RESUMO
CONTEXT: One of the most isolated areas in South-East Asia is the Tonle Sap Lake region in Cambodia. Scattered throughout the lake are remote fishing villages that are geographically isolated from the rest of the country. ISSUE: Receiving health care at a clinic or hospital often involves a full day of travel from the Tonle Sap Lake region, which is unaffordable for the vast majority of residents. INTERVENTION: The Lake Clinic (TLC) is a non-government organization established in 2007. In 2008, a ship was built that was designed for transport of a medical team and supplies to provide primary care to the fishing villages. Initially the project started with one team serving seven villages. TLC has since expanded to two full teams serving 19 villages. TLC provides adult and pediatric primary care, vaccinations, dental services, eyecare services, antenatal care and health education free of charge. From 2008 to 2012, there were a total of 13 160 pediatric visits and 17 722 adult visits. In addition to these services, 739 patients received dental care, 346 patients received eye care, there were 1239 antenatal visits, 116 family planning visits, and 1600 patients received health education. In total, 130 patients were referred to hospitals or health centers for a higher level of care. A total of 6627 immunizations were provided. The most common pediatric illness was upper respiratory infection (44.4%), and the most common adult illness observed was gastritis (20.6%). LESSONS LEARNED: Despite the challenges, TLC has been able to achieve a significant goal: to provide primary care medical services to a remote area of Cambodia where no medical services were previously available. TLC strives to strengthen healthcare delivery with the goal to provide the best possible care in the region. New partnerships have allowed laboratory capacity and a formalized hospital referral system for pediatric patients beginning in 2014. A new boat, which completed construction in December 2013 and is now fully operational, has allowed the TLC team to reach a greater number of patients more efficiently.
Assuntos
Lagos , Unidades Móveis de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , Navios , Camboja , Meio Ambiente , Humanos , Unidades Móveis de Saúde/economia , Unidades Móveis de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/estatística & dados numéricosRESUMO
OBJECTIVES: The objective was to estimate the impact of the meniscus on cartilage and subchondral bone in knee osteoarthritis (OA). METHODS: In a sample of 46 knee specimens (26 females), 13 (7 females) were classified as OA according to the Kellgren-Lawrence classification. Outerbridge and meniscal grading were performed. Using micro-computed tomography images, we analyzed the cartilage thickness, subchondral plate thickness and micro-architecture of trabecular subchondral bone at different depths and in two different locations of the medial tibial plateau: one peripheral (PER) covered by the meniscus and one central (CENT) uncovered by the meniscus. RESULTS: Uncoverage by the meniscus was associated with bone sclerosis, defined as higher bone volume to total volume (BV/TV), higher trabecular number, thicker trabeculae with lower spacing, and anisotropy and a more plate-like architecture. The protective effect of meniscal coverage was observed in the uppermost 5 to 6 mm of the subchondral bone. As compared with normal knees, knees with OA showed significantly higher bone sclerosis (P <0.050.001) at the PER location, but only BV/TV (P=0.03) and trabecular number (P=0.02) differed between OA and non-OA knees at the CENT location uncovered by meniscus. CONCLUSIONS: OA results showed a partial dedifferentiation of the subchondral bone micro-architecture between PER and CENT locations probably due to menisci that still retain some of their protective effects on the subchondral bone.