Optimizing community case management strategies to achieve equitable reduction of childhood pneumonia mortality:An application of Equitable Impact Sensitive Tool (EQUIST) in five low- and middle-income countries

BACKGROUND: The aim of this study was to populate the Equitable Impact Sensitive Tool (EQUIST) framework with all necessary data and conduct the first implementation of EQUIST in studying cost–effectiveness of community case management of childhood pneumonia in 5 low– and middle–income countries with relation to equity impact. METHODS: Wealth quintile–specific data were gathered or modelled for all contributory determinants of the EQUIST framework, namely: under–five mortality rate, cost of intervention, intervention effectiveness, current coverage of intervention and relative disease distribution. These were then combined statistically to calculate the final outcome of the EQUIST model for community case management of childhood pneumonia: US$ per life saved, in several different approaches to scaling–up. RESULTS: The current ‘mainstream’ approach to scaling–up of interventions is never the most cost–effective. Community–case management appears to strongly support an ‘equity–promoting’ approach to scaling–up, displaying the highest levels of cost–effectiveness in interventions targeted at the poorest quintile of each study country, although absolute cost differences vary by context. CONCLUSIONS: The relationship between cost–effectiveness and equity impact is complex, with many determinants to consider. One important way to increase intervention cost–effectiveness in poorer quintiles is to improve the efficiency and quality of delivery. More data are needed in all areas to increase the accuracy of EQUIST–based estimates

The Ecological Footprint Nowadays

This assessment refers to the ecological footprint which is a way to measure the impacts of human activities on Earth. It basically calculates the demand and consumption that measures the needs of a society, as well as the waste and greenhouse gases that generates daily in productive sea and fertile land areas. Moreover, it measures all the natural resources needed to support the material needs of a population or person through the technology, lifestyle and habits of each country. Subsequently we are going to examine the advantages and disadvantages of the phenomenon that human activities provoke and the ways to eliminate the caused problem. The world-average ecological footprint in 2013 was 2.8 global hectares per person and the average per country ranges from over 10 to under 1 global hectares per person. There is also a high variation within countries, based on individual lifestyle and economic possibilities that we also examine. Summarizing all those effects we are going to analyze open international data as far as the metabolism of the ecological footprint concerns in our word but especially in our country to form prospects for our planet the principles of life cycle assessments with the aid of statistics and charts

A Small History of Statues: Yannis Ritsos and the Monuments of History

What does it mean to write or speak in a moment of terror and censorship? How is it possible to resist the silencing, the muteness, the blindness that takes place under the banner of these two experiences, and especially when the punishment for such resistance is imprisonment, torture, exile, and dispossession? These questions -central to any reflection on the contemporary political climates within which, after September 11, we now live -are at the heart of the nearly twenty collections of short poems that Y annis Ritsos wrote during the dictatorship in Greece, including his remarkable collection of poems, Scripture of the Blind, written in a kind of white heat during the last four months of 1972 and the early days of 1973, and some of the longer poems and dramatic monologues, also written during these years, that would later become part of his collection, The Fourth Dimension. Written while he was imprisoned in several detention camps after his arrest in 1967, but also, after his release, while he was still under surveillance and observation, these poems bear the traces of his personal experiences of terror, displacement, censorship, and death, but also the signs of the intimidation, dispossession, and disfiguration that touched and defmed so much of Greece during this period of historical trauma

Colorectal cancer and diet in Scotland

Introduction Colorectal cancer is a cancer that forms in the tissues of the colon and/ or rectum and more than 95% of colorectal cancers are adenocarcinomas. It is the third most common cancer in incidence and mortality rates, accounting for 9% of all cancer cases and for 8% of all cancer related deaths (2002). The established risk factors of colorectal cancer include personal or family history of previous colorectal cancer or adenomatous polyps, chronic bowel inflammatory disease and presence of any of the hereditary syndromes. In addition, due to the fact that the majority of colorectal cancer cases (approximately 90%) occur after the age of 50, advanced age is also considered as a risk factor. Finally, evidence for significant associations between colorectal cancer and other risk factors, including diet, body weight, physical activity, smoking, alcohol intake, NSAIDs intake and HRT in post-menopausal women, is promising and increasing. Aims and objectives The main aims of this project were: 1) to investigate the associations between colorectal cancer and specific nutrients, including flavonoids, fatty acids, folate, vitamin B2, vitamin B6, vitamin B12, alcohol, vitamin D and calcium (prior hypotheses 1-4) and 2) to conduct an overall as well as forward and backward stepwise regression analyses of demographic, lifestyle and dietary risk factors. Methods The analysis of this thesis was based on a population-based case-control study of colorectal cancer (Scottish Colorectal Cancer Study; SOCCS). In total 3,417 colorectal cancer cases and 3,396 controls were recruited in the study. Dietary and lifestyle data were collected by two questionnaires (Lifestyle & Cancer and Food Frequency Questionnaire) and were available for 2,061 cases and 2,776 controls. For the analysis of the first two hypotheses (flavonoids and fatty acids) a matched dataset of 1,489 casecontrol pairs was used and conditional logistic regression models were applied, whereas for the analysis of the last two hypotheses (folate, vitamin B2, vitamin B6, vitamin B12, alcohol, vitamin D and calcium) an unmatched dataset including 2,061 cases and 2,776 v controls was used and unconditional logistic regression models were applied. For the overall and stepwise regression analyses the unmatched dataset was used (2,061 cases and 2,776 controls). Forward and backward stepwise regression was applied on three different sets of variables and the stability of the resultant models was checked in 100 bootstrap samples. Results Regarding the first two hypotheses, statistically significant odds ratios (ORs) (matched on sex, age and health board are and adjusted for family history of cancer, BMI, physical activity, smoking, and intakes of total energy, fibre, alcohol and NSAIDs) for highest versus lowest intakes (quartiles) were observed for flavonols OR (95% CI), p-value for trend: 0.78 (0.60, 0.99), 0.08) and for the individual flavonoid compounds quercetin and catechin (OR (95% CI), p-value for trend: 0.77 (0.60, 0.99), 0.04; 0.75 (0.58-0.97), 0.02; respectively); for the 3PUFAs fatty acids (OR (95% CI), p-value for trend: 0.75 (0.59, 0.97), 0.01) and for the individual fatty acids stearic acid, EPA and DHA (OR (95% CI), p-value for trend: 1.46 (1.11, 1.91), 0.01; 0.74 (0.58, 0.95), 0.02; 0.74 (0.58, 0.95), 0.02; respectively). Regarding the last two hypotheses, statistically significant odds ratios (ORs) (adjusted for age, sex, deprivation score, family history of cancer, BMI, physical activity, smoking, and intakes of total energy, fibre, alcohol and NSAIDs) for highest versus lowest intakes (quartiles) were observed for vitamin B6, vitamin B12 and alcohol (OR (95% CI), p-value for trend: 0.86 (0.72, 1.03), 0.08; 0.80 (0.67, 0.97), 0.05; 0.83 (0.68, 1.00), 0.03); and for vitamin D (OR (95% CI), p-value for trend: 0.83 (0.69, 0.99), 0.03). Regarding the second aim of the project, several risk factors were found to be significantly associated with colorectal cancer in the overall analysis including demographic and lifestyle factors (family history of cancer, NSAIDs intake, dietary energy intake, HRT intake and physical activity), food group variables (vegetables, eggs, sweets, fruit/ vegetable juice, oily fish, coffee, fruit, savoury foods and white fish) and nutrient variables (tMUFAs, 3PUFAs, SFAs, tFAs, MUFAs, quercetin, catechin, phytoestrogen, cholesterol, fibre, protein, starch, magnesium, potassium, manganese, copper, iron, zinc, phosphorus, selenium, niacin, vitamin B6, carotenes, vitamin C, vi vitamin A, potential niacin, biotin, folate, pantothenic acid, vitamin D, vitamin B1 and vitamin B12). In addition, the variables that were selected to be included in 100% of the models after applying forward and backward stepwise regression analyses were family history, NSAIDs, sweets and fruit/ vegetable juice. Finally according to the findings from the bootstrap analysis, the variables that were selected to be included in models for the majority of the bootstrap samples (more than 90%) were family history, NSAIDs, dietary energy, eggs, sweets, fruit/ vegetable juice and white fish. Discussion The particular dietary factors that were found to be inversely associated with colorectal cancer after applying several multivariable logistic regression models were: flavonols, quercetin, catechin, 3PUFAs, EPA, DHA, vitamin B6, vitamin B12 and vitamin D. In addition, high intakes of stearic acid were found to be positively associated with colorectal cancer. In contrast, high intakes of dietary and total folate were associated with a decreased colorectal cancer risk in the energy-adjusted model, but this inverse association was attenuated after further adjustment for several confounding factors including fibre. Regarding alcohol intake, when it was divided into quartiles, high alcohol consumption was associated with a statistically significant and dose-dependent decreased colorectal cancer risk. However, when alcohol intake was divided in categories an increased colorectal cancer risk for intakes of higher than 60 g/day was observed. Intakes of 3PUFAs, vitamin D and vitamin B12 were highly correlated due to having the same food source (oily fish) and therefore it is difficult to draw specific conclusions regarding which nutrient is truly associated with colorectal cancer and which not. Finally, it was observed that for calcium intakes to be inversely associated with colorectal cancer, a dosage of 1500mg/day or higher was necessary. The majority of these results are in accordance with results of previous epidemiological and laboratory studies; however their confirmation in further large-scale studies is required. Results from the overall and stepwise regression analysis supported previous findings of an increased colorectal cancer risk due to a high or moderate family history risk. In addition, high intakes of dietary energy were found to be positively associated with increased colorectal cancer risk in the overall analysis and in addition dietary energy was vii selected to be included in the majority of the stepwise regression models. On the other hand, regular intake of NSAIDs was found to be inversely associated with colorectal cancer risk in the overall analysis and in the majority of the stepwise regression models. Finally, the overall and stepwise regression analyses generated a few new hypotheses suggesting that low intakes of fruit/ vegetable juice, eggs, white fish and sweets (a combined variable of high-fat and high-sugar foods) and high intakes of coffee and magnesium were associated with a decreased colorectal cancer. These findings, though interesting and important for generation of new hypotheses, need further investigation (as prior hypotheses) in large-scale observational studies

Die Reifungsproteasen der Hydrogenasen

[NiFe]-Hydrogenasen sind weitverbreitete Enzyme, deren große Untereinheiten ein Metallzentrum enthalten, welches aus einem Nickel- und einem mit drei niedermolekularen Liganden, einem CO und zwei CN, koordinierten Eisenatom besteht. Nach Expression der sie kodierenden Gene durchlaufen die großen Untereinheiten einen komplexen posttranslationalen Reifungsprozess, in dessen Verlauf das [NiFe]-Zentrum schließlich assembliert wird. Der letzte Schritt der Reifungskaskade besteht in der proteolytischen Entfernung eines C-terminalen Peptids durch eine spezifische Reifungsprotease, was das Metallzentrum ins Innere des Proteins bringt. Diese besitzt eine Metallbindestelle, die von drei konservierten Resten ausgebildet wird. Ziel dieser Arbeit war es den Katalysemechanismus dieser Proteasen aufzuklären und Reste bzw. Motive oder Bereiche im Substratprotein und in der Protease ausfindig zu machen, die an der Substratbindung beteiligt sind. Im Rahmen dieses Unterfangens konnten folgende Ergebnisse erzielt werden: 1. Die Metallbindestelle der spezifischen Reifungsprotease dient zur Erkennung des Nickels im Vorläuferprotein der großen Untereinheit und stellt gleichzeitig auch das aktive Zentrum des Enzyms dar. 2. Der N-terminale Rest der Schnittstellenregion spielt keine Rolle für die Prozessierung durch die Protease; seine Funktion liegt im Protonentransfer von und zum aktiven Zentrum. 3. Der C-terminale Schnittstellenrest wirkt als „Hebel“, der den C-Terminus in der richtigen Position hält und damit die korrekte Faltung des Proteins sicherstellt. Diese ist Voraussetzung für die Substraterkennung durch die Protease, die damit konformationsabhängig ist. 4. Die Deletion der letzten 26 Aminosäuren des C-Terminus von HycE resultiert in einer unlöslichen Varianten, die nur noch in der Membranfraktion zu finden ist. Dabei unterliegt diese Variante ebenfalls einem raschen Abbau, der auf eine Konformationsänderung hindeutet. 5. HycH scheint die vorzeitige Bindung von HycG, der kleinen Untereinheit der Hydrogenase 3, an HycE, der großen Untereinheit der Hydrogenase 3, zu verhindern. Mit Hilfe der erhaltenen Ergebnisse konnten zwei mögliche Katalysemechanismen für die Reifungsproteasen postuliert werden. Desweiteren konnte eine potentielle Rolle des C-Terminus in der Substraterkennung durch die Protease dargestellt werden und schließlich auf eine mögliche Funktion des HycH-Proteins hingewiesen werden

Stress-related asthma and family therapy: Case study

This paper applies the Biobehavioral Family Model (BBFM) of stress- related illness to the study and treatment of an adolescent with intractable asthma. The model is described, along with supportive research findings. Then a case study is presented, demonstrating how the model is clinically applied. We tell the story of an asthmatic adolescent presenting for therapy due to her intense asthmatic crises, and the case is presented to exemplify how the BBFM can help understand the family-psychobiological contribution to exacerbation of disease activity, and therefore guide treatment towards the amelioration of severe physical symptoms. Facets of the patient’s intra-familial interactions are consistent with the BBFM, which support clinical validation of the model. In the case described, it is likely that additional asthma medications would not have had the desired ameliorative effect, because they did not target the family relational processes contributing to the symptoms. The recognition of the influences of family relational processes on the disease was crucial for effective intervention. The therapy incorporates and weaves together BBFM understanding of family patterns of interaction and physiological/medical concerns integrated with Bowenian intervention strategies. This case study validates the importance and usefulness of BBFM for intervention with stress-sensitive illnesses such as asthma

Aetiology of community-acquired neonatal sepsis in low and middle income countries

99% of the approximate 1 million annual neonatal deaths from life-threatening invasive bacterial infections occur in developing countries, at least 50% of which are from home births or community settings. Data concerning aetiology of sepsis in these settings are necessary to inform targeted therapy and devise management guidelines. This review describes and analyses the bacterial aetiology of community-acquired neonatal sepsis in developing countries