Catastrophic and impoverishing effects of out-of-pocket payments for health care in Albania: evidence from Albania Living Standards Measurement Surveys 2002, 2005 and 2008.

The absence of or poorly functioning risk pooling mechanisms and high amounts of out-of-pocket payments for health care expose households to financial risks associated with major illnesses or accidents. The aim of this article is to analyse the extent to which out-of-pocket health spending impoverishes households in Albania. The study augments existing evidence by analysing the dynamics of such payments over different years and the weight that informal payments have in the total out-of-pocket health spending. The data used in the study come from the Albania Living Standards Measurement Survey (ALSMS) for 2002, 2005 and 2008. We measure headcount catastrophic payments using different thresholds and the decomposition of indicators by expenditure quintiles to better understand their effects. We find that out-of-pocket and informal payments have increased in real value throughout the years. Even though their catastrophic effect has gone down (due also to declining trends in absolute poverty), the effect for the poorest expenditure quintiles remains high. Out-of-pocket payments deepen the poverty headcount and also enlarge the poverty gap and again the effect is larger for the poorest quintiles. Future policy interventions should provide better protection mechanisms for the poor by providing exemption criteria or subsidized transport. They should also seek to address the widespread informal payments in the country.

Factor analysis of the components of 12 standard test batteries, for unilateral spatial neglect, reveals that they contain a number of discrete and important clinical variables.

The aim of this study was to investigate a conventional battery of tests capable of assessing the presence of the component and extent of the lesions in patients with unilateral spatial neglect. Ninety-four patients who had unilateral spatial neglect with a stroke in right hemisphere were assessed on 12 traditional neglect batteries 4 weeks after the onset. Computerized tomography was also performed to investigate the possible anatomical relationships with each neglect battery. Factor analysis showed that the tests loaded significantly on five factors. There are not only visual scanning factors but also factors of imaging, visual judgement, visual cognition and effectiveness from left hemisphere in the unilateral spatial neglect. There are high correlations between each neuropsychological test and neglect batteries. Furthermore, lesions in the paraventricular white matter were associated with clock and person drawing tasks. Lesions in the occipital lobe were associated with reading, explaining and visual counting tasks. Lesions in the temporal lobe and the posterior limb of the internal capsule were associated with line bisection tasks. It is suggested that it is possible that there are some different components in unilateral spatial neglect. Failure in some tasks may predict different lesions in terms which include localization.

Apraxia and cerebral haemorrhage: the relationship between haematoma volume and prognosis.

In this study, we examined twenty-five patients with left putaminal haemorrhage to investigate the relations between ideational apraxia (IA) and intracerebral haemorrhage. Apraxias were determined at 1 and 6 months after the stroke onset. Extension and volume of haematoma were examined with CT scan within 2 days of stroke onset. IA was present in 10 cases at 1 month and disappeared in 6 cases (transient IA) and persisted in 4 cases(persisted IA) at 6 months from the onset. Although the haematoma volume related to the existence of IA, there was no significant difference between transient and persistent IA. All three patients with the haematoma volume larger than 40 ml in the transient IA group were younger than 50 years old. All cases with persistent IA were older than 50 years old. Consequently, the existence of IA seems to be partially dependent on the haematoma volume which may cause the organic damage of subcortical white matter. However, patient's age is also important to determine the prognosis of IA. This maybe related to the nature of the haemorrhage and the mode of the onset. These factors remain to be determined.

Lifestyle factors affecting bone ultrasonometry of the calcaneus in Japanese women.

Ultrasonometry is increasingly used to assess bone characteristics. A group of 1412 women with a mean age of 57 years attended a screening examination in a Japanese city. Seventy-four percent of participants were postmenopausal. Broadband ultrasound attenuation (BUA), speed of sound (SOS), and Stiffness index (SI) of the calcaneus were measured; subjects also completed a questionnaire examining lifestyle factors; anthropometric data were recorded. Analysis showed that the strongest predictors of decreased BUA, SOS, and SI were increased age and menopausal status. Higher body mass index and current participation in exercise or sports were significant predictors of increased BUA, SOS, and SI in a multivariate model. Higher calcium intake predicted increased BUA (P = 0.004) and missing meals predicted a lower SOS (P = 0.019). This study suggests that dietary factors as well as physical activity influence bone characteristics assessed by QUS. QUS may be a suitable technique to assess the effect of lifestyle changes on bone.

Neurological level effect on the discharge functional status of spinal cord injured persons after rehabilitation.

OBJECTIVE: To determine the relation between neurological level and functional status, measured by individual Functional Independence Measure (FIM) item scores, at discharge after rehabilitation in individuals with acute spinal cord injury (SCI). DESIGN: A cohort of spinal cord injured individuals (ASIA Impairment Scale grades A, B, and C) were classified in groups for analysis of variance (ANOVA) according to neurological level at discharge (C1-4, C5, C6, C7-8, T1-6, T7 and below). SETTING: A 20-bed SCI rehabilitation unit. PATIENTS: One hundred twelve individuals admitted between January 1993 and December 1996. INTERVENTION: Multidisciplinary rehabilitation program. MAIN OUTCOME MEASURES: FIM item scores at discharge after rehabilitation. RESULTS: ANOVA and post hoc testing showed significant differences and a systematic change in discharge FIM item scores between adjacent neurological groupings for the tetraplegic and T1-6 paraplegic groups for all the self-care items and between the high and low paraplegic groups for the mobility items. A systematic relation was also seen between lesion level and discharge FIM score for the sphincter control items but not for the locomotion and cognitive items. CONCLUSIONS: The finding of an inverse relationship between FIM score and neurological level for certain motor items supports clinical observations that functional performance in spinal cord injured individuals is reduced with greater neurological impairment. However, results for the locomotion and cognitive subscale items indicate a need for other measures, in addition to the FIM, for outcome measurement in SCI.

Buccofacial apraxia and left cerebral haemorrhage.

We examined 33 patients with left intracerebral haemorrhage to investigate the relations to buccofacial apraxia (BFA). BFA was present in 18 cases at 1 month and disappeared in 3 cases and persisted in 15 cases at 6 month from the onset. The existence of BFA seems to be partially dependent the haematoma volume which may cause the organic damage in lenticulate nucleus, insula, posterior limb or internal capsule and anterior portion of paraventricle white matter. All patients with BFA had aphasia (Broca 6, Wernicke 1, Total 10, Amnestic 1). Aphasia of the patients with transient BFA improved as well as the patients without BFA after BFA disappeared. We suspected that improvement or aphasia might be affected by BFA.

Is unilateral spatial neglect a single phenomenon? A comparative study between exploratory-motor and visual-counting tests.

The aim of this study is to report the preliminary findings of a traditional battery of tests and our original battery capable of assessing the presence of components and extent of lesions in patients with unilateral spatial neglect. Thirty patients who had unilateral spatial neglect with a stroke in the right hemisphere were assessed for unilateral spatial neglect on exploratory-motor (E-M) tasks, visual-counting (V-C) tasks, and traditional neglect batteries at least 4 weeks after the onset. Other neuropsychological tests and computed tomography were also performed to investigate the relationship with neglect. A factor analysis showed that our tasks loaded significantly on three factors. E-M neglect was found in 16 patients, and V-C neglect in 22 patients with unilateral spatial neglect. There were high correlations between E-M neglect and motor paralysis, word fluency, backward digit span and motor impersistence. There were high correlations between V-C neglect and visual-field defect, line bisection, line cancellation and figure copying. Lesions in the frontal lobe, caudate, insula, and anterior portion of the paraventricular white matter were commonly associated with E-M neglect. Lesions in the occipital lobe were also associated with V-C neglect. We suggest that unilateral neglect is not a single phenomenon, but rather involves several different components. We propose that E-M and V-C tasks are useful methods for evaluating the extent of lesions in patients with unilateral spatial neglect.

Functional outcome following thalamic haemorrhage: relationship between motor and cognitive functions and ADL.

Twenty-two patients with thalamic haemorrhage were examined to investigate the relationship between motor and cognitive function, and activities of daily living (ADL). Patients with unilateral spatial neglect had lower ADL scores on admission than patients without unilateral spatial neglect (Mean: 17.0 and 24.6, respectively; F = 4.38, df = 1, p < 0.05). Unilateral spatial neglect related to feeding, bowel control and transfer in Barthel index on admission. Patients with aphasia on admission had lower ADL at discharge than patients without aphasia on admission (Mean: 57.0 and 84.7, respectively; F = 7.70, df = 1, p < 0.05). Aphasia related to the bathing, toilet, stair climbing, dressing, and ambulation in Barthel index on discharge. There was a significant difference between the severity of paresis in upper and lower limb on admission and ADL at discharge. The two-way repeated measures ANOVA showed a significant difference between severity of paresis in lower limb and ADL improvement. It can be suggested that the most important predictor of outcome was paresis in lower limb, and not aphasia or unilateral spatial neglect.

The influence of bladder management on fertility in spinal cord injured males.

Male infertility is a well recognised problem following spinal cord injury. The techniques of vibration induced ejaculation and transrectal electroejaculation have significantly increased the likelihood of sperm retrieval in spinal cord injured males; however, the reproductive capacity remains markedly reduced due to poor semen quality. The Spinal Injuries Unit at Royal North Shore Hospital has developed a programme to achieve seminal emission and enhance fertility. This study analysed the results of the first sample obtained at stimulation in 70 spinal cord injured males with respect to procedure performed, neurological level, completeness of lesion, bladder management, infection, age and duration since injury. Our study demonstrated that bladder management and neurological level were significant factors affecting the presence of motile sperm. Individuals managing their neuropathic bladder by catheter (intermittent self-catheterisation, indwelling urethral or suprapubic catheter) had significantly enhanced semen quality compared to those voiding by reflex or straining. Differences were also noted within the catheter group itself with intermittent self-catheterisation achieving a higher percentage of motile sperm present.

Using Functional Independence Measure profiles as an index of outcome in the rehabilitation of brain-injured patients.

Rehabilitation preserves and restores everyday functions in people who have disabilities. Functional change for patients undergoing a rehabilitation program is the best measure of the effectiveness of the rehabilitation program. One tool used for measuring function is the Functional Independence Measure (FIM). However, there are problems with the psychometric properties of FIM. This article presents a method for using FIM with median patient profiles. We show the method with data from 53 patients. The results show a relationship between the pattern of recovery and the length of stay in the unit. Spearman's rank order correlation coefficients confirm this observation. Median patient profiles prove to be a useful method of displaying data as outcome measures of the effectiveness of a rehabilitation program.

Temporal regularity of tapping by the left and right hands in timed and untimed finger tapping.

The temporal characteristics of repetitive finger tapping by the left and right hands were examined in two experiments. In the first experiment, interresponse intervals (IRIs) were recorded while right-handed male subjects tapped in synchrony with an auditory timing pulse (the synchronization phase) and then attempted to maintain the same tapping rate without the timing pulses (the continuation phase). The left and right hands performed separately, at four different rates (interpulse intervals of 250, 500, 750, and 1500 ms). There was no asymmetry of the asynchronies of the timing pulses and the associated responses in the synchronization phase or of the IRIs in either phase, but there was an asymmetry of chronization phase or of the IRIs in either phase, but there was an asymmetry in the temporal dispersion of the responses in both phases. in the second experiment, right-handed males tapped separately with each hand at three different speeds: as quickly as possible, at a fast but steady rate, and at a slow rhythmical rate. The speed asymmetry present when tapping as quickly as possible (with the preferred hand tapping more quickly ) was reduced when tapping at the fast steady rate and was absent when tapping at the slow rhythmical rate. The temporal dispersion of the IRIs produced by the nonpreferred hand was greater than the temporal dispersion of those produced by the preferred hand in all speed conditions. These results show smaller temporal dispersion of tapping by the preferred hand in right-handed males under different conditions, including submaximal speeds at which both hands respond at the same rate. This suggests that the motor system controlling the preferred hand in right-handers had more precise timing of response output than that controlling the nonpreferred hand.