Παρασκευή 30 Ιουνίου 2017

Medicine A


15:57
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026
Obstructive sleep apnea in postmenopausal women: a comparative study using drug induced sleep endoscopy
 
Abstract Introduction: The key to successful treatment of OSAS is to individually tailor such treatment. Thus, it is very important to determine the severity of OSAS, its pattern, and the extent of collapse, by gender, age, and BMI. Objective: The objective of the study was to understand the characteristics...
15:57
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026
Comparison of microRNA profiles between benign and malignant salivary gland tumors in tissue, blood and saliva samples: a prospective, case-control study
 
Abstract Introduction: Salivary gland tumors (SGTs) are rare head and neck malignancies consisting of a spectrum of tumors with different biological behaviors. Objective: In this study we aimed to find out differential expression of microRNA profiles between benign and malignant SGTs. Methods: We investigated...
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026
The role of facial canal diameter in the pathogenesis and grade of Bell's palsy: a study by high resolution computed tomography
 
Abstract Introduction: The exact etiology of Bell's palsy still remains obscure. The only authenticated finding is inflammation and edema of the facial nerve leading to entrapment inside the facial canal. Objective: To identify if there is any relationship between the grade of Bell's palsy and diameter...
15:57
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026
Airway reconstruction: review of an approach to the advanced-stage laryngotracheal stenosis
 
Abstract Introduction: The management of laryngotracheal stenosis is complex and is influenced by multiple factors that can affect the ultimate outcome. Advanced lesions represent a special challenge to the treating surgeon to find the best remedying technique. Objective: To review the efficacy of our...
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026
Ophthalmic complications of endoscopic sinus surgery
 
Abstract Introduction: The proximity of the paranasal sinuses to the orbit and its contents allows the occurence of injuries in both primary or revision surgery. The majority of orbital complications are minor. The major complications are seen in 0.01-2.25% and some of them can be serious, leading to...
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026
LS CE-Chirp® vs. Click in the neuroaudiological diagnosis by ABR
 
Abstract Introduction: The chirp stimulus was developed seeking to counterbalance the delay of the sound wave on its journey through the cochlea, allowing the hair cells to depolarize at the same time. The result is a simultaneous stimulation providing better neural synchrony and, consequently, the recording...
15:57
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026
Ethics is the best professional policy
 
Abstract Introduction: The relationship between gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) is still a controversial issue in literature. Objective: A systematic review of the association between these two diseases in adult patients. Methods: Systematic review in PubMed and...
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026
Combined ocular and cervical vestibular evoked myogenic potential in individuals with vestibular hyporeflexia and in patients with Ménière's disease,
 
Abstract Introduction: The vestibular evoked myogenic potential is a potential of mean latency that measures the muscle response to auditory stimulation. This potential can be generated from the contraction of the sternocleidomastoid muscle and also from the contraction of extraocular muscles in response...
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026
Deep neck abscesses: study of 101 cases
 
Abstract Introduction: Although the incidence of Deep Cervical Abscess (DCA) has decreased mainly for the availability of antibiotics, this infection still occurs with considerable frequency and can be associated with high morbidity and mortality. Objective: This study aimed to present our clinical-surgical...
15:57
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026
Relation between chronic rhinosinusitis and gastroesophageal reflux in adults: systematic review
 
Abstract Introduction: The relationship between gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) is still a controversial issue in literature. Objective: A systematic review of the association between these two diseases in adult patients. Methods: Systematic review in PubMed and...
15:57
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026
Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base
 
Abstract Introduction: The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract...
15:57
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026
Vertebral artery dissection: an important differential diagnosis of vertigo
 
Abstract Introduction: The relationship between gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) is still a controversial issue in literature. Objective: A systematic review of the association between these two diseases in adult patients. Methods: Systematic review in PubMed and...
15:57
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026
First branchial cleft fistula: a difficult challenge
 
Abstract Introduction: The relationship between gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) is still a controversial issue in literature. Objective: A systematic review of the association between these two diseases in adult patients. Methods: Systematic review in PubMed and...
15:56
OtorhinolaryngologySfakianakis
Lower limb kinematics during the swing phase in patients with knee osteoarthritis measured using an inertial sensor
 
Publication date: September 2017Source:Gait & Posture, Volume 57 Author(s): Kenji Tanimoto, Makoto Takahashi, Kazuki Tokuda, Tomonori Sawada, Masaya Anan, Koichi Shinkoda BackgroundDuring gait, the swing limb requires flexible control to adapt to ever changing environmental circumstances. However,...
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OtoRhinoLaryngology by Alexandros G.Sfakianakis
Efficacy of a standardized extract of Matricariae chamomilla L., Melissa officinalis L. and tyndallized Lactobacillus acidophilus (HA122) in infantile colic: An open randomized controlled trial
 
Abstract Background Infant colic (IC) is a prevalent physiological event of infants, which can disrupt the child's home environment. We aimed to investigate the effectiveness of a mixture of Matricariae chamomilla L., Melissa officinalis L. and tyndallized Lactobacillus acidophilus (HA122) compared...
15:54
ΩΡΛ Ιατρικά Άρθρα απ' το Μελετητή
Scholar : The American Journal of Bioethics, Volume 17, Issue 7, July 2017 is now available online on Taylor & Francis Online
 
The online platform for Taylor & Francis Online content The American Journal of Bioethics, Volume 17, Issue 7, July 2017 is now available online on Taylor & Francis Online. This new issue contains the following articles: Guest Editorial Modernizing...
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Medicine by Sfakianakis Alexandros
Seeing the soil through the net: an eye-opener on the soil map of the Flemish region (Belgium)
 
A systematic soil survey of Belgium was conducted from 1948 to 1991. Field surveys were done at the detailed scale of 1:5000 with the final maps published at a 1:20,000 scale. The legend of these detailed soil maps (scale 1:20,000) has been converted to the 3rd edition of the international soil classification...
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Medicine by Sfakianakis Alexandros
Identification of candidate oncogenes and chromosomal breakpoint sequencing by targeted locus amplification in T-cell acute lymphoblastic leukemia
 
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Medicine by Sfakianakis Alexandros
Comparison between FLT3-ITD measurements based on RNA and DNA of childhood myeloid leukemia samples
 
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Medicine by Sfakianakis Alexandros
The long non-coding RNA H19 is regulated by LIN28B
 
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15:53
Medicine by Sfakianakis Alexandros
Morphology and spatial patterns of Macrotermes mounds in the SE Katanga, D.R. Congo
 
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15:53
Medicine by Sfakianakis Alexandros
Delineating the roles of lysine 27 methylation-associated epigenetic modulators in T cell leukemia
 
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15:51
Ιατρικά Άρθρα Αλέξανδρος Γ. Σφακιανάκης
Sporotrichosis: Update on Diagnostic Techniques
 
Abstract Purpose of Review Sporotrichosis, the disease caused by Sporothrix spp, ranges from subcutaneous infections to the severe disseminated or invasive diseases. The taxonomy of Sporothrix has been revised. The subcutaneous disease is suspected easily, but the extra-cutaneous disease is diagnosed...
15:50
Medicine Sfakianakis G. Alexandros
Toll like Receptor 2 engagement on CD4+ T cells promotes TH9 differentiation and function
 
We have recently demonstrated that mycobacterial ligands engage Toll like receptor 2 (TLR2) on CD4+ T cells and up-regulate T-cell receptor (TCR) triggered Th1 responses in vitro and in vivo. To better understand the role of T-cell expressed TLR2 on CD4+ T-cell differentiation and function, we conducted...
15:50
Medicine Sfakianakis G. Alexandros
Extracellular vesicles mediate intercellular communication: Transfer of functionally active microRNAs by microvesicles into phagocytes
 
Cell activation and apoptosis lead to the formation of extracellular vesicles (EVs) such as exosomes or microvesicles (MVs). EVs have been shown to modulate immune responses; recently, MVs were described to carry microRNA (miRNA) and a role for MVs in the pathogenesis of autoimmune diseases has been...
15:50
OtorhinolaryngologySfakianakis
Preparation and characterization of bioadhesive system containing hypericin for local photodynamic therapy
 
Publication date: Available online 29 June 2017Source:Photodiagnosis and Photodynamic Therapy Author(s): Fernanda Belincanta Borghi-Pangoni, Mariana Volpato Junqueira, Sabrina Barbosa de Souza Ferreira, Larissa Lachi Silva, Bruno Ribeiro Rabello, Lidiane Vizioli de Castro, Mauro Luciano Baesso, Andréa...
15:49
Cancer by Sfakianakis G.Alexandros
Dickkopf-4 is frequently overexpressed in epithelial ovarian carcinoma and promotes tumor invasion
 
Abstract Background Dickkopf-4 (DKK4), a member of DKK family, appears to be a divergent protein. It remained multi-biological functions in carcinogenesis. The effect of DKK4 on the ovarian cancer cells remains unclear. This study...
15:49
Cancer by Sfakianakis G.Alexandros
Optimizing the treatment of bevacizumab as first-line therapy for human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer: an updated meta-analysis of published randomized trials
 
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15:49
Cancer by Sfakianakis G.Alexandros
Clinical importance of serum HE4 and MMP2 levels in endometrial cancer patients
 
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15:49
Cancer by Sfakianakis G.Alexandros
Phase I dose-escalation study of long-acting pasireotide in patients with neuroendocrine tumors
 
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15:49
Cancer by Sfakianakis G.Alexandros
Patients harboring ALK rearrangement adenocarcinoma after acquired resistance to crizotinib and transformation to small-cell lung cancer: a case report
 
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15:49
Cancer by Sfakianakis G.Alexandros
RE: "RISK PREDICTION FOR EPITHELIAL OVARIAN CANCER IN 11 UNITED STATES–BASED CASE-CONTROL STUDIES: INCORPORATION OF EPIDEMIOLOGIC RISK FACTORS AND 17 CONFIRMED GENETIC LOCI"
 
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15:49
Cancer by Sfakianakis G.Alexandros
Protecting Confidentiality in Cancer Registry Data With Geographic Identifiers
 
AbstractThe National Cancer Institute's Surveillance, Epidemiology, and End Results Program releases research files of cancer registry data. These files include geographic information at the county level, but no finer. Access to finer geography, such as census tract identifiers, would enable richer analyses—for...
15:49
Cancer by Sfakianakis G.Alexandros
RE: "ASSOCIATIONS OF ACCELEROMETRY-ASSESSED AND SELF-REPORTED PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOR WITH ALL-CAUSE AND CARDIOVASCULAR MORTALITY AMONG US ADULTS"
 
In the article "Associations of Accelerometry-Assessed and Self-Reported Physical Activity and Sedentary Behavior With All-Cause and Cardiovascular Mortality Among US Adults" by Evenson et al. (1), the units of measure for screen time were incorrectly listed as hours/week and MET-hours/week in Tables...
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Cancer by Sfakianakis G.Alexandros
Skin Pigmentation and Risk of Hearing Loss in Women
 
AbstractBlack individuals have a lower risk of hearing loss than do whites, possibly because of differences in cochlear melanocytes. Previous studies have suggested that darker-skinned individuals tend to have more inner ear melanin, and cochlear melanocytes are important in generating the endocochlear...
15:49
Cancer by Sfakianakis G.Alexandros
RE: "MULTI-SITE CLINICAL ASSESSMENT OF MYALGIC ENCEPHALOMYELITIS/CHRONIC FATIGUE SYNDROME (MCAM): DESIGN AND IMPLEMENTATION OF A PROSPECTIVE/RETROSPECTIVE ROLLING COHORT STUDY"
 
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15:49
Cancer by Sfakianakis G.Alexandros
Association Between Serum Tumor Necrosis Factor Receptor 1 and Trajectories of Functional Status The Northern Manhattan Study
 
AbstractWe hypothesized that tumor necrosis factor receptor 1 (TNFR1) levels are associated with long-term trajectories of functional status independently of vascular risk factors and the occurrence of stroke and myocardial infarction (MI) during follow-up. In the Northern Manhattan Study, stroke-free...
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Cancer by Sfakianakis G.Alexandros
Cigarette Smoking and Risk of Incident Rosacea in Women
 
AbstractThe relationship between smoking and rosacea is poorly understood. We aimed to conduct the first cohort study to determine the association between smoking and risk of incident rosacea. We included 95,809 women from Nurses' Health Study II (1991–2005). Information on smoking was collected biennially...
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Cancer by Sfakianakis G.Alexandros
Modeling Seasonal and Spatiotemporal Variation: The Example of Respiratory Prescribing
 
AbstractMany measures of chronic diseases, including respiratory disease, exhibit seasonal variation together with residual correlation between consecutive time periods and neighboring areas. We demonstrate a strategy for modeling data that exhibit both seasonal trend and spatiotemporal correlation,...
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Cancer by Sfakianakis G.Alexandros
Time-Dependent Associations Between Body Composition, Physical Activity, and Current Asthma in Women: A Marginal Structural Modeling Analysis
 
AbstractThe role of obesity in adult asthma is well-known and has been partly attributed to a confounding role of physical inactivity. However, the interrelationships between obesity, physical activity, and asthma have been incompletely addressed, probably because their time-dependent and bidirectional...
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Cancer by Sfakianakis G.Alexandros
Original Findings and Updated Meta-Analysis for the Association Between Maternal Diabetes and Risk for Congenital Heart Disease Phenotypes
 
AbstractMaternal diabetes is associated with congenital heart defects (CHDs) as a group, but few studies have assessed risk for specific CHD phenotypes. We analyzed these relationships using data from the Texas Birth Defects Registry and statewide vital records for deliveries taking place in 1999–2009...
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Cancer by Sfakianakis G.Alexandros
RE: "RESPONSE AND FOLLOW-UP BIAS IN COHORT STUDIES"
 
In the article "Response and Follow-up Bias in Cohort Studies" by Greenland (1), there is a missing decimal point in the first footnote of Table 3. The risk ratio of 70 should be 0.70. from Cancer via xlomafota13 on Inoreader http://ift.tt/2trLoQR via IFTTT
15:47
OtoRhinoLaryngology - Head and Neck Surgery
Neuropsychiatry phenotype in asthma: Psychological stress-induced alterations of the neuroendocrine-immune system in allergic airway inflammation
 
Publication date: Available online 29 June 2017Source:Allergology International Author(s): Isao OhnoSince the recognition of asthma as a syndrome with complex pathophysiological signs and symptoms, recent research has sought to classify asthma phenotypes based on its clinical and molecular pathological...
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OtoRhinoLaryngology - Head and Neck Surgery
CME Activities Calendar
 
▪ AAAAI QCDR for Practice Improvement 2017http://ift.tt/2t8oxr3
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OtoRhinoLaryngology - Head and Neck Surgery
Cover 1
 
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OtoRhinoLaryngology - Head and Neck Surgery
News & Notes
 
Are you seeking additional training in the causes and mechanisms of atopic and contact dermatitis? Need to enhance your overall hands-on skills to accurately apply patch tests and interpret the results? Mark your calendar for the new, live course "Eczema and Contact Dermatitis in the Allergy/Immunology...
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OtoRhinoLaryngology - Head and Neck Surgery
Brief Overview of This Month's JACI
 
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OtoRhinoLaryngology - Head and Neck Surgery
News Beyond Our Pages
 
Infection with respiratory syncytial virus (RSV) during infancy has been linked to increased risk for later onset of asthma. Additionally, prophylactic use within the first year of life of palivizumab, an mAb directed against the RSV fusion glycoprotein, protects against chronic wheezing through the...
15:47
OtoRhinoLaryngology - Head and Neck Surgery
An exposome perspective: Early-life events and immune development in a changing world
 
Advances in metagenomics, proteomics, metabolomics, and systems biology are providing a new emphasis in research; interdisciplinary work suggests that personalized medicine is on the horizon. These advances are illuminating sophisticated interactions between human-associated microbes and the immune system....
15:47
OtoRhinoLaryngology - Head and Neck Surgery
The environment, epigenome, and asthma
 
Asthma prevalence has been on the increase, especially in North America compared with other continents. However, the prevalence of asthma differs worldwide, and in many countries the prevalence is stable or decreasing. This highlights the influence of environmental exposures, such as allergens, air pollution,...
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OtoRhinoLaryngology - Head and Neck Surgery
Environmental determinants of allergy and asthma in early life
 
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OtoRhinoLaryngology - Head and Neck Surgery
The Editors' Choice
 
Perturbations or "dysbiosis" of the bronchial microbiota have been implicated in the pathogenesis of asthma. However, it remains unclear whether reported differences are reflective of atopy, a common comorbidity of asthma. In a National Heart, Lung, and Blood Institute AsthmaNet study of well-characterized...
15:47
OtoRhinoLaryngology - Head and Neck Surgery
The Journal of Allergy and Clinical Immunology: An update on style and substance
 
Our stewardship of the Journal of Allergy and Clinical Immunology (JACI) is now in its sophomore year.1 In this short time, we have had the privilege of working with our authors and readers and have endeavored to respond to your concerns and suggestions. We have instituted several changes in our quest...
15:47
OtoRhinoLaryngology - Head and Neck Surgery
Information for Readers
 
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15:47
OtoRhinoLaryngology - Head and Neck Surgery
Correction
 
With regard to the article in the July 2016 issue entitled "Diminution of signal transducer and activator of transcription 3 signaling inhibits vascular permeability and anaphylaxis" (J Allergy Clin Immunol 2016;138:187-99), it has been brought to the Editors' attention that Fig 1 was incorrect as printed....
15:47
OtoRhinoLaryngology - Head and Neck Surgery
Table of Contents
 
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OtoRhinoLaryngology - Head and Neck Surgery
Editorial Board
 
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15:46
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174
Cells, Vol. 6, Pages 17: Standard Immunohistochemical Assays to Assess Autophagy in Mammalian Tissue
 
Autophagy is a highly conserved lysosomal degradation pathway with major impact on diverse human pathologies. Despite the development of different methodologies to detect autophagy both in vitro and in vivo, monitoring autophagy in tissue via immunohistochemical techniques is hampered due to the lack...
15:43
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174
Increase in Hospital Discharges for Inflammatory Bowel Diseases in Chile Between 2001 and 2012
 
Abstract Aim To determine the number of annual hospital discharges for inflammatory bowel diseases in Chile. The hypothesis is that there is a significant increase in the hospital discharges due to this disease from 2001 to 2012. Materials and Methods This is a descriptive study. Data were obtained...
15:42
Head and Neck Diseases by Alexandros G.Sfakianakis
Evolution of Spitz Nevi
 
Abstract Background/Objectives Spitz nevi are melanocytic lesions with clinical, dermoscopic, and histopathologic presentations that may resemble those of melanoma. The evolution of Spitz nevi is a well-known feature. The objectives of this study were to investigate the clinical and dermoscopic...
15:41
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolao
Photo-Induced Bending Behavior of Post-Crosslinked Liquid Crystalline Polymer/Polyurethane Blend Films
 
Photoresponsive blend films with post-crosslinked liquid crystalline polymer (CLCP) as a...
15:40
Emergency Medicine by Alexandros G. Sfakianakis
Prehospital parameters can help to predict coagulopathy and massive transfusion in trauma patients
 
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15:40
Emergency Medicine by Alexandros G. Sfakianakis
US Senate health bill would decimate long-term care coverage
 
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15:40
Emergency Medicine by Alexandros G. Sfakianakis
Reconstruction of AAOS type III and IV acetabular defects with the Ganz reinforcement ring: High failure in pelvic discontinuity
 
Archives of Orthopaedic and Trauma Surgeryfrom Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2tryi63
15:40
Emergency Medicine by Alexandros G. Sfakianakis
Cancer researchers may overestimate reliability of mouse studies
 
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15:40
Emergency Medicine by Alexandros G. Sfakianakis
Concussion assessment recommendations not followed during last World Cup, research finds
 
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15:40
Emergency Medicine by Alexandros G. Sfakianakis
Smoking is a risk factor for proliferative vitreoretinopathy after traumatic retinal detachment
 
Retinafrom Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2trKrYS
15:40
Emergency Medicine by Alexandros G. Sfakianakis
Markedly increased incidence of critical illness in adults with Type 1 diabetes
 
Diabetic Medicinefrom Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2trKqEi
15:40
Emergency Medicine by Alexandros G. Sfakianakis
US FDA outlines plan to speed rare disease drug reviews
 
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15:40
Emergency Medicine by Alexandros G. Sfakianakis
Patient-proxy agreement on the health-related quality of life one year after traumatic brain injury
 
Archives of Physical Medicine and Rehabilitationfrom Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2trgxno
15:40
Emergency Medicine by Alexandros G. Sfakianakis
Intraoperative cholangiography during cholecystectomy among hospitalized Medicare beneficiaries with non-neoplastic biliary disease
 
The American Journal of Surgeryfrom Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2trGGCG
15:40
Emergency Medicine by Alexandros G. Sfakianakis
Impact of a cardiac intensivist on mortality in patients with cardiogenic shock
 
International Journal of Cardiologyfrom Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2s8FaBo
15:40
Emergency Medicine by Alexandros G. Sfakianakis
Effect of bariatric surgery on emergency department visits and hospitalizations for atrial fibrillation
 
The American Journal of Cardiologyfrom Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2s8CuE5
15:40
Emergency Medicine by Alexandros G. Sfakianakis
Risk factors for early return visits to the emergency department in patients with urinary tract infection
 
The American Journal of Emergency Medicinefrom Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2s98szM
15:40
Emergency Medicine by Alexandros G. Sfakianakis
Salvage of failed ankle arthrodesis after posttraumatic septic arthritis by Ilizarov external fixator: Mid-term results
 
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15:40
Emergency Medicine by Alexandros G. Sfakianakis
Pain intensity, interference, and medication use after spinal cord injury: relationship with risk of mortality after controlling for socioeconomic and other health factors
 
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