Socio-demographic inequalities in satisfaction with primary health care and utilization of chosen doctors’ services: a cross-sectional study

Aim: The aim of the study was to examine socio-demographic inequalities in user satisfaction with PHC and utilization of chosen doctors’ services. Methods: This cross-sectional study was conducted in 2016 among 232 respondents who participated in PHC user satisfaction survey in PHC center Valjevo, Serbia. Inclusion criteria were an age of at least 20 years, sufficient skills of Serbian language to fill in questionnaires and consent to participation. Two hundreds and six patients completed an anonymous questionnaire about the user satisfaction with PHC. Results: The chosen doctor was seven times more often visited by the elderly (OR=7.03) and almost three times more often by the middle-aged (OR=2.66) compared to the youngest category of respondents. Those with low education and poor financial status of the household visited a doctor four (OR=4.14) and almost nine times (OR=8.66) more often, respectively, compared to those with high education and good socioeconomic status. A statistically significant higher level of PHC satisfaction was recorded in the rural population (p<0.001) and among respondents with poor socioeconomic status of the household (p=0.014). Conclusion: The chosen doctor was more frequently visited by respondents with low education and those with poor socioeconomic status of the household, while a higher degree of satisfaction with PHC was recorded in the rural population as well as in those with poor socioeconomic status of the household. &nbsp

Socio-demographic inequalities in satisfaction with primary health care and utilization of chosen doctors’ services: a cross-sectional study

Aim: The aim of the study was to examine socio-demographic inequalities in user satisfaction with PHC and utilization of chosen doctors’ services. Methods: This cross-sectional study was conducted in 2016 among 232 respondents who participated in PHC user satisfaction survey in PHC center Valjevo, Serbia. Inclusion criteria were an age of at least 20 years, sufficient skills of Serbian language to fill in questionnaires and consent to participation. Two hundreds and six patients completed an anonymous questionnaire about the user satisfaction with PHC. Results: The chosen doctor was seven times more often visited by the elderly (OR=7.03) and almost three times more often by the middle-aged (OR=2.66) compared to the youngest category of respondents. Those with low education and poor financial status of the household visited a doctor four (OR=4.14) and almost nine times (OR=8.66) more often, respectively, compared to those with high education and good socioeconomic status. A statistically significant higher level of PHC satisfaction was recorded in the rural population (p<0.001) and among respondents with poor socioeconomic status of the household (p=0.014). Conclusion: The chosen doctor was more frequently visited by respondents with low education and those with poor socioeconomic status of the household, while a higher degree of satisfaction with PHC was recorded in the rural population as well as in those with poor socioeconomic status of the household.   Conflicts of interest: None declared. &nbsp

Self formed Cu-W functionally graded material created via powder segregation

The aim of the present work is to develop a technique to produce continuously formed Cu-W functionally graded materials (FGMs) with adequate mechanical and electrical characteristics for application in extreme environmental conditions. For that purpose a novel process based on size segregation of W bimodal granular media (GM), composed of monomodal W agglomerates A1 (45-60µm) and A2 (200-250µm), has been applied. The study of compaction dynamics and related relaxation behavior of selected granular media have demonstrated that, under weak excitation and under controlled ambient condition, vibrated bimodal W GM segregates in a manner that a gradient in packing is self formed. During sintering, such a graded packing structure turns into a W preform with a gradient in porosity. Studied W GM fulfills both critical demands: i.e. size segregation and effective sintering process. The final Cu-W FGM has been produced by subsequent infiltration of molten Cu into W graded preform. Compaction dynamics of weakly excited W GM (frequency 600 Hz and acceleration 6 g) shows three distinguished stages. The first quasi linear stage is attributed to percolation. This process is controlled by an individual particle relaxation where inelastic collisions between particles dominate and it is effective for a moderate packing density. Through a transient stage, where critical slow down occurs, the system attains a steady state. The steady state stage is driven by collective relaxation of close packed particle clusters, where interparticle forces are of the primary importance. The compaction dynamics of studied W GM can be well predicted by Kohlrausch-Williams-Watts law. Size segregation of polymodal GM is a specific case of vibro-compaction, where collective nature is dominated by excitation level, particle size and friction force. In weakly excited GM, in regimes of geometrical segregation and geometrical segregation aided by convection motion, a gradient in packing can been self formed. Each of these regimes correspond to collective motion of the small agglomerates (A1), whereas the larger agglomerates (A2) play the role of an inert phase. It was shown that a gradient of packing represents the most effective random packing model. Sintering of the constitutive monomodal agglomerates (A1, A2) is strongly inhomogeneous with a statistical nature dependant on initial configuration of selected GM. The low temperature sintering (1400-1700 K) of monomodal W GM is controlled by simultaneous action of rearrangement process and grain boundary diffusion (GBD). A dominance of one of the processes is determined by initial agglomerate size and initial loose packing structure. Agglomerate / particle contact asymmetry and therefore induced transient / residual stresses cause the rearrangement process with the apparent activation energy of Ea~100 kJ/mol and Ea~80 kJ/mol for the agglomerates A1 and A2, respectively. Agglomerate mobility caused by agglomerate structure and polymodal porosity distribution result in viscose flow like regime in the available free volume of the porous W skeleton, similar to rearrangement in liquid phase sintering. Both mechanisms recognize that enhancement of densification can be achieved by improving the packing factor. Rearrangement process continues until a geometrical factor is exhausted, defined by the random close packing density limit, and makes a condition for GBD to be later operating. Sintering kinetics at higher temperature (1700-1950 K) revealed for both monomodal agglomerates important contribution to sintering coming from the action of GBD. Sintering kinetics of bimodal W GM is strongly influenced by a packing structure obtained during vibration. The packing structure evolves through three stages: 1) skeleton of smaller particles (percolation stage); 2) skeleton of larger particles (diffusion stage); and 3) graded structure (steady state). The self formed skeleton and graded structures exhibit different sintering behavior. Sintering kinetics of the skeleton type structure resembles the behavior of skeleton-forming powder. The sintering is controlled by a competition between rearrangement and GBD. Sintering of the W graded structure is similar to the sintering of the homogeneous mixture. Due to a improved packing density, the sintering of the graded structure dominantly controlled by GBD. After sintering the graded structure shows an increase in density of 10 % compared to corresponding percolation structure. The final Cu-W FGMs have been characterized by measurement of electrical resistivity and effective E-Modulus. The content of Cu and W-W contiguity are two features which determine the resistance for current flow and E-modulus of the studied materials. The higher W packing density in graded structure and correspondingly lower Cu content lead to poorer current flow, but higher E-modulus.Das Ziel der vorliegenden Arbeit besteht in der Entwicklung einer neuen Methode zur kontinuierlichen Herstellung funktioneller Cu-W Gradientenwerkstoffe (FGM) mit besonderen mechanischen und elektrischen Eigenschaften für Anwendungen unter extremen Umgebungsbedingungen. Zu diesem Zweck wurde ein neuer Prozess, der auf der Größensegregation granularer Medien beruht, eingesetzt. Ausgangspunkt waren bimodal verteilte granulare Medien bestehend aus Wolfram, die sich wiederum aus zwei verschiedenen Agglomeraten A1 (45-60 µm) und A2 (200-250 µm) zusammensetzen. Die grundlagenorientierte Studie der Kompaktierungsdynamik und dem damit zusammenhängenden Relaxationverhalten der genannten granularen Medien zeigt dass bei schwacher Anregung und unter kontrollieren Umgebungsbedingungen diese granularen Medien segregieren derart, dass sich selbstständig ein Gradient bildet. Während des Sintervorgangs wandelt sich eine solche Struktur in eine Wolfram-Vorform mit einem Porositätsgradienten um. Die untersuchten W bimodale granulare Medien erfüllen zwei wichtige Anforderungen: die Größensegregation und die Sinterfähigkeit. Der finale Cu-W-Gradientwerkstoff wird über eine nachträgliche Infiltration der zuvor hergestellten W-Vorform mit geschmolzenem Kupfer erzeugt. Die Kompaktierungsdynamik für schwach angeregte granulare Medien (Frequenz 600 Hz und Beschleunigung 6 g) zeigt drei unterschiedliche Stadien. Das erste nahezu lineare Stadium kann auf Perkolationsvorgänge zurückgeführt werden. Dieser Prozess wird durch eine individuelle Partikelrelaxation kontrolliert, wobei inelastische Stöße zwischen den Partikeln überwiegen. Daraus ergibt sich eine moderate Packungsdichte. Nach einem Übergangsbereich, in welchem eine kritische Verzögerung (critical slow down) auftritt, gelangt das System in einen stationären Zustand. Der stationäre Zustand wird dabei von einer kollektiven Relaxation dicht gepackter Partikelcluster gesteuert, wobei die Kräfte zwischen den Partikeln von entscheidender Bedeutung sind. Die Kompaktierungsdynamik der untersuchten Wolfram-Gradientenwerkstoffe kann sehr gut mit Hilfe eines erweiterten Exponentialgesetzes (Kohlrausch-Williams-Watts-Gesetz) beschrieben werden. Die Gültigkeit dieses Relaxationsgesetzes für bimodale Systeme wurde experimentell bestätigt. Größensegregation stellt einen spezifischen Fall der Vibro-Kompaktirung dar, mit einer kollektive Nature, die durch Anregungsniveau, Partikelgröße und Reibungskräfte gesteuert ist. Bei schwacher Anregung diese granulare Medien im Regime der geometrischen Segregation und der von einer Konvektionsbewegung unterstützten geometrischen Segregation bildet sich eine Gradientenpackung völlig selbständig. Jedes der genannten Regime entspricht der kollektiven Bewegung kleineren Agglomerate (A1), während die größeren Agglomerate (A2) eine inerte Phase darstellen. Es zeigt sich, dass das Modell der Gradientenpackung das effizienteste Modell für eine sich zufällig einstellende Packung repräsentiert. Während des Sintervorgangs, wandelt sich die Gradientenpackung in eine Wolfram-Vorform mit einem Porositätsgradienten um. Das Sinterverhalten der gründende (konstitutiven) monomodalen W Agglomeraten ist stark inhomogen und von statistischer Natur. Diese hängt entscheidend von der gewählten Ausgangskonfiguration der verwendeten granularen Medien ab. Das Sinterverhalten bei geringen Temperaturen (1400-1700 K) wird durch gleichzeitig auftretende Umordnungsprozesse und Korngrenzendiffusion (GBD) kontrolliert. Der dominierende Einfluss einer der beiden Prozesse ist abhängig von der anfänglichen Agglomeratgröße. Die Asymmetrie der Agglomerate / Partikelkontakte und infolge dessen die induzierten Eigenspannungen unterstützen die Umordnungsprozesse. Die Aktivierungsenergie liegt bei Ea ~100 kJ/mol für die Agglomerate A1 und bei Ea ~ 80 kJ/mol für die Agglomerate A2. Die Mobilität der Agglomerate in dem zur Verfügung stehenden freien Volumen der porösen Wolfram-Vorform aufgrund der Agglomeratstruktur mit polymodaler Porenverteilung, ruft in Analogie zum Flüssigphasensintern ein viskoses Fließen hervor. Die beiden Transportmechanismen lassen erkennen, dass eine Erhöhung der Verdichtung durch einen verbesserten Packungsfaktor erzielt werden kann. Die Umordnungsprozesse finden solange statt, bis der geometrische Faktor, welcher als obere Grenze für die Packungsdichte definiert ist, aufgebraucht ist. Dieser führt zu einem späteren Einsetzen der Korngrenzendiffusion. Bei höheren Temperaturen (1700-1950 K) wird das Sintern monomodaler Agglomerate lediglich durch die Korngrenzendiffusion bestimmt. Die Sinterkinetik bimodaler Agglomerate ist stark von der während der Vibration erzeugten Packungsstruktur abhängig. Die Einstellung der Packungsstruktur vollzieht sich in drei Stadien: 1) Bildung eines "Skeletts" bestehend aus kleineren Agglomeraten (Perkolationsstadium), 2) Entstehung eines Gerüstes aus größeren Agglomeraten (Diffusionstadium) und 3) Bildung einer Gradientenstruktur (stationärer Zustand). Das sich einstellende Gerüst und die Gradientenstruktur zeigen ein unterschiedliches Sinterverhalten. Die Sinterkinetik der Skelettstruktur ähnelt der eines skelettartigen Pulvers (skeleton-formed powder). Das Sintern wird durch die konkurrierenden Vorgänge in Form von Umordnungsprozessen und Korngrenzendiffusion gesteuert. Das Sinterverhalten der Gradientenstruktur ist mit dem einer homogenen Mischung vergleichbar. Aufgrund einer verbesserten Packungsdichte, wird das Sinterverhalten einer Gradientenstruktur wesentlich von Korngrenzendiffusion kontrolliert. Die gesinterte Gradientenstruktur zeigt im Vergleich zu der entsprechenden Perkolationstruktur eine um 10 % größere Dichte. Die hergestellten Cu-W Gradientenwerkstoffe wurden durch Messungen des elektrischen Widerstandes sowie des effektiven Elastizitätsmoduls näher charakterisiert. Es konnte dabei festgestellt werden, dass der Cu-Gehalt und die W-W Kontiguität zwei maßgebliche Faktoren hinsichtlich des elektrischen Widerstandes und des E-Moduls darstellen. Je höher die Packungsdichte des Wolframs in der Gradientenstruktur und entsprechend geringer der Cu-Gehalt ist, desto größer sind der elektrische Widerstand und der effektive E-Modul

Unge jenters påvirkning av retusjert reklame

Debatter i media og tidligere forskning den senere tid har gjenspeilet en bekymring for den offentlige markedsføringen i dagens samfunn. Det blir hevdet at markedsføringen har blitt preget av seksualisering og gjemte budskap bak retusjerte reklamer som man er bekymret for i unge jenters hverdag. Gjennom visuelle fremstillinger gis det signaler om hva som forventes om hvordan en skal se ut og det er spesielt motebransjen og dagens skjønnhetsideal som har fått kritikk. Markedsføring med retusjerte reklamebilder der modellene er blitt retusjert til syltynne, solbrune og halvnakne er eksempler på tendenser av reklamer i dagens samfunn. Eksponeringen for disse reklamekampanjene oppstår i alle sosiale medier og oppmerksomheten vekkes ved blant annet farger, vakre modeller og portrettets omgivelser som er appellerende for forbrukeren. Hvordan påvirker dette samfunnet? Og hvordan påvirker dette unge jenter og deres oppfattelse av bilde kontra virkeligheten? Dette handler om hvilket samfunn vi vil ha og hvilke verdier vi ønsker skal prege fremtidens generasjoner. Med dette som bakgrunn søker oppgaven å belyse påvirkningen av retusjert reklame og den visuelle fremstillingen av skjønnhetsideal mot barn og unge jenter i reklamer på markedet i dagens samfunn. Mer spesifikt har denne oppgaven handlet mye om Hennes og Mauritz sine kritiserte reklamekampanjer fra bikinisesongene 2011-2012 (se kilde, Buer 2012). Datakilden Hennes og Mauritz sine bikini reklamebilder ble valgt ut strategisk og hensiktsmessig for å analyseres i forhold til problemstillingen. Analysen tar for seg fire bilder og fem informanter. Den metodiske forskningen er tredelt. For å kartlegge den visuelle fremstillingen med materialet brukes en fokusgruppe for pretest. Disse er med på å velge ut bilder de som skal være med på å avdekke potensielle skjulte budskap i fremstillingen og analysen av materialet. Denne analysen undersøker bildene mer i dybden for å kartlegge tema nærmere rundt samhandling. Videre går analysen ut på en kvalitativ forskning hvor fem informanter blir intervjuet individuelt. Temaets emner i analysen går ut på påvirkning, skjønnhetsideal, retusjering av reklamer og dagens samfunn. I analysens siste del brukes en fokusgruppe som forsterkning av funnene i den kvalitative forskningen. Her analyseres hva informantene sier og hvordan deres holdninger er i forhold til intervjuene individuelt i den kvalitative forskningen. Funn i analysen viser at unge jenter blir ubevisst påvirket av retusjert reklame da de ikke er klar over hva som er retusjert og hvor mye de blir eksponert for dette uten å vite det selv. Dette fører til at de ikke ser eller forstår forskjellen på hva som er et retusjert eller fiktivt bilde kontra virkelighet og hva som er naturlig

Značaj i upotreba žita u ishrani riba

Proizvodnja hrane za ribe, poslednjih godina beleži najbrži rast u industrijskoj proizvodnji hrane za životinje (Jovanović i sar. 2006). Ukoliko sektor akvakulture nastavi sa dosadašnjim prosečnim rastom od 8-10% godišnje do 2025. godine, i proizvodnja hrane moraće da prati taj rast (Tacon,2010). Danas se u hranu za ribe uglavnom uključuju riblje brašno i riblje ulje zbog visoke nutritivne vrednosti. Zbog ograničenosti prirodnih resursa. nameće se potreba za značajnijim uključivanjem biljnih hraniva, pre svega žita u ishrani riba. Žita prvenstveno predstavljaju izvor energije i služe za prihranu riba, međutim, njihovom preradom mogu se dobiti koncentati proteina koji se mogu koristiti kao delimična zamena za proteine animalnog porekla. Žita kao energetska hraniva čine osnovni deo obroka u poluintenzivnom sistemu gajenja riba. Proteinski deo potreba obezbeđuje im fauna dna i zooplankton. U našoj zemlji kukuruz je najvažnije žito koja se koristi u ishrani životinja. Visok sadržaj skroba, srazmerno velika zastupljenost ulja i malo celuloze, čini kukuruz izrazito energetskim hranivom (Đorđević i Dinić, 2007). Kukuruz karakteriše nizak sadržaj proteina sa nepovoljnim aminokiselinskim sastavom. Protein kukuruza pretežno čini zein koji ima nisku nutritivnu vrednost, pre svega usled deficita lizina i triptofana. Proteini ječma su niske biološke vrednosti, ali nešto bolji u odnosu na proteine kukuruza (Perović, Janković et al.,2009). Siromašni su u lizinu i metioninu, mada su selekcijom dobijene sorte sa većim sadržajem lizina. U poređenju sa kukuruzom, po hranljivoj vrednosti, pšenica sadrži više proteina, a manje masti. Sadržaj proteina kod različitih sorata pšenice varira od 10-14% (Protić, Janković,1998). Proteini pšenice su siromašni lizinom, zatim metioninom, treoninom, leucinom i izoleucinom (Janković et al.,2008). Količina lizina, koji je prva limitirajuća aminokiselina, iznosi 0,3-0,37%. Tritikale je hibrid pšenice i raži, koji se zbog relativno visoke nutritivne vrednosti sve više se koristi u ishrani svih kategorija životinja, pa i riba. Tritikale sadrži 11-20% sirovih proteina. Sadržaj aminokiselina je sličan sadržaju aminokiselina pšenice. Najsavremeniju tehnološku operaciju u procesu proizvodnje hrane za ribe predstavlja proces ekstrudiranja. Ekstruzionim kuvanjem na principu «visoka temperatura-kratko vreme» postižu se veca svarljivosti skroba, veća nutritivna vrednost, plutanje ili sporo tonjenje sto omogucava vece učesće žita u hrani za ribe. (Jovanović et al.2006).. Žita kao komponente u kompletnim smešama za ribe u intenzivnom uzgoju imaju izuzetno veliki značaj, posebno u ishrani šarana koji značajan deo energetskih potreba može zadovoljiti iz skroba. Proteinska hraniva, uz dodatak sintetičkih aminokiselina dobijena preradom žita, poput kukuruznog, pšeničnog glutena, kao i proteina pirinča, u značajnoj meri mogu zameniti, riblje brašno kao najkvalitetnije hranivo u ishrani riba. Selekcijom i genetskim modofikacijama treba stvarati žita sa povoljnim nutritivnim svojstvima potrebnim za hranu za ribe

Erectile dysfunction as a predictor of two-year prognosis in acute myocardial infarction

  Background: Erectile dysfunction (ED) is a predictor or marker of coronary artery disease in patients at high risk of cardiovascular diseases. The aim of this study was to investigate the prevalence of ED in patients with acute myocardial infarction (AMI) and after 2 years of follow-up, and to determine the association between ED and the concentrations of the markers of inflammation, endothelial dysfunction and oxidative stress which were measured on the third day after hospital admission. Methods: The study included 80 patients aged 62.25 ± 10.47 years. The primary endpoints of interest were re-hospitalization due to cardiovascular causes and death during the 2 year period after hospital­ization. The Sexual Health Inventory for Men (SHIM) was assessed at the point of hospital discharge and 24 months thereafter. Results: 40.1% of patients had some degree of ED. The percentage of patients without ED increased (13.2%), while the percentage of patients with severe ED significantly decreased (14.7%) after 2 years. Patients with ED had significantly higher B-type natriuretic peptide (BNP) levels and decreased levels of nitric-oxide. During the 2 years of follow-up, 9 patients died (6.5% without ED, 68.6% with ED) (c2 = 7.19, p = 0.015). During the same time period, 22 (27.5%) patients were re-hospitalized due to cardiovascular causes, of whom 59.1% had ED at hospital admission (p < 0.05). Conclusions: Low levels of nitric-oxide were the best predictors of ED during AMI and after 2 years. ED predicted the worst outcomes of AMI: death and re-hospitalization. Lifestyle changes and nitric- -oxide donors could assist in the treatment of ED and in the improvement of long-term prognosis for AMI. (Cardiol J 2017; 24, 4: 393–402

TAP-1 indirectly regulates CD4+ T cell priming in Toxoplasma gondii infection by controlling NK cell IFN-γ production

To investigate if transporter associated with antigen processing (TAP)–1 is required for CD8+ T cell–mediated control of Toxoplasma gondii in vivo, we compared the resistance of TAP-1−/−, CD8−/−, and wild-type (WT) mice to infection with the parasite. Unexpectedly, TAP-1−/− mice displayed greater susceptibility than CD8−/−, β2-microglobulin−/− (β2m−/−), or WT mice to infection with an avirulent parasite strain. The decreased resistance of the TAP-1−/− mice correlated with a reduction in the frequency of activated (CD62Llow CD44hi) and interferon (IFN)-γ–producing CD4+ T cells. Interestingly, infected TAP-1−/− mice also showed reduced numbers of IFN-γ–producing natural killer (NK) cells relative to WT, CD8−/−, or β2m−/− mice, and after NK cell depletion both CD8−/− and WT mice succumbed to infection with the same kinetics as TAP-1−/− animals and displayed impaired CD4+ T cell IFN-γ responses. Moreover, adoptive transfer of NK cells obtained from IFN-γ+/+, but not IFN-γ−/−, animals restored the CD4+ T cell response of infected TAP-1−/− mice to normal levels. These results reveal a role for TAP-1 in the induction of IFN-γ–producing NK cells and demonstrate that NK cell licensing can influence host resistance to infection through its effect on cytokine production in addition to its role in cytotoxicity

Snus use and rejection in the USA

OBJECTIVE: To determine whether snus might become a strategy for reducing the harm associated with cigarette smoking in the USA as appears to be the case in Sweden, we examined receptivity to snus use in two cities with the greatest exposure to the major brands. METHODS: A dual frame, telephone survey and a brief mail survey were conducted in 2011 and 2012 in Indianapolis, Indiana and Dallas/Fort Worth Texas. Over 5000 adults completed surveys. Trial, ever use, current use and reasons for using or quitting snus after trial were measured. RESULTS: Among male smokers, 29.9% had ever tried snus (CI 22.7 to 38.1) and 4.2% were current users (CI 1.6 to 10.7). Among female smokers, 8.5% ever tried snus (CI 4.4 to 15.7) and current use was unknown. Current use was virtually absent among former smokers and never smokers. A major predictor of any level of snus use was current use of conventional smokeless tobacco. Those who tried and gave up snus cited curiosity (41.3%) and the fact that it was available at low or no cost (30%) as reasons for trial; reasons for not continuing included preferring another form of tobacco (75.1%) and disliking the mouth feel (34.6%). Almost all current snus users indicated that they were trying to cut down on cigarettes, but few (3.9%) were using it to quit smoking entirely. CONCLUSIONS: The low rate of adoption of snus suggests that neither the hopes nor the fears surrounding this new product are likely to be realised in the USA with the current marketing patterns