Basic patterns in national health expenditure

Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources - out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance - classified according to their completeness and reliability. Total health spending rises from around 2-3% of gross domestic product (GDP) at low incomes (< 1000 US dollars per capita) to typically 8-9% at high incomes (> 7000 US dollars). Surprisingly, there is as much relative variation in the share for poor countries as for rich ones, and even more relative variation in amounts in US dollars. Poor countries and poor people that most need protection from financial catastrophe are the least protected by any form of prepayment or risk-sharing. At low incomes, out-of-pocket spending is high on average and varies from 20-80% of the total; at high incomes that share drops sharply and the variation narrows. Absolute out-of-pocket expenditure nonetheless increases with income. Public financing increases faster, and as a share of GDP, and converges at high incomes. Health takes an increasing share of total public expenditure as income rises, from 5-6% to around 10%. This is arguably the opposite of the relation between total health needs and need for public spending, for any given combination of services. Within public spending, there is no convergence in the type of finance - general revenue versus social insurance. Private insurance is usually insignificant except in some rich countries.     

Effect of sucking characteristics on breast milk creamatocrit

One of the problems in the care of healthy children is that mothers often give infant formulae to their normally growing infants in the first 4 months of life because they believe that they are unable to satisfy them. However, the association of fat content in breast milk with the sucking pattern of the infant is not clearly known. In order to determine whether the fat concentration of human milk was associated with sucking characteristics of the infants, 80 healthy 2-month-old babies and their mothers were included in the study. Milk creamatocrit was assessed at the beginning, at the first, fifth and 10th minutes and at the end of breast feeding. The creamatocrit values increased as the time elapsed from the beginning of breast feeding. There was an inverse relationship between milk volume and creamatocrit at both the beginning and the end of breast feeding (P < 0.05). The mean milk volume was higher and the mean creamatocrit at the end of breast feeding was lower in the infants whose 2-month weight gain was higher than the 75th percentile (75P) compared with those whose 2-month weight gain was lower than the 25th percentile (25P) (for milk volume 105 +/- 36 mL vs. 76 +/- 30 mL, respectively, P < 0.05; and for creamatocrit value 11.4 +/- 4.0 vs. 14.3 +/- 3.8, respectively, P < 0.05). Milk volume is the most important factor affecting weight gain of exclusively breast-fed babies, and fat concentration of human milk is not a primary determining factor in individual differences in weight gain of the infants and appears to be secondary to factors such as number of feeds per day, duration of breast feeding and the volume of milk sucked.     

Embolization of uterine artery in terminal stage cervical cancers

Ligation of the hypogastric artery has been a standard and effective procedure in controlling massive bleeding in advanced cervical carcinoma. The authors wanted to demonstrate the selective use of embolization of hypogastric or uterine artery to achieve the same end result--the stoppage of vaginal bleeding. In a number of cases, surgical approach may not be appropriate either because of the critically ill patient or because of the highly deformed pelvic anatomy due to radiotherapy or to the recurrence of cancerous tissue. As an alternative therapy, we used selective embolization of the uterine artery in eight patients. In all the patients, embolization served to control bleeding. As the bleeding was brought under control, a gradual recovery of the patient was generally observed. The most common side-effect was temporary severe pain related to ischemia of tumoral tissue. Embolization may be regarded as an effective procedure, which can be used to control massive bleeding in selected cervical cancer patients.     

Pathomimia in upper limb

Pathomimia, or factitious disorders, are characterized by producing symptoms voluntarily with the intention of playing the role of the patient. Inspite of being considerd as a psychatric disorder, pathomimuia is often encountered in the daily professional life of doctors without being recognized or diagnosed. There are various clinical aspects of pathomimia. The items that decide the orientation of the diagnosis are essentially the uncommon and odd expression of the reported symptoms, A capricious evolution as well as the multiplicity of the past medical cases. We report a group of five patients who were followed and treated between the years 2000 and 2003. This group was composed of three men and two women with an average age of 30 years. In three cases, we found the notion of skin injury. In one case, we noted a median nerve lesion in the elbow and once in the right upper member. The evolution was performed towards recidives of the initial symptomatology with more or less long periods of improvements.     

Adenocarcinoma at the site of ileo-anal anastomosis in Crohn's disease: report of a case

We reported a case of patient born in 1967 who has been operated on in 1987 on three years after the beginning of ulcerative colitis which became severe and resistant to the medical treatment. A total colectomy with an ileo-rectal anastomosis had been performed. The pathological diagnosis carried of the specimen was Ulcerative colitis Then a proctectomy, followed by ileo-anal anastomosis, was performed in 1993. After several episodes of pochitis and the appearance of intestinal lesions upstream the ileal pocket, the retained diagnosis was Crohn's colitis. Eight years after the ileo-anal anastomosis, the patient developed an adenocarcinoma in the ileal pocket. He has been operated on in 2002 and he had abdominoperineal resection, radiotherapy and chemotherapy. Re died in January 2003. The death was related to the recurrence of malignancy. Endoscopic controls with biopsies are mandatory doing to follow up dysplasia predictive of degeneration.