Ability to pay and equity in access to Italian and British National Health Services

Background: Equity in delivery and distribution of health care is an important determinant of health and a cornerstone in the long way to social justice. We performed a comparative analysis of the prevalence of Italian and British residents who have fully paid out-of-pocket for health services which they could have obtained free of charge or at a lower cost from their respective National Health Services. Methods: Cross-sectional study based on a standardized questionnaire survey carried out in autumn 2006 among two representative samples (n = 1000) of the general population aged 20-74 years in each of the two countries. Results: 78% (OR 19.9; 95% CI 15.5-25.6) of Italian residents have fully paid out-of-pocket for at least one access to health services in their lives, and 45% (OR 18.1; 95% CI 12.9-25.5) for more than five accesses. Considering only the last 2 years, 61% (OR 16.5; 95% CI 12.6-21.5) of Italians have fully paid out-of-pocket for at least one access. The corresponding pattern for British residents is 20 and 4% for lifelong prevalence, and 10% for the last 2 years. Conclusions: Opening the public health facilities to a privileged private access to all hospital physicians based on patient's ability to pay, as Italy does, could be a source of social inequality in access to care and could probably represent a major obstacle to decreasing waiting times for patients in the standard formal ‘free of charge' way of acces

Analysis of X-ray Structures of Matrix Metalloproteinases via Chaotic Map Clustering

<p>Abstract</p> <p>Background</p> <p>Matrix metalloproteinases (MMPs) are well-known biological targets implicated in tumour progression, homeostatic regulation, innate immunity, impaired delivery of pro-apoptotic ligands, and the release and cleavage of cell-surface receptors. With this in mind, the perception of the intimate relationships among diverse MMPs could be a solid basis for accelerated learning in designing new selective MMP inhibitors. In this regard, decrypting the latent molecular reasons in order to elucidate similarity among MMPs is a key challenge.</p> <p>Results</p> <p>We describe a pairwise variant of the non-parametric chaotic map clustering (CMC) algorithm and its application to 104 X-ray MMP structures. In this analysis electrostatic potentials are computed and used as input for the CMC algorithm. It was shown that differences between proteins reflect genuine variation of their electrostatic potentials. In addition, the analysis has been also extended to analyze the protein primary structures and the molecular shapes of the MMP co-crystallised ligands.</p> <p>Conclusions</p> <p>The CMC algorithm was shown to be a valuable tool in knowledge acquisition and transfer from MMP structures. Based on the variation of electrostatic potentials, CMC was successful in analysing the MMP target family landscape and different subsites. The first investigation resulted in rational figure interpretation of both domain organization as well as of substrate specificity classifications. The second made it possible to distinguish the MMP classes, demonstrating the high specificity of the S₁' pocket, to detect both the occurrence of punctual mutations of ionisable residues and different side-chain conformations that likely account for induced-fit phenomena. In addition, CMC demonstrated a potential comparable to the most popular UPGMA (Unweighted Pair Group Method with Arithmetic mean) method that, at present, represents a standard clustering bioinformatics approach. Interestingly, CMC and UPGMA resulted in closely comparable outcomes, but often CMC produced more informative and more easy interpretable dendrograms. Finally, CMC was successful for standard pairwise analysis (i.e., Smith-Waterman algorithm) of protein sequences and was used to convincingly explain the complementarity existing between the molecular shapes of the co-crystallised ligand molecules and the accessible MMP void volumes.</p

La suggestione e il suo ruolo nella clinica tra passato, presente e futuro

Neuroscience has offered confirmation that perception of reality does not correspond to reality. The mind is a very effective tool of falsification, because it builds "virtual scenarios" so persuasive that they are interpreted by human beings for "reality". It has been known since ancient times that words have power over reality and philosophical disciplines have often dealt with the relationship between language and reality. Suggestion is based on a particular form of communication, traditionally used in care, that includes a set of techniques for manipulating expectations and perceptions. In many human activities the suggestion reached a high level of complexity and has been widely applied; main areas are advertising, economic choice and political vote. For over a century, however, medicine, in search of scientific foundations, has neglected the role of suggestion in the clinical field. The authors illustrate some historical paths of suggestion in medical context and an overview of its presence, sometimes not recognized and not studied, in various areas of the current clinic practice.Da tempo si è iniziato a dubitare che il rapporto con la realtà sia oggettivo e unicamente centrato su aspetti logico-razionali. Le neuroscienze hanno offerto conferme al fatto che la percezione della realtà non corrisponda alla realtà. La mente è uno strumento di falsificazione molto efficace, perché costruisce “scenari virtuali” così persuasivi da essere scambiati dagli esseri umani per “realtà”. È noto fin dall’antichità che le parole hanno potere sulla realtà e le discipline filosofiche si sono occupate spesso del rapporto tra linguaggio e realtà. La suggestione può essere intesa come una particolare forma di comunicazione, tradizionalmente impiegata nella cura, che comprende un insieme di tecniche per manipolare aspettative e percezioni. In molte attività umane il tema della suggestione ha raggiunto un alto livello di elaborazione ed è stato diffusamente applicato; tra questi ambiti ricordiamo quello pubblicitario, della scelta economica e del voto politico. Da oltre un secolo la medicina, alla ricerca di fondamenti scientifici, ha però trascurato il ruolo della suggestione nei processi di cura. Gli autori illustrano alcuni percorsi storici della suggestione nella cura e una panoramica della sua presenza, talvolta non riconosciuta e non studiata, in vari ambiti della clinica attuale

Production of a yeast-free focaccia with reduced salt content using a selected Leuconostoc citreum strain and seawater

Abstract A biotechnological protocol to produce a focaccia (a typical Italian flat bread) without bakers' yeast addition and with reduced salt was developed, to meet the current needs of the consumer. Based on its leavening capability, the Leuconostoc citreum strain C2.27 was selected to be used as a starter instead of the baker's yeast and inoculated in a liquid sourdough (type-II) for the production of the "yeast-free" focaccia. The addition of different NaCl concentrations and the replacement of the salt with food grade seawater were evaluated, and the capability of the selected strain to affect technological, nutritional and sensory features of the focaccia investigated. A significant improvement of the nutritional characteristics of the focaccia was observed compared to the control (leavened with bakers' yeast and added with NaCl 1.5 g/100 g) using 0.7 g/100 g of salt in the form of NaCl or seawater. Besides the reduced Na content (66% lower than the control), focaccia with seawater also showed a higher content of Ca2+ and Mg2+ (ca. 36% and 53%, respectively), and the lowest predicted glycemic index compared to the other experimental focaccia

Phase diagram of QCD with four quark flavors at finite temperature and baryon density

We analyze the phase diagram of QCD with four staggered flavors in the (mu, T) plane using a method recently proposed by us. We explore the region T > 0.7 Tc and mu <1.4 Tc, where Tc is the transition temperature at zero baryon density, and find a first order transition line. Our results are quantitatively compatible with those obtained with the imaginary chemical potential approach and the double reweighting method, in the region where these approaches are reliable, T > 0.9 Tc and mu < Tc. But, in addition, our method allows us to extend the transition line to lower temperatures and higher chemical potentials.Comment: 14 pages, 8 figures. Comments and new data added. Version to be published in Nuclear Physics

Procalcific Phenotypic Drift of Circulating Progenitor Cells in Type 2 Diabetes with Coronary Artery Disease

Diabetes mellitus (DM) alters circulating progenitor cells relevant for the pathophysiology of coronary artery disease (CAD). While endothelial progenitor cells (EPCs) are reduced, there is no data on procalcific polarization of circulating progenitors, which may contribute to vascular calcification in these patients. In a cohort of 107 subjects with and without DM and CAD, we analyzed the pro-calcific versus endothelial differentiation status of circulating CD34+ progenitor cells. Endothelial commitment was determined by expression of VEGFR-2 (KDR) and pro-calcific polarization by expression of osteocalcin (OC) and bone alkaline phosphatase (BAP). We found that DM patients had significantly higher expression of OC and BAP on circulating CD34+ cells than control subjects, especially in the presence of CAD. In patients with DM and CAD, the ratio of OC/KDR, BAP/KDR, and OC+BAP/KDR was about 3-fold increased than in other groups. EPCs cultured from DM patients with CAD occasionally formed structures highly suggestive of calcified nodules, and the expression of osteogenic markers by EPCs from control subjects was significantly increased in response to the toll-like receptor agonist LPS. In conclusion, circulating progenitor cells of diabetic patients show a phenotypic drift toward a pro-calcific phenotype that may be driven by inflammatory signals

The Oral Dipeptidyl Peptidase-4 Inhibitor Sitagliptin Increases Circulating Endothelial Progenitor Cells in Patients With Type 2 Diabetes: Possible role of stromal-derived factor-1α

OBJECTIVE: Vasculoprotective endothelial progenitor cells (EPCs) are regulated by stromal-derived factor-1alpha (SDF-1alpha) and are reduced in type 2 diabetes. Because SDF-1alpha is a substrate of dipeptidyl-peptidase-4 (DPP-4), we investigated whether the DPP-4 inhibitor sitagliptin modulates EPC levels in type 2 diabetic patients. RESEARCH DESIGN AND METHODS: This was a controlled, nonrandomized clinical trial comparing 4-week sitagliptin (n = 16) versus no additional treatment (n = 16) in addition to metformin and/or secretagogues in type 2 diabetic patients. We determined circulating EPC levels and plasma concentrations of SDF-1alpha, monocyte chemoattractant protein-1 (MCP-1), vascular endothelial growth factor (VEGF), and nitrites/nitrates. RESULTS: There was no difference in clinical baseline data between the sitagliptin and control arms. After 4 weeks, as compared with control subjects, patients receiving sitagliptin showed a significant increase in EPCs and SDF-1alpha and a decrease in MCP-1. CONCLUSIONS: Sitagliptin increases circulating EPCs in type 2 diabetic patients with concomitant upregulation of SDF-1alpha. This ancillary effect of DPP-4 inhibition might have potential favorable cardiovascular implications

Time Course and Mechanisms of Circulating Progenitor Cell Reduction in the Natural History of Type 2 Diabetes

OBJECTIVE: Reduction of bone marrow-derived circulating progenitor cells has been proposed as a novel mechanism of cardiovascular disease in type 2 diabetes. The present study was designed to describe the extent and potential mechanisms of progenitor cell reduction during the natural history of type 2 diabetes. RESEARCH DESIGN AND METHODS: We identified 425 individuals, divided into seven categories according to carbohydrate metabolism status (normal glucose tolerance [NGT], impaired fasting glucose, impaired glucose tolerance [IGT], and newly diagnosed type 2 diabetes) and diabetes duration (0-9, 10-19, and >or=20 years). These categories were examined as ideally describing the natural history of type 2 diabetes development and progression. We measured CD34+ and CD34+KDR+ progenitor cells by flow cytometry. We also evaluated progenitor cells in 20 coupled bone marrow and peripheral blood samples and examined progenitor cell apoptosis in 34 subjects. RESULTS: In comparison to NGT, CD34+ cells were significantly reduced in IGT and had a first nadir in newly diagnosed type 2 diabetes and a second nadir after 20 years of diabetes. Statistical adjustment for possible confounders confirmed that CD34+ cell counts are deeply reduced at time of diagnosis, that they partially recover during the subsequent 0-19 years, and that they dip again after >or=20 years. A similar, but less consistent, trend was detected for CD34+KDR+ cells. Peripheral blood CD34+ cells were directly correlated with bone marrow CD34+ cells and inversely correlated with CD34+ cell apoptosis. CONCLUSIONS: Circulating progenitor cell reduction marks the clinical onset of type 2 diabetes. Both defective mobilization and increased apoptosis may account for this phenomenon. While a partial recovery occurs during subsequent years, bone marrow reserve seems exhausted in the long term