Economic burden of cervical cancer and premalignant lesions associated with human papilloma virus: a societal perspective.

BACKGROUND: Cervical cancer is one of the most common cancers in women, the cause of which is mostly human papilloma virus (HPV). The aim of this study was to determine the economic burden of cervical cancer and premalignant lesions associated with HPV infection from a societal perspective. METHODS: The study is a partial economic evaluation (cost of illness), which was conducted cross-sectionally in the referral university clinic in Fars province in 2021. The prevalence-based and bottom-up approaches used to calculate the costs, the indirect costs were calculated by human capital approach. RESULTS: The mean cost of premalignant lesions associated with HPV infection was USD 2,853 per patient, which 68.57% was direct medical costs. In addition, the mean cost of cervical cancer was USD 39,327 per patient, the largest share of which (57.9%) was related to indirect costs. The mean annual cost of cervical cancer patients in the country was estimated at USD 40,884,609 as well. CONCLUSION: Cervical cancer and premalignant lesions associated with HPV infection imposed a significant economic burden on the health system and patients. The results of the present study can help health policymakers with efficient and equitable prioritization and allocation of resources.

Inequality in households' access to primary health care (PHC): a case study in Kerman, southeast Iran.

BACKGROUND: Fair access to health services is a vital issue in low-and middle-income countries. Therefore, the present study was conducted to evaluate the equity in access to primary health care (PHC) services in southeastern Iran. METHODS: This household-based survey was conducted on 1128 households in Kerman, southeastern Iran in 2019-20. A multistage probability method was used to select the samples. The online questionnaire was designed and its link was provided to the questioners. After receiving the training, the questioners went to the door according to the sampling guide. The collected data were analyzed at a significance level of 0.05, using the STATA software. The concentration index (CI) was also used to measure inequality in access to PHC services. RESULTS: The results showed that there was a significant difference between gender and location in access to PHC services (P < 0.05). However, no significant difference was found between the access rates to PHC services and the variables of age, marital, education, health insurance, and Supplementary insurance (P > 0.05). The mean rate of access to PHC services was 3.51 ± 0.53. Cultural access (3.76 ± 0.54) and timely receipt of PHC services (2.51 ± 0.72) accounted for the highest and the lowest access rates, respectively. The concentration index for the distribution of PHC services among the income-adjusted population was 0.014 (CI 95%: -0.022 to 0.051), indicating pro-rich inequalities in access to PHC services. CONCLUSION: The results indicated that pro-rich inequality, but it was close to the equality line. Also, the access level was assessed as moderate to high. Therefore, planning and policy-making seems essential for reduce inequality, and development and promotion of access to PHC services, especially timely provision of services and organizational access.

Insight into the unwrapping of the dinucleosome.

Dynamics of nucleosomes, the building blocks of chromatin, has crucial effects on the expression, replication and repair of genomes in eukaryotes. Beside the constant movements of nucleosomes by thermal fluctuations, ATP-dependent chromatin remodelling complexes cause their active displacements. Here we propose a theoretical analysis of dinucleosome wrapping and unwrapping dynamics in the presence of an external force. We explore the energy landscape and configurations of a dinucleosome in different unwrapped states. Moreover, using a dynamical Monte-Carlo simulation algorithm, we demonstrate the dynamical features of the system such as the unwrapping force for partial and full wrapping processes. Furthermore, we show that in the short length of linker DNA (∼10-90 bp), asymmetric unwrapping occurs. These findings could shed some light on chromatin dynamics and gene accessibility.

Elastic model for dinucleosome structure and energy.

The equilibrium structure of a dinucleosome is studied using an elastic model that takes into account the force and torque balance conditions. Using the proper boundary conditions, it is found that the conformational energy of the problem does not depend on the length of the linker DNA. In addition it is shown that the two histone octamers are almost perpendicular to each other, and the linker DNA in short lengths is almost straight. These findings could shed some light on the role of DNA elasticity in the chromatin structure.