Integration of suicide prevention program into primary health care network: A field clinical trial in Iran

Background: Suicide prevention is one of the priorities in policies of Iranian Ministry of Health and Medical Education (MHME). The suicide prevention program had two main parts of identifying and treatment of the depressed and suicide high risk individuals by Primary Health Care (PHC) network. The main aim of this study was to evaluate the results of integration of the program into PHC network in two cities with moderate to high rate of suicide with diverse socio-cultural backgrounds. Methods: This work as a field trial study was conducted in Nahavand and Savojbolagh from April 2010 to March 2011 (12 months). A screening tool was designed. Required capacities such as treatment, referral and registration system were provided six months before the main study. The intervention phase (for one year) including the treatment process and five consultation sessions was conducted to identify depressed people and individuals with high risk of suicide. The data were analyzed by Chi square test. Results: After one year of intervention, the rate of committing suicide became 4.98 and 3.36 per one hundred thousand population in Nahavand and Savojbolagh, respectively (16 and 1.6 per 100,000 in the year of before intervention respectively, 2009-2010). The female: male ratio of committing suicide was 2:1 in Nahavand and 1:1 in Savojbolagh. The most common method of committing suicide was drug intoxication in both cities. The identified cases by health workers at rural setting were 33 to 44 per 1000, in which 1.3 cases per 1000 population had been approved by general physicians. Conclusion: This study approved the feasibility and efficacy of integration of suicide prevention program into PHC. The increased rate of suicide in Savojbolagh could be related to low rate of screening and lack of treatment facilities (hospitalization and electroconvulsive therapy (ECT), and part-time psychiatrist. Increasing the PHC capacities could improve the health network efficiency to identify and manage depressed and at risk of suicide individuals. Screening tool/s and method have to be improved to provide better results

In-vivo time-dependent articular cartilage contact behavior of the tibiofemoral joint

SummaryObjectiveThe purpose of this study was to investigate the in-vivo time-dependent contact behavior of tibiofemoral cartilage of human subjects during the first 300s after applying a constant full body weight loading and determine whether there are differences in cartilage contact responses between the medial and lateral compartments.DesignSix healthy knees were investigated in this study. Each knee joint was subjected to full body weight loading and the in-vivo positions of the knee were captured by two orthogonal fluoroscopes during the first 300s after applying the load. Three-dimensional models of the knee were created from MR images and used to reproduce the in-vivo knee positions recorded by the fluoroscopes. The time-dependent contact behavior of the cartilage was represented using the peak cartilage contact deformation and the cartilage contact area as functions of time under the constant full body weight.ResultsBoth medial and lateral compartments showed a rapid increase in contact deformation and contact area during the first 20s of loading. After 50s of loading, the peak contact deformation values were 10.5±0.8% (medial) and 12.6±3.4% (lateral), and the contact areas were 223.9±14.8mm2 (medial) and 123.0±22.8mm2 (lateral). Thereafter, the peak cartilage contact deformation and contact area remained relatively constant. The respective changing rates of cartilage contact deformation were 1.4±0.9%/s (medial) and 3.1±2.5%/s (lateral); and of contact areas were 40.6±20.8mm2/s (medial) and 24.0±11.4mm2/s (lateral), at the first second of loading. Beyond 50s, both changing rates approached zero.ConclusionsThe peak cartilage contact deformation increased rapidly within the first 20s of loading and remained relatively constant after ∼50s of loading. The time-dependent response of cartilage contact behavior under constant full body weight loading was significantly different in the medial and lateral tibiofemoral compartments, with greater peak cartilage contact deformation on the lateral side and greater contact area on the medial side. These data can provide insight into normal in-vivo cartilage function and provide guidelines for the improvement of ex-vivo cartilage experiments and the validation of computational models that simulate human knee joint contact

Characterization of lung fibroblasts more than two decades after mustard gas exposure

Purpose: In patients with short-term exposure to the sulfur mustard gas, the delayed cellular effects on lungs have not been well understood yet. The lung pathology shows a dominant feature consistent with obliterative bronchiolitis, in which fibroblasts play a central role. This study aims to characterize alterations to lung fibroblasts, at the cellular level, in patients with delayed respiratory complications after short-term exposure to the sulfur mustard gas. Methods: Fibroblasts were isolated from the transbronchial biopsies of patients with documented history of exposure to single high-dose sulfur mustard during 1985-7 and compared with the fibroblasts of control subjects. Results: Compared with controls, patients' fibroblasts were thinner and shorter, and showed a higher population doubling level, migration capacity and number of filopodia. Sulfur mustard decreased the in vitro viability of fibroblasts and increased their sensitivity to induction of apoptosis, but did not change the rate of spontaneous apoptosis. In addition, higher expression of alpha smooth muscle actin showed that the lung's microenvironment in these patients is permissive for myofibroblastic differentiation. Conclusions: These findings suggest that in patients under the study, the delayed pulmonary complications of sulfur mustard should be considered as a unique pathology, which might need a specific management by manipulation of cellular components. © 2015 Pirzad Jahromi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Variable-range hopping in quasi-one-dimensional electron crystals

We study the effect of impurities on the ground state and the low-temperature dc transport in a 1D chain and quasi-1D systems of many parallel chains. We assume that strong interactions impose a short-range periodicicity of the electron positions. The long-range order of such an electron crystal (or equivalently, a $4 k_F$ charge-density wave) is destroyed by impurities. The 3D array of chains behaves differently at large and at small impurity concentrations $N$. At large $N$, impurities divide the chains into metallic rods. The low-temperature conductivity is due to the variable-range hopping of electrons between the rods. It obeys the Efros-Shklovskii (ES) law and increases exponentially as $N$ decreases. When $N$ is small, the metallic-rod picture of the ground state survives only in the form of rare clusters of atypically short rods. They are the source of low-energy charge excitations. In the bulk the charge excitations are gapped and the electron crystal is pinned collectively. A strongly anisotropic screening of the Coulomb potential produces an unconventional linear in energy Coulomb gap and a new law of the variable-range hopping $-\ln\sigma \sim (T_1 / T)^{2/5}$. $T_1$ remains constant over a finite range of impurity concentrations. At smaller $N$ the 2/5-law is replaced by the Mott law, where the conductivity gets suppressed as $N$ goes down. Thus, the overall dependence of $\sigma$ on $N$ is nonmonotonic. In 1D, the granular-rod picture and the ES apply at all $N$. The conductivity decreases exponentially with $N$. Our theory provides a qualitative explanation for the transport in organic charge-density wave compounds.Comment: 20 pages, 7 figures. (v1) The abstract is abridged to 24 lines. For the full abstract, see the manuscript (v2) several changes in presentation per referee's comments. No change in result

Study on the possibility of producing low-fat spread using gelatin extracted from cultured carp wastes

By-products consist of more than half of the total weight of fish. Most part of these wastes made from connective tissue proteins that provide good potential to produce gelatin. Nowadays, consumers are more health conscious and have responded to the call for a diet that contains low calorie and low fat. This work involved the characterization of a low-fat spread made of fish gelatin as gelling agent, emulsifier and fat replacer. Six treatments with Fish gelatin (FG) to pectin ratio 1:1 and 2:1, with pectin concentration of 1, 2 and 3%, were produced and evaluated for quality changes and storage-life at refrigerated storage. The results showed that prepared emulsions were physically stable and no phase separation observed during 8 wks. The pH of treatments was 4.5 to 4.9. The moisture content of treatments varied from 68.9% for T1 (FG/pectin ratio 1:1) to 65.4% for T6 (FG/pectin ratio 6:3). The Max. lipid of samples was measured 28.4%. Max. and min. protein of samples were 3.8% for T6 and 1.6% for T2 (FG/pectin ratio 2:1), respectively. No significant differences (p≥0.05) were observed between ash content of all treatments and control (commercial margarin). The acidity of treatments increased during storage and were significantly different from production day (p≤0.05). Peroxide value (PV) of treatments increased significantly at refrigerated storage. No significant differences were observed between PV of treatments during different wks of sampling. The results of texture profile analysis showed that firmness, compressibility and adhesiveness properties were significantly increase with higher substitution of FG with pectin. Color, Aroma, Taste and texture properties of prepared samples were found to significantly lower than control, according to sensory evaluation. Significant increases were observed in mold/yeast and psychrophilic count of treatments during storage. The macroscopic growth of molds was observed on all samples in 8th wks. No coliform growth was observed in all treatments at any time. Results suggest that low-fat spread properties were significantly influenced by different ratios of fish gelatin and pectin incorporated. It seems that these results can provide new opportunities to develop market with introducing novel products to response consumer demands. Some quality defects observed in this study can be improved by using suitable machinery at industrial scale

Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations.Peer reviewe

Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

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