Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia

We analyse nine low-income and lower-middle-income countries in Africa and Asia that have implemented national health insurance reforms designed to move towards universal health coverage. Using the functions-of-health-systems framework, we describe these countries' approaches to raising prepaid revenues, pooling risk, and purchasing services. Then, using the coverage-box framework, we assess their progress across three dimensions of coverage: who, what services, and what proportion of health costs are covered. We identify some patterns in the structure of these countries' reforms, such as use of tax revenues to subsidise target populations, steps towards broader risk pools, and emphasis on purchasing services through demand-side financing mechanisms. However, none of the reforms purely conform to common health-system archetypes, nor are they identical to each other. We report some trends in these countries' progress towards universal coverage, such as increasing enrolment in government health insurance, a movement towards expanded benefits packages, and decreasing out-of-pocket spending accompanied by increasing government share of spending on health. Common, comparable indicators of progress towards universal coverage are needed to enable countries undergoing reforms to assess outcomes and make midcourse corrections in policy and implementation.     

Coronary revascularization in women

Historically, mortality rates have been higher in women than in men for both PCI and CABG. Recent registries and studies have shown that women have mortality rates similar to men after correcting for age and comorbidities. The gender gap is narrowing with respect to outcomes for women with both PCI and CABG. Revascularization with PCI and CABG in women with stable angina (SA), unstable angina (UA), non ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI) will all be reviewed in light of the most recent studies and registries.     

Linguistic Indicators of a False Confession

To date, most investigations of false confessions have focused on their prevention rather than their identification. In this study we investigated whether certain linguistic variables might help to distinguish between false confessional statements and true accounts. Using a within-subjects design, we elicited both false confessional statements and true accounts from 85 participants. We examined these for the presence of nouns, verbs and adjectives. Additionally, participants completed the Depression, Anxiety and Stress Scale (DASS) to determine the relationship between noun, verb and adjective use and self-reported measures of state anxiety. Results showed that whereas nouns and verbs failed to discriminate between false confessions and true accounts, adjective use significantly decreased during false confessions. Anxiety was not associated with veracity. The current findings suggest that there are measurable linguistic differences between false confessions and true accounts that cannot be attributed to level of state anxiety.     

Magical ideation is related to questionnaire but not behavioural measures of handedness

Magical ideation has repeatedly been shown to be related to handedness, with mixed-handers exhibiting higher levels of magical thinking. However, most previous research has assessed hand preference with a questionnaire measure, leaving open the possibility that the correlation reflects some aspect of questionnaire-taking behaviour and not an underlying neuropsychological relationship. The present study addressed this issue by administering the Magical Ideation Scale (Eckblad & Chapman, 1983), the Waterloo Handedness Questionnaire-Revised (Elias, Bryden, & Bulman-Fleming, 1998), and a manual dot-filling task (Tapley & Bryden, 1985) as a behavioural measure of handedness to an undergraduate student sample. The expected relationship between magical ideation and handedness as assessed by the questionnaire was observed. However, magical ideation was not related to the behavioural measure of handedness. Results cast doubt on a neuropsychological interpretation of the relationship between handedness and magical ideation in sub-clinical populations.     

QT Interval and Long‐Term Mortality Risk in the Framingham Heart Study

Background : The association between QT interval and mortality has been demonstrated in large, prospective population‐based studies, but the strength of the association varies considerably based on the method of heart rate correction. We examined the QT‐mortality relationship in the Framingham Heart Study (FHS). Methods : Participants in the first (original cohort, n = 2,365) and second generation (offspring cohort, n = 4,530) cohorts were included in this study with a mean follow up of 27.5 years. QT interval measurements were obtained manually using a reproducible digital caliper technique. Results : Using Cox proportional hazards regression adjusting for age and sex, a 20 millisecond increase in QTc (using Bazett's correction; QT/RR^1/2 interval) was associated with a modest increase in risk of all‐cause mortality (HR 1.14, 95% CI 1.10–1.18, P < 0.0001), coronary heart disease (CHD) mortality (HR 1.15, 95% CI 1.05–1.26, P = 0.003), and sudden cardiac death (SCD, HR 1.19, 95% CI 1.03–1.37, P = 0.02). However, adjustment for heart rate using RR interval in linear regression attenuated this association. The association of QT interval with all‐cause mortality persisted after adjustment for cardiovascular risk factors, but associations with CHD mortality and SCD were no longer significant. Conclusion : In FHS, there is evidence of a graded relation between QTc and all‐cause mortality, CHD death, and SCD; however, this association is attenuated by adjustment for RR interval. These data confirm that using Bazett's heart rate correction, QTc, overestimates the association with mortality. An association with all‐cause mortality persists despite a more complete adjustment for heart rate and known cardiovascular risk factors.