Prominent transverse (Bowdler) bone spurs as a diagnostic clue in a case of neonatal hypophosphatasia without metaphyseal irregularity

Transverse midshaft spurs allowed a diagnosis of hypophosphatasia in a newborn infant without metaphyseal irregularity.     

Postsplenectomy abscess leading to acute gastric hemorrhage.

A case is presented of a 14-year-old boy with massive gastric bleeding 8 months after a splenectomy. A linear gastric ulcer was found associated with perforation leading to an abscess in the former splenic site. The vulnerability of proximal greater curvature to perforation after splenectomy, and the possibility of extrinsic erosion causing gastric or duodenal ulceration are emphasized.     

The lateral clavicle hook — An acquired as well as a congenital anomaly

The lateral clavicle hook (LCH), an excessive upward convexity of the lateral clavicle, was formally defined by Igual and Giedion, and reported as always present in thrombocytopenia-radial aplasia syndrome and sometimes in other congenital malformations. Additional malformation syndrome including camptomelia are added. In addition, the hook may be seen in acquired upper extremity weakness such as in persistent brachial plexus injury after birth trauma and in severe osteogenesis imperfecta.Presented in part at the Society for Pediatric Radiology, San Francisco, California, March 1981     

Air-fluid level detection in neonatal lung cyst identification

In abnormal neonatal lungs it may take several days for prenatally accumulated lung fluid to clear. In a 2 day old infant, partial clearing in a pulmonary cyst resulted in a diagnostically useful air-fluid level on horizontal beam radiograph. At 3 days the cyst became lucent, and was no longer easily distinguishable from lobar emphysema.     

Beliefs about informal payments in Albania

Informal payments for health care are a growing concern in Albania and other transitional economy countries. Recent international studies have shown that informal payments can have negative effects on health care access, equity and health status by causing people to forgo or delay seeking care, or sell assets to pay for care. Many countries are putting in place reforms meant to reduce informal payments. In order to be successful, such policies need to consider people's attitudes and beliefs about the practice. This study collected data from 222 citizens in Albania regarding intentions, past behaviours, attitudes and beliefs about informal payments. Comparing people who intend to make informal payments with people who do not intend to make payments, the study found differences in attitudes as well as beliefs about the consequences of making informal payments, in perceptions about what others think and in control beliefs, but no difference in moral beliefs or demographic characteristics. People who intend to make informal payments the next time they seek care are more likely to believe they will get faster and better quality care than non-intenders, but also think they must pay to receive any care at all. People who do not intend to make informal payments are more likely to report that they have connections with medical personnel, which may be substituting for informal payments. The study has implications for educational campaigns accompanying policy reforms. Campaigns which focus on anti-corruption messages are unlikely to be effective, as moral beliefs do not appear to influence intention.     

Informal payments in government health facilities in Albania: results of a qualitative study

As governments seek to expand access to quality health care services, policy makers in many countries are confronting the problem of informal payments to medical personnel. The aim of this study was to help health planners in Albania understand informal payments occurring in government health facilities. Researchers used in-depth interviews and focus groups with 131 general public and provider informants in three districts. The results suggest that factors promoting informal payments in Albania include perceived low salaries of health staff; a belief that good health is worth any price; the desire to get better service; the fear of being denied treatment; and the tradition of giving a gift to express gratitude. Members of the general public also believe informal payments create uncertainties and anxiety during the care-seeking process, while providers perceive that informal payments harm their professional reputation, induce unnecessary medical interventions, and create discontinuity of care. The study showed that focusing on the most harmful effects and targeting the most vulnerable populations may be one way to gain consensus for policy reform. Understanding citizens' and caregivers' viewpoints is an important step in designing regulatory and bureaucratic interventions.