Health inequalities and development plans in Iran: An analysis of the past three decades (1984–2010)

Introduction: Reducing inequalities in health care is one of the main challenges in all countries. In Iran as in other oil-exporting upper middle income countries, we expected to witness fewer inequalities especially in the health sector with the increase in governmental revenues. Methods: This study presents an inequalities assessment of health care expenditures in Iran. We used data from the Household Income and Expenditure Survey (HIES) in Iran from 1984–2010. The analysis included 308,735 urban and 342,532 rural households. Results: The results suggest heightened inequality in health care expenditures in Iran over the past three decades, including an increase in the gap between urban and rural areas. Furthermore, inflation has affected the poor more than the rich. The Kakwani progressivity index in all years is positive, averaging 0.436 in rural and 0.470 in urban areas during the time period of analysis. Compared to inequality in income distribution over the last 30 years, health expenditures continuously show more inequality and progressivity over the same period of time. Conclusions: According to the result of our study, during this period Iran introduced four National Development Plans (NDPs); however, the NDPs failed to provide sustainable strategies for reducing inequalities in health care expenditures. Policies that protect vulnerable groups should be prioritized

Level and length of cyclic solar activity during the Maunder minimum as deduced from the active day statistics

The Maunder minimum (MM) of greatly reduced solar activity took place in 1645-1715, but the exact level of sunspot activity is uncertain as based, to a large extent, on historical generic statements of the absence of spots on the Sun. Here we aim, using a conservative approach, to assess the level and length of solar cycle during the Maunder minimum, on the basis of direct historical records by astronomers of that time. A database of the active and inactive days (days with and without recorded sunspots on the solar disc respectively) is constructed for three models of different levels of conservatism (loose ML, optimum MO and strict MS models) regarding generic no-spot records. We have used the active day fraction to estimate the group sunspot number during the MM. A clear cyclic variability is found throughout the MM with peaks at around 1655--1657, 1675, 1684 and 1705, and possibly 1666, with the active day fraction not exceeding 0.2, 0.3 or 0.4 during the core MM, for the three models. Estimated sunspot numbers are found very low in accordance with a grand minimum of solar activity. We have found, for the core MM (1650-1700), that: (1) A large fraction of no-spot records, corresponding to the solar meridian observations, may be unreliable in the conventional database. (2) The active day fraction remained low (below 0.3-0.4) throughout the MM, indicating the low level of sunspot activity. (3) The solar cycle appears clearly during the core MM. (4) The length of the solar cycle during the core MM appears $9\pm 1$ years, but there is an uncertainty in that. (5) The magnitude of the sunspot cycle during MM is assessed to be below 5-10 in sunspot numbers; A hypothesis of the high solar cycles during the MM is not confirmed.Comment: Accepted to Astron. Astrophy

Carers\u27 preferences for the delivery of therapy services for people with disability in rural Australia: Evidence from a discrete choice experiment

Background: The implementation of the Australian National Disability Insurance Scheme (NDIS) is expected to generate a responsive, person-centred system that will empower people with disability to choose the services and support they receive. However little attention has been paid to examine how users of the NDIS will choose and spend their individual budgets. This study aimed to determine quantitatively the relative importance that carers of people with a disability living in rural Australia place on different therapy service delivery characteristics. Methods: A stated preference discrete choice experiment (DCE) was incorporated into a survey of carers of people with disability living in rural Australia. Carers chose between therapy delivery services differing in attributes such as travel time to receive therapy, sector providing the service (i.e. Government, not-for-profit, private), out-of-pocket costs, person who delivers the therapy (therapist or other staff) and waiting time. Results: A total of 133 carers completed the DCE. The majority of respondents cared for a child with a disability (84%), the average age of the person they cared for was 17 years (SD 14.25). Participants expressed strong preferences for a short waiting time (0-3 months) to receive therapy services; services delivered by a therapist, no out of pocket cost and travelling up to 4 hours to receive a therapy session (p Conclusion: Carers of people with a disability in rural Australia exhibited strongest preferences for short waiting times (0-3 months). Therapy services that are delivered by therapy assistants or support workers will require careful introduction to achieve uptake and acceptability

Factors affecting retention of allied health professionals working with people with disability in rural New South Wales, Australia: discrete choice experiment questionnaire development

Objective: This paper describes the development of a discrete choice experiment (DCE) questionnaire to identify the factors (attributes) that allied health professionals (AHPs) working with people with disability identify as important to encouraging them to remain practising in rural areas. Methods: Focus groups and semi-structured interviews were conducted with 97 purposively selected service providers working with people with disability in rural New South Wales, Australia. Focus groups and interviews were digitally recorded, transcribed, and analysed using a modified grounded theory approach involving thematic analysis and constant comparison. Results: Six attributes that may influence AHPs working with people with disability in rural areas to continue to do so were inductively identified: travel arrangements, work flexibility, professional support, professional development, remuneration, and autonomy of practice. The qualitative research information was combined with a policy review to define these retention factors and ensure that they are amenable to policy changes. Conclusion: The use of various qualitative research methods allowed the development of a policy-relevant DCE questionnaire that was grounded in the experience of the target population (AHPs)

Friedel oscillations induced surface magnetic anisotropy

We present detailed numerical studies of the magnetic anisotropy energy of a magnetic impurity near the surface of metallic hosts (Au and Cu), that we describe in terms of a realistic tight-binding surface Green's function technique. We study the case when spin-orbit coupling originates from the d-band of the host material and we also investigate the case of a strong local spin-orbit coupling on the impurity itself. The splitting of the impurity's spin-states is calculated to leading order in the exchange interaction between the impurity and the host atoms using a diagrammatic Green's function technique. The magnetic anisotropy constant is an oscillating function of the separation d from the surface: it asymptotically decays as 1/d2 and its oscillation period is determined by the extremal vectors of the host's Fermi Surface. Our results clearly show that the host-induced magnetic anisotropy energy is by several orders of magnitude smaller than the anisotropy induced by the local mechanism, which provides sufficiently large anisotropy values to explain the size dependence of the Kondo resistance observed experimentally.Comment: 11 pages, 7 figures, submitted to PR

Should I stay or should I go? Exploring the job preferences of allied health professionals working with people with disability in rural Australia

Introduction: The uneven distribution of allied health professionals (AHPs) in rural and remote Australia and other countries is well documented. In Australia, like elsewhere, service delivery to rural and remote communities is complicated because relatively small numbers of clients are dispersed over large geographic areas. This uneven distribution of AHPs impacts significantly on the provision of services particularly in areas of special need such as mental health, aged care and disability services. Objective: This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapists, speech pathologists and psychologists – “therapists”) living in a rural area of Australia and working with people with disability, place on different job characteristics and how these may affect their retention. Methods: A cross-sectional survey was conducted using an online questionnaire distributed to AHPs working with people with disability in a rural area of Australia over a 3-month period. Information was sought about various aspects of the AHPs’ current job, and their workforce preferences were explored using a best–worst scaling discrete choice experiment (BWSDCE). Conditional logistic and latent class regression models were used to determine AHPs’ relative preferences for six different job attributes. Results: One hundred ninety-nine AHPs completed the survey; response rate was 51 %. Of those, 165 completed the BWSDCE task. For this group of AHPs, “high autonomy of practice” is the most valued attribute level, followed by “travel BWSDCE arrangements: one or less nights away per month”, “travel arrangements: two or three nights away per month” and “adequate access to professional development”. On the other hand, the least valued attribute levels were “travel arrangements: four or more nights per month”, “limited autonomy of practice” and “minimal access to professional development”. Except for “some job flexibility”, all other attributes had a statistical influence on AHPs’ job preference. Preferences differed according to age, marital status and having dependent children. Conclusions: This study allowed the identification of factors that contribute to AHPs’ employment decisions about staying and working in a rural area. This information can improve job designs in rural areas to increase retention

Spain and the crisis: housing prices, credit, and macroprudential policies

In this paper, we propose a two-country, two sector monetary union DSGE model with housing. One of the countries is calibrated to represent the Spanish economy while the other one is the rest of the European monetary union. First, we illustrate how looser credit conditions coming from the Euro area, together with increases in housing demand, lead to an increase in house prices and credit in Spain. Then, we analyze to what extent, macroprudential policies could have avoided the excess in credit that triggered the financial crisis in Spain. We find that a countercyclical loan-to-value rule that mainly responds to house prices would have mitigated the credit boom in Spain. These results can also be applied to other countries facing similar problems in the housing sector and thinking about implementing macroprudential policies

Acute febrile illness is associated with Rickettsia spp infection in dogs

BACKGROUND: Rickettsia conorii is transmitted by Rhipicephalus sanguineus ticks and causes Mediterranean Spotted Fever (MSF) in humans. Although dogs are considered the natural host of the vector, the clinical and epidemiological significance of R. conorii infection in dogs remains unclear. The aim of this prospective study was to investigate whether Rickettsia infection causes febrile illness in dogs living in areas endemic for human MSF. METHODS: Dogs from southern Italy with acute fever (n = 99) were compared with case–control dogs with normal body temperatures (n = 72). Serology and real-time PCR were performed for Rickettsia spp., Ehrlichia canis, Anaplasma phagocytophilum/A. platys and Leishmania infantum. Conventional PCR was performed for Babesia spp. and Hepatozoon spp. Acute and convalescent antibodies to R. conorii, E. canis and A. phagocytophilum were determined. RESULTS: The seroprevalence rates at first visit for R. conorii, E. canis, A. phagocytophilum and L. infantum were 44.8%, 48.5%, 37.8% and 17.6%, respectively. The seroconversion rates for R. conorii, E. canis and A. phagocytophilum were 20.7%, 14.3% and 8.8%, respectively. The molecular positive rates at first visit for Rickettsia spp., E. canis, A. phagocytophilum, A. platys, L. infantum, Babesia spp. and Hepatozoon spp. were 1.8%, 4.1%, 0%, 2.3%, 11.1%, 2.3% and 0.6%, respectively. Positive PCR for E. canis (7%), Rickettsia spp. (3%), Babesia spp. (4.0%) and Hepatozoon spp. (1.0%) were found only in febrile dogs. The DNA sequences obtained from Rickettsia and Babesia PCRs positive samples were 100% identical to the R. conorii and Babesia vogeli sequences in GenBank®, respectively. Febrile illness was statistically associated with acute and convalescent positive R. conorii antibodies, seroconversion to R. conorii, E. canis positive PCR, and positivity to any tick pathogen PCRs. Fourteen febrile dogs (31.8%) were diagnosed with Rickettsia spp. infection based on seroconversion and/or PCR while only six afebrile dogs (12.5%) seroconverted (P = 0.0248). The most common clinical findings of dogs with Rickettsia infection diagnosed by seroconversion and/or PCR were fever, myalgia, lameness, elevation of C-reactive protein, thrombocytopenia and hypoalbuminemia. CONCLUSIONS: This study demonstrates acute febrile illness associated with Rickettsia infection in dogs living in endemic areas of human MSF based on seroconversion alone or in combination with PCR