Investigating sustainability challenges for the National Health Insurance Fund in Tanzania: a modelling approach.

OBJECTIVE: This study aimed to model the long-term cost associated with expanding public health insurance coverage in Tanzania. DESIGN, SETTING AND PARTICIPANTS: We analysed the 2016 claims of 2 923 524 beneficiaries of the National Health Insurance Fund in Tanzania. The analysis focused on determining the average cost per beneficiary across 5-year age groups separated by gender, and grouped by broad health condition categories. We then modelled three different insurance coverage scenarios from 2020 to 2050 and we estimated the associated costs. OUTCOME MEASURES: Average cost per beneficiary and the projected financing requirements, projected from 2020 to 2050. RESULTS: The analysis revealed that the average per beneficiary cost for insurance claims was $38.58. Among males over 75 years, the average insurance claims costs were highest, amounting to $125. The total estimated annual cost of claims in 2020 was $151 million. Under the status quo coverage scenario, total claims were projected to increase to $415 million by 2050. Increasing coverage from 7% to 50% would result in an additional financing requirement of $2.27 billion. If coverage would increase by 10% annually, reaching 56% of the population by 2050, the additional financing need would amount to $2.84 billion. CONCLUSION: This study highlights the critical importance of assessing the long-term financial viability of health insurance schemes aimed to cover large segments of the population in low-income countries. The findings demonstrate that even without expansion of coverage, financing requirements for insurance will more than triple by 2050. Furthermore, increasing coverage is likely to substantially escalate the cost of claims, potentially requiring significant government or external contributions to finance these additional costs. Policymakers and stakeholders should carefully evaluate the sustainability of insurance schemes to ensure adequate financial support for expanding coverage and improving healthcare access in low-income settings.

Association Between Conflict of Interest and Published Position on Hypoglossal Nerve Stimulation for Sleep Apnea.

OBJECTIVE: To determine if there is an association between authors' financial conflict of interest and published position on clinical use of hypoglossal nerve stimulation for obstructive sleep apnea. STUDY DESIGN: Retrospective cross-sectional analysis. SETTING: International roster of authors and articles analyzed. METHODS: A Google Scholar search was performed for editorials and reviews citing the 2014 New England Journal of Medicine article on hypoglossal nerve stimulation for obstructive sleep apnea. Included articles were coded as favorable or neutral. Conflict of interest was recorded as declared by the authors in these articles and as independently searched in the Open Payments registry. RESULTS: Sixteen articles from 45 independent authors were analyzed. Nine articles by authors were coded as favorable. Among authors of articles with favorable views, 16 (59%) had a financial conflict of interest with the manufacturer of the hypoglossal nerve stimulator device, as opposed to only 1 of 21 (5%) authors of neutral/unfavorable articles. When we included only authors to whom payments could be identified or excluded on Open Payments, 16 of 20 (80%; 95% CI, 62%-98%) authors of favorable articles had a financial conflict, while 1 of 10 (10%; 95% CI, 0%-29.6%) of neutral/unfavorable articles did (P = .004). CONCLUSION: Our study demonstrates an association between published position on hypoglossal nerve stimulator use and financial conflict with the device manufacturer. Several undeclared conflicts were also found, suggesting a role for independent search for conflicts during the review process.

"a gente tem que somar": fontes de captação financeira de atletas da seleção brasileira de judô / "we have to add": funding sources for athletes of brazil's national judo team / "tenemos que sumar": fuentes de captación financiera de los deportistas de la selección brasileña de judo

Resumo O judô é um esporte em destaque no Brasil. Um dos motivos para isso é o suporte financeiro que o país oferta. Por conta disso, este trabalho objetivou descrever e analisar as formas de captação de recursos financeiros dos atletas de ponta do judô e detalhar a utilização do Programa Bolsa Atleta em suas carreiras. Foram entrevistados 17 atletas da seleção brasileira de judô. Geralmente, os atletas se beneficiam de quatro fontes de recursos financeiros - clube, patrocínios individuais, Programa de Atletas do Alto Rendimento (PAAR) e Programa Bolsa Atleta. Além disso, a Confederação Brasileira de Judô (CBJ) auxilia com outros recursos. Concluiu-se, então, que as principais fontes de financiamento dos atletas vêm do governo federal. É possível se manter financeiramente como atleta de alto rendimento, contudo, há um déficit no financiamento de judocas de base, falta de suporte para recuperação de lesões e para o pós-carreira do atleta.

Abstract Judo is a prominent sport in Brazil, partly as a result of government-provided financial support. This work describes and analyzes top judo athletes' fundraising strategies and the uses they make of the Athlete Scholarship Program in their careers. Seventeen athletes from Brazil's national judo team were interviewed. Athletes usually benefit from four funding sources - clubs, individual sponsors, the High-Performance Athletes Program (PAAR), and the Athlete Scholarship Program. In addition, the Brazilian Judo Confederation (CBJ) assists with other resources. The study concludes that the main funding sources for athletes are provided by the federal government. High performance athletes are able support themselves, but lower-level athletes are underfunded and lack support to recover from injuries and for their post-career times.

Resumen El judo es un deporte destacado en Brasil, y una de las razones de esto es el apoyo financiero que ofrece el país. Por eso, este trabajo tuvo como objetivo describir y analizar las formas de captación de recursos económicos de los deportistas de élite del judo, y detalla la utilización del Programa Bolsa Atleta (Beca Atleta) en sus carreras. Fueron entrevistados 17 deportistas de la selección brasileña de judo. Generalmente, los deportistas se benefician de cuatro fuentes de recursos financieros: club, patrocinios individuales, Programa de Atletas de Alto Rendimiento (PAAR) y Programa Bolsa-Atleta. Además, la Confederación Brasileña de Judo (CBJ) colabora con otros recursos. Se concluyó que las principales fuentes de financiación de los deportistas provienen del gobierno federal. Es posible mantenerse económicamente como deportista de alto rendimiento, sin embargo, existe un déficit en la financiación de los judokas de base, falta de apoyo para la recuperación de lesiones y para la poscarrera del deportista.

Communities as 'renewable energy' for healthcare services? a multimethods study into the form, scale and role of voluntary support for community hospitals in England.

OBJECTIVE: To examine the forms, scale and role of community and voluntary support for community hospitals in England. DESIGN: A multimethods study. Quantitative analysis of Charity Commission data on levels of volunteering and voluntary income for charities supporting community hospitals. Nine qualitative case studies of community hospitals and their surrounding communities, including interviews and focus groups. SETTING: Community hospitals in England and their surrounding communities. PARTICIPANTS: Charity Commission data for 245 community hospital Leagues of Friends. Interviews with staff (89), patients (60), carers (28), volunteers (35), community representatives (20), managers and commissioners (9). Focus groups with multidisciplinary teams (8 groups across nine sites, involving 43 respondents), volunteers (6 groups, 33 respondents) and community stakeholders (8 groups, 54 respondents). RESULTS: Communities support community hospitals through: human resources (average=24 volunteers a year per hospital); financial resources (median voluntary income = £15 632); practical resources through services and activities provided by voluntary and community groups; and intellectual resources (eg, consultation and coproduction). Communities provide valuable supplementary resources to the National Health Service, enhancing community hospital services, patient experience, staff morale and volunteer well-being. Such resources, however, vary in level and form from hospital to hospital and over time: voluntary income is on the decline, as is membership of League of Friends, and it can be hard to recruit regular, active volunteers. CONCLUSIONS: Communities can be a significant resource for healthcare services, in ways which can enhance patient experience and service quality. Harnessing that resource, however, is not straight forward and there is a perception that it might be becoming more difficult questioning the extent to which it can be considered sustainable or 'renewable'.

Financial Incentives to Increase Colorectal Cancer Screening Uptake and Decrease Disparities: A Randomized Clinical Trial.

Importance: Colorectal cancer screening rates are suboptimal, particularly among sociodemographically disadvantaged groups. Objective: To examine whether guaranteed money or probabilistic lottery financial incentives conditional on completion of colorectal cancer screening increase screening uptake, particularly among groups with lower screening rates. Design, Setting, and Participants: This parallel, 3-arm randomized clinical trial was conducted from March 13, 2017, through April 12, 2018, at 21 medical centers in an integrated health care system in western Washington. A total of 838 age-eligible patients overdue for colorectal cancer screening who completed a questionnaire that confirmed eligibility and included sociodemographic and psychosocial questions were enrolled. Interventions: Interventions were (1) mail only (n = 284; up to 3 mailings that included information on the importance of colorectal cancer screening and screening test choices, a fecal immunochemical test [FIT], and a reminder letter if necessary), (2) mail and monetary (n = 270; mailings plus guaranteed $10 on screening completion), or (3) mail and lottery (n = 284; mailings plus a 1 in 10 chance of receiving $50 on screening completion). Main Outcomes and Measures: The primary outcome was completion of any colorectal cancer screening within 6 months of randomization. Secondary outcomes were FIT or colonoscopy completion within 6 months of randomization. Intervention effects were compared across sociodemographic subgroups and self-reported psychosocial measures. Results: A total of 838 participants (mean [SD] age, 59.7 [7.2] years; 546 [65.2%] female; 433 [52.2%] white race and 101 [12.1%] Hispanic ethnicity) were included in the study. Completion of any colorectal screening was not significantly higher for the mail and monetary group (207 of 270 [76.7%]) or the mail and lottery group (212 of 284 [74.6%]) than for the mail only group (203 of 284 [71.5%]) (P = .11). For FIT completion, interventions had a statistically significant effect (P = .04), with a net increase of 7.7% (95% CI, 0.3%-15.1%) in the mail and monetary group and 7.1% (95% CI, -0.2% to 14.3%) in the mail and lottery group compared with the mail only group. For patients with Medicaid insurance, the net increase compared with mail only in FIT completion for the mail and monetary or the mail and lottery group was 37.7% (95% CI, 11.0%-64.3%) (34.2% for the mail and monetary group and 40.4% for the mail and lottery group) compared with a net increase of only 5.6% (95% CI, -0.9% to 12.2%) among those not Medicaid insured (test for interaction P = .03). Conclusions and Relevance: Financial incentives increased FIT uptake but not overall colorectal cancer screening. Financial incentives may decrease screening disparities among some sociodemographically disadvantaged groups. Trial Registration: ClinicalTrials.gov identifier: NCT00697047.

Evidence Underlying Recommendations and Payments from Industry to Authors of the National Comprehensive Cancer Network Guidelines.

BACKGROUND: The National Comprehensive Cancer Network (NCCN) guidelines are among the most widely used guidance in oncology. It is critical to understand the extent to which the recommendations in these guidelines are supported by evidence and to investigate whether these recommendations have been influenced by payments from industry to authors. MATERIALS AND METHODS: We examined the quality and consistency of evidence, as scored by guidelines authors, for systemic treatment incorporated in the NCCN guidelines. Payments data in 2015 were manually abstracted using the Open Payments database, which discloses all payments between the industry and American physicians. Correlations between the percentage of authors who received payments and the proportion of recommendations developed from low-level evidence per guideline were calculated using Spearman rank correlation. RESULTS: In total, 1,782 recommendations were identified in 29 guidelines, of which 1,282 (71.9%) were based on low-quality or low-consistency evidence (low-level evidence), including "case reports or clinical experience only" (18.9%). A substantial proportion (31/143, 21.7%) of category 1 (the highest level) recommendations were based on low-level evidence. The majority of authors (87.1%) received payments from industry. However, no association was found between the prevalence of payments among authors and the percentage of recommendations developed from low-level evidence per guideline. CONCLUSION: The majority of systemic treatment recommendations in the NCCN guidelines are based on low-level evidence, including more than one in five category 1 recommendations. Payments from industry were prevalent among authors. However, industrial payments among authors were not associated with inclusion of regimen/agent for which there is no conclusive evidence in the guidelines. IMPLICATIONS FOR PRACTICE: The authors found that the majority (71.9%) of systemic treatment recommendations issued in the current National Comprehensive Cancer Network guidelines were based on low-level evidence. Physicians should remain cautious when using current guidelines as the sole source guiding patient care decisions.

Cancer support services: Are they meeting the needs of rural radiotherapy patients?

This paper examines the supportive care in place to meet the needs of patients receiving radiotherapy at a regional oncology service in Bunbury, Western Australia. Semi-structured in-depth interviews with 21 service providers and 17 adults diagnosed with cancer who underwent radiotherapy at the Service were recorded, transcribed and analysed thematically. Key themes relevant were co-operation and collaboration of interdisciplinary team members; support from organisations to assist with accommodation, transport, emotional support and provision of practical assistance, as well as barriers to accessing support. Most participants were positive about the support available, recognising the needs of rural radiotherapy patients for assistance with travel, accommodation and psychosocial support to help deal with the stressors they face. Collaboration between the various service providers maximised the support available to patients but the drop off in psychosocial support once the intensity of treatment was completed was identified as a weakness in the support available. The support system, established around a regional radiotherapy service, was enhanced by the collaborative professional relationships developed among service providers. The service extends beyond clinical service delivery by recognising financial, logistical and psychosocial support needs, factors to be considered to ensure rural radiotherapy patients are provided with holistic care.

Reducing chronic disease through changes in food aid: A microsimulation of nutrition and cardiometabolic disease among Palestinian refugees in the Middle East.

BACKGROUND: Type 2 diabetes mellitus and cardiovascular disease and have become leading causes of morbidity and mortality among Palestinian refugees in the Middle East, many of whom live in long-term settlements and receive grain-based food aid. The objective of this study was to estimate changes in type 2 diabetes and cardiovascular disease morbidity and mortality attributable to a transition from traditional food aid to either (i) a debit card restricted to food purchases, (ii) cash, or (iii) an alternative food parcel with less grain and more fruits and vegetables, each valued at $30/person/month. METHODS AND FINDINGS: An individual-level microsimulation was created to estimate relationships between food aid delivery method, food consumption, type 2 diabetes, and cardiovascular disease morbidity and mortality using demographic data from the United Nations (UN; 2017) on 5,340,443 registered Palestinian refugees in Syria, Jordan, Lebanon, Gaza, and the West Bank, food consumption data (2011-2017) from households receiving traditional food parcel delivery of food aid (n = 1,507 households) and electronic debit card delivery of food aid (n = 1,047 households), and health data from a random 10% sample of refugees receiving medical care through the UN (2012-2015; n = 516,386). Outcome metrics included incidence per 1,000 person-years of hypertension, type 2 diabetes, atherosclerotic cardiovascular disease events, microvascular events (end-stage renal disease, diabetic neuropathy, and proliferative diabetic retinopathy), and all-cause mortality. The model estimated changes in total calories, sodium and potassium intake, fatty acid intake, and overall dietary quality (Mediterranean Dietary Score [MDS]) as mediators to each outcome metric. We did not observe that a change from food parcel to electronic debit card delivery of food aid or to cash aid led to a meaningful change in consumption, biomarkers, or disease outcomes. By contrast, a shift to an alternative food parcel with less grain and more fruits and vegetables was estimated to produce a 0.08 per 1,000 person-years decrease in the incidence of hypertension (95% confidence interval [CI] 0.05-0.11), 0.18 per 1,000 person-years decrease in the incidence of type 2 diabetes (95% CI 0.14-0.22), 0.18 per 1,000 person-years decrease in the incidence of atherosclerotic cardiovascular disease events (95% CI 0.17-0.19), and 0.02 decrease per 1,000 person-years all-cause mortality (95% CI 0.01 decrease to 0.04 increase) among those receiving aid. The benefits of this shift, however, could be neutralized by a small (2%) increase in compensatory (out-of-pocket) increases in consumption of refined grains, fats and oils, or confectionaries. A larger alternative parcel requiring an increase in total food aid expenditure by 27% would be more likely to have a clinically meaningful improvement on type 2 diabetes and cardiovascular disease incidence. CONCLUSIONS: Contrary to the supposition in the literature, our findings do not robustly support the theory that transitioning from traditional food aid to either debit card or cash delivery alone would necessarily reduce chronic disease outcomes. Rather, an alternative food parcel would be more effective, even after matching current budget ceilings. But compensatory increases in consumption of less healthy foods may neutralize the improvements from an alternative food parcel unless total aid funding were increased substantially. Our analysis is limited by uncertainty in estimates of modeling long-term outcomes from shorter-term trials, focusing on diabetes and cardiovascular outcomes for which validated equations are available instead of all nutrition-associated health outcomes, and using data from food frequency questionnaires in the absence of 24-hour dietary recall data.

Physiotherapy education is a good financial investment, up to a certain level of student debt: an inter-professional economic analysis.

QUESTIONS: What is the economic value of a physiotherapy career relative to other healthcare professions? Is the graduate debt reported for physiotherapy manageable according to recommended salary-weighted debt service ratio benchmarks? DESIGN: Net present value (NPV) is an economic modelling approach that compares costs and benefits of an investment such as healthcare education. An economic analysis using the NPV approach was conducted and reported in US dollars for the Doctor of Physical Therapy degree. Comparable calculations were made for a range of other healthcare qualifications. Debt service ratios were also calculated under a range of scenarios. OUTCOME MEASURES: Entry-level salaries and rate of salary growth were obtained from government databases. Student debt levels were obtained from published sources. Because no national estimate exists for physical therapy student debt, debt was modelled for recent Doctor of Physical Therapy (DPT) graduates and for several hypothetical debt tiers. The NPV modelled future physical therapy earnings less the cost of education and the opportunity cost of foregone earnings from alternate careers. RESULTS: At the debt level reported by recent graduates (US $86563), physical therapy NPV was higher than occupational therapy, optometry, veterinary medicine, and chiropractic but lower than dentistry, pharmacy, nurse practitioner, physician assistant, and all medical specialties. At $150000 debt, physical therapy NPV falls below all careers except veterinary medicine and chiropractic. Students with>$200000 debt may not achieve recommended repayment benchmarks. At high debt levels (>$266000), physical therapy NPV no longer exceeds that of a bachelor's degree. CONCLUSION: Physiotherapy education is a good financial investment, up to a certain level of student debt. Students should carefully consider the amount of debt they are willing to incur in order to pursue a physiotherapy career. Likewise, physiotherapy education programs should consider the role they may play in bolstering the economic value of their graduates' future careers. [Shields RK, Dudley-Javoroski S (2018) Physiotherapy education is a good financial investment, up to a certain level of student debt: an inter-professional economic analysis. Journal of Physiotherapy 64: 182-190].

[The analysis on the funding of Natural Science Foundation of China for acupuncture projects from 2005 to 2015].

The funding of Natural Science Foundation of China (NSFC) for acupuncture projects from 2005 to 2015 was summarized and analyzed. The results indicated during past 11 years, 711 projects regarding acupuncture were funded by NSFC, with a total of 281 million RMB, accounting for 12.39% in TCM projects. It was concluded the funding for acupuncture projects was increased year by year, but was still relatively weak; in addition, the funding was unbalanced in different areas and organizations, mainly in Beijing, Shanghai, Sichuan, Guangdong, Tianjin, and the continuity and variability both existed in research content and direction.

Microfinance Institutions' Successful Delivery Of Micronutrient Powders: A Randomized Trial In Rural Haiti.

Globally, two-thirds of child deaths could be prevented by increased provision of health interventions such as vaccines, micronutrient supplements, and water purification tablets. We report the results from a randomized controlled trial in Haiti during 2012 that tested whether microfinance institutions-which reach 200 million households worldwide-can effectively deliver health products. These institutions provide loans to underserved entrepreneurs, primarily poor women in rural areas. In the intervention group, micronutrient powders to improve the nutrition of young children were distributed at regularly occurring microfinance meetings by a trained borrower. In both the control and the intervention groups, nurses led seminars on nutrition and extended breastfeeding during microfinance meetings. At three-month follow-up, the mean difference in hemoglobin concentration between children in the intervention group and those in the control group was 0.28 grams per deciliter (g/dL)-with a subsample of younger children (under two years of age) showing greater relative improvement (0.46 g/dL)-and the odds ratio for children in the intervention group meeting the diagnostic criteria for anemia was 0.64. The results are similar to those of previous studies that evaluated micronutrient powder distribution through dedicated health institutions. Our findings suggest that microfinance institutions are a promising platform for the large-scale delivery of health products in low-income countries.

Making The Most Of Microfinance Networks.

Together, data scientists and microfinance institutions are bringing vital health products to Haiti's rural communities.

Incentivo governamental para Arranjos Produtivos Locais de Plantas Medicinais e Fitoterápicos no âmbito do SUS / Government incentives for Local Productive Arrangements of Medicinal Plants and Herbal Medicines at Unified Health System (SUS)

O Ministério da Saúde vem publicando, desde 2012, editais para a seleção pública de projetos de Arranjos Produtivos Locais (APLs) em plantas medicinais e fitoterápicos no âmbito do SUS. APL pode ser definido como aglomeração de empresas, localizadas em um mesmo território, que apresentam especialização produtiva e mantêm algum vínculo de articulação, interação, cooperação e aprendizagem entre si e com outros atores locais, tais como: governo, associações empresariais, instituições de crédito, ensino e pesquisa. O presente estudo teve como objetivo descrever, de modo sistematizado e conciso, as informações essenciais sobre os APLs selecionados nos anos de 2012 e 2013. De dezembro de 2014 a março de 2015 foi solicitado aos coordenadores dos 23 APLs selecionados responder um questionário. Destes, 17 responderam. O recurso financeiro aportado pelo Ministério da Saúde possibilitou a aquisição de materiais de consumo e permanentes para a reestruturação dos setores de cultivo e de manipulação, bem como a realização de cursos de capacitação para profissionais de saúde e agricultores familiares envolvidos no projeto. Quanto aos problemas identificados, o mais citado pelos coordenadores foi a dificuldade na execução do recurso financeiro, o que resultou no atraso do início de alguns projetos. Contudo, o incentivo governamental para a formação de APLs consolida o serviço de fitoterapia na atenção primária à saúde no SUS.(AU)

The Ministry of Health has since 2012 been issuing public bids for the selection of local productive arrangements (LPAs) projects in the area of medicinal plants and herbal medicines, under the auspices of the government's Unified Health System (SUS). LPAs can be defined as groups or communities, located in the same area, which have a productive specialization and possess some type of cooperation and exchange of knowledge among themselves and with other local stakeholders such as the government, business associations, credit institutions, educational and research. The present study aimed to describe, in a systematic and concise way, the essential informations about the LPAs which were selected in the years 2012 and 2013. From December 2014 to March 2015 coordinators of 23 LPAs were requested to answer a questionnaire. Of these, 17 replied. The resources invested by the Ministry of Health enabled the LPAs to purchase supplies and equipment for cultivation and production, as well as to provide technical training courses for health professionals and agricultural workers involved in the project. The most problem reported was the management of financial resources, which resulted in startup delays of some projects. However, these government incentives for settling LPAs in Brazil has contributed to establishing phytotherapy in SUS clinics.(AU)

Financial Relationships With Industry Among National Comprehensive Cancer Network Guideline Authors.

IMPORTANCE: Financial conflicts of interest (FCOIs) among authors of clinical practice guidelines have the potential to influence treatment recommendations. OBJECTIVE: To quantify FCOIs with industry among authors of the National Comprehensive Cancer Network (NCCN) guidelines. DESIGN, SETTING, AND PARTICIPANTS: We assessed FCOIs occurring during 2014 among NCCN guideline authors in the United States. All were physician members of the NCCN guideline committees for lung, breast, prostate, and colorectal cancer as of the end of 2014. The data source for FCOIs was Open Payments, which is publically reported by the Centers for Medicare and Medicaid Services. This study was cross-sectional. MAIN OUTCOMES AND MEASURES: The proportion of NCCN authors having FCOIs with industry; the average amount received from industry sources per author. RESULTS: Of 125 guideline authors, 108 (86%) had at least 1 reported FCOI. Authors received an average of $10 011 (range, $0-$106 859) in general payments (GPs), which include consulting, meals, lodging, and similar transfers of value, and $236 066 (range $0-$2 756 713) in industry research payments (RPs), including funding associated with clinical trials. Approximately 84% of authors received GPs, while 47% received RPs. Eight (6%) had FCOIs in excess of the $50 000 net and/or $20 000 single-company maximums stipulated by NCCN. CONCLUSIONS AND RELEVANCE: Among NCCN guideline authors, FCOIs involving RPs were of greater value, while those involving GPs were more prevalent. Although FCOIs may result from engaging in important scholarship, FCOIs may still influence guideline authors in counterproductive ways. Research is needed to understand how best to manage author FCOIs during guideline creation.

[Review and analysis of transplant biological research projects funded by National Natural Science Foundation of China].

OBJECTIVE: To study the funding and achievements in the field of organ transplantation support by the National Natural Science Foundation of China (NSFC). METHODS: A search of NSFC database was made by using the key word "transplantation" and excluding "bone marrow transplantation" for the projects funded between 1988 and 2013. SCI indexed publications that marked with NSFC project number were collected by searching each grant number in the database of the Web of Science. RESULTS: Six hundreds fifty-five projects were identified and received about 220 million yuan in grant funding. These funded research projects were distributed among 25 provinces and autonomous regions, however, which were mainly in the developed coastal areas; of them, 43 (6.56%) projects were granted in xenotransplantation and 17 projects (2.60%) were funded in the field of traditional Chinese medicine-related organ transplantation; Transplantation on blood vessels, heart, kidney, liver, lung, small intestine, pancreatic, cornea, trachea, skin, etc. were primarily performed in research. Nine hundreds and sixty-one SCI-indexed publications were achieved. CONCLUSIONS: Magnitude and intensity of NSFC funding, output of SCI publications have been increasing, suggesting that NSFC positively promotes the development of organ transplantation. Although a great progress of transplantation has been made, basic and translational studies should be vigorously strengthened.

Qualitative Analysis of the American College of Nurse-Midwives Student Reports, 2005 to 2014.

INTRODUCTION: The Patient Protection and Affordable Care Act (ACA) is changing the health care landscape in the United States. It is now more important than ever to understand the needs of students who are preparing for roles as health care providers. The purpose of this study was to describe and analyze the American College of Nurse-Midwives (ACNM) Student Reports from 2005 through 2014 to acquire a better understanding of student needs in light of the historic change in health care reform. METHODS: A document analysis was conducted to review and evaluate 10 student reports using qualitative content analysis. Data were coded, categories were formed, and themes were discovered. The interpretation of the student reports elicited meaning, gained understanding, and developed empirical knowledge. RESULTS: Eight themes emerged from the data contained in the 10 student reports. These were: 1) public awareness and marketing; 2) midwifery education; 3) funding for midwifery education; 4) preceptor issues; 5) communication and professional issues; 6) diversity and inclusion; 7) transition to practice; and 8) the ACNM Annual Meeting. DISCUSSION: Students bring a unique perspective to the profession of midwifery and ACNM. This study revealed 8 themes emanating from the student reports spanning 10 years. Each theme showcased in this study is presented through a student lens and was deemed important enough to be mentioned in the majority of the student reports. These themes identify key areas affecting students such as education program content and clinical experiences, diversity and inclusion, preceptor availability and relationships, funding for graduate school and for attending the ACNM Annual Meeting, and a myriad of other significant topics. These students will begin their new careers with the changing structure of the health care industry under the ACA. At this complex and vulnerable time, it is imperative that student voices be heard and that their professional organization remains receptive to their concerns. A continuing dialogue between students and midwifery leadership, faculty, and preceptors will be beneficial to move our profession in the direction of achieving access to high-quality health care for all.

An evaluation of China's new rural cooperative medical system: achievements and inadequacies from policy goals.

BACKGROUND: Although much public scrutiny and academic attention has focused on the evaluations of system implementation since the beginning of New Rural Cooperative Medical System (NRCMS) in China, few studies have systematically evaluated the achievements of the stated policy goals. The purpose of this study is to examine to what extent the policy goals of NRCMS have been achieved. METHODS: Using multistage sampling processes, two rounds of cross-sectional household surveys including 9787 and 7921 rural households were conducted in Eastern China in year 2000 and year 2008, respectively. A pre- and post-implementation comparison was used to evaluate the achievement of policy goals in three measures: impoverishment from major health hazards, household financial risk from medical expenses, and rural income inequity. Intention surveys were also applied to find out potential obstacles in the implementation of NRCMS. RESULTS: The rate of re-impoverishment from health hazard was reduced from 2.69 % ex ante to 2.12 % ex post, a decrease of 21.13 %. The severity of impoverishment fell from a previous 4.66 % to 3.02 %, a decline of 35.18 %. Economic risk of medical treatment population relative to the whole population fell from 2.62 ex ante to 2.03 ex post, a 22.52 % reduction. As indication of effect on improving income equity, the Gini coefficient fell from 0.4629 to 0.4541. The effects of NRCMS were significantly better than those of RCMS. Despite the preliminary achievements, our intention survey of key respondents identified that technical difficulties in actuarial funding and more sustainable reimbursement schedules has become the most challenging barriers in achieving the goals of NRCMS, while raising the insurance premium on NRCMS was no longer as big a barrier. CONCLUSIONS: With NRCMS, China has established a medical security system to reduce the financial burden of healthcare on rural residents. NRCMS has achieved some positive though limited effects; but technical difficulties in the implementation of NRCMS have become barriers to achieve the pre-set policy goals. Efforts should be made to improve the capacity building in the design of the reimbursement schemes for the implementers of NRCMS, such as identifying medical impoverishment, calculating actuarial funding levels for the risk pooling.