Assessment of equity in public health care financing in 2013

زمینه و هدف: تأمین مالی در نظام سلامت زمانی عادلانه خواهد بود که هزینه‌های مربوط به مراقبت‌های سلامت برای خانوارها برحسب توان پرداخت آن‌ها نه بر‌اساس خطر خود بیماری توزیع شده باشد. ﻫﺪف از اﻧﺠﺎم اﯾﻦ ﭘﮋوﻫﺶ ارزﯾﺎﺑﯽ عدالت در تأمین مالی مراقبت‌های دولتی سلامت براساس دو منبع اصلی تأمین مالی شامل پرداخت‌های مستقیم خانوارها برای ﻣﺮاﻗﺒﺖﻫﺎی دولتی و ﺗﻮزﯾﻊ بودجه دولتی ﻣﯽﺑﺎﺷﺪ. روش‌ بررسی: اﯾﻦ ﻣﻄﺎﻟﻌﻪ از ﻧﻮع ﺗﻮﺻﯿﻔﯽ- ﺗﺤﻠﯿلی اﺳﺖ. در این مطالعه از آﻣﺎرﻫﺎی ﺛﺒﺘﯽ وزارت بهداشت درمان و آموزش پزشکی و مرکز آمار ایران، در ﺳﺎل 1392 اﺳﺘﻔﺎده ﺷﺪه اﺳﺖ. ﻣﺘﻐﯿﺮﻫﺎی اﺻﻠﯽ ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﺷﺎﻣﻞ پرداخت‌های مستقیم خانوارها برای ﻣﺮاﻗﺒﺖﻫﺎی دولتی ﺳﻼﻣﺖ، ﺗﻮزﯾﻊ بودجه دولتی سلامت و درآمد خانوارها ﺑﻪ ﺗﻔﮑﯿﮏ اﺳﺘﺎنﻫﺎی ﮐﺸﻮر ﺑﻮده‌ اﺳﺖ. برای تحلیل داده‌ها و انجام محاسبات از نرم‌افزار Excel و شاخص‌های ضریب ‌جینی، شاخص‌ تمرکز و شاخص پیش‌رونده کاکوانی برای سنجش عدالت در تأمین مالی هزینه‌های سلامت استفاده شده است. یافته‌ها: در سال 1392، محاسبه شاخص ضریب جینی توزیع درآمد بین خانوارها، معادل 387/0 و شاخص تمرکز پرداخت‌های مستقیم خانوارها برای مراقبت‌های سلامت در استان‌های کشور معادل 056/0 به‌دست آمد. شاخص پیش‌رونده کاکوانی معادل 331/0-، شاخص تمرکز توزیع بودجه سلامت در استان‌های کشور معادل 05/0- و شاخص پیش‌رونده کاکوانی معادل 337/0- محاسبه گردید. نتیجه‌گیری: ارزیابی به عمل آمده براساس شاخص‌های ضریب جینی، شاخص تمرکز و شاخص پیش‌رونده کاکوانی نشان می‌دهد که توزیع بودجه دولتی سلامت در استان‌های کشور و پرداخت‌های مستقیم خانوارها برای مراقبت‌های دولتی سلامت براساس متغیر درآمد خانوارها، غیرعادلانه می‌باشد

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Islamic republic of Iran health system financing: Weak and strength points with a qualitative attitude

Regarding the importance of Health Financing system and since there are different studies with compliance attitude for submission a suitable pattern for any financial supply, it seems that there is an open space of betterment and change in this field. This study intends to collect and classify all views of specialists in the field of weak and strength points of State's Health Financing System with a new attitude and on a qualitative approach. This was a qualitative research applying 5-step framework analysis and thematic analysis in 2011. 15 managers and specializes selected through a purposive sampling with maximum variance, were deeply interveiwed until the saturation level Results revealed that there are five major themes out of content analysis of interviews in the field of strength points and nine major themes as the weaknesses of Health Financing system. In conclusion: It is possible to say that any pay attention to weak points of current health financing system and since most of mentioned shortages and limitations may cause a defective financial supplying system, therefore this may in itself cause a non-justice financing system as well. Any pay attention to this program may guarantee other guideline for removing the mentioned defects and changing of current system towards a justice and incremental financial system. © IDOSI Publications, 2013

IL-23 Gene Expression in PBMCs of Patients with Coronary Artery Disease

Objective: Both adaptive and innate immune systems are involved in coronary artery disease (CAD). The aim of this study was to evaluate TH17 cytokines expression profiles in un-stimulated peripheral blood lymphocytes (PBMCs) of patients with coronary artery disease. Methods: Expression profiles of IL-17, IL-23, and TGF-β1 were determined in individuals with and without CAD using Real-time PCR. Results: A significant decrease in IL-23 gene expression in un-stimulated PBMCs of patients with CAD compared to those without CAD was found (p=0.003, OR=0.045, 95% CI: 0.006–0.355). Conclusion: Our data reinforce the potential role of the IL-23 as a critical regulatory molecule that bridges the innate and adaptive arms of the immune system in the complex mechanisms associated with the development of atherosclerosis