Impact of Fee For Service on the Efficiency and Survival of Seguro Popular's Patients With Acute Lymphoblastic Leukemia in Mexico.

PURPOSE: Cost containment and efficiency in the provision of health care are primary concerns for health systems that aim to provide affordable, high-quality care. Between 2005 and 2015, Seguro Poplar's Fund against Catastrophic Expenditures (FPGC) funded ALL treatment in Mexico. Before January 1, 2011, FPGC reimbursed a fixed amount per patient according to risk. In 2011, the per capita reimbursement method changed to fee for service. We used this natural experiment to estimate the impact of the reimbursement policy change on average expenditure and quality of care for ALL treatment in Mexico. METHODS: We used nationwide reimbursement data from the Seguro Poplar's FPGC from 2005 to 2015. We created a patient cohort to assess 3-year survival and estimate the average reimbursement before and after the fee-for-service policy. We examined survival and expenditure impacts, controlling for patients' and providers' characteristics, including sex, risk (standard and high), the volume of patients served, type of institution (federally funded v other), and level of care. To quantify the impact, we used a regression discontinuity approach. RESULTS: The average reimbursement for standard-risk patients in the 3-year survival cohort was $16,512 US dollars (USD; 95% CI, 16,042 to 17,032) before 2011 and $10,205 USD (95% CI, 4,659 to 12,541) under the fee-for-service reimbursement scheme after 2011. The average annual reimbursement per patient decreased by 136% among high-risk patients. The reduction was also significant for the standard-risk cohort, although the magnitude was substantially smaller (34%). CONCLUSION: As Mexico's government is currently restructuring the health system, our study provides evidence of the efficiency and effectiveness of the funding mechanism in the Mexican context. It also serves as a proof of concept for using administrative data to evaluate economic performance and quality of care of publicly funded health programs.

The Sigatoka Disease Complex Caused by Pseudocercospora spp. and Other Fungal Pathogens Associated with Musa spp. in Puerto Rico.

Bananas (Musa spp.) are among the world's most economically important staple food crops. The most important fungal leaf diseases of Musa spp. worldwide are caused by the Sigatoka disease complex, which comprise black Sigatoka (Pseudocercospora fijiensis), yellow Sigatoka (P. musae), and Eumusae leaf spot (P. eumusae). Considering the rapid spreading rate of black Sigatoka in Puerto Rico after its first observation in 2004, a disease survey was conducted from 2018 to 2020 to evaluate the Sigatoka disease complex on the island. Sixty-one leaf samples showing Sigatoka-like symptoms were collected throughout the island for diagnosis by molecular approaches and fungal isolation. Molecular analysis using species-specific primers for P. fijiensis, P. musae and P. eumusae detected the presence of P. fijiensis in fifty leaf samples. Thirty-eight fungal isolates were collected and identified by morphology and genomic sequencing from various nuclear genes. The analysis identified 24 isolates as P. fijiensis, while the rest of the isolates belonged to the genus Cladosporium spp. and Cladosporium-like spp. (n=5), Neocordana musae (n=2), Zasmidium spp. (n=6), and Z. musigenum (n=1). The high frequency of P. fijiensis found in leaf samples and collected isolates suggest that black Sigatoka has displaced the yellow Sigatoka (P. musae) in Puerto Rico. Accurate identification of fungal species causing foliar diseases in Musa spp. will allow the establishment of quarantine regulations and specific management approaches in Puerto Rico.

Latino Parents' Perspectives on the Life Trajectories of Mixed-Status Children.

Many immigrant Latino families have one or more U.S. -born children and at least one foreign-born non-citizen child. Contextual theories of human development would argue that these siblings would have very different life trajectories by virtue of their citizenship status or lack thereof. However, researchers and policy-makers know very little about the home environment of mixed-status siblings. Using data from in-depth personal interviews, this study examined parental perceptions of the life trajectories of mixed-status youth. Participants were 18 parents with at least one adolescent between the ages of 10-18 residing at home. Using grounded theory, two broad themes emerged. First, parental perceptions of children's life trajectories based on citizenship and parental concerns' regarding their children's mixed legal status. Within this first theme, parents discussed youth's educational opportunities, job prospects, health care access, and travel restrictions. The second theme was parental concerns' about their children's citizenship status; ambivalence about migrating to the United States; and coping with fear and anxiety. Results of this study highlight the pervasive influence of immigration policies and practices on family dynamics and child development, the risk they posit to youth development and individual family resilience.

Adverse and Protective Childhood Experiences and Parenting Attitudes: the Role of Cumulative Protection in Understanding Resilience.

Theory and research indicate that adverse childhood experiences (ACEs) are linked to negative parenting attitudes and behaviors. We posit that protective and compensatory experiences (PACEs) in childhood buffer the negative effects of ACEs on later parenting. To test this premise, the present study examined associations between ACEs, PACEs, and attitudes towards nurturing and harsh parenting in an ethnically diverse sample of parents with children of various ages (N = 109; 65% mothers, 35% fathers; M age = 38). Parents completed a widely used parenting attitudes questionnaire and the ACEs and PACEs surveys. PACEs were negatively correlated with ACEs and positively correlated with nurturing parenting attitudes and parent income and education levels. Linear regression models indicate that higher PACEs, ACEs, and family income and less harsh parenting attitudes predict nurturing parenting attitudes. In contrast, higher ACEs and less nurturing attitudes were correlated with harsh parenting attitudes. As expected, moderation analyses indicated that the association between ACEs and harsh parenting attitudes was conditional upon the level of PACEs. When PACE scores were low (M - 1 SD), but not when PACE scores were average or high (M + 1 SD), ACEs were associated with harsh parenting attitudes, suggesting a buffering effect of PACEs on negative parenting attitudes. These findings support the importance of including protective as well as adverse childhood experiences when assessing the role of childhood experiences on parenting attitudes and practices. Implications of these findings for researchers and practitioners are discussed, as well as new directions for PACEs research using a cumulative protection approach.

Parent engagement in an original and culturally adapted evidence-based parenting program, Legacy for Children™.

Legacy for Children™ (Legacy) is an evidence-based program focused on promoting sensitive, responsive parenting for socioeconomically disadvantaged families. Legacy has recently been culturally and linguistically adapted for Spanish-monolingual Latino families and is being piloted in partnership with an early childhood education program. We conducted a mixed methods study to identify barriers and facilitators to engagement, using program monitoring data sources from both participant and group leader perspectives. We conducted qualitative analyses of open-ended data to identify distinct barriers (e.g., employment challenges, health-related challenges and appointments) and facilitators (e.g., other mothers in group, interest in program topics) to engagement that emerged across English and Spanish language curriculum versions; curriculum-specific barriers and facilitators were also documented. We interpret these findings in light of quantitative data on measures of engagement, showing that participants in the Spanish curriculum evidenced comparable levels of parent-group leader relationship quality relative to the English group, and higher levels of parent's group support/connectedness and overall satisfaction. These results offer promising considerations for optimizing families' engagement in parenting programs in the context of early care and education settings.

Legado para los Niños™ (Legado) es un programa basado en la evidencia que se centra en promover una crianza sensible y susceptible para familias con desventajas socioeconómicas. Recientemente, Legado se ha adaptado cultural y lingüísticamente para familias Latinas en las que sólo se habla español, y está siendo puesto en práctica experimental en asociación con un programa de educación en la temprana niñez. Llevamos a cabo un estudio con una variedad mixta de métodos para identificar obstáculos y promotores para ser incluidos usando recursos de información de la supervisión del programa provenientes de las perspectivas tanto de participantes como de líderes de grupo. Realizamos análisis cuantitativos de información no limitada de antemano para identificar diferentes obstáculos (v.g. dificultades de empleo, dificultades y citas relacionadas con la salud) y promotores (v.g. otras madres en el grupo, interés en los temas del programa) para ser incluidos los cuales surgieron a lo largo de las versiones curriculares del inglés y del español; también se documentaron los obstáculos y promotores relacionados con el currículo específico. Interpretamos estos resultados a la luz de la información cuantitativa sobre medidas de participación, mostrando que los participantes en el currículo en español demostraron comparables niveles de calidad de la relación progenitor-líder de grupo en relación con el grupo de inglés, y más altos niveles de apoyo del grupo a los progenitores y satisfacción en general. Estos resultados ofrecen consideraciones prometedoras para lograr una óptima participación de las familias en programas de crianza en el contexto de escenarios de cuidado y educación tempranos.

Le programme Legacy for ChildrenTM (Legacy) est un programme factuel se concentrant sur la promotion d'une parentage sensible et réactif pour des familles de milieu socioéconomique défavorisé. Legacy a récemment été culturellement et linguistiquement adapté aux familles Latino américaines, en espagnol, et se trouve testé en partenariat avec un programme éducatif de la petite enfance. Nous avons procédé à une étude au moyen de méthodes mixtes afin d'identifier les barrières qui existent et freinent l'engagement, ainsi que ce qui facilite l'engagement, en utilisant des sources de données d'évaluation du programme à la fois de la perspective des participants et du leader de groupe. Nous avons fait des analyses qualitatives de données ouvertes afin d'identifier des barrières précises (i.e. les défis du chômage, les défis liés à la santé et aux rendez-vous) et les aspects facilitateurs (i.e. autres mères dans le groupe, intérêt pour les sujets du programme) pour l'engagement qui ont émergé au travers des deux versions, la version en anglais et la version en espagnol. Les barrières tenant au curriculum et aux facilitateurs ont aussi été répertoriées. Nous avons interprété ces résultats à la lumière de données quantitatives sur des mesures d'engagement, montrant que les personnes participant au curriculum espagnol faisaient preuve de niveaux comparables de qualité de la relation parent-meneur de groupe que le groupe anglais, et de niveaux plus élevés de soutien/connexion et de satisfaction générale du groupe parent. Ces résultats offrent des considérations prometteuses pour l'optimisation de l'engagement des familles dans des programmes de parentage dans le contexte du soin précoce et de l'éducation de la petite enfance.

A New Method to Quantify Ifosfamide Blood Levels Using Dried Blood Spots and UPLC-MS/MS in Paediatric Patients with Embryonic Solid Tumours.

Ifosfamide blood concentrations are necessary to monitor its therapeutic response, avoiding any adverse effect. We developed and validated an analytical method by UPLC-MS/MS to quantify ifosfamide in dried blood spots (DBS). Blood samples were collected on Whatman 903® filter paper cards. Five 3 mm disks were punched out from each dried blood spot. Acetonitrile and ethyl acetate were used for drug extraction. Chromatographic separation was carried out in an Acquity UPLC equipment with a BEH-C18 column, 2.1 x 100 mm, 1.7 µm (Waters®). The mobile phase consisted in 5 mM ammonium formate and methanol:acetonitrile (40:48:12 v/v/v) at 0.2 mL/min. LC-MS/MS detection was done by ESI+ and multiple reaction mode monitoring, ionic transitions were m/z1+ 260.99 > 91.63 for ifosfamide and 261.00 > 139.90 for cyclophosphamide (internal standard). This method was linear within a 100-10000 ng/mL range and it was accurate, precise and selective. Ifosfamide samples in DBS were stable for up to 52 days at -80°C. The procedure was tested in 14 patients, ages 1 month to 17 years (9 males and 5 females), with embryonic tumours treated with ifosfamide, alone or combined, at a public tertiary referral hospital. Ifosfamide blood levels ranged from 11.1 to 39.7 µmol/L at 12 hours after the last infusion, while 24-hour levels ranged from 0.7-19.7 µmol/L. The median at 12 hours was 19.5 µmol/L (Q25 14.4-Q75 29.0) and 3.8 µmol/L (Q25 1.5-Q75 9.9) at 24 hours, p<0.001. This method is feasible to determine ifosfamide plasma levels in paediatric patients.

Does landscape context mediate the nature of density dependence for a coral reef fish?

Over-harvest and landscape change are two of the greatest threats to marine ecosystems. Over-harvest may directly affect key population regulation mechanisms (e.g., density dependence), with the magnitude of the effects being further influenced by changes in landscape structure and associated resource availability. Because resource availability and conspecific density often co-vary within the natural landscape, manipulative experiments are needed to understand how changes in these two drivers may affect density dependence in wild populations. We used a common, shoaling, coral reef fish (white grunt, Haemulon plumierii) as our model species, and manipulated fish densities and landscape context of artificial reef habitats to assess the effects of each on fish condition. We found evidence of inverse density dependence, where individual condition was positively related to conspecific density; landscape context had little effect. Mean grunt condition on natural patch reefs was similar to that for our low grunt density treatment artificial reefs, possibly due to differences in fish densities or landscape context. These findings suggest that over-harvest may have detrimental effects on wild populations that extend beyond mere reductions in population size, especially for group-living species.