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Cuba's health system: challenges ahead [commentary]
No full textThis is a pre-copy-editing, author-produced PDF of an article accepted for publication in Health Policy and Planning following peer review. The definitive publisher-authenticated version Health Policy Plan. 2008 Jul;23(4):288-90 is available online at: http://heapol.oxfordjournals.org/cgi/content/full/23/4/288.This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Health Policy and Planning following peer review. The definitive publisher-authenticated version De Vos P, De Ceukelaire W, Bonet M, Van der Stuyft P. Health Policy Plan. 2008 Jul;23(4):288-90 is available online at: http://heapol.oxfordjournals.org/cgi/content/full/23/4/288.Cuba's exclusively public health system has been quite unique in pairing limited resources with excellent results. It continued to perform well during the economic crisis of the 1990s, and now that the hardships are being overcome, new opportunities are developing—as well as threats: (1) economic recovery should permit reinforcing of the system's effectiveness; (2) Cuba's increasing international solidarity in health also poses it corresponding challenges at home; (3) the ageing of the population necessitates adjustments to the health care system. However, the original principles of the health care system are not under question. Cuba can be considered a unique laboratory, and deserves more attention from the international public health community
Ingreso en el hogar: empleo de medicamentos y sus efectos económicos
No full textThe pharmacological prescription was characterized in a group of patients admitted at home from July 2002 to June 2003 in 4 Cuban geographical areas. Costs per drugs, per patients and per admission cause were estimated. A partial economic evaluation of the cost description type was developed. The most common age groups were those under 1 year old, 40-59 and 60 and over. The respiratory affections proved to be the most frequent cause of admission. The antibiotics and antibacterials were the most prescribed, followed by analgesics and antipyretics. More than 80 % of the drugs were acquired in the community drug stores. The indication of more than 4 drugs was only observed in urban areas, not in metropolitan or rural areas. The mean of the drug cost per patient was between 5.85 and 12.67 pesos. It was observed a proportionally direct relation between the cost per patient and the number of drugs indicated. . A deeper study of the pharmacological prescription and of the cost-benefit ratio of the indicated schemes will lead to a more assumable service for the family from the economic point of view
Culicoides trapping with Rothamsted suction traps before and during the bluetongue epidemic of 2006 in Belgium
No full textThe collection of biting midges was taking place some months before the first bluetongue outbreak in Belgium in August 2006. The Walloon Agricultural Research Centre had been monitoring aphid populations at two sites annually in Belgium (Gembloux and Libramont), using two stationary '12-m' Rothamsted suction traps. For the Gembloux trap, collections of insects captured daily from 11 May 2006 onwards were already available at the time of the outbreak. An examination of these samples revealed the presence of Culicoides, some species of which are considered as potential vectors of the bluetongue virus (BTV). The trapping was therefore extended beyond the normal aphid activity period and the Culicoides captured were identified to species level. From 11 May to 31 December 2006, the Gembloux trap caught 664 Culicoides specimens belonging to 19 species comprising known BTV-vectors. The second trap, at Libramont, was reactivated from 12 September to 13 October and caught 97 specimens belonging to nine species, all of which had been found at the Gembloux site. Among the 19 species identified, four were new to Belgian fauna: Culicoides achrayi, C. deltus, C. lupicaris and C. newsteadi. This paper examines the overall phenology and the physiological status of Culicoides in 2006 before and during the bluetongue epidemic. It discusses the potential of the Rothamsted suction trap to monitor Culicoides
The economic burden of malaria on the household in south-central Vietnam
No full textBackground: Each year, several thousand cases of malaria occur in south-central Vietnam.
Evidence from elsewhere suggests that malaria can have an economic impact on the household as
the illness prevents households from completing their normal, physically demanding, productive
duties such as tending crops and animals. The economic impact of malaria on households was
explored within the Raglay ethnic minority living in the montainous and forested area of southcentral
Vietnam (Ninh Thuan Province).
Methods: Two-hundred fifty-one malaria patients were identified and interviewed in an exit
survey at Community Health Centres. The same patient sample was then re-interviewed in a
household survey two to four weeks later. Survey data were complemented by approximately 40
informal discussions with health workers, vendors, patients, and community leaders.
Results: Each episode of malaria was estimated to cost the patient's household an average of 11.79
USD (2005 prices), direct costs for travel and treatment representing 6% of the total while the
remainder was loss in annual income.
Conclusion: Whilst government provision of malaria treatment keeps the direct costs relatively
low, the overall loss in income due to illness can still be significant given the poverty amongst this
population, especially when multiple cases of malaria occur annually within the same household
The epidemiology of Trichomonas vaginalis; prevalence of Trichomonas sp., and sexual and hygienic risk factors associated with genital trichomoniasis
No full textTransplacental infection and apparently immunotolerance induced by a wild-type bluetongue virus serotype 8 natural infection
No full textUntil recently, bluetongue (BT) virus (BTV) serotypes reportedly causing transplacental infections were all ascribed to the use of modified live virus strains. During the 2007 BT epidemic in Belgium, a significant increase in the incidence of abortions was reported. A study including 1348 foetuses, newborns and young animals with or without suspicion of BTV infection, was conducted to investigate the occurrence of natural transplacental infection caused by wild-type BTV-8 and to check the immunocompetence of newborns. BTV RNA was present in 41% and 18.5% of aborted foetuses from dams with or without suspected BTV involvement during pregnancy, respectively. The results of dam/calf pairs sampled before colostrum uptake provide evidence of almost 10% transplacental BTV infection in newborns. Apparently immunotolerant calves were found at a level of 2.4%. The current study concludes that the combined serological and real-time PCR (RT-qPCR) result of pregnant dams gives no indication of the infection status of the offspring except in the case of a double negative result. In a group of 109 calves with clinical suspicion of BT, born during the vector-free period, 11% were found to be RT-qPCR positive. The true prevalence was estimated to be 2.3%, indicating the extent of transplacental infection in a group of 733 calves of one to 4 months of age without BT suspicion. Moreover, virus isolation was successful for two newborn calves, emphasizing the need for restricting trade to BT-free regions of pregnant dams possibly infected during gestation, even if they are BTV RT-qPCR negative
Rapid culture-based methods for drug resistance detection in Mycobacterium tuberculosis
No full textTuberculosis still represents a major public health problem, especially in low-resource countries where the burden of the disease is more important. Multidrug-resistant and extensively drug drug-resistant tuberculosis constitute serious problems for the efficient control of the disease stressing the need to investigate resistance to first- and second-line drugs. Conventional methods for detecting drug-resistance in Mycobacterium tuberculosis are slow and cumbersome. The most commonly used proportion method on Löwenstein-Jensen medium or Middlebrook agar requires a minimum of 3-4 weeks to produce results. Several new approaches have been proposed in the last years for the rapid and timely detection of drug-resistance in tuberculosis. This review will address phenotypic culture-based methods for rapid drug susceptibility testing in M. tuberculosis
