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T Bencheikh 《World health forum》1988,9(4):607-610
Morocco's severe financial problems have threatened its health-for-all goals. Restrictions have affected the recruitment and replacement of health personnel, the purchase and maintenance of equipment and buildings, hospital catering services and drug procurement. Several methods have been used to try and ease this crisis, rationalization and better deployment of resources, mobilization of national resources, and mobilization of external resources. In attaining the 1st, restrictions on the credits allocated to the Ministry of Public health have forced it to work out better ways of using its resources. These have included plans for better administrative and financial management of hospitals, improvements in drug procurement and distribution, new methods of personnel management, and efforts at improving information facilities and analytical capabilities at the central and local levels. To mobilize internal resources several steps were taken. These included revising too-low hospital charges, and charging people with social security coverage or those able to pay directly, raising funds through private charities, and the establishment of alternative, less expensive types of health centers. Morocco's continued need for funds to achieve health-for-all goals led it to also receive substantial assistance from international agencies (including the World Bank, UNICEF, UNFPA, and USAID) and friendly countries. External assistance cannot provide definitive solutions however, because of 1) the use of foreign experts and the payment of salaries abroad, 2) the purchase of products from the countries providing assistance, and 3) the unpredictability of external support and the danger programs may have to be abandoned. In times of financial crisis it is necessary to continue to budget adequately in order to reach health objectives. 相似文献
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Emmanuelle Ponty Michel Carton Georges Soula Gillcs Favre Rachid Benaniba Andre Boneu Henriette Lucot 《International journal of cancer. Journal international du cancer》1993,54(3):411-417
Since there is strong evidence of a preferential LDL accumulation in tumor cells, LDL might be of interest for tumor imaging. We have tested the ability of 99mTc-LDL in tumor imaging with B16-melanoma-bearing mice as a model for further applications in human studies. The LDL fixation rate was higher with 99mTc-labeled LDL than with 125I labeled LDL. Since technetium-99m remains trapped in the cells, 99mTc-LDL is a well-adapted radioligand because of information given by this radiotracer on the receptor metabolism. We observed that, at early growth stages, the tumor took up the LDL at a maximal rate, suggesting differences in cholesterol metabolism as a function of tumor growth. Accumulation of label in the tumor area was perfectly observable in tumor-bearing mice on scintigraphic images. Computerized quantification of the regions of interest (as well as biodistribution studies including killing of the animals) showed a 1.81 -fold increase in uptake by the tumor as compared to the liver and a 28-fold increase as compared with corresponding normal tissue (muscle of the left leg) at day 8 of tumor growth. These data give strong support to the value of this non-invasive method in visualizing and quantifying the tissue LDL uptake in vivo, including the precise information provided by nuclear scintigraphy on the distribution of the radiolabeled LDL in the different tissues. 99mTc-LDL could be an efficient tool for further diagnostic or therapeutic exploration in cancer patients. 相似文献
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Rachid Haraoubia Chantal Bonnans-Plaisance Guy Levesque 《Macromolecular chemistry and physics.》1981,182(9):2409-2419
The syntheses and free-radical polymerizations of methyl and carboxymethyl 4-vinyldithiobenzoates are described as well as various copolymers. Copolymerisation parameters were determined for the copolymerizations of the methyl dithioester with styrene and with methyl methacrylate. 相似文献
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The effect of yoghurt on the cytotoxic and phagocytic activity of macrophages in tumour‐bearing mice
Juan Carlos Valdez Mirta Rachid Elena Bru Gabriela Perdigón 《Food and Agricultural Immunology》1997,9(4):299-308
In a previous paper, it was demonstrated that feeding yoghurt was able to inhibit the growth of an intestinal tumour induced chemically with 1,2‐dimethylhydrazine (DMH). This effect was due to the increase in IgA‐producing cells and a diminution of the inflammatory immune response. In this paper the phagocytic and cytotoxic capacity of macrophages both involved and not involved in the target organ are studied. The study was aimed at determining whether in the intestinal tumour inhibition demonstrated previously the systemic immune response was also increased. The cytotoxic capacity and ß‐glucuronidase enzyme levels of the peritoneal macrophages were analyzed together with the cytolytic effect of the serum on tumour cells and the phagocytic activity of the macrophages infiltrating the intestinal mucosa. Groups of mice were split into three experimental groups. One group was treated with DMH. The others were treated with DMH, and their diets were supplemented with yoghurt for 7 or 10 consecutive days, during 24 weeks. It was demonstrated that feeding yoghurt for 7 or 10 days increased cytotoxic and ß‐glucuronidase levels in peritoneal macrophages, and also the cytolytic capacity of serum, reaching values significantly higher than those in the DMH control. Enhancement of the phagocytic activity of the macrophages associated with the large intestine was also observed. This increase in the macrophage activity involved in the systemic and mucosal immune responses could also be responsible for the tumour inhibition observed in the group of mice fed with yoghurt. The presence in the serum of lytic factors (cytokines) which were released by immune cells activated by feeding yoghurt may also have had a role in tumour inhibition. 相似文献
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Chakib Nejjari Abdelghafour Marfak Ahmed Rguig Abderrahmane Maaroufi Ihssane El Marouani Abderrafii El Haloui Bouchra El Johra Rachid Ouahabi Rachid Moulki Amina Idrissi Azami Youness El Achhab 《AIMS Public Health》2021,8(2):285
This study presents the relationships between ambient air pollutants and morbidity and emergency department visits among children and adults performed in Great Casablanca, the most populated and economic region in Morocco. This research was analyzed using conditional Poisson model for the period 2011–2013. In the period of study, the daily average concentrations of SO2, NO2, O3 and PM10 in Casablanca were 209.4 µg/m3, 61 µg/m3, 113.2 µg/m3 and 75.1 µg/m3, respectively. In children less than 5 years old, risk of asthma could be increased until 12% per 10 µg/m3 increase in NO2, PM10, SO2 and O3. In children over 5 years and adults, an increase of 10 µg/m3 air pollutant can cause an increase until 3% and 4% in respiratory consultations and acute respiratory infection, respectively. Similarly, impact on emergency department visits due to respiratory and cardiac illness was established. Our results suggest a not negligible impact on morbidity of outdoor air pollution by NO2, SO2, O3, and PM10. 相似文献
10.
Rachid Rassir Maarten Schuiling Inger N. Sierevelt Casper W. P. van der Hoeven Peter A. Nolte 《Clinical orthopaedics and related research》2021,479(4):755
BackgroundBone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, and the loss of consciousness during cemented arthroplasty; it may result in death. Its incidence has only been explored for hemiarthroplasty and THA after fracture or cancer. To our knowledge, there are no studies that comprehensively explore and compare the incidence of BCIS in other arthroplasty procedures.Questions/purposes(1) To report the incidence of BCIS in TKA, unicondylar knee arthroplasty, hip hemiarthroplasty, THA, shoulder arthroplasty, TKA, and revision THA and TKA; (2) to determine whether severe BCIS is associated with an increased risk of death within 30 days of surgery; and (3) to identify factors associated with the development of severe BCIS.MethodsAll patients undergoing cemented arthroplasty for any reason (TKA [11% cemented, 766 of 7293], unicondylar knee arthroplasty [100% cemented, 562 procedures], hip hemiarthroplasty for femur fractures [100% cemented, 969 procedures], THA [8% cemented, 683 of 8447], shoulder arthroplasty [84% cemented, 185 of 219], and revision arthroplasty of the hip and knee [36% cemented, 240 of 660]) between January 2008 and August 2019 were considered for inclusion in the current retrospective observational study. Fixation choice was dependent on surgeon preference (THA and TKA), prosthesis design (shoulder arthroplasty), or bone quality (revision arthroplasty). The following procedures were excluded because of insufficient data: < 1% (1 of 766) of TKAs, 1% (4 of 562) of unicondylar knee arthroplasties, 6% (54 of 969) of hip hemiarthroplasties, 1% (6 of 683) of THAs, 6% (12 of 185) of shoulder arthroplasties, and 14% (34 of 240) of revision procedures. This resulted in a final inclusion of 3294 procedures (765 TKAs [23%], 558 unicondylar knee arthroplasties [17%], 915 hip hemiarthroplasties [28%], 677 THA [21%], 173 shoulder arthroplasties [5%], and 206 revision arthroplasties [6%]), of which 28% (930 of 3294) had an emergent indication for surgery. Of the patients, 68% (2240 of 3294) were females, with a mean age of 75 ± 11 years. All anesthetic records were extracted from our hospital’s database, and the severity of BCIS was retrospectively scored (Grade 0 [no BCIS], Grade 1 [O2% < 94% or fall in systolic blood pressure of 20% to 40%], Grade 2 [O2% < 88% or fall in systolic blood pressure of > 40%], and Grade 3 [cardiovascular collapse requiring CPR]). Procedures were dichotomized into no or moderate BCIS (Grades 0 and 1) and severe BCIS (Grades 2 and 3). The adjusted 30-day mortality of patients with severe BCIS was assessed with a multivariate Cox regression analysis. A multivariate logistic regression analysis was performed to identify factors associated with the development of severe BCIS.ResultsBCIS occurred in 26% (845 of 3294) of arthoplasty procedures. The incidence was 31% (282 of 915) in hip hemiarthroplasty, 28% (210 of 765) in TKA, 24% (165 of 677) in THA, 23% (47 of 206) in revision arthroplasty, 20% (113 of 558) in unicondylar knee arthroplasty, and 16% (28 of 173) in shoulder arthroplasty. Patients with severe BCIS were more likely (hazard ratio 3.46 [95% confidence interval 2.07 to 5.77]; p < 0.001) to die within 30 days of the index procedure than were patients with less severe or no BCIS. Factors independently associated with the development of severe BCIS were age older than 75 years (odds ratio 1.57 [95% CI 1.09 to 2.27]; p = 0.02), American Society of Anesthesiologists Class III or IV (OR 1.58 [95% CI 1.09 to 2.30]; p = 0.02), and renal impairment (OR 3.32 [95% CI 1.45 to 7.46]; p = 0.004).ConclusionBCIS is common during cemented arthroplasty; severe BCIS is uncommon, but it is associated with an increased risk of death within 30 days of surgery. Medically complex patients undergoing hip hemiarthroplasty may be at particular risk. Patients at high risk for severe BCIS (renal impairment, ASA III/IV, and age older than 75 years) should be identified and preventive measures such as medullary lavage before cementation, femoral venting, and avoidance of excessive pressurization of implants should be taken to reduce the likelihood and consequences of BCIS. Because of the increased risk of periprosthetic fractures in uncemented hip stems, factors associated with the development of BCIS should be weighed against the risk factors for sustaining periprosthetic fractures (poor bone quality, female sex) to balance the risks of fixation method against those of BCIS for each patient.Level of EvidenceLevel III, therapeutic study. 相似文献