Página 17 dos resultados de 380 itens digitais encontrados em 0.036 segundos

High cholesterol intake modifies chylomicron metabolism in normolipidemic young men

César, Thais B.; Oliveira, Maria Rita M.; Mesquita, Carlos H.; Maranhão, Raul C.
Fonte: Universidade Estadual Paulista Publicador: Universidade Estadual Paulista
Tipo: Artigo de Revista Científica Formato: 971-976
Português
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Whether the consumption of egg yolk, which has a very high cholesterol content without excess saturated fats, has deleterious effects on lipid metabolism is controversial. Absorbed dietary cholesterol enters the bloodstream as chylomicrons, but the effects of regular consumption of large amounts of cholesterol on the metabolism of this lipoprotein have not been explored even though the accumulation of chylomicron remnants is associated with coronary artery disease (CAD). We investigated the effects of high dietary cholesterol on chylomicron metabolism in normolipidemic, healthy young men. The plasma kinetics of a chylomicron-like emulsion, doubly-labeled with 14C-cholesteryl ester ( 14C-CE) and 3H-triolein ( 3H-TG) were assessed in 25 men (17-22 y old, BMI 24.1 ± 3.4 kg/m 2). One group (n = 13) consumed 174 ± 41 mg cholesterol/d and no egg yolk. The other group (n = 12) consumed 3 whole eggs/d for a total cholesterol intake of 804 ± 40 mg/d. The nutritional composition of diets was the same for both groups, including total lipids and saturated fat, which comprised 25 and 7%, respectively, of energy intake. Serum LDL and HDL cholesterol and apoprotein B concentrations were higher in the group consuming the high-cholesterol diet (P < 0.05)...

Transplante alogenico de celulas-tronco perifericas mobilizadas por rhG-CSF, não manipuladas in vitro, para tratamento de neoplasias hematologicas

Wellington Morais de Azevedo
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 06/10/1995 Português
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Transplantes autoplásticos de células-tronco periféricas (CTP) já vêm sendo realizados há algum tempo, tendo mostrado algumas vantagens em relação aos transplantes do mesmo tipo que utilizam medula óssea. Dentre estas vantagens, destaca-se a capacidade das CTP de produzir uma "pega" mais rápida do enxerto, encurtando o período de aplasia de medula óssea que se segue ao condicionamento do paciente. A coleta de CTP por aférese oferece maior conforto ao doador, que não precisa ser submetido à anestesia geral e às numerosas punções da crista ilíaca necessárias à obtenção do número de células suficientes para o transplante. Apesar das evidentes vantagens observadas no cenário autoplástico, a aplicação da mesma técnica aos transplantes alogênicos só se iniciou no começo dos anos 90. Este retardo se deveu ao temor de que os enxertos de CTP alogênicas, mais ricos em células T imunocompetentes, pudessem acarretar aumentos na incidência e gravidade da doença do enxerto-contra-o-hospedeiro (DECH). Outro empecilho à realização desses transplantes é a ecessidade de mobilização das CTP para a circulação sangüínea, que se fez possível nos transplantes autoplásticos, inicialmente, pelo uso de quimioterápicos citotóxicos; tal prática seria eticamente condenável em doadores sadios e...

Morphological changes of the jejunal mucosa in protracted diarrhea and their correlation with disease duration, weight loss and serum albumin levels

Péret-Filho,L.A.; Brasileiro-Filho,G.; Penna,F.J.
Fonte: Associação Brasileira de Divulgação Científica Publicador: Associação Brasileira de Divulgação Científica
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/1997 Português
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The pathogenesis of protracted diarrhea is multifactorial. In developing countries, intestinal infectious processes seem to play an important role in triggering the syndrome. Thirty-four children aged 1 to 14 months, mean 6.5 months, with protracted diarrhea were studied clinically and in terms of small intestinal mucosal morphology. Mild, moderate or severe hypotrophy of the jejunal mucosa was detected in 82% of cases, and mucosal atrophy was observed in 12%. The intensity of the morphological changes of the jejunal mucosa correlated negatively with serum albumin levels. No correlation was detected between mucosal grading and duration of diarrhea or between mucosal grading and weight reported as percentile. After nutritional support was instituted, serial jejunal biopsies were obtained from 12 patients: five patients submitted to parenteral nutrition for 7 to 38 days, mean 17 days, and 7 patients receiving a hypoallergenic oral diet (semi-elemental formula, 3; chicken formula, 3; human milk, 1). In seven cases (58%) a progressive increase in villus height and a decrease in the number of inflammatory cells were noted. Recovery of the morphologic pattern was accompanied by clinical improvement in all patients

Dietary nucleotides and gut mucosal defence.

Grimble, G K
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /01/1994 Português
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The informational aspects of nucleic acid synthesis have attracted much more attention than the quantitative significance of DNA, rRNA, tRNA, and nucleotide synthesis. Animal and human studies suggest that in energetic terms, 5-10% of the energy used in synthesising tissue protein is expended in manufacturing an appropriate amount of synthetic machinery, that is the ribosome and tRNA. The two sources for synthesis of nucleotides are salvage of nucleotides released by intracellular degradation or derived from the diet, and nucleotides synthesised de novo from amino acids (for example, glutamine) and sugars (glucose). The comparative importance of these two processes is not well defined, but rRNA production requires a high de novo input in cell types with the capacity for rapid division (for example, lymphocytes). The gut is unusual in requiring a ready arterial supply of nucleotides synthesised by hepatic de novo pathways. Animal studies show that an exogenous supply of nucleotides (salvage) can improve liver regrowth, immune responsiveness to a microbial challenge, and gut morphology in diarrhoea models. Humans adapt to dietary nucleotide intake by downregulating de novo pathways. All total parental nutrition regimens, and most enteral regimens lack nucleotides...

Multifactorial Etiology of Cervical Cancer: A Hypothesis

Haverkos, Harry W.
Fonte: Medscape Publicador: Medscape
Tipo: Artigo de Revista Científica
Publicado em 30/11/2005 Português
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Cancer of the cervix is the second most common life-threatening cancer among women worldwide, with incidence rates ranging from 4.8 per 100,000 women per year in the Middle East to 44.3 per 100,000 in East Africa. Epidemiologic and clinical data demonstrate that human papillomaviruses (HPV), especially HPV-16 and HPV-18, play at least a major if not a necessary role in the etiology of cervical cancer. However, many investigators acknowledge that HPV is not sufficient to induce cervical cancer and that a multifactorial etiology is likely. HPV can be found in a growing proportion of patients with cervical cancer, approaching 100%, but is not yet found in every patient with disease. Other factors, such as herpes simplex virus type 2 infections, cigarette smoking, vaginal douching, nutrition, and use of oral contraceptives, have been proposed as contributing factors. In the first half of the 20th century, Peyton Rous and colleagues demonstrated the joint action of tars and Shope papillomavirus to consistently induce squamous cell carcinomas in rabbits. Using the Rous model as a prototype, one might hypothesize that some cases of cervical cancer arise from an interaction between oncogenic viruses and cervical tar exposures. Cervical tar exposures include cigarette smoking...

Hunterian Lecture: Insulin resistance in human sepsis: implications for the nutritional and metabolic care of the critically ill surgical patient.

Carlson, Gordon L.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /03/2004 Português
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Loss of the anabolic effect of insulin (insulin resistance) is a key component of the adverse metabolic consequences of sepsis and may contribute to the apparent lack of efficacy of feeding regimens in critically ill patients. The mechanisms which underlie the development of insulin resistance in stress remain unclear. In this series of studies, the locus of insulin resistance in the septic patient was shown to lie within the metabolic pathways of glucose storage (glycogen synthesis) within skeletal muscle, was noted to be unrelated to the actions of hormone mediators such as leptin and was shown not to be associated with altered nutrient-induced thermogenesis during total parenteral nutrition (TPN). Clinically applicable maximal rates of glucose-based TPN for septic patients were calculated. A technique was also developed in which insulin resistance could be induced and studied in healthy volunteers. These studies demonstrated that insulin resistance develops within 7 h of an inflammatory stimulus and, as in clinical sepsis, is characterised by selective impairment of glucose storage. Finally, a series of related studies indicated that the magnitude and nature of the inflammatory response in vivo could be enhanced by exogenous insulin infusion...

Tocotrienols in health and disease: the other half of the natural vitamin E family

Sen, Chandan K.; Khanna, Savita; Roy, Sashwati
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Português
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Tocochromanols encompass a group of compounds with vitamin E activity essential for human nutrition. Structurally, natural vitamin E includes eight chemically distinct molecules: α-, β-, γ- and δ-tocopherol; and α-, β-, γ- and δ-tocotrienol. Symptoms caused by α-tocopherol deficiency can be alleviated by tocotrienols. Thus, tocotrienols may be viewed as being members of the natural vitamin E family not only structurally but also functionally. Palm oil and rice bran oil represent two major nutritional sources of natural tocotrienol. Taken orally, tocotrienols are bioavailable to all vital organs. The tocotrienol forms of natural vitamin E possesses powerful hypocholesterolemic, anti-cancer and neuroprotective properties that are often not exhibited by tocopherols. Oral tocotrienol protects against stroke-associated brain damage in vivo. Disappointments with outcomes-based clinical studies testing the efficacy of α-tocopherol need to be handled with caution and prudence recognizing the untapped opportunities offered by the other forms of natural vitamin E. Although tocotrienols represent half of the natural vitamin E family, work on tocotrienols account for roughly 1% of the total literature on vitamin E. The current state of knowledge warrants strategic investment into investigating the lesser known forms of vitamin E.

Inflammation at the Molecular Interface of Atherogenesis : An Anthropological Journey

Lamon, Brian D.; Hajjar, David P.
Fonte: American Society for Investigative Pathology Publicador: American Society for Investigative Pathology
Tipo: Artigo de Revista Científica
Publicado em /11/2008 Português
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Despite the multifactorial nature of atherosclerosis, substantial evidence has established inflammation as an often surreptitious, yet critical and unifying driving force which promotes disease progression. To this end, research has defined molecular networks initiated by cytokines, growth factors and other pro-inflammatory molecules which promote hallmarks of atherosclerosis such as endothelial dysfunction, macrophage infiltration, LDL oxidation, cell proliferation and thrombosis. Although commonly associated with risk factors such as dyslipidemia, diabetes and hypertension, the global etiology of atherosclerosis may be alternatively attributed to underlying anthropological pressures. The agricultural, industrial and technological revolutions produced alterations in dietary, social and economic factors which have collectively exaggerated the exposure of the human genome to environmental stimuli. Furthermore, advances in sanitation, nutrition, and medicine have increased the lifespan of humans, effectively prolonging blood vessel exposure to these factors. As a result, the vasculature has become conditioned to respond to injury with what is arguably an overzealous immunological response; thus setting the stage for the prevalence of cardiovascular disease...

Guar gum and similar soluble fibers in the regulation of cholesterol metabolism: Current understandings and future research priorities

Rideout, Todd C; Harding, Scott V; Jones, Peter JH; Fan, Ming Z
Fonte: Dove Medical Press Publicador: Dove Medical Press
Tipo: Artigo de Revista Científica
Publicado em /10/2008 Português
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The hypocholesterolemic effects associated with soluble fiber consumption are clear from animal model and human clinical investigations. Moreover, the modulation of whole-body cholesterol metabolism in response to dietary fiber consumption, including intestinal cholesterol absorption and fecal sterol and bile acid loss, has been the subject of many published reports. However, our understanding of how dietary fibers regulate molecular events at the gene/protein level and alter cellular cholesterol metabolism is limited. The modern emphasis on molecular nutrition and rapid progress in ‘high-dimensional’ biological techniques will permit further explorations of the role of genetic polymorphisms in determining the variable interindividual responses to soluble fibers. Furthermore, with traditional molecular biology tools and the application of ‘omic’ technology, specific insight into how fibers modulate the expression of genes and proteins that regulate intestinal cholesterol absorption and alter hepatic sterol balance will be gained. Detailed knowledge of the molecular mechanisms by which soluble fibers reduce plasma cholesterol concentrations is paramount to developing novel fiber-based “cocktails” that target specific metabolic pathways to gain maximal cholesterol reductions.

Anthocyanins in Cardiovascular Disease1

Wallace, Taylor C.
Fonte: American Society for Nutrition Publicador: American Society for Nutrition
Tipo: Artigo de Revista Científica
Publicado em 10/01/2011 Português
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Anthocyanins are a group of abundant and widely consumed flavonoid constituents that occur ubiquitously in the plant kingdom, providing the bright red-orange to blue-violet colors present in many fruit- and vegetable-based food products. Their intake has been estimated to be up to 9-fold higher than that of other dietary flavonoids. Anthocyanins have become increasingly important to the food industry as their use as natural alternatives to artificial colors has become widespread and knowledge of their health-promoting properties has become more evident. Epidemiological studies suggest that increased consumption of anthocyanins lowers the risk of cardiovascular disease (CVD), the most common cause of mortality among men and women. Anthocyanins frequently interact with other phytochemicals, exhibiting synergistic biological effects but making contributions from individual components difficult to decipher. Over the past 2 decades, many peer-reviewed publications have demonstrated that in addition to their noted in vitro antioxidant activity, anthocyanins may regulate different signaling pathways involved in the development of CVD. This review summarizes the latest developments on the bioavailability/bioactivity and CVD preventative activities of anthocyanins...

Olfaction

Pinto1, Jayant M.
Fonte: American Thoracic Society Publicador: American Thoracic Society
Tipo: Artigo de Revista Científica
Publicado em 01/03/2011 Português
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Olfaction represents an ancient, evolutionarily critical physiologic system. In humans, chemosensation mediates safety, nutrition, sensation of pleasure, and general well-being. Factors that affect human olfaction included structural aspects of the nasal cavity that can modulate airflow and therefore odorant access to the olfactory cleft, and inflammatory disease, which can affect both airflow as well as olfactory nerve function. After signals are generated, olfactory information is processed and coded in the olfactory bulb and disseminated to several areas in the brain. The discovery of olfactory receptors by Axel and Buck sparked greater understanding of the molecular basis of olfaction. However, the precise mechanisms used by this system are still under great scrutiny due to the complexity of understanding how an enormous number of chemically diverse odorant molecules are coded into signals understood by the brain. Additionally, it has been challenging to dissect olfactory sensation due to the multiple areas of areas of the brain that receive and modulate this information. Consequently, our knowledge of olfactory dysfunction in humans remains primitive. Aging represents the major cause of loss of smell, although a number of clinical and environmental factors are thought to affect chemosensory function. Treatment options focus on reducing sinonasal inflammation when present...

Liver-Specific Expression of Transcriptionally Active SREBP-1c Is Associated with Fatty Liver and Increased Visceral Fat Mass

Knebel, Birgit; Haas, Jutta; Hartwig, Sonja; Jacob, Sylvia; Köllmer, Cornelia; Nitzgen, Ulrike; Muller–Wieland, Dirk; Kotzka, Jorg
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Publicado em 21/02/2012 Português
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The pathogenesis of fatty liver is not understood in detail, but lipid overflow as well as de novo lipogenesis (DNL) seem to be the key points of hepatocyte accumulation of lipids. One key transcription factor in DNL is sterol regulatory element-binding protein (SREBP)-1c. We generated mice with liver-specific over-expression of mature human SREBP-1c under control of the albumin promoter and a liver-specific enhancer (alb-SREBP-1c) to analyze systemic perturbations caused by this distinct alteration. SREBP-1c targets specific genes and causes key enzymes in DNL and lipid metabolism to be up-regulated. The alb-SREBP-1c mice developed hepatic lipid accumulation featuring a fatty liver by the age of 24 weeks under normocaloric nutrition. On a molecular level, clinical parameters and lipid-profiles varied according to the fatty liver phenotype. The desaturation index was increased compared to wild type mice. In liver, fatty acids (FA) were increased by 50% (p<0.01) and lipid composition was shifted to mono unsaturated FA, whereas lipid profile in adipose tissue or serum was not altered. Serum analyses revealed a ∼2-fold (p<0.01) increase in triglycerides and free fatty acids, and a ∼3-fold (p<0.01) increase in insulin levels, indicating insulin resistance; however...

ADV36 adipogenic adenovirus in human liver disease

Trovato, Francesca M; Catalano, Daniela; Garozzo, Adriana; Martines, G Fabio; Pirri, Clara; Trovato, Guglielmo M
Fonte: Baishideng Publishing Group Inc Publicador: Baishideng Publishing Group Inc
Tipo: Artigo de Revista Científica
Português
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Obesity and liver steatosis are usually described as related diseases. Obesity is regarded as exclusive consequence of an imbalance between food intake and physical exercise, modulated by endocrine and genetic factors. Non-alcoholic fatty liver disease (NAFLD), is a condition whose natural history is related to, but not completely explained by over-nutrition, obesity and insulin resistance. There is evidence that environmental infections, and notably adipogenic adenoviruses (ADV) infections in humans, are associated not only with obesity, which is sufficiently established, but also with allied conditions, such as fatty liver. In order to elucidate the role, if any, of previous ADV36 infection in humans, we investigated association of ADV36-ADV37 seropositivity with obesity and fatty liver in humans. Moreover, the possibility that lifestyle-nutritional intervention in patients with NAFLD and different ADV36 seropositive status, achieves different clinical outcomes on ultrasound bright liver imaging, insulin resistance and obesity was challenged. ADV36 seropositive patients have a more consistent decrease in insulin resistance, fatty liver severity and body weight in comparison with ADV36 seronegative patients, indicating a greater responsiveness to nutritional intervention. These effects were not dependent on a greater pre-interventional body weight and older age. These results imply that no obvious disadvantage - and...

Suboptimal Serum α-Tocopherol Concentrations Observed among Younger Adults and Those Depending Exclusively upon Food Sources, NHANES 2003-20061-3

McBurney, Michael I.; Yu, Elaine A.; Ciappio, Eric D.; Bird, Julia K.; Eggersdorfer, Manfred; Mehta, Saurabh
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Publicado em 19/08/2015 Português
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Vitamin E is an essential nutrient for human health, with an established function as a lipid-soluble antioxidant that protects cell membranes from free radical damage. Low vitamin E status has been linked to multiple health outcomes, including total mortality. With vitamin E being identified as a ‘shortfall nutrient’ because >90% of American adults are not consuming recommended amounts of vitamin E, we aimed to determine the prevalence of both clinical vitamin E deficiency (serum α-tocopherol concentration < 12 μmol/L) and failure to meet a criterion of vitamin E adequacy, serum α-tocopherol concentration of 30 μmol/L, based on the Estimated Average Requirement (EAR) and lowest mortality rate in the Alpha-Tocopherol Beta-Carotene (ATBC) study. The most recent nationally-representative cross-sectional data (2003–2006) among non-institutionalized US citizens with available serum concentrations of α-tocopherol from the National Health and Nutrition Examination Survey (NHANES); Centers for Disease Control and Prevention were analyzed. Serum α-tocopherol distributions were compared between those reporting consumption of food without supplement use (FOOD) and food and supplement use (FOOD+DS) by sex, age, and race/ethnicity. Only 1% of the US population is clinically deficient. FOOD consumers have lower average α-tocopherol levels (24.9± 0.2 μmol/L) than FOOD+DS users (33.7 ± 0.3 μmol/L)...

Verification of Performance in Result-Based Financing : The Case of Burundi

Renaud, Adrien
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
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Paying health facilities incentives based on their performance is one form of results-based financing (RBF). Verification of the performance of the providers is a vital part of RBF program implementation. Burundi was one of the first African countries to introduce performance-based financing (PBF). The PBF scheme is implemented in the whole country and is led by the Ministry of Health (MoH). It pays incentives based on quantity of services provided as well as a quality of care component. This study describes the methods used for verification in Burundi, which include monthly verification of the quantity and technical quality of services provided on a quarterly basis; semiannual patient tracing and assessment of patient satisfaction; and counter-verification of the information provided by these three mechanisms. The results of verification are presented and it discusses obstacles to verification, how they have been addressed, and the challenges ahead. The case study is part of a broader analysis, which includes multiple country case examples...

Assessment of Health Financing Options : Papua New Guinea

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Português
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Papua New Guinea s (PNG) health system is characterized by low health inputs per capita, low health service contact rates and significant inequities in health care use. Health spending relative to GNI per capital and as a revenue share of GDP is low. Government spending as a share of total health expenditure is, however, high and the financing system is dependent on a number of complex interactions between a number of agencies, both at the national and subnational level. Anecdotal evidence suggests that out-of-pocket (OOP) spending is minimal. The current system of health financing has not delivered improved health outcomes; in fact health outcomes in PNG have been stagnant in recent decades. PNG is not on track to meet any of the health-related Millennium Development Goals (MDGs). Significant investment in the heath sector is needed to address the decline, meet current demographic trends and address inefficiencies and inequities. These additional resource requirements will have to be met while maintaining the high levels of financial risk protection and relatively equitable access to health care. The additional resource requirements will have to be financed in a sustainable manner. This report examines three broad health financing options in PNG: (i) increasing the level of general revenue spending; (ii) introducing contributory...

Paying Primary Health Care Centers for Performance in Rwanda

Basinga, Paulin; Gertler, Paul J.; Soucat, Agnes L.B.; Binagwaho, Agnes; Soucat, Agnes L.B.; Sturdy, Jennifer R.; Vermeersch, Christel M.J.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
Português
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Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. P4P can affect health care by providing incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery of services. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. Treatment facilities were enrolled in the P4P scheme in 2006 and comparison facilities were enrolled two years later. The incentive effect is isolated from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments to the treatment facilities. The data were collected from 166 facilities and a random sample of 2158 households. P4P had a large and significant positive impact on institutional deliveries and preventive care visits by young children...

Romania : Health Sector Policy Note

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Policy Note; Economic & Sector Work
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Many of Romania's basic health indicators have shown steady improvement since the 1970s. Both male and female life expectancy has gone up, and infant and maternal mortality have declined. Despite this progress, Romania still faces considerable challenges in improving the overall health status of its population. The overarching challenge for the next Romanian government is how to improve equity in access to better quality health care services in a financially sustainable manner. To achieve this goal, the government will need to consider not only overall funding levels, but also further changes to the composition of health sector funding, the distribution and organization of service delivery, accountability and decisions regarding who pays for what services, and incentive mechanisms to improve service quality. The likelihood of an economic slowdown and corresponding pressure on government budgets means that containing health care costs while simultaneously seeking ways to improve the equity, quality and efficiency of care will be paramount. The report ends with several policy options or recommendations.

Zambia Health Sector Public : Accounting for Resources to Improve Effective Service Coverage

Picazo, Oscar F.; Zhao, Feng
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
Tipo: Publications & Research :: Publication; Publications & Research
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Over the past few years, three nagging problems have bedeviled Zambia's health sector: the country is falling off-track from reaching the Millennium Development Goals (MDGs), it is facing severe financing constraints on the government front, and the health and HIV/AIDS sector is increasingly being fragmented by the reemergence of global disease initiatives. This health sector pubic expenditure review (PER) seeks to assist the Government of the Republic of Zambia (GRZ) and its development partners take stock of the resources in the health sector and how these resources can be better used to produce better health services. The results of the PER are expected to be the used for a variety of purposes, including the preparation of the health sector strategic plan, and succeeding rounds of the global fund request for proposals. Policy dialogue between the Bank and GRZ, both at the macro and sector levels, can also be enriched by the PER. The PER also provides critical inputs into the Medium-Term Expenditure Framework (MTEF) process, and in the assessment of the Poverty Reduction Strategy Paper (PRSP). Likewise, the PER can provide inputs to fine-tune the process of the pooled basket funding mechanism under the sector-wide approach (SWAp).

Getting Incentives Right : An Impact Evaluation of District Hospital Capitation Payment in Vietnam

Nguyen, Ha Thi Hong; Bales, Sarah; Wagstaff, Adam; Dao, Huyen
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
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With the movement toward universal health coverage gaining momentum, the global health research community has made significant efforts to advance knowledge about the impact of various schemes to expand population coverage. The impacts on efficiency, quality, and gaps in service utilization of reforms to provider payment methods are less well studied and understood. The current paper contributes to this limited knowledge by evaluating the impact of a shift by Vietnam's social health insurance agency from reimbursing hospitals on a fee-for-service basis to making a capitation payment to the district hospital where the enrollee lives. The analysis uses panel data on hospitals over the period 2005-2011 and multiple cross-section data sets from the Vietnam Household Living Standards Surveys to estimate impacts on efficiency, quality, and equity. The paper finds that capitation increases hospitals' efficiency, as measured by recurrent expenditure and drug expenditure per case, but has no effect on surgery complication rates or in-hospital deaths. In response to the shift to capitation...