Calibration-free parallel transmission of the cervical, thoracic, and lumbar spinal cord at 7T.

PURPOSE: To address the limitations of spinal cord imaging at ultra-high field (UHF) due to time-consuming parallel transmit (pTx) adjustments. This study introduces calibration-free offline computed universal shim modes that can be applied seamlessly for different pTx RF coils and spinal cord target regions, substantially enhancing spinal cord imaging efficiency at UHF. METHODS: A library of channel-wise relative B 1 + $$ {B}_1^{+} $$ maps for the cervical spinal cord (six datasets) and thoracic and lumbar spinal cord (nine datasets) was constructed to optimize transmit homogeneity and efficiency for these regions. A tailored B0 shim was optimized for the cervical spine to enhance spatial magnetic field homogeneity further. The performance of the universal shims was validated using absolute saturation based B 1 + $$ {B}_1^{+} $$ mapping and high-resolution 2D and 3D multi-echo gradient-recalled echo (GRE) data to assess the image quality. RESULTS: The proposed universal shims demonstrated a 50% improvement in B 1 + $$ {B}_1^{+} $$ efficiency compared to the default (zero phase) shim mode. B 1 + $$ {B}_1^{+} $$ homogeneity was also improved by 20%. The optimized universal shims achieved performance comparable to subject-specific pTx adjustments, while eliminating the need for lengthy pTx calibration times, saving about 10 min per experiment. CONCLUSION: The development of universal shims represents a significant advance by eliminating time-consuming subject-specific pTx adjustments. This approach is expected to make UHF spinal cord imaging more accessible and user-friendly, particularly for non-pTx experts.

How to increase COVID-19 vaccination among a population with persistently suboptimal vaccine uptake? Evidence from the North Macedonia mobile vaccination and public health advice caravan.

Over three years since the first COVID-19 vaccine was approved, many countries still have suboptimal vaccination rates despite holding great amounts of vaccines. Overall, there is little evidence on which policies are more effective to encourage vaccination, particularly in countries where a large share of the population remains unvaccinated. In this study, we examine the effectiveness of a community-based intervention carried out in March 2022 in North Macedonia, a country with a large and persistent share of the population that remains unvaccinated. The intervention, spearheaded by the Ministry of Health and supported by the World Health Organization and UNICEF, consisted of a mobile caravan offering vaccination and public health advice to different locations across the country on different days. Results from our staggered difference-in-difference model show that the mobile vaccination caravan increased daily vaccination rates by 7.7 vaccines per 100,000 inhabitants during the three weeks after the day of the caravan visit. This corresponds to a 35 % increase with respect to pre-intervention vaccination rates. We estimate a cost-effectiveness of 25.4 US dollars (USD) per additional vaccination induced. These results point to mobile caravan vaccines as an effective and cost-effective strategy to increase COVID-19 vaccination rates, even in a context of persistently suboptimal uptake.

Health and labor market effects of an unanticipated rise in retirement age. Evidence from the 2012 Italian pension reform.

As retirement ages increase around the world, not all workers may be equally able to extend their working lives. In this article, we examine the health and labor market effects of an Italian pension reform that suddenly increased the normal retirement age up to 7 years for women and up to 2 years for men. To do this, we use linked labor and healthcare administrative data, jointly with survey data and difference-in-difference methods. Our results show that the reform was effective in postponing retirement among both genders, as pension claiming dropped substantially for older workers. However, there were also side effects as the reform significantly pushed previously employed men and women into unemployment and disability pension. Among women only, the reform also increased sick leave and hospitalizations related to mental health and injuries. These effects were driven by women with previously low health status, suggesting that undifferentiated and abrupt increases in pension age might harm more vulnerable workers. Coherently with the milder tightening of retirement age experienced by men, labor market responses were smaller in size, and they did not suffer any significant health effects.

The far-right and anti-vaccine attitudes: lessons from Spain's mass COVID-19 vaccine roll-out.

BACKGROUND: Far-right politicians in several countries have been vocal opponents of COVID-19 vaccination. But can this threaten vaccine roll-out? METHODS: We take advantage of repeated cross-sectional surveys with samples of around 3800 individuals across Spain conducted monthly from December 2020 to January 2022 (n = 51 294) to examine any association between far-right politics and vaccine hesitancy through the whole vaccine roll-out. RESULTS: Consistent with prior data, we found that far-right supporters were almost twice as likely to be vaccine-hesitant than the overall population in December 2020, before vaccines became available. However, with a successful vaccine roll out, this difference shrank, reaching non-significance by September 2021. From October 2021, however, vaccine hesitancy rebounded among this group at a time when the leadership of the far-right promoted a 'freedom of choice' discourse common among anti-vax supporters. By the latest month analysed (January 2022), far-right voters had returned to being twice as likely to be vaccine-hesitant and 7 percentage points less likely to be vaccinated than the general population. CONCLUSIONS: Our results are consistent with evidence that far-right politicians can encourage vaccine hesitancy. Nonetheless, we show that public attitudes towards vaccination are not immutable. Whereas a rapid and effective vaccine rollout can help to overcome the resistance of far-right voters to get vaccinated, they also seem to be susceptible to their party leader's discourse on vaccines.

Do missing teeth cause early-onset cognitive impairment? Re-examining the evidence using a quasi-natural experiment.

PURPOSE: Multiple studies have reported a positive association between missing teeth and cognitive impairment. While some authors have postulated causal mechanisms, existing designs preclude assessing this. METHODS: We sought evidence of a causal effect of missing teeth on early-onset cognitive impairment in a natural experiment, using differential exposure to fluoridated water during critical childhood years (ages 5-20 years) in England as the instrument. We coded missing teeth from 0 (≤ 12 missing) to 3 (all missing) and measured the association with cognitive impairment in the English Longitudinal Study of Ageing data (2014-5), covering 4958 persons aged 50-70 years. RESULTS: We first replicated previous evidence of the strongly positive association of missing teeth with cognitive impairment (ß = 0.25 [0.11, 0.39]), after adjusting for socio-demographic covariates, such as age, gender, education, and wealth. Using an instrumental variable design, we found that childhood exposure to water fluoridation was strongly associated with fewer missing teeth, with being exposed to fluoridated water during childhood (16 years) associated with a 0.96 reduction in the missing teeth scale (ß = - 0.06 [- 0.10, - 0.02]). However, when using the instrumented measure of missing teeth, predicted by probability of fluoride exposure, we found that missing teeth no longer had an association with cognitive impairment (ß = 1.48 [- 1.22, 4.17]), suggesting that previous oral health-cognitive impairment associations had unobserved confounding. CONCLUSIONS: Our findings are consistent with the possibility that unobserved confounding leads to the oft-observed association between missing teeth and early-onset cognitive impairment, suggesting that the relationship is spurious rather than causal.

[Social valuation of the maternal lactation and difficulties that entails the precocious weaning in smaller infants]. / Valoración social de la lactancia materna y dificultades que conlleva el destete precoz en lactantes menores.

Breastfeeding provides all the nutrients to strengthen the immune system and the physical and mental development of the infant. It is exclusively recommended up to 6 months of age and prolonged up to two years. To increase the prevalence of breastfeeding, it must be valued by the breastfeeding women themselves. OBJECTIVES: To know the social valuation of the practice of breastfeeding and the diffi culties that influence the early weaning in infants from five regions of Chile. PATIENTS AND METHOD: This investigation was based on the interpretive paradigm, from a phenomenological approach with a qualitative methodology. Thirty-five breastfeeding mothers participated in a semi-structured inter view. The analytical strategy of grounded theory was used for the analysis. The qualitative data mana gement software Atlas Ti, 8 was used. RESULTS: It is evident that the social dimension and its categories (support network of the partner, family, and women of the family) are fundamental to maintaining EBF since weaning occurred when these were not available. CONCLUSIONS: Women perceive great value in the support networks of the partner, family, and female family members to maintain breast feeding. The breastfeeding process is a complex phenomenon and not without problems, which is highly influenced by the social dimensions that generate the possibility of maintaining breastfeeding until 6 months or longer or, on the contrary, they influence its suspension.

Effects of long-term care benefits on healthcare utilization in Catalonia.

This paper estimates effects of long-term care (LTC) benefits on utilization of primary and secondary healthcare in Catalonia (Spain). Identification comes from plausibly exogenous variation in the leniency of LTC needs assessment. We estimate that receiving LTC benefits worth 365 euros per month, on average, reduces the probability of avoidable hospital admissions by 66%, and has no significant effect on planned hospitalisations nor on hospitalisation for any reason. Receiving LTC benefits is estimated to reduce unscheduled primary care visits by 44% and has no significant effect on scheduled visits. These findings have important policy implications suggesting that allocating resources to LTC may not only increase the welfare of LTC beneficiaries but also reduce avoidable and unscheduled utilisation of healthcare.

Impact of COVID-19 lockdowns on mental health: Evidence from a quasi-natural experiment in England and Scotland.

The COVID-19 pandemic has been associated with worsening mental health but it is unclear whether this is a direct consequence of containment measures, like "Stay at Home" orders, or due to other considerations, such as fear and uncertainty about becoming infected. It is also unclear how responsive mental health is to a changing situation. Exploiting the different policy responses to COVID-19 in England and Scotland and using a difference-in-difference analysis, we show that easing lockdown measures rapidly improves mental health. The results were driven by individuals with lower socioeconomic position, in terms of education or financial situation, who benefited more from the end of the strict lockdown, whereas they suffered a larger decline in mental health where the lockdown was extended. Overall, mental health appears to be more sensitive to the imposition of containment policies than to the evolution of the pandemic itself. As lockdown measures may continue to be necessary in the future, further efforts (both financial and mental health support) are required to minimize the consequences of COVID-19 containment policies for mental health.

Effect of a national primary care reform on avoidable hospital admissions (2000-2015): A difference-in-difference analysis.

In 2006 a major primary care reform was initiated in Portugal. The most significant aspect of this reform was the creation of a new organizational model of primary care provision: Family Health Units (FHUs), consisting of small voluntarily constituted multidisciplinary teams that have functional autonomy and are partly financed through capitation and pay-for-performance. The creation of FHUs sought to increase access to care and to chronic disease management by improving the long-term relationship between health professionals and patients. The objectives of this study are to evaluate the impact of the FHUs implementation on population health outcomes, measured by the rate of hospitalizations for ambulatory care sensitive conditions (ACSC), i.e. avoidable hospital inpatient admissions, and to explore the effectiveness of the pay-for-performance in primary care by analysing the subset of disease specific hospitalizations for ACSC related to the financial incentives. Using data from 276 Portuguese municipalities from 2000 to 2015 (n = 4416) and exploiting the gradual introduction of the FHUs over time, we used a difference-in-differences approach contrasting the evolution of the hospitalization rate for ACSC in municipalities that implemented or not the FHUs. We then explored heterogeneous effects by incentivized (diabetes and hypertension) and non-incentivized disease-specific rates of hospitalizations for ACSC. During the period under analysis, 448 FHUs were created in 126 municipalities. No significant impact of the FHUs implementation on the reduction of the hospitalization rate for ACSC was found. This result also held for the incentivized hospitalizations for ACSC. We only found a statistically significant effect of the FHUs implementation in the reduction of one non-incentivized area (the rate of urinary tract infection ACSC). Our results question the capacity of this payment mechanism to achieve better health outcomes, and invites a more careful and evidence-based action toward its wider diffusion.

Tobacco control policies and smoking among older adults: a longitudinal analysis of 10 European countries.

BACKGROUND AND AIMS: The impact of tobacco control on European older adults has not been studied, despite evidence that smoking cessation at old age can bring significant life expectancy gains. Our aim was to evaluate the impact of tobacco control policies on smoking among older adults in Europe from 2004 to 2013. DESIGN: We used longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE, aged 50+ years) from four waves from 2004 to 2013. We used logistic regression models with clustered standard errors to determine whether the implementation of tobacco control policies was associated with changes in smoking status. Furthermore, we studied whether these associations varied by socio-demographic characteristics. Regression coefficients were converted to changes the probability of smoking [marginal effects (ME)]. MEASUREMENTS: Smoking status was the dependent variable, and the Tobacco Control Scale (TCS) was the explanatory variable, overall and by its main policy components (pricing and smoke-free policies). Covariates included age, sex, education and country and wave fixed-effects. FINDINGS: A 10-point increase in TCS was associated with a lower probability of smoking by 1.6 percentage points [95% confidence interval (CI) = -3.208, -0.056] for those aged 50-65, but not for older Europeans. Among those with primary school or no education, the associated drop was of 1.5 percentage points (95% CI = -2.751, -0.253). By contrast, no significant relation between TCS and smoking was observed among those with high education. Higher TCS scores for pricing (ME = -0.636, 95% CI = -0.998, -0.275) and smoke-free policies (ME = -0.243, 95% CI = -0.445, -0.041) were associated with a significantly lower probability of smoking (P = 0.001 and P = 0.018, respectively). CONCLUSION: Increases in tobacco taxes and smoke-free policies are significantly related with a reduction in smoking among European older adults, suggesting potential health gains for this rising share of the population. These policies may be more effective among the lowest educated.

Ageing under unequal circumstances: a cross-sectional analysis of the gender and socioeconomic patterning of functional limitations among the Southern European elderly.

BACKGROUND: In a context of population ageing, it is a priority for planning and prevention to understand the socioeconomic (SE) patterning of functional limitations and its consequences on healthcare needs. This paper aims at measuring the gender and SE inequalities in functional limitations and their age of onset among the Southern European elderly; then, we evaluate how functional status is linked to formal and informal care use. METHODS: We used Portuguese, Italian and Spanish data from the Survey of Health, Ageing and Retirement in Europe (SHARE) of 2011 (n = 9233). We constructed a summary functional limitation score as the sum of two variables: i) Activities of Daily Living (ADL) and ii) Instrumental Activities of Daily Living (IADL). We modelled the functional limitation as a function of age, gender, education, subjective poverty, employment and marital status using multinomial logit models. We then estimated how functional limitation affected informal and formal care demand using negative binomial and logistic models. RESULTS: Women were 2.3 percentage points (pp) more likely to experience severe functional limitation than men, and overcame a 10% probability threshold of suffering from severe limitation around 5 years earlier. Subjective poverty was associated with a 3.1 pp. higher probability of severe functional limitation. Having a university degree reduced the probability of severe functional limitation by 3.5 pp. as compared to none educational level. Discrepancies were wider for the oldest old: women aged 65-79 years old were 3.3 pp. more likely to suffer severe limitations, the excess risk increasing to 15.5 pp. among those older than 80. Similarly, educational inequalities in functional limitation were wider at older ages. Being severely limited was related with a 32.1 pp. higher probability of receiving any informal care, as compared to those moderately limited. Finally, those severely limited had on average 3.2 hospitalization days and 4.6 doctor consultations more, per year, than those without limitations. CONCLUSION: Functional limitations are unequally distributed, hitting women and the worse-off earlier and more severely, with consequences on care needs. Considering the burden on healthcare systems and families, public health policies should seek to reduce current inequalities in functional limitations.

Carcinoma indiferenciado de trompa / Undifferentiated carcinoma of the fallopian tube

La neoplasia primaria de trompa de Falopio es una entidad poco frecuente. El diagnóstico preoperatorio es difícil y en muchas ocasiones es un hallazgo intraoperatorio o un diagnóstico histopatológico. Presentamos un caso de cáncer primario de trompa en una mujer de 61 años con algias pélvicas de un mes de evolución, masa pélvica izquierda dolorosa y Ca 125 elevado. Las pruebas diagnósticas fueron compatibles con patología uterina maligna (sarcoma uterino) o patología neoplásica ovárica izquierda con infiltración uterina como segunda posibilidad. El resultado histológico fue de carcinoma indiferenciado de trompa izquierda que infiltra pared uterina en cuerpo y cérvix. Actualmente, la paciente se encuentra sometida a tratamiento quimioterápico (AU)

Primary carcinoma of the fallopian tube is a rare entity. Preoperative diagnosis is difficult and these tumors are usually detected during surgery or on histopathological examination. We describe the case of a 61-year-old woman with pelvic pain, left adnexal mass and elevated Ca125 levels. Diagnostic tests were compatible with uterine sarcoma or primary left ovarian carcinoma with uterine invasion. Histopathological analysis showed a primary undifferentiated carcinoma of the left fallopian tube involving the uterus and cervix. The patient is currently undergoing chemotherapy (AU)

Recombinant Candida rugosa lipase 2 from Pichia pastoris: immobilization and use as biocatalyst in a stereoselective reaction.

The characterization of the recombinant Candida rugosa Lip2 (r-Lip2) isoenzyme obtained from fed-batch cultures of Pichia pastoris under PAOX promoter was carried out, determining the optimal pH and temperature as well as their catalytic performance in both hydrolysis and synthesis reactions comparing with purified native Lip2 (n-Lip2) previously determined. The substrate specificity of r-Lip2 in hydrolysis reactions was determined with a series of triacylglycerols and p-nitrophenyl esters of variable acyl chain length. r-Lip2 showed the maximum specificity for both substrates towards medium-chain esters (C-8), similar behavior was observed with n-Lip2. However, significant differences were observed towards unsaturated substrates (triolein) or short-chain esters. A statistical design applied to study the effect of pH and temperature on lipase stability shown that r-Lip2, like n-Lip2, was more sensitive to pH than temperature changes. Nevertheless, the overall stability of soluble r-Lip2 was lower than soluble n-Lip2. The stability of r-lip2 was significantly improved by immobilization onto EP100, an excellent support for lipases with yields around 95% for offered lipolytic activity lower than 600 AU/mL. Finally, immobilized r-Lip2 was tested in the resolution of ibuprofen in isooctane by means of enantioselective esterification using 1-butanol as esterifying agent. r-Lip2 showed a better performance in terms of enantiomeric excess (74%) and enatiomeric factor (96%) than n-Lip2 (56 and 80%, respectively) for the same conversion (40%). Thus, r-Lip2 should be considered a good and pure biocatalyst, easy to produce and with a remaining activity of ca. 90% after one reaction cycle when immobilized on EP100.

Effect of ammonia on the methanogenic activity of methylaminotrophic methane producing Archaea enriched biofilm.

Ammonia is a metabolic product in the decomposition of protein wastes, and has a recognized inhibitory effect on methanogenesis; this effect has been slightly quantified on methanogenic biofilms and particularly those populated by methanogenic Archaea which produce ammonia as a catabolic product from methylated amines. This paper presents studies on the effect of ammonia on maximum methanogenic activity of anaerobic biofilms enriched by methylaminotrophic methane producing Archaea (mMPA). The effect of unionized free ammonia on the specific maximum methanogenic activity of a mMPA enriched biofilm was studied, using 250 mL flasks containing ceramic rings colonized by 30 day-old experimental biofilm and adding 48.8 (control system), 73.8, 98.8, 148.8, 248.8, 448.8 and 848.8 mg NH(3)-N/L. The systems were maintained for ten days at a pH of 7.5 and temperature of 37 degrees C. The results showed that at 848.8 mg NH(3)-N/L, biofilm methane production required 36 h adaptation period, prior to entering into maximum production phase. The highest maximum methanogenic activity reached a value of 2.337+/-0.213 g COD methane/g VSS *day when 48.8 mg NH(3)-N/L was added, and inhibition was clearly observed in those systems above 148.8 mg NH(3)-N/L, producing under 1.658+/-0.185 g COD methane/g VSS *day. The lowest methanogenic activity reached was 0.639+/-0.162 g COD methane/g VSS *day at the system added with 848.8 mg NH(3)-N/L. When applying the Luong and non-competitive inhibition models, the best fit was obtained with the non-competitive model, which predicted 50% inhibition of methanogenic activity at 365.288 mg NH(3)-N/L.

El puesto de socorro de la Legión en Kosovo / First-aid post of the Kosovo Legion

Se expone la actividad desarrollada por el Puesto de Socorro de una unidad tipo batallón desplegada en Kosovo, en el marco de la intervención internacional posterior a la pacificación del territorio. Se formulan propuestas de cambio en la preparación de las misiones y en la dotación de material sanitario (AU)

Manejo anestésico de fisura de labio-paladar. Revisión de 3 años en el Hospital ABC / A review of the anesthetic management of the cleft lip in ABC Hospital, Mexico: Experience

La frecuencia de fisura de labio es de 1:1000; mientras que la de paladar es de 1:2500. Nosotros presentamos un estudio retrospectivo analizando la técnica utilizada, la evolución y las complicaciones, durante los últimos 3 años en el Hospital ABC. Material y Métodos: se revisaron 327 expedientes del programa de "Operación Sonrisa" de Brimex del Hospital ABC de enero de 1994 a diciembre de 1996. Se incluyeron expedientes completos de pacientes de 3 meses hasta 21 años, analizando únicamente 84 expedientes. Resultados: la edad promedio para la cirugía de fisura de labio es a los 45.11 meses, mientras que para la de paladar es a los 52.25 meses. Se realiza una comparación de las diferentes técnicas anestésicas utilizadas en los últimos tres años. Conclusión: la técnica anestésica ha mejorado, la vigilancia perioperatoria es la clave para evitar complicaciones y la valoración preanestésica es de suma importancia para detectar cualquier anomalía asociada