Effects of Price,Information, and Transactions Cost Interventions to Raise Voluntary Enrollment in a Social Health Insurance Scheme: A Randomized Experiment in the Philippines

A cluster randomized experiment was undertaken testing two sets of interventions encouraging enrollment in the Individually Paying Program (IPP), the voluntary component of the Philippines' social health insurance program. In early 2011, 1037 unenrolled IPP‐eligible families in 179 randomly selected intervention municipalities were given an information kit and offered a 50% premium subsidy valid until the end of 2011; 383 IPP‐eligible families in 64 control municipalities were not. In February 2012, the 787 families in the intervention sites who were still IPP‐eligible but had not enrolled had their vouchers extended, were resent the enrollment kits and received SMS reminders. Half the group also received a ‘handholding’ intervention: in the endline interview, the enumerator offered to help complete the enrollment form, deliver it to the insurer's office in the provincial capital, and mail the membership cards. The main intervention raised the enrollment rate by 3 percentage points (ppts) (p = 0.11), with an 8 ppt larger effect (p < 0.01) among city‐dwellers, consistent with travel time to the insurance office affecting enrollment. The handholding intervention raised enrollment by 29 ppts (p < 0.01), with a smaller effect (p < 0.01) among city‐dwellers, likely because of shorter travel times, and higher education levels facilitating unaided completion of the enrollment form. Copyright © The World Bank Health Economics © 2015 John Wiley & Sons, Ltd.     

Nursing Students' Attitudes Towards Assisted Suicide and Euthanasia

In 1991/92, 289 students from four different schools of nursing in Norway participated in a case-related attitudes test. The nursing students answered questions concerning their personal views on the moral and legal implications of either assisting suicide or performing euthanasia. They also indicated whether they thermselves were willing to perform these acts. The results were compared with responses from a study on students from other faculties in 1988. The findings suggested that nursing students were significantly (p < 0.0005) more restrictive than the other students in their attitudes towards voluntary active euthanasia (VAE). Factors that influenced the nursing students' attitudes towards VAE were measured by the index of VAE. Religious belief (p < 0.0001), conservative political view (p < 0.01), and the perception of life as meaningful (p < 0.02) were the best predictors of the dependent variable.     

Cardio-respiratory measures following isocapnic voluntary hyperventilation

In some individuals, breathing is greater than at rest following voluntary hyperventilation. Most previous investigations have employed short hyperventilation periods; here we examine the time course of cardio-respiratory measures before, during, and after a 5-min voluntary hyperventilation, maintaining isocapnia throughout. We examined the possible co-involvement of the cardiovascular system; hypothesising that post-hyperventilation hyperpnoea results from an increase in autonomic arousal. In four subjects (two males, two females) of 18 (nine males, nine females) we observed a post-hyperventilation hyperpnoea, characterised by a slow decline of ventilation toward resting levels with a time constant of 109.0 +/- 16.1s. By contrast, heart rate, and systolic and diastolic blood pressure were unchanged from rest during and after voluntary hyperventilation for all subjects. We concluded that males and females were equally likely to exhibit post-hyperventilation hyperpnoea, and suggest that they may be characterised by an increased resting heart rate and the choice of breathing frequency to increase ventilation during the voluntary hyperventilation. We further concluded that post-hyperventilation hyperpnoea is rare, but when present is a strong and lasting phenomenon, and that it is not the result of an increased autonomic arousal.     

Passive hyperthermia reduces voluntary activation and isometric force production

It has been suggested that a critically high body core temperature may impair central neuromuscular activation and cause fatigue. We investigated the effects of passive hyperthermia on maximal isometric force production (MVC) and voluntary activation (VA) to determine the relative roles of skin (T_sk) and body core temperature (T_c) on these factors. Twenty-two males [O_2max=64.2 (8.9) ml kg^–1 min^–1, body fat=8.2 (3.9)%] were seated in a knee-extension myograph, then passively heated from 37.4 to 39.4°C rectal temperature (T_re) and then cooled back to 37.4^oC using a liquid conditioning garment. Voluntary strength and VA (interpolated twitch) were examined during an isometric 10-s MVC at 0.5°C intervals during both heating and cooling. Passive heating to a T_c of 39.4^oC reduced VA by 11 (11)% and MVC by 13 (18)% (P<0.05), but rapid skin cooling, with a concomitant reduction in cardiovascular strain [percentage heart rate reserve decreased from 64 (11)% to 29 (11)%] and psychophysical strain did not restore either of these measures to baseline. Only when cooling lowered T_c back to normal did VA and MVC return to baseline (P<0.05). We conclude that an elevated T_c reduces VA during isometric MVC, and neither T_sk nor cardiovascular or psychophysical strain modulates this response. Results are given as mean (SD) unless otherwise stated.     

Planning for health: the significance of life style

The health of a population is related to more than the volume and quality of health services available. Ischaemic heart diseases and cancers are the main causes of death for adults in most developed countries. Partly, these diseases are related to diet and other life style variables. The purpose of this article is to discuss some prevention possibilities related to health practices. Empirical data were collected by means of a questionnaire on health status and 'life style' among long-standing members of a Swedish popular movement for physical culture. The principal question was what could be learned for health planning and management. Genetic factors have lately come more in focus as an explanation of untimely death and disease while, for example, life style has been de-emphasized. There is a risk, thereby, that a purchaser-provider approach, where short-sighted returns are in focus, will give too low a priority to health promotion.     

Differential control of in-phase and anti-phase coupling of rhythmic movements of ipsilateral hand and foot

Summary Rhythmic flexion-extensions of ipsilateral hand and foot are easily performed (easy association) when the two segments are moved in phase (isodirectionally), whereas great care and attention are required (difficult association) to move them in phase opposition. We searched for features distinguishing the two types of coupling by analyzing, on ten subjects: 1) the frequency limit in each association; and, 2) if coupling is modified by inertial or elastic loading of the hand. 1) Subjects were asked to oscillate hand and foot at various paced frequencies, in the easy or in the difficult association for one minute at least. In the easy coupling, the task was performed up to 2.0–2.5 Hz, the duration being thereafter shortened by muscular fatigue. In the difficult coupling when the frequency was increased above 0.7–1.7 Hz, the performance rapidly shortened, not because of fatigue but because of an inevitable reversal to the in-phase movement. The frequency-duration curve always followed a similar decay, although it covered different frequency ranges in the various subjects. 2) The effect of charging the hand with inertial or elastic loads was studied at the subject's preferred frequency, chosen when the hand was unloaded. Without loading, in the easy association the hand cycle slightly lagged the foot cycle while in the difficult one an almost perfect phase opposition was maintained. Under inertial load (inertial momentum: 9 gm²), in the easy association the hand lag was increased by 10° to 45°, despite a compensatory advanced activation of the forearm EMG; in the difficult association, instead, the hand lag was small (less than 10°), thanks to an even earlier onset of the forearm EMG. The elastic load (torque: 4 gm) had negligible effects on the phase relation between movements but improved the phase relation between EMGs. These findings show that coupling is tighter in the difficult than in the easy association, a feature that is emphasized by the effect of the load. This supports the idea that kinaesthetic afferences have more pronounced influences on control of the anti-phase than the in-phase coupling.     

Subthalamic neuron activity related to tremor and movement in Parkinson's disease

Single cell activity recorded in the subthalamic nucleus (STN) of Parkinson's patients and the effect of tremor, passive and voluntary movement upon the same cells are described. Three types of cells were distinguished by the pattern of discharge: tonic, phasic and rhythmic. They all demonstrated high mean firing rates (65, 59 and 69 Hz, respectively). Simultaneous recordings of muscle activity and tremor helped in defining cell activity. The implantation of the definitive stimulating electrode in the patients was based on the number of STN cells related to tremor, active and passive movements (mean = 68%) along the track chosen. Cells were related to tremor (n = 21; 11%), modified the discharge with differences in the amplitude of tremor (n = 4), and changed the rate and pattern when tremor stopped spontaneously or artificially (n = 6). Movement-related cells (n = 97; 51%) showed a cyclic activity correlated with phases of the movement, or modified the firing rate along the performance of the movement. Tremor and movement-related cells (n = 11; 6%) revealed an interesting sensory-motor integrative function.     

Assessing the Efficiency of HIV Prevention around the World: Methods of the PANCEA Project

Objective. To develop data collection methods suitable to obtain data to assess the costs, cost-efficiency, and cost-effectiveness of eight types of HIV prevention programs in five countries.
Data Sources/Study Setting. Primary data collection from prevention programs for 2002–2003 and prior years, in Uganda, South Africa, India, Mexico, and Russia.
Study Design. This study consisted of a retrospective review of HIV prevention programs covering one to several years of data. Key variables include services delivered (outputs), quality indicators, and costs.
Data Collection/Extraction Methods. Data were collected by trained in-country teams during week-long site visits, by reviewing service and financial records and interviewing program managers and clients.
Principal Findings. Preliminary data suggest that the unit cost of HIV prevention programs may be both higher and more variable than previous studies suggest.
Conclusions. A mix of standard data collection methods can be successfully implemented across different HIV prevention program types and countries. These methods can provide comprehensive services and cost data, which may carry valuable information for the allocation of HIV prevention resources.