The catastrophic and impoverishing effects of out-of-pocket healthcare payments in Kenya, 2018

Progress towards effective service coverage and financial protection-the two dimensions of Universal Health Coverage (UHC)-has been limited in Kenya in the last decade. The government of Kenya has embarked on a highly ambitious reform programme currently being piloted in four Kenyan counties and aiming at national rollout by 2022. This study provides an updated assessment of the performance of the Kenyan health system in terms of financial protection allowing to monitor trends over time. In light of the UHC initiative, the study provides a baseline to assess the impact of the UHC pilot programme and inform scale-up plans. It also investigates household characteristics associated with catastrophic payments.; Using data from the Kenya Household Health Expenditure and Utilization Survey (KHHEUS) 2018, we investigated the incidence and intensity of catastrophic and impoverishing health expenditure. We used a logistic regression analysis to assess households' characteristics associated with the probability of incurring catastrophic health expenditures.; The results show that the incidence of catastrophic payments is more severe for the poorest households and in the rural areas and mainly due to outpatient services. Results for the impoverishing effect suggest that after accounting for out-of-pocket(OOP) payments, the proportion of poor people increases by 2.2 percentage points in both rural and urban areas. Thus, between 1 and 1.1 million individuals are pushed into poverty due to OOP payments. Among the characteristics associated with the probability of incurring OOP expenditures, socioeconomic conditions, the presence of elderly and of people affected by chronic conditions showed significant results.; Kenya is still lagging behind in terms of protecting its citizens against financial risks associated with ill health and healthcare seeking behaviour. More effort is needed to protect the most vulnerable population groups from the high costs of illness

The Effect of Simple Melodic Lines on Aesthetic Experience: Brain Response to Structural Manipulations

This fMRI study investigates the effect of melody on aesthetic experience in listeners na \u308\u131ve to formal musical knowledge. Using simple melodic lines, whose syntactic structure was manipulated, we created systematic acoustic dissonance. Two stimulus categories were created: canonical (syntactically \u201ccorrect,\u201d in the Western culture) and modified (made of an altered version of the canonical melodies). The stimuli were presented under two tasks: listening and aesthetic judgment. Data were analyzed as a function of stimulus structure (canonical and modified) and stimulus aesthetics, as appraised by each participant during scanning. The critical contrast modified versus canonical stimuli produced enhanced activation of deep temporal regions, including the parahippocampus, suggesting that melody manipulation induced feelings of unpleasantness in the listeners. This was supported by our behavioral data indicating decreased aesthetic preference for the modified melodies. Medial temporal activation could also have been evoked by stimulus structural novelty determining increased memory load for the modified stimuli. The analysis of melodies judged as beautiful revealed that aesthetic judgment of simple melodies relied on a fine-structural analysis of the stimuli subserved by a left frontal activation and, possibly, on meaning attribution at the charge of right superior temporal sulcus for increasingly pleasurable stimul

Hyperplastic and atrophic changes in the genital tract of a female cat following repeated treatment with deslorelin acetate – a case report

This study aimed to investigate the morphological patterns of the genital tract after long-term treatment of deslorelin acetate in a female cat, a gonadotropin-releasing hormone agonist currently used in adult cats to obtain transient oestrus suppression. A 1-year-old Chartreux female cat was treated with 4.7 mg deslorelin acetate to suppress oestrus manifestations. The treatment was repeated for a total of × 3 every 2 years. After 8 years, the female cat came into oestrus again, but she was no more implanted, and an ovariohysterectomy was performed. Before surgery, an ultrasound examination was performed that showed a normal uterus and the presence of about 5 follicles in ovaries. Concentrations of oestradiol, progesterone, and vaginal smears were compatible with oestrus. During surgery, a very short ovarian pedicle was observed yet neither uterus nor ovaries presented appreciable alterations. At histology, the ovaries presented a juvenile appearance with numerous primordial and periovulatory follicles. The uterus showed marked endometrial hyperplasia with polypoid projection and atrophic myometrium. Based on this case report, deslorelin acetate is a powerful drug able to preserve ovarian function. However, the suppression of gonadotrophin, especially for a long period, has a detrimental atrophic effect on the target organs during treatment and, on the opposite, hyperplastic changes may occur after the restoring of normal cyclicity

Evaluation of the application of italian national guidelines for prevention and management of dental injuries in developmental age

Background: The objective of this study is to evaluate the application of National guidelines for prevention and clinical management of traumatic dental injuries (NGPCMTDI) in developmental age published by the Italian Ministry of Health. Methods: In the present retrospective and multicenter study, 246 patients who underwent dental injury were selected to assess the management of the traumatic event compiled with the protocol provided by the National guidelines. Each health worker involved completed a form related to the dental injury in order to standardize the collected data. Two reference centers have been identified for data collection. Analyses for comparisons between groups were performed using the X2 test for categorical variables or by Fisher exact test as appropriate. Statistical significance was assumed at p < 0.05. Results: Evaluating the distribution by age we concluded that: 27.24% of the enrolled patients were aged 1-5 years, 51.63% 6-10 years, and 19.92% 11-17 years. The dental injuries occurred in 10.16% of the situations at home, 50.81% at school, 28.86% during recreation, and 9.35% at the gym. The deciduous dentition is involved in 34.96% of the traumas while the permanent dentition is involved in 69.51%. Conclusion: From the present study it emerged that the National guidelines are not uniformly applied

Effect of 20 mg Fluorogestone Acetate (FGA) Sponges on Reproductive Parameters of Dairy Ovine Breeds in Southern Italy

Background: Intravaginal devices containing progestins are widely used for oestrus synchronization in sheep. Progestins give economic benefits to farmers but may have some limitations and the efficacy strictly depends on farm management. There are different devices, with different molecules (progesterone, medroxyprogesterone acetate, fluorogestone acetate), different dosages and long (12-14 days) and short-term (5-7 days) protocols. Experimental studies often include a limited number of animals and are held at different latitudes and with different system of management. To our knowledge, there are few reports in the literature on field application of the recently licensed 20 mg fluorogestone acetate (FGA) sponges in large ewe flocks, excluding the registration trials. Materials, Methods & Results: This study was designed to evaluate oestrous synchronization in 2 different breeds. A total of 1100 Lacaune (L) and 618 Sarda (S) were assigned to 8 groups, comparing multiparous (M) and nulliparous (N) and those synchronized in November (n) and May (m). The animals were assigned to 8 groups: LMm (n. 556), LNm (n. 180), SMm (n. 70), SNm (n. 32), LMn (n. 242), LNn (n. 222), SMn (n. 440) e SNn (n. 76). The intravaginal sponge was inserted for 14 days. At sponge withdrawal, eCG (400 IU, IM) was injected, and rams were joined into flocks 30 h later with a male/female ratio of 1:8. Transrectal ultrasonography was performed for pregnancy diagnosis after 30 days. Fertility parameters such as oestrus (OR), pregnancy (PR), lambing rates (LR) and prolificacy were calculated. Fisher exact test was used to compare parameters of each group with the corresponding and significance was set at P < 0.01. The use of intravaginal sponges in this study was easily performed in all animals. In nulliparous groups, digital insertion of the sponge, instead of the applicator, was preferred to avoid discomfort. Sponge loss was observed in 2% of treated ewes. At the removal of the sponge, mild vaginal contamination was observed in 90% of the ewes. Ultrasound finding of embryo resorption, pseudopregnancy and pyometra were found in rates under 2%. The loss of pregnancy ranged from 0 to 3.6% without significant differences among groups. The SMn group showed the best performances (0.91 OR, 0.88 PR, 0.85 LR), significantly higher than the other groups. Prolificacy was maximum in the LMn (1.68) and minimum in the SNm group (1.06), without significant differences among groups. Discussion: The 14-day regimen based on 20 mg FGA-releasing intravaginal devices is an easy and satisfactory synchronization regimen to improve the productivity and the fertility of sheep farm, and this can be managed and optimized in different breeding conditions. In this study, Sarda breed shows a good adaption to the environment with adult ewes giving the best results in reproductive season. However young Sarda ewes were less productive especially in non-breading season. Lacaune showed good reproductive potential, young and adult ewes responded to progestins in reproductive and non-reproductive season. It was confirmed that the reproductive performance is affected by season, age, and breed. This study encourages the breeding of indigenous breeds by implementing the management with modern technologies. The imported highly productive breeds, if well managed, can give a production less influenced by seasonal variables and age. Keywords: ewe, sheep, Lacaune, Sarda, oestrus synchronization, progestins, intravaginal device, indigenous breeds

Interface and Composition Analysis on Perovskite Solar Cells.

Organometal halide (hybrid) perovskite solar cells have been fabricated following four different deposition procedures and investigated in order to find correlations between the solar cell characteristics/performance and their structure and composition as determined by combining depth-resolved imaging with time-of-flight secondary ion mass spectrometry (ToF-SIMS), X-ray photoelectron spectroscopy (XPS), and analytical scanning transmission electron microscopy (STEM). The interface quality is found to be strongly affected by the perovskite deposition procedure, and in particular from the environment where the conversion of the starting precursors into the final perovskite is performed (air, nitrogen, or vacuum). The conversion efficiency of the precursors into the hybrid perovskite layer is compared between the different solar cells by looking at the ToF-SIMS intensities of the characteristic molecular fragments from the perovskite and the precursor materials. Energy dispersive X-ray spectroscopy in the STEM confirms the macroscopic ToF-SIMS findings and allows elemental mapping with nanometer resolution. Clear evidence for iodine diffusion has been observed and related to the fabrication procedure.We acknowledge Lucio Cinà, Simone Casaluci, Stefano Razza and Narges Yaghoobi Nia for the technical support, “Polo Solare Organico” Regione Lazio, the “DSSCX” MIUR-PRIN2010 and FP7 ITN “Destiny” for funds. G.D., S.C. and C.D. acknowledge funding from ERC under grant number 259619 PHOTO EM. C.D. acknowledges financial support from the EU under grant number 312483 ESTEEM2.This is the final version of the article. It was first available from ACS via http://dx.doi.org/10.1021/acsami.5b0803

Does TLS Exist in Canine Mammary Gland Tumours? Preliminary Results in Simple Carcinomas

Abstract: Neoplastic progression is influenced by the expression of tumour antigens that activate an anti-tumour immune response. Human medical studies show that this body defence is carried out in secondary lymphoid organs (SLOs) but also directly in the tumour through organized cellular aggregates that are called tertiary lymphoid structures (TLSs). However, their occurrence has different meanings in different tumour types. For example, the presence of TLSs in breast cancer is associated with the most aggressive subtypes. This paper aimed to study TLSs in canine mammary simple carcinomas. A morphological assessment of the inflammatory infiltrate was performed on H&E sections of fifty cases. Immunohistochemistry was then carried out to typify the inflammatory cells in the tumour microenvironment. Results showed that, sometimes, inflammatory infiltrates were organized in follicles close to high-grade carcinomas, simulating a lymphoid organization, as in breast cancer. Therefore, we can assume that even in canine mammary tumours, TLSs exist and they are entities to consider due to their presence in the most aggressive histotypes or tumours with a high degree of malignancy

Immunohistochemical localization and mRNA expression of matrix Gla protein and fetuin-A in bone biopsies of hemodialysis patients

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The C-X-C Motif Chemokine Ligand 1 Sustains Breast Cancer Stem Cell Self-Renewal and Promotes Tumor Progression and Immune Escape Programs

Breast cancer (BC) mortality is mainly due to metastatic disease, which is primarily driven by cancer stem cells (CSC). The chemokine C-X-C motif ligand-1 (CXCL1) is involved in BC metastasis, but the question of whether it regulates breast cancer stem cell (BCSC) behavior is yet to be explored. Here, we demonstrate that BCSCs express CXCR2 and produce CXCL1, which stimulates their proliferation and self-renewal, and that CXCL1 blockade inhibits both BCSC proliferation and mammosphere formation efficiency. CXCL1 amplifies its own production and remarkably induces both tumor-promoting and immunosuppressive factors, including SPP1/OPN, ACKR3/CXCR7, TLR4, TNFSF10/TRAIL and CCL18 and, to a lesser extent, immunostimulatory cytokines, including IL15, while it downregulates CCL2, CCL28, and CXCR4. CXCL1 downregulates TWIST2 and SNAI2, while it boosts TWIST1 expression in association with the loss of E-Cadherin, ultimately promoting BCSC epithelial-mesenchymal transition. Bioinformatic analyses of transcriptional data obtained from BC samples of 1,084 patients, reveals that CXCL1 expressing BCs mostly belong to the Triple-Negative (TN) subtype, and that BC expression of CXCL1 strongly correlates with that of pro-angiogenic and cancer promoting genes, such as CXCL2-3-5-6, FGFBP1, BCL11A, PI3, B3GNT5, BBOX1, and PTX3, suggesting that the CXCL1 signaling cascade is part of a broader tumor-promoting signaling network. Our findings reveal that CXCL1 functions as an autocrine growth factor for BCSCs and elicits primarily tumor progression and immune escape programs. Targeting the CXCL1/CXCR2 axis could restrain the BCSC compartment and improve the treatment of aggressive BC

Cannabinoid CB1 receptor antagonism prevents neurochemical and behavioural deficits induced by chronic phencyclidine.

Clinical and laboratory studies suggest that the endocannabinoid system is involved in schizophrenia disorders. Recent evidence indicates that cannabinoid receptor (CB1) antagonists have a pharmacological profile similar to antipsychotic drugs. We investigated the behavioural and biochemical effects of the CB1 antagonist AM251 in a phencyclidine (PCP) animal paradigm modelling the cognitive deficit and some negative symptoms of schizophrenia. Chronic AM251 (0.5 mg/kg for 3 wk) improved the PCP-altered recognition memory, as indicated by a significant amelioration of the discrimination index compared to chronic PCP alone (2.58 mg/kg for 1 month). AM251 also reversed the PCP-induced increase in immobility in the forced swim test resembling avolition, a negative sign of schizophrenia. In order to analyse the mechanisms underlying these behaviours, we studied the effects of AM251 on the endocannabinoid system (in terms of CB1 receptor density and functional activity and endocannabinoid levels) and c-Fos protein expression. The antagonist counteracted the alterations in CB1 receptor function induced by PCP in selected cerebral regions involved in schizophrenia. In addition, in the prefrontal cortex, the key region in the integration of cognitive and negative functions, AM251 markedly raised anandamide levels and reversed the PCP-induced increase of 2-arachidonoylglycerol concentrations. Finally, chronic AM251 fully reversed the PCP-elicited expression of c-Fos protein in the prefrontal cortical region. These findings suggest an antipsychotic-like profile of the CB1 cannabinoid receptor antagonist which, by restoring the function of the endocannabinoid system, might directly or indirectly normalize some of the neurochemical maladaptations present in this schizophrenia-like animal model