To analyze the impacts of the care to the population displaced by violence on the health system and the challenges that this entails. This is a narrative review of the national and international literature in PubMed, SciELO, WHO/PAHO, and Bireme. Inclusion criteria were date of publication (from 2000), relation with the subject, and language (Spanish or English). We found 292 documents, of which 91 met the inclusion criteria. The main challenges are the intersectoral, participatory, and integral approach , ensured accessibility to health services, the need for a reliable registration and information system of the population displaced by violence and its characteristics, and the addressing of the biopsychosocial problems of the different groups, especially women, persons with disabilities or infectious diseases, adolescents, children, ethnic minorities, older adults and the lesbian, gay, bisexual, transsexual, and intersexual population. The lack of political will to accept and see the internal displacement by violence and its importance as a humanitarian and public health problem is an obstacle to the adequate and timely care of the population displaced by violence in Mexico. This usually means shortages of resources, family conflicts, health risk behaviors, sexual abuse, physical and mental health problems, and human rights violations,Official statistics on forced displacement are scarce and incomplete in Mexico. The internally population displaced by violence has increased in the country, especially in states such as Chihuahua, Michoacán, Sinaloa, Durango, and GuerreroMexico had high internal migration for economic reasons, mainly from the south to the north of the country. It is also a transit point for Central and South American migrants to the United StatesGiven the exposed problem, the objective of the study was to analyze the impacts of the care to populations displaced by violence to the health system and the challenges that this entails.This first approach was based on the identification and analysis of the national and international literature, which contributes with information for the formulation of public policies that allow the preparation, allocation of resources, design, and implementation of national programs that respond to the needs of this vulnerable population.We carried out a narrative review of the literature on forced migration associated with violence and the response of health systems in documents published from 1995 to 2016. We included studies with different methodologies, from any country. The searches in PubMed, SciELO, WHO/PAHO, and Bireme were performed under the following terms in English and Spanish:Health services and/or Health system and internal displacement by violence;Displaced population and health services;Forced displacement and health in Mexico.Inclusion criteria were date of publication, relation with the subject, and language (Spanish or English). Each document was classified by document type, geographical context, and category in relation to the subject .,We found 292 documents, of which 91 met the inclusion criteria. Most (n = 75) were from the Latin America, almost all from Colombia. Of the 11 documents from Mexico, two were directly related to health servicesWe found scarce specific literature on the effect of forced displacement on HS. The articles related to the subject have identified its potential negative impact on human resources, as well as the increase in the needs of drugs, inputs, and infrastructure in health servicesA study on health and forced displacement in Sri Lanka, although focusing on post-conflict, has found three documents on HS. Most focused on the mental health problems of the displaced populationThe article of the International Center for Migration and Health5,12,27–30. Some strategies used in Colombia to ensure access were the priority affiliation to social security or the portability of this affiliation, the flexibility to adapt to obstacles such as the frequent absence of identification document, and the care with mobile health brigades and managers29,31–33.Some studies have focused on barriers to access to services. The most mentioned ones were the geographic, economic, cultural, and bureaucratic barriers,,Others have mentioned the lack of staff training to handle social and health emergencies, aggravated by the high turnover from the work under stress conditions, lack of resources, and insecurity2,5,26,37–39, integrality,4,41–43, being it intersectoral4,12,29,44–47, participatory,,24,27–31,37,43,48–5,,,,There is a consensus about the characteristics that the HS should have for displaced populations, such as cultural acceptabilityOther factors have also been identified on the challenges for the HS:,The amount of displaced populations: individual or family (drop by drop) or massive (more than 10 families or 50 persons),The existing resources in the receiving area and previous planning. According to the WHO, the political and security conditions of a country allow predicting possible displacements, planning activities and resources, and creating protocols for when the situation occurs,,,The displacement stage: initial  or in the final settlement stage14,56–58.Population type: minority ethnic groups or population similar to the receiving area1,5,27,28,47,59–67, with emphasis on childhood, adolescence, adult women, minority ethnic groups, the lesbian, gay, bisexual, transsexual, and intersexual population (LGBTI) population, and persons with disabilities or chronic or infectious disease requiring long-term treatment, such as TB and AIDS  or collective ,,,,,,-Human resources (HR). The health staff needs to be trained on the care of displaced populations,,,Reinforcement of services: in particular SRH,,,The financing of health care for displaced populations was a scarce subject in the documents. There was a consensus that financial resources are scarce or late,,,,,,,,,Other components: different subjects have been addressed, such as intersectoriality, participation, and empowerment of the displaced population,,,Despite underreporting, 281,418 persons are known to be victims of internal displacement forced by violence, mainly in the Northern states and Guerrero, caused by organized crimeThe Arana document on the situation in Chiapas highlights the lack of information to identify population groups and needs for their care, and it reinforces the connection between forced displacement and health“Forced displacement is one of the clearest examples of the interdependence between rights. Violation of civil rights of security and free residence from the use of physical and/or psychological force to expel a population unleashes an unpredictable series of negative consequences that hinder the exercise of the right to health and a long list of economic, social, and cultural rights.” (p.79)Forced displacement is an issue that violates human rights. It produces highly frail individuals and groups from a profound deterioration in the quality of life and health and the lack of care by the Government against the right to healthWhile most documents refer to migration by violence from one country to another, rather than internal migration, the diagnosis of the needs of the migrant population generally allows the deduction of the impact and challenges for the HS. In Latin America, most of the literature refers to Colombia, where the magnitude of the problem is enormous and has been assumed as a national priority. This has resulted in a reliable system of registration, strategies, and policies specific to this population and a large number of research and interventions have been carried out by the academia, cities, NGO, and international organizations. For this reason, the Colombian experience is recommended as an example for Mexico,,,,,Based on the results, the main challenges for the Mexican health system would beIntegral, intersectoral, and participatory approach, which requires multidisciplinary teams that are sensitized and trainedEnsuring of the geographical, cultural, economic, and functional accessibility to the HS, taking into account the psychosocial particularities of the displaced population, such as psychosocial trauma  and lack of resources, as well as the limitations of the benefit plan of the Popular Insurance.Presence of a reliable information and registration system for the displaced population and its characteristics, which allows prioritizing activities and groups, with the participation of community leaders that facilitate the approach of the population and the flow of information.Analysis and adaptation of successful experiences of other Latin American countries for the care and reparation of the population displaced by violence.Full addressing of the problems of different groups, especially women, and within them, young women, who, in addition to the specific SRH needs, face the risk of sexual violence and domestic violence because of the gender. In addition, many become the head of a family, thus requiring great psychosocial support.Given the high vulnerability of the displaced population to mental health problems, this problem must be studied and addressed in order to avoid negative individual, family, and social consequences.,,To address these challenges adequately, the Mexican government must recognize the existence of displaced populations to plan resources and design policiesForced displacement accumulates vulnerabilities from losses: political and social rights, family and social networks, and adverse social and health conditions that are present in the receiving areas. These situations increase the burden of the disease and pressure the demand for health services that respond to health needs, particularly mental health needs. The WHO warns about the consequences of conflicts for public health and health systems which may have a decreased ability to respond adequately to new demandsForced displacement is a determinant of social and health inequities. It is closely related to structural factors, such as economic distribution, land, human rights, and intermediate factors such as socioeconomic status and health system. This aspect exposes another challenge for health systems regarding the inter- and trans-sectoral work that favors the social mobilization of players other than those in the health sector to enhance interventions in health services. Health systems should be centered on more comprehensive strategies, such as Primary Health Care and Health Promotion, and focused on Social Determinants, which have close relations.Knowledge about the health problems and needs of the displaced population and its impact on the HS can be used to define programs, strategies, and policies that address this growing problem in Mexico. National and international experiences are an important reference for the country. Colombia has a broad trajectory in this area and has a National System of Integral Care for displaced populations and specific strategies of health care. Strategies include the training of health managers and mobile brigades, in addition to those designed and evaluated with the follow-up of the Pan American Health OrganizationDespite the limitation of the scarcity of specific information on the subject, as shown in the


The objective of the present study was to investigate the strength and weaknesses of healthcare management during the first 10 days after the earthquake in Sarpol-e Zahab in Kermanshah, Iran.This qualitative, observational study was conducted on November 13–23, 2017 in the disaster area, by using content analysis. Data was collected through experts and focus group interviews with professional and healthcare staff, and policy-makers.Our findings were categorized into 7 major groups; environmental health; mental health; mothers, infants and children’s health; field hospital; nutrition; contagious diseases; drug delivery. There were good cooperation and coordination regarding environmental health issues. However, other categories were handled by different organizations and resulted in a chaotic situation.The post-earthquake period is overwhelmed with considerable issues regarding the care of victims and therapeutic measures. Lack of quick, reliable, and appropriate management will result in extensive health issues, including epidemic, worsening of chronic diseases, and exacerbation of mental disorders. Iran is one of the 10 disaster-prone countries in the world with 90% of its population exposed to earthquake and flooding. Statistically speaking, Iran has been ranked six in terms of the incident of natural events . SeveralEzgeleh is a city in Kermanshah Province, located in Ezgeleh district, Salas-e Babajani County, with a population of 1502 people according to 2016 census of population , and an Regarding the importance of the quick and vital responsiveness of the health system, especially the human force and facilities related to health, this study was done and aimed at investigating the strengths, weaknesses, and the health-related needs in the first 10 days after the large earthquake in the west of Iran by interviewing the experts in 2017; it is hoped that the results of the present study would be useful for the probable disasters in the future.This qualitative, observational study was conducted on November 13–23, 2017 in regions affected by earthquake including Sarpol-e Zahab, Ezgeleh, Eslamabad-e Gharb, Salas-e Babajani, Kerend-e Gharb, and Qasr-e Shirin in Kermanshah Province. This study was conducted in Sarpol-e Zahab, which is an endemic region of cutaneous leishmaniosis.Data were collected through observation, and in-depth interview with 54 experts and stakeholders, and five focus groups consisting of experts, employees, and policymakers. Since the researcher was an expert of health in disasters, a part of data collection was done with observation. All observations were registered and interviews and meetings were recorded and were analyzed by authors.Inclusions criteria for participants and focus groups; 1) being actively involved in the disaster area, and 2) Working experience of at least for 2 years. Exclusions criteria for participants and focus groups; 1) reluctance to participate in the study.A total number of 54 experts participated in the semi-structured and in-depth interviews. Semi-structured questions about the strengths and challenges of the health system services were asked from the experts. Probing questions were also asked based on the answers of the participants. The interviews lasted approximately 20–40 minutes. They were conducted in a quiet place. After each interview, it was immediately transcribed and the weaknesses, strengths, and challenges were extracted.Finally, 5 focus group sessions were held; the number of the people in each of the focus groups varied from 7 to 10 people. The duration of each focus group interview was between 1–2 hours. The sessions were directed and coordinated by the researcher. Semi-structured questions were asked from each expert in their profession regarding the undertaken actions, and measures, strengths, weaknesses, challenges, and needs. Each point was discussed in detail if needed. Data were analyzed, using the Inductive and Conventional approach based on the Graneheim and Lundman method.All participants in the study completed the informed consent form, and they could withdraw from the study at any stage of the study. The text of the interview was also completely confidential and the participants’ demographics remained confidential.The research findings were categorized into 7 major groups of environmental health, mental health, mothers’, infants’, and children’s health, field hospital, nutrition, contagious diseases, and drug. The strengths and challenges of each issue are presented below.Strengths: very appropriate measures had been adopted regarding the control and inspection of the drinking water resources, providing healthy water by adding Chlorine, turbidity test, monitoring the mobile water tanks and Chlorine residual testing, visiting the temporary housing camps, monitoring the kitchens, visiting food preparation and distribution centers, and disinfection of the mobile toilets and baths by Chlorine. In the first 8 days after the earthquake, the Chlorine residual in the water was 0 ppm and the turbidity of the urban water was over 5 NTU; however, the Chlorine residual level gradually rose to over 1.5 ppm and turbidity of the water fell to lower than 5 NTU.Challenges: various problems were observed such as lack of human force and the necessary equipment for the environmental health teams, lack of trash bags in the tents of the earthquake survivors, inappropriate burial of garbage, release of leachate in the environment because of raining, inappropriate transportation and distribution of the hot food, distribution of moldy bread and rancid dates among the affected people, disposal of animal manure in rural environments, presence of the corpses of the cattle and livestock in the city, lack or a few number of healthy water tanks and restrooms in the city and villages, and the presence of louse and scabies.Lack of restrooms and weak disposal of wastes and wastewater are two serious dangers which increase the incidence probability of contagious diseases among the earthquake survivors.Strengths: in the affected region, the psychologists screened all of the people and referred the individuals with the acute disorder to the psychiatrist. The actions taken by the mental health team included establishing an effective communication with families, sympathy and expression of feelings in order to gain confidence, and identify primary psychological reactions, and signs and symptoms of anxiety.Challenges: the majority of the disorders reported in the affected region included anxiety, the stress of the reoccurrence of the incident, overexcitement, sleep disorder and insomnia, suicidal tendency, and complaint from religious principles. Furthermore, there was no necessary equipment including whiteboard, marker, color pencil, wax oil crayon, toy, painting notebook, and gift for children which are necessary for the mental health team.I’ve been addressing the people, and I realized that a lot of people were afraid and anxious. And the complaints of religious rituals were much higher”.One of the experts said: “Strengths: some necessary measures were taken for the affected society including visiting and examining the pregnant women and the children below one year old, examining the nutritional status of the infants with breastmilk and needs assessment of the nutrition of children and pregnant women, conducting delivery, visiting the girls and women in reproductive age, providing services for seniors and the children below one year old, helping vulnerable groups, distributing baby formulas, diapers, sanitary pads, baby bottles, distributing the facilities for birth control among people, vaginal examination (if needed), and checking the vital signs and fetal heartbeat.Challenges: lack of contraceptives, especially condoms, lack of fetal electrocardiography, lack of multivitamins and, in some cases, excessive intake of vitamins, lack of midwifery Sonic aids and Pinard, thermometer, otoscope, ophthalmoscopy, flashlight, tongue depressor, gloves and mask, blood pressure measurement device, baby scale, suture thread, and dressing set were seriously felt. Moreover, there were very few drugs such as methyldopa pill, magnesium sulfate and hydralazine ampoule for the pregnant women affected by high blood pressure.Strengths: various medical specialties were accessible in the mobile hospital.Challenges: some field hospitals were located on the outskirts of the city and the considerable point was the very low distance of the 3 field hospitals from each other. The assessment of the location of the field hospitals was very incomplete. There were problems such as imperfect setup of Incident Command System (ICS), absence of the environmental health personnel for spraying the hospital, lack of drugs, surgical instruments, and operating room, lack of the emergency box and surgical sets, lack of a helicopter near the hospital to dispatch sick patients, lack of specialties of orthopedics, internal medicine, emergency medicine, pediatricians, general practitioners and nurses , lack of radiological devices, and few number of security forces in the field hospitals.Strengths: in the first week, the following works were done: quick assessment of the children below 5 years old using mid-upper arm circumference, assessment of the malnutrition status of the children below 5 years old, screening the nutritional status of the infants and nursing mothers, providing proper nutrition to the patients with diabetes and those with high blood pressure, investigating the diet portion of the families, A+D supplements and calcium for the children below 2 years old, iron pill, and multivitamins.Challenges: lack of nutrition specialists was seriously felt in the first 10 days after the earthquake. In the first week after the earthquake, hot food was distributed among the earthquake survivors; there were some problems regarding the health status of the food and its maintenance. The distribution of the expired tuna and canned beans exacerbated the nutritional condition of the people. Lack of coordination between the Ministry of Health and Medical Education and the Red Crescent Society was also seriously felt regarding the food supply and distribution.Strengths: the syndromic care system was established by the employees of the contagious diseases. No case of contagious diseases was discovered in the first 10 days. Pediatric vaccination was carried out based on the immunization program; however, diphtheria and tetanus vaccines were injected in some cases. Fortunately, no case of Cholera, Measles, and Meningitis was observed in the affected region.Challenges: the specialists diagnosed some cases of Pediculosis and Scabies. Due to the cold weather, many people caught a cold. There were many cases of acute bloody diarrhea, especially in the children. Regarding the fact that the affected region is an endemic region of Cutaneous leishmaniosis, there should be an appropriate control over the reduction of the Phlebotomus.One expert said: “Given that the earthquake has damaged urban and rural water pipes, immediately” the pipes should be replaced or rebuilt to prevent the spread of contagious diseases”.Strengths: most of the drugs were given to those who needed them. The drugs were distributed in especial centers such as health centers, rural health centers, and mobile hospitals.Challenges: There was a severe shortage of these drugs; anti-cough and allergy syrups of Diphenhydramine, Dextromethorphan, and Ketotifen; antibiotics of Amoxicillin, Cefixime, and Azithromycin; the ophthalmic drugs of Sulfacetamide and Chloramphenicol; gastrointestinal pills and painkillers such as gelofen, acetaminophen and Codeine-acetaminophen; Piroxicam gel; and drugs for reducing blood pressure (Captopril) and diabetes (Metformin and Glibenclamide); there was a severe shortage of these drugs. Due to high levels of stress among the earthquake survivors, many of them were affected by Herpes simplex; hence, Aciclovir ointment was consumed to a large extent. There was a shortage of the general drugs such as alcohol pad, sieve, Betadine, the drugs such as gelofen, Chloramphenicol, Betamethasone, Piroxicam gel and A+D, eye drops, and painkillers. The drugs were distributed based on the words of the patients themselves and there was no examination regarding the necessity of the drug by a pharmacist or pharmacist technician; in fact, there was no monitoring.One of the experts said: “Health care staff distributed widely and widely drugs among people, which could create long-term problems for the people in the future. There is no supervision on the distribution of drugs at all”.Natural disasters mostly occur in the developing countries due to the lack of a comprehensive emergency response program , 12. TheThe study of Udomratn (2008) showed that, after the occurrence of the natural disasters, the prevalence of psychological disorders and social functions, especially the Post-traumatic stress disorder (PTSD) in the earthquake survivors is between 8.6% and 57.3% in terms of intensity, kind of disaster, and individual characteristics . Other sThe incident of infectious diseases increases after the earthquake due to injuries, increased wastes, and the poor environmental health status of the affected region . RespiraFew studies have been conducted on the impacts of the earthquake on the pregnant women , 23. BecIn the great east Japan earthquake, there was lack of soluble drugs such as glucose 50%, oxytocin, phtharal, olopatadine tablets, normal saline, and levothyroxine tablet . The resMany health-related services were provided in Bam earthquake , which wThe Iranian healthcare system, including hospitals, prehospital entities, healthcare centers, and other involved stakeholders need a coordinated readiness plan to cope with new incidents and crises . This neSince Iran is prone to disasters, the occurrence of earthquakes is inevitable. Therefore, it is necessary to plan and implement appropriate measures for higher readiness and mitigation ability. Regional disaster plans for rapid healthcare response should be written, reviewed and revised at least once or twice a year. Furthermore, these plans should be tested by holding table top and operational exercises to identify new risks and weaknesses. Elimination of risks and mitigating disasters consequences enable a quick return to normalcy after a disaster such as an earthquake.There are some limitations to this study. One of the limitations of the study was the lack of access to all key informants for interviewing. Another limitation is the fact that the results reflect the observation by one researcher, whose impression and experience may have had an impact on the comprehension of the results.There were many deficiencies in healthcare response to Kermanshah earthquake, of which the most important one was the intra- and extra-organizational inconsistency and lack of human force and equipment, which resulted in more chaos in the affected region. Since Sarpol-e Zahab is an endemic region of cutaneous leishmaniosis with considerable health issues, rapid and appropriate measures should be implemented to prevent extensive health issues, including epidemics of contagious diseases, worsening of chronic diseases, and the exacerbation of mental disorders. Improved collaboration and coordination among different agencies are a necessary step, which may only be possible by a united regional leadership. Resource management, information-sharing, and training are all natural steps towards an increased healthcare readiness to combat disasters and to provide better services to the victims.Ethical issues  have been completely observed by the authors.


Waste management for municipal solid waste is considered a public health services, providing citizens with a system of disposing of their waste in an environmentally sound and economically feasible way. The amount and composition of waste generated comprise the basic information needed for the planning, operation and optimization of waste management systems. In this study, paper and plastic quantity changes in the MSW  of the region 10 of Tehran city were evaluated. This study was conducted in 6 months, in the summer and autumn seasons, at the region 10 of Tehran city. In this study, paper and plastic were segregated and data were analyzed by SPSS software. The paper parameter of solid wastes was consisted of folder paper, cardboard and used newspaper. The plastic parameter of solid wastes was consisted of plastic materials, plastic house shoes, plastic sack, nylon sack, linoleum, radiology photograph and PET. Samples were collected and weighed daily. The total quantity of paper and plastic portion of this region solid waste were 203,930 Kg and 180,101 Kg, respectively. The percentage of paper and plastic portion of this region solid waste also were 6.82% and 6.03%, respectively. The analyses showed a significant difference between these parameters and season, some months and days . So, because of the results of this study and economical issues, the paper and plastic segregation from generated source point and recycling them are important. The cornerstone of successful planning for a waste management program is the availability of reliable information about the quantity and the type of material being generated and an understanding about how much of that material that collection program manager can expect to prevent or capture. Effective waste management through MSW composition studies is important for numerous reasons, including the need to estimate material recovery potential, to identify sources of component generation, to facilitate design of processing equipment, to estimate physical, chemical, and thermal properties of the waste and to maintain compliance with national law and European directives. The composition of generated waste is extremely variable as a consequence of seasonal, lifestyle, culture, demographic, geographic, and legislation impacts. This variability makes defining and measuring the composition of waste more difficult and at the same time more essential  Fig. 1,, Fig. 3F2) and is restricted from north by Azadi Ave., from south by Qazvin Ave., from east by Navab highway and from west by Shahidan St.The region 10 is on of the most crowded regions of Tehran city. The Area of this region is about 807 ha . Then, for normal parts of those parameters, the One-way ANOVA test and Independent-sample T-test and for abnormal parameters, the Mann-Whitney and Kruskal-Wallis Tests were used. Then, the results were compared with other results of similar studies in Iran and other parts of the world.The normal condition of the data was determined by the Kolmogorov-Smirnov test . This test showed that plastic materials and plastic house shoes were normal and other components were abnormal.In This test method is applied for the determination of the mean composition of MSW based on the collection and manual sorting of a number of samples of waste over a selected time of period covering a 183 days. This test method includes procedures for the collection of a representative sorting sample of unprocessed waste, manual sorting of the waste into individual waste components, data reduction, and reporting of the results. This test method may be applied at landfill sites, waste processing and conversion facilities, and transfer stations. Its level of confidence and precision values are, respectively, 95% and 0.05%.The results of this study showed that the total weight of paper and plastic parameters in the solid waste of this region were 203,930 and 180101 kg, and the percentage of these parameters were 6.82%and 6.02%, respectively.So the total weight of paper and plastic is assumed about 406,745 and 359217 kg, respectively. In comparing the previous study that conducted in 1991 on the solid waste of Tehran province that showed the amount of paper in the solid waste was 10.3% with this study results, it seems that the amount of paper was decreased during last decade . In 2000The Iranian recycling and material recovery organization reported that the income of each kilogram paper and plastic recycling is about 2.5 and 6.5 cents, respectively. By calculating these numbers in the total collected amount of paper and plastic parameters in this region, the total yearly income of paper and plastic recycling is about 10,162 and 23,350 dollars, respectively. So, the special notice from economical point of view to the amount of paper and plastic in the MSW of this region and recycling them is very critical. Unfortunately, the most of MSW of this region is buried without any recycling process and the Tehran municipality organization should make instant and effective decision to recycling the recyclable materials that buried daily.


At the beginning of 2018, and after closing the international symposium on Nanoparticles, Nanomaterials and ApplicationsConcerning the first term, Rational Design, one of the most important subjects when a nanomaterial is designed, is to control the synthetic pathways to ensure the final desired product. A combination of dry and wet synthetic techniques, in conjunction with the adequate chemical and physical characterization methodologies, it is possible to prepare new nanomaterials successfully. This complex issue frequently is a result of multidisciplinary cooperation between chemists, physics, biologist, physicians, material engineers, among other disciplines. The second statement, Multifunctional applications, deals with the use of nanomaterials in fields some time collaboratives, such as drug delivery, cell and tissue imaging, as new antibiotic tools, in environmental detection and removing of contaminants, catalysis, and many industrial applications directly rely on properties such as water solubility, permeability, photostability, cell penetration, magnetic properties, related shape, and size control among others. Nowadays, functionalized nanomaterials play a crucial role in modern research areas because of their unique physical and chemical properties arise from their size and shape.In the international year of the Periodic Table, we can highlight in this collection of papers the use of gold, silver, iron, platinum, molybdenum, titanium, and cobalt as metal precursors among the use of organic@inorganic polymers, and Silica as the chemical protagonist in this collection of papers.Caponetti et al. in Italy reported an elegant paper on Fluorescent Nanoparticles for bioimaging; The use of Gold Nanoparticles for Photothermal therapy was studied by Vines et al. in South Korea and the USA, and also Gold Based Organometallic nanocomposites for Antitumoral activity studies were reported by Dalmases et al. in a collaborative paper including researchers from Spain and Germany, and finally iron was Price et al. including researchers from the United States of America, Saudi Arabia, and Russia. The actually topic of antibiotic resistance and new antibiotic studies was covered using silver nanomaterials by Djafari et al. in Portugal with a manuscript about Silver Nanotriangles as antibacterial tools, and Nuti et al. with the contribution of researchers in Portugal, Spain, and Italy with the synthesis of Mesoporous Silver nanoparticles for antibiotic delivery.Sixty-eight researchers from Portugal, Spain, Italy, Germany, Switzerland, Hungary, Russia, United States of America, Saudi Arabia, South Korea, Taiwan, and Indonesia, submitted 10 original and review articles covering all the aspects highlighted in the title. Related to the contributions in the field of biomedical sciences and applications, Sahroni et al. from Taiwan and Indonesia with Hybrid Nanomaterials for reversible lithium storage based on MoS2, Szabó et al. from Hungary and Switzerland present a paper on Titanium based nanomaterials for catalysis applications, Martinez et al. studied several Pt-Co Nanoparticles for CO oxidation, and finally the use of TiO2/Au nanoparticles for hydrogen generation via photocatalysis was explored by May-Masnou et al. from Spain.Catalysis and industrial applications were represented by the contributions of In summary, this Research Topic have explored the state-of-the-art and beyond in the rational design of nanoparticles and nanocomposites, based on metallic, polymeric, or soft raw materials, as well as their different applications in medicine, imaging, drug delivery, catalysis, energy storage, or sensing.For all future technological applications, the rational design of these multifunctional nanomaterials is critical, and in many cases will be controlled by the organic and inorganic chemical reactions involved during the production. The success of their applications relies directly on the photophysical and chemical properties created in the final material, including the emission of light or colourimetric responses, water solubility, selectivity, sensitivity, stability, thermal stability, functionalization, etc.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


As it may be argued that many surgical interventions provide obvious patient benefits, formal, staged assessment of the efficacy and safety of surgical procedures has historically been and remains uncommon. The majority of innovative surgical procedures have therefore often been developed based on anatomical and pathophysiological principles in an attempt to better manage clinical problems.In this manuscript, we sought to review and contrast the models for pharmaceutical and surgical innovation in North America, including their stages of development and methods of evaluation, monitoring, and regulation. We also aimed to review the present structure of academic surgery, the role of methodological experts and funding in conducting surgical research, and the current system of regulation of innovative surgical procedures. Finally, we highlight the influence that evidence and surgical history, education, training, and culture have on elective and emergency surgical decision-making. The above discussion is used to support the argument that the model used for assessment of innovative pharmaceuticals cannot be applied to that for evaluating surgical innovations. It is also used to support our position that although the evaluation and monitoring of innovative surgical procedures requires a rigorous, fit-for-purpose, and formal system of assessment to protect patient safety and prevent unexpected adverse health outcomes, it will only succeed if it is supported and championed by surgical practice leaders and respects surgical history, education, training, and culture.We conclude the above debate by providing a recommended approach to the evaluation, monitoring, and regulation of surgical innovations, which we hope may be used as a guide for all stakeholders involved in interpreting and/or conducting future surgical research. As it may be argued that many surgical interventions provide obvious patient benefits, formal, staged assessment of the efficacy and safety of surgical procedures has historically been and remains uncommon . The majIn this manuscript, we sought to review and contrast the models for pharmaceutical and surgical innovation in North America, including their stages of development and methods of evaluation, monitoring, and regulation. We also aimed to review the present structure of academic surgery, the role of methodological experts and funding in conducting surgical research, and the current system of regulation of innovative surgical procedures. Finally, we sought to highlight the influence that evidence and surgical history, education, training, and culture have on elective and emergency surgical decision-making. The above discussion is used to support the argument that the model used for assessment of innovative pharmaceuticals cannot be applied to that for evaluating surgical innovations. It is also used to support our position that although the evaluation and monitoring of innovative surgical procedures requires a rigorous, fit-for-purpose, and formal system of assessment to protect patient safety and prevent unexpected adverse health outcomes, it will only succeed if it is supported and championed by surgical practice leaders and respects surgical history, education, training, and culture. We conclude the above debate by providing a recommended approach to the evaluation, monitoring, and regulation of surgical innovations, which we hope may be used as a guide for all stakeholders involved in interpreting and/or conducting future surgical research.Assessment of innovative pharmaceuticals within the United States and Canada occurs within a highly structured model regulated by the U.S. Food and Drug Administration (FDA) and Health Canada, respectively . The devPhase I studies are conducted within a small cohort of healthy volunteers and assess the safety, tolerability, accepted dosage range, and pharmacokinetics of the IND after one or more doses , 5. PhasIn contrast to the highly structured and regulated model of pharmaceutical innovation, the development of innovative surgical procedures remains largely unregulated, unstructured, and variable , 6, 7. DIn the IDEAL model, stage 0 refers to the initial pre-human  work and development, whereas stage 1 is the first time the innovative procedure is performed on a small group of highly selected patients . FrequenDiseases of the Colon & Rectum, Surgery, and the British Journal of Surgery) in the year 2000 were RCTs and that this percentage increased to only 10% in 2010 , permit conclusions to be drawn, and thereby to develop and contribute to generalizable knowledge”, it is frequently challenging to define an innovative surgical procedure as an intervention or research . Thus, uIn part to address this problem, a formal document was issued by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in 1979 known as the Belmont Report . AlthougAs a practical system for the development and evaluation of surgical procedures that does not unnecessarily hinder surgical innovation is required, the Balliol Collaboration created recommendations in 2009 that coincide with their proposed model of surgical innovation described above . The Colbefore patient recruitment commences . The. The7].


Reproductive health of vulnerable adolescent girls is a top priority in global programs. Alcohol consumption, drug abuse, high risk sexual behaviors, sexually transmitted diseases, sexual assault, escape from home, unrestrained sex in the family, history of robbery, imprisonment and living in drug hangouts expose adolescents to different sorts of damage and injury. These adolescent girls are at risk of AIDS and other STDs, unwanted pregnancies, illegal and unsafe abortions, unplanned pregnancy and childbirth, and unsafe motherhood. Therefore, assessing these girls’ reproductive health needs and designing programs to improve their sexual and reproductive health seem to be essential. This study will be conducted to design a comprehensive program for improving the reproductive health of vulnerable adolescent girls.The present study is an exploratory sequential mixed methods study  designed in three phases. In the first phase, a qualitative study will be used to describe the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, and explain the strategies of reproductive health programs for these girls. Participants will be selected in this phase using purposive sampling method, and the data will be collected through semi-structured interviews. The obtained data will be analyzed using conventional qualitative content analysis. In the second phase, through a quantitative study, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners to prioritize and select the best strategies. In the third phase, the initial draft of the program will be formulated based on prioritized strategies and will be proposed in a panel comprised of specialists in the areas of reproductive and sexual health, health promotion, social injuries and a psychiatrist. Finally, the final program will be developed and presented after obtaining the agreement and approval of the panel members.Designing a program based on a qualitative study, review of the existing evidence and programs, and using the opinions of experts in different areas can lead to different aspects of reproductive and sexual health of vulnerable adolescent girls. On the other hand, taking into account all cultural sensitivities and taboos as well as political, economic and social barriers, the development of such a program can provide the appropriate possibility of presenting comprehensive reproductive and sexual health services to vulnerable adolescent girls and achieve the goals agreed universally. One of the most important components of human health is reproductive health that planning to provide it, especially with particular regard to women and girls, is one of the essential steps in ensuring the health of the family and society. This study can provide strong, comprehensive information and need-based strategies to ensure reproductive health of vulnerable adolescent girls. This study is an exploratory sequential mixed methods design that consists of three phases. A qualitative study is conducted to assess the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, as well as strategies which can help ensure their reproductive health. The participants in this phase will be selected using purposeful sampling method and the data will be collected using semi-structured interviews. The obtained data is analyzed using qualitative content analysis. In the second phase, through a quantitative study and using the SFF method , first introduced by Landsberger, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners to prioritize and select the best strategies. At the end of this study, the most prioritized strategies are selected. In the third phase, initial drafts of the program will be formulated based on prioritized strategies and will be proposed in a panel comprised of specialists in the areas of reproductive and sexual health, health promotion, social injuries as well as a psychiatrist. Finally, the final program will be developed and presented after obtaining the agreement and approval of the panel members.Designing a program based on a qualitative study, review of the existing evidence and programs, together with using the opinions of experts in different areas can lead to different aspects of reproductive and sexual health of vulnerable adolescent girls. Furthermore, the development of such a program through considering all cultural sensitivities and taboos as well as political, economic and social barriers, can provide the appropriate possibility of presenting comprehensive reproductive and sexual health services to vulnerable adolescent girls and help us in achieving the internationally agreed goals.Reproductive health is one of the most important components of human health. The most important components of reproductive health include informing, educating and counseling on sex and creation of responsibility in both sexes with respect to the cultural conditions of the society, counseling,education and treatment of sexually transmitted infections and sexually transmitted diseases especially AIDS and hepatitis, timely and appropriate prevention and treatment of the complications of abortion, family planning and provision of services in this regard, prevention and appropriate treatment of infertility, provision of prenatal care, safe delivery and postpartum care, especially education and promotion of breastfeeding. The development of programs related to reproductive health and addressing its various components and dimensions at national and international levels is one of the essential steps in ensuring society and family health  . AdolescIt is for these reasons that the provision and promotion of reproductive health among adolescents is one of the most important commitments of societies in achieving Sustainable Development Goals (SDGs), and there is an emphasis on the public access to reproductive health care services and its integration into strategies and programs by 2030 .However, there are still barriers in many countries, especially developing countries, to the design and implementation of reproductive health programs for adolescents. In many cultures, providing reproductive health to this social group faces many challenges . At the Therefore, given the necessity of policymaking and program development before doing any operational action, this study was designed through using an exploratory mixed method to identify the reproductive health needs of vulnerable adolescent girls by taking into account all the factors affecting it in the present situation of the society and, then, develop and present a comprehensive reproductive health program for vulnerable adolescent girls.Describe the reproductive health needs of vulnerable adolescent girls.Identify facilitating and inhibiting of reproductive health factors.Explain the strategies of reproductive health programs for these girls.Decision-making and prioritization of the strategies obtained from the qualitative study and review of the literature by using SFF matrix.The initial draft of the program will be developed based on the prioritized strategies and then modify the program by comments expressed from panel of experts.The present study is an exploratory sequential mixed methods study  designed in three phases. The first phase of the study is a qualitative study to describe and evaluate the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, and explain the strategies of reproductive health programs for these girls. In the second phase, through a quantitative study, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners. The most prioritized strategies will be selected in this phase. In the third phase, the initial draft of the program will be formulated based on the prioritized strategies and will be proposed in a panel consisting of specialists in the areas of reproductive and sexual health, health promotion, social injuries and a psychiatrist. Finally, after obtaining the agreement and approval of the panel members, the final program will be developed and presented.In the first phase of the study, the reproductive health needs of vulnerable adolescent girls, the factors affecting, and the strategies for providing their reproductive health are explained using in-depth semi-structured interviews which will be analyzed using conventional content analysis. The research setting for this study where the adolescent girls will be interviewed includes health homes in welfare centers, prison health centers, the Department of Prevention in the Ministry of Justice, and drug abuse hangouts. Interviews with service providers, decision-makers and policymakers in the areas of vulnerable women and girls will be conducted in their workplaces including public health centers, private offices of the midwives, gynecologists and psychologists, prison, the branch of social injuries in the Ministry of Justice, the Social Security Branch of the Police, the Department of Social Injury in the Department of Education, the Deputy of public health in the province and the university.The population of study in this phase consists of all vulnerable adolescent girls aged between 12 and 19, reproductive health providers, psychologists, decision-makers and policymakers in the field of reproductive health. Purposive sampling method will be used in this phase of the study. Sampling method with the maximum diversity will be used to ensure the validity of the study. As such, adolescent girls with different ages, education levels, and socioeconomic status will be included in the study. Similarly, decision-makers, policymakers, and service providers are also selected to participate in the study, taking into account the maximum diversity in terms of characteristics such as age, education, work experience, type of specialty, job and organizational position. Sampling and data coding will continue until there is no more new code and saturation is reached.Inclusion criteria for adolescent girls include aged between 12 and 19 years old, starting and maintaining a menstrual cycle, having no known mental illness that requires to be treated and willingness to participate in the study, and for other participants, willingness to participate in the study.For data collection at this phase, we will use in-depth semi-structured individual interviews, field notes, reminder writing and document review. All actions at this phase will be performed taking into account ethical considerations. Prior to the interviews, the participants will be briefed about the purpose of the research, and written or verbal consent will be obtained from them. The scheduled time for the interview, the duration of the interview and the interview location will be chosen based on the preferences of the participants.Conventional qualitative content analysis will be used for data analysis and interpretation.In order to evaluate the accuracy and stability of the data, the four criteria of credibility, dependability, confirmability and transferability will be used .In this phase, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health service providers, experts, policymakers and reproductive and sexual health planners for decision-making and prioritization. This phase will be conducted quantitatively and using descriptive research method. In this phase, reviews of the literature will be performed using an extensive and in-depth library study  and searching in electronic databases to evaluate the writings related to the subject of study. Searching keywords such as adolescent, vulnerable, unmarried, and reproductive health, all studies published from 2006 to 2019 in -persian or English will be evaluated. For access to this information, PubMed, Science Direct, Web of Science, Cochrane Library, Ovid, Scopus, ProQuest, Magiran, Embase, SID databases will be used. After extracting the strategies, the participants will be provided with a list of strategies in the quantitative phase of the study.Comprehensive health services centers, the offices of midwives, gynecologists, psychologists and psychiatrists, the Department of health in the province, Social Welfare Organization, the Social Deputy of the Police, the Social Injuries Unit of the Justice Ministry, and the Social Injury Units of the Department of Education are considered as the setting of the study.The population of the study consists of the decision-makers and providers of services for vulnerable adolescents include midwives, gynecologists, specialists of reproductive health and health promotion, psychologists, psychiatrists, the authorities of the family health promotion units in the provincial health department, the authorities of social injuries in the police department, the authorities of social injuries in the Ministry of Justice, Social Welfare Organization authorities working in the field of reproductive health, and the authorities of the social injuries unit in the Department of Education.Convenience sampling method is used for this part of the study.Experts and service providers with the minimum of 2 years of work experience and health professionals and policymakers with at least 3 years of work experience who are willing to participate in the study can take part in it.Unwillingness to participate in the study and the questionnaires that are not filled completely.The data collection tool is a two-part questionnaire. The first part deals with the demographic characteristics of the participants, including age, sex, occupation, education, work experience, workplace and job position, and the second part is related to the scoring of the extracted strategies by using SFF matrix. This matrix contains three criteria of importance, necessity and ease of implementation. Each criterion has a score of 1 to 3  and, thus, each matrix or strategy can have a score of 3 to 9. The questionnaire of strategies for reproductive health of vulnerable adolescent girls will be completed in-person or via email by the research population identified based on their expertise and activities related to vulnerable adolescents. At this set time, the researcher will refer to these people frequently and follow the work process in answering the questionnaire. In addition, the participants can contact the researcher by telephone if necessary. After the end of the deadline, the questionnaires are collected by the researcher and the scores for each item are calculated and analyzed. At the end of this study, the most prioritized strategies will be used for the development of the program.The collected data will be analyzed by descriptive statistics methods and using SPSS20 statistical software.In this phase, the initial draft of the program will be developed based on the prioritized strategies. As such, the panel of experts will be used to reach the consensus of experts on the developed draft at this phase. This phase will aim to determine the opinion of experts on the structure and applicability of the program and is performed as a group discussion among experts. In this panel, reproductive health specialists, social injury specialists, psychiatrists, health promotion professionals, and health policymakers and planners are invited, and the draft of the program together with the purpose of the session will be sent to them. Then, the comments expressed in the session, after being approved by all experts, will be used to modify the program.Vulnerable adolescents are one of the social groups that, because of being affected by poverty, addiction, disability, ethnic and gender discrimination, AIDS, exposure to violence or physical, sexual and psychological abuse by peers or adults in the family, school, or society, child marriage and girl circumcision are more at risk than other adolescents . Various


The School Fruit and Vegetables Scheme (SFVS) implemented by the European Union in 2009/2010 aims to improve the diet of students and to support agricultural markets and environmental sustainability. The objective of this study was to identify the characteristics of the School Fruit and Vegetables Scheme implementation from 2009 to 2017 in Spain and its autonomous communities. A descriptive, longitudinal, observational, and retrospective study was carried out on the basis of document analysis of SFVS reports. We studied the average budget for Spain and its autonomous communities (AC), the number of students enrolled, the cost of the SFVS by student and by day, the duration of the SFVS, the quantity of fruits and vegetables (FV) per student and day (g), the variety of FV, the recommendation to include local, seasonal, and organic foods, and the educational activities (EA). The results were studied by the AC which are territorial entities of Spain. The budget almost doubled during the study, thanks mainly to EU funds. However, the number of students increased only from 18% in 2009 to 20% in 2016. The quantity of FV increased from 2579 to 4000 tons, and the duration of the SFVS increased from 9.8 to 19.6 days. In the AC, there were variations in EA, in the number of enrolled students (7.4% to 45.6%), in the cost per student (from €2.3 to €28), and in the duration in days (5.6 to 70 days). The recommendation to include local, seasonal, and organic foods was implemented in five of the eight years studied. The development and scope of the SFVS in Spain are still insufficient to generate an equitable healthy dietary pattern in the school population. However, the SFVS has generated an economic market for agricultural production due to the amount of FV distributed in each academic course. The low intake of fruits and vegetables (FV) is an important risk factor for the development of non-transmissible diseases ,2. PromoFrom this perspective, the European Commission (EC) recognizes the importance of developing a plan to promote the consumption of fruit and vegetables in schools, supported by the EU   which are administrative-territorial entities. For these reasons, the SFVS is carried out at the regional level, although the competent national authority establishes a common framework. Therefore, AC establish, in their respective regional strategies, how and when to distribute the produce. The EC considers the distribution of produce at mealtimes (school canteen) not to be appropriate for three fundamental reasons: control difficulties, inaccessibility of some students to the school canteen, and the possibility of replacing the item with other menu options ,6. The SFVS receives funding from the European Commission, central government, regional governments (autonomous communities) and, in some cases, private companies . The budFor SFVS implementation, authorization requests are solicited annually in accordance with the conditions established by the competent authority of the autonomous community. The State can select schools that meet specific conditions .Following the international recommendations for promoting a healthy diet ,9, the SCurrently, in Spain, the SFVS is being carried out in different AC in a coordinated way between the Ministry of Agriculture, Fishing, and Food (MAPA), the Ministry of Health, Social Services, and Equality, and the Ministry of Education, Culture, and Sports . HoweverWe carried out a descriptive, longitudinal, observational, and retrospective study nationally based on secondary sources. Sources included all the annual SFVS plans in Spain from 2009/2010 to 2016/2017, available on the webpage of MAPA ,19,20.n), duration of the SFVS (days), quantity of FV included (t), varieties of FV (n), recommendation of local foods , seasonal foods  and organic foods , and education activities.The following variables were extracted from the reports consulted and were calculated by academic course (school time period between September and June) and AC: European and state budget (€), number of students enrolled , the cost of the SFVS per student and per day (€), the duration of the SFVS (days), the quantity per student (kg), the quantity per student and day (g), and the variety of FV (n). Also, we studied the correlation between cost per student and recommendation of local, seasonal, and organic foods. In order to calculate the average number of students enrolled, the average cost per student, and the average quantity of FV per student, the values were weighted by the number of students enrolled in the SFVS in each studied autonomous community. To calculate the percentage of students covered by the SFVS, we used the target group of students enrolled in each AC between 3 and 18 years of age, as indicated in the regulations [For each AC and academic course, we calculated the average budget financed by the EU and by state , the number of students enrolled in the SFVS  Playful educational activities ; (2) Didactic material ; (3) Visits to the field and/or to farms, fruit and vegetable producers, and marketers of FV; (4) Training sessions ; (5) Cooking workshops ; (6) School gardens that included agricultural workshops and gardening sessions. The number of times each of them was present in the SFVS was counted by the autonomous community and academic course, and the first year of incorporation was identified.Finally, The purpose of this study was to identify the characteristics of the School Fruit and Vegetables Scheme implementation from 2009 to 2017 in Spain and its autonomous communities. The majority of the AC participated in the different editions of the SFVS organizing the distribution of FV along with various educational activities. Although the SFVS had increasing coverage in terms of the students, its scope was limited. In addition, the implementation of the SFVS in each of the AC was very heterogeneous. The SFVS received more and more financial support from the European Union for its implementation, while funding at the state level was progressively reduced. Even so, the quantities of fruits and vegetables provided in the SFVS increased. This, together with the incorporation of local, seasonal, and organic foods in some autonomous regions is in accordance with the strategies to promote a healthy diet and a more sustainable food system.The participation of a large proportion of the autonomous communities in the different editions of the SFVS shows their interest in incorporating the international recommendations in their educational offerings to promote the consumption of fruits and vegetables among the student population. Specifically, childhood is the ideal time to establish healthy eating behaviors, since these will probably persist in adult life ,24,25.The availability of fruits and vegetables in the school environment seems to encourage consumption among children ,27,28, wFurthermore, the distribution of fruits and vegetables alone is not sufficient to establish a healthy eating pattern ,32,33,34However, a large number of theory-based training activities  that are being developed may limit the scope of the educational objectives of the SFVS, given that they emphasize the conceptual objectives of the SFVS more than changing attitudes or procedures. In fact, previous studies show that with recreational–educational activities and cooking workshops, better results are achieved ,36,37,38Furthermore, the heterogeneous development of the SFVS in the autonomous communities observed in the variables studied suggests unequal access to the program for the students according to their place of residence. This could lead to greater inequality in health, especially in families with low incomes and difficulties in accessing adequate food supplies ,29,30. TThe progressive increase in the quantities of fruits and vegetables provided in schools can favor the development of agricultural markets. That is why institutional buying creates a new market for family farmers. Prioritizing the purchase of local, seasonal, and organic foods would contribute to a more sustainable food system ,45. In aWhen interpreting these results, we must remember that the information used came from the annual reports of the SFVS, prepared by the strategy managers in each AC. This can result in certain limitations due to the use of secondary data; as such, we do not have de control of the collection of these data. Also, we have no information on which schools implemented better the SFVS in each AC. However, the reports present the information in a homogeneous way for the different academic courses studied, which allowed us to explore how the SFVS is implemented in Spain. On the other hand, although this study focuses on a single country (Spain), which makes it difficult to extrapolate and generalize the results, the proposed methodology allowed us the describe some characteristics of the implementation and evolution of the SFVS. However, we do not have information about whether the availability of FV was equal in all schools which adhered to the SFVS. This is the first study to explore the scope of the SFVS. Given that the SFVS is an EU strategy, this study can contribute to decision-making to strengthen or introduce changes in the SFVS.The development and scope of the SFVS in Spain are still insufficient to generate an equitable healthy dietary pattern for the students. The SFVS covers a limited percentage of the target group of students and is carried out heterogeneously in the different autonomous communities. This finding is contradictory to the purpose of the SFVS, that is, to improve the dietary pattern of students regardless of their geographic and socioeconomic status. Also, the continuity of the program depends largely on the funds that come from the EU. However, the SFVS has generated a consumer market for agricultural production. This information is related to the fact that, according to the data presented, thanks to the SFVS, a great amount of FV is being distributed. Before the implementation of the SFVS, these quantities were not acquired by schools. Taking into account the potential of the SFVS to improve children’s food consumption in line with sustainable development objectives, it is important to guarantee its implementation. Increasing the Spanish portion of the budget and promoting synergies among the agents involved could improve the coverage and duration of the SFVS, which would help promote sustainable food systems.


On July 6, 2018, at the age of 92, Professor Kimishige Ishizaka has died. Prof. Ishizaka, known as Kimi from his friends and colleagues, together with his wife Teruko, known as Terry, discovered IgE antibodies in 1966. Kimi Ishizaka was born on December 3, 1925, graduated in Medicine in 1948 and obtained his Ph.D. in 1954 at the University of Tokyo, quickly became Chief of the Department of Serology at the National Institute of Health in Japan. From 1957 to 1959 he was a Research Fellow at the California Institute of Technology (CALTECH) in Pasadena under the enlightened guidance of Prof. Dan H. Campbell. From 1962 to 1970 he was Chief of the Department of Immunology at the Children’s Asthma Research Institute at the University of Colorado Medical School. This last period was of fundamental importance in the scientific career of Kimi and Terry Ishizaka who, in 1966, using a series of sophisticated techniques, showed unequivocally the existence in the serum of allergic patients of a new class of immunoglobulins, which was named IgE, later recognized by the WHO. This extraordinary discovery has allowed the development of modern Allergology.The move of the Ishizakas in 1970 to Johns Hopkins University in Baltimore marked a turning point in their scientific evolution. For almost 30 years an unrepeatable scientific collaboration was realized between the Ishizakas, Basic Immunologists, and the group of Philip Norman and Lawrence M. Lichtenstein, Clinical Immunologists and Allergists. This fantastic scientific interaction was also possible thanks to the proximity of the Divisions of Basic Immunology and Clinical Immunology at the Good Samaritan Hospital of Johns Hopkins University. In that location from 1976 to 1980 I had the fortunate opportunity to meet almost daily Kimi and Terry Ishizaka, to be able to enjoy their precious suggestions and their always constructive criticism and to establish a friendly relationship. In the following years, a number of Italian researchers from different Universities had the opportunity to meet the Ishizakas in Baltimore, to attend their seminars and to interact with their almost always extraordinary collaborators. Among these, it is sufficient to mention Tomio Tada, the discoverer of T suppressor lymphocytes and Tadamitsu Kishimoto, the discoverer of IL-6 and its receptor. Among the few non-Japanese I remember Thomas Platts-Mills, the discoverer of the Dermatophagoides antigens and a member of the Royal Society of London.In 1989, Ishizakas moved to the West Coast and Kimi became first Scientific Director, later President and finally President Emeritus of La Jolla Institute for Allergy and Immunology, one of the most qualified research centers in the world in the field of Immunology.The scientific production of Kimishige Ishizaka is monumental and of the highest level. He will be remembered among the Masters of Immunology for the discovery of IgE and for having elegantly elucidated their role in allergic reactions. For these discoveries, Kimi Ishizaka has received countless and prestigious scientific prizes including the Paul Ehrlich Award, the Emperor Award, the American College of Physicians Award and the First Order of Merit of the Sacred Treasure. Many distinguished Immunologists believe that he deserved to receive Stockholm’s honor for his discovery which revolutionized not only the pathophysiology, but also the immunological therapies of allergic diseases. The latest publication of Prof. Kimishige Ishizaka, entitled “The Way We Walked with Immunology” , summarizes his extraordinary scientific journey that places him among the giants of modern Immunology.Collegium Internationale Allergologicum. In this role, he honored our country by choosing Sorrento (October 1982) as the site of the X Collegium Internationale Allergologicum, which I had the honor of organizing, under his friendly supervision, together with the late Professors Mario Condorelli and Mario Ricci.Prof. Ishizaka has been President of prestigious Scientific Societies such as the American Academy of Allergy and Clinical Immunology, the American Society of Immunology and the Gianni MaronePast-PresidentCollegium Internationale Allergologicum


Following publication of this  article,As stated in the article, the authors received approval from the University of Arkansas for Medical Sciences (UAMS) Institutional Review Board (UAMS IRB 2010 approved protocol #130212) where patients were recruited, consented, and participated. However, analysis of the specimens occurred, in part, at CAVHS. The specimens were not de-identified, and thus required approval from the CAVHS IRB prior to initiating this work. The authors explained that they were unaware of the requirements at the time. The CAVHS Chief of Staff and IRB agreed that the investigators had received inadequate education about the ethics approval requirements, and both the study and the program were determined to be non-compliant.PLOS ONE Editors retract this article.Owing to lack of required IRB oversight for the research reported in this article, the All authors did not agree with retraction.


Describe the sampling design and other methodological aspects of the Study of Chronic Diseases (Edoc).Edoc comprises two household surveys with distinct populations, one with adults aged 18 to 59 years (Edoc-A) and another with older adults aged 60 years or more (Edoc-I), living in Rio Branco, Acre. The selection of the participants used complex samples by clusters in two stages of selection, census enumeration areas (CEA) and household. In the first stage, common to both surveys, 40 CEAs were selected with probability proportional to size, and in the second stage, independent for each survey, households were selected with equal probability, and all the residents eligible for each survey were selected. Sampling weights were estimated by the inverse of the product of inclusion probabilities at each stage and then calibrated to produce unbiased population estimates. Interviews were held with questionnaires about socioeconomic and demographic conditions, life habits and health conditions. Anthropometric measures focused on measures of body height, girths and mass, while the vital signs analyzed were blood pressure, heart rate and respiratory rate. Blood and urine samples were collected for analysis.The Edoc comprised 1,701 participants, 685 of Edoc-A and 1,016 of Edoc-I. Considering the loss of information of some participants and the need of studying specific themes with production of population inferences, 16 subsamples of complete information by theme were generated and two subsamples were exclusive of Edoc-I.The Edoc has as important developments the analyses of epidemiological profile of the population from the capital of the state of Acre, contributing to the production of knowledge in public health with useful information for decisions in public health policies. This article aims to document the methods applied in the Study of Chronic Diseases (Edoc) in Rio Branco, state of Acre. This study is composed of two household surveys: one with adults, named Edoc-A, and another with older adults, Edoc-I.Although distinct and independent, these two surveys shared some objectives and methods. This survey aimed to analyze prevalence and factors associated with health problems in adults and older people from Rio Branco, state of Acre. To do so, data about the characteristics of the household were collected in both surveys, such as socioeconomic and demographic conditions, exposure to substances and heavy metals, food and life habits, health conditions. Anthropometry was conducted, and biological material was collected. In the specific case of Edoc-I, data about the functional autonomy and depression were obtained. The samples were collected and selected in two stages (census enumeration area and household), with the first selection stage being common to both surveys.Another important point is that both surveys have distinct and mutually exclusive populations, which allows estimating data for the union of populations and shaping the data of both surveys in an integrated manner.This study describes the survey populations, sampling design, instruments used, training and pilot test, procedure of data collection, data entry and information consistency editing, in addition to setting up the database and the files by theme.The project regarding both surveys was approved by the Research Ethics Committee of the Federal University of Acre, under the Certificate of Ethical Assessment (CAAE) 17543013.0.0000.5010, and all the participants signed the informed consent form.The city of Rio Branco is crossed by the Acre River, which gives its name to the state and divides it into two districts. On July 31, 2010, the state had a population of 336,038 inhabitants, 96,276 households and 338 census enumeration areas (CEAs), which were defined by IBGE for 2010 Population Census (CD2010). Rio Branco was the sixth largest city in the North regionThe survey population of Edoc-A comprises the residents aged 18 to 59 years, while Edoc-I comprises the residents aged 60 years or more. According to CD2010, Rio Branco had 204,094 adult inhabitants and 14,480 older people. Individuals with compromises that hindered communication or the understanding of the questions were excluded from both research populations, as well as pregnant women.Thus, the union of both surveys defines the total survey population of Edoc, i.e. the set of residents aged 18 years or more in the city of Rio Branco.Both surveys used cluster sampling plans in two stages. In the first stage, CEAs with probability proportional to the number of households observed in CD2010 were selected. In the second stage, the households were selected systematically with equal probability for each survey.AAS) needed to estimate a prevalence P with absolute error d and confidence level 1-α is given by:According to CochranHowever, the research did not use SRS, but the sampling plan described earlier. To consider the effects of this sampling design in sample size, Pessoa and SilvaThe sample size of Edoc-A was determined by assuming a prevalence of 15% in kidney function alteration among adults (18 to 59 years)The sample size of Edoc-I was estimated using a prevalence of 40% in kidney function alteration among older adultsBefore determining the number of households and CEAs to be selected, the size of the samples were increased to compensate for possible nonresponses, assuming 20% of loss for adults and 12.5% for older adults, who are more easily found in households and tend to refuse to participate less than adults. Thus, samples of adults and seniors went from 652 and 1,148, respectively, totaling 1,800 people being interviewed in both surveys.Then, using the mean of adults (1.482) and older people per household (0.394) in the city, we noted that it was necessary to select 440 and 2,914 households to achieve the sample sizes for adults and seniors, respectively. Once such numbers were fixed, we defined the selection of 40 CEAs, the same for both surveys.i/11 and HHi/73, where HHi is the number of households in CEA i. Thus, although the household selections are independent, a same household could be selected for both surveys. In the selected households, all eligible residents were interviewed. Therefore, there was no selection of residents in households. The The CEAs were selected with probability proportional to size (PPS), to deal with different in cluster sizes. Eleven households were selected, by systematic sampling, for Edoc-A and 73 households for Edoc-I, independently, with interval selection equal to HHThe However, as occurs in all household surveys, there may be nonresponses and biases in the distribution of population by sex and age. The solution usually adopted has been the calibration of sampling weightsThe variables used in the calibration were sex and age group . The population totals used in the calibration of weights by sex and age group was estimated for July 1, 2014 , using the linear trend methodThe comparison of sizes of both samples demonstrates that the loss rate of 20% for the sample of Edoc-A was overestimated , while the loss rate for Edoc-I was well estimated . Additionally, the initial weight leads to an underestimate of 22.1% of the population size, composed by an underestimate of 29.3% for adults and by an overestimate of 43.1% for older adults. In addition, the analysis by sex confirms what is known in sampling as availability bias: women tend to be more available at home to be interviewed, both among adults and older people.However, it was not always possible to obtain all the information about everyone. Thus, nonresponses were observed in different degrees according to the theme. A possibility to handle that would be to adopt a mechanism of probabilistic imputation, which would generate a file with all the information. However, considering the sampling size and the difficulty of ascribing results of laboratory tests or physical assessment, we decided to give a treatment similar to that adopted in the Study of Cardiovascular Risks in Adolescents (Erica), which designed different databases with the variables required for each analysis theme and the set of records with the complete information. Thus, the calibration of weights in each thematic database was used to treat nonresponses and correct possible biases in the calibration variablesSeventeen databases were created, one for the set of interviews (which includes specific nonresponses) and 16 for the subsamples of complete information about each theme. For Edoc-A, fourteen files of complete subsamples were created, which were given the following names: albumin, alcohol, waist circumference, cholesterol, creatinine, diabetes, dyslipidemia, hand grip strength, hemoglobin, hypertension, obesity, metabolic syndrome, smoking and triglycerides. In the case of Edoc-I, two other themes were the subject of exclusive research: functional autonomy and depression.Three semi-structured questionnaires were used for the interviews: 1) household, containing information of family, housing, sanitation and the Socioeconomic ClassificationThe socioeconomic and demographic information included data on place of birth, age, sex, skin color or ethnicity, educational level, marital status, work and occupation. Occupational exposure data included information on toxic agents, route and exposure time.Data on life habits, such as smoking and alcoholism, were the report of daily and occasional consumption, performed before the survey. To collect information on physical activity while commuting to work or school, at work, at home and during leisure time, we used the questions employed in the study of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey in 2013Still in the module of behavioral information, we used the Quantitative Food Frequency Questionnaire, previously validatedIn the module about health, the questions dealt with history of first-degree relatives for cardiovascular, renal and metabolic morbidities. Questions about self-assessment of health, self-reported morbidities, pain and complaints of the physical state and about the perception of stress were also included. Information about the current use of medication, dose and frequency, through presentation of a prescription or packaging of the product was also obtained, as well as long-term use, for one month or more, of antihypertensive medications, insulin, anti-diabetic medication, antibiotics, non-steroidal anti-inflammatory medications, antidepressant/anti-anxiety drugs and immunosuppressants. The use and evaluation of health services were also investigated.To assess the quality of life, the quality of life questionnaire of the World Health Organization (WHO) was applied, the WHOQOL-BrefAdditionally, to investigate the functional autonomy among older adults, the Activities of Daily Living scale (ADL) was employed, modified by KatzThe anthropometric data included the measurement of weight, height and waist circumferences, hip, arm and calf, following the protocols recommended by the American College of Sports Medicine (ACSM)2), subsequently categorized, as well as the waist circumference, according to WHO criteriaThe body mass index (BMI) was estimated by dividing the weight (kg) by the square of height , determined in accordance with the protocol recommended by the Brazilian Society of CardiologyThe biological material used included blood and urine samples. The blood samples were obtained by peripheral blood collection, with prior antisepsis of the cubital fossa of the participants. Part of the sample taken, 4 ml, was packed in vacuum test tube without anticoagulant and centrifuged at 1,500 rpm for 15 minutes. The serum extracted was stored for biochemical dosage of triglycerides, total cholesterol and fractions: high-density lipoprotein (HDL), low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL).Total cholesterol was dosed by colorimetric enzymatic method COD/PAD, in the same way as fractions  and triglycerides GPO/PAP (Labtest Diagnóstica). LDL was obtained from VLDL by hydrolysis of different lipolytic enzymes.Four ml of whole blood was packed in a vacuum tube containing 2 mg/ml of ethylenediaminetetraacetic acid (EDTA) for hematological and serum creatinine analysis. The serum creatinine was dosed by traceable enzymatic method of isotope dilution mass spectrometry (IDMS) in an automatic analyzer (Labmax 240 Premium).The complete blood count was performed by electronic cell counting. The differential leukocyte count was performed by microscopic analysis of 200 cells in a blood distension stained by the Romanowsky method.For the analysis of serum glycemia, a 4 ml blood sample was used and stored in vacuum tube containing 2 mg/ml sodium fluoride, being centrifuged before analysis. The dosage used the glucose oxidase method (Labtest Diagnóstica).For urine samples, approximately 50 ml of the midstream of the first morning urine of each individual were collected. The samples were placed in standard bottles and transported from the collection site to the lab for analysis in controlled temperature. They were processed by physicochemical and microscopic analysis of the sediment. Some of it was centrifuged, and the supernatant was removed for biochemical analysis of albuminuria concentrations.® (Labtest Diagnóstica), reacting with a specific antibody.For the urine test type I (ASE), physical, chemical and microscopic analyses were conducted. The amount of albumin and urinary creatinine was determined by turbidimetric analysis POP Kit LabtestThe analyses of biological material were performed in the same laboratory to ensure standardization of procedures.All data collection procedures were performed by qualified personnel, trained and supervised by the coordination of the study. The team of interviewers was composed by students or health professionals who participated in a preparatory course promoted by the coordination to understand the role, function and importance of the interviewer in scientific research, in addition to the familiarity, understanding and application of the instruments. To standardize the interviews, a manual for study and activities basis was prepared.The team responsible for the physical assessment, vital signs and collection of biological samples, named the health team, was composed of health professionals: nurses, physical education professional, nursing and laboratory technicians. All professionals were previously trained in order to understand and standardize the procedures adopted.A pilot study was conducted in a CEA not included in the sample. During mapping, difficulties in locating addresses were corrected, being added the address information and references to the description and visual presentation of the household. Later, interviews were initiated, in which participants were asked to comment on the difficulties in understanding the questions and assess the interviewer and the health team.For quality control of information, the interviews were reconducted, as well as the physical assessments in 20 adults and 30 older people assessed in the pilot study.The mapping of the selected CEA respected the geographical limits and beginning and end established by IBGE, with the election of households always starting by the right limit of each CEA. With the total number of households in each CEA, a calculation was carried out for setting the number of households to be skipped from the first CEA. The households eligible to interview adults, older people or both were indicated in detailed addresses and image in the spreadsheet used by the team of interviewers.The definition of household adopted was the place structurally separate and independent that is intended to be a dwelling for one or more people or that is being used as such. We selected only private households characterized as residences where the relationship was dictated by ties of kinship, domestic dependency or by living standards, such as houses, apartments and dwelling units in single-room houses or tenementsWith the address lists, the trained professionals interviewed all of the people eligible for the study that lived there. In closed households or in the absence of eligible resident, the team returned up to three times to the local, in different periods, for data collection; when they were not successful, the loss was characterized, without replacement of households. At the end of the interview, a date for the collection of blood and urine and for the physical assessment was scheduled. At that time, guidelines were given on the procedures for the collection of biological samples, as well as for the physical assessment: 12-hour fast for blood collection; collection of the first morning urine, disregarding the first part of the flow and after personal hygiene, in individual bottle available and identified by the interviewers; and use of light clothes, preferably shorts or skirt and shirt, for the physical assessment.Data were collected from April to September 2014. Before the assessments, research professionals had to come forward with official identity document with photo. In the previously defined date and time , the team previously trained performed physical assessments and collected blood and urine samples.The results of laboratory tests and physical assessment, upon examination by authorized health professional, were delivered to the participants. In case of alterations, the research team scheduled the appointment with a medical professional in the health unit of reference to the neighborhood. For the schedule of appointments in public health units, partnerships with health departments in the state of Acre and in the city of Rio Branco were conducted.® program, version 3.5.2.The questionnaires and evaluations were reviewed and coded simultaneously to data collection. The information was coded in featured next to the original question, for easier typing, being subsequently held dual independent typing in Microsoft Office Access, with the adoption of filters to avoid typos. The database was compared and corrected using EpiInfoThe inconsistencies observed were corrected by reviewing the original instruments , without imputation of data.


To explore the safety of the essential medicines recorded in China's list through the comparison of the list of essential medicines of China and the World Health Organization (WHO), as well as the analysis of the basic situation and characteristics of adverse drug reactions (ADRs) on the two essential medicines recorded in China's and WHO lists in order to provide a reference for the improvement of China's list. A retrospective descriptive study was conducted, based on the database in Jiangsu Province ADR Monitoring Center from 2013 to 2015. A total of 266869 cases reports were collected within this period, comparing the differences between the two essential medicines recorded in China's and WHO lists, considering number of ADRs, type of report, and modes of administration. Compare the differences between the two groups of drugs in the presence of new, severe, and new severe adverse events using chi square test. Comparing the two essential medicines list, they have the same 117 species. When comparing ADRs in the two groups, most are antimicrobial, electrolytes, and acid-base balance drugs, regulate water, and are higher in China. In addition, with respect to the number of ADR types in the two groups, there is statistical significance (p<0.001) . Compared to the WHO list of essential drugs, China's list is still to be improved. Essential medicines satisfy people's desire for health; they are selected through cost-effectiveness comparison and according to the current situation, effectiveness, and safety of public health , 2. The Although many reports which used the ADR database to advance the safety of drugs have been published , 6, therChina's national essential medicines list (2015 edition) and WHO model list of essential medicines (19th edition) were obtained from the ministry of health website. Using the database of Jiangsu Province ADR Monitoring Center from 2013 to 2015 to perform a retrospective study, we analyze the differences between the two essential medicines recorded in China's and WHO lists with ADR by the number, type of report, and the way of administration. Analyses employed descriptive statistics and chi square test.There are 373 essential medicines recorded in WHO and 301 in China. The same species are 117. A total of 266869 cases of ADR were discharged within this period, with 76282 cases occurring in essential medicines recorded in China and 48310 cases in WHO. Among them, the most ADR are all anti-infective adjust water, electrolyte, and acid-base balance medicines. The second are respiratory medicines, medicines for pain and palliative care, and gastrointestinal medicines. The number of ADRs of these medicines in China's list is significantly higher than that in WHO .It is presents the characteristics of the type of ADR discharged in the two essential medicines list . CompariIt is illustrate that oral, intravenous drip, external use, local, Yin/intestinal administration, and inhalation are the main modes of administration for adverse reactions to essential medicines recorded in China and WHO list . Also itIn recent years, the ADR reporting systems have been providing a basis for drug safety evaluation. There are authors who showed the necessity and feasibility of using big data to study the research on active monitoring of drugs , 11. AccTherefore, exploring the safety of the drugs recorded in China's essential medicines list based on a large sample is necessary. The results showed that the number of ADRs in China's list was much higher than that of the WHO.It is necessary to discuss the safety of the drugs recorded in China's essential medicines list based on the large sample data. The results showed that the number of ADRs in China's list was much higher than that of the WHO. Among them, anti-infective medicine and regulating water, electrolyte, and acid-base balance drugs have the most ADR  and ChinIn addition, comparing from the type of report , they haIn administration, our study shows that oral and intravenous drips have the highest proportion, in the two essential medicines lists. The other modes of administration have a lower ratio. The reason may be due to injection and injection of sterile powder compared with other medication, endotoxin, pH, osmotic pressure, and particles and other internal factors are more likely to lead to ADR in injection . Oral adTherefore, we should pay close attention to the patient's complaints and first-line clinical feedback of adverse reactions. For the revision of China's essential medicines list, an updated drug manual provides the most stringent basis .


The economic value of family caregiving, by any measure, dwarfs actual expenditures on formal long-term services and supports (LTSS). This presentation discusses new estimates of the number of caregivers, intensity of caregiving, and the total economic value of family caregiving in 2017 in the United States, and in every state, the District of Columbia, Puerto Rico, and the Virgin Islands, based on a meta-analysis of recent nationally representative surveys of family caregivers. Previous analyses of this type have found that the total economic value of family caregiving has increased steadily from $350 billion in 2005 to $470 billion in 2013. State variation in the incidence, intensity, and economic value of caregiving will be discussed, and key predictors of this variation will be identified.


In the published article, there was an error in affiliation 1. Instead of Department of Medical Physics and Biomedical Engineering, School of Medicine, Shahid Beheshti Medical University, Tehran, Iran, it should be Department of Medical Physics and Biomedical Engineering, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way.The original article has been updated.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Brazil is experiencing one of the fastest rates of population aging worldwideLarge population-based longitudinal studies on aging have been conducted in various countries of the Americas, Europe, and Asia. These studies, known as the Health and Retirement Family of StudiesThe selection of topics covered in these articles was based on the three pillars of the policy framework for active aging of the World Health Organization, i.e., participation, health, and securityHigh levels of social inequality are found in the majority of topics investigated, with the poorest or those with lower educational level affected most. Inequalities are observed in physical activity,One of the goals of the Post-2015 Development Agenda, supported by 193 members states of the United Nations, is to ensure healthy lives and promote well-being for all at all ages