BackgroundMaternal and infant mortality are highly devastating, yet, in many cases, preventable events for a community. The human development of a country is a strong predictor of maternal and infant mortality, reflecting the importance of socioeconomic factors in determinants of health. Previous research has shown that the Human Development Index (HDI) predicts infant mortality rate (IMR) and the maternal mortality ratio (MMR). Inequality has also been shown to be associated with worse health in certain populations. The main purpose of the present study was to determine the correlation and predictive power of the Inequality Adjusted Human Development Index (IHDI) as a measure of inequality with the Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR), Early Neonatal Mortality Rate (ENMR), Late Neonatal Mortality Rate (LNMR), and the Post Neonatal Mortality Rate (PNMR).Methods and FindingsData for the present study were downloaded from two sources: infant and maternal mortality data were downloaded from the Global Burden of Disease 2013 Cause of Death Database and the Human Development Index (HDI) and Inequality-Adjusted Human Development Index (IHDI) data were downloaded from the United Nations Development Program (UNDP). Pearson correlation coefficients were estimated, following logarithmic transformations to the data, to examine the relationship between HDI and IHDI with MMR, IMR, ENMR, LNMR, and PNMR. Steiger’s Z test for the equality of two dependent correlations was utilized in order to determine whether the HDI or IHDI was more strongly associated with the outcome variables. Lastly, we constructed OLS regression models in order to determine the predictive power of the HDI and IHDI in terms of the MMR, IMR, ENMR, LNMR, and PNMR.Maternal and infant mortality were both strongly and negatively correlated with both HDI and IHDI; however, Steiger’s Z test for the equality of two dependent correlations revealed that IHDI was more strongly correlated than HDI with MMR (Z = 4.897, p < 0.001), IMR (Z = 2.524, p = 0.012), ENMR (Z = 2.936, p = 0.003), LNMR (Z = 2.272, p = 0.023), and PNMR (Z = 2.277, p = 0.023). Furthermore, side-by-side OLS regression models revealed that, when IHDI was used as the predictor variable instead of HDI, the R 2 value was 0.053 higher for MMR, 0.025 higher for IMR, 0.038 higher for ENMR, 0.029 higher for LNMR, and 0.026 higher for PNMR.ConclusionsEven when both the HDI and the IHDI correlate with the infant and maternal mortality rates, the IHDI is a better predictor for these two health indicators. Therefore, these results add more evidence that inequality is playing an important role in determining the health status of various populations in the world and more efforts should be put into programs to fight inequality.

Given that healthcare spending can mediate the relationship between HDI and NM and MM, increases in healthcare spending among countries with low HDI could improve NM and MM outcomes.

Dexamethasone has a neurotoxic action on rodent hippocampus. The objective of this study was to examine the extent of neuroprotection exerted by melatonin on that neurotoxic effect. A group of 24 rats received 9 daily subcutaneous injections of 0.5 mg/kg of dexamethasone. Half of them received 25 μg/ml of melatonin in the drinking water for 10 days. Controls included rats injected with vehicle or rats injected with vehicle plus melatonin in the drinking water. At the end of treatment, the brains were processed for a morphometric analysis, the results being expressed as percent number of abnormal hipoccampal neurons (defined as necrotic cells) per field. Melatonin decreased by 77 % the effect of dexamethasone (p< 0.001). A laterality of neurotoxic effect of dexamethasone was apparent in rats that did not receive melatonin (percent of necrotic cells in left and right hippocampus: 32.0 ± 4.4 and 19.6 ± 1.9 %, respectively, p< 0.01). The results indicate a protective effect of melatonin on glucocorticoid neurotoxicity in the rat hippocampus.

Physicians are frequently faced with questions related to their patients' care that they cannot answer. A vast number of randomised trials have tested a wide variety of behaviour-changing strategies designed to improve practitioners' evidence utilisation, but systematic reviews have concluded that the effects are generally small and inconsistent. We conducted a randomised controlled trial to determine whether a question identification and solving system, using structured evidence summaries with recommendations, would change physician's behaviour related to the care of their hospitalised patients. The trial was conducted at the secondary level, internal medicine ward. Relevant clinical questions were the units of randomisation; 14 clinicians participated in the study. The question identification and answering system was carried out using evidence summaries with recommendations based on the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach stressing influence on clinician behaviour (decision/recommendation concordance). During 131 morning reports, 553 questions were identified (4.2 questions per meeting). 398 were excluded because they were not about diagnostic or therapeutic interventions or because their answers could not have impact on clinician behaviour, and 31 were excluded because of lack of time to answer them, leaving 124 included questions. The proportion of clinical decisions concordant with the proposed recommendations was 79% in the intervention arm and 44% in the control arm: relative risk 1.8 (95% CI 1.3 to 2.4), number of evidence summaries needed to change a care decision for one question raised was 3 (95% CI 2 to 6). A question identification and answering system was feasible, effectively performed and significantly influenced clinician behaviour related to the care of hospitalised patients, which suggests that interventions facilitating accessibility and interpretability of the best available evidence at the point of care have the potential to significantly impact on the quality of healthcare.

BackgroundImmune checkpoint inhibitors (ICI) can cause off-target inflammatory and immune-related adverse events (irAE). Conceivably, COVID-19 vaccination could trigger an inflammatory and immune response that could induce or aggravate irAE.MethodsThe objective of this systematic review is to appraise the efficacy and safety of COVID-19 vaccination in patients with cancer treated with ICI. The literature search was performed in PubMed and Embase in English from December 2019 to February 2022. The review included clinical trials, observational cohort studies, case series, and case reports reporting on the clinical efficacy and safety of COVID-19 vaccines on patients with cancer treated with ICI. Outcomes of interest included seroconversion, SARS-CoV-2 infection rate, severe COVID-19, COVID-19 mortality rate. Incidence of ICI irAEs was also ascertained as well as vaccine adverse events. A meta-analysis was conducted to estimate the pooled effect sizes of the outcomes when possible, using random effects models.ResultsOverall, 19 studies were included for the analysis (n=10 865 with 2477 receiving ICI). We analyzed 15 cohort studies, 1 cross-sectional study, and 3 case reports. There were no statistically significant differences in seroconversion rates after the second dose of the vaccine when comparing patients with cancer receiving ICI with patients without cancer (risk ratio, RR 0.97, 95% CI 0.92 to 1.03) or with patients with cancer without active treatment (RR 1.00, 95% CI 0.96 to 1.04). There was a higher probability of seroconversion in patients with cancer treated with ICI compared with patients with cancer treated with chemotherapy (RR 1.09, 95% CI 1.00 to 1.18). In a single study in patients receiving ICI, no differences were observed in risk of irAE between those receiving inactivated vaccine and those unvaccinated (pneumonitis RR 0.88, 95% CI 0.33 to 2.3; rash RR 1.03, 95% CI 0.66 to 1.62; arthralgia RR 0.94, 95% CI 0.51 to 1.75). There were no studies for other types of vaccines comparing vaccinated vs not vaccinated in patients treated with ICI. The most common vaccine-related adverse events were local pain or fatigue. Overall, the quality of evidence was rated as very low.ConclusionCOVID-19 vaccination appears to be effective and safe in patients with cancer receiving ICI.

PurposeExplore the factors making emergency procurement more prone to corruption by advancing explanations for when rules and transparency are relaxed allowing corrupt practices to emerge. Describe institutional factors, such as corruption syndrome (Johnston, 2005, 2015) and legal system, and their impact on procurement rules changes.Design/methodology/approachA qualitative event study using publicly available data offer a timeline and explanation of government procurement control mechanisms and transparency roles in emergencies by comparing two countries. Argentina and Canada had very similar and advanced food procurement systems prior to COVID-19, but they took different stances when the pandemic broke out.FindingsLegal systems and corruption syndrome are linked, where Civil Law is related to Elite Cartels (Argentina) and Common Law with Influence Markets (Canada). The study contributes to understand the role of transparency to minimize the opportunity for direct purchases (electronic trails of decisions, justifications and approvals). Judicial system's actions favor corrupt practices and are aligned with elites despite the civil society outcry.Research limitations/implicationsResearch on corrupt practices has limited access to primary data due to fear of reprisals. Informal conversations revealing glimpses of corruption were used to identify publicly available documents. Numbers play a role in emergencies and performativity theory literature is enriched by providing an example of different interpretation of information when frameworks differ between civil society and courts.Originality/valueA comparative analysis that evidences the role of pre-existing institutional and social conditions shows when emergency situations will be used as an excuse to relax procurement control and transparency mechanisms which in turn facilitate corrupt practices.

Dexamethasone has a neurotoxic action on rodent hippocampus. The objective of this study was to examine the extent of neuroprotection exerted by melatonin on that neurotoxic effect. A group of 24 rats received 9 daily subcutaneous injections of 0.5 mg/kg of dexamethasone. Half of them received 25 μg/ml of melatonin in the drinking water for 10 days. Controls included rats injected with vehicle or rats injected with vehicle plus melatonin in the drinking water. At the end of treatment, the brains were processed for a morphometric analysis, the results being expressed as percent number of abnormal hipoccampal neurons (defined as necrotic cells) per field. Melatonin decreased by 77 % the effect of dexamethasone (p< 0.001). A laterality of neurotoxic effect of dexamethasone was apparent in rats that did not receive melatonin (percent of necrotic cells in left and right hippocampus: 32.0 ± 4.4 and 19.6 ± 1.9 %, respectively, p< 0.01). The results indicate a protective effect of melatonin on glucocorticoid neurotoxicity in the rat hippocampus.

No abstract