Scaling up cancer care for children without medical insurance in developing countries: The case of Mexico

Background

In 2006, the Mexican government launched the Fund for Protection Against Catastrophic Expenditures (FPGC) to support financially healthcare of high cost illnesses. This study aimed at answering the question whether FPGC improved coverage for cancer care and to measure survival of FPGC affiliated children with cancer.

Procedure

A retrospective cohort study (2006–2009) was conducted in 47 public hospitals. Information of children and adolescents with cancer was analyzed. The coverage was estimated in accordance with expected number of incident cases and those registered at FPGC. The survival was analyzed by using Kaplan–Meier survival curves and Cox proportional hazards regression modeling.

Results

The study included 3,821 patients. From 2006 to 2009, coverage of new cancer cases increased from 3.3% to 55.3%. Principal diagnoses were acute lymphoblastic leukemia (ALL, 46.4%), central nervous system (CNS) tumors (8.2%), and acute myeloid leukemia (AML, 7.4%). The survival rates at 36 months were ALL (50%), AML (30.5%), Hodgkin lymphoma (74.5%), Non‐Hodgkin lymphoma (40.1%), CNS tumors (32.8%), renal tumors (58.4%), bone tumors (33.4%), retinoblastoma (59.2%), and other solid tumors (52.6%). The 3‐year overall survival rates varied among the regions; children between the east and south‐southeast had the higher risks (hazard ratio 3.0; 95% CI: 2.3–3.9) and 2.4; 95% CI: 2.0–2.8) of death from disease when compared with those from the central region.

Conclusion

FPGC has increased coverage of cancer cases. Survival rates were different throughout the country. It is necessary to evaluate the effectiveness of this policy to increase access and identify opportunities to reduce the differences in survival. Pediatr Blood Cancer 2013;60:196–203. © 2012 Wiley Periodicals, Inc.     

Public trust is earned: Historical discrimination,carceral violence,and the COVID-19 pandemic

Objective

To assess whether knowledge of Tuskegee, the U.S. Immigration and Customs Enforcement (ICE) agency's detainment of children, and satisfaction with the George Floyd death investigation were associated with trust in actors involved in the development and distribution of coronavirus vaccines.

Data Sources and Study Setting

National survey with a convenience sample of Black (n = 1019) and Hispanic (n = 994) adults between July 1 and 26, 2021.

Study Design

Observational study using stratified adjusted logistic regression models to measure the association between ratings of the trustworthiness of actors involved in the development and distribution of coronavirus vaccines.

Principal Findings

Among Black respondents, lower satisfaction with the George Floyd death investigation was associated with lower trustworthiness ratings of pharmaceutical companies (ME: −0.09; CI: −0.15, 0.02), the FDA (ME: −0.07; CI: −0.14, −0.00), the Trump Administration (ME: −0.09; CI: −0.16, −0.02), the Biden Administration (ME: −0.07, CI: −0.10, 0.04), and elected officials (ME: −0.10, CI: −0.18, −0.03). Among Hispanic respondents, lower satisfaction was associated with lower trustworthiness ratings of the Trump Administration (ME: −0.14, CI: −0.22, −0.06) and elected officials (ME: −0.11; CI: −0.19, −0.02). Greater knowledge of ICE's detainment of children and families among Hispanic respondents was associated with lower trustworthiness ratings of state elected officials (ME: −0.09, CI: −0.16, 0.01). Greater knowledge of the US Public Health Service Study of Syphilis in Tuskegee was associated with higher trustworthiness ratings of their usual source of care (ME: 0.09; CI: 0.28, 0.15) among Black respondents (ME: 0.09; CI: 0.01, 0.16).

Conclusions

Among Black respondents, lower satisfaction with the George Floyd death investigation was associated with lowered levels of trust in pharmaceutical companies, some government officials, and administrators; it was not associated with the erosion of trust in direct sources of health care delivery, information, or regulation. Among Hispanic respondents, greater knowledge of the ICE detainments was associated with lower trustworthiness ratings of elected state officials. Paradoxically, higher knowledge of the Study of Syphilis in Tuskegee was associated with higher trustworthiness ratings in usual sources of care.     

Functional disability screening of ambulatory patients

The authors conducted a randomized controlled trial of functional disability screening in a hospital-based internal medicine group practice. They assigned 60 physicians and 497 of their patients to either an experimental or a control group. Every four months the patients in both groups completed a self-administered questionnaire measuring physical, psychological, and social function. The experimental group physicians received reports summarizing their patients’ responses; the control group physicians received no report. At the end of one year the authors found no significant difference between the patients of the experimental and control group physicians on any measure of functional status. Functional disability screening alone does not improve patient function. Supported by a grant from the Robert Wood Johnson Foundation, Princeton, New Jersey.     

Cultivating social relationships and disrupting social isolation in low-income,high-disparity neighbourhoods in Ohio,USA

Social isolation undermines health. Inequities in social networks exist due to historical and contemporary practices of socioeconomic and racial segregation. Thus, lower income and minority families are less likely to have the number, strength, and variety of social connections as higher income and white families. Therefore, social isolation may contribute to inequities in health and well-being across socioeconomic and racial groups. Disrupting social isolation by strengthening social networks may be a meaningful way to equitably improve population health. In this study we aimed to better understand the factors that influence the formation and sustainment of social connections in neighbourhoods experiencing a disproportionate burden of social needs and poor health outcomes. Participants were recruited through our community–academic partnership, Healthy Homes (HH). Healthy Homes serves families with pregnant women and/or children <6 years in two low-income, high-morbidity neighbourhoods, focusing on supporting families’ needs and hopes. Between October 2016 and April 2017, we conducted in-depth qualitative interviews (n = 20) with English-speaking mothers and grandmothers of children under <6 years. Interviews were audio-recorded, transcribed verbatim and independently coded. After applying an a priori code list, we conducted emergent coding to identify additional themes. Themes focused on the social environment, including social connections and social isolation, among vulnerable populations in included neighbourhoods. Families want connection to one another and to resources but look to others to facilitate those connections. Families may want or need social connections but do not engage if it means sacrificing their values or sense of self-worth. These findings provide a deeper understanding of the factors that might allow us to disrupt social isolation by building relationships in communities that face social and health inequities.