To analyze and compare the effect of a new reimbursement model (based on a modified version of the Swedish free choice reform) on private and public primary care in Iceland during its first year of ...use.
Descriptive comparison based on official data from the Ministry of Welfare, Directorate of Health, and the Icelandic Health Insurance on payments in the Icelandic primary care system.
Primary care system operating in the Reykjavik capital area. Public primary care has dominated the Icelandic health sector. Both public and private primary care is financed by public taxation.
Fifteen public and four private primary care centers in the capital region.
Different indexes used in the reimbursement model and public vs. private primary care costs.
No statistically significant cost differences were found between public and private primary care centers regarding total reimbursements, reimbursements per GP, number of registered patients, or per visit. Two indexes covered over 80% of reimbursements in the model.
The cost for Icelandic taxpayers was equal in numerous indexes between public and private primary care centers. Only public centers got reimbursements for the care need index, which considers a patient's social needs, strengths, and weaknesses.
KEY POINTS
The Icelandic primary care system underwent a reform in 2017 to improve availability and quality. A new reimbursement model was introduced, and two new private centers opened following a tender.
Two out of 14 indexes cover over 80% of total reimbursements from the new model.
Only 5 primary care centers, all publicly driven, got reimbursement for the care need index, which is a social deprivation index.
Reimbursement systems should mirror the policies of health authorities and empower the workforce.
Smoking during pregnancy OSKARSDOTTIR, GUDRUN NINA; SIGURDSSON, HEDINN; GUDMUNDSSON, KRISTJAN G.
Scandinavian journal of public health,
02/2017, Letnik:
45, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Aims: Tobacco is a major cause of disease and mortality in modern times. The risk of smoking in pregnancy is a serious threat to the development and future health of an unborn child. The aim of this ...study was to explore the epidemiological factors associated with smoking during pregnancy in a primary healthcare setting. Methods: All 856 maternity records at the Glaesibaer Health Care Centre in Reykjavik during 2006–2013 were reviewed and information on smoking habits investigated. Results: The records showed that in 108 (12.2%) pregnancies, women smoked at first visit and 63 stopped smoking in early pregnancy, leaving 45 (5.3%) mothers smoking throughout the whole gestational period. The mean age of the smoking women was 27.8 years and for the non-smokers 29.7 years. Low social status (odds ratio (OR) = 2.66; 95% confidence interval (CI): 1.19–5.96), previous mental health diagnosis (OR = 2.7; 95% CI: 1.3–5.6), and unstable relationship with a partner (OR = 3.78; 95% CI: 2.1–7.0) were associated with smoking. Smoking fewer cigarettes was associated with a 0.04-unit lower risk of smoking during pregnancy (OR = 0.04: 95% CI: 0.02–0.08). Conclusions: Our results indicated that the women who smoked during pregnancy were often heavy smokers and living without a partner. They were younger, had worse mental health, and a lower social status than those pregnant women who did not smoke. Bearing in mind the consequence of smoking in pregnancy, this subgroup should get increased assistance to quit smoking before and during early pregnancy, as well as appropriate medical and social support.
Synthesis of a series of 2-aryl-3-pyrimidyl-imidazo1,2-
apyridines with potent activity against herpes simplex viruses is described. Synthetic approaches allowing for variation of the 2-aryl, ...3-heteroaryl as well as other imidazopyridine substituents are outlined and resulting effects on antiviral activity are highlighted. Several compounds with in vitro antiviral activity similar or better than acyclovir are described.
Synthesis of a series of 2-aryl-3-pyrimidyl-imidazo1,2-
apyridines with potent activity against herpes simplex viruses is described. Synthetic approaches allowing for variation of the 2-aryl, 3-heteroaryl as well as other imidazopyridine substituents are outlined and resulting effects on antiviral activity are highlighted. Several compounds with in vitro antiviral activity similar or better than acyclovir are described.
Fine-needle aspiration cytology is a valuable method for preoperative assessment of head and neck tumors. However, its accuracy in detection of salivary gland masses is controversial compared with ...other methods. The aim of this work was to evaluate the effectiveness and accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses.
Over a 10-year period, 126 parotid gland masses were resected. Retrospective chart reviews of 114 patients were performed. The results of FNAC and final histological diagnosis were compared and the accuracy of FNAC was determined.
Final histological evaluation revealed 11 malignant tumors and 103 benign lesions. Pleomorphic adenoma was the most common neoplasm (63%), followed by Warthin's tumor (17.5%). The sensitivity of FNAC in detecting malignant tumors was 73% and the specificity was 97%. Positive predictive value (PPV) was 73% and negative predictive value (NPV) was 97%. The overall accuracy of FNAC in detecting parotid masses was 95%. False-negative diagnosis was found in mucoepidermoid carcinoma, acinic cell carcinoma, and epithelial-myoepithelial carcinoma whereas there was false-positive diagnosis in cases of pleomorphic adenoma and normal parotid gland tissue.
FNAC is a reliable minimally invasive diagnostic method with a high sensitivity in diagnosis of lesions in parotid glands. The sensitivity of detection of malignant tumors in parotid glands was low due to the biopsy technique used, and depended on tumor location. Postoperative complications decreased after superficial parotidectomy.
Synthesis of several pyrazolo1,5-
cpyrimidines, pyrazolo1,5-
apyrimidines and pyrazolo1,5-
a1,3,5triazines with potent activity against herpes simplex viruses is described.
Synthesis of several ...pyrazolo1,5-
cpyrimidines, pyrazolo1,5-
apyrimidines and pyrazolo1,5-
a1,3,5triazines with potent activity against herpes simplex viruses is described. Synthetic approaches allowing for variation of the substitution pattern are outlined and resulting changes in antiviral activity are highlighted. Several compounds with in vitro antiviral activity similar or better than acyclovir are described.
The lead optimization of a series of N-substituted benzimidazole CXCR4 antagonists is described. Side chain modifications and stereochemical optimization led to substantial improvements in potency ...and protein shift to afford compounds with low nanomolar anti-HIV activity.
The lead optimization of a series of N-substituted benzimidazole CXCR4 antagonists is described. Side chain modifications and stereochemical optimization led to substantial improvements in potency and protein shift to afford compounds with low nanomolar anti-HIV activity.
Synthesis of several novel imidazopyridine-5,6,7,8-tetrahydro-8-quinolinamine derivatives with potent activity against HIV-1 are described.
Synthesis of several novel ...imidazopyridine-5,6,7,8-tetrahydro-8-quinolinamine derivatives with potent activity against HIV are described. Synthetic approaches allowing for variation of the substitution pattern are outlined and resulting changes in antiviral activity and pharmacokinetics are highlighted. Several compounds with low nanomolar anti-HIV activity and oral bioavailability are described.
Studies of melatonin photoreactivity in water solutions: An effect of an external heavy atom I
−
on UV/Vis absorption, fluorescence and phosphorescence spectra is explored. The data allowed ...determination of relevant energetics for the system.The heavy atom effect (HAE) of I
−
on melatonin is clearly found to induce an intersystem crossing from the lowest energy singlet state to the lowest energy triplet state (
T
1
) by a state mixing. Lifetime for the first excited triplet states of melatonin in association with I
−
and quenching rates for halomethanes (CH
2
X
2
, CHX
3
, CY
4
, X = Cl, Br, Y = Cl) are determined from Time-Correlated Single-Photon Counting decay curves for the phosphorescence. Dramatic alterations in quenching rate constants with quenchers as CH
2
X
2
< CHX
3
< CX
4
and Cl < Br are attributed to energy transfer from an I
−…
M
e*
(
T
1
) complex to low-lying electronic states of the halomethanes followed by dissociation to form R and X fragments. Relevance of the melatonin photoreactivity to photosensitizer properties in organic media is discussed.
Graphical abstract
2,5,6-Trichloro-1-(beta-d-ribofuranosyl)benzimidazole (TCRB) and certain analogues have shown significant activity against human cytomegalovirus. The metabolic instability of the glycosidic linkage ...in TCRB prompted us to synthesize the structurally similar imidazo1,2-apyridine erythrofuranosyl C-nucleosides. As an approach to the synthesis of polychlorinated imidazo1,2-apyridine C-3-erythrofuranosides, a palladium-based methodology for coupling 2,3-dihydrofuran with chlorinated 3-iodoimidazo1,2-apyridines was developed and optimized to give 80-90% yields of 2,6-dichloro- and 2,6,7-trichloro-3-(2,3-dideoxy-2,3-didehydro-d/l-erythrofuranosyl)imidazo1,2-apyridine. Dihydroxylation of these didehydro derivatives with osmium tetroxide or with AD-mix alpha gave a mixture of erythrofuranosyl C-nucleosides that were separated by standard and then chiral chromatography. When screened for anti-HCMV and HSV-1 activity, the alpha-d anomer of 2,6,7-trichloro-3-(erythrofuranosyl)imidazo1,2-apyridine proved to be the most active member of the series, while the beta-anomers all proved to be inactive.
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