The World Health Report –Health systems Empowering Citizens and Improving Performance

Background: Oman is a Middle Eastern country bordering the Arabian Sea, Sea of Oman and the Persian Gulf. It has a population of about four million people, about 50% of whom are expatriates. The WHO report is the first international assessment of Oman’s health system (HS). More, the WHO report is the first-ever comprehensive assessment of the world’s health systems. Purpose of the study: To discuss the WHO report assessment of Oman’s health system. In addition, we will explore how a small country with relatively a young health system could, achieve such a high ranking where others with high financial capacity and well mature health system fail to achieve a goo ranking by the WHO standard. Methods: The study utilises WHO report that relies on the following major components: (1) goal attainment (effectiveness), (2) health expenditures per-capita, and (3) efficiency and the overall level of health performance. Its analysis identifies the key outcomes in terms of three main goals for HS: to improve health; to improve the responsiveness of the HS to people’s legitimate expectations of being treated with dignity and autonomy and due care; and to encourage, the third component, the HS to be fairly financed. Results: Oman was ranked highly by the WHO report. Its success is very impressive compared to many countries that are well advanced and have a better health finance system. WHO used five performance indicators to measure HS in 191 member states, it finds that France provides the best overall health care followed among major countries by Italy, Spain, Oman, Austria and Japan. Conclusions, brief summary and potential implications: This highly innovative study has been criticised for its choice of objectives and advocate a case for omitting the equity of financing from the list and replacing it with an index of access, both financial and geographical. The weights attached to the system objectives have not been validated. However, it is highly unlikely that a single set of weights or a single set of objectives can be obtained which are valid reflections of the aspirations of every country in the world. Key words: World Health Organization, health report, health system, Oman, health system, effectiveness, health expenditures, efficiency, health performance, dignity and autonomy

Cells of the synovium in rheumatoid arthritis. Dendritic cells

Dendritic cells are the major antigen-presenting and antigen-priming cells of the immune system. We review the antigen-presenting and proinflammatory roles played by dendritic cells in the initiation of rheumatoid arthritis (RA) and atherosclerosis, which complicates RA. Various signals that promote the activation of NF-κB and the secretion of TNF and IL-1 drive the maturation of dendritic cells to prime self-specific responses, and drive the perpetuation of synovial inflammation. These signals may include genetic factors, infection, cigarette smoking, immunostimulatory DNA and oxidized low-density lipoprotein, with major involvement of autoantibodies. We propose that the pathogenesis of RA and atherosclerosis is intimately linked, with the vascular disease of RA driven by similar and simultaneous triggers to NF-κB

Inflammation predicts accelerated brachial arterial wall changes in patients with recent-onset rheumatoid arthritis

Introduction Patients with recent-onset rheumatoid arthritis (RA) have impaired brachial artery endothelial function compared with controls matched for age, sex and cardiovascular risk factors. The present study examined endothelium-dependent (flow-mediated dilatation (FMD)) and independent (glyceryl trinitrate (GTN)-mediated dilatation (GMD)) structural responses in early RA patients, and determined progress over one year

Effect of different types of fibers on the microstructure and the mechanical behavior of Ultra-High Performance Fiber-Reinforced Concretes

International audienceThis study investigates the effect of adding different types of fibers on the microstructure and the mechanical behavior of cementitious composites, in particular on UHPC. These fibers were distinguished mainly by their differing nature (steel, mineral and synthetic), their dimensions (macroscopic or microscopic), and their mechanical properties. The microstructure of the specimens was examined by using SEM observation and by measuring the porosity, the intrinsic permeability and the P-wave velocity. The mechanical behavior under loading has been studied using a uni-axial compression test which combines the gas permeability and the acoustic emission (AE) measurement. This work focuses on the cracking process under mechanical loading. The experimental results show that the fiber has a relatively slight influence on the compressive strength and elastic modulus of concrete, except for the steel fiber which improves the strength because of its intrinsic rigidity. However, The addition of fiber significantly reduces the lateral strain at peak loading and increases the threshold of initial cracking (σk-ci) and that of unstable cracking (σk-pi). Therefore, the fibers clearly restrain the cracking process in concrete under the mechanic loadin

Effects of thermal damage on physical properties and cracking behavior of ultrahigh-performance fiber-reinforced concrete

International audienceIn this work, we study the impact of thermal damage on the physical and mechanical properties of ultrahigh-performance fiber-reinforced concrete (UHPFRC), especially on their cracking process under compressive loading. Four mixtures of UHPFRC were prepared using identical composition but reinforced with different types of fibers: mineral fibers (Steel or Wollastonite) or organic fibers (PP or PVA) and compared with that without fibers (UHPC). To induce a thermal damage on UHPFRC, the samples were subjected to temperatures ranging from 150 to 400 °C. After each degradation stage, the gas permeability and the P-wave velocity were measured. The mechanical behavior under loading has been studied using a uniaxial compression test which combines the gas permeability and the acoustic emission measurement. The results show that the melting of organic fibers at approximately 180 °C builds a tunnel across the cement paste and increases brutally the gas permeability. At 400 °C treatment, a decrease of compression strength by 30 % and of Young modulus by approximately 60 % was observed. However, we can see that the thermal damage results a decrease in the threshold of initial cracking (rk-ci) and that of unstable cracking (rk-pi), and this can be explained by the initiation of new cracks and their coalescence

Atherosclerotic disease is increased in recent-onset rheumatoid arthritis: a critical role for inflammation

Rheumatoid arthritis (RA) patients have increased mortality and morbidity as a result of cardiovascular and cerebrovascular disease. What is not clear, however, is either how early accelerated atherosclerosis begins in RA or how soon risk factors must be rigorously controlled. Furthermore, given the strong relationship of vascular disease to RA mortality and of inflammation to the accelerated atherosclerosis associated with RA, it is important to evaluate indices that could serially and noninvasively quantify atherosclerotic disease in RA patients. The carotid intima-media thickness (cIMT) and plaque, measured by ultrasound, correlate closely with direct measurement of the local and systemic atherosclerotic burden. To investigate the presence of subclinical atherosclerosis in the early stages of RA, the cIMT and plaque were measured using carotid duplex scanning in 40 RA patients with disease duration < 12 months and in 40 control subjects matched for age, sex and established cardiovascular risk factors. Patients with RA had significantly higher average cIMT values and more plaque than the control group (cIMT 0.64 ± 0.13 mm versus 0.58 ± 0.09 mm, respectively; P = 0.03). In RA patients, the cIMT was predicted by age and C-reactive protein level at first presentation to the clinic (R2 = 0.64). C-reactive protein was associated with age of disease onset and history of smoking. Since inflammation has been shown to predate onset of clinical RA, the accelerated atherogenic process related to inflammation may precede RA symptom onset

Durabilité d’un ciment composé à base de mâchefer de Tefereyre (Niger): absorption capillaire, porosité accessible à l’eau et attaque acide

In this study, we evaluate the durability characteristics of composite cement with coal bottom ash produced by SONICHAR (Société Nigérienne de Charbon). The study firstly consists in the determination of the pozzolanic activity index of the coal bottom ash and the optimum rate to use in the composite cement. Thereafter an evaluation of capillary absorption, porosity accessible to water and resistance to sulfuric and nitric acid attack of mortar prepared made with the composite cement is performed. The results showed that the coal bottom ash powder obtained by grinding can partially substitute Portland cement at a rate of 15% enable to develop a CEM II A composite cement according to EN 197-1 Standard.Dans la présente étude, nous évaluons les caractéristiques vis-à-vis de la durabilité d’un ciment composé à base de mâchefer de charbon produit par la SONICHAR (Société Nigérienne de production d’énergie à base de  charbon minéral). L’étude consiste d’abord en la détermination de l’indice d’activité pouzzolanique du mâchefer et du taux optimal à utiliser pour mettre en place un ciment composé. Par la suite une évaluation du taux d’absorption capillaire, de la porosité accessible à l’eau et à la résistance à l’attaque acide sulfurique et nitrique de mortier confectionné à base du ciment composé élaboré est effectuée. Les résultats montrent que la poudre de ce mâchefer obtenu par broyage peut substituer partiellement le ciment Portland à un taux de 15% permettant d’élaborer un ciment composé de type CEM II A selon la norme EN 197-1