Analysis of Step Therapy Reform on Floridians with Autoimmune Conditions

Background: Step therapy is a cost-saving measure employed by insurance companies to reduce rising drug costs; however, studies have indicated this policy has neutral or – in some cases – negative effects on patients. Specifically for indivdiuals with autoimmune diseases, the delay of proper treatment, increased risk of negative, irreversible side effects, and an underdeveloped preferred drug lists harm autoimmune patients because of the disconnect between the heterogeneity of autoimmune disease and the one-size-fits-all approach of step therapy. Objective: To determine the most effective policy for dealing with the harms of step therapy as they currently affect Floridians. Methods: Five policy options, gathered from various research experts in the field, named Insurance Company Directed Reform, Patient Direct Reform, Complete Reform, Insurance Company Directed Reform only for autoimmunity, and Patient Directed Reform only for autoimmunity were review and judged on a scale from 1 to 10, the higher the number indicating a more beneficial rating, with respect to feasibility, benefits to insurance companies, benefits to patients, and benefits to physicians. The rankings of each evaluative criteria were averaged to determine the most beneficial policy. Results: Insurance Company Directed Reform only for autoimmunity ranked lowest with an average score of 4.25. Patient Directed Reform ranked fourth with an average score of 4.375. Insurance Company Directed Reform ranked third with an average score of 4.5 followed by Patient Directed Reform with an average score of 5.5. Finally, Complete Reform had the highest average score of 5.625. Conclusion: After the evaluation, Complete Reform which includes clinical review reform, transparency and rereporting requirements, exemptions criteria, and a streamlined appeals process ranked the highest. It will increase all patients’ access to appropriate, doctor-prescribed medication in a timely manner dramatically increasing health while preserving physician autonomy and protecting insurance companies’ revenues

Microenvironmental hCAP-18/LL-37 promotes pancreatic ductal adenocarcinoma by activating its cancer stem cell compartment

This is the peer reviewed version of the following article: Microenvironmental hCAP-18/LL-37 promotes pancreatic ductal adenocarcinoma by activating its cancer stem cell compartment. Gut 64.12 (2015): 1921-1935 and which has been published in final form at http://dx.doi.org/10.1136/gutjnl-2014-308935OBJECTIVES: The tumour stroma/microenvironment not only provides structural support for tumour development, but more importantly it provides cues to cancer stem cells (CSCs) that regulate their self-renewal and metastatic potential. This is certainly true for pancreatic ductal adenocarcinomas (PDAC), where tumour-associated fibroblasts, pancreatic stellate cells and immune cells create an abundant paracrine niche for CSCs via microenvironment-secreted factors. Thus understanding the role that tumour stroma cells play in PDAC development and CSC biology is of utmost importance. DESIGN: Microarray analyses, tumour microarray immunohistochemical assays, in vitro co-culture experiments, recombinant protein treatment approaches and in vivo intervention studies were performed to understand the role that the immunomodulatory cationic antimicrobial peptide 18/LL-37 (hCAP-18/LL-37) plays in PDAC biology. RESULTS: We found that hCAP-18/LL-37 was strongly expressed in the stroma of advanced primary and secondary PDAC tumours and is secreted by immune cells of the stroma (eg, tumour-associated macrophages) in response to tumour growth factor-β1 and particularly CSC-secreted Nodal/ActivinA. Treatment of pancreatic CSCs with recombinant LL-37 increased pluripotency-associated gene expression, self-renewal, invasion and tumourigenicity via formyl peptide receptor 2 (FPR2)- and P2X purinoceptor 7 receptor (P2X7R)-dependent mechanisms, which could be reversed by inhibiting these receptors. Importantly, in a genetically engineered mouse model of K-Ras-driven pancreatic tumourigenesis, we also showed that tumour formation was inhibited by either reconstituting these mice with bone marrow from cathelicidin-related antimicrobial peptide (ie, murine homologue of hCAP-18/LL-37) knockout mice or by pharmacologically inhibiting FPR2 and P2X7R. CONCLUSIONS: Thus, hCAP-18/LL-37 represents a previously unrecognised PDAC microenvironment factor that plays a critical role in pancreatic CSC-mediated tumourigenesis.CH: ERC Advanced Investigator Grant (Pa-CSC 233460), European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 256974 (EPC-TM-NET) and n° 602783 (CAM-PaC), the Subdirección General de Evaluación y Fomento de la Investigación, Fondo de Investigación Sanitaria (PS09/02129 & PI12/02643) and the Programa Nacional de Internacionalización de la I+D, Subprogramma: FCCI 2009 (PLE2009-0105; both Ministerio de Economía y Competitividad (es), Spain), BSJr: Rámon y Cajal Merit Award from the Ministerio de Economía y Competitividad, Spain and Clinic and Laboratory Integration Program (CLIP) grant from the Cancer Research Institute, NY, NY. MC: La Caixa Predoctoral Fellowshi

Self-Awareness Counseling on Quality of Life of Menopausal Women

Background: Counseling interventions are among the available strategies to improve the menopausal quality of life and self-awareness counseling is effective in improving adaptation, self-confidence and quality of life. Therefore, the present study aimed to examine effects of self-awareness counseling on quality of life of menopausal women in Gorgan, Iran. Methods: In this clinical trial, we examined 52 menopause women referred to health centers of Gorgan, Iran in 2018. Data collection tools included a demographic characteristics form and the menopause-specific quality of life questionnaire. First, the control group completed the data collection tools at the beginning of the study and 6 and 10 weeks after the first session. Then the intervention group completed the tools at base line and participated in six 45-60-minute self-awareness-based group counseling sessions, once a week. After that, they were completed questionnaire, immediately and a month after the end of the intervention. Data were expressed as mean ± standard deviation. Results: In the intervention group, the baseline mean scores of menopausal quality of life and its vasomotor, physical, psychosocial and sexual domains were 55.69±19.47, 5.30±4.57, 30.26±12.24, 12.15±6.64 and 7.96±5.34, respectively. A month after the intervention, the mean scores of menopausal quality of life (30.42±19.64) and its vasomotor (2.65±2.33), physical (16.38±8.64), psychosocial (7.19±4.63) and sexual (4.19±3.42) domains increased significantly in the intervention group (p=0.001). In between group comparison, except for the psychosocial domain, the mean scores of quality of life and its various domains showed a statistically significant difference in one month after the intervention (P=0.001). Conclusion: The menopausal quality of life and its various domains improved one month after the end of self-awareness counseling. Therefore, we recommend offering self-awareness counseling in health centers for improving the quality of life of menopausal women

Preventing Child Sexual Abuse in Iran: Mothers Teaching Body Safety to Their Sons

Abstract Background: Parents play important roles in protecting their children from child sexual abuse (CSA). In Iran, mothers have been shown to effectively improve and maintain female children’s protective behaviors and knowledge regarding CSA. This study aimed to determine the effect of personal safety education for mothers in Gorgan (northeastern Iran) on their sons’ knowledge and skills for the prevention of CSA. Methods: This clinical trial was conducted in 2019 on 46 preschool-aged boys and their mothers. Eligible subjects were recruited by systematic random sampling from two health centers in Gorgan. Boys were pretested using Persian versions of the Personal Safety Questionnaire and ’What If’ Situations Test and then randomly assigned to either an education group (mothertaught program) or a control group. Mothers assigned to the education group participated in a 2-hour training session and were given the Body Safety Training workbook to teach their sons during the following week. Two days after the training by their mothers, boys in both groups were post tested and also followed up one month later. Data were analyzed in SPSS software (version 16) by using repeated-measures ANOVA, general estimation equation, Mann-Whitney U test, and Fisher’s exact test. Results: Children taught by their mothers demonstrated significant increases in the mean scores of knowledge (P=0.001), total safety skills (P<0.001), and appropriate-touch recognition (P=0.005). These increases were maintained at the one-month follow-up. Children in both groups recognized almost all inappropriate-touch requests correctly at all three time periods (P=0.99). Conclusion: Educated mothers effectively taught their young sons skills and knowledge to protect from CSA, and these gains were maintained for one month. Although all participants were able to recognize inappropriate-touch requests, boys did not recognize that requests to touch the genitals are appropriate for health or hygiene purposes until they were educated by their mothers. In Iran, parents teach children that any touching or looking at their private parts by anyone is forbidden

A comparative study of depression and its relationship with physical health among families with and without COVID-19 patients in comprehensive health centers

Abstract Background: The prevalence of the coronavirus has had various psychological effects on families with patients suffering from COVID-19, including depression. Depression can also affect the physical health of family members. This study was conducted with the aim of comparing the level of depression and its relationship with physical health among families with and without COVID-19 patients in comprehensive health centers. Methods: This case-control study was conducted in 2022 in comprehensive health centers in Gorgan (Iran) among 98 families with and without COVID-19 patients, using simple random sampling. The data collection tools included the Beck Depression Inventory and the PHQ physical health questionnaire. The data were analyzed using descriptive statistics and tests such as the Mann-Whitney U test, Chi-square test, and Spearman's correlation test at a significance level of 0.05. Results: The study revealed that the mean scores of depression and physical health in family members with COVID-19 patients were 11.56±7.50 and 7.60±4.32, respectively, while in families without COVID-19 patients, they were 8.01±4.67 and 3.98±3.43, respectively. The odds of depression (OR=5.11, p=0.001) and physical symptoms (OR=4.68, p=0.002) were higher in families with COVID-19 patients compared to those without. The findings also showed a direct and significant linear correlation between depression and physical health in both groups (p<0.001, r=0.44). Conclusion: These findings increase the awareness of health managers about the prevalence of depression and physical health disorders among families with COVID-19 patients and can help provide economic, social, and psychological support programs for these families

Evaluating Correlation of General Self-Concept with Sexual Self-Concept in Infertile Women

Background: General self-concept refers to a set of feelings and perceptions toward oneself, and sexual self-concept is defined as individual's perception of his/her sexual feelings and actions. These two concepts are affected by various life problems, including infertility. The present study aimed to evaluate correlation of general self-concept and sexual self-concept in infertile women. Methods: This descriptive correlational study was carried out on all infertile women who visited the Gorgan Infertility Center in 2018. Overall, 105 eligible infertile women were included in the study via convenience sampling. Data were collected using Persian versions of the Rogers self-concept questionnaire and the Snell sexual self-concept questionnaire. Data were analyzed using the Pearson and Spearman's correlation tests in SPSS 16 and at significance of 0.05. Results: Mean age of subjects was 28.88±5.14 years (range: 17 and 40 years). Based on the findings, 19% of the participants had normal general self-concept, 31.4% had moderate self-concept, and 49.5% had weak self-concept. Mean scores of positive sexual self-concept, negative self-concept and situational sexual self-concept were 118.9±24.85, 13.33±8.94 and 41.98±10.53, respectively. There was no correlation between general self-concept and different dimensions of sexual self-concept of the infertile women. Conclusion: Due to the lack of correlation between general self-concept and sexual self-concept in infertile women, it is suggested to conduct evaluations and interventions on the general and sexual self-concepts of the participants separately

Knowledge, Attitude, and Practice toward Prevention of COVID-19 Among Nursing and Midwifery Students: A cross-sectional Study in Gorgan, Northern Iran

Background: Healthcare providers are high-risk groups for the novel coronavirus disease (COVID-19) infection. Nursing students are an essential part of high-risk healthcare providers. The aim of this study was to evaluate the knowledge, attitude, and practice of nursing and midwifery students at Golestan University of Medical Sciences (GOUMS) toward the prevention of COVID-19.Methods: This cross-sectional study was conducted on 174 nursing and midwifery students of GOUMS (northeast of IRAN) in 2020. Data were gathered using an online questionnaire comprising three parts - Knowledge (8 questions), Attitude (10 questions), and Practice (8 questions) toward the prevention of COVID-19. The range of scores in each subscale (knowledge, attitude, and preventive practices) were 8-24, 10-50, and 8-24, respectively. Data were analyzed using the SPSS v.16 software. The Mann-Whitney and Kruskal-Wallis tests were used for the analysis.Results: Overall, in this study, nursing and midwifery students had a good knowledge (mean score: 23.19 +/- 2.56), a positive attitude (mean score: 45.48 +/- 4.21), and appropriate practice (mean score: 23.30 +/- 3.51) regarding COVID-19 prevention. Also, the results revealed a positive correlation between knowledge and attitude (r = 0.1, P = 0.18) and attitude and practice (r = 0.2, P = 0.01) among the students. Conclusion: The findings demonstrated a good preventive knowledge, attitude, and practice toward COVID-19 among nursing and midwifery students

Effects of Deficit and Cutoff Irrigation During Different Phenological Stages of Fruit Growth on Production in Mature Almond Trees cv. 'Mamaei'

Abstract Regulated deficit irrigation (RDI) is commonly used during different phenological stages of fruit growth and development in almond trees to reduce the amount of irrigation water applied without or with only very small reductions in yield. Therefore, to study the effects of deficit and cutoff irrigation during different phenological stages of fruit growth and development in almond cv. "Mamaei" production, an experiment was carried out in a split plot on randomized block design with three replications. The main plots were three different phenological stages of fruit growth and development i.e. Stage I (fruit growth period), Stage II (kernel growth period) and stage III (preharvest period). The subplots had different irrigation regimes, namely T1= 100% ETc (Full irrigation), T2= 80% ETc (deficit irrigation), T3= 40% ETc (deficit irrigation) and T4= 0% ETc (cutoff or drought period). Traits such as fruit size (length, width and diameter), fresh and dry weight of fruit, fresh and dry weight of kernel, percentage of fruit drop, kernel percentage and yield were measured. The results showed that deficit and cutoff irrigation during stage-I decreased fruit size, both fresh and dry weight of fruit. Deficit and cutoff irrigation during stage-II decreased fruit fresh weight, fresh and dry weights of kernel, but no significant differences were observed for the measured traits when irrigation treatments were applied at stage III. These results indicated that preharvest stage (stage III) in 'Mamaei' cultivar has low sensitivity to deficit irrigation. Therefore, it is concluded that deficit irrigation with 40% of full irrigation (%40 ETc) during stage III for two months prior to harvest can be used without considerable reduction of yield for this cultivar under the climatic conditions in Saman region