Coping with the economic burden of Diabetes, TB and co-prevalence - Evidence from Bishkek, Kyrgyzstan

Background: The increasing number of patients co-affected with Diabetes and TB may place individuals with low socio-economic status at particular risk of persistent poverty. Kyrgyz health sector reforms aim at reducing this burden, with the provision of essential health services free at the point of use through a State-Guaranteed Benefit Package (SGBP). However, despite a declining trend in out-of-pocket expenditure, there is still a considerable funding gap in the SGBP. Using data from Bishkek, Kyrgyzstan, this study aims to explore how households cope with the economic burden of Diabetes, TB and co-prevalence. Methods: This study uses cross-sectional data collected in 2010 from Diabetes and TB patients in Bishkek, Kyrgyzstan. Quantitative questionnaires were administered to 309 individuals capturing information on patients' socioeconomic status and a range of coping strategies. Coarsened exact matching (CEM) is used to generate socio-economically balanced patient groups. Descriptive statistics and logistic regression are used for data analysis. Results: TB patients are much younger than Diabetes and co-affected patients. Old age affects not only the health of the patients, but also the patient's socio-economic context. TB patients are more likely to be employed and to have higher incomes while Diabetes patients are more likely to be retired. Co-affected patients, despite being in the same age group as Diabetes patients, are less likely to receive pensions but often earn income in informal arrangements. Out-of-pocket (OOP) payments are higher for Diabetes care than for TB care. Diabetes patients cope with the economic burden by using social welfare support. TB patients are most often in a position to draw on income or savings. Co-affected patients are less likely to receive social welfare support than Diabetes patients. Catastrophic health spending is more likely in Diabetes and co-affected patients than in TB patients. Conclusions: This study shows that while OOP are moderate for TB affected patients, there are severe consequences for Diabetes affected patients. As a result of the underfunding of the SGBP, Diabetes and co-affected patients are challenged by OOP. Especially those who belong to lower socio-economic groups are challenged in coping with the economic burden

Efeitos do uso da máscara para análise de gases sobre variáveis fisiológicas e perceptuais máximas e submáximas durante um teste incremental

This study aimed to determine the effects of using the mask to gas analysis on maximal and submaximal physiological and perceptual variables during an incremental test. We assessed 21 recreationally endurance trained runners (VO2max: 54.0 ± 7.6 mL·kg-1·min-1) aged 30 to 49 years. These runners were submitted to two different incremental tests in randomized order to determination of maximum aerobic velocity (MAV), being used in one of them the equipment to gas analysis and not in the other. Peak velocity (Vpeak) was determined based on KUIPERS et al.17 adjustment. It was also analyzed physiological (HR and %HRmax) and perceptual (RPE) variables in each stage to comparison between protocols. Runners did a 10 and 15 km performance in field track to verify the relationship with maximal aerobic speed obtained in both protocols. The use of the mask for gas analysis reduced Vpeak, but did not modify HRmax and RPEmax. In regard to submaximal variables, HR was influenced mainly in initial stages in which values were higher in the test which the mask was used. However, when expressed as %HRmax, runners remained in the majority of submaximal stages in higher percentages during the protocol with mask. For RPE, there was no significant difference, except in the stage of 10 km·h-1, which RPE was higher when the mask was used. MAV is reduced when mask is used to gas analysis and HR and %HRmax in submaximal stages are higher due to the use of this equipment especially in initial stages.Este estudo teve como objetivo determinar os efeitos do uso da máscara para análise de gases sobre variáveis fisiológicas e perceptuais máximas e submáximas durante um teste incremental. Foram avaliados 21 corredores recreacionais de “endurance” (VO2max: 54,0 ± 7,6 mL·kg-1·min-1) com idade entre 30 e 49 anos. Os mesmos foram submetidos a dois diferentes testes incrementais em ordem aleatória para determinação da MVA, sendo utilizado em um deles o equipamento para análises de gases e no outro não. A velocidade pico em esteira foi determinada com base no ajuste de KUIPERS et al.17. Foram também analisadas variáveis fisiológicas (FC e %FCmax) e perceptuais (PSE) a cada estágio para comparação entre os protocolos. Os corredores realizaram uma performance de 10 e 15 km em pista de atletismo para verificar a relação com a máxima velocidade aeróbia obtida nos dois testes. O uso da máscara para a análise de gases reduziu a Vpico, mas não modificou a FCmax e a PSEmax. Em relação às variáveis submáximas, a FC foi influenciada principalmente nos estágios iniciais em que os valores foram maiores no teste em que a análise de gases foi feita. Porém, quando expressa em %FCmax, os atletas permaneceram na maioria dos estágios submáximos em percentuais maiores durante o protocolo com o uso da máscara. Para a PSE, não houve diferenças significativas, com exceção do estágio a 10 km·h-1, em que a PSE foi maior quando se utilizou a máscara. A Vpico é reduzida devido à utilização da máscara para análise de gases e a FC e o %FCmax em estágios submáximos são maiores devido ao uso desse equipamento, especialmente nos estágios iniciais

Current status of boron neutron capture therapy of high grade gliomas and recurrent head and neck cancer

Boron neutron capture therapy (BNCT) is a biochemically targeted radiotherapy based on the nuclear capture and fission reactions that occur when non-radioactive boron-10, which is a constituent of natural elemental boron, is irradiated with low energy thermal neutrons to yield high linear energy transfer alpha particles and recoiling lithium-7 nuclei. Clinical interest in BNCT has focused primarily on the treatment of high grade gliomas, recurrent cancers of the head and neck region and either primary or metastatic melanoma. Neutron sources for BNCT currently have been limited to specially modified nuclear reactors, which are or until the recent Japanese natural disaster, were available in Japan, United States, Finland and several other European countries, Argentina and Taiwan. Accelerators producing epithermal neutron beams also could be used for BNCT and these are being developed in several countries. It is anticipated that the first Japanese accelerator will be available for therapeutic use in 2013. The major hurdle for the design and synthesis of boron delivery agents has been the requirement for selective tumor targeting to achieve boron concentrations in the range of 20 μg/g. This would be sufficient to deliver therapeutic doses of radiation with minimal normal tissue toxicity. Two boron drugs have been used clinically, a dihydroxyboryl derivative of phenylalanine, referred to as boronophenylalanine or “BPA”, and sodium borocaptate or “BSH” (Na2B12H11SH). In this report we will provide an overview of other boron delivery agents that currently are under evaluation, neutron sources in use or under development for BNCT, clinical dosimetry, treatment planning, and finally a summary of previous and on-going clinical studies for high grade gliomas and recurrent tumors of the head and neck region. Promising results have been obtained with both groups of patients but these outcomes must be more rigorously evaluated in larger, possibly randomized clinical trials. Finally, we will summarize the critical issues that must be addressed if BNCT is to become a more widely established clinical modality for the treatment of those malignancies for which there currently are no good treatment options.National Institutes of Health (U.S.)United States. Dept. of Energ