Acesso para quem quer ou para quem pode? Equidade na utilização de consultas médicas em Portugal com base no INS 2019 / Access for those who want or for those who can? Equity in the use of doctor's appointments in Portugal based on the HIS 2019

Resumo A equidade horizontal no uso de cuidados de saúde requer igual uso para igual necessidade, independentemente de outros fatores - predisponentes ou de capacitação (modelo de Andersen). O objetivo é avaliar a equidade no uso de consultas médicas em Portugal em 2019, comparando os resultados com os obtidos em estudo anterior, com dados de 2014. Os dados vêm do Inquérito Nacional de Saúde 2019. O uso de cuidados é medido pelo número de consultas. Para avaliar as determinantes da utilização, adota-se o modelo binomial negativo. Para quantificar a desigualdade/iniquidade relacionada com o rendimento, calcula-se o índice de concentração. Face a 2014, os efeitos do estado de saúde autoavaliado, limitação nas atividades diárias e problema de saúde prolongado são mais pronunciados e, a região, rendimento, tipo de agregado e estado civil são significativos, nas consultas de medicina geral e familiar. Nas outras consultas, o seguro perdeu significância estatística e o efeito educação foi atenuado, mas emergiu um efeito rendimento. O índice de iniquidade não é significativo nas consultas de medicina geral e familiar, como em 2014, mas o valor (significativo) desse índice aumentou para as consultas de outras especialidades.

Abstract Horizontal equity in the use of healthcare implies equal use for equal needs, regardless of other factors - be they predisposing or enabling (Andersen's model). This study aimed to assess equity in the use of doctor's appointments in Portugal in 2019, comparing the results with those obtained in a previous study, based on data from 2014. Data were retrieved from the Health Interview Survey 2019 (HIS 2019). Healthcare is measured by the number of doctor's appointments. Our study adopted the Negative Binomial Model to assess the factors affecting use. The concentration index was calculated to quantify income-related inequality/inequity. Compared to 2014, the effects of self-assessed health, limitations in daily living activities, and longstanding illnesses are more pronounced, and the region, income, household type and marital status are significant for appointments scheduled with a General Practitioner. In the case of appointments with specialists, health insurance lost statistical significance and the effect of education dropped; however, income became significant. The inequity index is not significant for appointments scheduled with a General Practitioner, as in 2014, but the (significant) value of this index increased for appointments with other specialists.

Structural elucidation, mechanism of action, antibacterial proficiency and synergistic forte of purified Euphorbia hirta whole plant extract against multi-drug resistant otitis media infection / Elucidación estructural, mecanismo de acción, competencia antibacteriana y fuerza sinérgica del extracto de planta entera de Euphorbia hirta purificado contra la infección por otitis media resistente a múltiples fármacos

This study investigated the antibacterial potential of Euphorbia hirtawhole plant extracts, honey and conventional antibiotics and their synergistic effects against selected multidrug resistant and typed bacterial strains associated with otitis media. E. hirtawhole plant extract was purified using column chromatography technique. The antibacterial assays of extracts were done using standard microbiological procedures. Protein, sodium and potassium ion leakage of the synergistic mixtures was determined using flame-photometry. At 100 mg/ml, acetone extracts presented highest inhibition against S. aureus (NCTC 6571) with 32 ± 0.83 mm zone of inhibition. The fractional inhibitory concentration indices displayed higher synergism in combination of plant extract, honey and ciprofloxacin against P. mirabilisat 0.02 compared to drug combination synergy standard (≤ 0.5). This work revealed augmentation of ciprofloxacin potency when combined with purified E. hirta acetone extract and honey and implies their high potential in the treatment of multidrug resistant infectionof otitis media.

Este estudio investigó el potencial antibacteriano de extractos de plantas enteras de Euphorbia hirta, miel y antibióticos convencionales y sus efectos sinérgicos contra cepas bacterianas seleccionadas multirresistentes y tipificadas asociadas con la otitis media. El extracto de la planta entera de E. hirtase purificó usando la técnica de cromatografía en columna. Los ensayos antibacterianos de extractos se realizaron utilizando procedimientos microbiológicos estándar. La fuga de iones de proteínas, sodio y potasio de las mezclas sinérgicas se determinó mediante fotometría de llama. A 100 mg/ml, los extractos de acetona presentaron la mayor inhibición contra S. aureus (NCTC 6571) con una zona de inhibición de 32 ± 0,83 mm. Los índices de concentración inhibitoria fraccional mostraron un mayor sinergismo en combinación de extracto de planta, miel y ciprofloxacina contra P. mirabilisa 0,02 en comparación con el estándar de sinergia de combinación de fármacos (≤ 0,5). Este trabajo reveló un aumento de la potencia de la ciprofloxacina cuando se combina con extracto de acetona purificado de E. hirtay miel e implica sualto potencial en el tratamiento de infecciones de otitis media resistentes a múltiples fármacos.

Antibacterial effects of small molecule antidiabetic agent Halicin against Staphylococcus aureus / 中华检验医学杂志

Objective:To investigate the effect of small molecule antibacterial agent Halicin against Staphylococcus aureus. Methods:The minimum inhibitory concentration (MIC) and minimum bactericidal concentration of Halicin against S. aureus were detected by the microbroth dilution method. The time-kill assay of Halicin against S. aureus was detected by agar plate dilution method. Micro checkerboard dilution method was used to determine the synergistic antibacterial activity between Halicin and conventional antibiotics. Crystal violet staining method was used to assess the biofilm inhibitory and eradicating activity of Halicin. Hemolysis rate was used to detect the mammal cell toxicity of Halicin. Through the mouse skin abscess model, take the skin tissue around the abscess to grind and dilute the colony to detect the antibacterial effect of Halicin in vivo. Results:Halicin showed significant bacteriostasis effects against S. aureus with the minimum inhibitory concentration of 2-4 mg/L. Halicin could significantly reduce the average CFU counts of S. aureus about 5.5×10 6 CFU/ml in a concentration-dependent manner after 8 h treatment at the concentration of 16 mg/L. The fractional inhibitory concentration value between Halicin and ampicillin was 0.5, showing a synergistic antibacterial efficacy. Halicin effectively inhibited the formation of biofilms at the concentration of 4 × MIC, reducing the total biofilm biomass ( A570) from (2.89±0.09) to (1.35±0.17) ( t=11.12, P<0.05). However, there was no eradication effect against preformed biofilms. In addition, Halicin had almost no hemolytic activity on red blood cells even at the concentration up to 128 mg/L. It showed that 20 mg/kg Halicin reduced bacterial burden about 3.0×10 7 CFU/ml in vivo. Conclusion:Halicin had a strong antimicrobial activity against S. aureus with no hemolytic activity.

Global burden of periodontal disease and its relation with socioeconomic development during 1990-2019 / 浙江大学学报·医学版

To analyze the global burden of periodontal disease and its relation with socioeconomic development. Data of global disability-adjusted life year (DALY) due to periodontal disease and human development index (HDI) from 1990 to 2019 were obtained from Global Health Data Exchange (GHDx) and human development reports. The trend of the global burden of periodontal disease from 1990 to 2019 was described. The correlation between age-standardized DALY rates and HDI were examined in 2019, and between-country periodontal disease burden inequality from 1990 to 2019 was measured using health-related Gini coefficients and concentration indexes. From 1990 to 2019, the global DALY rate due to periodontal disease increased from 78.63 to 85.48, and the epidemiological burden did not increase significantly. Statistical differences were found across different HDI categories for age-standardized DALY rates of periodontal disease ( 44.315, <0.01) in 2019. Linear regression analysis also revealed a negative correlation between age-standardized DALY rate of periodontal disease and HDI ( = -0.417, <0.01) . Gini coefficients decreased from 0.361 to 0.281 and concentration indexes fell from 0.0339 to -0.0538 between 1990 and 2019. The global burden of periodontal disease did not increase between 1990 and 2019, though the socioeconomic-associated inequality still existed. The burden of periodontal disease was more concentrated in less developed countries, and the socioeconomic-associated inequality has increased since 2000.

Synergic effect of simvastatin in combination with amphotericin B against environmental strains of Cryptococcus neoformans from northeastern Brazil: a prospective experimental study

BACKGROUND: Statins are used as cholesterol-lowering drugs and may also have direct antimicrobial effects. OBJECTIVE: To evaluate synergic interactions between simvastatin and both amphotericin B and fluconazole, against environmental strains of Cryptococcus neoformans isolated from captive birds' droppings. DESIGNAND SETTING: Experimental study conducted at Federal University of Piauí, Parnaíba, in collaboration with Federal University of Triângulo Mineiro, Uberaba, Brazil. METHODS: Statin susceptibility tests of Cryptococcus neoformans samples were performed as prescribed in standards. Interactions of simvastatin with amphotericin and fluconazole were evaluated using the checkerboard microdilution method. Presence of these interactions was quantitatively detected through determining the fractional inhibitory concentration index (FICI). RESULTS: Isolates of Cryptococcus neoformans were obtained from 30 of the 206 samples of dry bird excreta (14.5%) that were collected from pet shops and houses. Ten isolates were selected for susceptibility tests. All of them were susceptible to amphotericin and fluconazole. All presented minimum inhibitory concentration (MIC) > 128 µg/ml and, thus, were resistant in vitro to simvastatin. An in vitro synergic effect was shown through combined testing of amphotericin B and simvastatin, such that six isolates (60%) presented FICI < 0.500. Two isolates showed considerable reductions in MIC, from 1 µg/ml to 0.250 µg/ml. No synergic effect was observed through combining fluconazole and simvastatin. CONCLUSION: These results demonstrate that simvastatin should be considered to be a therapeutic alternative, capable of potentiating the action of amphotericin B. However, further studies are necessary to clarify the real effect of simvastatin as an antifungal agent.

Reduction in inequalities in health insurance coverage and healthcare utilization among older adults in the Philippines after mandatory national health insurance coverage: trend analysis for 2003-2017

BACKGROUND@#Health policies in the Philippines have evolved in response to increasing health demands of older adults. However, there is a lack of research on equity among the ageing population in low-middle income countries. The objective of this study was to identify the trends in National Health Insurance Program (NHIP) coverage and healthcare utilization among older adults in the Philippines for the period from 2003 to 2017, during which NHIP expansion policies were implemented, focusing on reductions in socio-economic inequalities.@*METHODS@#A literature search of policies for older adults and an analysis of four Philippine National Demographic and Health Surveys (2003, 2008, 2013, and 2017) with data from 25,217 older adults who were 60 years or older were performed. The major outcome variables were NHIP coverage, self-reported illness, outpatient healthcare utilization, and inpatient healthcare utilization. Inequalities in NHIP coverage and healthcare utilization according to wealth were evaluated by calculating the concentration index for individual years, followed by a regression-based decomposition analysis.@*RESULTS@#NHIP coverage among older adults increased from 9.4 (2003) to 87.6% (2017). Although inequalities according to wealth quintile were observed in all four surveys (all P < 0.001), the concentration index declined from 0.3000 (2003) to 0.0247 (2017), showing reduced inequalities in NHIP coverage over time as observed for self-reported illness and healthcare utilization. NHIP coverage expansion for older adults in 2014 enabled equal opportunity for access to healthcare.@*CONCLUSION@#The passage of mandatory NHIP coverage for older Filipino adults in 2014 was followed by a reduction in inequality in NHIP coverage and healthcare utilization according to wealth.

Research on equity and influencing factors of disability among Chinese middle-aged and old people / 北京大学学报(医学版)

OBJECTIVE@#To evaluate disability status and equity of the middle-aged and old population in China, and to explore the influencing factors contributing to the inequity of disability.@*METHODS@#This study was based on data collected from the first wave survey (2007-2010) of World Health Organization Study on Global Ageing and Adult Health (SAGE). Concentration index (CI) and concentration curve were calculated to measure the economic-related inequity of disability among the Chinese middle-aged and old people. The CI was further decomposed in which the attributions of social and individual determinants were calculated.@*RESULTS@#The mean score of the World Health Organization Disability Assessment Sche-dule (WHODAS) was 7.32 among the Chinese middle-aged and old people, 6.37 for males and 8.21 for females. The CI for the whole participants was -0.190 9, compared with -0.184 4 for the middle-aged and old men and -0.196 1 for the women. After decomposition of the CI, socioeconomic status contributed most to disability inequity among the Chinese middle-aged and old population. Financial status, educational level and work type contributed 66.41%, 16.45% and 13.10% respectively to inequity of disability. Individual lifestyle factors, including tobacco use, alcohol consumption and physical activities, contributed less to inequity of disability compared with social structural determinants.@*CONCLUSION@#There was inequity of disability among Chinese middle-aged and old population, and those with better financial status were less likely to suffer from functional disability. Middle-aged and old males were less disabled than females, and had less inequity of disability. Financial status, educational level and work type took the highest contribution to inequity of disability among Chinese middle-aged and old population, suggesting that promoting healthy lifestyles alone cannot effectively reduce the inequity of disability. The government needs to continually strengthen and improve appropriate social and medical protection measures on the basis of the importance it attaches to the health of the middle-aged and old population, and makes reducing health inequities a policy priority. The government should pay attention to the provision of healthcare and other resources in areas where development is relatively lagging and where there is a relative concentration of middle-aged and old population. Meanwhile, there should be more significant support for research on health status and equity among the middle-aged and old population to obtain more evidence for proactive responses to rapid population aging in China and policy development.

Effects Of Alpha-Mangostin And Citronella Oil Against Acne Causing Bacteria

Objective: This study assessed the effects of alpha-mangostin (AM) and citronella oil (CO) working alone or in combination against Propionibacterium acnes (P. acnes) and Staphylococcus aureus (S. aureus). Methods: The screening for antibacterial activity of AM and CO against P. acnes and S. aureus was carried out using the disk diffusion method. The minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of these two substances were determined using the broth microdilution method. The fractional inhibitory concentration indices (FICI) of a combination of AM and CO were obtained by checkerboard dilution assay. Results: The results showed that alpha-mangostin and citronella oil do indeed fight against P. acnes and S. aureus. The MICs and MBCs of AM against P. acnes and S. aureus were the same at 6.25 and 50 µg/ml, respectively. Both the MIC and the MBC of CO against P. acnes were 27.81µg/ml. The MIC and the MBC of CO against S. aureus were 112.13 and 224.25 µg/ml, respectively. The FICI of a combination of AM and CO against P. acnes and S. aureus were 2.00, indicating indifferent interaction with no additional inhibitory effect. Conclusion: AM and CO are very effective against P. acnes and S. aureus, nevertheless their effect when used together was indifferent from using alone. Further research may find that either or both of these substances combined with yet a different natural agent could provide synergy againstP. acnes and S. aureus.

An Analysis on the Determinants and Equity of the Postpartum Care Service Utilization / 보건행정학회지

BACKGROUND: This study aimed to analyze effects of postpartum care services to women after birth, identify the factors affecting their use, and examine the extent of income-related inequality in the postpartum care services utilization and expenditures using Korean Health Panel data between 2010 and 2013. METHODS: The panel data of the year 2010–2013 of the 247 women after birth were used. First, EuroQoL-5D was used to evaluate the effects of postpartum care service to women's quality of life. Second, multinominal logistic regression analysis was used to identify determinants of the use of the postpartum care services. Finally, concentration index and HIwv (horizontal equity) index were used to find that the concentration index for the inequality in the use of postpartum care services showed negative sign, which implied pro-rich. RESULTS: The estimation results showed that utilization of the postpartum services has a positive effect on women after birth. Also age, area of residence, and number of household members turn out to be the factors of using postpartum services. And there are inequality in the use of postpartum care services whose HIwv index showed positive sign, which implied pro-rich. CONCLUSION: Therefore, the government's policy of the postpartum care service is necessary to be expanded and diversified considering the personal characteristics and equity of the women after birth.

In Vitro Activities of Tigecycline in Combination with Imipenem Against Multi-drug Resistant and Pan-drug Resistant Acinetobacter Baumannii Isolates / 医药导报

Objective To evaluate the in vitro antimicrobial activity of tigecycline in combination with imipenem against multi-drug resistant and pan-drug resistant Acinetobacter baumannii isolates,so as to discuss the feasibility of drug combination and provide the basis for chnical rational use of antimicrobial agents.Methods Sixteen multi-drug resistant and pan-drug resistant Acinetobacter baumannii isolates were collected between January and April in 2015 from all kinds of infected specimens of Nanjing Drun Tower Hospital.The protocol was designed by checkerboard method,and the minimum inhibitory concentration (MIC) of antibiotics was determined by microdilution broth method,and the fractional inhibitory concentration (FIC) index was calculated according to MIC results.Results The average value of MIC (MICG),MIC50,MIC90 of tigecycline and imipenem single were 1.73,1,4 μg·mL-1and 31.00,32,64 μg·mL-1.When tigecycline was combined with imipenem,MICG,MIC50,MIC90 of tigecycline and imipenem were 0.24,0.25,0.50 μg·mL-1 and 8.16,8.00,16.00 μg·mL-1,respectively.Compared with the drug single use groups,MIC was significandy decreased in the drug combination group.In 6 strains (37.50％),synergy effect (FIC≤0.5) was observed,and in 10 strains (62.50％),additive effect (0.5 ＜ FIC ≤ 1) was found.No negative and independent effects were shown.Conclusion Both additive and synergistic action is observed when tigecyclineis combined with imipenem against multi-drug resistant and pan-drug resistant Acinetobacter baumannii isolates.No negative and independent effects are shown.This combination use against multi-drug resistant and pan-drug resistant Acinetobacter baumannii may be an effective therapy for clinical treatment.

Synergistic Antimicrobial Activity of Berberine Hydrochloride, Baicalein and Borneol against Candida albicans / 中草药·英文版

Objective To determine the synergistic effects of berberine hydrochloride, baicalein, and borneol in different combinations on Candida albicans. Methods The broth microdilution method was used to determine the minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) of the three agents, and the checkerboard method was simultaneously used to determine the MIC and fractional inhibitory concentration index (FICI) of the combination of three antimicrobial agents to study their extracorporeal effects. Results Berberine hydrochloride was the most potent inhibitor of C. albicans (MIC and MBC of 0.160 and 0.640 mg/mL), followed by borneol (MIC and MBC of 0.320 and 0.640 mg/mL) and baicalein (MIC and MBC of 1.28 and 20.48 mg/mL). Moreover, the antifungal effect of the combination was significantly stronger than that tested alone. Further in vivo study showed that the mortality rate of tainted mice reduced over 50% compared with the control group. Conclusion The results of experiments in vitro and in vivo indicate the synergistic effect of the combination of three antimicrobial agents on C. albicans, which can make reference for the future clinical treatment.

Decomposing Socioeconomic Inequality Determinants in Suicide Deaths in Iran: A Concentration Index Approach / 가정의학회지

BACKGROUND: It is recognized that socioeconomic status (SES) has a significant impact on health and wellbeing; however, the effect of SES on suicide is contested. This study explored the effect of SES in suicide deaths and decomposed inequality into its determinants to calculate relative contributions. METHODS: Through a cross-sectional study, 546 suicide deaths and 6,818 suicide attempts from January 1, 2010 to December 31, 2014 in Ilam Province, Western Iran were explored. Inequality was measured by the absolute concentration index (ACI) and decomposed contributions were identified. All analyses were performed using STATA ver. 11.2 (Stata Corp., College Station, TX, USA). RESULTS: The overall ACI for suicide deaths was −0.352 (95% confidence interval, −0.389 to −0.301). According to the results, 9.8% of socioeconomic inequality in suicide deaths was due to addiction in attempters. ACI ranged from −0.34 to −0.03 in 2010–2014, showing that inequality in suicide deaths declined over time. CONCLUSION: Findings showed suicide deaths were distributed among the study population unequally, and our results confirmed a gap between advantaged and disadvantaged attempters in terms of death. Socioeconomic inequalities in suicide deaths tended to diminish over time, as suicide attempts progressed in Ilam Province.

Evaluation on equalization of the essential public health services utilization based on Theil index and concen-tration index:evidence from Shandong province / 中华医院管理杂志

Objective To analyze and evaluate the level of equity of essential public health services utilization in Shandong Province.Methods The main methods in use were the concentration index(CI) aided by Theil index,to assess the equity among various items of essential public health services.Results The CI of healthcare archiving,health education,elderly health management,hypertension health management,diabetes management,maternal health management,vaccination and child health management utilization between different income groups were -0.01 9 2,-0.01 1 0,0.025 8,-0.008 0,-0.006 4,0.037 1,0.045 0 and 0.106 7 respectively.Theil index demonstrated the inequity in healthcare archiving and health management service utilization in Shandong resulted from regional differences.The inequity in elderly health management,hypertension health,diabetes management, vaccination and child health management utilization in Shandong resulted from urban and rural differences.The inequity in maternal health management utilization in Shandong resulted from urban and rural differences.Conclusions The utilization rate of essential public health services is different among the items,and its equity is influenced by the above-mentioned differences.

In Vitro Antibacterial Activity of Tanreqing Injection Combined with Cefuroxime Sodium Injection Against Staphylococcus Aureus / 医药导报

Objective To explore the in vitro antibacterial effect of tanreqing injection combined with cefuroxime sodium injection against staphylococcus aureus. Methods The MIC of tanreqing injection or cefuroxime sodium injection against staphylococcus aureus was detected by microamount dilution method.The antibacterial activity of tanreqing injection combined with cefuroxime sodium injection was determined by a chess board dilution method and assessed according to FIC index. Results The MIC of tanreqing injection and cefuroxime sodium injection against staphylococcus aureus was 1∶256 and 2 μg . mL-1 , respectively. While combined with each other, the MIC of tanreqing injection and cefuroxime sodium injection against staphylococcus aureus was 1∶4 096 and 0. 125 μg . mL-1 , respectively. The FIC index of tanreqing injection combined with cefuroxime sodium injection against staphylococcus aureus was 0. 125. Conclusion Tanreqing injection has a synergistic antibacterial effect against staphylococcus aureus when it was combined with cefuroxime sodium injection.

Antibacterial effect of crude methanol Carica papaya L. (papaya) extract and amoxicillin combination

Background: the emergence of multi-drug resistant bacteria and the diseases caused by them are a serious threat to global health necessitating an urgent need for new approaches to combat them. Synergy studies of conventional antimicrobial drugs and medicinal plants with antibacterial effects are important to establish whether it is prudent to recommend their concurrent administration to get successful treatments. Objective: evaluate the antibacterial effect resulting from the combination of Carica papaya (papaya) and amoxicillin. Methods: the papaya methanol extract was obtained from seeds and phytochemical screening was done. Checkerboard assay was used to determine the Minimum Inhibitory Concentration. Combined effect of both Carica papaya methanol extract and amoxicillin was determined by calculating the Fractional Inhibitory Concentration index. Strains of Staphylococcus aureus ATCC 25923 and Escherichia coli ATCC 25922 were used in the tests. Results: phenols and tannins were found in the Carica papaya seed methanol extract. The minimum inhibitory concentration of Carica papaya extract was 100 µg/mL for both microorganisms studied which was higher than the Minimum Inhibitory Concentration of amoxicillin being 3.12 µg/mL for Escherichia coli and 0.2 µg/mL for Staphylococcus aureus. The Fractional Inhibitory Concentration of the combination of drugs was 0.99 for Escherichia coli and 2.51 for Staphylococcus aureus. Conclusions: the antibacterial effect of Carica papaya extract may be attributed to the presence of phenolic compounds. There was no interaction between amoxicillin and Carica papaya extract on Staphylococcus aureus, but the antimicrobial activity against Escherichia coli of both drugs can be potentiated by their additive interaction(AU)

Introducción: la creciente multi-resistencia bacteriana y emergencia de enfermedades causadas por estas bacterias, constituyen un serio problema global, por lo que es importante y urgente el desarrollo de nuevas propuestas terapéuticas para combatirlas. Estudios sinérgicos sobre la combinación de antimicrobianos convencionales y plantas con efectos antibacterianos son importantes para determinar si es aconsejable la administración concomitante de los mismos. Objetivo: evaluar el efecto antibacteriano de la combinación de Carica papaya (papaya) y amoxicilina. Método: fueron usadas semillas de papaya para obtener el extracto alcohólico de papaya y realizado el estudio fitoquímico. La Concentración Mínima Inhibitoria fue determinada por el método del tablero de ajedrez. La Concentración Inhibitoria Fraccionada se calculó para medir el posible efecto sinérgico de la combinación entre el extracto alcohólico de Carica papaya y la amoxicilina. Cepas de Staphylococcus aureus ATCC 25923 y Escherichia coli ATCC 25922 fueron usadas. Resultados: en el extracto alcohólico de papaya fueron encontrados fenoles y taninos. La Concentración Mínima Inhibitoria del extracto de papaya coincidió para ambos microorganismos (100 µg/mL), la cual fue mayor que la Concentración Mínima Inhibitoria de la amoxicilina, siendo 3.125 µg/mL para Escherichia coli y 0.2 µg/mL para Staphylococcus aureus. La Concentración Inhibitoria Fraccionada de la combinación de drogas, fue 0.99 para Escherichia coli y 2.51 para Staphylococcus aureus. Conclusiones: los compuestos fenólicos presentes en el extracto de papaya pueden ser responsables de su efecto antimicrobiano. No existe interacción entre la amoxicilina y el extracto metanólico de papaya contra Staphylococcus aureus. Sin embargo, la actividad antomicrobiana contra Escherichia coli puede ser potenciada por su interacción aditiva(AU)

Impact of choice of living standard indicators on the equality index of health and health service utilization / 中国卫生政策研究

Objective:To evaluate outcomes and differences of the equality indexes of health and health service utilization in different living standard indicators. Methods: Using multi-phase stratified random sampling to select samples of rural families in Ningxia region and collect data about sample families' income, consumption, wealth and some relevant data on family members' health status and health services utilization. Using concentration index to measure the equality of health and health services utilization with income, consumption or wealth index as living standard indicators respectively and discuss the differences of the outcomes. Results:For different living standard in-dicators, the correlation between each other was weak. The differences of concentration indexes with different living standard indicators between 0. 01 to 0. 21 , and most of whichweresignificant on the level of 0. 05. Conclusion: The impact of choice of living standard indicators on the equality index of health and health service utilization was signifi-cant. In a limited area, living standards measured by wealth index could be more accurate and objective than by in-come or consumption, but the condition of this method wasmore strict.

Horizontal inequities in dental service utilization / 대한구강보건학회지

OBJECTIVES: Health inequity across social classes is closely associated with unequal healthcare utilization, and there have been sustained efforts to improve healthcare accessibility. Public healthcare insurance is one attempt to eliminate such health inequities. The purpose of this study was to examine a horizontal equity index for dental service utilization, which included diverse factors affecting health inequity, such as personal health and social context variables. METHODS: The 2008 to 2011 outpatient datasets of the Korean Healthcare Panel were analyzed. Zero-inflated negative binomial regression (ZINB) was conducted to estimate need-adjusted healthcare use with the following independent variables: health outcome (EQ-5D), chronic disease, and the Composite Deprivation Index. The concentration index and horizontal inequality index were calculated for the actual use of dental services and resource use-based dental visits. RESULTS: The ZINB regression analysis showed that age and personal health level on the EQ-5D were significant predictors, and the Composite Deprivation Index was influential. The concentration index for dental service utilization indicated that there was inequity favoring high-income brackets, but there was inequity favoring low-income groups when health level was taken into account. Overall, the horizontal equity index for dental service utilization estimated based on the two values was positive, meaning that there was inequity favoring high-income groups. CONCLUSIONS: The use of dental services has been steadily on the rise, and dental service accessibility and public healthcare coverage seem to have expanded. However, when the horizontal equity index for dental service utilization was estimated based on health level, there was inequity, with high-income groups making more use of dental services. Thus, equal access to dental services is not guaranteed, despite the adjustment for need. Methods of increasing dental service use in different income brackets must be carefully considered to remove disparities in the use of dental services.

Equity analysis of health resources allocation with the concentration index method for provinces in China / 中华医院管理杂志

Objective To analyze allocation of health resources and utilization of health services,and evaluate the equity of health resources allocation and health services utilization.Methods Concentration curve and concentration index(CI)were used to evaluate the equity of health resources allocation in terms of health professionals,hospital beds,medical institutions,outpatient visits and hospitalizations in China.Results The CI for health professionals,hospital beds,and medical institutions is 0.038,-0.012,and-0.116 respectively.That for outpatient visits and hospitalizations is 0.111 and -0.023 respectively.Conclusion Health resources allocation in hospital beds and health professionals is fair,while the equity of medical institutions and outpatient service utilization needs to be improved.

Trends of household income and dental care spending / 대한구강보건학회지

OBJECTIVES: This empirical study aimed to identify the differences in expenditures by household income level, as well as the patterns of dental care spending by dental services. METHODS: We analyzed the Korea Health Panel's data collected between 2008 and 2010. We calculated expenditures by service items by itemizing dental care services such as conservative, prosthetic, orthodontic, periodontal, surgical, preventive, dental implant care. Then we obtained the ratios of spending per item and per visit to overall out-of-pocket spending on dental care and used these as the weights for dental care cost allocation. Income quintiles were derived using the equivalence scale. Kakwani's concentration index was used to determine the degree of disparity by income quintile, and 95% confidence intervals were computed. RESULTS: Out-of-pocket expenditures on dental care steadily increased over time and income quintile. The analysis of dental care spending by income quintile revealed that the level of expenditure of the first income quintile was 3.6 times lower than that of the fifth income quintile. In terms of expenditure comparison between 2008 and 2010, the first quintile households showed an increased spending on prosthetic and periodontal treatments, whereas the fifth quintile households spent a relatively high proportion on orthodontic and dental implant care. The concentration index revealed that conservative services and root canal treatments was significant and positive, indicating that the demand for, and utilization of, these services increase as household income increases. In contrast, prosthetic services showed a significant negative trend, indicating that these services are not as common among those with higher incomes. CONCLUSIONS: To address the problems associated with the disparity in dental care expenditures based on income levels, it is necessary to establish policies that expand health insurance coverage and provide other supportive measures for low-income populations.

Health Equity and Health Performance of Urban Residents in China / 中国卫生经济

Objective: To analyze the status and general trend of urban residents’ health equity and health performance. Methods:Adopting standardization of concentration index, the extended concentration index and health performance index. Results: Chronic disease and self-assessed health of urban residents in China gradually improved from 2007 to 2011, while disability of those people did not improve significantly. Health inequity exists among urban residents with different incomes. Chronic disease and disability are inclined to the poor while self-assessed health is inclined to the rich, but the unfair degree has decreased gradually by year; the self-assessed health and the health performance of chronic disease has been improved from the comprehensive health level and equity, the disability sustains serious condition. Conclusion: China’s new health care reform does not significantly improve the domestic urban residents’ health equity and health performance, the objective set of the health care reform in China should pay more attention to health equity.