Short and long-term relationship between physician density on infant mortality: a longitudinal econometric analysis

While countries with higher levels of human resources for health typically have better population health, the evidence that increases in the level of human resources for health leads to improvements in population health is limited. We provide estimates of short-run and long-term effects of physician density on infant mortality. We use a dynamic regression model that allows an estimation of both short- and long-run effects of physician density on infant mortality. We also used instrumental variables analysis to identify the causal effect of physician density on health. We estimate that increasing the number of physicians by one per 1,000 population decreases the infant mortality rate by 15% within five years and by 45% in the long-run. We find all countries are moving towards their own steady state at around 3% a year and are only half way there after 15 years. We conclude that the long-run effects of human resources for health are substantially larger than previously estimated. Our results suggest that health sector inputs can play a role in reducing infant mortality. However, meeting the Millennium Development Goal of reducing child mortality rate by two thirds from 1990 to 2015 would have required much earlier action.Physician density, infant mortality, longitudinal, eocnometric

Performance of electrophysiologic study in an asymptomatic patient with type 2 intermittent Brugada syndrome: To do or not to do

Background: Brugada syndrome (BrS) is an inherited channelopathy, which is associated with sudden cardiac death due to rapid polymorphic VT or VF. There is no definite consensus regarding the management of asymptomatic patients. Some experts advocate close follow-up; others propose the programmed stimulation for risk stratification. We aimed to evaluate the benefit of complete atrial and ventricular stimulation in patients with BrS and palpitation. Case Presentation: A 30-year-old man was admitted to our hospital because of a family history of sudden cardiac death (SCD) at age less than 45 years. He complained of self-terminated episodes of palpitation with no history of syncope. Baseline ECG showed incomplete right bundle branch block (RBBB) and saddle-back-like ST deviation in V1. Flecainide challenge test (FCT) revealed Brugada pattern. Complete EPS was done for evaluation of VT/VF inducibility and probable concomitant supraventricular arrhythmias. Programmed atrial stimulation showed inducible typical slow-fast AVNRT with AH jump 75 msec. Successful slow pathway ablation was done. There was no inducible ventricular arrhythmia. Conclusions: Patients with drug-induced BrS, positive family history of SCD and also episodes of palpitation, benefit from complete EPS. However, ICD implementation is not recommended in asymptomatic patients with drug-induced BrS and negative EPS for ventricular stimulation

Outcomes of the Botswana national HIV/AIDS treatment programme from 2002 to 2010: a longitudinal analysis

Background Short-term mortality rates among patients with HIV receiving antiretroviral therapy (ART) in sub- Saharan Africa are higher than those recorded in high-income countries, but systematic long-term comparisons have not been made because of the scarcity of available data. We analysed the eff ect of the implementation of Botswana’s national ART programme, known as Masa, from 2002 to 2010. Methods The Masa programme started on Jan 21, 2002. Patients who were eligible for ART according to national guidelines had their data collected prospectively through a clinical information system developed by the Botswana Ministry of Health. A dataset of all available electronic records for adults (≥18 years) who had enrolled by April 30, 2010, was extracted and sent to the study team. All data were anonymised before analysis. The primary outcome was mortality. To assess the eff ect of loss to follow-up, we did a series of sensitivity analyses assuming varying proportions of the population lost to follow-up to be dead. Findings We analysed the records of 126 263 patients, of whom 102 713 had documented initiation of ART. Median follow-up time was 35 months (IQR 14–56), with a median of eight follow-up visits (4–14). 15 270 patients were deemed lost to follow-up by the end of the study. 63% (78 866) of the study population were women; median age at baseline was 34 years for women (IQR 29–41) and 38 years for men (33–45). 10 230 (8%) deaths were documented during the 9 years of the study. Mortality was highest during the fi rst 3 months after treatment initiation at 12·8 deaths per 100 person-years (95% CI 12·4–13·2), but decreased to 1·16 deaths per 100 person-years (1·12–1·2) in the second year of treatment, and to 0·15 deaths per 100 person-years (0·09–0·25) over the next 7 years of follow-up. In each calendar year after the start of the Masa programme in 2002, average CD4 cell counts at enrolment increased (from 101 cells/μL [IQR 44–156] in 2002, to 191 cells/μL [115–239] in 2010). In each year, the proportion of the total enrolled population who died in that year decreased, from 63% (88 of 140) in 2002, to 0·8% (13 of 1599) in 2010. A sensitivity analysis assuming that 60% of the population lost to follow-up had died gave 3000 additional deaths, increasing overall mortality from 8% to 11–13%. Interpretation The Botswana national HIV/AIDS treatment programme reduced mortality among adults with HIV to levels much the same as in other low-income or middle-income countries

Insulin and insulin receptor gene polymorphisms and susceptibility to nonalcoholic fatty liver disease Insulina e polimorfismos do gene do receptor de insulina e a suscetibilidade à doença hepática gordurosa não alcoólica

Background � Nonalcoholic fatty liver disease (NAFLD) is an increasing global health concern defined by excessive hepatic fat content in the absence of excessive alcohol consumption. Objective � Given the pivotal role of insulin resistance in NAFLD, we hypothesized that insulin (INS) and insulin receptor (INSR) gene polymorphisms may be associated with NAFLD risk. Methods � A total of 312 subjects, including 153 cases with biopsy-proven NAFLD and 159 controls were enrolled in this case-control study. Four polymorphisms in INS (rs3842752, rs689) and INSR (rs1052371, rs1799817) genes were genotyped using PCR-RFLP method. Results � The cases with NAFLD were older and had higher BMI, systolic blood pressure, diastolic blood pressure, as well as higher serum levels of aspartate aminotransferase, alanine aminotransferase, and gamma glutamyl transferase than the controls (P<0.001). The �TT� genotype of INSR rs1799817 compared with �CC� genotype occurred more frequently in the controls than the cases with NAFLD and the difference remained significant after adjustment for confounding factors (P=0.018; OR=0.10, 95CI=0.02�0.76). However, no significant difference was found for INS rs3842752, INS rs689, and INSR rs1052371 gene polymorphisms between the cases with NAFLD and the controls either before or after adjustment for the confounders. Conclusion � These findings corroborate the hypothesis that genetic polymorphisms related to insulin resistance play a role in NAFLD susceptibility. Specifically, the INSR rs1799817 �TT� genotype had a protective effect for NAFLD. However, our results remain to be validated in other studies. © 2020, IBEPEGE - Inst. Bras. Estudos Pesquisas Gastroent. All rights reserved

Pregnancy outcomes and birth defects from an antiretroviral drug safety study of women in South Africa and Zambia

OBJECTIVE : To evaluate the safety of combination antiretroviral therapy (ART) in conception and pregnancy in different health systems. DESIGN : A pilot ART registry to measure the prevalence of birth defects and adverse pregnancy outcomes in South Africa and Zambia. METHODS : HIV-infected pregnant women on ART prior to conception were enrolled until delivery, and their infants were followed until 1 year old. RESULTS : Between October 2010 and April 2011, 600 women were enrolled. The median CD4þ cell count at study enrollment was lower in South Africa than Zambia (320 vs. 430 cells/ml; P<0.01). The most common antiretroviral drugs at the time of conception included stavudine, lamivudine, and nevirapine. There were 16 abortions (2.7%), 1 ectopic pregnancy (0.2%), 12 (2.0%) stillbirths, and 571 (95.2%) live infants. Deliveries were more often preterm (29.7 vs. 18.4%; P¼0.01) and the infants had lower birth weights (2900 vs. 2995 g; P¼0.11) in Zambia compared to South Africa. Thirty-six infants had birth defects: 13 major and 23 minor. There were more major anomalies detected in South Africa and more minor ones in Zambia. No neonatal deaths were attributed to congenital birth defects. CONCLUSIONS : An Africa-specific, multi-site antiretroviral drug safety registry for pregnant women is feasible. Different prevalence for preterm delivery, delivery mode, and birth defect types between women on preconception ART in South Africa and Zambia highlight the potential impact of health systems on pregnancy outcomes. As countries establish ART drug safety registries, documenting health facility limitations may be as essential as the specific ART details.President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreements U62/CCU123541, 3U2GGH000175–01W1, and 3U2GPS001421.http://www.lww.com/product/?0269-9370hb201

Pregnancy outcomes and birth defects from an antiretroviral drug safety study of women in South Africa and Zambia

To evaluate the safety of combination antiretroviral therapy (ART) in conception and pregnancy in different health systems

Effect of Micronutrient Supplementation on Disease Progression in Asymptomatic, Antiretroviral-Naive, HIV-Infected Adults in Botswana

IMPORTANCE Micronutrient deficiencies occur early in human immunodeficiency virus (HIV) infection, and supplementation with micronutrients may be beneficial; however, its effectiveness has not been investigated early in HIV disease among adults who are antiretroviral therapy (ART) naive. OBJECTIVE To investigate whether long-term micronutrient supplementation is effective and safe in delaying disease progression when implemented early in adults infected with HIV subtype C who are ART-naive. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of supplementation with either daily multivitamins (B vitamins and vitamins C and E), seleniumalone, or multivitamins with selenium vs placebo inafactorial design for 24 months. The study was conducted in 878 patients infected with HIV subtype C with a CD4 cell count greater than 350/μL who were not receiving ART at Princess Marina Hospital in Gaborone, Botswana, between December 2004 and July 2009. INTERVENTIONS Daily oral supplements of B vitamins and vitamins C and E, selenium alone, or multivitamins plus selenium, compared with placebo. MAIN OUTCOMES AND MEASURES Reaching a CD4 cell count less than 200/μL until May 2008; after this date, reaching a CD4 cell count of 250/μL or less, consistent with the standard of care in Botswana for initiation of ART at the time of the study. RESULTS There were 878 participants enrolled and randomized into the study. All participants were ART-naive throughout the study. In intent-to-treat analysis, participants receiving the combined supplement of multivitamins plus selenium had a significantly lower risk vs placebo of reaching CD4 cell count 250/μL or less (adjusted hazard ratio [HR], 0.46; 95% CI, 0.25-0.85; P = .01; absolute event rate [AER], 4.79/100 person-years; censoring rate, 0.92; 17 events; placebo AER, 9.22/100 person-years; censoring rate, 0.85; 32 events). Multivitamins plus selenium in a single supplement, vs placebo, also reduced the risk of secondary events of combined outcomes for disease progression (CD4 cell count ≤250/μL, AIDS-defining conditions, or AIDS-related death, whichever occurred earlier [adjusted HR, 0.56; 95% CI, 0.33-0.95; P = .03; AER, 6.48/100 person-years; censoring rate, 0.90; 23 events]). There was no effect of supplementation on HIV viral load. Multivitamins alone and selenium supplementation alone were not statistically different from placebo for any end point. Reported adverse events were adjudicated as unlikely to be related to the intervention, and there were no notable differences in incidence of HIV-related and health-related events among study groups. CONCLUSIONS AND RELEVANCE In ART-naive HIV-infected adults, 24-month supplementation with a single supplement containing multivitamins and selenium was safe and significantl

The effect of changes in health sector resources on infant mortality in the short-run and the long-run: A longitudinal econometric analysis

While countries with higher levels of human resources for health typically have better population health, the evidence that increases in the level of human resources for health leads to improvements in population health is limited. We use a dynamic regression model to obtain estimates of both the short-run and long-term effects of changes in physicians per capita, our measure of health system resources, on infant mortality. Using a dataset of 99 countries at 5-year intervals from 1960-2000, we estimate that increasing the number of physicians by one per 1000 population (roughly a doubling of current levels of provision) decreases the infant mortality rate by 15% within 5 years and by 45% in the long-run with half the long-run gain being achieved in 15 years. We conclude that the long-run effects of heath system resources are substantially larger than previously estimated. Our results suggest, however, that countries that have delayed action on the Millennium Development Goal of reducing infant and child mortality rate by two-thirds by 2015 (relative to 1990) may have difficulty meeting this goal even if they rapidly increase resources now.Health-related human resources Physician density Infant mortality Global

Welfare Cost of Inflation in Iran: A DOLS Approach

The purpose of this paper is to study the welfare cost of inflation in Iranian economy by using dynamic models. An increase in inflation rate makes individuals to increase their desired level of real balance which in turn leads to an increase in the transaction cost and a decrease in the resources allocated to production of consumption goods. This issue can be analysed as the welfare cost of inflation. To reach that end, we first estimate the money demand function. The estimation is based on cointegration and dynamic least square model (DOLS). The estimation of money demand function is done with the aim of extracting parameters of income and productivity elasticity, parameter of money demand sensitivity to inflation. This estimation has been carried out by applying both static and dynamic models. In the static model, for an inflation rate of 10 percent, the welfare cost of inflation as a portion of income is 36.5 and for a dynamic model, it is 35.4. The results indicate that the central bank policies which have led to a reduction in the rate of inflation have had sufficiently reduced the welfare costs of inflation and this inflation rate is close to its Friedman-Rule value