Enhancing community based health programs in Iran: a multi-objective location-allocation model.

Community Based Organizations (CBOs) are important health system stakeholders with the mission of addressing the social and economic needs of individuals and groups in a defined geographic area, usually no larger than a county. The access and success efforts of CBOs vary, depending on the integration between health care providers and CBOs but also in relation to the community participation level. To achieve widespread results, it is important to carefully design an efficient network which can serve as a bridge between the community and the health care system. This study addresses this challenge through a location-allocation model that deals with the hierarchical nature of the system explicitly. To reflect social welfare concerns of equity, local accessibility, and efficiency, we develop the model in a multi-objective framework, capturing the ambiguity in the decision makers' aspiration levels through a fuzzy goal programming approach. This study reports the findings for the real case of Shiraz city, Fars province, Iran, obtained by a thorough analysis of the results.

Drug Survival of IL-12/23, IL-17 and IL-23 Inhibitors for Psoriasis Treatment: A Retrospective Multi-Country, Multicentric Cohort Study.

BACKGROUND: Drug survival analysis of biologic agents in psoriasis is of extreme importance, as it allows not only the evaluation of objective clinical outcomes (such as effectiveness and safety) but also of factors that are associated with patients' adherence to treatment. The aim of this study was to evaluate and compare the drug survival of the most recent biologic agents approved for the treatment of moderate-to-severe psoriasis-ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, and risankizumab-and to identify clinical predictors that can influence the drug survival of these drugs. METHODS: This retrospective multicentric cohort study from 16 dermatology centers in Portugal, Spain, Italy, Switzerland, Czech Republic, Canada, and the United States included patients that started IL-12/23, IL-17 (IL-17A and IL-17R) and IL-23 inhibitors for the treatment of psoriasis between January 1, 2012 and December 31, 2019. Survival analysis was performed using a Kaplan-Meier estimator, to obtain descriptive survival curves, and proportional hazard Cox regression models. RESULTS: A total of 3312 treatment courses (total patients: 3145) were included in the study; 1118 (33.8%) with an IL-12/23 inhibitor (ustekinumab), 1678 (50.7%) with an IL-17 inhibitor [911 (27.5%) on secukinumab, 651 (19.7%) on ixekizumab, 116 (3.5%) on brodalumab], and 516 (15.5%) with an IL-23 inhibitor [398 (12.0%) on guselkumab, 118 (3.5%) on risankizumab]. At 18 months, the cumulative probability of survival was 96.4% for risankizumab, 91.1% for guselkumab, 86.3% for brodalumab, 86.1% for ustekinumab, 82.0% for ixekizumab, and 79.9% for secukinumab. Using ustekinumab as reference, drug survival of guselkumab was higher (HR 0.609; 95% CI 0.418-0.887) and that of secukinumab was lower (HR 1.490; 95% CI 1.257-1.766). In the final multivariable model, secukinumab, female sex, higher BMI, and prior exposure to biologic agents significantly increased the risk of drug discontinuation, whereas risankizumab was protective. CONCLUSION: In this multinational cohort with 8439 patient-years of follow-up, the cumulative probability of drug survival for all drugs was >79% at 18 months. Prescribed biologic, female sex, higher BMI, and previous exposure to biologic agents were predictors of drug discontinuation. Drug survival of guselkumab and risankizumab was higher than that of ustekinumab, and secukinumab was lower.

Evaluation of new computerized method for recording 7-day food intake in IDDM patients.

OBJECTIVE: To evaluate a new computerized method for recording 7-day food intake. RESEARCH DESIGN AND METHODS: Randomized crossover trial was conducted with patients recording the amount and type of every food and drink consumed during a week by either a computerized device (Food-meter) or recording the data in a diary. Each method was applied twice. Twenty-one insulin-dependent diabetic patients (mean +/- SD age 25 +/- 9 yr) were studied. RESULTS: The two methods showed very good agreement in the evaluation of the patients' diets (1792 +/- 408 vs. 1764 +/- 436 kcal/day, 84 +/- 19 vs. 82 +/- 21 g/day protein, 68 +/- 22 vs. 67 +/- 23 g/day fat, 210 +/- 60 vs. 207 +/- 58 g/day carbohydrate with the conventional and computerized methods, respectively). The variability between the methods and the variability within each method were of similar magnitude. CONCLUSIONS: The Food-meter represents a useful tool for computerizing the 7-day food record. The method is easy, reliable, and time saving. Moreover, it minimizes the risk of transcriptional errors.

Theoretical study of electronic spectra and photophysics of uracil derivatives.

The changes that the UV absorption spectrum and the photophysics of uracil undergo under hydrogen substitution or deprotonation, were studied theoretically within the CS-INDO/CI scheme. First of all this method was tested on uracil. It was then used for the calculation of the electronic structure of excited states (Sn, Tn) of a large number of uracil derivatives (1-, 3- and 5-methyluracil; 1,3-, 1,5- and 3,5-dimethyluracil; 5-fluoro- and 5-chlorouracil), including some anions (1- and 3-methyluracil anion). The excited states were obtained in the singly-excited configuration interaction approximation (S-CI) and the correlation effects on (pi pi*) states were studied by including the most important doubly- and triply-excited configurations in the CI. The S-CI wavefunctions were used for the calculation of the most important electronic matrix elements for spin-orbit coupling. The photophysics of these compounds is discussed using Jablonski diagrams.

Asymmetrical distribution of beta-endorphin in cerebral hemispheres of suicides: preliminary data.

The assessment of beta-endorphin levels in several symmetrical brain regions of seven suicides and seven sudden death controls reveals a decreased concentration in the left temporal cortex, the left frontal cortex, and the left caudate nucleus of suicides compared to controls. Moreover, the comparisons of beta-endorphin concentrations in the symmetrical brain regions reveals an asymmetrical concentration in suicides (left less than right) in frontal cortex and caudate nucleus. These data confirm previous reports of abnormalities of neurochemical pathways in the brains of suicides and suggest that suicidal behavior might be related to the lateralized mechanisms of mood control.

Paths and impacts in the progressive independence model: a homelessness and substance abuse intervention in Chicago.

In an attempt to reduce homelessness and substance abuse, Chicago graduates of short-term inpatient substance abuse programs who lacked domiciles were placed into one of three conditions: (1) a case management only intervention (n = 96), (2) a case management with supported housing intervention (n = 136), or (3) a control condition (n = 187) that allowed access to normal aftercare in the community. The two treatment interventions used a "progressive independence" approach, which focuses on simultaneously ameliorating tangible needs and clinical problems. Multivariate analyses suggest that subjects in both treatment interventions experienced lower levels of substance abuse and higher levels of residential stability than subjects in the control condition, as measured over the course of a year. Further analysis suggests that retention was improved by the focus on immediate tangible resources, substance abuse was reduced by both the support of outpatient substance abuse treatment and the promulgation of changes in coping styles, and residential stability was increased by both the focus on access to income maintenance benefits and help with location of housing.

Validation of a computerised measurement system for guided routine evaluation of cardiovascular autonomic neuropathy.

A study for evaluating the use of the Cardionomic system was conducted in six Italian Centres for Diabetes. Cardionomic is a portable computerised system that is used for a guided step-by-step performance of several cardiovascular tests for autonomic neuropathy (heart rate and blood pressure). It has been compared to the traditional method using an electrocardiograph. In this study, which involved 74 diabetic patients, 392 cardiovascular tests were conducted with the electrocardiograph and 392 were done using the portable system. The results were compared to the results obtained with the ECG assuming the latter as the standard ones. All the indices of validity that were investigated (sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio) indicate that the proposed system is reliable. Because it saves a considerable amount of time and is also easy to use, it represents a valid alternative for the routine screening of autonomic neuropathy.

Rediffusion of nitrous oxide prevents increases in endotracheal tube cuff pressure.

An endotracheal tube designed to reduce nitrous oxide-induced intracuff pressure increases (Mallinckrodt Brandt rediffusion tracheal tube) and its relationship to nitrous oxide exposure was studied. Thirty-two subjects undergoing general anesthesia with endotracheal intubation used either a conventional endotracheal tube (Mallinckrodt Intermediate Hi-Lo) or a nitrous oxide rediffusion endotracheal tube (Mallinckrodt Brandt rediffusion). Intracuff pressures and nitrous oxide concentration were monitored continuously throughout surgery and recorded at 10-minute intervals for 50 minutes. The mean intratracheal cuff pressure in the rediffusion tube rose slightly from an initial 15.0 +/- 0.0 mmHg (mean +/- 1 SD) to 18.5 +/- 2.2 mmHg, which was less than in the conventional tube, 15.0 +/- 0.0 mmHg (initial) to 29.5 +/- 3.8 mmHg (50 minutes). Mean nitrous oxide concentration measured near the pilot balloon was 19.57 +/- 15.8 ppm with the conventional tube and 13.0 +/- 20.7 ppm with the rediffusion tube. Mean nitrous oxide concentration measured near the anesthetist's breathing area was 7.57 +/- 5.8 ppm with the conventional tube and 3.57 +/- 3.3 ppm in the rediffusion tube. All nitrous oxide concentration values remained within National Institute for Occupational Safety and Health recommendations (less than 25 ppm) and did not differ significantly between groups.

[The presence of asbestos on board ships: optical microscopy as a research instrument]. / Presenza di amianto sulle navi: microscopia ottica come strumento di indagine.

Identification of asbestos in many different kinds of bulk materials was performed by means of optical microscopy and the results are reported in the present paper. Some hundreds of various samples taken aboard ships were analysed: panels, laggings, spray insulations, etc. These analyses were required to be not only reliable but also rapid. The results demonstrated the high reliability as well as the rapidity of the technique. Using both the well-known dispersion staining technique (with central stop objectives or with dark field condensers) and phase-contrast analyses on the same polarizing microscope, we carried out numerous checks on the optical properties of the fibres. Not only were dispersion staining colours detected but also refractive index, elongation and extinction signs, in order to obtain an absolutely certain identification. The Italian laws which deal with the asbestos detection discourage the use of the optical microscope because of its presumed unreliability. This paper tends to demonstrate that Italian laws underestimate the potential of the optical microscope. Optical microscopy is probably the only technique that is reliable, inexpensive and rapid at the same time.

An alternative method of detecting dispersion staining colors for the determination of asbestos fibers in bulk materials.

Asbestiform mineral particles can be detected and identified by means of a polarized light microscope, making use of the dispersion staining technique. In order to obtain dispersion staining (central stop), che rays which pass undeviated through liquid and specimen must be stopped. A microscope objective can be fitted with a device which can insert a central stop on the objective back focal plane to prevent undeviated rays from reaching the objective. Alternatively, the sample can be observed in a conventional dark field set-up, that is, it can be illuminated by a hollow cone of light of greater aperture than the microscope objective so that only rays which are strongly deviated can enter the objective. The first method, proposed by McCrone and widely used in the USA, allows very bright and defined colors to be obtained but at the same time entails low resolution. The second method, recommended by italian regulations as a method that can be used in asbestos characterization, produces less defined and fainter colors. By suitably modifying the angular aperture of the illuminating cone and regulating the distance between condenser and specimen, good results were achieved: on the one hand a good image resolution were retained, on the other, the colors observed were bright and well defined. The detection of these colors can represent a fundamental step in the characterization of the specimen under analysis.

[Demographic balances, economic growth, and occupational resource needs in the Mediterranean countries from 1950 to 2000]. / Squilibri demografici, crescita economica e fabbisogno occupazionale nei paesi del Mediterraneo dal 1950 al 2000.

PIP: A general analysis of the demographic conditions prevailing in the countries bordering the Mediterranean is presented. The authors examine the demographic diversities among the countries concerned, the differences in levels of economic development, and the contrasts between manpower needs and resources.^ieng

Gravitational collapse on the brane: a no-go theorem.

We investigate how braneworld gravity affects gravitational collapse and black hole formation by studying Oppenheimer-Snyder-like collapse on a Randall-Sundrum-type brane. Without making any assumptions about the bulk, we prove a no-go theorem: the exterior spacetime on the brane cannot be static, which is in stark contrast with general relativity. We also consider the role of Kaluza-Klein energy density in collapse, using a toy model.

Homelessness and vulnerability among adults with and without alcohol problems.

While many works compare traits of homeless adults across levels of alcohol use, few specifically consider whether drinking status affects determinants of either homelessness or "vulnerability" to homelessness. This paper relies on a 1986 Chicago, Illinois sample (n = 535) to consider the potential contributions of resources, social network characteristics, disaffiliation, and mental health problems. Results suggest that resource problems may determine homelessness regardless of drinking status. But drinking-associated problems may raise the resource threshold for "vulnerability," reduce the protection afforded by social networks against both homelessness and "vulnerability," increase the deleterious impact of disaffiliation, and spur complicating mental health problems.

Impact of Travel-Related Health Impairments.

Background: Few recent data exist on the impact of travel-related health problems. Methods: A cohort study was conducted with follow-up by questionnaire of 2567 persons who had consulted the Zurich University Travel Clinic for travel health advice prior to visiting a developing country or eastern Europe. Of those questioned, 2109 (82.2%) could be evaluated. Results: More than one-third (800; 37.9%) had a health impairment, mainly illness leading to medical consultations in 224 (10.6%) individuals. Incapacitation was reported by 303 (14.4%) travelers, accounting for 2% of the total time abroad. The most frequent reasons for incapacitation were diarrhea and the common cold, particularly when accompanied by fever. Some 57 (7.1%) travelers consulted a doctor while abroad, and more than twice as many did so after returning home. Conclusions: This survey illustrates that despite efforts of travel medicine, the attack rate of health impairments remains virtually unchanged compared to 20 years ago. It provides one of the first overviews of incapacitation in travelers. To reduce the duration of incapacitation, one may wish to consider a travel kit which allows the patient self therapy for frequent and uncomplicated ailments.