Search results for: health screening

Authors: Piña-Ronces Laura Gabriela, Reyes-Escogido María de Lourdes

Abstract:

Exist a large variability in Exopolysaccharides (EPS) produced by LAB depending on carbon source, they have multiple applications in food industry mainly, but they have become important for the health. In this study, we identified EPS-producing strains belonging to the BAL group; they were previously isolated from humans. After that, we extracted and evaluated the antioxidant activity of EPS produced by all strains. Antioxidant activity was determined by DPPH method using ascorbic acid as standard for both comparison and quantification. 31 strains (51.66 %) produced EPS at concentrations between 451 and 1.561 mg/l, 16 of EPS extracted showed antioxidant effect superior to ascorbic acid at the same concentrations. EPS-producing strains were L. plantarum, L. sp and L. fermentum corresponding to Lactobacillus genus and, E. faecium, E. durans, and E. hirae of Enterococcus genus. Antioxidant activity showed by EPS from 3 strains of L. plantarum and 3 strains of E. faecium was different into specie, while the antioxidant activity determined for EPS obtained from the other strains did not show difference at specie level, but was superior to ascorbic acid. EPS produced by L. plantarum and E. hirae had the best activity, it could be considerate for selection them as a possible new alternative for therapy or treatment of diseases related whit oxidative stress. Further studies about biological functions of EPS have to be conducted for new applications in health.

Keywords: oxidative stress, lactic acid bacteria, exopolysaccharides, antioxidant activity

Procedia PDF Downloads 337

Authors: Azene Tesfaye, Yohannes Petros, Habtamu Zeleke

Abstract:

To evaluate genetic variation among Ethiopian lentil, laboratory experiment were conducted to screen 12 accessions of lentil (Lens culinaris M.) for salt tolerance. Seeds of 12 Lentil accessions were grown at laboratory (Petri dish) condition with different levels of salinity (0, 2, 4, and 8 dSm-1 NaCl) for 4 weeks. The experimental design was completely randomized design (CRD) in factorial combination with three replications. Data analysis was carried out using SAS software. Average germination time, germination percentage, seedling shoot and root traits, seedling shoot and root weight were evaluated. The two way ANOVA for varieties revealed statistically significant variation among lentil accession, NaCl level and their interactions (p<0.001) with respect to the entire parameters. It was found that salt stress significantly delays germination rate and decreases germination percentage, shoot and root length, seedling shoot and root weight of lentil accessions. The degree of decrement varied with accessions and salinity levels. Accessions 36120, 9235 and 36004 were better salt tolerant than the other accessions. As the result, it is recommended to be used as a genetic resource for the development of lentil accession and other very salt sensitive crop with improved germination under salt stress condition.

Keywords: accession, germination, lentil, NaCl, screening, seedling stage

Procedia PDF Downloads 307

Authors: Li Shihao, Dieter Trau

Abstract:

Bilirubin is a yellow substance that is made when the body breaks down old red blood cells. High levels of bilirubin can cause jaundice, a condition that makes the newborn's skin and the white part of the eyes look yellow. Jaundice is a serial-killer in developing countries in Southeast Asia such as Myanmar and most parts of Africa where jaundice screening is largely unavailable. Worldwide, 60% of newborns experience infant jaundice. One in ten will require therapy to prevent serious complications and lifelong neurologic sequelae. Limitations of current solutions: - Blood test: Blood tests are painful may largely unavailable in poor areas of developing countries, and also can be costly and unsafe due to the insufficient investment and lack of access to health care systems. - Transcutaneous jaundice-meter: 1) can only provide reliable results to caucasian newborns, due to skin pigmentations since current technologies measure bilirubin by the color of the skin. Basically, the darker the skin is, the harder to measure, 2) current jaundice meters are not affordable for most underdeveloped areas in Africa like Kenya and Togo, 3) fat tissue under the skin also influences the accuracy, which will give overestimated results, 4) current jaundice meters are not reliable after treatment (phototherapy) because bilirubin levels underneath the skin will be reduced first, while overall levels may be quite high. Thus, there is an urgent need for a low-cost non-invasive device, which can be effective not only for caucasian babies but also Asian and African newborns, to save lives at the most vulnerable time and prevent any complications like brain damage. Instead of measuring bilirubin on skin, we proposed a new method to do the measurement on the sclera, which can avoid the difference of skin pigmentations and ethnicities, due to the necessity for the sclera to be white regardless of racial background. This is a novel approach for measuring bilirubin by an optical method of light reflection off the white part of the eye. Moreover, the device is connected to a smart device, which can provide a user-friendly interface and the ability to record the clinical data continuously A disposable eye cap will be provided avoiding contamination and fixing the distance to the eye.

Keywords: Jaundice, bilirubin, non-invasive, sclera

Procedia PDF Downloads 215

Authors: Mamta Kumari, Shashi Jain

Abstract:

Tannins are a unique category of plant phytochemicals especially in terms of their vast potential health-benefiting properties. Researchers have described the capacity of tannins to enhance glucose uptake and inhibit adipogenesis, thus being potential drugs for the treatment of non-insulin dependent diabetes mellitus. Thus, the present research was conducted to find out tannin content of food products. The percentage of tannin in various analyzed sources ranged from 0.0 to 108.53%; highest in kathaa and lowest in ker and mango bark. The percentage of tannins present in the plants, however, varies. Numerous studies have confirmed that the naturally occurring polyphenols are key factor for the beneficial effects of the herbal medicines. Isolation and identification of active constituents from plants, preparation of standardized dose & dosage regimen can play a significant role in improving the hypoglycaemic action.

Keywords: tannins, diabetes, polyphenols, antioxidant, hypoglycemia

Procedia PDF Downloads 361

Authors: Thiwanka Weerakkody, Lakmali Handagiripathira, Poshitha Dabare, Thisari Guruge

Abstract:

The determination of gross alpha and beta activity in water is important in a wide array of environmental studies and these parameters are considered in international legislations on the quality of water. This technique is commonly applied as screening method in radioecology, environmental monitoring, industrial applications, etc. Measuring of Gross Alpha and Beta emitters by using iSolo alpha beta counting system is an adequate nuclear technique to assess radioactivity levels in natural and waste water samples due to its simplicity and low cost compared with the other methods. Twelve water samples (Six samples of commercially available bottled drinking water and six samples of industrial waste water) were measured by standard method EPA 900.0 consisting of the gas-less, firm wear based, single sample, manual iSolo alpha beta counter (Model: SOLO300G) with solid state silicon PIPS detector. Am-241 and Sr90/ Y90 calibration standards were used to calibrate the detector. The minimum detectable activities are 2.32mBq/L and 406mBq/L, for alpha and beta activity, respectively. Each of the 2L water samples was evaporated (at low heat) to a small volume and transferred into 50mm stainless steel counting planchet evenly (for homogenization) and heated by IR lamp and the constant weighted residue was obtained. Then the samples were counted for gross alpha and beta. Sample density on the planchet area was maintained below 5mg/cm. Large quantities of solid wastes sludges and waste water are generated every year due to various industries. This water can be reused for different applications. Therefore implementation of water treatment plants and measuring water quality parameters in industrial waste water discharge is very important before releasing them into the environment. This waste may contain different types of pollutants, including radioactive substances. All these measured waste water samples having gross alpha and beta activities, lower than the maximum tolerance limits for industrial waste water discharge of industrial waste in to inland surface water, that is 10-9µCi/mL and 10-8µCi/mL for gross alpha and beta respectively (National Environmental Act, No. 47 of 1980). This is according to extraordinary gazette of the democratic socialist republic of Sri Lanka in February 2008. The measured water samples were below the recommended radioactivity levels and do not pose any radiological hazard when releasing the environment. Drinking water is an essential requirement of life. All the drinking water samples were below the permissible levels of 0.5Bq/L for gross alpha activity and 1Bq/L for gross beta activity. The values have been proposed by World Health Organization in 2011; therefore the water is acceptable for consumption of humans without any further clarification with respect to their radioactivity. As these screening levels are very low, the individual dose criterion (IDC) would usually not be exceeded (0.1mSv y⁻¹). IDC is a criterion for evaluating health risks from long term exposure to radionuclides in drinking water. Recommended level of 0.1mSv/y expressed a very low level of health risk. This monitoring work will be continued further for environmental protection purposes.

Keywords: drinking water, gross alpha, gross beta, waste water

Procedia PDF Downloads 164

Authors: Ekele Alih, Enejo Jalija

Abstract:

Female Genital Mutilation (FGM) is made up of three types namely: Clitoridectomy, Excision and Infibulation. In this study, we examine the factors responsible for FGM in order to identify the causality variables in a logistic regression approach. From the result of the survey conducted by the Public Health Division, Nigeria Institute of Medical Research, Yaba, Lagos State, the tau statistic, τ was used to screen 9 factors that causes FGM in order to select few of the predictors before multiple regression equation is obtained. The need for this may be that the sample size may not be able to sustain having a regression with all the predictors or to avoid multi-collinearity. A total of 300 respondents, comprising 150 adult males and 150 adult females were selected for the household survey based on the multi-stage sampling procedure. The tau statistic,

Keywords: female genital mutilation, logistic regression, tau statistic, African society

Procedia PDF Downloads 230

Authors: Y. Mohammed, A. I. Kabuga

Abstract:

Sexually transmitted infections (STIs) have continued to be a major public health problem in sub-Saharan Africa especially with the recent resurgence of syphilis. Syphilis is a systemic disease caused by the bacterium, spirochete Treponema pallidum and has been reported as one of the common sexually transmitted infections (STIs) in Nigeria. Presence of genital ulcer disease from syphilis facilitates human immunodeficiency virus (HIV) transmission and their ¬diagnosis is essential for the proper management. Venereal Disease Research Laboratory (VDRL) test is used as a screening test for the diagnosis of syphilis. However, unusual VDRL test results have been reported in HIV-infected persons with syphilis. There are reports showing higher than expected VDRL titers as well as biological false positive in most of the studies. A negative Rapid Plasma Reagin (RPR) test or VDRL test result may not rule out syphilis in patients with HIV infection. For laboratory confirmation of syphilis, one specific Treponemal test, namely, Fluroscent Treponemal Antibody Absorption (FTA-ABS) test or Treponema Pallidum Haemagglutination Assay (TPHA) should be done along with VDRL. A prospective cross sectional study was conducted for 2 years from Jun, 2012 to Jun 2014 to determine the prevalence of syphilis in HIV-seroreactive patients at 5 selected HIV/AIDS treatment and counseling centers in Kano State, North Western, Nigeria. New HIV-Seroreactive patients who gave informed consent to participate in the study were recruited. Venereal Diseases Research Laboratory (VDRL) test for Syphilis screening was performed on the same sera samples which were collected for HIV testing. A total of 238 patients, 113 (47%) males and 125 (53%) females, were enrolled. In the present study, 238 HIV-seropositive patients were screened for syphilis by VDRL test. Out of these 238 cases, 72 (32%) patients were positive for TPHA and 8 (3.4%) patients were reactive for VDRL in various titers with an overall prevalence of 3.4%. All the eight patients who were reactive for VDRL test were also positive for TPHA test. In Conclusions, with high prevalence of syphilis among HIV-infected people from this study, it is recommended that serological testing for syphilis should be carried out in all patients with newly diagnosed HIV infection. Detection and treatment of STI should have a central role in HIV prevention and control. This will help in proper management of patients having STIs and HIV co infection.

Keywords: HIV, infections, STIs, syphilis

Procedia PDF Downloads 294

Authors: Laila Vivas

Abstract:

Fossil Health is proposed as a value-concept to describe the hegemonic health paradigms that underpin health enactment. Such representation is justified by Foucaldian and related ideas on biopower and biosocialities, calling for the politicization of health and signalling the importance of narratives. This approach, hence, enables contemplating health paradigms as reflexive or co-constitutive of health itself or, in other words, conceiving health as a verb. Fossil health is a symbolic representation, influenced by Andreas Malm’s concept of fossil capitalism, that integrates environment and health as non-dichotomic areas. Fossil Health sustains that current notions of human and non-human health revolve around fossil fuel dependencies. Moreover, addressing disequilibria from established health ideals involves fossil-fixes. Fossil Health, therefore, represents causes and consequences of a health conception that has the agency to contribute to the functioning of a particular structural eco-social model. Moreover, within current capitalist relations, Fossil Health expands its meaning to cover not only fossil implications but also other dominant paradigms of the capitalist system that are (re)produced through health paradigms, such as the burgeoning of technoscience and biomedicalization, privatization of health, expertization of health, or the imposing of standards of uniformity. Overall, Fossil Health is a comprehensive approach to environment and health, where understanding hegemonic health paradigms means understanding our (human-non-human) nature paradigms and the structuring effect these narratives convey.

Keywords: fossil health, environment, paradigm, capitalism

Procedia PDF Downloads 91

Authors: Nalini C. Iyer, Shraddha H., Anagha B. Varahamurthy, Dikshith C. S., Ishwar G. Kubasad, Vinayak I. Karalatti, Pavan B. Mulimani

Abstract:

The current scenario of the pandemic due to COVID-19 has led to the awareness among the people to avoid unneces-sary contact in public places. There is a need to avoid contact with physical objects to stop the spreading of infection. The contactless feature has to be included in the systems in public places wherever possible. For example, attendance monitoring systems with fingerprint biometric can be replaced with a contactless feature. One more important protocol followed in the current situation is temperature monitoring and screening. The paper describes an attendance system with a contactless feature and temperature screening for the university. The system displays a QR code to scan, which redirects to the student login web page only if the location is valid (the location where the student scans the QR code should be the location of the display of the QR code). Once the student logs in, the temperature of the student is scanned by the contactless temperature sensor (mlx90614) with an error of 0.5°C. If the temperature falls in the range of the desired value (range of normal body temperature), then the attendance of the student is marked as present, stored in the database, and the door opens automatically. The attendance is marked as absent in the other case, alerted with the display of temperature, and the door remains closed. The door is automated with the help of a servomotor. To avoid the proxy, IR sensors are used to count the number of students in the classroom. The hardware system consisting of a contactless temperature sensor and IR sensor is implemented on the microcontroller, NodeMCU.

Keywords: NodeMCU, IR sensor, attendance monitoring, contactless, temperature

Procedia PDF Downloads 159

Authors: Scott Ashby, Emily Granger, Mark Connellan

Abstract:

Background: In-hospital management of Out-of-Hospital Cardiac Arrest (OHCA) is complex as the aetiologies are varied. Acute coronary angiography has been shown to improve outcomes for patients with coronary occlusion as the cause; however, these patients are difficult to identify. ECG results may help identify these patients, but the accuracy of this diagnostic test is under debate, and requires further investigation. Methods: Arrest and hospital management information was collated retrospectively for OHCA patients who presented to a single clinical site between 2009 and 2013. Angiography results were then collected and checked for significance with survival to discharge. The presence of a severe lesion (>70%) was then compared to categorised ECG findings, and the accuracy of the test was calculated. Results: 104 patients were included in this study, 44 survived to discharge, 52 died and 8 were transferred to other clinical sites. Angiography appears to significantly correlate with survival to discharge. ECG showed 54.8% sensitivity for detecting the presence of a severe lesion within the group that received angiography. A combined criterion including any ECG pathology showed 100% sensitivity and negative predictive value, however, a low specificity and positive predictive value. Conclusion: In the cohort investigated, ST elevation on ECG is not a sensitive enough screening test to be used to determine whether OHCA patients have coronary stenosis as the likely cause of their arrest, and more investigation into whether screening with a combined ECG criterion, or whether all patients should receive angiography routinely following OHCA is needed.

Keywords: out of hospital cardiac arrest, coronary angiography, resuscitation, emergency medicine

Procedia PDF Downloads 366

Authors: Rim Frikha, Nouha Bouayed, Afifa Sellami, Nozha Chakroun, Salima Daoud, Leila Keskes, Tarek Rebai

Abstract:

Introduction: Recurrent pregnancy loss (RPL) defined as two or more pregnancy losses, is a serious clinical problem. Methylene-tetrahydro-folate-reductase (MTHFR) polymorphisms, commonly the variant C677T is recognized as an inherited thrombophilia which might affect embryonic development and pregnancy success and cause pregnancy complications as RPL. Material and Methods DNA was extracted from peripheral blood samples and PCR-RFLP was performed for the molecular diagnosis of the C677T MTHFR polymorphism among 70 patients (35 couples) with more than 2 fetal losses. Aims and Objective: The aim of this study is to determine the frequency of MTHFR C677T among Tunisian couples with RPL and to critically analyze the available literature on the importance of MTHFR polymorphism testing in the management of RPL. Result and comments: No C677T mutation was detected in the carriers of RPL. This result would be related to sample size and to different criteria (number of abortion), - The association between MTHFR polymorphisms and pregnancy complications has been reported but with controversial results. - A lack of evidence for MTHFR polymorphism testing previously recommended by ACMG (American College of Medical medicine). Our study highlights the importance of screening of MTHFR polymorphism since the real impact of such thrombotic molecular defect on the pregnancy outcome is evident. - Folic supplementation of these patients during pregnancy can prevent such complications and lead to a successful pregnancy outcome.

Keywords: methylenetetrahydrofolate reductase, C677T, recurrent pregnancy loss, genetic testing

Procedia PDF Downloads 281

Authors: Nur Farah Ain Zainee, Ahmad Ismail, Nazlina Ibrahim, Asmida Ismail

Abstract:

Seaweeds are economically important as they have the potential of being utilized, the capabilities and opportunities for further expansion as well as the availability of other species for future development. Hence, research on the diversity and distribution of seaweeds have to be expanded whilst the seaweeds are one of the Malaysian marine valuable heritage. The study on the distribution of seaweeds at Pengerang, Johor was carried out between February and November 2015 at Kampung Jawa Darat and Kampung Sungai Buntu. The study sites are located at the south-southeast of Peninsular Malaysia where the Petronas Refinery and Petrochemicals Integrated Project Development (RAPID) are in progress. In future, the richness of seaweeds in Pengerang will vanish soon due to the loss of habitat prior to RAPID project. The research was completed to study the diversity of seaweed and to determine the present of fungal endophyte isolated from the seaweed. The sample was calculated by using quadrat with 25-meter line transect by 3 replication for each site. The specimen were preserved, identified, processed in the laboratory and kept as herbarium specimen in Algae Herbarium, Universiti Kebangsaan Malaysia. The complete thallus specimens for fungal endophyte screening were chosen meticulously, transferred into sterile zip-lock plastic bag and kept in the freezer for further process. A total of 29 species has been identified including 12 species of Chlorophyta, 2 species of Phaeophyta and 14 species of Rhodophyta. From February to November 2015, the number of species highly varied and there was a significant change in community structure of seaweeds. Kampung Sungai Buntu shows the highest diversity throughout the study compared to Kampung Jawa Darat. This evidence can be related to the high habitat preference such as types of shores which is rocky, sandy and having lagoon and bay. These can enhance the existence of the seaweeds community due to variations of the habitat. Eighteen seaweed species were selected and screened for the capability presence of fungal endophyte; Sargassum polycystum marked having the highest number of fungal endophyte compared to the other species. These evidence has proved the seaweed have capable of accommodating a lot of species of fungal endophytes. Thus, these evidence leads to positive consequences where further research should be employed.

Keywords: diversity, fungal endophyte, macroalgae, screening, seaweed

Procedia PDF Downloads 206

Authors: Woosik Jang, Seung Heon Han, Seung Won Baek

Abstract:

Natural gas (NG) is an energy resource in a few countries, and most NG producers do business in politically unstable countries. In addition, as 90% of the LNG market is controlled by a small number of international oil companies (IOCs) and national oil companies (NOCs), entry of latecomers into the market is extremely limited. To meet these challenges, project viability needs to be assessed based on limited information from a project screening perspective. However, the early stages of the project have the following difficulties: (1) What are the factors to consider? (2) How many professionals do you need to decide? (3) How to make the best decision with limited information? To address this problem, this study proposes a model for evaluating LNG project viability based on the Dempster-Shafer theory (DST). A total of 11 indicators for analyzing the gas field, reflecting the characteristics of the LNG industry, and 23 indicators for analyzing the market environment, were identified. The proposed model also evaluates the LNG project based on the survey and provides uncertainty of the results based on DST as well as quantified results. Thus, the proposed model is expected to be able to support the decision-making process of the gas field project using quantitative results as a systematic framework, and it was developed as a stand-alone system to improve its usefulness in practice. Consequently, the amount of information and the mathematical approach are expected to improve the quality and opportunity of decision making for LNG projects for enterprises.

Keywords: project screen, energy enterprise, decision support system, Dempster-Shafer theory

Procedia PDF Downloads 313

Authors: Julie Mariam Abraham, G. J. Melendez-Torres

Abstract:

Background. Maternal mortality is disproportionately higher in low- and middle- income countries (LMICs) compared to other parts of the world. At the current pace of progress, the Sustainable Development Goals for maternal mortality rate will not be achieved by 2030. A variety of factors influence the increased risk of maternal complications in LMICs. These are exacerbated by socio-economic and political factors, including poverty, illiteracy, and gender inequality. This paper aims to use realist synthesis to identify the contexts, mechanisms, and outcomes (CMOs) of maternal health interventions conducted in LMICs to inform evidence-based practice for future maternal health interventions. Methods. In May 2022, we searched four electronic databases for systematic reviews of maternal health interventions in LMICs published in the last five years. We used open and axial coding of CMOs to develop an explanatory framework for intervention effectiveness. Results. After eligibility screening and full-text analysis, 44 papers were included. The intervention strategies and measured outcomes varied within reviews. Healthcare system level contextual factors were the most frequently reported, and infrastructural capacity was the most reported context. The most prevalent mechanism was increased knowledge and awareness. Discussion. Health system infrastructure must be considered in interventions to ensure effective implementation and sustainability. Healthcare-seeking behaviours are embedded within social and cultural norms, environmental conditions, family influences, and provider attitudes. Therefore, effective engagement with communities and families is important to create new norms surrounding pregnancy and delivery. Future research should explore community mobilisation and involvement to enable tailored interventions with optimal contextual fit.

Keywords: maternal mortality, service delivery and organisation, realist synthesis, sustainable development goals, overview of reviews

Procedia PDF Downloads 52

Authors: Helen Coronel, Will Brewer, Peggy Bergeron, Clarissa Hall, Victoria Casson

Abstract:

Simulation-based training provides the nurse practitioner (NP) student with a safe and controlled environment in which they can practice a real-life scenario. This type of learning fosters critical thinking skills essential to practice. The expectation of this study was that students would have an increase in their competency and confidence after performing the simulation. Approximately 8.4% of Americans suffer from depression. The state of Alabama is ranked 47th out of 50 for access to mental health care. As a result of this significant shortage of mental health providers, primary care providers are frequently put in the position of screening for and treating mental health conditions, such as depression. Family nurse practitioners are often utilized as primary care providers, making their ability to assess, diagnose and treat these disorders a necessary skill. The expected outcome of this simulation is an increase in confidence, competency and the empowerment of the nurse practitioner student’s ability to assess, diagnose and treat a common mood disorder they may encounter in practice. The Kirkpatrick Module was applied for this study. A non-experimental design using descriptive statistical analysis was utilized. The simulation was based on a common psychiatric mood disorder frequently observed in primary care and mental health clinics. Students were asked to watch a voiceover power point presentation prior to their on-campus simulation. The presentation included training on the assessment, diagnosis, and treatment of a patient with depression. Prior to the simulation, the students completed a pre-test, then participated in the simulation, and completed a post-test when done. Apple iPads were utilized to access a simulated health record. Major findings of the study support an increase in students’ competency and confidence when assessing, diagnosing, and treating an adult patient with depression.

Keywords: advanced practice, nurse practitioner, simulation, primary care, depression

Procedia PDF Downloads 75

Authors: Elaheh Ezami, Behzad Mohammadian, Elham Aznab

Abstract:

Health service design will need to change due to bringing in new digital health tools. This highlights the importance of innovation in adopting Health Information Technology (HIT). It can be argued that innovation in the health sector correlates with entrepreneurship. Various reasons exist for health entrepreneurs to advocate increased investment in HIT to compensate for shortcomings in the health sector and improve the quality of healthcare. Furthermore, every innovative program presents challenges and motivations for entrepreneurs that may distract or encourage the adoption of technology. Our study used a systematic literature review to identify relevant articles that defined the frustrations and promotions of using health information technology in organizations or enterprises. A meta-analysis of the articles was conducted to identify the factors driving or pulling entrepreneurs to use HIT.

Keywords: health information technology, health entrepreneurship, health enterprise, health entrepreneurs' innovation

Procedia PDF Downloads 81

Authors: Melanie Ostermann, Eivind Birkeland, Ying Xue, Alexander Sauter, Mihaela R. Cimpan

Abstract:

Background: New reliable and robust techniques to assess biological effects of nanomaterials (NMs) in vitro are needed to speed up safety analysis and to identify key physicochemical parameters of NMs, which are responsible for their acute cytotoxicity. The central aim of this study was to validate and evaluate the applicability and reliability of an impedance-based flow cytometry (IFC) technique for the high-throughput screening of NMs. Methods: Eight inorganic NMs from the European Commission Joint Research Centre Repository were used: NM-302 and NM-300k (Ag: 200 nm rods and 16.7 nm spheres, respectively), NM-200 and NM- 203 (SiO₂: 18.3 nm and 24.7 nm amorphous, respectively), NM-100 and NM-101 (TiO₂: 100 nm and 6 nm anatase, respectively), and NM-110 and NM-111 (ZnO: 147 nm and 141 nm, respectively). The aim was to assess the biological effects of these materials on human monoblastoid (U937) cells. Dispersions of NMs were prepared as described in the NANOGENOTOX dispersion protocol and cells were exposed to NMs at relevant concentrations (2, 10, 20, 50, and 100 µg/mL) for 24 hrs. The change in electrical impedance was measured at 0.5, 2, 6, and 12 MHz using the IFC AmphaZ30 (Amphasys AG, Switzerland). A traditional toxicity assay, Trypan Blue Dye Exclusion assay, and dark-field microscopy were used to validate the IFC method. Results: Spherical Ag particles (NM-300K) showed the highest toxic effect on U937 cells followed by ZnO (NM-111 ≥ NM-110) particles. Silica particles were moderate to non-toxic at all used concentrations under these conditions. A higher toxic effect was seen with smaller sized TiO2 particles (NM-101) compared to their larger analogues (NM-100). No interferences between the IFC and the used NMs were seen. Uptake and internalization of NMs were observed after 24 hours exposure, confirming actual NM-cell interactions. Conclusion: Results collected with the IFC demonstrate the applicability of this method for rapid nanotoxicity assessment, which proved to be less prone to nano-related interference issues compared to some traditional toxicity assays. Furthermore, this label-free and novel technique shows good potential for up-scaling in directions of an automated high-throughput screening and for future NM toxicity assessment. This work was supported by the EC FP7 NANoREG (Grant Agreement NMP4-LA-2013-310584), the Research Council of Norway, project NorNANoREG (239199/O70), the EuroNanoMed II 'GEMN' project (246672), and the UH-Nett Vest project.

Keywords: cytotoxicity, high-throughput, impedance, nanomaterials

Procedia PDF Downloads 332

Authors: Fatemeh Abdollahi, Munn-Sann Lye, Jamshid Yazdani Charati, Mehran Zarghami

Abstract:

Fathers are at risk of depression during the postpartum period. Some studies have been reported maternal depression is the key predictor of paternal postpartum depression (PPD). This study aimed to estimate the prevalence and predictors of parental PPD and its association with maternal PPD. In a cross-sectional study, via a stratified random and convenience sampling method, participants referring to health centers during 2-8 weeks postpartum were recruited from March to October 2017. Paternal PPD and its relation to maternal PPD and other related factors were assessed using multiple logistic regression. Participants were 591 literate couples who referred to Mazandaran province primary health centers during to study period. Couples were screened for depression using Edinburgh Postnatal Depression Scale (EPDS). Fathers provided information on socio-demographic characteristics, life events, neonatal stressor, perceived stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), and general health status using General Health Questionnaire (GHQ) as well. Data on mothers ‘demographic characteristics and obstetrics factors was also gathered. Overall, 93 fathers (15.7%) and 188 mothers (31.8%) reported depressive symptoms above the cut-off EPDS score of 12. In the multiple logistic regression model, older age [OR=1.20, (95%CI: 1.05- 1.36)], maternal depressive symptoms [OR=1.15, (95%CI: 1.04-1.27)], higher GHQ scores [OR=1.21, (95%CI: 1.11-1.33)] and increased recent life events [OR=1.42, (95%CI: 1.01-1.2.00)] were related to paternal PPD. A significant inverse association was found between number of children and paternal PPD [OR=0.20, (95%CI: 0.07-0.53)]. Depressive symptoms, especially in first-time fathers following the birth of a child, are not uncommon. Maternal depressive symptoms and paternal well-being were strong predictors of parental PPD. Creating opportunities for men to access special health care services, parental education to help adapting to parenthood, screening programs, and psychiatric/psychosocial interventions to decrease the suffering of depression for both depressed parents are recommended.

Keywords: depression, men, postpartum, risk factors, women

Procedia PDF Downloads 53

Authors: Thais O. de Paula, Marjorie R. A. Sarmiento, Francis M. Borges, Alessandra B. Ferreira-Machado, Juliana A. Resende, Dioneia E. Cesar, Vania L. Silva, Claudio G. Diniz

Abstract:

Obesity is currently a worldwide public health threat, being considered a pandemic multifactorial disease related to the human gut microbiota (GM). Add to that GM is considered an important reservoir of antimicrobial resistance genes (ARG) and little is known on GM and ARG in obesity, considering the altered physiology and xenobiotics intake. As regional and social behavior may play important roles in GM modulation, and most of the studies are based on small sample size and various methodological approaches resulting in difficulties for data comparisons, this study was focused on the investigation of GM bacterial diversity in obese (OB), overweight (OW) and eutrophic individuals (ET) considering their nutritional, clinical and social characteristics; and comparative screening of AGR related to their physiology and xenobiotics intake. Microbial community was accessed by FISH considering phyla as a taxonomic level, and PCR-DGGE followed by dendrograms evaluation (UPGMA method) from fecal metagenome of 72 volunteers classified according to their body mass index (BMI). Nutritional, clinical, social parameters and xenobiotics intake were recorded for correlation analysis. The fecal metagenome was also used as template for PCR targeting 59 different ARG. Overall, 62% of OB were hypertensive, and 12% or 4% were, regarding the OW and ET individuals. Most of the OB were rated as low income (80%). Lower relative bacterial densities were observed in the OB compared to ET for almost all studied taxa (p < 0.05) with Firmicutes/Bacteroidetes ratio increased in the OB group. OW individuals showed a bacterial density representative of GM more likely to the OB. All the participants were clustered in 3 different groups based on the PCR-DGGE fingerprint patterns (C1, C2, C3), being OB mostly grouped in C1 (83.3%) and ET mostly grouped in C3 (50%). The cluster C2 showed to be transitional. Among 27 ARG detected, a cluster of 17 was observed in all groups suggesting a common core. In general, ARG were observed mostly within OB individuals followed by OW and ET. The ratio between ARG and bacterial groups may suggest that AGR were more related to enterobacteria. Positive correlations were observed between ARG and BMI, calories and xenobiotics intake (especially use of sweeteners). As with nutritional and clinical characteristics, our data may suggest that GM of OW individuals behave in a heterogeneous pattern, occasionally more likely to the OB or to the ET. Regardless the regional and social behaviors of our population, the methodological approaches in this study were complementary and confirmatory. The imbalance of GM over the health-disease interface in obesity is a matter of fact, but its influence in host's physiology is still to be clearly elucidated to help understanding the multifactorial etiology of obesity. Although the results are in agreement with observations that GM is altered in obesity, the altered physiology in OB individuals seems to be also associated to the increased xenobiotics intake and may interfere with GM towards antimicrobial resistance, as observed by the fecal metagenome and ARG screening. Support: FAPEMIG, CNPQ, CAPES, PPGCBIO/UFJF.

Keywords: antimicrobial resistance, bacterial diversity, gut microbiota, obesity

Procedia PDF Downloads 136

Authors: Yudhitya Kusumawati, Yuki Mitsuya, Tomooki Shiba, Mitsuru Uesaka

Abstract:

After the Fukushima Daiichi nuclear power reactor incident, there are a lot of unaccountable nuclear fuel debris in the reactor core area, which is subject to safeguard and criticality safety. Before the actual precise analysis is performed, preliminary on-site screening and mapping of nuclear debris activity need to be performed to provide a reliable data on the nuclear debris mass-extraction planning. Through a collaboration project with Japan Atomic Energy Agency, an on-site nuclear debris screening system by using dual energy X-Ray inspection and neutron energy resonance analysis has been established. By using the compact and mobile pulsed neutron source constructed from 3.95 MeV X-Band electron linac, coupled with Tungsten as electron-to-photon converter and Beryllium as a photon-to-neutron converter, short-distance neutron Time of Flight measurement can be performed. Experiment result shows this system can measure neutron energy spectrum up to 100 eV range with only 2.5 meters Time of Flightpath in regards to the X-Band accelerator’s short pulse. With this, on-site neutron Time of Flight measurement can be used to identify the nuclear debris isotope contents through Neutron Resonance Transmission Analysis (NRTA). Some preliminary NRTA experiments have been done with Tungsten sample as dummy nuclear debris material, which isotopes Tungsten-186 has close energy absorption value with Uranium-238 (15 eV). The results obtained shows that this system can detect energy absorption in the resonance neutron area within 1-100 eV. It can also detect multiple elements in a material at once with the experiment using a combined sample of Indium, Tantalum, and silver makes it feasible to identify debris containing mixed material. This compact neutron Time of Flight measurement system is a great complementary for dual energy X-Ray Computed Tomography (CT) method that can identify atomic number quantitatively but with 1-mm spatial resolution and high error bar. The combination of these two measurement methods will able to perform on-site nuclear debris screening at Fukushima Daiichi reactor core area, providing the data for nuclear debris activity mapping.

Keywords: neutron source, neutron resonance, nuclear debris, time of flight

Procedia PDF Downloads 214

Authors: Shazia Mannan, Zunera Khalid, Hammad-Ul-Mubeen

Abstract:

Wingless type Mouse mammary tumor virus (MMTV) Integration site-10B (Wnt10B) is an important member of the Wnt protein family that functions as cellular messenger in paracrine manner. Aberrant Wnt10B activity is the cause of several abnormalities including cancers of breast, cervix, liver, gastric tract, esophagus, pancreas as well as physiological problems like obesity, and osteoporosis. The objective of this study was to determine the possible inhibitors against aberrant expression of Wnt10B in order to prevent and treat the physiological disorders associated with it. Wnt10B3D structure was predicted by using comparative modeling and then analyzed by PROCHECK, Verify3D, and Errat. The model having 84.54% quality value was selected and acylated to satisfy the hydrophobic nature of Wnt10B. For search of inhibitors, virtual screening was performed on Natural Products (NP) database. The compounds were filtered and ligand-based screening was performed using the antagonist for mouse Wnt-3A. This resulted in a library of 272 unique compounds having most potent drug like activities for Wnt-4. Out of the 271 molecules analyzed three small molecules ZINC35442871, ZINC85876388, and ZINC00754234 having activity against Wnt4 abbarent expression were found common through docking experiment of Wnt10B. It is concluded that the three molecules ZINC35442871, ZINC85876388, and ZINC00754234 can be considered as lead compounds for performing further drug designing experiments against aberrant Wnt expressions.

Keywords: Wnt10B inhibitors, comparative computational studies, proto-oncogene, molecular docking

Procedia PDF Downloads 134

Authors: Assia Belfar, Mohamed Hadjadj, Messaouda Dakmouche, Zineb Ghiaba

Abstract:

Introduction: This study aims to phytochemical screening; Extracting the active compounds and estimate the effectiveness of antioxidant in Medicinal plants desert Limoniastrum guyonianum (Zeïta) from South Algeria. Methods: Total phenolic content and total flavonoid content using Folin-Ciocalteu and aluminum chloride colorimetric methods, respectively. The total antioxidant capacity was estimated by the following methods: DPPH (1.1-diphenyl-2-picrylhydrazyl radical) and reducing power assay. Results: Phytochemical screening of the plant part reveals the presence of phenols, saponins, flavonoids and tannins. While alkaloids and Terpenoids were absent. The acetonic extract of L. guyonianum was extracted successively with ethyl acetate and butanol. Extraction of yield varied widely in the L. guyonianum ranging from (0.9425 %to 11.131%). The total phenolic content ranged from 53.33 mg GAE/g DW to 672.79 mg GAE/g DW. The total flavonoid concentrations varied from 5.45 to 21.71 mg/100g. IC50 values ranged from 0.02 ± 0.0004 to 0.13 ± 0.002 mg/ml. All extracts showed very good activity of ferric reducing power, the higher power was in butanol fraction (23.91 mM) more effective than BHA, BHT and VC. Conclusions: Demonstrated this study that the acetonic extract of L. guyonianum contain a considerable quantity of phenolic compounds and possess a good antioxidant activity. Can be used as an easily accessible source of Natural Antioxidants and as a possible food supplement and in the pharmaceutical industry.

Keywords: limoniastrum guyonianum, phenolics compounds, flavonoid compound, antioxidant activity

Procedia PDF Downloads 322

Authors: Nidhi Chadha, A. K. Tiwari, Marilyn D. Milton, Anil K. Mishra

Abstract:

Translocator protein (18 kDa) TSPO is highly expressed during microglia activation in neuroinflammation. Although a number of PET ligands have been developed for the visualization of activated microglia, one of the advantageous approaches is to develop potential optical imaging (OI) probe. Our study involves computational screening, synthesis and evaluation of TSPO ligand through various imaging modalities namely PET/SPECT/Optical. The initial computational screening involves pharmacophore modeling from the library designing having oxo-benzooxazol-3-yl-N-phenyl-acetamide groups and synthesis for visualization of efficacy of these compounds as multimodal imaging probes. Structure modeling of monomer, Ala147Thr mutated, parallel and anti-parallel TSPO dimers was performed and docking analysis was performed for distinct binding sites. Computational analysis showed pattern of variable binding profile of known diagnostic ligands and NBMP via interactions with conserved residues along with TSPO’s natural polymorphism of Ala147→Thr, which showed alteration in the binding affinity due to considerable changes in tertiary structure. Preliminary in vitro binding studies shows binding affinity in the range of 1-5 nm and selectivity was also certified by blocking studies. In summary, this skeleton was found to be potential probe for TSPO imaging due to ease in synthesis, appropriate lipophilicity and reach to specific region of brain.

Keywords: TSPO, molecular modeling, imaging, docking

Procedia PDF Downloads 433

Authors: Shusmita Khan, Shams El Arifeen, Kanta Jamil

Abstract:

Background: Nutrition transition in Bangladesh has progressed across various relevant socio-demographic contextual issues. For a developing country like Bangladesh, its is believed that, overnutrition is less prevalent than undernutrition. However, recent evidence suggests that a rapid shift is taking place where overweight is subduing underweight. With this rapid increase, for Bangladesh, it will be challenging to achieve the global agenda on halting overweight and obesity. Methods: A secondary analysis was performed from six successive national demographic and health surveys to get the trend on undernutrition and overnutrition for women from reproductive age. In addition, national relevant policy papers were reviewed to determine the countries readiness for whole of the systems approach to tackle this epidemic. Results: Over the last decade, the proportion of women with low body mass index (BMI<18.5), an indicator of undernutrition, has decreased markedly from 34% to 19%. However, the proportion of overweight women (BMI ≥25) increased alarmingly from 9% to 24% over the same period. If the WHO cutoff for public health action (BMI ≥23) is used, the proportion of overweight women has increased from 17% in 2004 to 39% in 2014. The increasing rate of obesity among women is a major challenge to obstetric practice for both women and fetuses. In the long term, overweight women are also at risk of future obesity, diabetes, hyperlipidemia, hypertension, and heart disease. These diseases have serious impact on health care systems. Costs associated with overweight and obesity involves direct and indirect costs. Direct costs include preventive, diagnostic, and treatment services related to obesity. Indirect costs relate to morbidity and mortality costs including productivity. Looking at the Bangladesh Health Facility Survey, it is found that the country is bot prepared for providing nutrition-related health services, regarding prevention, screening, management and treatment. Therefore, if this nutrition transition is not addressed properly, Bangladesh will not be able to achieve the target of the NCD global monitoring framework of the WHO. Conclusion: Addressing this nutrition transition requires contending ‘malnutrition in all its forms’ and addressing it with integrated approaches. Whole of the systems action is required at all levels—starting from improving multi-sectoral coordination to scaling up nutrition-specific and nutrition-sensitive mainstreamed interventions keeping health system in mind.

Keywords: nutrition transition, Bangladesh, health system, undernutrition, overnutrition, obesity

Procedia PDF Downloads 257

Authors: Prasad Urvashi, Wynn Yezarni, Williams Shehan, Ravindran Arun

Abstract:

Introduction: Primary health services are often the first point of contact that patients with mental illness have with the healthcare system. A number of tools have been developed to increase detection of depression in the context of primary care. However, one challenge amongst many includes utilizing these tools within the limited primary care consultation timeframe. Therefore, short questionnaires that screen for depression that are just as effective as more comprehensive diagnostic tools may be beneficial in improving detection rates of patients visiting a primary care setting. Objective: To develop and determine the sensitivity and specificity of a 2-Question Questionnaire (2-QQ) to screen for depression in in a suburban primary care clinic in Ragama, Sri Lanka. The purpose is to develop a short screening tool for depression that is culturally adapted in order to increase the detection of depression in the Sri Lankan patient population. Methods: This was a cross-sectional study involving two steps. Step one: verbal administration of 2-QQ to patients by their primary care physician. Step two: completion of the Peradeniya Depression Scale, a validated diagnostic tool for depression, the patient after their consultation with the primary care physician. The results from the PDS were then correlated to the results from the 2-QQ for each patient to determine sensitivity and specificity of the 2-QQ. Results: A score of 1/+ on the 2-QQ was most sensitive but least specific. Thus, setting the threshold at this level is effective for correctly identifying depressed patients, but also inaccurately captures patients who are not depressed. A score of 6 on the 2-QQ was most specific but least sensitive. Setting the threshold at this level is effective for correctly identifying patients without depression, but not very effective at capturing patients with depression. Discussion: In the context of primary care, it may be worthwhile setting the 2-QQ screen at a lower threshold for positivity (such as a score of 1 or above). This would generate a high test sensitivity and thus capture the majority of patients that have depression. On the other hand, by setting a low threshold for positivity, patients who do not have depression but score higher than 1 on the 2-QQ will also be falsely identified as testing positive for depression. However, the benefits of identifying patients who present with depression may outweigh the harms of falsely identifying a non-depressed patient. It is our hope that the 2-QQ will serve as a quick primary screen for depression in the primary care setting and serve as a catalyst to identify and treat individuals with depression.

Keywords: depression, primary care, screening tool, Sri Lanka

Procedia PDF Downloads 227

Authors: Shahid Mahboob, Hafiz Muhammad Ashraf, Salma Sultana, Tayyaba Sultana, Khalid Al-Ghanim, Fahid Al-Misned, Zubair Ahmedd

Abstract:

There is an increasing need for an effective tool to estimate the risks derived from the large number of pollutants released to the environment by human activities. Typical screening procedures are highly invasive or lethal to the fish. Recent studies show that fish scales biochemically respond to a range of contaminants, including toxic metals, organic compounds, and endocrine disruptors. The present study evaluated the effects of the surface water contaminants on Cyprinus carpio in the Ravi River by comparing DNA extracted non-lethally from their scales to DNA extracted from the scales of fish collected from a controlled fish farm. A single, random sampling was conducted. Fish were broadly categorised into three weight categories (W1, W2 and W3). The experimental samples in the W1, W2 and W3 categories had an average DNA concentration (µg/µl) that was lower than the control samples. All control samples had a single DNA band; whereas the experimental samples in W1 fish had 1 to 2 bands, the experimental samples in W2 fish had two bands and the experimental samples in W3 fish had fragmentation in the form of three bands. These bands exhibit the effects of pollution on fish in the Ravi River. On the basis findings of this study, we propose that fish scales can be successfully employed as a new non-lethal tool for the evaluation of the effect of surface water contaminants.

Keywords: fish scales, Cyprinus carpio, heavy metals, non-invasive, DNA fragmentation

Procedia PDF Downloads 375

Authors: Jarel Elgin Tolentino, Arby Denise Nera, Mary Rose Roco, Angela Vianca Aspa, Nikko Beltran, Else Dapat

Abstract:

Drug resistance by cells has been the problem in the medical field for decades now. The use of medicinal plants as a source of creating powerful drugs has been nowadays recognized worldwide to treat such resistant diseases. In the present study, the potential for Diospyros philippinensis A. DC. to inhibit growth of both bacteria and cancer cell line was conducted. The leaf crude extracts were screened for the presence of phytochemicals and examined for potential bioactivities by employing several assays like Kirby-Bauer disc diffusion method, DPPH (2,2-diphenyl-1-picryl-hydrazyl-hydrate) assay and MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) tetrazolium assay for the antibacterial, antioxidant and cytotoxic activities of the extract, respectively. Phytochemical test results of the extracts revealed the presence of alkaloids, flavonoids, saponins, phenols, quinones, cardiac glycosides, phlobatannins, carbohydrate, cardenolides and proteins. The leaf extracts were found to exhibit antibacterial activity against gram-positive bacteria, high antioxidant activity (99.22% ± 0.005) but did not show any sign of cytotoxicity towards HCT116 (ATCC CCL-247). The study therefore concludes that D. philippinensis A. DC. leaf extract can be a source of antibacterial and chemopreventive agents. This claim may be used as basis for future investigation.

Keywords: bioassay, medicinal plants, plant crude extracts, phytochemical screening

Procedia PDF Downloads 240

Authors: Mehwish Asghar

Abstract:

Breast Cancer (BC) is a common type of cancer among women. Its screening is usually performed using different imaging modalities such as magnetic resonance imaging, mammogram, X-ray, CT, etc. Among these modalities’ mammogram is considered a powerful tool for diagnosis and screening of breast cancer. Sophisticated machine learning approaches have shown promising results in complementing human diagnosis. Generally, machine learning methods can be divided into two major classes: one is Radiomics analysis (RA), where image features are extracted manually; and the other one is the concept of convolutional neural networks (CNN), in which the computer learns to recognize image features on its own. This research aims to improve the incidence of early detection, thus reducing the mortality rate caused by breast cancer through the latest advancements in computer science, in general, and machine learning, in particular. It has also been aimed to ease the burden of doctors by improving and automating the process of breast cancer detection. This research is related to a relative analysis of different techniques for the implementation of different models for detecting and classifying breast cancer. The main goal of this research is to provide a detailed view of results and performances between different techniques. The purpose of this paper is to explore the potential of a convolutional neural network (CNN) w.r.t feature extractor and as a classifier. Also, in this research, it has been aimed to add the module of Radiomics for comparison of its results with deep learning techniques.

Keywords: breast cancer (BC), machine learning (ML), convolutional neural network (CNN), radionics, magnetic resonance imaging, artificial intelligence

Procedia PDF Downloads 195

Authors: Anupalli Roja Rani, Saraswathi Jaggali

Abstract:

Rose-scented geranium (Pelargonium graveolens L’Hér.) is an erect, much-branched shrub. It is indigenous to various parts of southern Africa, and it is often called Geranium. Pelargonium species are widely used by traditional healers in the areas of Southern Africa by Sotho, Xhosa, Khoi-San and Zulus for its curative and palliative effects in the treatment of diarrhea, dysentery, fever, respiratory tract infections, liver complaints, wounds, gastroenteritis, haemorrhage, kidney and bladder disorders. We have used Plant materials for extracting active compounds from analytical grades of solvents methanol, ethyl acetate, chloroform and water by a soxhlet apparatus. The phytochemical screening reveals that extracts of Pelargonium graveolens contains alkaloids, glycosides, steroids, tannins, saponins and phenols in ethyl acetate solvent. The antioxidant activity was determined using 1, 1-diphenyl-2-picrylhydrazyl (DPPH) bleaching method and the total phenolic content in the extracts was determined by the Folin–Ciocalteu method. Due to the presence of different phytochemical compounds in Pelargonium the anti-microbial activity against different micro-organisms like E.coli, Streptococcus, Klebsiella and Bacillus. Fractionation of plant extract was performed by column chromatography and was confirmed with HPLC analysis, NMR and FTIR spectroscopy for the compound identification in different organic solvent extracts.

Keywords: Pelargonium graveolens L’Hér, DPPH, micro-organisms, HPLC analysis, NMR, FTIR spectroscopy

Procedia PDF Downloads 467

Authors: Ayşe Coban, Orhan Coban, Haldun Soydal, Sükrü Sürücü

Abstract:

While health is a source of prosperity for individuals, it is also one of the most important determinants of economic growth for a country. Health, by increasing the productivity of labor, contributes to economic growth. Therefore, countries should give the necessary emphasis to health services. The primary aim of this study is to analyze the changes occurring in health services in Turkey by examining the developments in the sector. In this scope, the second aim of the study is to reveal the place of health expenditures in the Turkish economy. As a result of the analysis in the dataset, in which the 1999-2013 periods is considered, it was determined that some increase in health expenditures took place and that the increase in the share of health expenditures in GDP was too small. Furthermore, analysis of the results points out that in financing health expenditures, the public sector is prominent compared to the private sector.

Keywords: health, health service, health expenditures, Turkey

Procedia PDF Downloads 338