Adding to official development assistance (ODA), private foundations have emerged as important donors to the global health agenda. Amid this increasing funder diversity and growing global health budgets, responsiveness to recipients' needs is a central concern. Merging datasets on ODA flows in 2005-2007, over 2,800 foundation grants, disease burden, and perceived priorities in 27 low-and middle-income countries, this study offers the first comprehensive national-level analysis of global health aid responsiveness. Our analysis shows that national patterns of disease burden explain neither public nor private aid flows during this period. While ODA committed during these years was weakly yet significantly correlated with health priorities, private grants' responsiveness was even weaker and did not achieve ODA significance levels either.

Social stigma is increasingly recognized as a cause of stress‐induced pathophysiology. We tested the hypothesis that stigma is associated with obesity‐related morbidity, using a cohort of subjects from the Dominican Republic who value fat bodies over thin ones. We surveyed 87 subjects from Batey Algodón—a small region in the Dominican Republic where obesity is not stigmatized. We obtained information on ideal body norms, perceptions of one's own body and self‐rated health. We also measured height, weight, waist circumference and blood pressure. We then performed linear regression analyses to ascertain the extent to which body mass index (BMI) and body norm perceptions were related to self‐rated health and blood pressure. Self‐rated health was strongly associated with one's satisfaction with his or her physical appearance (p < 0.001) and weight (p < 0.001). As expected, self‐rated health was not independently associated with BMI in this community, which does not stigmatize obesity. However, BMI was nevertheless associated with both systolic and diastolic blood pressure (p < 0.05). While de‐stigmatizing obesity may improve perceptions of health, it might not significantly reduce the incidence of hypertension among heavier persons. Copyright © 2008 John Wiley & Sons, Ltd.

POEM-GMV may be a useful approach in the treatment of pediatric obesity in an underserved community. There were statistically significantly improved outcomes in obesity, especially for boys. Significant improvement was observed in many lifestyle factors associated with obesity. Weight loss most closely correlated with reduced stress levels and sugary beverage consumption. Additional studies are needed to further evaluate the efficacy of POEM-GMV.

BackgroundAchieving better care at lower cost in the US healthcare safety net will require federally qualified health centres (FQHC) to implement new models of team-based population healthcare. Lean thinking may offer a way to reduce the financial risk of practice transformation while increasing the likelihood of sustained improvement.ObjectiveTo demonstrate system-level improvement in hypertension control in a large FQHC through the situational use of lean thinking and statistical process control.SettingLynn Community Health Center, the third largest FQHC in Massachusetts, USA.Participants4762 adult patients with a diagnosis of hypertension.InterventionFirst, we created an organisation-wide focus on hypertension. Second, we implemented a multicomponent hypertension care pathway. The lean tools of strategy deployment, standardised work, job instruction, Plan-Do-Study-Adjust, 5S and visual control were used to overcome specific obstacles in the implementation.MeasurementsThe primary outcome was hypertension control, defined as last measured blood pressure <140/90. Statistical process control was used to establish baseline performance and assess special cause variation resulting from the two-step intervention.ResultsHypertension control improved by 11.6% from a baseline of 66.8% to a 6 month average of 78.2%.LimitationsDurability of system changes has not been demonstrated beyond the 14-month period of the intervention. The observed improvement may underestimate the effect size of the full hypertension care pathway, as two of the five steps have only been partially implemented.ConclusionsSuccess factors included experienced improvement leaders, a focus on engaging front-line staff, the situational use of lean principles to make the work easier, better, faster and cheaper (in that order of emphasis), and the use of statistical process control to learn from variation. The challenge of transforming care delivery in the safety net warrants a closer look at the principles, relevance and potential impact of lean thinking in FQHCs.