Physician density: will we ever close the gap?

OBJECTIVE: Physician density is a crucial element of a well-functioning health system. Previous research has investigated factors affecting country-level physician supply. To date, however, no evidence has been provided about the patterns of convergence in physician density among countries. This paper thus tested club convergence in physician density in 204 countries worldwide from 1990 to 2019. A nonlinear time-varying factor model was adopted to identify potential clubs, wherein groups of countries tend to converge towards the same level of physician density. Our primary purpose was to document the potential long-lasting disparity in future global physician distribution. RESULTS: Despite physician density increasing in all regions globally from 1990 to 2019, we found no evidence in favor of the hypothesis of global convergence. Conversely, the clustering algorithm successfully identified three main patterns (i.e., three final clubs). With few exceptions, the results indicated an uneven physician distribution between the majority of North and Sub-Saharan African countries (where physician density would remain well below the estimated threshold of at least 70% of the Universal Health Coverage Services Index) and the rest of the world. These findings support the WHO's global strategy to reverse the chronic under-investment in human resources for health.

Testing Club Convergence in Female Smoking Prevalence.

In this paper, we applied the concept of convergence to examine the evolution of smoking prevalence among women in 191 countries worldwide from 1990 to 2019. First, the non-linear time-varying factor model proposed by Phillips and Sul was adopted to identify potential clusters (clubs), wherein groups of countries converge to similar female smoking rates. Second, an ordered logit regression model was used to assess the impact of cigarette affordability on the probability of falling within a given cluster. The hypothesis of global convergence was rejected. However, the clustering algorithm successfully identified five and nine clubs, within countries with increasing and decreasing smoking prevalence, respectively. A higher relative income-price ratio (i.e., lower cigarette affordability) increased the likelihood of belonging to a club of countries with a low prevalence of female tobacco smoking.

Does the Prevalence of Obesity Affect the Demand for Soft Drinks? Evidence from Cross-Country Panel Data.

The impact of soft drinks on obesity has been widely investigated during the last decades. Conversely, the role of obesity as a factor influencing the demand for soft drinks remains largely unexplored. However, understanding potential changes in the demand for soft drinks, as a result of changes in the spread of obesity, may be useful to better design a comprehensive strategy to curb soft drink consumption. In this paper, we aim to answer the following research question: Does the prevalence of obesity affect the demand for soft drinks? For this purpose, we collected data in a sample of 97 countries worldwide for the period 2005-2019. To deal with problems of reverse causality, an instrumental variable approach and a two-stage least squares method were used to estimate the impact of the age-standardized obesity rate on the market demand for soft drinks. After controlling for several demographic and socio-economic confounding factors, we found that a one percent increase in the prevalence of obesity increases the consumption of soft drinks and carbonated soft drinks by about 2.37 and 1.11 L per person/year, respectively. Our findings corroborate the idea that the development of an obesogenic food environment is a self-sustaining process, in which obesity and unhealthy lifestyles reinforce each other, and further support the need for an integrated approach to curb soft drink consumption by combining sugar taxes with bans, regulations, and nutrition education programs.

Is the development of obesogenic food environments a self-reinforcing process? Evidence from soft drink consumption.

BACKGROUND: Understanding how the development of obesogenic food environments and the consumption of ultra-processed foods and beverages influence each other can help policymakers to identify effective ways to curb the current obesity epidemic. This paper was designed to investigate whether, and to what extent, the consumption of soft drinks and the prevalence of obesity are linked through feedback effects. METHODS: An ecological study design and a simultaneous equation model were used to investigate the existence of a vicious cycle between the consumption of soft drinks and the prevalence of obesity. The analysis was based on a longitudinal dataset covering per capita sales of soft drinks, the age-standardised prevalence rate of obesity and several demographic and socio-economic control variables in a sample of 98 countries worldwide for the period 2005-2019. RESULTS: Using a Two-Stage Least Squares (2SLS) regression model with fixed effects, we documented a self-reinforcing process that links consumption and obesity. Changes in the spread of obesity were associated with changes in soft drink consumption: a one-unit increase in the age-adjusted prevalence rate of obesity increased consumption by about 2.39 l per person per year. Similarly, as the consumption of soft drinks rose, so did the prevalence of obesity: the age-adjusted rate of obesity increased by 0.07% for every additional litre consumed per capita. Computing the impact multipliers, we found that the outcome of a one-unit decrease in the average price of soft drinks was twofold: a) the prevalence of obesity increased by around 0.17%; and b) consumption increased by around 2.40 l per person, the sum of the increase directly caused by the price reduction (2 l) and the increase due to the interplay between consumption and obesity (0.4 l). CONCLUSIONS: This study has identified a feedback loop between unhealthy habits (i.e. the consumption of soft drinks) and health outcomes (i.e. the prevalence of obesity). This interplay amplifies the impact of any exogenous changes in the determinants of consumption and obesity. These feedback effects should be considered and exploited in planning effective strategies to tackle the burden of obesity and the global epidemic of non-​communicable diseases.

High-Silica Zeolites as Sorbent Media for Adsorption and Pre-Concentration of Pharmaceuticals in Aqueous Solutions.

The present work focused on the use of high-silica commercial zeolites as sorbent media for pharmaceuticals in an aqueous matrix. As drug probes, ketoprofen, hydrochlorothiazide, and atenolol were selected, because of their occurrence in surface waters and effluents from wastewater treatment plants. Pharmaceuticals adsorption was evaluated for two Faujasite topology zeolites with Silica/Alumina Ratio 30 and 200. The selected zeolites were demonstrated to be efficient sorbents towards all investigated pharmaceuticals, thanks to their high saturation capacities (from 12 to 32% w/w) and binding constants. These results were corroborated by thermal and structural analyses, which revealed that adsorption occurred inside zeolite's porosities, causing lattice modifications. Finally, zeolites have been tested as a pre-concentration media in the dispersive-solid phase extraction procedure. Recoveries higher than 95% were gained for ketoprofen and hydrochlorothiazide and approximately 85% for atenolol, at conditions that promoted the dissolution of the neutral solute into a phase mainly organic. The results were obtained by using a short contact time (5 min) and reduced volume of extraction (500 µL), without halogenated solvents. These appealing features make the proposed procedure a cost and time saving method for sample enrichment as well as for the regeneration of exhausted sorbent, rather than the more energetically expensive thermal treatment.

Combined Robotic Surgery for Double Renal Masses and Prostate Cancer: Myth or Reality?

With the widespread use of imaging modalities performed for the staging of prostate cancer, the incidental detection of synchronous tumors is increasing in frequency. Robotic surgery represents a technical evolution in the treatment of solid tumors of the urinary tract, and it can be a valid option in the case of multi-organ involvement. We reported a case of synchronous prostate cancer and bifocal renal carcinoma in a 66-year-old male. We performed the first case of a combined upper- and lower-tract robotic surgery for a double-left-partial nephrectomy associated with radical prostatectomy by the transperitoneal approach. A comprehensive literature review in this field has also been carried out. Total operative time was 265 min. Renal hypotension time was 25 min. Blood loss was 250 mL. The patient had an uneventful postoperative course. No recurrence occurred after 12 months. In the literature, 10 cases of robotic, radical, or partial nephrectomy and simultaneous radical prostatectomy have been described. Robotic surgery provides less invasiveness than open surgery with comparable oncological efficacy, overcoming the limitations of the traditional laparoscopy. During robotic combined surgery for synchronous tumors, the planning of the trocars' positioning is crucial to obtain good surgical results, reducing the abdominal trauma, the convalescence, and the length of hospitalization with a consequent cost reduction. Rare complications can be related to prolonged pneumoperitoneum. Simultaneous robotic prostatectomy and partial nephrectomy appears to be a safe and feasible surgical option in patients with synchronous prostate cancer and renal cell carcinoma.

Formation of Supramolecular Clusters at the Interface of Zeolite X Following the Adsorption of Rare-Earth Cations and Their Impact on the Macroscopic Properties of the Zeolite.

The adsorption behavior of neodymium (Nd3+ ) and yttrium (Y3+ ) cations on synthetic FAU zeolite X in its sodium form (NaX) has been investigated by means of macroscopic (adsorption isotherm determination and thermal analysis) and microscopic measurements (including solid-state NMR spectroscopy and X-ray powder diffraction). The multidisciplinary study reveals some unexpected features. Firstly, adsorption constants of cations are not correlated to their ionic radii or hydration enthalpy. The adsorption constant of Y3+ on NaX was indeed about twice that of Nd3+ , which is the opposite of what could be expected based on the size of the cations. In addition, adsorption was accompanied by partial dealumination of the zeolite framework. The extent of dealumination changed depending on the exchanged cations, with the extent being more significant on the Nd-exchanged zeolite than on the Y-exchanged one. The most interesting finding of this study, however, is the presence of supramolecular clusters composed of water, Nd3+ , residual sodium ions, and extra-framework aluminum at the interface of Nd-exchanged zeolite. The hypothesis that these host-guest complexes are responsible of the significantly different behavior exhibited by NaX towards the adsorption/desorption of Nd3+ and Y3+ has been formulated.

Self-reported unemployment status and recession: An analysis on the Italian population with and without mental health problems.

PURPOSE: During economic recession people with mental health problems have higher risk of losing their job. This paper analyses the issue by considering the Italian rates of unemployment amongst individuals with and without mental health problems in 2005 and 2013, that is prior and during the economic crisis. METHODS: We used data from the National surveys on "Health conditions and use of health services" carried out by the Italian National Institute of Statistics (ISTAT) for the years 2005 and 2013. The surveys collected information on the health status and socioeconomic conditions of the Italian population. Self-reported unemployment status was analysed amongst individuals with and without reported mental health problems. In addition, descriptive statistics were performed in order to detect possible differences in the risk of unemployment within different regional contexts characterised by different socio-economic conditions. RESULTS: The recession determined increased disparities in unemployment rates between people with and without mental health problems. Regardless to the presence of mental health problems, young people were more likely to be unemployed. Among people who reported mental health problems, males were more likely to be unemployed than females. People with low education level were more likely to be unemployed, particularly during the recession and in presence of mental health problems. Changes in unemployment rates due to the crisis showed different patterns across different regions of the Country. CONCLUSIONS: These analyses confirm that in periods of economic crisis people with mental health problems are at risk of experiencing exclusion from labour market. In addition, the impact is even worse within the group with low education and younger age. These findings emphasise the importance of specific interventions aimed at promoting labour market participation and reintegration for people with mental health problems.

Urban PM2.5 oxidative potential: Importance of chemical species and comparison of two spectrophotometric cell-free assays.

Oxidative potential (OP) of particulate matter (PM) - defined as the capacity of PM to oxidize target molecules generating reactive oxygen species (ROS) - has been proposed as a more health relevant metric than PM mass. In this study two cell-free methods were used to assess the OP of PM filters collected at an urban site and to evaluate correlation with PM mass and PM composition. Among the different assays existing, two inexpensive and user-friendly methods were used both based on spectrophotometric measurements of depletion rate of target reagents oxidized by redox-active species present in PM. One assay measures the consumption of dithiothreitol (OPDTT) and the other the ascorbate (OPAA). Although both assays respond to the same redox-active species, i.e., quinones and transition metals, no correlations were found between OPDTT and OPAA responses to compounds standard solutions as well as to ambient samples. When expressed in relation to air volume, OPDTT m-3 strongly correlates with PM2.5 mass whereas no correlation was found for OPAA m-3 with PM2.5. When expressed on mass basis, both OPDTT µg-1 and OPAA µg-1 show a strong dependence on the sample composition, with higher OP for summer samples. OPDTT m-3 were highly correlated with the determined metals (Cu, Zn, Cr, Fe, Ni, Mn) whereas OPAA m-3 showed only moderate correlation with Cu and Mn. Thus, the two assays could potentially provide complementary information on oxidative potential characteristic of PM. Consequently, the combination of the two approaches can strengthen each other in giving insight into the contribution of chemical composition to oxidative properties of PM, which can subsequently be used to study health effects.

Being hit twice: The psychological consequences of the economic crisis and an earthquake.

BACKGROUND: The Great Recession has caused worldwide tangible costs in terms of cuts in employment and income, which have been widely recognised also as major social determinants of mental health. Italy has not been spared from the financial crisis with severe societal and mental health consequences. In addition, a strong earthquake hit the province of Modena, Italy, in 2012, that is, amid the crisis. AIMS: In this study, we explored and investigated the possible additional impact of concurrent events such as economic crisis and a natural disaster. METHODS: Our analysis elaborated data from two local surveys, ICESmo2 (2006) and ICESmo3 (2012), and a national survey carried out in 2013 by the Italian National Institute of Statistics (Istituto Nazionale di Statistica (ISTAT)). A regression model was adopted to distinguish the effect of the crisis and the earthquake. RESULTS: Our analysis confirmed the negative effect of the economic crisis on psychological wellbeing, but within the province of Modena such an effect resulted as even stronger compared with the rest of Italy, particularly within those areas struck by the earthquake. CONCLUSION: Being hit by a combination of two major negative events might have a significantly increased negative effect on psychological health. The higher repercussion observed is not only attributable to the occurrence of a natural disaster but can be reasonably related to the additional effect of unemployment on psychological dimensions.

Gold-nanoparticle extraction and reversed-electrode-polarity stacking mode combined to enhance capillary electrophoresis sensitivity for conjugated nucleosides and oligonucleotides containing thioether linkers.

We present a capillary electrophoresis method for determining two different C8-conjugated deoxyadenosines, and for oligonucleotides containing them, in which a psoralen or an acridine molecule is bonded to the base via a short alkyl chain containing sulfur ethers at both ends. The sensitivity of the micellar electrokinetic chromatography (MEKC) method was increased by using two preconcentration techniques, micro solid-phase extraction (µSPE) followed by reversed-electrode-polarity stacking mode (REPSM). Variables that affect the efficiency of the extraction in µSPE and preconcentration by REPSM, including the type and volume of extraction nanoparticle, concentration, and injection time, were investigated. Under the optimum conditions, enrichment factors obtained were in the range 360-400. The limits of detection (LODs) at a signal-to-noise ratio of 3 ranged from 2 to 5 nmol L(-1). The relative recoveries of labelled adenosines from water samples were 95-103%. The proposed method provided high enrichment factors and good precision and accuracy with a short analysis time. On the basis of the advantages of simplicity, high selectivity, high sensitivity, and good reproducibility, the proposed method may have great potential for biochemical applications.

Factors affecting drug adsorption on beta zeolites.

The adsorption behaviour of three commonly used drugs, namely ketoprofen, hydrochlorothiazide and atenolol, from diluted aqueous solutions on beta zeolites with different SiO2/Al2O3 ratio (i.e. 25, 38 and 360) was investigated by changing the ionic strength and the pH, before and after thermal treatment of the adsorbents. The selective adsorption of drugs was confirmed by thermogravimetry and X-ray diffraction. The adsorption capacity of beta zeolites was strongly dependent on both the solution pH and the alumina content of the adsorbent. Such a remarkable difference was interpreted as a function of the interactions between drug molecules and zeolite surface functional groups. Atenolol was readily adsorbed on the less hydrophobic zeolite, under pH conditions in which electrostatic interactions were predominant. On the other hand, ketoprofen adsorption was mainly driven by hydrophobic interactions. For undissociated molecules the adsorption capability increased with the increase of hydrophobicity.