Resource planning strategies for healthcare systems during a pandemic

We study resource planning strategies, including the integrated healthcare resources’ allocation and sharing as well as patients’ transfer, to improve the response of health systems to massive increases in demand during epidemics and pandemics. Our study considers various types of patients and resources to provide access to patient care with minimum capacity extension. Adding new resources takes time that most patients don't have during pandemics. The number of patients requiring scarce healthcare resources is uncertain and dependent on the speed of the pandemic's transmission through a region. We develop a multi-stage stochastic program to optimize various strategies for planning limited and necessary healthcare resources. We simulate uncertain parameters by deploying an agent-based continuous-time stochastic model, and then capture the uncertainty by a forward scenario tree construction approach. Finally, we propose a data-driven rolling horizon procedure to facilitate decision-making in real-time, which mitigates some critical limitations of stochastic programming approaches and makes the resulting strategies implementable in practice. We use two different case studies related to COVID-19 to examine our optimization and simulation tools by extensive computational results. The results highlight these strategies can significantly improve patient access to care during pandemics; their significance will vary under different situations. Our methodology is not limited to the presented setting and can be employed in other service industries where urgent access matters

Smokeless Tobacco Use in Iran: A Systematic Review

Background: Smokeless tobacco (ST) use is one of the most important public health problems in SoutheastAsia. The use of these substances increases the incidence of some cancers and other diseases. The purpose ofthis review study was to investigate on ST use in Iran.Methods: A literature search was conducted on PubMed, Google Scholar, and three national databases[Scientific Information Database (SID), IranMedex, and IranDoc] based on the standard search strategy.Findings: Most consumer people lived in Sistan and Baluchestan Province (Zahedan and Chabahar Cities)and Golestan Province, Iran. ST use rates ranged from 11.0% to 45.7% among college students in Sistan andBaluchestan (Zahedan and Chabahar) and Golestan. There are various types of ST consumed in Iran thathave been mentioned in various articles, including Pan, Gutka, Nass, Naswar, Biti, and Supari.Conclusion: Most studies on ST have been conducted in Sistan and Baluchestan and Golestan Provinces andwe need more research for other provinces. Consumption by women is a warning and a threat to women'shealth in the future. Further studies will be needed to find out more precisely the prevalence of consumptionin Iran

Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Funding: F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia, I.P. (FCT), in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; FCT/MCTES through the project UIDB/50006/2020. J Conde acknowledges the European Research Council Starting Grant (ERC-StG-2019-848325). V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006.proofepub_ahead_of_prin

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95$7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95$43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and$37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained

Investigating the effect of Diazinon poison on Sex hormone serum levels and Ovarian Follicle in Female Rats

Background & objective: Diazinon (DZN) as an environmental pollutant adversely effects reproductive system. This study was done to investigate the effect of DZN on sex hormone serum levels and ovarian histological changes in rats. Material & Methods: In this study, 40 female Wistar rats were randomly divided into four groups including experimental groups 1 and 2 that received 5 and 10 mg/kg diazinon intraperitoneally for 4 weeks respectively. The sham group received olive oil, and the control group received no injection. The animals were anesthetized while proestrus phase and blood samples were collected from the heart and the blood serum sex hormones were measured. by Radioimmunoassay (RIA) method. In addition, ovaries were removed and sections were prepared for histological studies. Data were analyzed using one-way ANOVA and Duncan test. Results: The results showed that the levels of estrogen and progesterone, number of corpus luteum, primordial, primary, growing, Graafian follicles and diameter of oocyte, corpus luteum, theca and granulosa thickness significantly decreased in the experimental groups compared to control group (p<0.001). Also, the number of atretic follicles in the experimental groups significantly increased com­pared to that of the control (p<0.001). Conclusion: The results indicated that diazinon causes changes in ovarian tissue and reduces the estrogen and progesterone hormones and can have adverse effects on oogenesis

Protective Effects of Eryngium Caucasicum Trautv Hydroalcholic Extract on Tricyclazole Induced Hepatotoxicity in Mice

Abstract Background: Eryngium caucasicum Trautv has antioxidant properties due to the presence of flavonoids and phenolic compounds. So, the present study was done to investigate the protective effects of Eryngium caucasicum Trautv extract on tricyclazole induced hepatotoxicity in mice. Materials and Methods: In this experimental study, 42 mice were divided into 6 groups including control, sham, tricyclazole (TCZ) and three experimental groups. The mice in the tricyclazole group, received 50 mg/kg TCZ via intraperitoneal injection and experimental groups 2, 3 and 4 received respectively 100,200and 400 mg/kg of extract via gavage for 4 weeks and 2 days per week. The sham group received only sterile water. At the end, serum levels of ALT, AST and ALP, serum concentration of albumin and total bilirubin were measured. Also, total phenolic compounds and flavonoids in the extract were measured. Data were analyzed by using ANOVA. Results: Tricyclazole increased serum levels of aminotransferase, phosphatase alkaline and total bilirubin and decreased serum concentration of albumin. But, treatment with extract decreased liver enzymes and bilirubin and increased levels of albumin (p<0.05). Amount of total phenolic compounds and the flavonoids were measured 91.16 mg/gr galicacid in extract and 84.48 mg/gr quercetin in extract, respectively. Conclusion: The results demonstrated that Eryngium caucasicum Trautv extract due to the presence of high phenolic compounds has protective effects on tricyclazole induced hepatotoxicity