The Philippines health system review

The Asia Pacific Observatory on Health Systems and Policies (the APO) is a collaborative partnership of interested governments, international agencies, foundations, and researchers that promotes evidence-informed health systems policy regionally and in all countries in the Asia Pacific region. The APO collaboratively identifies priority health system issues across the Asia Pacific region; develops and synthesizes relevant research to support and inform countries' evidence-based policy development; and builds country and regional health systems research and evidence-informed policy capacity.

Spermatozoa from normozoospermic fertile and infertile individuals convey a distinct miRNA cargo.

Deciphering the underlying causes of idiopathic male infertility is one of the main challenges in reproductive medicine. This is especially relevant in infertile patients displaying normal seminal parameters and no urogenital or genetic abnormalities. In these cases, the search for additional sperm biomarkers is of high interest. This study was aimed to determine the implications of the sperm miRNA expression profiles in the reproductive capacity of normozoospermic infertile individuals. The expression level of 736 miRNAs was evaluated in spermatozoa from eight normozoospermic infertile males using TaqMan® qRT-PCR. Results were contrasted with data from 10 control normozoospermic fertile individuals analyzed under the same conditions. Clustering analysis of miRNA expression data separated the individuals according to their fertility condition (fertile and infertile). Fifty-seven miRNAs were differentially expressed (DE-miRNAs) between populations; 20 of them was regulated by a host gene promoter that in three cases comprised genes involved in fertility. The predicted targets of the DE-miRNAs (n = 8,606) unveiled a significant enrichment of biological processes related to embryonic morphogenesis and chromatin modification. Normozoospermic infertile individuals exhibit a specific sperm miRNA expression profile clearly differentiated from normozoospermic fertile individuals. This miRNA cargo has potential implications in the individuals' reproductive competence.

[Evaluation of neonatal care discharge practices: three years experience]. / Evaluation des pratiques autour de la sortie de néonatalogie: 3 ans d'expérience.

OBJECTIVES: This study purpose was to identify the advantages and limitations of our practice in planning newborns' discharge from the neonatal unit. We searched for appropriate actions to promote good family conditions and environment for infants being discharged from the neonatal unit. MATERIALS AND METHODS: During a six-month period in 1999, we interviewed 110 families whose infants were discharged from our units. All interviews were conducted by the same person using a semi-directive protocol to collect the parents' perceptions of their child's hospitalisation and discharge and their recall of the first days at home. Data were collected after a sufficient period of adaptation at home. Analysis of the interviews showed that different difficulties could be prevented. Based on these findings, we instituted different pluridisciplinary discharge group to review practices in September 2000. In 2002, the same type of survey was conducted to evaluate improvement. RESULTS: Discharge from the neonatal unit was affected by the parents' perceptions of hospitalization, their ability to anticipate, before announcement of the "medical" discharge, home life with their child and to imagine their own professional and familial network. CONCLUSION: The parents' abilities to elaborate a discharge plan all along their child's hospitalisation helps improve the newborn's arrival in the family.

Triplet pregnancy achieved through intracytoplasmic sperm injection with spermatozoa obtained by prostatic massage of a paraplegic patient: case report.

Spinal cord-injured men with ejaculation disorders can have children thanks to assisted reproduction techniques. Spermatozoa from these patients are usually obtained through vibratory stimulation, electroejaculation or by puncturing the seminal duct or the testicle. We present the first published case, as far as we are aware, of spermatozoa obtained through prostatic massage of a paraplegic patient. Penile vibratory stimulation was unsuccessful in this patient. In-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) with spermatozoa obtained through electroejaculation was performed at another centre but pregnancy was not achieved. Through prostatic massage, we obtained a total semen volume of 6 ml containing a total count of 12.32x10(6) spermatozoa (6.24x10(6) with tails), 8% of which had motility (graded + and ++); and 16% of which had normal morphology. The spermatozoa obtained were then used to perform IVF with ICSI and a triplet pregnancy was achieved. Prostatic massage appears to be an easy, non-traumatic and risk-free method to obtain spermatozoa from paraplegic patients.

Household health care facility utilization in the Philippines.

This paper presents probit estimates of household utilization of health care facilities in the Philippines. Using household data from the 1987 National Health Survey and supply data from the Department of Health, separate probit equations are estimated for each of the four major types of facilities in the Philippines: Public hospitals, private hospitals, major rural health units and barangay (village) health stations. The probability that a household will utilize services from these facilities is estimated as a function of socioeconomic, demographic and supply variables. The results indicate substantial differences in utilization patterns by income class. Households in the highest income quartile are approximately twice as likely (0.451 versus 0.236) to utilize private hospital services vis-à-vis households in the lowest income quartile, ceteris paribus. The results also indicate substantial substitution between public and private services. An increase in the availability of private hospital beds significantly reduces the probability that a household will utilize government facilities.

Winners show the way to good management in health care.

To stimulate resourcefulness in the health care services of the Philippines, the German Agency for Technical Cooperation (GTZ) organized a competition to discover and publicize examples of good management. The results provide a rich fund of new ideas.

PIP: In August 1990, the Health and Management Information System project of the German Agency for Technical Cooperation hosted a nationwide competition in the Philippines to discover, award, and publicize examples of good management (increased effectiveness, efficiency, and equity) in the field of health care. 102 entries were obtained from nongovernmental organizations and governmental agencies in all 12 regions of the Philippines and in 52 of the 75 provinces. Site visits were made to 70 projects, 50 were found to merit support, and 12 of these were considered outstanding. The final selection committee chose 3 projects for gold medals, 8 for silver medals, and 38 for bronze medals; accompanying monetary prizes ranged from US $1000 to $9000. Projects awarded gold medals were a voluntary diabetics' association which conducts monthly testing and training and provides support for sufferers, a drugstore cooperative run by a group of poor garbage collectors, and a network of mothers' clubs which emphasizes activities to improve self-reliance. The silver medal projects included a program to provide field experience for medical students, a series of health committees which advocate using health care as a catalyst for community empowerment in remote areas, a program offering community-development experience for students of social work, a university-based testing and development program for herbal medicines, a medical clinic for the urban poor, a radio broadcasting program on health topics, a maternal and child health care program, and a herbal medicine production and marketing program. The winning projects showed an intelligent and creative use of previously untapped human and material resources. Flyers summarizing ideas from all of the winning projects are being disseminated to spark participation in a second contest scheduled for 1994.