Potential Barriers to Healthcare in Malawi for Under-five Children with Cough and Fever: A National Household Survey

Failure to access healthcare is an important contributor to child mortality in many developing countries. In a national household survey in Malawi, we explored demographic and socioeconomic barriers to healthcare for childhood illnesses and assessed the direct and indirect costs of seeking care. Using a cluster-sample design, we selected 2,697 households and interviewed 1,669 caretakers. The main reason for households not being surveyed was the absence of a primary caretaker in the household. Among 2,077 children aged less than five years, 504 episodes of cough and fever during the previous two weeks were reported. A trained healthcare provider was visited for 48.0% of illness episodes. A multivariate regression model showed that children from the poorest households (p=0.02) and children aged >12 months (p=0.02) were less likely to seek care when ill compared to those living in wealthier households and children of higher age-group respectively. Families from rural households spent more time travelling compared to urban households (68.9 vs 14.1 minutes; p<0.001). In addition, visiting a trained healthcare provider was associated with longer travel time (p<0.001) and higher direct costs (p<0.001) compared to visiting an untrained provider. Thus, several barriers to accessing healthcare in Malawi for childhood illnesses exist. Continued efforts to reduce these barriers are needed to narrow the gap in the health and healthcare equity in Malawi.Key words: Healthcare surveys, Health expenditure, Health services accessibility, Malaria, Pneumonia, Malawi     

Metabolic and secretory properties of peripheral and synovial granulocytes in rheumatoid arthritis

The metabolic and secretory properties of peripheral and synovial granulocytes of patients with rheumatoid arthritis were investigated with serum- or immunoglobulin-treated zymosan as activators of cell metabolism. During isolation of the synovial cells precautions were taken to prevent in vitro phagocytosis of immune materials present in the synovial fluids. Oxygen uptake, extracellular release of lysosomal enzymes under resting and activated conditions, yield of the isolated granulocytes, and the granule enzyme content of peripheral and synovial cells did not differ significantly from those of peripheral granulocytes from healthy volunteers. In agreement with the biochemical results, intracellular inclusions could be detected in only a few synovial cells with a direct immunofluorescence technique. The possibility that formation of “ragocytes” may be an in vitro phenomenon is discussed.     

SOCIETAL BURDEN OF STROKE REHABILITATION: COSTS AND HEALTH OUTCOMES AFTER ADMISSION TO STROKE REHABILITATION

ObjectiveTo estimate societal costs and changes in health-related quality of life in stroke patients, up to one year after start of medical specialist rehabilitation.DesignObservational.PatientsConsecutive patients who received medical specialist rehabilitation in the Stroke Cohort Out-comes of REhabilitation (SCORE) study.MethodsParticipants completed questionnaires on health-related quality of life (EuroQol EQ-5D-3L), absenteeism, out-of-pocket costs and healthcare use at start and end of rehabilitation and 6 and 12 months after start. Clinical characteristics and rehabilitation costs were extracted from the medical and financial records, respectively.ResultsFrom 2014 to 2016 a total of 313 stroke patients completed the study. Mean age was 59 (standard deviation (SD) 12) years, 185 (59%) were male, and 244 (78%) inpatients. Mean costs for inpatient and outpatient rehabilitation were US$70,601 and US$27,473, respectively. For inpatients, utility (an expression of quality of life) increased significantly between baseline and 6 months (EQ-5D-3L 0.66–0.73, p = 0.01; visual analogue scale 0.77–0.82, p < 0.001) and between baseline and 12 months (visual analogue scale 0.77–0.81, p < 0.001).ConclusionOne-year societal costs from after the start of rehabilitation in stroke patients were considerable. Future research should also include costs prior to rehabilitation. For inpatients, health-related quality of life, expressed in terms of utility, improved significantly over time.LAY ABSTRACTThe objective of this study was to estimate societal costs and changes in health-related quality of life in stroke patients, up to one year after the start of rehabilitation. Participants were stroke patients who received inpatient or outpatient rehabilitation. They completed questionnaires on quality of life, absenteeism, out-of-pocket costs and healthcare use at start and end of rehabilitation and 6 and 12 months after the start of rehabilitation. Rehabilitation costs were obtained from the financial records. From 2014 to 2016 a total of 313 patients completed the study. Mean age was 59 years, 185 (59%) were male and 244 (78%) inpatients. Mean costs for inpatient and outpatient rehabilitation were $70,601 and $27,473, respectively. For inpatients, health-related quality of life increased significantly between baseline and 6 months, and between baseline and 12 months. In conclusion, societal costs one year after the start of rehabilitation were considerable and health-related quality of life improved for inpatients.Key words: stroke, rehabilitation, cost analysis, utility, health-related quality of life

The number of people living with stroke in Europe is expected to increase from 1.1 million per year in 2000 to 1.5 million per year in 2025 (1). Stroke survivors may experience severe functional impairments, including impairments in physical functioning (2), cognition (3), and speech/language (4), which, in turn, lead to limitations in activities and participation and to worse quality of life (QoL) (5). Specialist rehabilitation was proven to be effective in improving functional outcomes after stroke (6), such as motor function, balance, walking speed and activities of daily living (7–9). Furthermore, in stroke patients admitted for inpatient rehabilitation, QoL increased significantly between admission and discharge (10).Besides the fact that rehabilitation after stroke is effective, rehabilitation was also found to be the main contributor to the costs of post-stroke care, according to a systematic review published in 2018 including 42 publications (11). Costs of post-stroke care, but not those of acute care, were included. Rehabilitation in different care settings was evaluated, which included primary, secondary and tertiary care, and the costs often applied to part of the patients and were not described in detail. For the delivery of value-based healthcare (VBHC), it is important to consider not only the health effects and patient-reported outcome measures, but to also evaluate the costs of care, since it is important to achieve good patient outcomes per dollar spent (12, 13).The aim of the current study was therefore: (i) to estimate the 1-year societal costs from the start of the rehabilitation in stroke patients treated in a medical specialist rehabilitation facility in The Netherlands; and (ii) to evaluate health changes in terms of utility (an expression of quality of life) over that year.     

Cell-based assays for the detection of MOG antibodies: a comparative study

Journal of Neurology - The detection of antibodies to myelin oligodendrocyte glycoprotein (MOG) is fundamental for the identification of MOG antibody-associated disorders (MOGAD), and the...     

Breast Fibroblasts Modulate Early Dissemination,Tumorigenesis, and Metastasis through Alteration of Extracellular Matrix Characteristics

A wealth of evidence has now demonstrated that the microenvironment in which a tumorigenic cell evolves is as critical to its evolution as the genetic mutations it accrues. However, there is still relatively little known about how signals from the microenvironment contribute to the early events in the progression to malignancy. To address this question, we used a premalignant mammary model to examine how fibroblasts, and the extracellular matrix (ECM) proteins they secrete, influence progression to malignancy. Their effect on metastatic malignant cells was also assessed for comparison. We found that carcinoma-associated fibroblasts, and the distinct aligned ECM they deposit, can cause both premalignant and malignant mammary epithelial cells to assume a mesenchymal morphology that is associated with increased dissemination and metastasis, while benign reduction mammoplasty fibroblasts favor the maintenance of an epithelial morphology and constrain early dissemination, tumor growth, and metastasis. Our results suggest that normalizing the organization of the ECM could be effective in limiting systemic dissemination and tumor growth.     

Accuracy of a newly developed integrated system for dental implant planning

Objectives: To evaluate the accuracy of the first integrated system for cone-beam CT (CBCT) imaging, dental implant planning and surgical template-aided implant placement.
Materials and methods: On the basis of CBCT scans, a total of 54 implant positions were planned for 10 partially edentulous anatomical patient-equivalent models. Surgical guides were ordered from the manufacturer (SICAT). Two different types of guidance were assessed: for assessment of the SICAT system inherent accuracy vendor's titanium sleeves of 2 mm internal diameter and 5 mm length were utilized for pilot drills. The guide sleeves of the NobelGuide system were implemented for fully guided surgery and implant insertion. Deviations perpendicular to the implant axes at the crestal and apical end, as well as the angle deviations between the virtual planning data and the surgical results, were measured utilizing a follow-up CBCT investigation and referential marker-based registration.
Results: The SICAT system inherent mean deviation rates for the drilled pilot osteotomies were determined to be smaller than 500 μm even at the apical end. Mean angle deviations of 1.18° were determined. Utilizing the NobelGuide sleeve-in-sleeve system for fully guided implant insertion in combination with the investigated template technology enabled to insert dental implants with the same accuracy. Crestal deviations, in general, were significantly lower than the apical deviations.
Conclusion: Although hardly comparable due to different study designs and measurement strategies, the investigated SICAT system's inherent accuracy corresponds to the most favourable results for computer-aided surgery systems published so far. In combination with the NobelGuide surgical set for fully guided insertion, the same accuracy level could be maintained for implant positioning.     

Functions of p53 suppress critical consequences of damage and repair in the initiation of cancer

A pivotal study reveals a long-sought-after mechanism for gene amplification and provides important implications for oncogenesis.     

Odor discrimination in patients with frontal lobe damage and Korsakoff's syndrome

The involvement of the frontal cortex and thalamic nucleus in odor discrimination in humans was assessed. Six patients with frontal lobe brain damage, seven patients with alcoholic Korsakoff's syndrome and 16 healthy comparison subjects completed odor detection and odor discrimination tasks. Multivariate general linear modeling with age as a covariant revealed significantly decreased odor discrimination ability in frontal lobe damaged patients and marginally decreased odor discrimination ability in Korsakoff's syndrome patients as compared to the healthy comparison subjects. No deficits were found in odor detection ability. The findings suggest that in human odor discrimination, there is more involvement of cortico-cortical pathways than of thalamo-cortical pathways.