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Kasabji F, Alrajo A, Vincze F, Kőrösi L, Ádány R, Sándor J. Self-Declared Roma Ethnicity and Health Insurance Expenditures: A Nationwide Cross-Sectional Investigation at the General Medical Practice Level in Hungary. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238998. [PMID: 33287122 PMCID: PMC7730532 DOI: 10.3390/ijerph17238998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
The inevitable rising costs of health care and the accompanying risk of increasing inequalities raise concerns. In order to make tailored policies and interventions that can reduce this risk, it is necessary to investigate whether vulnerable groups (such as Roma, the largest ethnic minority in Europe) are being left out of access to medical advances. Objectives: The study aimed to describe the association between general medical practice (GMP) level of average per capita expenditure of the National Health Insurance Fund (NHIF), and the proportion of Roma people receiving GMP in Hungary, controlled for other socioeconomic and structural factors. Methods: A cross-sectional study that included all GMPs providing care for adults in Hungary (N = 4818) was conducted for the period 2012–2016. GMP specific data on health expenditures and structural indicators (GMP list size, providing care for adults only or children also, type and geographical location of settlement, age of GP, vacancy) for secondary analysis were obtained from the NHIF. Data for the socioeconomic variables were from the last census. Age and sex standardized specific socioeconomic status indicators (standardized relative education, srEDU; standardized relative employment, srEMP; relative housing density, rHD; relative Roma proportion based on self-reported data, rRP) and average per capita health expenditure (standardized relative health expenditure, srEXP) were computed. Multivariate linear regression model was applied to evaluate the relationship of socioeconomic and structural indicators with srEXP. Results: The srEDU had significant positive (b = 0.199, 95% CI: 0.128; 0.271) and the srEMP had significant negative (b = −0.282, 95% CI: −0.359; −0.204) effect on srEXP. GP age > 65 (b = −0.026, 95% CI: −0.036; −0.016), list size <800 (b = −0.043, 95% CI: −0.066; −0.020) and 800–1200 (b = −0.018, 95% CI: −0.031; −0.004]), had significant negative association with srEXP, and GMP providing adults only (b = 0.016, 95% CI: 0.001;0.032) had a positive effect. There was also significant expenditure variability across counties. However, rRP proved not to be a significant influencing factor (b = 0.002, 95% CI: −0.001; 0.005). Conclusion: As was expected, lower education, employment, and small practice size were associated with lower NHIF expenditures in Hungary, while the share of self-reported Roma did not significantly affect health expenditures according to our GMP level study. These findings do not suggest the necessity for Roma specific indicators elaborating health policy to control for the risk of widening inequalities imposed by rising health expenses.
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Affiliation(s)
- Feras Kasabji
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
- Doctoral School of Health Sciences, University of Debrecen, H-4012 Debrecen, Hungary
| | - Alaa Alrajo
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
| | - Ferenc Vincze
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
- Doctoral School of Health Sciences, University of Debrecen, H-4012 Debrecen, Hungary
| | - László Kőrösi
- Department of Financing, National Health Insurance Fund, H-1139 Budapest, Hungary;
| | - Róza Ádány
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
- Correspondence:
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Marais R, Grobbelaar SS, Kock IHD. Healthcare Technology Transfer in Sub-Saharan Africa: An Inductive Approach. INTERNATIONAL JOURNAL OF INNOVATION AND TECHNOLOGY MANAGEMENT 2020. [DOI: 10.1142/s021987701950055x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The research addressed within this paper sets out to develop a framework towards facilitating health-related technology transfer (TT) to and within sub-Saharan African countries. In turn, this framework will attempt to alleviate healthcare burdens in developing nations through a combination of acquisitions and collaborative technology development. Systematic conceptual and comparative literature reviews have been conducted to identify the major characteristics of TT. The conceptual review has outlined the universal characteristics of TT such as TT methods, prominent stakeholders and the importance of knowledge transfer while the systematic comparative review exclusively evaluated sub-Saharan African healthcare TT characteristics such as infrastructure barriers and the marketability of the transfer object. The outcomes of the literature reviews have been clustered into five phases, forming the basis of the conceptual framework. This framework aims to guide a user through the phases of technology development, technology analysis, technology transfer method application, change management and commercialization by providing managerial best practices at each phase. The conceptual framework has been evaluated by incorporating the outcomes of 16 semi-structured interviews conducted with healthcare and TT industry experts. The final framework aims to provide guidelines for any stakeholder involved in healthcare technology transfer regardless of the healthcare implementation by highlighting best practices surrounding stakeholder co-creation, transfer method application and constructing a sustainable healthcare technology transfer venture.
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Affiliation(s)
- Rian Marais
- Department of Industrial Engineering, Stellenbosch University, Joubert Rd Stellenbosch, 7600, South Africa
| | - Sara S. Grobbelaar
- Department of Industrial Engineering, Stellenbosch University, Joubert Rd, AND DST-NRF Centre of Excellence in Scientometrics and Science, Technology and Innovation Policy (SciSTIP) Stellenbosch, 7600, South Africa
| | - Imke H. de Kock
- Department of Industrial Engineering, Stellenbosch University, Joubert Rd Stellenbosch 7600, South Africa
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Katzelnick LC, Harris E. The use of longitudinal cohorts for studies of dengue viral pathogenesis and protection. Curr Opin Virol 2018; 29:51-61. [PMID: 29597086 PMCID: PMC5996389 DOI: 10.1016/j.coviro.2018.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/12/2018] [Indexed: 12/31/2022]
Abstract
In this review, we describe how longitudinal prospective community-based, school-based, and household-based cohort studies contribute to improving our knowledge of viral disease, focusing specifically on contributions to understanding and preventing dengue. We describe how longitudinal cohorts enable measurement of essential disease parameters and risk factors; provide insights into biological correlates of protection and disease risk; enable rapid application of novel biological and statistical technologies; lead to development of new interventions and inform vaccine trial design; serve as sentinels in outbreak conditions and facilitate development of critical diagnostic assays; enable holistic studies on disease in the context of other infections, comorbidities, and environmental risk factors; and build research capacity that strengthens national and global public health response and disease surveillance.
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Affiliation(s)
- Leah C Katzelnick
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, 185 Li Ka Shing Center, 1951 Oxford Street, Berkeley, CA 94720-3370, United States
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, 185 Li Ka Shing Center, 1951 Oxford Street, Berkeley, CA 94720-3370, United States.
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Affiliation(s)
- Hildy Fong
- Center for Global Public Health and Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, United States of America
| | - Eva Harris
- Center for Global Public Health and Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, United States of America
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Pang T, Chong YS, Fong H, Harris E, Horton R, Lee K, Liu E, Mahbubani K, Pangestu M, Yeoh KG, Wong JEL. Yes we can! The Raffles Dialogue on Human Wellbeing and Security. LANCET GLOBAL HEALTH 2016; 3:e496-e500. [PMID: 26187492 DOI: 10.1016/s2214-109x(15)00102-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
The future of human wellbeing and security depends on our ability to deal with the multiple effects of globalisation and on adoption of a new paradigm and philosophy for living and for health that emphasises people's wellbeing and social justice. Such was the topic of the inaugural Raffles Dialogue on Human Wellbeing and Security held in Singapore on Feb 2-3, 2015. Participants agreed that, to achieve these goals, four conditions must be met. First, equity must be integral to the implementation of technology. Second, there is an urgent need for innovations within our global institutions to make them "fit for purpose" in a rapidly changing world. Third, we must find the right balance between the roles of government and markets so that all those in need can access affordable medicine and health care. Finally, we must realise that we live in a small and interdependent "global village", where Asian countries need to assume greater leadership of our global village councils. This is the great imperative of our times.
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Affiliation(s)
- Tikki Pang
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore.
| | - Yap Seng Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hildy Fong
- Center for Global Public Health, School of Public Health, University of California, Berkeley, CA, USA
| | - Eva Harris
- Center for Global Public Health, School of Public Health, University of California, Berkeley, CA, USA; Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley and Sustainable Sciences Institute, San Francisco, CA, USA
| | | | - Kelley Lee
- Simon Fraser University, Vancouver, BC, Canada
| | - Eugene Liu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kishore Mahbubani
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | - Mari Pangestu
- Faculty of Economics, University of Indonesia, Jakarta, Indonesia
| | - Khay Guan Yeoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John Eu-Li Wong
- National University Health System, National University of Singapore, Singapore
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Abstract
Josefina Coloma and Eva Harris discuss advances in genomics in resource-limited settings and argue that access to training and capacity building in bioinformatics and data mining will be crucial for the future
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Coloma J, Harris E. From construction workers to architects: developing scientific research capacity in low-income countries. PLoS Biol 2009; 7:e1000156. [PMID: 19621063 PMCID: PMC2704958 DOI: 10.1371/journal.pbio.1000156] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Solving global health challenges in a sustainable manner depends on explicitly addressing scientific capacity-building needs, as well as establishing long-term, meaningful partnerships with colleagues in the developing world.
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Affiliation(s)
- Josefina Coloma
- Sustainable Sciences Institute, San Francisco, California, United States of America
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Eva Harris
- Sustainable Sciences Institute, San Francisco, California, United States of America
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
- * E-mail:
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Kuan G, Gordon A, Avilés W, Ortega O, Hammond SN, Elizondo D, Nuñez A, Coloma J, Balmaseda A, Harris E. The Nicaraguan pediatric dengue cohort study: study design, methods, use of information technology, and extension to other infectious diseases. Am J Epidemiol 2009; 170:120-9. [PMID: 19435864 PMCID: PMC2700880 DOI: 10.1093/aje/kwp092] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Dengue is a mosquito-borne viral disease that is a major public health problem worldwide. In 2004, the Pediatric Dengue Cohort Study was established in Managua, Nicaragua, to study the natural history and transmission of dengue in children. Here, the authors describe the study design, methods, and results from 2004 to 2008. Initially, 3,721 children 2–9 years of age were recruited through door-to-door visits. Each year, new children aged 2 years are enrolled in the study to maintain the age structure. Children are provided with medical care through the study, and data from each medical visit are recorded on systematic study forms. All participants presenting with suspected dengue or undifferentiated fever are tested for dengue by virologic, serologic, and molecular biologic assays. Yearly blood samples are collected to detect inapparent dengue virus infections. Numerous information and communications technologies are used to manage study data, track samples, and maintain quality control, including personal data assistants, barcodes, global information systems, and fingerprint scans. Close collaboration with the Nicaraguan Ministry of Health and use of almost entirely local staff are essential components for success. This study is providing critical data on the epidemiology and transmission of dengue in the Americas needed for future vaccine trials.
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Affiliation(s)
- Guillermina Kuan
- Centro de Salud Sócrates Flores Vivas, Barrio Monseñor Lezcano, Managua, Nicaragua
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Hang NTL, Ishizuka N, Keicho N, Hong LT, Tam DB, Thu VTX, Matsushita I, Harada N, Higuchi K, Sakurada S, Lien LT. Quality assessment of an interferon-gamma release assay for tuberculosis infection in a resource-limited setting. BMC Infect Dis 2009; 9:66. [PMID: 19450241 PMCID: PMC2700813 DOI: 10.1186/1471-2334-9-66] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 05/18/2009] [Indexed: 11/23/2022] Open
Abstract
Background When a test for diagnosis of infectious diseases is introduced in a resource-limited setting, monitoring quality is a major concern. An optimized design of experiment and statistical models are required for this assessment. Methods Interferon-gamma release assay to detect tuberculosis (TB) infection from whole blood was tested in Hanoi, Viet Nam. Balanced incomplete block design (BIBD) was planned and fixed-effect models with heterogeneous error variance were used for analysis. In the first trial, the whole blood from 12 donors was incubated with nil, TB-specific antigens or mitogen. In 72 measurements, two laboratory members exchanged their roles in harvesting plasma and testing for interferon-gamma release using enzyme linked immunosorbent assay (ELISA) technique. After intervention including checkup of all steps and standard operation procedures, the second trial was implemented in a similar manner. Results The lack of precision in the first trial was clearly demonstrated. Large within-individual error was significantly affected by both harvester and ELISA operator, indicating that both of the steps had problems. After the intervention, overall within-individual error was significantly reduced (P < 0.0001) and error variance was no longer affected by laboratory personnel in charge, indicating that a marked improvement could be objectively observed. Conclusion BIBD and analysis of fixed-effect models with heterogeneous variance are suitable and useful for objective and individualized assessment of proficiency in a multistep diagnostic test for infectious diseases in a resource-constrained laboratory. The action plan based on our findings would be worth considering when monitoring for internal quality control is difficult on site.
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Affiliation(s)
- Nguyen T L Hang
- IMCJ-BMH Medical Collaboration Center, Bach Mai Hospital, Hanoi, Viet Nam.
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