Healthcare workforce equity for health equity: An overview of its importance for the level of primary health care.

BACKGROUND: Healthcare workforce crises often stem from healthcare workers' inequities. This study provides an overview of the main PHC workforce policy questions related to health equity, offering examples of evidence necessary to support the implementation of policies and strategies that increase equity in the health workforce and access to the PHC workforce and services. METHODS: The equity-related policies in PHC and workforce were linked with the indicators listed in the Global Health Workforce Network Data and Evidence Hub and guidelines for health workforce management. RESULTS: The policy-relevant questions in PHC cover many workforce issues such as the optimal size, equitable distribution, relevant competencies to ensure equitable healthcare access, and equitable approaches for retention, training, recruitment, benefits and incentive schemes and governance. This will require intersectionality evidence of the optimised staffing to PHC workload, that PHC practitioners' training demonstrates evidence-based knowledge aligned with locally relevant expertise. CONCLUSION: Critical for equitable PHC access and health equity is the establishment of efficient measurement of PHC workforce equity and its implications for population health. Using indicators that measure health and workforce equity in research, policy, and practices may improve recruitment and retention, and respond more effectively to the PHC workforce crises.

[Management of nipple-areolar complex anomalies]. / Comment j'explore une atteinte de la plaque aréolo-mamelonnaire.

Nipple-areolar complex anomalies may be secondary to many etiologies from simple anatomic variations to malignant processes as Paget disease or invasive breast cancer, passing through benign locally aggressive processes as erosive adenomatosis of the nipple. Differential diagnosis is not always simple. If clinical exam and standard radiological checkup can't confirm the benignity of the lesion, a biopsy specimen will be obtained to allow an anatomopathological examination. A precise diagnosis can then be made leading to optimal management. This paper describes how to explore nipple-areolar complex anomalies through an uncommon clinical case associating independently an invasive retro-areolar cancer and a dermatological disease of the areola mimicking a Paget disease.

Les anomalies de la plaque aréolo-mamelonnaire peuvent être secondaires à de nombreuses étiologies, allant de simples variantes anatomiques à des pathologies malignes telles que la maladie de Paget ou un cancer invasif, tout en passant par des pathologies bénignes localement agressives comme l'adénomatose érosive du mamelon. Le diagnostic différentiel n'est pas toujours aisé. Si l'examen clinique et le bilan radiologique standard ne permettent pas d'affirmer la bénignité de la lésion, un prélèvement biopsique sera réalisé afin de permettre une analyse anatomopathologique. Un diagnostic précis pourra alors être posé pour guider la prise en charge optimale. Cet article a pour but de détailler la mise au point d'une atteinte de la plaque aréolo-mamelonnaire par l'intermédiaire d'un cas clinique peu fréquent associant de manière indépendante un cancer invasif rétro-aréolaire et une atteinte dermatologique de l'aréole mimant une maladie de Paget.

[Odontogenic myxoma in children : an exceptional locally aggressive lesion]. / Myxome odontogénique chez l'enfant : une lésion exceptionnelle, localement destructrice.

Odontogenic myxoma is a histologically benign and aggressive tumour of the maxillofacial region. It mainly affects young adults and remains exceptional in children. Due to its local invasive nature, it is difficult to differentiate this tumour from malignant neoplasma and from other destructive odontogenic benign tumours. Imaging plays an essential role in the initial exploration and follow-up. Its management is still a challenge today, due to its aggressive potential and its significant risk of recurrence in children among whom extensive surgical treatment involves significant morbidity in children.

Le myxome odontogénique est une tumeur histologiquement bénigne, mais très agressive, de la région maxillo-faciale, touchant principalement le jeune adulte. Elle est exceptionnelle chez l'enfant. De par son caractère invasif locorégional, elle est difficilement différentiable des tumeurs malignes et des autres tumeurs bénignes odontogéniques destructrices. L'imagerie tient un rôle essentiel dans le bilan d'exploration initiale et de suivi de cette lésion. Sa prise en charge chez l'enfant reste encore aujourd'hui un défi, compte tenu de son potentiel agressif et donc de son risque de récidive chez un être en croissance chez lequel une exérèse chirurgicale élargie comporte une morbidité importante.

Measuring Topological Invariants in a Polaritonic Analog of Graphene.

Topological materials rely on engineering global properties of their bulk energy bands called topological invariants. These invariants, usually defined over the entire Brillouin zone, are related to the existence of protected edge states. However, for an important class of Hamiltonians corresponding to 2D lattices with time-reversal and chiral symmetry (e.g., graphene), the existence of edge states is linked to invariants that are not defined over the full 2D Brillouin zone, but on reduced 1D subspaces. Here, we demonstrate a novel scheme based on a combined real- and momentum-space measurement to directly access these 1D topological invariants in lattices of semiconductor microcavities confining exciton polaritons. We extract these invariants in arrays emulating the physics of regular and critically compressed graphene where Dirac cones have merged. Our scheme provides a direct evidence of the bulk-edge correspondence in these systems and opens the door to the exploration of more complex topological effects, e.g., involving disorder and interactions.

Semi-Dirac Transport and Anisotropic Localization in Polariton Honeycomb Lattices.

Compression dramatically changes the transport and localization properties of graphene. This is intimately related to the change of symmetry of the Dirac cone when the particle hopping is different along different directions of the lattice. In particular, for a critical compression, a semi-Dirac cone is formed with massless and massive dispersions along perpendicular directions. Here we show direct evidence of the highly anisotropic transport of polaritons in a honeycomb lattice of coupled micropillars implementing a semi-Dirac cone. If we optically induce a vacancylike defect in the lattice, we observe an anisotropically localized polariton distribution in a single sublattice, a consequence of the semi-Dirac dispersion. Our work opens up new horizons for the study of transport and localization in lattices with chiral symmetry and exotic Dirac dispersions.

[Exploration of destructive lesions of the jaws]. / Comment j'explore... Les lésions destructrices des mâchoires.

The destructive lesions of the jaws destroying the normal bone structure with involvement of the cortex are mostly diagnosed incidentally during a dental examination. or imaging examination for another pathology. The rest of the time they are suspected in front of an aesthetic deformation of the face, in particular of the cheek or the chin. In order to explore these lesions we use the Panoramic Radiography, Computed Tomography (CT) without and with intravenous injection of contrast medium, Cone Beam Computed Tomography (CBCT) and nuclear Magnetic Resonance Imaging (MRI). This article aims to determine the diagnostic range of destructive lesions of the jaws by CT, especially by CBCT, and to propose a diagnostic algorithm according to the circumstances of discovery of these lesions.

Les lésions destructrices des mâchoires, c'est-à-dire des lésions détruisant la structure osseuse normale avec atteinte de la corticale, sont, la plupart du temps, diagnostiquées de manière fortuite lors d'une exploration dentaire ou d'un examen d'imagerie réalisé pour une autre pathologie. Le reste du temps, elles sont suspectées à cause d'une déformation esthétique de la face, en particulier de la joue ou du menton. Afin d'explorer ces lésions, on utilise la radiographie panoramique dentaire, la tomodensitométrie (TDM), sans et avec injection intraveineuse de produit de contraste, la cone-beam tomographie computérisée (CBCT), et l'imagerie par résonance magnétique nucléaire (RMN). Cet article a pour objectif de déterminer la gamme diagnostique des lésions destructrices des mâchoires par la TDM, surtout par le CBCT, et de proposer un algorithme diagnostique en fonction des circonstances de découverte de ces lésions.

[Contribution of medical imaging in the study of complications of kidney transplant]. / Apport de l'imagerie médicale dans l'étude des complications du rein transplanté.

The role of medical imaging is of major impor¬tance in the follow-up of patients with kidney transplant.There as many and various renal transplant complications. The development of techniques in medical imaging, especially the progression of clinical and biological monitoring improve their detection. In this article, we will remind the diverses complications of renal transplant and their expression in the various imaging modalities, including Doppler ultrasound which remains the principal examination modality.

Le rôle de l'imagerie médicale est primordial dans le suivi des patients greffés rénaux. Les complications du greffon rénal sont diverses et nombreuses. L'avancée des techniques en imagerie dans les dernières décennies, surtout couplée au progrès du suivi clinico-biologique, a permis d'améliorer le seuil de détection de ces complications. Nous rappellerons, dans cet article, les complications du rein transplanté ainsi que leur expression dans les différentes modalités d'imagerie, notamment l'échographie couplée au doppler qui reste l'examen de référence pour cette étude.

[Follow-up of kidney transplant by medical imaging techniques]. / Comment j'explore Suivi d'un rein greffé par l'imagerie médicale.

There are few hospitals performing kidney transplantation. Thereby the residency in radiodiagnostics does not allow to master the essential skills of follow up kidney transplantation except in the case of staying in such a transplantation center. Furthermore, in the last 20 years the scientific publications related to kidney transplantation were of 31.001 all medical disciplines combined, from which only 1730 (5,6x%) focused on medical imaging. In the same period in medical journals focused on radiology, there was 216.661 articles from which 642 (0,3x%) about kidney transplantation. Even the development of new medical imaging techniques did not contribute to clinical practice in a meaningful way. Here we will make a reminder of medical imaging techniques and their indications in the follow-up after transplantation, emphasizing the contribution of standard ultrasound and doppler.

Rares sont les centres hospitaliers pratiquant la transplantation rénale. De ce fait, la spécialisation en radiodiagnostic ne permet pas d'apprendre à maîtriser les techniques indispensables au suivi du rein greffé, sauf dans le cas du passage des assistants cliniques par un centre de référence. De plus, dans les 20 dernières années, les publications scientifiques se rapportant au rein greffé ont été de 31.001, toutes disciplines médicales confondues dont 1.730 (5,6x%) focalisées sur l'imagerie. Durant la même période, dans les journaux axés sur l'imagerie, il y a eu 216.661 articles dont 642 (0,3x%) sur le transplant rénal. Même le développement de nouvelles techniques en imagerie n'a pas contribué à la pratique clinique d'une manière significative. Dès lors, on fera un rappel des techniques d'imagerie médicale et de leurs indications dans le suivi post-opératoire du greffon, en insistant surtout sur l'apport de l'échographie standard et du doppler.

Association between non-communicable disease multimorbidity and health care utilization in a middle-income country: population-based study.

OBJECTIVE: The objective was to analyze possible inequalities by gender in the utilization of health services (general practitioner [GP] and hospital), among people with non-communicable diseases (NCDs) in the Republic of Serbia, with special reference to multimorbidity. In addition, we examined the prevalence patterns of NCDs by sociodemographic characteristics of the population. STUDY DESIGN: This study is a population-based, cross-sectional survey. METHODS: A secondary analysis from the 2013 Serbian National Health Survey included 13,765 adults aged ≥20 years. Multivariable logistic and linear regression analyses were performed to assess the association between NCDs and health care utilization. RESULTS: Multimorbidity was present in 30.2% of the total sample. An increased number of NCDs was associated with a higher utilization of both primary (odds ratio [OR] for having any GP visit is 3.17 in males and 3.14 in females; unstandardized coefficient [B] for number of GP visits is 0.33 for both gender) and secondary health care services (OR for having any hospitalization is 2.45 in males and 1.97 in females; B for number of overnight stays in hospital is 1.62 in males and 0.97 in females) in Serbia. CONCLUSIONS: Our study provided strong evidence that an increased number of NCDs was significantly associated with a higher utilization of health care services in Serbia. There is a need for wise, decisive, and integrated care interventions for effective management of NCDs and their risk factors. Further research is necessary with special emphasis on the role of the health system in satisfying needs of such patients.

Case-series study of hepatic echinococcal cysts in Serbia: viability of scolices, seropositivity and epidemiological characteristics.

Cystic echinococcosis (CE) is an endemic helminthic disease caused by infection with Echinococcus granulosus metacestodes. Although CE is endemic in the Balkan region, the exact epidemiology remains unknown. We conducted a case-series study with the aim of evaluating the correlation between seropositivity, socio-epidemiological data, pre-operative treatment with albendazole and viability of protoscolices in human hepatic hydatid cysts. Consecutive patients with hepatic CE underwent surgery to extract E. granulosis cysts. The viability of protoscolices was measured by their ability to absorb 0.1% eosin. Socio-epidemiological data were collected and serological testing was performed. In the present study, 38 patients (28 adults and 10 children) with hepatic CE were treated surgically. The scolex viability test was positive in 30/38 (79%) samples. All patients with non-viable cysts had seronegative results. The viability test was positive in 11/12 (91.6%) adult patients with pre-operative albendazole treatment and in 9/10 (90%) children. Statistically more patients were from an urban area compared with a rural area (65.8% vs. 15.7%). The increasing number of stray dogs shedding E. granulosus eggs in urban public areas in the Balkans might be the reason for the significant difference in the rate of infection between urban and rural areas in the present study. In addition, uncontrolled slaughtering of livestock, common in rural settlements, and feeding the infected viscera to dogs, favour the maintenance of the parasite cycle. We believe that the results of our study will encourage physicians, veterinarians and health authorities to initiate a programme to prevent and control CE in the Balkan region.

[Cone Beam CT New tool in diagnostic imaging]. / Comment j'explore... Cone Beam CT Nouvel outil dans l'imagerie diagnostique.

The goal of this article is to show the advantages of the Cone Beam Computerized Tomography (CBCT) compared to classical Computerized Tomography (CT) and to describe several clinical applications of interest with this rather new technology. Invented practically for dentistry, in particular in implantology, the CBCT found major indications in paranasal sinus imaging, in maxillofacial and oral surgery, in periodontology, endodontics and orthodontics. CBCT is very useful to characterize various lesions of jaws with a reserve concerning the study of soft tissues (in that case, an MRI or CT with contrast injection should be preferred). Recently, CBCT is more and more used for temporal bone imaging and studies of small peripheral articulations.

Le but de cet article est de présenter les avantages de la tomographie computérisée à faisceau conique (CBCT) par rapport à la tomographie computérisée (CT) classique et de rapporter quelques applications cliniques. Inventé pratiquement pour les dentistes, en particulier pour l'implantologie, le CBCT a trouvé une indication incontournable dans l'imagerie des sinus, de la chirurgie maxillo-faciale et orale, en parodontologie, endodontie et orthodontie. Le CBCT s'est avéré utile également dans l'imagerie des lésions de différentes origines des mâchoires avec, toutefois, une réserve concernant le bilan d'atteinte des tissus mous (dans ce cas, une IRM - ou un CT avec injection de produit de contraste - serait préférable). Dernièrement, l'application du CBCT s'est élargie à l'imagerie du rocher et, même, des petites articulations des extrémités.

[Mixed radiopaque and radiolucent jaw lesions]. / Lésions mixtes des mâchoires, radio-opaques et radiotransparentes.

Neoplasic and non neoplasic lesions of the jaws are regularly classified as radiopaque or radiolucent, odontogenic or not odontogenic.However, a significant number of pathologies can be classified as mixed or are initially radiolucent to later become radiopaque or mixed. Certain diseases present different stages of development that are radiolucent, radio opaque or mixed. The purpose of this article is to provide a better understanding of the imaging of these lesions based on a literature review ,and illustrated by personal clinical observations.

Les lésions néoplasiques et non néoplasiques des mâchoires sont généralement classifiées comme radio-opaques ou radio-transparentes, odontogènes ou non odontogènes. Toutefois, il existe un nombre significatif de pathologies qui peuvent être classifiées comme étant mixtes ou qui, au départ, sont radio-transparentes et deviennent ultérieurement radio-opaques ou mixtes. Certaines pathologies s'expriment en différents stades de développement qui sont radio-transparents, radio-opaques ou mixtes. Le but de cet article est d'apporter une meilleure compréhension de l'imagerie de ces lésions, fondée sur une revue de la littérature, illustrée par des images de cas cliniques personnels.

Orbital Edge States in a Photonic Honeycomb Lattice.

We experimentally reveal the emergence of edge states in a photonic lattice with orbital bands. We use a two-dimensional honeycomb lattice of coupled micropillars whose bulk spectrum shows four gapless bands arising from the coupling of p-like photonic orbitals. We observe zero-energy edge states whose topological origin is similar to that of conventional edge states in graphene. Additionally, we report novel dispersive edge states in zigzag and armchair edges. The observations are reproduced by tight-binding and analytical calculations, which we extend to bearded edges. Our work shows the potentiality of coupled micropillars in elucidating some of the electronic properties of emergent two-dimensional materials with orbital bands.

Do health care workforce, population, and service provision significantly contribute to the total health expenditure? An econometric analysis of Serbia.

BACKGROUND: In times of austerity, the availability of econometric health knowledge assists policy-makers in understanding and balancing health expenditure with health care plans within fiscal constraints. The objective of this study is to explore whether the health workforce supply of the public health care sector, population number, and utilization of inpatient care significantly contribute to total health expenditure. METHODS: The dependent variable is the total health expenditure (THE) in Serbia from the years 2003 to 2011. The independent variables are the number of health workers employed in the public health care sector, population number, and inpatient care discharges per 100 population. The statistical analyses include the quadratic interpolation method, natural logarithm and differentiation, and multiple linear regression analyses. The level of significance is set at P < 0.05. RESULTS: The regression model captures 90 % of all variations of observed dependent variables (adjusted R square), and the model is significant (P < 0.001). Total health expenditure increased by 1.21 standard deviations, with an increase in health workforce growth rate by 1 standard deviation. Furthermore, this rate decreased by 1.12 standard deviations, with an increase in (negative) population growth rate by 1 standard deviation. Finally, the growth rate increased by 0.38 standard deviation, with an increase of the growth rate of inpatient care discharges per 100 population by 1 standard deviation (P < 0.001). CONCLUSIONS: Study results demonstrate that the government has been making an effort to control strongly health budget growth. Exploring causality relationships between health expenditure and health workforce is important for countries that are trying to consolidate their public health finances and achieve universal health coverage at the same time.

[How I EXPLORE ... SIGMOID VOLVULUS]. / COMMENT J'EXPLORE.... un volvulus du sigmoïde: le rôle du radiologue.

Sigmoid volvulus is a significant cause of bowel obstruction and will become a major cause in the future given its prevalence in the elderly and/or institutionalized patients. Furthermore that's the first cause of bowel obstruction in pregnant women. Given it's a non specific clinical presentation, the clinician has to do complementary exams, above all the x ray examinations. So, the role of radiologist is primordial in diagnostic, sometimes in the treatment given important morbidity and mortality of this pathology. We bring you here a typical case of sigmoid volvulus in 60 years old patient seen in emergency department for bloating and vomiting since several days.

Determinants of intention to work abroad of college and specialist nursing graduates in Serbia.

BACKGROUND: In a country with a poor economy and limited job opportunities, the outmigration of students is not commonly perceived as a problem but rather is perceived as a solution to the high unemployment facing young health professionals. OBJECTIVES: Study objectives were to identify the prevalence of intention to work abroad of nursing graduates to point to the predictors of intention to work abroad and predictors of having a firm plan to work in a foreign country. DESIGN: Descriptive study, a survey. SETTINGS: College and specialist nursing schools, Serbia. PARTICIPANTS: 719 nursing graduates from the 2012/2013 school year. METHODS: Voluntarily completed a questionnaire that was designed with regard to similar surveys administered in EU-candidate countries during the pre-accession period. Data were analysed with descriptive and multivariate regression analyses. RESULTS: Almost 70% (501) of respondents indicated an intention to work abroad. Of the nurses, 13% already had established a firm plan to work abroad. Single graduates and those with a friend or relative living abroad were more likely to consider working abroad than were their counterparts (odds ratios were 2.3 and 1.7, respectively). The likelihood of considering working abroad decreased by 29% when the individuals' financial situation was improved. Factors associated with having a firm plan were previous professional experience in a foreign country, having someone abroad and financial improvement (5.4 times, 4.8 times and 2 times greater likelihood, respectively). CONCLUSIONS: The high prevalence of intention to work abroad suggests the need to place the issue of the out-migration of nursing graduates on the policy agenda. College and specialty nursing graduates and health technicians are prepared to work abroad in search of a better quality of life, better working conditions and higher salaries.

Prediction of difficulties in laparoscopic cholecystectomy on the base of routinely available parameters in a smaller regional hospital.

BACKGROUND: Identification of preoperative factors that indicate difficulties in the operation are in the function of primary prevention of intraoperative complications and require selection of an experienced surgical team, planning of operating program and timely provision of information to patients about the increased likelihood of conversion. AIM: Identification of preoperative factors of operative difficulties by analysis of routine clinical parameters. PATIENTS AND METHODS: A prospective cohort study of patients who underwent laparoscopic cholecystectomy from February 2005 to December 2009. All patients were operated by the same surgeon. There were 369 operated patients. Conversion was done in 10 patients. Main outcome measures were: duration of stages of laparoscopic cholecystectomy and conversion; identification of predictive parameters; assessment of their predictive value; assessment of the predictive value of individual parameters in respect to the duration of stages of laparoscopic cholecystectomy; correlation of parameter predictive value and duration of laparoscopic cholecystectomy stage. RESULTS: Multivariate stepwise linear regression analysis showed that previous history of acute cholecystitis, gallbladder wall thickness ˃ 4 mm, acute cholecystitis to admission, size of calculus > 2 cm, > 5 attacks of pain that lasted longer of 4 hours, diabetes mellitus, duration of symptoms longer then 36 months and pericholecystic fluid collection were significant for prediction of difficulties of laparoscopic cholecystectomy. CONCLUSIONS: Based on clinical, laboratory and ultrasonographic parameters without the use of highly sophisticated diagnostic procedures and increasing medical costs it is possible to predict difficulties in the laparoscopic cholecystectomy.