Ovarian cancer survival in sub-Saharan Africa by human development index and histological subtypes: A population-based registry study

Ovarian cancer (OC) is the fourth most common cancer of women in sub-Saharan Africa (SSA), although few data have been published on population-level survival. We estimate ovarian cancer survival in SSA by human development index and histological subtype, using data from seven population-based cancer registries in six countries: Kenya (Nairobi and Eldoret), Mauritius, Uganda (Kampala), Cote d'Ivoire (Abidjan), Ethiopia (Addis Ababa) and South Africa (Eastern Cape). A total of 644 cases diagnosed during 2008-2014 were included, with 77% being of epithelial subtypes (range 47% [Abidjan]-80% [Mauritius]). The overall observed survival in the study cohort was 73.4% (95% CI: 69.8, 77.0) at 1 year, 54.4% (95% CI: 50.4, 58.7) at 3 years and 45.0% (95% CI: 41.0, 49.4) at 5 years. Relative survival at Year 1 ranged from 44.4% in Kampala to 86.3% in Mauritius, with a mean for the seven series of 67.4%. Relative survival was highest in Mauritius at 72.2% and lowest in Kampala, Uganda at 19.5%, with a mean of 47.8%. There was no difference in survival by age at diagnosis. Patients from high and medium HDI countries had significantly better survival than those from low HDI countries. Women with cancers of epithelial cell origin had much lower survival compared to women with other histological subtypes (p = .02). Adjusted for the young age of the African patients with ovarian cancer (44% aged <50) survival is much lower than in USA or Europe, and underlines the need for improvements in the access to diagnosis and treatment of OC in SSA.

Socio-economic factors determine maternal and neonatal outcomes in women with peripartum cardiomyopathy: A study of the ESC EORP PPCM registry

BACKGROUND

Peripartum cardiomyopathy (PPCM) is a global disease with substantial morbidity and mortality. The aim of this study was to analyze to what extent socioeconomic factors were associated with maternal and neonatal outcomes.

METHODS

In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global PPCM registry, under the auspices of the ESC EORP Programme. We investigated the characteristics and outcomes of women with PPCM and their babies according to individual and country-level sociodemographic factors (Gini index coefficient [GINI index], health expenditure [HE] and human developmental index [HDI]).

RESULTS

739 women from 49 countries (Europe [33%], Africa [29%], Asia-Pacific [15%], Middle East [22%]) were enrolled. Low HDI was associated with greater left ventricular (LV) dilatation at time of diagnosis. However, baseline LV ejection fraction did not differ according to sociodemographic factors. Countries with low HE prescribed guideline-directed heart failure therapy less frequently. Six-month mortality was higher in countries with low HE; and LV non-recovery in those with low HDI, low HE and lower levels of education. Maternal outcome (death, re-hospitalization, or persistent LV dysfunction) was independently associated with income. Neonatal death was significantly more common in countries with low HE and low HDI, but was not influenced by maternal income or education attainment.

CONCLUSIONS

Maternal and neonatal outcomes depend on country-specific socioeconomic characteristics. Attempts should therefore be made to allocate adequate resources to health and education, to improve maternal and fetal outcomes in PPCM.

Distribution incidence, mortality of tuberculosis and human development index in Iran: estimates from the global burden of disease study 2019

BACKGROUND

Tuberculosis is one of the most serious challenges facing the global healthcare system. This study aims to investigate the incidence and mortality of tuberculosis in Iran from 2010 to 2019 as well as its relationship with the human development index (HDI).

METHODS

The present study is an ecological study aiming at investigating the incidence and mortality of tuberculosis in Iran during the years 2010 to 2019. The related data were extracted from the Global Burden of Disease (GBD) website. The spatial pattern attributed to tuberculosis in the provinces of Iran was analyzed using ArcGIS software. In this study, the two-variable correlation method was used to analyze the data extracted to study the correlation between Tuberculosis and HDI.

RESULT

Based on the results recorded in GBD, the incidence of tuberculosis in 2010, that is, 14.61 (12.72, 16.74), declined compared to 2019, namely 12.29 (10.71, 14.09). The age-standardized mortality rate which was 1.63 (1.52, 1.73) in 2010, has decreased compared to 2019: 1.17 (1.07, 1.32). The incidence and mortality rates of tuberculosis in Iran in all age groups have decreased in 2019 compared to 2010. The highest incidence and mortality among tuberculosis patients were recorded in Sistan and Baluchistan and Golestan provinces. The results indicated that there was a negative and significant correlation between the mortality rate of tuberculosis and the human development index in 2010 (r = -0.509, P-value = 0.003) and 2019 (r = -0.36, P-value = 0.001); however, this correlation between incidence and human development index was not significant (p > 0.05).

CONCLUSION

Since mortality is mostly observed in areas with low HDI, health system policymakers must pay more attention to these areas in order to improve care and perform screenings to diagnose and treat patients thus reducing the mortality rate of tuberculosis and preventing an increase in its incidence in Iran.

Environmental quality and its impact on total fertility rate: an econometric analysis from a new perspective

BACKGROUND

Environmental quality significantly affects various aspects of human existence. This study employs ecological footprint as a proxy to assess the impact of environmental quality on the TFR, measured as births per woman. This study investigates the extent to which ecological footprint indicators impact on the TFR in across 31 countries between from 1990 to 2017.

METHODS

We gathered data on ecological footprints, specifically carbon, agricultural land, grazing land, forest products, and fisheries, from the Global Footprint Network. Information on the TFR, Human Development Index (HDI), and per capita Gross National Income (GNI) were sourced from the World Bank and the United Nations. We applied static panel and quantile regression models to scrutinize the connection between the ecological footprint and TFR, showing how the former influences the latter.

RESULTS

The outcomes reveal that, in both fixed and random effects models, factors including HDI, carbon, and fishing grounds exert a negative influence on TFR, all at a significance level of p < 0.01. Conversely, cropland and forest product footprints exhibited a favorable impact on the TFR (p < 0.01). Furthermore, GNI per capita positively affected the TFR in both models, with a p-value of 0.01. Quantiles regression analysis demonstrated that HDI and carbon footprint had a negative impact on TFR across all quantiles. This statistical significance is maintained for all quantiles, although it is only significant for the carbon footprint up to the 60th quantile, at p < 0.01.

CONCLUSIONS

This study establishes a negative correlation between specific ecological footprint indicators, such as carbon and fishing grounds, and TFR. Conversely, there was a positive correlation between the footprint of forest products and the TFR. The primary conclusion drawn is that there is heterogeneity in the results regarding the relationship between ecological footprint and TFR. Moreover, the ecological footprint indicators considered in this study did not uniformly influence TFR. Each ecological footprint indicator exhibited distinct effects on the TFR, displaying either positive or negative correlation coefficients. Future research endeavors may delve into how ecological footprints impact other population dynamics, such as mortality and migration.

The geographic diversity of authorship in leading general surgery journals; A study of 24,332 authors

BACKGROUND

Research guides evidence-based general surgery practice, advocacy, policy and resource allocation, but is seemingly lacking representation from those countries with greatest disease burden and mortality. Accordingly, we conducted a geographic study of publications in the most impactful general surgery journals worldwide.

METHODS

The six general surgery journals with the highest 2020 impact factors were selected. Only journals specific to general surgery were included. For all original articles over the past five years, the affiliated country and city were extracted for the first, second and last author. Number of publications were adjusted per capita, and compared to Human Development Index (HDI) using logistic regression.

RESULTS

8274 original articles were published in the top six ranked general surgery journals over 2016-2020, with 24,332 affiliated authors. Authors were most commonly associated with the US (27.88%), Japan (9.09%) and China (8.46%), or per capita, The Netherlands, Sweden and Singapore. There is a linear association between publishing in a top six journal and HDI of country of affiliation. Just four publications were from medium or low HDI countries over the period.

CONCLUSION

Authorship in leading general surgery journals is predominantly from wealthy, Western countries. Authorship is associated with affiliation with a high HDI country, with few authors from medium or low HDI countries. There is a lack of representation in literature from Africa, Russia, and parts of Southeast Asia, and thus a lack of locally relevant evidence to guide surgical practice in these areas of high disease burden and low life expectancy.

Socio-Economic Factors Associated with Ethnic Disparities in SARS-CoV-2 Infection and Hospitalization

BACKGROUND

There is evidence that non-Italians presented higher incidence of infection and worse health outcomes if compared to native populations in the COVID-19 pandemic. The aim of the study was to compare Italian- and non-Italian-born health outcomes, accounting for socio-economic levels.

METHODS

We analyzed data relative to 906,463 people in Umbria (Italy) from 21 February 2020 to 31 May 2021. We considered the National Deprivation Index, the Urban-Rural Municipalities Index and the Human Development Index (HDI) of the country of birth. We used a multilevel logistic regression model to explore the influence of these factors on SARS-CoV-2 infection and hospitalization rates. Diagnosis in the 48 h preceding admission was an indicator of late diagnosis among hospitalized cases.

RESULTS

Overall, 54,448 persons tested positive (6%), and 9.7% of them were hospitalized. The risk of hospital admission was higher among non-Italians and was inversely related to the HDI of the country of birth. A diagnosis within 48 h before hospitalization was more frequent among non-Italians and correlated to the HDI level.

CONCLUSIONS

COVID-19 had unequal health outcomes among the population in Umbria. Reduced access to primary care services in the non-Italian group could explain our findings. Policies on immigrants' access to primary healthcare need to be improved.

Cancer incidence and mortality trends in Asia based on regions and human development index levels: an analyses from GLOBOCAN 2020

OBJECTIVE

As Asian countries transition socially and economically to higher Human Development Index (HDI) levels, cancer trends are expected to shift to those seen in the Western World. A strong correlation also exists between HDI levels and age-standardized rates (ASR) for the incidence and mortality of cancer. However, there are very few reports on the trends in Asian countries, particularly in Low and Middle-Income Countries (LMICs). In this study, we have investigated the relationship between socioeconomic developments in Asia (determined using HDI levels of countries) and cancer incidence and mortality in these nations.

METHODS

The GLOBOCAN 2020 database was used to study the cancer incidence and mortality data for all cancers combined and those most commonly diagnosed in Asia. The difference in data was analyzed based on region and HDI level. Further, the predictions for cancer incidence and mortality in 2040 according to the GLOBOCAN 2020 were analyzed using the updated HDI stratification described in the UNDP 2020 report.

RESULTS

Asia has the highest cancer burden compared to the other regions worldwide. Lung cancer carries the highest cancer incidence and mortality rates in the region. Inequitable distribution of cancer incidence and mortality is seen across regions and HDI levels in Asia.

CONCLUSIONS

Inequalities in cancer incidence and mortality can only be expected to increase unless innovative and cost-effective interventions are urgently implemented. An effective cancer management plan is needed in Asia, particularly in LMICs, prioritizing effective cancer prevention and control measures for health systems.

Federalism, an alternative to overcome the inequalities of sustainable development in the natural regions and macro regions of Peru

Political doctrines determine the formation of territorial units or geopolitical models more adequate to generate public value in subnational organizations, with positive results in the HDI, productivity indicators and national competitiveness oriented to improve the quality of public service for citizens who participate in democratic electoral processes with identity and that promote a decentralized State that does not generate development obstacles as an effect of geographical limits by departments and regional governments with inequalities in natural resources and comparative advantages, but that projects integration, better economic performance, sustainability, and sustainability for regional and national development and as an alternative to achieve political stability in Peru. The aim of this article is to explore whether the contribution of natural regions and macro-regions to sustainable development is unequal. Information from official web pages. The disparity index, analysis of variance (ANOVA) and Tukey's analysis were used. The GDP per capita of the coastal departments is 64% higher than that of the Andes and 136% higher than those of the Amazon; the HDI of the coast exceeds those regions by 31 and 19%; 44% of the urban population residing in marginal neighborhoods are on the coast, 67% in the Andes and 69% in the Amazon. The percentage of corruption is highest on the coast, followed by the Amazon. At the regional macro level, the primacy in GDP per capita and the HDI moves to the south, although the superiority of the corruption index persists in the center, followed by the south; both significantly higher than the east and north. This fact would reveal the possibility of a regional macro development without Lima and through axes of various development nodes, feasible in the era of globalization.

Distribution of nursing workforce in the world using Gini coefficient

INTRODUCTION

Unequal Access to human resources for health, reduces access to healthcare services, worsens the quality of services and reduces health outcomes. This study aims to investigate the distribution of the nursing workforce around the world.

METHODS

This is a descriptive-analytical study, which was conducted in 2021. The number of nurses and world populations was gathered from World Health Organization (WHO) and The United Nations (UN) databases. The UN has divided world countries based on the Human Development Index (HDI) into four categories of very high, high, medium and low HDI. To investigate the distribution of the nurses around the world, we used the nurse population ratio (per 10,000 population), Gini coefficient, Lorenz curve and Pareto curve.

FINDINGS

On average, there were 38.6 nurses for every 10,000 people in the world. Nations with the very high HDI, had the highest nurse/population ratio (95/10,000), while the low HDI nations had the lowest nurse/population ratio (7/10,000). Most nurses around the world were females (76.91%) who were in the age group of 35-44 (29.1%). The Gini coefficient of nations in the each four HDI categories varied from 0.217 to 0.283. The Gini coefficient of the nations between the four HDI categories was 0.467, and the Gini coefficient of the whole world was 0.667.

CONCLUSION

There were inequalities between countries all over the world. Policymakers should focus on the equitable distribution of the nursing workforce across all local, national and regional levels.

The transition journey of EU vs. NON-EU countries for waste management

This study aims to identify macroeconomic indicators that can be used as predictors of waste management on the European continent. The study was conducted taking in account the intensification of urbanizations, the increase of standard of leaving that fuels to consumerism phenomenon, and imposed challenges for waste management. The research focuses on the interval from 2010 to 2020 for 37 European countries grouped according to EU15/EU28/non-EU and EU/non-EU members. As macroeconomic indicators, human development index (HDI), GDP/capita. GNI/capita, general government expenditure with environment protection, people at risk of poverty or social exclusion, population by educational attainment level, sex, and age (%)-less than primary, primary and lower secondary education (levels 0-2) were used. A multilinear regression model with collinearity diagnosis was applied to find out the direction and intensity of the contribution of independent variables and to hierarchy the predictors of waste management.. For multiple comparison between and inside of each grouping of countries, statistical inference methods were used: one-way ANOVA with Bonferroni post hoc test multiple comparisons and independent samples Kruskal-Wallis test with Dunn's post hoc test. The main conclusions of the study are that EU15 countries have the highest average values for most indicators of waste management, comparative with EU28 and with non-EU countries, followed by a group of EU28 countries. For indicators of recycling rate of packaging waste by type of packaging-metallic and recycling rate of e-waste, the non-EU countries have the highest values of mean compared with the EU15 and EU28 groups of countries. This can be explained by the high level of development of the some non-euro area countries (Iceland, Norway, Switzerland, Liechtenstein) that have intense concerns about waste recycling and have the necessary financial strength to carry out complex environmental protection programs.

Breast cancer screening programmes and self-reported mammography use in European countries

Mammography screening has been shown to be able to reduce breast cancer mortality, leading most European countries to implement mammography-based screening programmes. In our study, we analysed key characteristics of breast cancer screening programmes and mammography use in European countries. Information on screening programmes were obtained from the 2017 European Union (EU) screening report, websites from governments and cancer registries, and through literature search in PubMed (studies published up to 20 June 2022). Data on self-reported mammography use in the past 2 years were obtained from Eurostat and had been derived from the European health interview survey (cross-sectional survey), conducted in the 27 EU countries, Iceland, Norway, Serbia, Turkey and the UK in 2013 to 2015 and 2018 to 2020. Data were analysed for each country according to their human development index (HDI). By 2022, all included countries besides Bulgaria and Greece had introduced an organised mammography-based screening programme; Romania and Turkey had only pilot programmes. Screening programmes differ substantially across countries, particularly in timing of implementation (e.g., in Sweden, the Netherlands before 1990; Belgium, France between 2000 and 2004; Denmark, Germany between 2005 and 2009; Austria, Slovakia after 2010). Self-reported mammography use also differed considerably across countries, and went along with HDI-from <36% in all countries with HDI <0.85 to >70% in most countries with HDI >0.90. The data call for efforts to improve mammography screening use across Europe, particularly in countries with lower development levels where breast cancer mortality rates are also among the highest in the region.

The Study on Cervical Cancer Burden in 127 Countries and Its Socioeconomic Influence Factors

OBJECTIVES

To explore the relationship between cervical cancer burden and HDI and other socioeconomic influence factors in 127 countries.

METHODS

Dividing 127 countries into low-, medium-, high-, ultrahigh-HDI groups, and using statistical method to compare the prevalence trend of cervical cancer in different HDI country groups. Then selecting mortality-to-incidence ratio (MIR) to measure the cancer burden as the dependent variable, HDI and other socioeconomic factors selected from 2020 Human Development Report as independent variables, and using multi-regression model to analyze the correlation between variables.

RESULTS

Countries with higher HDI were found to have lower prevalence and mortality of cervical cancer, and vice versa. Besides that, air and water pollution, government-coordinated spending, and the intimate partner of 15-49-year-old women and girls have positive correlation impact on cervical cancer burden.

DISCUSSION

The cancer prevention and control policies in countries with high HDI have achieved relatively ideal implementation effects. Countries with relatively backward social and economic development level, cancer prevention and control policies had little effect, such as lower HPV vaccination coverage, poor regional health resource allocation, and week public education awareness. Therefore, cervical cancer control plan must be integrated into national strategies and implemented in people-oriented comprehensive health services.

A novel method for quantifying human disturbances: A case study of Huaihe River Basin, China

Human disturbances have become the main factors affecting the ecological environment. Therefore, evaluating the intensity of human disturbances is of great significance for ensuring effective regional conservation and ecosystem management. In this study, we constructed a novel method to quantify human disturbances based on three components of human disturbances into three types, namely naturalness transformation, natural resource consumption, and pollutant emissions. These components were quantified using the land use naturalness index (LNI), resource consumption index (RCI), and pollution emission index (PEI). Based on these three indicators, the human disturbances index (HDI) was calculated to reflect the intensity of human disturbances. In addition, remote sensing (RS), geographic information system (GIS), and multisource data were combined in the HDI method, taking into account the temporal variability of input parameters to achieve more convenient and comprehensive dynamic monitoring and evaluation of human disturbances. The applicability and effectiveness of the HDI method were assessed in the Huaihe River Basin, China. The obtained results revealed an increase and decrease in the intensities of human disturbances in the Huaihe River Basin from 1990 to 2005 and from 2010 to 2018, respectively. In addition, areas with a high level of human disturbances in the 1990-2005 period were mainly concentrated in the agricultural and industrial areas, while those in the 2010-2018 period were mainly observed in urban areas. This change was mainly due to a decrease in the pollutant emission amounts from agricultural and industrial lands and a marked increase in resource consumption in urban areas. This study provides theoretical guidance for regional conservation in the Huaihe River Basin and a new method for quantifying human disturbances.

COVID-19 and Water Variables: Review and Scientometric Analysis

COVID-19 has changed the world since 2020, and the field of water specifically, boosting scientific productivity (in terms of published articles). This paper focuses on the influence of COVID-19 on scientific productivity with respect to four water variables: (i) wastewater, (ii) renewable water resources, (iii) freshwater withdrawal, and (iv) access to improved and safe drinking water. The field's literature was firstly reviewed, and then the maps were built, emphasizing the strong connections between COVID-19 and water-related variables. A total of 94 countries with publications that assess COVID-19 vs. water were considered and evaluated for how they clustered. The final step of the research shows that, on average, scientific productivity on the water topic was mostly conducted in countries with lower COVID-19 infection rates but higher development levels as represented by gross domestic product (GDP) per capita and the human development index (HDI). According to the statistical analysis, the water-related variables are highly significant, with positive coefficients. This validates that countries with higher water-related values conducted more research on the relationship with COVID-19. Wastewater and freshwater withdrawal had the highest impact on the scientific productivity with respect to COVID-19. Access to safe drinking water becomes insignificant in the presence of the development parameters.

Patterns of better breast cancer care in countries with higher human development index and healthcare expenditure: Insights from GLOBOCAN 2020

Background

The huge burden of breast cancer (BC) necessitates the profound and accurate knowledge of the most recent cancer epidemiology and quality of care provided. We aimed to evaluate BC epidemiology and quality of care and examine the effects of socioeconomic development and healthcare expenditure on disparities in BC care.

Methods

The results from the GLOBOCAN 2020 study were utilized to extract data on female BC, including incidence and mortality numbers, crude rates, and age-standardized rates [age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs)]. The mortality-to-incidence ratio (MIR) was calculated for different locations and socioeconomic stratifications to examine disparities in BC care, with higher values reflecting poor quality of care and vice versa. In both descriptive and analytic approaches, the human development index (HDI) and the proportion of current healthcare expenditure (CHE) to gross domestic product (CHE/GDP%) were used to evaluate the values of MIR.

Results

Globally, 2,261,419 (95% uncertainty interval (UI): 2,244,260-2,278,710) new cases of female BC were diagnosed in 2020, with a crude rate of 58.5/100,000 population, and caused 684,996 (675,493-694,633) deaths, with a crude rate of 17.7. The WHO region with the highest BC ASIR (69.7) was Europe, and the WHO region with the highest ASMR (19.1) was Africa. The very high HDI category had the highest BC ASIR (75.6), and low HDI areas had the highest ASMR (20.1). The overall calculated value of female BC MIR in 2020 was 0.30, with Africa having the highest value (0.48) and the low HDI category (0.53). A strong statistically significant inverse correlation was observed between the MIR and HDI values for countries/territories (Pearson's coefficient = -0.850, p-value < 0.001). A significant moderate inverse correlation was observed between the MIR and CHE/GDP values (Pearson's coefficient = -0.431, p-value < 0.001).

Conclusions

This study highlighted that MIR of BC was higher in less developed areas and less wealthy countries. MIR as an indicator of the quality of care showed that locations with higher healthcare expenditure had better BC care. More focused interventions in developing regions and in those with limited resources are needed to alleviate the burden of BC and resolve disparities in BC care.

Spatial Human Development Index in China: Measurement and Interpretation Based on Bayesian Estimation

The development of urban agglomerations dominated by the service industry is an important driving force for further sustainable economic growth of China. Spatial analysis marked by population density and regional integration is an essential perspective for studying the human development index (HDI) in China. Based on Bayesian estimation, this paper examines the influence of a spatial factor on HDI by using a spatial hierarchical factor model within the framework of Sen Capability Approach theory, overcoming the neglect of spatial factors and their equal weight in traditional measurement of HDI. On this basis, the HDI including the spatial factor was measured based on the panel data from 2000 to 2018. The results reveal that (1) provinces with high population densities and regional integration have higher rankings and low uncertainties of HDI, which can be attributed to the improvement of education weights; (2) HDI has a certain spatial spillover effect, and the spatial association increases year by year; (3) robust test by using nighttime lighting as an alternative indicator of GDP supports that the spatial correlation is positively related to HDI ranking. The policy recommendations of this paper are to remove the obstacles for cross-regional population mobility and adjust the direction and structure of public expenditure.

Heterocycles in Breast Cancer Treatment: The Use of Pyrazole Derivatives

Among the aromatic heterocycle rings, pyrazole -a five-membered ring with two adjacent nitrogen atoms in its structure has been postulated as a potent candidate in the pharmacological context. This moiety is an interesting therapeutic target covering a broad spectrum of biological activities due to its presence in many natural substances. Hence, the potential of the pyrazole derivatives as antitumor agents has been explored in many investigations, showing promising results in some cases. In this sense, breast cancer, which is already the leading cause of cancer mortality in women in some countries, has been the topic selected for this review, which covers a range of different research from the earliest studies published in 2003 to the most recent ones in 2021.

Influence of Population Size, the Human Development Index and the Gross Domestic Product on Mortality by COVID-19 in the Southeast Region of Brazil

We evaluated the influence of population size (POP), HDI (Human Development Index) and GDP (gross domestic product) on the COVID-19 pandemic in the Southeast region of Brazil, between February 2020 and May 2021.

METHODS

Cases, deaths, incidence coefficient, mortality rate and lethality rate were compared among states. The cities were divided into strata according to POP, GDP, and HDI. Data were compared by Welch's ANOVA, nonlinear polynomial regression, and Spearman's correlation test (rS).

RESULTS

The highest incidence coefficient (p < 0.0001) and mortality rate (p < 0.05) were observed in the states of Espírito Santo and Rio de Janeiro, respectively. Until the 45th week, the higher the POP, the higher the mortality rate (p < 0.01), with no differences in the remaining period (p > 0.05). There was a strong positive correlation between POP size and the number of cases (rS = 0.92, p < 0.0001) and deaths (rS = 0.88, p < 0.0001). The incidence coefficient and mortality rate were lower (p < 0.0001) for low GDP cities. Both coefficients were higher in high- and very high HDI cities (p < 0.0001). The lethality rate was higher in the state of Rio de Janeiro (p < 0.0001), in large cities (p < 0.0001), in cities with medium GDP (p < 0.0001), and in those with high HDI (p < 0.05).

CONCLUSIONS

Both incidence and mortality were affected by time, with minimal influence of POP, GDP and HDI.

Effect of herbal formulation on glimepiride pharmacokinetics and pharmacodynamics in nicotinamide-streptozotocin-induced diabetic rats

BACKGROUND

Traditional medicinal herbs are widely consumed in developing countries to treat diabetes as they are perceived to be safer, less expensive, and have fewer side effects as compared to the conventional medicines. Diabecon (DB), Himalaya Herbal Healthcare, India is herbal over-the-counter formulation which contains several herbs that are reported in the traditional texts for the treatment of diabetes. The majority of these herbs have been investigated and found to interfere with the cytochrome pathway. The most common oral antihyperglycemic drug used today in clinical practice is Glimepiride (GP).The CYP2C9 enzyme is mainly responsible for the metabolism of GP. Herein we hypothesize that the co-administration of GP with DB may result in possible Herb-Drug Interactions (HDIs) as DB has the potential to significantly inhibit the CYP2C9 enzyme.

OBJECTIVE

In the current study, the pharmacokinetic and pharmacodynamic interactions of GP (0.82 mg/kg) with DB (110.95 mg/kg) was investigated in diabetes induced (Nicotinamide-STZ) rats by co-administering both drugs orally for 21 days.

MATERIALS AND METHODS

For the study of the HDI, Bioanalytical RP-HPLC/PDA method for quantifying GP in plasma of rats was developed and validated as per US-FDA guidelines. In vivo pharmacokinetic and pharmacodynamic parameters were studied on day 1 and day 21 post administration.

RESULTS

The RP-HPLC/PDA method was successfully employed for quantification of GP in the PK studies. The co-administration of GP and DB in diabetic rats resulted in beneficial pharmacodynamic interactions, but there were no notable changes in the pharmacokinetic parameters of GP.

CONCLUSION

This current investigation in an animal model suggests that co-administration of GP and DB may have significant therapeutic benefits in the treatment of diabetes; however, additional research, randomized clinical trials or case studies in humans, is needed.

Refugees, governance, and sustainable environment: PQARDL method

Although many variables that have adverse impacts on the sustainable environment are investigated from many aspects, some variables are missing. In this study, it will be simultaneously focused on the relation between refugees, governance, sustainable environment, economic growth, energy consumption, and supplementary explanatory variables, HDI, the trade deficit, and financial development, for Bangladesh, Ethiopia, Jordan, Lebanon, Pakistan, Sudan, and Uganda using the panel quantile autoregressive distributed lag (PQARDL) and causality methods for the 1996-2019 period. Long-run coefficients found by PQARDL method showed the evidence of the long-run relationship between the sustainable environment, refugee population, governance, economic growth, energy consumption, and explanatory variables. Both traditional and Dumitrescu and Hurlin (2012) causality tests determined the evidence of a unidirectional causality from political and economic governance to greenhouse gas (GHG) emissions and deforestation, as well as a unidirectional causality from refugees to GHG emissions and deforestation.

The COVID-19 vaccination acceptance/hesitancy rate and its determinants among healthcare workers of 91 Countries: A multicenter cross-sectional study

The aim of this study was to investigate the COVID-19 vaccination acceptance rate and its determinants among healthcare workers in a multicenter study. This was a cross-sectional multi-center survey conducted from February 5 to April 29, 2021. The questionnaire consisted of 26 items in 6 subscales. The English version of the questionnaire was translated into seven languages and distributed through Google Forms using snowball sampling; a colleague in each country was responsible for the forward and backward translation, and also the distribution of the questionnaire. A forward stepwise logistic regression was utilized to explore the variables and questionnaire factors tied to the intention to COVID-19 vaccination. 4630 participants from 91 countries completed the questionnaire. According to the United Nations Development Program 2020, 43.6 % of participants were from low Human Development Index (HDI) regions, 48.3 % high and very high, and 8.1 % from medium. The overall vaccination hesitancy rate was 37 %. Three out of six factors of the questionnaire were significantly related to intention to the vaccination. While 'Perceived benefits of the COVID-19 vaccination' (OR: 3.82, p-value<0.001) and 'Prosocial norms' (OR: 5.18, p-value<0.001) were associated with vaccination acceptance, 'The vaccine safety/cost concerns' with OR: 3.52, p-value<0.001 was tied to vaccination hesitancy. Medical doctors and pharmacists were more willing to take the vaccine in comparison to others. Importantly, HDI with OR: 12.28, 95 % CI: 6.10-24.72 was a strong positive determinant of COVID-19 vaccination acceptance. This study highlighted the vaccination hesitancy rate of 37 % in our sample among HCWs. Increasing awareness regarding vaccination benefits, confronting the misinformation, and strengthening the prosocial norms would be the primary domains for maximizing the vaccination coverage. The study also showed that the HDI is strongly associated with the vaccination acceptance/hesitancy, in a way that those living in low HDI contexts are more hesitant to receive the vaccine.

How Socio-Economic Drivers Explain Landscape Soil Erosion Regulation Services in Polish Catchments

Most studies that address the relationship between socio-economic characteristics and soil erosion focus on the effects of soil erosion on socio-economic conditions at different levels, from global to smallholder. Few, if any, efforts are made to address the influence of socio-economic variables on the soil erosion rate as an indicator of landscape degradation. The present study was carried out using spatial data from 402 catchments that cover Poland, to find out how socio-economic variables, which include area-weighted average income per capita (PLN km^-2), area-weighted average gross domestic product (PLN km^-2), population density (person km^-2), and human development index can drive the soil erosion rate (kg ha^-1 yr^-1), along with annual precipitation, soil and geomorphological variables that include soil organic carbon content, soil water content, clay ratio, stream gradient, and terrain slope. The results showed that the soil erosion rate is indirectly driven by the socio-economic variables in the study catchments, as it is alleviated by increasing population density, the area-weighted average gross domestic product, and the human development index. Furthermore, analyzing the incremental relationship between soil erosion rate and the area-weighted average of socio-economic variables revealed that no uniform change can be observed in the relationship between the area-weighted average socio-economic variables and soil erosion in the study catchments.

Substrate-dependent inhibition of hypericin on human carboxylesterase 2: implications for herb-drug combination

BACKGROUND

Hypericin is the main active ingredient of St. John's wort, a Chinese herb commonly used in treating depression. Previous studies have shown that hypericin can strongly inhibit human cytochrome P450 (CYP) enzyme activities; however, its potential interactions that inhibit human carboxylesterases 2 (hCE2) were unclear.

PURPOSE

The study aimed to investigate the inhibition of hypericin on hCE2.

METHODS

The inhibition of hypericin on hCE2 was studied by using N-(2-butyl-1,3-dioxo-2,3-dihydro-1H-phenalen-6-yl)-2-chloroacetamide (NCEN). The type of inhibition of hypericin on hCE2 and the corresponding inhibition constant (Ki) value were determined. The inhibition of hypericin on hCE2 in living cells was discussed. The herb-drug interactions (HDI) risk of hypericin and hCE2 in vivo was predicted by estimating the drug concentration-time curve (AUC) ratio of hypericin and hypericin free. To understand the inhibition mechanism of hypericin on the activity of hCE2 in-depth, molecular docking was performed.

RESULTS

The half-maximal inhibitory concentration (IC50) values of hypericin against the hydrolysis of NCEN and irinotecan (CPT-11) were calculated to be 26.59 μM and 112.8 μM, respectively. Hypericin inhibited the hydrolysis of NCEN and CPT-11. Their Ki values were 10.53 μM and 81.77 μM, respectively. Moreover, hypericin distinctly suppressed hCE2 activity in living cells. In addition, the AUC of hCE2 metabolic drugs with metabolic sites similar to NCEN was estimated to increase by up to 5%, in the presence of hypericin. More importantly, the exposure of CPT-11 in the intestinal epithelium was predicted to increase by 2%-69% following the oral co-administration of hypericin. Further, molecular simulations indicated that hypericin could strongly interact with ASP98, PHE307, and ARG355 to form four hydrogen bonds within hCE2.

CONCLUSION

These findings are of considerable clinical significance to the combination of hypericin-containing herbs and drugs metabolized by hCE2.

A fair and progressive carbon price for a sustainable economy

The principle of "common but differentiated responsibility", as a key concept of the United Nations Framework Convention on Climate Change (UNFCCC), acknowledges the conditions for a generally acceptable and differentiated pricing mechanism on carbon emissions. With reference to this principle, carbon price determination has become a necessary instrument for sustainable policies. Considering the development gaps and the historical responsibility of the OECD's countries, a single carbon price would raise a major issue of equity between "developed" and "developing" countries. Although from a climate perspective each molecule of CO₂ produces the same level of damage despite the nature or the location of the activity generating the emissions, all CO₂ emissions are not on an equal footing. Indeed, some are necessary to improve the lives of people in "developing" countries when others can be considered not indispensable, especially beyond a certain level of development. In this policy paper, we explain how the price of carbon should be fixed according to a reference price depending on the Human Development Index (HDI) and CO₂ emissions per capita. The HDI criterion enables to integrate progressivity into taxation while distinguishing what is essential from what is not. By taking a reference price based on the HDI, countries with low HDIs should pay a lower carbon price. However, with same HDI levels, countries with higher CO₂ emissions should pay a penalty on the reference price. Our policy paper analyses the benefits of a differentiated and progressive carbon pricing mechanism to facilitate intergovernmental cooperation for a more sustainable economy.

Talent map: how demographic rate, human development index and birthdate can be decisive for the identification and development of soccer players in Brazil

Aim:The aim of this paper is to verify how cities' demographic rates and Human Development Index (HDI), as well as the birthdate of Brazilian elite soccer players influenced their identification and development.Methods:The sample was comprised of 5,359 players from the Brazilian Serie A Soccer Championship between 2003 and 2019. Players' birthdate and birthplace data were collected, as well as the HDI from their hometowns. Descriptive statistics, chi-square, Pearson correlation and linear regression tests were performed.Results:Results indicated that players born in the first semester of the year, in cities with a demographic rate of up to 100,000 inhabitants and HDI above 0.501, are more likely to play at the highest level (Serie A) of Brazilian soccer. Correlations were observed between birth quartile and HDI (r = -.059; se = 0.04; p < 0.001), birth quartile and demographic rates (r = -063, se = 0.03; p < 0.001), and between HDI and demographic rates (r = 0.458; se = 0.02; p < 0.001). The linear regression method yielded a valid model that included all three variables in this study (F₍₂₎ = 9.512; p < 0.001).Conclusion:Based on these findings, it is possible to conclude that birthdate, demographic rate and HDI are important factors in the identification and development of soccer players in Brazil.

Neverland or Tomorrowland? Addressing (In)compatibility among the SDG Pillars in Europe

The 2015–2030 agenda framed Sustainable Development as a Universal venture. This decision has a great historic significance as it encompasses building a better future for the whole of humanity, enrolling the millions who have been denied the chance to live a decent, dignified and fulfilling life and to achieve their potential. For the first time, an entire generation will have the chance to succeed in ending poverty while being the last to have a chance of saving the planet. The world will be a better place in 2030 if humanity succeeds in this journey. However, there is hovering skepticism around the feasibility of this accomplishment. The article aims to empirically test the (in)compatibilities among these objectives even for developed economies such as the European Union countries, demonstrating that unless solid bridges are built promoting innovative networks at a transnational level, welfare and prosperity among those ecosystems will be compromised. The results show that the Sustainable Development Goals (SDG) pillars have heterogeneous determinants, which are to some extent incompatible. Moreover, policy makers need to further reinforce multi-country compensations if the environment is to be preserved.

Revised environmental Kuznets Curve in CEE countries. Evidence from panel threshold models for economic sectors

The recent environmental debates in the European Green Deal to reduce pollution determine the reconsideration of the relationship between economic development and environmental quality. In this context, this paper explains the GHG emissions in few Central and Eastern European countries (CEEs) (Bulgaria, Poland, Hungary, Slovak Republic, Czech Republic and Romania) in the period 1990-2019 and proposes suitable economic policies to reduce pollution. Environmental Kuznets Curve (EKC) and renewable energy Kuznets Curve (RKC) are considered in a methodological framework based on panel threshold and dynamic panel models. The analysis based on GHG emissions from all economic sectors and GHG emissions from agriculture indicates similarities and differences related to the impact of economic indicators on pollution. The results of estimations indicated an inverted N-shaped relationship between GDP and GHG emissions and an N-shaped pattern between value added in agriculture and pollution. The U-shaped RKC was confirmed for overall economy and for agriculture. The policy proposals based on empirical findings promote sustainable development in the analysed states by reducing pollution.

Variability in insulin pharmacokinetics following high-dose insulin therapy

INTRODUCTION

High dose insulin (HDI) therapy for cardiogenic shock from acute poisoning can be complicated by treatable hypoglycemia which persists following poisoning recovery. Glucose requirements post-HDI reflect supraphysiological insulin plasma concentration. A publication reported a patient treated with HDI with plasma insulin concentrations >1000 µU/mL and elimination half-life 10-18 h requiring intravenous glucose replacement for >5 days. We report two cases treated with HDI (Actrapid; soluble or regular insulin) with shorter elimination half-lives.

CASE REPORTS

A man ingesting diltiazem received HDI for approximately 60 h (maximum dose 10 U/kg/h) and supplemental intravenous dextrose for 44 h post-HDI. Post-HDI the maximum measured plasma insulin concentration was 6345 µU/mL and elimination half-life 5.5 h. A man ingesting propranolol received HDI for approximately 12 h (maximum dose 1.5 U/kg/h) and supplemental intravenous dextrose for 4 h post-HDI. Post-HDI the maximum measured plasma insulin concentration was 368 µU/mL and elimination half-life 2.2 h.

DISCUSSION

Markedly different insulin pharmacokinetics post-HDI is observed in two cases and a previously published report, and factors contributing to the interpatient differences are poorly defined. This pharmacokinetic variability impacts on the severity and duration of treatable hypoglycemia post-HDI. Analytical factors impacting on the measured plasma insulin concentrations include appropriate sample dilution and differing analytical specificity for the type of insulin.

Do health expenditure and human development index matter in the carbon emission function for ensuring sustainable development? Evidence from the heterogeneous panel

This study is an attempt to explain the nexus between health expenditures, GDP, human development index (HDI), CO₂ emissions (COEM), renewable energy (RENE), financial development (FD) and electricity consumption (EC) using data from 2000Q₁ to 2014Q₄ for Brazil, India, China and South Africa. The study applies CIPS and CADF to determine the integration order. The tests confirmed the unique order of integration. The study further uses the Westerlund panel cointegration, which suggests the existence of a long-run relationship. Moreover, the panels dynamic ordinary least squares (DOLS) and fully modified ordinary least squares (FMOLS) are applied to ascertain the long-run elasticity. The health expenditure and electricity consumption affect the COEM positively. Moreover, HDI and RE affect COEM negatively. The study further confirms the existence of an N-shaped EKC in the long run. The pairwise Dumitrescu and Hurlin, Econ Model 29:1450-1460, (2012) test is used to uncover the direction of the association between the variables. The findings obtained from DH confirm a bidirectional causality between HDI and FD. Likewise, another bidirectional causal relationship has also been found between FD and EC. The findings of our study advocate policies in the direction of HDI and health expenditure by adopting RENE. This study highlights the importance of RENE, which can facilitate a reduction in carbon emissions and decreasing health expenditures. Moreover, the financial sector needs to be improved to create entrepreneurship opportunities for the public in improving the HDI in ensuring sustainable development.

Majority world successes and European and American failure to contain COVID-19: Cultural collectivism and global leadership

United Nations and World Health Organization data show a positive correlation, r = .53, p < .0001, N = 189, between COVID-19 infection rates and the human development index (HDI). Less wealthy, less educated countries with lower life spans were also more successful in maintaining lower fatality rates, r = .46, p < .0001, N = 189 whereas 9 of the top-10 countries in the world in per capita fatalities due to COVID-19 were Western societies high in HDI. Similar positive correlations were found between COVID-19 infection and fatality rates and a smaller sample of 76 countries measured on Schwartz intellectual autonomy (or individualism), and negative correlations of similar magnitude were found for embeddedness (or collectivism). East Asia was a global leader in preventing the spread of COVID-19 because of a vigilant public concerned for public safety and compliant with public safety measures. African Union leaders coordinated their responses, and bought into a continent-wide African Medical Supplies Platform that prevented panicked competition for scare supplies. Western global media and scholars have not paid attention to the successes of East Asia, Africa, and the South Pacific in fighting the pandemic. It is worth asking why this should be the case; understand the weaknesses of extreme individualism in fighting a pandemic requiring coordinated and unified public response, and consider the lessons for global scholars from the pandemic for doing research in the future.

Cost per DALY averted in low, middle- and high-income countries: evidence from the global burden of disease study to estimate the cost-effectiveness thresholds

BACKGROUND

Determining the cost-effectiveness thresholds for healthcare interventions has been a severe challenge for policymakers, especially in low- and middle-income countries. This study aimed to estimate the cost per disability-adjusted life-year (DALY) averted for countries with different levels of Human Development Index (HDI) and Gross Domestic Product (GDP).

METHODS

The data about DALYs, per capita health expenditure (HE), HDI, and GDP per capita were extracted for 176 countries during the years 2000 to 2016. Then we examined the trends on these variables. Panel regression analysis was performed to explore the correlation between DALY and HE per capita. The results of the regression models were used to calculate the cost per DALY averted for each country.

RESULTS

Age-standardized rate (ASR) DALY (DALY per 100,000 population) had a nonlinear inverse correlation with HE per capita and a linear inverse correlation with HDI. One percent increase in HE per capita was associated with an average of 0.28, 0.24, 0.18, and 0.27% decrease on the ASR DALY in low HDI, medium HDI, high HDI, and very high HDI countries, respectively. The estimated cost per DALY averted was $998, $6522, $23,782, and $69,499 in low HDI, medium HDI, high HDI, and very high HDI countries. On average, the cost per DALY averted was 0.34 times the GDP per capita in low HDI countries. While in medium HDI, high HDI, and very high HDI countries, it was 0.67, 1.22, and 1.46 times the GDP per capita, respectively.

CONCLUSIONS

This study suggests that the cost-effectiveness thresholds might be less than a GDP per capita in low and medium HDI countries and between one and two GDP per capita in high and very high HDI countries.

Nexus between environmental, social and economic development in South Asia: evidence from econometric models

This study investigates the impact of various economic, social and environmental indicators on economic growth in South Asian countries. Using the data throughout 1990–2017, a panel data estimation method is adopted with sophisticated econometric approaches. The obtained results indicate a long-term positive effect of biological capacity, financial development, human development index, income inequality on economic growth while the effect of energy use is the opposite. The findings of the study suggest that governments and associated bodies must promote financial development, human development, and biocapacity to not only attain economic growth in the long-run and but dissuade ecological footprint, and income inequality at the same time while matching the energy consumption with the bio-capacity of each economy.

Characterization of PLA/PBSeT Blends Prepared with Various Hexamethylene Diisocyanate Contents

Poly (lactic acid) (PLA) is the most widely available commercial bioplastic that is used in various medical and packaging applications and three-dimensional filaments. However, because neat PLA is brittle, it conventionally has been blended with ductile polymers and plasticizers. In this study, PLA was blended with the high-ductility biopolymer poly (butylene-sebacate–co–terephthalate) (PBSeT), and hexamethylene diisocyanate (HDI) was applied as a crosslinking compatibilizer to increase the miscibility between the two polymers. PLA (80%) and PBSeT (20%) were combined with various HDI contents in the range 0.1–1.0 parts-per-hundred rubber (phr) to prepare blends, and the resulting physical, thermal, and hydrolysis properties were analyzed. Fourier-transform infrared analysis confirmed that –NH–C=OO⁻ bonds had formed between the HDI and the other polymers and that the chemical bonding had influenced the thermal behavior. All the HDI-treated specimens showed tensile strengths and elongations higher than those of the control. In particular, the 0.3-phr-HDI specimen showed the highest elongation (exceeding 150%) and tensile strength. In addition, all the specimens were hydrolyzed under alkaline conditions, and all the HDI-treated specimens degraded faster than the neat PLA one.

Are child and youth population at lower risk of COVID-19 fatalities? Evidences from South-East Asian and European countries

BACKGROUND

The coronavirus disease (COVID-19) pandemic has revealed many lacunas of public health preparedness, especially in lower and middle-income countries and fatality differentials between European and South-East Asian countries. The case fatality rate (CFR) in most of the South-East Asian countries is much lower than the European countries. The percentages of child and youth population are more in South-East countries.

OBJECTIVE

The study aims to show the impacts of age composition on fatality differentials in European and South-East Asian countries by age-structure, especially the percentage share of child and youth population.

DATA AND METHODS

This study has been done based on data provided by UNDP, WHO and worldometers. The case fatality rate (CFR) has been calculated to find out the mortality differentials of countries, and the higher fatality risk countries have been identified by the composite Z score technique.

RESULTS

It is revealed that the COVID-19 case fatality rates are substantially high in highly developed countries of the European countries compared to the South-East Asian countries. Our study shows that there is an issue of child and youth population which affects the lower CFR in SE Asian countries. In France, the CFR was 16.72% which was nearly 7 times more than India (2.31%). The COVID-19 fatality risk ratio was highest in Germany (0.77) while the lowest risk ratio was observed in Bangladesh (-0.71).

CONCLUSION

Despite of having a very high level of human development and preparedness, the current pandemic COVID-19 has revealed that there exist significant differentials among fatality status of European and South-East Asian countries. The CFR is lower in the SE Asian countries where the child and youth population are more than the older population.

A global trend of caffeine consumption over time and related-environmental impacts

Caffeine is one of the most consumed substances, and it has been largely detected in aquatic ecosystems. We investigated the trends in caffeine consumption over three decades and its relationships with gross domestic product (GDP) and human development index (HDI) to understand global patterns and to identify potential hotspots of contamination. The total caffeine consumption is increasing mainly due to population growth. Moreover, caffeine consumption per capita is also increasing in some countries, such as Brazil, Italy, and Ethiopia. A high positive correlation between caffeine consumption per capita with HDI and GDP was found for coffee-importing countries in Europe, while a high negative correlation was found for coffee-exporting countries in Africa. The literature review showed that the highest caffeine concentrations coincide with countries that present an increasing caffeine consumption per capita. Also, approximately 35% of the caffeine concentrations reported in the literature were above the predicted no-effect concentration in the environment and, again, overlaps with countries with increasing per capita consumption. Despite the high degradation rate, caffeine consumption tends to increase in a near future, which may also increase the overall amount of caffeine that comes into the environment, possibly exceeding the thresholds of several species described as tolerant to the current environmental concentrations. Therefore, it is essential to prevent caffeine from reaching aquatic ecosystems, implementing sewage treatment systems, and improving their efficiency.

Association between the Human Development Index and Millennium Development Goals 6 Indicators in Sub-Saharan Africa from 2000 to 2014: Implications for the New Sustainable Development Goals

It is important to assess whether regional progress toward achieving the millennium development goals (MDGs) has contributed to human development and whether this has had an effect on the triple burden of disease in the continent. This analysis investigates the association between the human development index (HDI) and co-occurrence of HIV/AIDS, tuberculosis (TB), and malaria as measured by MDG 6 indicators in 35 selected sub-Saharan African countries from 2000 to 2014. The analysis used secondary data from the United Nations Development Programme data repository for HDI and disease data from WHO Global Health observatory data repository. Generalized Linear Regression Models were used to analyze relationships between HDI and MDG 6 indicators. HDI was observed to improve from 2001 to 2014, and this varied across the selected sub-regions. There was a significant positive relationship between HDI and HIV prevalence in East Africa (β = 0.048 [95% CI: 0.040–0.056], p < 0.001) and Southern Africa (β = 0.032 [95% CI: 0.002–0.062], p = 0.034). A significant positive relationship was observed with TB incidence (β = 0.009 [95% CI: 0.003–0.015], p = 0.002) and a significant negative relationship was observed with malaria incidence (β = −0.020 (95% CI: −0.029 to −0.010, p < 0.001) in East Africa. Observed improvements in HDI from the year 2000 to 2014 did not translate into commensurate progress in MDG 6 goals.

Histone Deacetylase Inhibitors and Phenotypical Transformation of Cancer Cells

Histone deacetylase inhibitors (HDIs) are a group of potent epigenetic drugs which have been investigated for their therapeutic potential in various clinical disorders, including hematological malignancies and solid tumors. Currently, several HDIs are already in clinical use and many more are on clinical trials. HDIs have shown efficacy to inhibit initiation and progression of cancer cells. Nevertheless, both pro-invasive and anti-invasive activities of HDIs have been reported, questioning their impact in carcinogenesis. The aim of this review is to compile and discuss the most recent findings on the effect of HDIs on the epithelial-mesenchymal transition (EMT) process in human cancers. We have summarized the impact of HDIs on epithelial (E-cadherin, β-catenin) and mesenchymal (N-cadherin, vimentin) markers, EMT activators (TWIST, SNAIL, SLUG, SMAD, ZEB), as well as morphology, migration and invasion potential of cancer cells. We further discuss the use of HDIs as monotherapy or in combination with existing or novel anti-neoplastic drugs in relation to changes in EMT.

Impacts of human development index and climate conditions on prevalence of Blastocystis: A systematic review and meta-analysis

Blastocystis is a prevalent eukaryotic microorganism that has been frequently reported from the stool samples of human and animals, all over the world. The prevalence of this parasite has close correlation with the climate and hygiene situation of studied populations. For the current study, English and Persian databases were searched for the following terms: "Blastocystis hominis", "Blastocystis sp.", "Intestinal Parasites", "Prevalence" and "Iran". In order to data analysis and assess the possibility of publication bias, STATA v11 and Begg's Funnel plot were employed respectively. From 605 searched cases, 86 publications met our criteria for the analysis. The pooled prevalence of Blastocystis was 9.1% (95%CI: 8.2%, 10.1%). The results represented that the prevalence of the parasite using molecular techniques or cultivation followed by molecular techniques (20.89%) was higher than only microscopical examination (8.96%). The prevalence rate of Blastocystis according to human development index was 7.6%, 7.2%, 11.9%, 13.4%, and 3.3% for ranks 1 to 5, respectively. This is the first study signifying the prevalence of Blastocystis regarding the human development index and climate conditions. The findings represented that although human development index, low levels of socioeconomic situations together with appropriate climate such as sufficient humidity and high temperature increase the chance of transmission of Blastocystis in a society.

Apigenin, a novel candidate involving herb-drug interaction (HDI), interacts with organic anion transporter 1 (OAT1)

BACKGROUND

Apigenin is a flavonoid compound, widely distributed in natural plants. Various studies have suggested that apigenin has inhibitory effects towards several drug transporters, such as the organic anion transporting (OAT) polypeptides, 1B1 and 1B3 (OATP1B1 and OATP1B3). However, the mechanism by which apigenin interacts with OAT1 has not been well studied.

METHODS

MDCK cells stably-expressing OAT1 were used to examine the inhibitory effects of apigenin on OAT1. UPLC-MS/MS was used to evaluate the in vitro and in vivo effects of apigenin on the uptake of acyclovir by OAT1. Cytotoxicity was determined by the cell viability, MTT assays.

RESULTS

Apigenin effectively inhibited the activity of OAT1 in a dose-dependent manner with an IC50 value of 0.737μM. Pre-incubation of cells with apigenin caused a time-dependent inhibition (TDI) of OAT1. Additionally, we examined the interactions between apigenin and acyclovir or adefovir. Data showed that apigenin (1μM) significantly blocked the uptake of acyclovir by OAT1 in vitro with an inhibition rate of 55%. In vivo, apigenin could increase the concentration of acyclovir in plasma when co-administered with acyclovir. Importantly, the MTT assays showed that, at a dose of 50μM, apigenin significantly reduced the cytotoxicity of adefovir and substantially increased cell viability from 50.6% to 112.62%.

CONCLUSION

Our results demonstrate that apigenin regulates OAT1, and can cause TDI or herb-drug interaction (HDI) when used in combination with acyclovir or adefovir. Therefore, apigenin could be used as a nephroprotective agent when used in combination with the substrates of OAT1.

An HDAC Inhibitor, Entinostat/MS-275, Partially Prevents Delayed Cranial Suture Closure in Heterozygous Runx2 Null Mice

Cleidocranial dysplasia (CCD) is an autosomal dominant skeletal disorder caused by mutations in RUNX2, coding a key transcription factor of early osteogenesis. CCD patients suffer from developmental defects in cranial bones. Despite numerous investigations and clinical approaches, no therapeutic strategy has been suggested to prevent CCD. Here, we show that fetal administration of Entinostat/MS-275, a class I histone deacetylase (HDAC)-specific inhibitor, partially prevents delayed closure of cranial sutures in Runx2^+/- mice strain of C57BL/6J by two mechanisms: 1) posttranslational acetylation of Runx2 protein, which stabilized the protein and activated its transcriptional activity; and 2) epigenetic regulation of Runx2 and other bone marker genes. Moreover, we show that MS-275 stimulates osteoblast proliferation effectively both in vivo and in vitro, suggesting that delayed skeletal development in CCD is closely related to the decreased number of progenitor cells as well as the delayed osteogenic differentiation. These findings provide the potential benefits of the therapeutic strategy using MS-275 to prevent CCD. © 2017 American Society for Bone and Mineral Research.

Mechanism-Based Inhibitors from Phytomedicine: Risks of Hepatotoxicity and their Potential Hepatotoxic Substructures

BACKGROUND

The adverse drug reactions and poisoning events associated with the use of herbal medicines, especially the potential damaging effects of them on the liver organs, have increasingly been reported worldwide. Some herbal ingredients in medicinal plants carry the risk of herb-induced liver injury with a severe or potentially lethal clinical course, but the hepatotoxicity mechanisms and risk factors of them are not well characterized until now. Xenobiotics are converted by cytochrome P450 enzymes into highly reactive metabolites that covalently bind to the catalytic site of the enzyme itself, subsequently causing mechanism-based inhibition (MBI). Compared to reversible inhibition, MBI more frequently results in unfavorable acute and/or immune system-mediated idiosyncratic toxicities and drug/herb-drug interactions (DDI/HDIs).

METHODS

We searched PubMed databases (1980-2015) for articles published in the English language to identify publications on mechanism-based inhibitors from phytomedicine and herbal ingredients hepatotoxicity.

RESULTS

43 mechanism-based inhibitors from phytomedicine were summarized. Twelve of these inhibitors could cause hepatotoxicity, whereas the rest have no related reports. Among them, six hepatotoxic mechanism-based inhibitors are proven to induce hepatotoxicity via their reactive metabolites (RMs). The possible mechanism for this hepatotoxicity is that RMs react with cellular components such as proteins, DNA, and membranes, resulting in ROS overproduction, respiratory chain dysfunction, and cell stress. Moreover, the amine and furan heterocycle groups might be the most potential substructures in mechanism-based inhibitors which can cause hepatotoxicity.

CONCLUSION

These results suggest that when mechanism-based inhibitors from phytomedicine containing amine or furan heterocycle substructures are used alone or with other drugs, in vivo hepatotoxicity screening or its clinical implications for herb-drug interactions are needed to attention.

Epidemiology and Inequality in the Incidence and Mortality of Nasopharynx Cancer in Asia

OBJECTIVES

One of the most common head and neck cancers is nasopharynx cancer. Knowledge about the incidence and mortality of this disease and its distribution in terms of geographical areas is necessary for further study and better planning. Therefore, this study was conducted with the aim of determining the incidence and mortality rates of nasopharynx cancer and its relationship with the Human Development Index (HDI) in Asia in 2012.

METHODS

The aim of this ecologic study was to assess the correlation between age-specific incidence rate (ASIR) and age-specific mortality rate (ASMR) with HDI and its components, which include the following: life expectancy at birth, mean years of schooling, and gross national income per capita. Data about SIR and SMR for every Asian country for 2012 were obtained from the global cancer project. We used the correlation bivariate method for the assessment. Statistical significance was assumed if p < 0.05. All reported p values are two-sided. Statistical analyses were performed using SPSS (Version 15.0, SPSS Inc.).

RESULTS

A total of 68,272 cases (males, 71.02%; females, 28.97%; sex ratio, 2.45) and 40,530 mortalities (males, 71.63%; females, 28.36%; sex ratio, 2.52) were recorded in Asian countries in 2012. The five countries with the highest ASIR of nasopharynx cancer were Malaysia, Singapore, Indonesia, Vietnam, and Brunei, and the five countries with the highest ASMR were Indonesia, Vietnam, Singapore, Malaysia, and Brunei. The correlation between HDI and ASIR was 0.097 (p = 0.520) [0.105 in men (p = 0.488) and 0.119 in women (p = 0.901)]. The correlation between HDI and ASMR was -0.102 (p = 0.502) [-0.072 in men (p = 0.633) and -0.224 in women (p = 0.134)].

CONCLUSION

Nasopharynx cancer is native to Southeast Asia. The highest incidence and mortality rates are found in Malaysia, Singapore, Indonesia, Vietnam, and Brunei. No significant relation was found between the standardized incidence and mortality rates of nasopharynx cancer and the HDI components. Further studies are recommended in Southeast Asian countries in order to find the etiology of cancer, as well as its diagnosis and treatment.

The impact of surgical resection on headache disability and quality of life in patients with colloid cyst

Introduction Colloid cysts are histologically benign but can present with a broad spectrum of symptoms. A systematic review of the literature did not reveal any patient-centered data on the headache disability and quality of life (QoL) of these patients. Methods This is a retrospective cohort study of 187 colloid cyst patients from the Colloid Cyst Survival Group who completed a survey that included demographic data, clinical data, a modified QoL survey (SF36v2), and a headache disability inventory or index (HDI). Results Using multivariable linear regressions, we confirmed that the physical (PCS) and mental (MCS) components of SF-36 were significantly increased in the surgery group after adjustment for various baseline characteristics ( p = 0.025; p = 0.006). Self-reported headache disability was significantly decreased with surgery when adjusted for the same baseline characteristics ( p = 0.02). Finally, patients with an incidental diagnosis of colloid cyst reported similar benefits from surgery in PCS, MCS and HDI. Conclusion Our results suggest that colloid cyst patients who underwent a surgical resection self-report a better QoL and less headache disability compared with patients who did not undergo surgery. Future prospective studies with baseline measures of QoL are indicated to confirm our findings.

Adjuvant Therapy of Melanoma

The incidence of melanoma is rapidly increasing, especially in younger female and older male patients. Recent fundamental advances in our knowledge of melanoma tumorigenesis have established roles for inhibitors of the MAPK pathway and regulatory immune checkpoints CTLA-4 and PD-1/PD-L1. However, the majority of patients continue to present with non-metastatic disease-typically managed with surgical resection and adjuvant therapy. High-dose IFN-α2b (HDI) is the main adjuvant therapeutic mainstay in high-risk disease following definitive resection. In this chapter, we review the evidence supporting the use of adjuvant HDI in high-risk melanoma. We also discuss some of the other treatment modalities that have been evaluated including vaccines, chemotherapy, and radiotherapy.

Economics and Outcome After Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study

Hematopoietic stem cell transplantation (HSCT) is a lifesaving expensive medical procedure. Hence, more transplants are performed in more affluent countries. The impact of economic factors on patient outcome is less defined. We analyzed retrospectively a defined cohort of 102,549 patients treated with an allogeneic (N = 37,542; 37%) or autologous (N = 65,007; 63%) HSCT. They were transplanted by one of 404 HSCT centers in 25 European countries between 1999 and 2006. We searched for associations between center-specific microeconomic or country-specific macroeconomic factors and outcome. Center patient-volume and center program-duration were significantly and systematically associated with improved survival after allogeneic HSCT (HR 0·87; 0·84-0·91 per 10 patients; p < 0·0001; HR 0·90;0·85-0·90 per 10 years; p < 0·001) and autologous HSCT (HR 0·91;0·87-0·96 per 10 patients; p < 0·001; HR 0·93;0·87-0·99 per 10 years; p = 0·02). The product of Health Care Expenditures by Gross National Income/capita was significantly associated in multivariate analysis with all endpoints (R(2) = 18%; for relapse free survival) after allogeneic HSCT. Data indicate that country- and center-specific economic factors are associated with distinct, significant, systematic, and clinically relevant effects on survival after HSCT. They impact on center expertise in long-term disease and complication management. It is likely that these findings apply to other forms of complex treatments.

Isocyanate exposure and asthma in the UK vehicle repair industry

Background

Organic diisocyanates are a common cause of occupational asthma, particularly in motor vehicle repair (MVR) workers. The UK Health & Safety Laboratory provides screening for urinary hexamethylenediamine (UHDA), a biomarker of exposure to 1,6-hexamethylene diisocyanate (HDI). The UK Surveillance of Work-related and Occupational Respiratory Disease scheme (SWORD) has collected reports of occupational asthma since 1996.

Aims

To compare trends in HDI exposure with trends in the incidence of work-related asthma attributed to isocyanates or paint spraying in MVR workers reported to SWORD.

Methods

Two-level regression models were used to estimate trends in UHDA levels and work-related asthma in MVR workers reported to SWORD. The direction and magnitude of the trends were compared descriptively.

Results

From 2006 to 2014, there was a significant decline in the number of urine samples with detectable levels of UHDA (odds ratio = 0.96; 95% confidence intervals 0.94–0.98) and minimal change in those over the guidance value (1.03; 1.00–1.06). Over the same period, there was a significant decline in all asthma cases attributed to isocyanates or paint spraying reported to SWORD (0.90; 0.86–0.94) and a non-significant decline among MVR workers (0.94; 0.86–1.02).

Conclusions

The simultaneous decrease in HDI exposure and incident cases of asthma reported to SWORD is temporally consistent with a reduction in exposure to airborne isocyanate leading to a reduction in asthma. Although this is not direct evidence of a causal relationship between the two trends, it is suggestive.

Emerging correlations between measures of population well-being, suicide and homicide: a look at global and Australian data

OBJECTIVE

Our aim was (1) to examine global and Australian data with a view to determining the presence of an inverse relationship between suicide and homicide rates, and (2) to examine global Human Development Index (HDI) values and suicide and homicide rates, with a view to determining any statistical relationship.

METHOD

Suicide and homicide rates and HDI values were available for 102 countries, and suicide and homicide rates were available for the states and territories of Australia. The three data sets had non-normal distributions, and the non-parametric Spearman's ρ was used for correlation statistics with α = 0.05.

RESULTS

We found a weak, statistically significant inverse relationship between the suicide and homicide rates of 102 countries (ρ = -0.244, p = 0.014). No relationship was established for the Australian values, however. As anticipated, we found a significant negative correlation between homicide and HDI values. We unexpectedly demonstrated a positive correlation between suicide rates and HDI values.

CONCLUSION

The notion that suicide and homicide have an inverse relationship now has some scientific support; but additional research is warranted to characterise and explain this relationship. The unexpected finding of a positive correlation between suicide rates and HDI values requires further examination.

Development of sandwich ELISAs for the detection of aromatic diisocyanate adducts

Diisocyanates (dNCOs) are highly reactive low molecular weight chemicals commonly used in the manufacturing industry. Occupational exposures to dNCOs have been shown to elicit allergic sensitization and occupational asthma. Among the most commonly used dNCOs in industry are the aromatic dNCOs, toluene diisocyanate (TDI) and methylene diphenyl diisocyanate (MDI). This study aimed to develop enzyme linked immunosorbent assays (ELISA) utilizing aromatic dNCO-specific monoclonal antibodies (mAbs) for the detection of aromatic dNCO adducts. Two sandwich ELISAs were developed. The first sandwich ELISA utilized mAb 60G2 along with an anti-human serum albumin (HSA) polyclonal antibody. This assay detected MDI-, 2,4- and 2,6-TDI-HSA adducts with limits of detection (LOD) of 2.67, <0.10, and 1.70 ng/mL, respectively. When spiked into human serum, the LOD of this ELISA increased to 34.37, 7.64 and 24.06 ng/mL, respectively. The second ELISA utilized mAbs 62G5 and 60G2 for capture and detection. This assay was capable of detecting 2,4- and 2,6-TDI-HSA adducts with LODs of <4.90 and 26.92 ng/mL, respectively, and when spiked in human serum, <4.90 and 95.93 ng/mL, respectively. This 62G5-60G2 sandwich assay was also able to detect dNCO adducted transferrin, hemoglobin, keratin and actin, but with less sensitivity than dNCO-HSA. The results of this study demonstrate potential application of these ELISAs in the identification and characterization of aromatic dNCO adducts as well as in biomonitoring occupational and environmental dNCO exposures.

Connecting glutathione with immune responses to occupational methylene diphenyl diisocyanate exposure

Methylene diphenyl diisocyanate (MDI) is among the leading chemical causes of occupational asthma world-wide, however, the mechanisms of disease pathogenesis remain unclear. This study tests the hypothesis that glutathione (GSH) reacts with MDI to form quasi-stable conjugates, capable of mediating the formation of MDI-conjugated "self" protein antigens, which may participate in pathogenic inflammatory responses. To test this hypothesis, an occupationally relevant dose of MDI (0.1%w/v) was reacted with varying concentrations of GSH (10μM-10mM), and the reaction products were characterized with regard to mass/structure, and ability to carbamoylate human albumin, a major carrier protein for MDI in vivo. LC-MS/MS analysis of GSH-MDI reaction products identified products possessing the exact mass of previously described S-linked bis(GSH)-MDI and its partial hydrolysis product, as well as novel cyclized GSH-MDI structures. Upon co-incubation of GSH-MDI reaction products with human albumin, MDI was rapidly transferred to specific lysines of albumin, and the protein's native conformation/charge was altered, based on electrophoretic mobility. Three types of modification were observed, intra-molecular MDI cross-linking, addition of partially hydrolyzed MDI, and addition of "MDI-GSH", where MDI's 2nd NCO had reacted with GSH's "N-terminus". Importantly, human albumin carbamoylated by GSH-MDI was specifically recognized by serum IgG from MDI exposed workers, with binding dependent upon the starting GSH concentration, pH, and NaCl levels. Together, the data define a non-enzymatic, thiol-mediated transcarbamoylating mechanism by which GSH may promote immune responses to MDI exposure, and identify specific factors that might further modulate this process.