SUMMARYDespite its a priori attractiveness, health insurance schemes are rare in developing countries. A recent external review of the Bamako Initiative in Burundi considered the extent to which the 'Carte d'Assurance Maladie' (CAM) has the potential to improve the quality of, and access to, health services. Although utilization of the CAM was found to be low overall, most of those visiting the health centres were in possession of a card, leading the team to conclude that health service utilization for curative care is extremely low. Focus group discussion revealed that users perceive the quality of health services to be poor, and that frequent shortages of basic drugs and supplies create uncertainty as to whether the CAM will provide good value for money. the shortage of basic drugs, the lack of community participation in the management of health services, and the fact that very little of the revenue from sales of the CAM is spent on health service provision provide possible explanations for the weak uptake of health insurance. Closing the link between the payment for health services and the jfinancing of those services would contribute to an improvement in the quality and the confidence of the population in government health services.
Airway resistance measurements using oscillometry provide a potential alternative to spirometry in assessing airway obstruction and dynamics due to measurements taken during tidal breathing. Oscillometry typically requires participants to form a tight seal around a mouthpiece which can prove challenging in some people. To address this challenge, we conducted a prospective study to evaluate the effect of different interfaces: mouthpiece, mouth mask and nasal mask; on respiratory impendence results from oscillometry in a cohort of healthy adults. Ten healthy adults (seven females; mean age: 38.9 years (SD ±15.5) underwent oscillometry using each of the three interfaces. We measured resistance at 5Hz (Rrs5); frequency dependence of resistance at 5 -20Hz (Rrs5-20); and reactance area (Ax). Rrs5 was not different when using the mouthpiece compared to the mouth mask (mean 2.98 cmH2O.l-1.s (SD ±0.68) vs mean 3.2 cmH2O.l-1.s (SD ±0.81; p=0.92; 95% CI -0.82 to +0.38) respectively. Nasal mask Rrs5 measurements were significant higher than mouthpiece measurements (mean 7.31 cmH2O.l-1.s; SD ±2.62; p < 0.01; 95%CI -6.91 to -1.75). With Ax5 we found a mean of 4.01 cm H2O/l (SD ±2.04) with the mouth mask compared to a mean of 4.02 cm H2O/l (SD ±1.87;p=1.0 95% CI -1.86 to +1.87) for the mouthpiece, however, we found a significant difference between the mouthpiece and nasal mask for Ax (mean= 10.71; SD ±7.0 H2O/l; p=0.04, 95% CI -12.96 to -0.43). Our findings show that oscillometry using a mouth mask may be just as effective as using a mouthpiece in assessing airway dynamics and resistance.
AimsTo study the provision of paediatric liver services in a regional centre in the South of EnglandMethodsChildren with liver diseases seen in paediatric Hepatology clinics over the last 5 years were included in the study. Details of demographics, underlying diagnosis, investigations and treatments were extracted in a database.ResultsThere are two paediatric liver clinics in Southampton; one in conjunction with the supra-regional liver centre in London and the other a regional transitional clinic, with 3 consultants (supraregional, regional and transitional), dietetic, specialist nursing support and representation of the national charity Children Liver Disease Foundation in the clinics. Overall 223 children (Median Age: 12.2 years IQR: 6.8–17.1 years) were seen in the services (M:F 54.7:45.3) over the last 5 years (45 patients diagnosed/year). Children were referred from 11 hospitals across the network (Hampshire, Dorset, Wiltshire and Sussex). The most common 3 diagnoses seen in the clinics were Alpha-1-Antitrypsin deficiency (17%), Viral Hepatitides (11.7%) and Autoimmune liver disease (9.9%). With an increasing national incidence, 9.4% of the children presented with fatty liver and 15 patients with liver transplant are seen in the services. Nearly a third of patients graduated from the joint supra-regional clinic to the regional transitional clinic with provision of local radiology, bile duct stenting, bile duct botox and variceal banding services (endoscopic).ConclusionsThis study reflects the busy work load of a regional liver paediatric gastroenterology centre in the South of England. The paediatric liver services bridge an important gap between DGHs and supra-regional centres providing family centred specialist care for children with liver diseases, at convenience and closer to their homes. With an increasing new patient referral from DGHs and nearly third of patients transitioning to adult services, the need of a regional hepatology transitional clinic cannot be underestimated which can work in tandem with the joint supra-regional liver clinics providing uninterrupted smooth transition and continuity of care. With these increasing responsibilities, the role of a regional paediatric GI centre needs to be better recognised in managing paediatric liver patients, as currently highlighted in the NHS England specialist liver disease services contract.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.