Background: Demography, politics, economy, and governance appear to be the major structural factors for health and well-being. These factors have a significant role to play in achieving universal health coverage (UHC). The majority of previous studies did not highlight those factors. The aim of this study is to explore the basic structural factors (political stability, demography, gross national income, governance, and transparency) associated with a UHC index of low-and middle-income countries because for a long time there has be a stagnation achieving universal health coverage. Methodology: This study was a cross-sectional study applying multiple indices as variables. Low-and middle-income countries' selected indicators were the study variables. Data concerned the current political stability, sociodemographic status, gross national income (GNI), and governance status as independent variables and the UHC index of the countries as the dependent variable. Mean and standard deviations were used for the average values of the variables, a raw correlation was shown among variables and a hierarchical linear regression model was used for multi variate analysis. Results: Government health expenditure is 6% out of the total budget in upper middle countries (UMIC) and ∼5% in lower middle countries (LMIC) and low-income countries (LIC), population below poverty line is more than 2-fold higher in LIC in comparison with high income countries, UHC index, and socio-demographic index (SDI) index is similar in LMIC and LIC and slightly higher in UMIC. There is a positive association between government health expenditure, governance index, stability index, the SDI index, and GNI per capita and a negative association between populations below poverty line with UHC index. According to our full regression analysis model, governance, stability, and SDI index were associated with a significantly increased UHC index by 0.33, 0.41, and 0.57 (p < 0.05). Ranabhat et al. Structural Factors and UHC Conclusion: To achieve UHC, good governance, political stability, and demographic balance are prerequisites and addressing these factors would help to meet by 2030 across countries.

This study was performed to integrate the results of previous studies that investigated the relationship between body mass index (BMI) and prognosis in breast cancer. We reviewed the English literatures using the MEDLINE database from 1966 to 1999. The materials included 12 published articles with a total of 8,029 cases of breast cancer. The effect size was obtained from hazard ratio in each study. Homogeneity test was conducted before the integration of each effect size and the result demonstrated that the studies were heterogeneous. A random effect model was used to integrate the overall effect size. The integrated effect size was 1.56 (95% confidence interval, 1.22-2.00). In addition, publication bias should be accounted for because each published study was asymmetric in shape revealed by funnel plot. These results suggest that BMI have a prognostic significance in breast cancer. We believe that well-designed longitudinal studies, involving a large number of samples are required to resolve these issues.

ObjectiveWe wanted to review the usefulness of ultrasonography (US) for the diagnosis of appendicitis and to evaluate the diagnostic accuracy of US according to patients' and researchers' characteristics.Materials and MethodsThe relevant Korean articles published between 1985 and 2003 were included in this study if the patients had clinical symptoms of acute appendicitis. The histopathologic findings were the reference standard and the data were presented for 2×2 tables. Articles were excluded if patients had no sonographic signs of appendicitis according to graded-compression US. Two reviewers independently extracted the data on study characteristics. The Hasselblad method was used to obtain the combined estimates of sensitivity and specificity for the performance of US.ResultsTwenty-two articles (2,643 patients) fulfilled all inclusion criteria. The estimate of đ calculated by combining the sensitivity and specificity was 2.0054 (95% confidence interval [CI]: 1.8553, 2.1554) by a random effects model. The overall sensitivity and specificity (95% CI) were 86.7% (85.4 to 88.0), and 90.0% (88.9 to 91.2), respectively. According to the subgroup meta-analysis by patients' characteristics, the đ estimate (95% CI) of dominantly younger age, male, and highly clinical suggestive group for US was 2.2388 (1.8758 to 2.6019), 2.7131 (2.2493 to 3.1770), and 2.4582 (1.7387 to 3.1777), respectively. Also, according to subgroup meta-analysis by researchers' characteristics, the đ value (95% CI) for US done by diagnostic radiologists and gray-scale was 2.0195 (1.7942 to 2.2447) and 2.2630 (1.8444 to 2.6815).ConclusionThis evidence suggests that US may be useful for the diagnosis of acute appendicitis, especially when patients are younger age, male, and highly clinical suggestive.

The objective of this study was to identify the association of blood lead level (BLL) with mortality in inorganic lead-exposed workers of South Korea. A cohort was compiled comprising 81,067 inorganic lead exposed workers working between January 1, 2000, and December 31, 2004. This cohort was merged with the Korean National Statistical Office to follow-up for mortality between 2000 and 2008. After adjusting for age and other carcinogenic metal exposure, all-cause mortality (Relative risk [RR] 1.36, 95% confidence interval [CI] 1.03–1.79), digestive disease (RR 3.23, 95% CI 1.33–7.86), and intentional self-harm (RR 2.92, 95% CI 1.07–7.81) were statistically significantly higher in males with BLL >20 μg/dl than of those with BLL ≤10μg/dl. The RR of males with BLL of 10–20 μg/dl was statistically higher than of those with BLL ≤10μg/dl in infection (RR 3.73. 95% CI, 1.06–13.06). The RRs of females with 10–20 μg/dl BLL was statistically significantly greater than those with BLL <10μg/dl in all-cause mortality (RR 1.93, 95% CI 1.16–3.20) and colon and rectal cancer (RR 13.42, 95% CI 1.21–149.4). The RRs of females with BLL 10–20 μg/dl (RR 10.45, 95% CI 1.74–62.93) and BLL ≥20 μg/dl (RR 12.68, 95% CI 1.69–147.86) was statistically significantly increased in bronchus and lung cancer. The increased suicide of males with ≥20 μg/dl BLLs, which might be caused by major depression, might be associated with higher lead exposure. Also, increased bronchus and lung cancer mortality in female workers with higher BLL might be related to lead exposure considering low smoking rate in females. The kinds of BLL-associated mortality differed by gender.