of Palestine, as well as the desire to clearly articulate the factors that contributed to the freedom of other nations, as compared to a local context.Al-Quds Universit

The need to promote behaviour change at the cultural level: one factor explaining the limited impact of the MEMA kwa Vijana adolescent sexual health intervention in rural Tanzania. A process evaluation

Background - Few of the many behavioral sexual health interventions in Africa have been rigorously evaluated. Where biological outcomes have been measured, improvements have rarely been found. One of the most rigorous trials was of the multi-component MEMA kwa Vijana adolescent sexual health programme, which showed improvements in knowledge and reported attitudes and behaviour, but none in biological outcomes. This paper attempts to explain these outcomes by reviewing the process evaluation findings, particularly in terms of contextual factors. Methods - A large-scale, primarily qualitative process evaluation based mainly on participant observation identified the principal contextual barriers and facilitators of behavioural change. Results - The contextual barriers involved four interrelated socio-structural factors: culture (i.e. shared practices and systems of belief), economic circumstances, social status, and gender. At an individual level they appeared to operate through the constructs of the theories underlying MEMA kwa Vijana - Social Cognitive Theory and the Theory of Reasoned Action – but the intervention was unable to substantially modify these individual-level constructs, apart from knowledge. Conclusion - The process evaluation suggests that one important reason for this failure is that the intervention did not operate sufficiently at a structural level, particularly in regard to culture. Recently most structural interventions have focused on gender or/and economics. Complementing these with a cultural approach could address the belief systems that justify and perpetuate gender and economic inequalities, as well as other barriers to behaviour change

Number of Unfavorable Intermediate‐Risk Factors Predicts Pathologic Upstaging and Prostate Cancer‐Specific Mortality Following Radical Prostatectomy: Results From the SEARCH Database

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135480/1/pros23255.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135480/2/pros23255_am.pd

Modified risk stratification grouping using standard clinical and biopsy information for patients undergoing radical prostatectomy: Results from SEARCH

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139104/1/pros23436_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139104/2/pros23436.pd

Mitochondrial reprogramming by activating OXPHOS via glutamine metabolism in African American patients with bladder cancer

Bladder cancer (BLCA) mortality is higher in African American (AA) patients compared with European American (EA) patients, but the molecular mechanism underlying race-specific differences are unknown. To address this gap, we conducted comprehensive RNA-Seq, proteomics, and metabolomics analysis of BLCA tumors from AA and EA. Our findings reveal a distinct metabolic phenotype in AA BLCA characterized by elevated mitochondrial oxidative phosphorylation (OXPHOS), particularly through the activation of complex I. The results provide insight into the complex I activation-driven higher OXPHOS activity resulting in glutamine-mediated metabolic rewiring and increased disease progression, which was also confirmed by [U]13C-glutamine tracing. Mechanistic studies further demonstrate that knockdown of NDUFB8, one of the components of complex I in AA BLCA cells, resulted in reduced basal respiration, ATP production, GLS1 expression, and proliferation. Moreover, preclinical studies demonstrate the therapeutic potential of targeting complex I, as evidenced by decreased tumor growth in NDUFB8-depleted AA BLCA tumors. Additionally, genetic and pharmacological inhibition of GLS1 attenuated mitochondrial respiration rates and tumor growth potential in AA BLCA. Taken together, these findings provide insight into BLCA disparity for targeting GLS1-Complex I for future therapy