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The purpose of this paper is to highlight the range of cleaning practices and processes in 11 Australian hospitals and to discuss the challenges this variation poses to the implementation of clinical trials or changes to hospital cleaning practices.

In January 1999, a new institutional structure for Poland's health care system was laid out, instigated by the dramatic change in both the political and economic system. Following the dissolution of state socialism, private financing of health care services was encouraged to fill an important role in meeting rising consumer demand and to encourage a more efficient use of resources through competition and private initiative. However, from the outset of the intended transformations, systemic limitations to the privatization process hindered progression, resulting in varying rates of privatization amongst the distinct health care sectors. The aim of this paper is to describe the privatization process and to analyze its pace and differences in strategic approach in all major health care sectors.

This study investigates the effectiveness and cost of typical versus atypical antipsychotics in a nationwide German cohort of patients with schizophrenia. The study sample consisted of patients insured with 4 sickness funds (n = 8,610) who were followed up for 12 months after hospital discharge with a diagnosis of schizophrenia in 2003. Multivariate regression models were fitted to assess the relationship between outcome variables (rehospitalization, bed-days, prescriptions against adverse effects, cost) and medication type, sex, age, and severity. Severity was assessed by prior bed-days due to schizophrenia during 2000 to 2002. Risk of rehospitalization did not differ between groups but within each group severity (P= 0.0003). Males (P= 0.0016) and patients younger than 35 years (P< 0.0001) had a higher risk of rehospitalization. Number of bed-days was lower for treatment with typicals compared with atypicals (P< 0.0001); furthermore, bed-days depended on severity of disease (P< 0.0001). Prescriptions of drugs against extrapyramidal symptoms, anxiety, and agitation were higher for patients treated with typicals (P< 0.0001 for each). Mean predicted treatment cost per year was 6442 for atypicals versus ;4443 for typicals (P< 0.0001). This study does not support unconditional superiority of atypicals over typicals, neither in terms of effectiveness nor in terms of cost.

Abstract: Aim: The implementation of the Chinese New Rural Cooperative Medical Scheme (NRCMS) spread fast since a county pilot trial in 2003. The purpose of this survey is to guide policy-makers on how to improve the current national NRCMS policy. Subject and methods: Cross-sectional survey of 1,978 farmers in 50 villages in Huxian Shaanxi Province on their attitudes towards the NRCMS administered door-to-door in 2005. Results: Most farmers hold a positive attitude towards the NRCMS. However, they do not trust the scheme management. Farmers place more trust in village doctors rather than village cadres for fund collection. More than two thirds of farmers seek care in county hospitals directly, bypassing village clinics and township hospitals. Not all hospitals and doctors fully comply with the NRCMS rules, and supplier-induced demand is still widespread. More than half of farmers worry that the NRCMS is not sustainable. Importantly, the survey showed a high enrolment rate of 92% (95% CI, 91; 93) in a voluntary insurance scheme. Conclusion: A number of remedial actions in health financing, planning and management to counteract the identified issues are proposed.

Abstract: Background: After the fall of communism, Poland implemented one of the widest reaching programmes of socio-economic reforms. However, in comparison health system reforms were less radical. At the end of the 1990s a change process had been started, but the political fight for power has heavily influenced the health reforms and led to two different reform concepts being implemented over a period of a few years. Aim: The paper assesses the chances of implementation of the reform proposed in 2001 to recentralise health financing and organisation by replacing regional sickness funds by a National Health Fund. A hypothetical model is proposed which is placed at the start of the reforms and compares the model to the actual political course observed. Methods: PolicyMaker software was used for a political mapping analysis. The policy content (goals and mechanisms) was based on official political documents as well as verbal declarations made by key policymakers in the media, newspapers and magazines. Results: The analysis showed that the political situation was in favour of the government implementing a single National Health Fund. Nevertheless, this generated a strong resistance by the political opposition, experts and health care workers which could be a substantial obstacle for the realisation and effectiveness of the implemented model. The feasibility of the project could have been increased by implementing a number of strategies aimed at modifying the attitude of key stakeholders and by introducing the proposed reform as part of an overall improvement of the work environment for health professionals. Conclusions: The concept of a National Health Fund generated important opposition against the proposed changes in the health care system. With its majority in Parliament, the government was nevertheless able to establish the new system. The actual course of the reforms however contained a large number of formal errors, which led the Constitutional Court to rule the reform as unconstitutional. Substantial imperfection of the reform caused a destabilization of the whole health care system. In addition, defeat of the reform caused a decrease of electoral support for the governing coalition.

The Government of Egypt has embarked on a process of reforming health care financing in the country. Under the influence of external advisers it, has so far focused on social health insurance as the main funding mechanism. Other options, in particular tax-based financing, have hardly been considered. In this article, social health insurance and taxation-based financing are analysed on their ability to meet Egypt's stated health policy goals and their viability. Review of current health care financing arrangements in Egypt, of potential areas for improvement, and of stated health policy goals. Analysis of social health insurance and taxation-based financing on their ability to meet the stated policy goals and their viability. Although both funding mechanisms have distinct advantages and disadvantages when applied to the Egyptian health system, tax-based financing seems better able to meet the official policy goals of the Government of Egypt than social health insurance on grounds of efficiency, equity and technical feasibility. The Government of Egypt will have to raise public health expenditure substantially to finance care at an adequate level. Expanding and refining the present tax-based financing scheme, rather than switching to an insurance-based scheme seems the technically superior strategy. Other measures to improve the coordination of financing, such as the creation of a single fundholding agency, are needed as well as tighter regulation of private providers and the pharmaceutical market.

This prospective, open, video‐EEG‐controlled study examined the efficacy of lamotrigine (LTG) as add‐on and monotherapy in idiopathic generalized epilepsy (IGE). 47 patients received LTG either because of insufficient seizure control (n = 35) or serious side effects of prior antiepileptic drugs (AED). Long‐term video‐EEG recordings were performed before and after the introduction of LTG. The mean follow‐up time was 25.5 months. Of 12 patients with refractory childhood absence epilepsy, 9 became seizure free; in one child with absences with eyelid myoclonia, absence frequency was reduced > 50%; in 2 children with absences with a mild atonic component, seizure reduction was only transient. Of 12 patients with juvenile absence epilepsy, 10 became seizure‐free and, in 2, a > 50% reduction was obtained. In 15 patients with juvenile myoclonic epilepsy, complete seizure control was achieved in 7 patients, in 6 patients myoclonia persisted. In one patient generalized tonic‐clonic seizures also persisted and another patient developed a rash, LTG was therefore stopped. Of 5 patients with grand‐mal on awakening, 3 became seizure‐free, and a reduction of > 50% was obtained in one patient; LTG was stopped in one patient because of poor compliance. Three patients with pure photosensitive epilepsy became seizure‐free. At the end of the study, 11 patients were seizure‐free on LTG monotherapy, and in most other patients concomitant AED dosage could be substantially reduced. Lamotrigine was effective and well tolerated in patients with various IGE syndromes, although differences were observed between individual syndromes and seizure types.

There is increasing evidence that in Alzheimers disease nerve growth factor (NGF)protein and NGF mRNA content in post-mortemcortex is not decreased, but may evenbe elevated although the NGF-sensitive cholinergic basal forebrain neurons are preferentiallyaffected. However, only little is known about the early pathophysiological events leading toAlzheimers disease. We therefore measured the post-mortemNGF concentrations intemporal and frontal cortex of Alzheimers disease patients, non-demented controls withoutAlzheimers disease-related pathology, as well as non-demented patients with ßA4plaques who might be classified as preclinical cases. In the Alzheimers disease group we found upto 43% increase in NGF concentrations in the frontal and temporal cortex as compared to the twoother groups. In a subgroup analysis of the non-demented patients with plaques, NGFconcentrations were lower in the frontal cortex when ßA4 plaques were present (46% ofthe control temporal area) than in patients without evidence of frontal plaques (81% of the controltemporal area). This NGF decrease was paralleled to a similar decrease of cholineacetyltransferase activity, which is regulated by NGF in the cholinergic basal forebrain. Thesefindings support the hypothesis of lower cortical NGF content at the onset of plaque formationand of elevated NGF levels in the clinically manifest and neuropathologically advanced stage ofthe disease.

BackgroundWith the NHS facing one of its toughest periods financially, most, if not all, primary care trusts (PCTs) in England have started to prioritise services and sought to identify those that are either ineffective or of low clinical value for disinvestment. Although the notion of disinvestment (withdrawal of health services from an existing health-care service that is considered to deliver little or no health gain for its cost) has an obvious logic, since the practical implementation of disinvestment decisions has proven to be both controversial and problematic. The absence of a nationally accepted list of identified procedures has resulted in PCTs developing their own approaches, with many applying different priority thresholds to different procedures. This approach has created several so-called black lists of interventions that will either not be funded or their commissioning severely curtailed. With the uptake and diffusion of disinvestment decisions often affected by a range of social, financial, professional, and institutional factors rather than clinical evidence, a postcode lottery in provision has ensued across the UK. We aimed to develop an evidence-based approach towards disinvestment, which will be piloted across the UK southwest peninsula before a national roll-out.

Presents a letter to the editor in response to an article about fighting AIDS, "Help at last" in the November 29th issue.