Primary Health Care Implementation in Asia: A systematic review

Background@#Primary health care (PHC) is a central feature of the UHC. Across Asia, health system planners seeking to strengthen PHC systems may be hindered by several factors, including lack of knowledge of what works in the setting. Pressures placed on health care systems of Asian nations caused by epidemiological changes, including COVID-19 pandemic, and other health issues, are amplified by the demands of population seeking for high-quality care.@*Objective@#To determine the implementation of primary health care across the Asian region @*Methods@#This review utilized 9 online databases, based on the Preferred Reporting Items for Systematic Review Guidelines. Inclusion criteria were studies evaluating the policy implementation of PHC in Asia, published from 2002-2022, accessible online in full-text, English or translation, published in peer-reviewed journals. Three reviewers independently evaluated the abstracts, extracted the data, and assessed the quality of the included studies based on the Critical Appraisal Skills Programme checklist. Descriptive synthesis was undertaken to summarize and report the study findings. @*Results@#Sixteen studies met the inclusion criteria out of 815 search results. Four indicators were included: governance, financing, health workforce, and medicines and other health products showed both positive and negative results. However, recurring challenges are still prevalent in the implementation of PHC, especially in health service delivery. Enabling factors for effective implementation of PHC were community behavioral change, committed political will, increased health coverage and free access, health workforce performance and evaluation among others. Barriers included were economic shocks, corruption, preventive health inequalities and inequities, resource misallocation, and health insurance status among others. @*Conclusion@#Much has already been done in PHC implementation within Asia. However, greater efforts are still needed to implement PHC efficiently in the areas of governance, financing, health workforce, and medicines and other health products. Enablers should be modeled, while barriers should be overcome.

A precise measurement of the 117mSn half-life.

The 117mSn isotope was produced via fast, 14.1MeV neutron activation of natural tin and studied with a background shielded HPGe detector. To enable time-resolved γ-ray spectroscopy to precisely measure the half-life of 117mSn, a commercial DAQ was replaced with a CAMAC-based analogue DAQ. The deadtime response of the applied DAQ was verified for the measurement. The half-life of 117mSn was measured to be 13.91±0.03 days and the I(158.6keV)/I(156.0keV) γ-ray ratio was measured to be 43.6±1.5.

NEUTRON GENERATOR FACILITY AT SFU: GEANT4 DOSE RATE PREDICTION AND VERIFICATION.

Detailed dose rate maps for a neutron generator facility at Simon Fraser University were produced via the GEANT4 Monte Carlo framework. Predicted neutron dose rates throughout the facility were compared with radiation survey measurements made during the facility commissioning process. When accounting for thermal neutrons, the prediction and measurement agree within a factor of 2 or better in most survey locations, and within 10 % inside the vault housing the neutron generator.

The effect of orally administered probiotic Lactobacillus reuteri-containing tablets in peri-implant mucositis: a double-blind randomized controlled trial.

BACKGROUND AND OBJECTIVES: Probiotics create a biofilm and protect the oral tissues against the action of periodontal pathogenic bacteria. The aim of this study was to evaluate the effects of the oral probiotic Lactobacillus reuteri Prodentis upon the peri-implant health of edentulous patients with dental implants and peri-implant mucositis, establishing comparisons vs implants without peri-implant disease. MATERIAL AND METHODS: A double-blind, placebo-controlled, prospective cross-over study was made. The patients were all edentulous and were divided into two groups, (A) no peri-implant disease, and (B) peri-implant mucositis affecting one or more implants. Patients with peri-implantitis were excluded. The dosage was one tablet every 24 h over 30 d. All patients in both groups initially received the oral probiotic Lactobacillus reuteri Prodentis, followed by placebo. Patients started with probiotic treatment during 30 d, followed by a 6 mo washout period and the administration of placebo for the same period. The following parameters were studied: crevicular fluid volume, modified plaque index, probing depth, modified gingival index, and concentrations of interleukin 1ß, interleukin 6 and interleukin 8. RESULTS: A total of 77 implants were evaluated in 34 patients. Group A involved 22 patients with 54 implants without peri-implant alterations, and group B, 12 patients with mucositis affecting one or more implants (23 implants). After treatment with the probiotic, both the patients with mucositis and the patients without peri-implant disease showed improvements in the clinical parameters, with reductions in cytokine levels. In contrast, no such changes were observed with placebo. CONCLUSIONS: After treatment with the probiotic Lactobacillus reuteri in patients with implants presenting mucositis, the clinical parameters improved, and the cytokine levels decreased - in contraposition to the observations in the placebo group. Probiotic administration may be regarded as a good alternative for both the treatment of peri-implant mucositis and its prevention, as it also improved clinical parameters in the healthy individuals. Further studies involving larger patient series are needed regarding the effects of probiotics upon peri-implant health.

Monitoring rainwater and seaweed reveals the presence of (131)I in southwest and central British Columbia, Canada following the Fukushima nuclear accident in Japan.

Detailed analysis of (131)I levels in rainwater and in three species of seaweed (Fucus distichus Linnaeus, Macrocystis pyrifera, and Pyropia fallax) collected in southwest British Columbia and Bella Bella, B.C., Canada was performed using gamma-ray spectroscopy following the Fukushima nuclear power plant accident on March 11, 2011. Maximum (131)I activity was found to be 5.8(7) Bq/L in rainwater collected at the campus of Simon Fraser University in Burnaby, B.C. nine days after the accident. Concomitantly, maximum observed activity in the brown seaweed F. distichus Linnaeus was observed to be 130(7) Bq/kg dry weight in samples collected in North Vancouver 11 days following the accident and 67(6) Bq/kg dry weight in samples collected from the Bamfield Marine Sciences Centre on Vancouver Island 17 days following the accident. The (131)I activity in seaweed samples collected in southwest B.C. following the Fukushima accident was an order of magnitude less than what was observed following Chernobyl. Iodine-131 activity in F. distichus Linnaeus remained detectable for 60 days following the accident and was detectable in each seaweed species collected. The Germanium Detector for Elemental Analysis and Radioactivity Studies (GEARS) was modeled using the Geant4 software package and developed as an analytical tool by the Nuclear Science group in the Simon Fraser University Department of Chemistry for the purpose of these measurements.

Analysis of the peri-implant microbiota in 90 dental implants and its relationship to crevicular fluid volume.

OBJECTIVE: To evaluate the presence within the peri-implant sulcus of Tannerela forsythia (Tf), Porphyromonas gingivales (Pg), Treponema denticola (Td) and Aggregatibacter actinomycetemcomitans (Aa), and relate these bacteria to the peri-implant crevicular fluid volume (PICFV). MATERIAL AND METHOD: A prospective and cross-sectional clinical case series study was made. For the measurement of crevicular fluid, use was made of the Periotron® 8000 (Proflow Incorporated. New York, USA), measuring the volume in Periotron units (PU). For the detection of periodontopathogenic bacteria we used the IAI-PadoTest 4.5 (IAI Inc., IAI Institute, Zuchwil, Switzerland) - a system for the detection of Tf, Pg, Td and Aa based on the use of RNA arrays. RESULTS: We included 34 patients (19 females and 15 males) with a mean age of 56.4 years. Of these subjects, 30.8% were smokers and 69.2% non-smokers. Out of a total series of 213 implants, we analyzed the crevicular fluid and microbiota in 90 implants. A total of 16.5% of the implants presented mucositis, while 83.5% were in healthy peri-implant conditions. The microbiological study revealed the presence of Tf in 17.1% of the implants, Pg in 9.3%, Td in 13.6%, in Aa in none of the implants. The mean Periotron reading was 93.4 PU (range 12-198 PU). A statistically significant (p<0.05) relationship was observed between PICFV and the total percentage bacteria (Tf, Pg and Td) - with a strong association between the Td levels and smoking (p<0.01). In the implants with mucositis, the concentration of Pg and Td was greater. CONCLUSIONS: In the implants studied, the subgingival peri-implant microbiota was characterized by low levels of Pg, Tf, Td, and none of the patients proved positive for Aa. These bacteria showed a positive correlation to crevicular fluid volume, and a statistically significant relationship was observed between Td and smoking.

Fibrosing mediastinitis causing acute ostial left main myocardial infarction.

This report describes an unusual etiology of acute coronary syndrome. A 48-year-old female presented with anginal chest discomfort and was found to have evidence of acute pulmonary edema requiring mechanical ventilation. She underwent emergency coronary angiography and stenting of the culprit left-main artery ostial discrete stenosis. Subsequent echocardiography and magnetic resonance imaging revealed severe aortic regurgitation and periaortic valve tissue infiltrates. Pericardiectomy and mediastinal mass biopsy were performed which indicated the pathology of fibrosing mediastinitis.

Duodenal derotation as an effective treatment of superior mesenteric artery syndrome: a thirty-three year experience.

We evaluated the use of duodenal derotation as a surgical option for superior mesenteric artery syndrome (SMAS) in two groups of young patients. Sixteen patients with SMAS diagnosed by barium upper gastrointestinal series (UGI) from 1974 to 2001, and six patients diagnosed by computerized tomography with three-dimensional reconstructions (3D CT) from 2001 to 2007 were referred to our surgical service, 19 of whom underwent duodenal derotation as the primary surgical treatment after a failed trial of conservative treatment. The main measured outcomes were the resolution of typical symptoms of SMAS and the development of long-term surgical complications. Of the first 16 patients, three (19%) responded to nasojejunal feedings. Of 13 patients undergoing derotation, only one (7.7%) failed derotation and required a gastrojejunostomy bypass, whereas 12 (92%) became asymptomatic after the derotation procedure. After a mean follow-up of 5.13 years (range 0.1-15), two patients (15%) presented with small bowel obstructions and were treated with a simple lysis of the adhesion. All six patients from 2001 to 2007 responded well to surgical derotation. Overall, duodenal derotations successfully relieved symptoms in 18 out of 19 (95%) patients with SMAS, with two (11%) major long-term surgical complications. No volvulus was observed in our patients at the mean follow-up of 4.37 years.

Schawannoma maligno epitelioide / Malignant epithelioid schawannoma

Presentamos 4 casos de Schawannoma maligno epitelioide, una rara neoplasia de nervios periféricos. Las edades de aparición oscilan entre 12 y 82 años con predominio masculino (3 casos) sobre muy infrecuente. Su pronóstico es muy ominoso, con menor sobrevida (15 a 20% en 5 años) para aquellos casos asociados con enfermedad de Von Recklinghausen, y mejor para aquellos con tumores menores de 5 cm localizados en porciones distales de extremidades (50 a 75%)

[Serum theophylline levels after oral administration in a group of asthmatic children]. / Niveles séricos de teofilina tras administración oral en un grupo de niños asmáticos.

Serum levels of theophylline were determined in 54 asthmatics children aged 3,92 +/- 2,45 years, who were taken oral theophylline at doses of 4,99 +/- 0,45 mg. The serum levels at 0 hours (9,22 +/- 4,90 mcg/ml) and at 2 hours (15,22 +/- 5,5 mcg/ml) showed a great variation, although they were taken similar doses. Two hours after ingestion, 34 patients showed levels between 10-20 mcg/ml in 10 children were less than 10 mcg/ml, and another 10 shown serum levels over 20 mcg/ml without symptoms. There was a good correlation between levels at 0 and 2 hours (p less than 0,002). These data may support the utility of doses employed. It is advisable knowing the individual response to theophylline for managing episodes of asthma in children, that can be made by only one determination 2 hours after ingestion.