64 research outputs found
Health Policy and Systems Research in Twelve Eastern Mediterranean Countries: a stocktaking of production and gaps (2000-2008)
<p>Abstract</p> <p>Background</p> <p>The objectives of this study are to: (1) profile the production of Health Policy and Systems Research (HPSR) published between 2000 and 2008 in 12 countries in the Eastern Mediterranean Region (EMR): Bahrain, Egypt, Jordan, Lebanon, Libya, Morocco, Oman, Palestine, Sudan, Syria, Tunisia, and Yemen; (2) identify gaps; and (3) assess the extent to which existing HPSR produced in the region addresses regional priorities pertaining to Health Financing, Human Resources for Health and the Role of the Non-State Sector. This is the first stocktaking paper of HPSR production and gaps in the EMR.</p> <p>Methods</p> <p>Articles indexed on Medline between years 2000 and 2008 for the 12 study countries were selected. A MeSH term based search was conducted using country names. Articles were assessed using a coding sheet adapted for the region which included themes on: Governance Arrangements, Financial Arrangements, Delivery Arrangements, and Implementation Strategies. Identified articles were matched against regional research priorities to assess the extent to which research production aligns with priorities.</p> <p>Results</p> <p>A total of 1,487 articles (11.94%) fit the criteria in the coding sheet. Results showed an increase in HPSR production which peaked after 2005. Most identified articles focused on Delivery Arrangements (68.1%), and Implementation Strategies (24.4%). Most HPSR addressed priorities in Human Resources for Health (39%<b>)</b>, and some articles focused on Health Financing (12%) and Role of the Non-State Sector (6.1%).</p> <p>Conclusions</p> <p>Despite global calls for producing and translating HPSR into policy, there are still significant gaps in the EMR. More efforts are needed to produce HPSR and align production and translation with the demand for evidence by policymakers. Findings can help inform and direct future plans and activities for the Evidence Informed Policy Network- EMR, World Health Organization- EMR, and the Middle East and North Africa Health Policy Forum, in addition to being useful for countries that host or are planning to host KT platforms in the region.</p
Revealing Dissociable Attention Biases in Chronic Smokers Through an Individual-Differences Approach
Addiction is accompanied by attentional biases (AB), wherein drug-related cues grab attention
independently of their perceptual salience. AB have emerged in different flavours depending on
the experimental approach, and their clinical relevance is still debated. In chronic smokers we
sought evidence for dissociable attention abnormalities that may play distinct roles in the clinical
manifestations of the disorder. Fifty smokers performed a modified visual probe-task measuring two
forms of AB and their temporal dynamics, and data on their personality traits and smoking history/
status were collected. Two fully dissociable AB effects were found: A Global effect, reflecting the overall
impact of smoke cues on attention, and a Location-specific effect, indexing the impact of smoke cues
on visuospatial orienting. Importantly, the two effects could be neatly separated from one another
as they: (i) unfolded with dissimilar temporal dynamics, (ii) were accounted for by different sets of
predictors associated with personality traits and smoking history and (iii) were not correlated with one
another. Importantly, the relevance of each of these two components in the single individual depends
on a complex blend of personality traits and smoking habits, a result that future efforts addressing the
clinical relevance of addiction-related AB should take into careful consideration.This study was supported by funding provided by the University of Verona to CDL, CC and L
Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study
Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised
LH prevents cisplatin-induced apoptosis in oocytes and preserves female fertility in mouse
Premature ovarian failure and female infertility are frequent side effects of anticancer therapies, owing to the extreme sensitivity of the ovarian reserve oocytes to the damaging effects of irradiation and chemotherapy on DNA. We report here a robust protective effect of luteinizing hormone (LH) on the primordial follicle pool of prepubertal ovaries against the cisplatin (Cs)-induced apoptosis. In vitro LH treatment of prepubertal ovarian fragments generated anti-apoptotic signals by a subset of ovarian somatic cells expressing LH receptor (LHR) through cAMP/PKA and Akt pathways. Such signals, reducing the oocyte level of pro-apoptotic TAp63 protein and favoring the repair of the Cs-damaged DNA in the oocytes, prevented their apoptosis. Noteworthy, in vivo administration to prepubertal female mice of a single dose of LH together with Cs inhibited the depletion of the primordial follicle reserve caused by the drug and preserved their fertility in reproductive age, preventing significant alteration in the number of pregnancy and of delivered pups. In conclusion, these findings establish a novel ovoprotective role for LH and further support the very attracting prospective to use physiological 'fertoprotective' approaches for preventing premature infertility and risks linked to precocious menopause in young patients who survived cancer after chemotherapy
Raising the Bar: Improving Methodological Rigour in Cognitive Alcohol Research
Background and Aims: A range of experimental paradigms claim to measure the cognitive processes underpinning alcohol use, suggesting that heightened attentional bias, greater approach tendencies and reduced cue-specific inhibitory control are important drivers of consumption. This paper identifies methodological shortcomings within this broad domain of research and exemplifies them in studies focused specifically on alcohol-related attentional bias. Argument and analysis: We highlight five main methodological issues: (i) the use of inappropriately matched control stimuli; (ii) opacity of stimulus selection and validation procedures; (iii) a credence in noisy measures; (iv) a reliance on unreliable tasks; and (v) variability in design and analysis. This is evidenced through a review of alcohol-related attentional bias (64 empirical articles, 68 tasks), which reveals the following: only 53% of tasks use appropriately matched control stimuli; as few as 38% report their stimulus selection and 19% their validation procedures; less than 28% used indices capable of disambiguating attentional processes; 22% assess reliability; and under 2% of studies were pre-registered. Conclusions: Well-matched and validated experimental stimuli, the development of reliable cognitive tasks and explicit assessment of their psychometric properties, and careful consideration of behavioural indices and their analysis will improve the methodological rigour of cognitive alcohol research. Open science principles can facilitate replication and reproducibility in alcohol research
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
The Usefulness of Implicit Measures for the Screening, Assessment and Treatment of Problematic Alcohol Use in Individuals with Mild to Borderline Intellectual Disability
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
Alterations in Humoral Immunity After Partial Versus Total Tonsillectomy: A Pilot Study and Systematic Review of Literature
Background: The palatine tonsils are secondary lymphoid organs, important in sampling antigens directly from the epithelial surfaces. They produce antibodies locally and distally through their migrating B cells.
Objectives: The aim of this study was to compare the changes in serum and saliva immunoglobulin (Ig) levels after total vs. partial tonsillectomy and also to systematically review the literature regarding the changes in humoral immunity following tonsillar surgery.
Patients and Methods: Children with obstructive tonsils were recruited in a pilot study and randomized to undergo total or partial tonsillectomy. Blood and saliva samples were obtained immediately preoperatively and within 3 months postoperatively, to measure serum Ig (G, M and A) and saliva secretory IgA concentrations. Patients’ clinical history was reviewed at one year postoperatively. Systematic literature review regarding the effects of tonsillar surgery on humoral immunity was performed, using Medline, Embase and Cochrane.
Results: Nineteen patients completed the study (11 partial, 8 total). No statistically significant changes noted in the serum Ig’s level in both groups, except for IgM which increased (P = 0.018) after partial tonsillectomy, mainly in males (P = 0.04), and in those aged 5 years and older (P = 0.02). There was noticeable decrease in susceptibility to infections. Four out of 30 studies (406 out of 1796 patients) showed decrease in some elements of the humoral immunity or suspected a negative impact of tonsillectomy on the immune system.
Conclusions: Partial tonsillectomy does not seem to offer an immunological advantage over total tonsillectomy. The literature does not imply a significant negative impact of tonsillectomy on the humoral immune system
Cloning and molecular study of Aspergillus niger uric acid oxidase in Escherichia coli
Urate oxidase enzyme or uricase (UOX) is a uric acid metabolizing enzyme that exists in most terrestrial animals, except primates (including human). An elevation in uric acid levels in the blood leads to many health problems, such as gout, electrolyte disturbances, and renal failure. Recently, recombinant UOX has been approved by the FDA to be used as a therapeutic agent for the treatment of hyperuricemia and Tumor Lysis Syndrome (TLS). Moreover, it is used to manufacture diagnostic kits for enzymatic uric acid determination. In the present study, we cloned the UOX gene from Aspergillus niger. The open reading frame of an UOX of 906 bp, encoding a protein of 302 amino acids, was synthesized using previous data from Genbank and cloned in pET-15b. The predicted amino acid sequence was used as a template to screen orthologues from evolutionarily related organisms and to explore their phylogenetic relationships. The monomeric subunit secondary structure was constructed; the molecular weight from the predicted amino acid sequences was 34.0 kDa and the isoelectric point value (pI) was7.19. The recombinant enzyme was expressed in soluble form as a 6-Histidine N-terminal fusion protein in E. coli BL21 (DE3) and purified using Ni-NTA-agarose affinity column. The UOX enzyme showed good activity toward uric acid
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