Rebuilding human resources for health: a case study from Liberia

<p>Abstract</p> <p>Introduction</p> <p>Following twenty years of economic and social growth, Liberia's fourteen-year civil war destroyed its health system, with most of the health workforce leaving the country. Following the inauguration of the Sirleaf administration in 2006, the Ministry of Health & Social Welfare (MOHSW) has focused on rebuilding, with an emphasis on increasing the size and capacity of its human resources for health (HRH). Given resource constraints and the high maternal and neonatal mortality rates, MOHSW concentrated on its largest cadre of health workers: nurses.</p> <p>Case description</p> <p>Based on results from a post-war rapid assessment of health workers, facilities and community access, MOHSW developed the Emergency Human Resources (HR) Plan for 2007-2011. MOHSW established a central HR Unit and county-level HR officers and prioritized nursing cadres in order to quickly increase workforce numbers, improve equitable distribution of workers and enhance performance. Strategies included increasing and standardizing salaries to attract workers and prevent outflow to the private sector; mobilizing donor funds to improve management capacity and fund incentive packages in order to retain staff in hard to reach areas; reopening training institutions and providing scholarships to increase the pool of available workers.</p> <p>Discussion and evaluation</p> <p>MOHSW has increased the total number of clinical health workers from 1396 in 1998 to 4653 in 2010, 3394 of which are nurses and midwives. From 2006 to 2010, the number of nurses has more than doubled. Certified midwives and nurse aides also increased by 28% and 31% respectively. In 2010, the percentage of the clinical workforce made up by nurses and nurse aides increased to 73%. While the nursing cadre numbers are strong and demonstrate significant improvement since the creation of the Emergency HR Plan, equitable distribution, retention and performance management continue to be challenges.</p> <p>Conclusion</p> <p>This paper illustrates the process, successes, ongoing challenges and current strategies Liberia has used to increase and improve HRH since 2006, particularly the nursing workforce. The methods used here and lessons learned might be applied in other similar settings.</p

Conformational Altered p53 as an Early Marker of Oxidative Stress in Alzheimer's Disease

In order to study oxidative stress in peripheral cells of Alzheimer's disease (AD) patients, immortalized lymphocytes derived from two peculiar cohorts of patients, referring to early onset AD (EOSAD) and subjects harboured AD related mutation (ADmut), were used. Oxidative stress was evaluated measuring i) the typical oxidative markers, such as HNE Michel adducts, 3 Nitro-Tyrosine residues and protein carbonyl on protein extracts, ii) and the antioxidant capacity, following the enzymatic kinetic of superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione reductase (GRD). We found that the signs of oxidative stress, measured as oxidative marker levels, were evident only in ADmut but not in EOSAD patients. However, oxidative imbalance in EOSAD as well as ADmut lymphocytes was underlined by a reduced SOD activity and GRD activity in both pathological groups in comparison with cells derived from healthy subjects. Furthermore, a redox modulated p53 protein was found conformational altered in both EOSAD and ADmut B lymphocytes in comparison with control cells. This conformational altered p53 isoform, named “unfolded p53”, was recognized by the use of two specific conformational anti-p53 antibodies. Immunoprecipitation experiments, performed with the monoclonal antibodies PAb1620 (that recognizes p53wt) and PAb240 (that is direct towards unfolded p53), and followed by the immunoblotting with anti-4-hydroxynonenal (HNE) and anti- 3-nitrotyrosine (3NT) antibodies, showed a preferential increase of nitrated tyrosine residues in unfolded p53 isoform comparing to p53 wt protein, in both ADmut and EOSAD. In addition, a correlation between unfolded p53 and SOD activity was further found. Thus this study suggests that ROS/RNS contributed to change of p53 tertiary structure and that unfolded p53 can be considered as an early marker of oxidative imbalance in these patients

Occlusal Contact Changes in Patients Treated with Clear Aligners

Thesis (Master's)--University of Washington, 2022Introduction: Clear aligners are commonly used in orthodontic treatment to correct malocclusions and enhance smile esthetics. There is little quantitative data on how occlusal contacts are altered by clear aligners. This study uses digital intra-oral scans to evaluate how clear aligners affect occlusal contacts and to determine the influence of sex and age on contact changes. Results are compared to contact changes that occur during fixed appliance therapy. Methods: Patients included in this study were treated at the University of Washington orthodontic clinic between January 2017-August 2021 and in a local private practice between May 2016-February 2021. Inclusion criteria were a Class I malocclusion treated non-extraction with Invisalign and the presence of digital intra-oral scans obtained before treatment was initiated (T1) and post-treatment following debond (T2). Scans were imported into GOM Inspect Software (GOM Precise Industrial 3D Metrology, Braunschweig, Germany) and occlusal contacts were analyzed. Contacts studied ranged from 0-1.25 mm of space between maxillary and mandibular teeth and were grouped into five categories (tight, near, approximating, open, and no contacts). Analysis was done for the total contact area, anterior area, and posterior areas. The effect of age and sex on contact changes during clear aligner treatment was determined. Changes in occlusal contacts were compared to contact changes that occur during fixed appliance treatment using an existing dataset. Results: A total of 45 patients fit the eligibility criteria for this study. Clear aligners reduced the percentage of tight, near and approximating contacts while the percentage of open and no contacts increased. These changes in occlusal contacts were greater for the older age group studied. Sex influenced occlusal contact changes in the anterior dentition only where the decrease in near contacts and increase in open contacts was greater for males. These results for patients treated with clear aligners were similar to those for patients treated with fixed appliances; both treatment modalities reduce close occlusal contacts at the time active treatment is completed. Conclusions: Clear aligners reduce close contacts and increase open contacts. Overall contact changes during clear aligner treatment are influenced by age, and anterior contact changes are influenced by sex. Clear aligners and fixed appliances result in similar occlusal contact changes

Salivary mucins in host defense and disease prevention

Mucus forms a protective coating on wet epithelial surfaces throughout the body that houses the microbiota and plays a key role in host defense. Mucins, the primary structural components of mucus that creates its viscoelastic properties, are critical components of the gel layer that protect against invading pathogens. Altered mucin production has been implicated in diseases such as ulcerative colitis, asthma, and cystic fibrosis, which highlights the importance of mucins in maintaining homeostasis. Different types of mucins exist throughout the body in various locations such as the gastrointestinal tract, lungs, and female genital tract, but this review will focus on mucins in the oral cavity. Salivary mucin structure, localization within the oral cavity, and defense mechanisms will be discussed. These concepts will then be applied to present what is known about the protective function of mucins in oral diseases such as HIV/AIDS, oral candidiasis, and dental caries