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1.
Lancet Glob Health ; 12(5): e756-e770, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38614629

RESUMO

BACKGROUND: There are 1·3 billion people with disabilities globally. On average, they have poorer health than their non-disabled peers, but the extent of increased risk of premature mortality is unknown. We aimed to systematically review the association between disability and mortality in low-income and middle-income countries (LMICs). METHODS: We searched MEDLINE, Global Health, PsycINFO, and EMBASE from Jan 1, 1990 to Nov 14, 2022. Longitudinal epidemiological studies in any language with a comparator group that measured the association between disability and all-cause mortality in people of any age were eligible for inclusion. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. We used a random-effects meta-analysis to calculate the pooled hazard ratio (HR) for all-cause mortality by disability status. We then conducted meta-analyses separately for different impairment and age groups. FINDINGS: We identified 6146 unique articles, of which 70 studies (81 cohorts) were included in the systematic review, from 22 countries. There was variability in the methods used to assess and report disability and mortality. The meta-analysis included 54 studies, representing 62 cohorts (comprising 270 571 people with disabilities). Pooled HRs for all-cause mortality were 2·02 (95% CI 1·77-2·30) for people with disabilities versus those without disabilities, with high heterogeneity between studies (τ2=0·23, I2=98%). This association varied by impairment type: from 1·36 (1·17-1·57) for visual impairment to 3·95 (1·60-9·74) for multiple impairments. The association was highest for children younger than 18 years (4·46, [3·01-6·59]) and lower in people aged 15-49 years (2·45 [1·21-4·97]) and people older than 60 years (1·97 [1·65-2·36]). INTERPRETATION: People with disabilities had a two-fold higher mortality rate than people without disabilities in LMICs. Interventions are needed to improve the health of people with disabilities and reduce their higher mortality rate. FUNDING: UK National Institute for Health and Care Research; and UK Foreign, Commonwealth and Development Office.


Assuntos
Países em Desenvolvimento , Pessoas com Deficiência , Criança , Humanos , Mortalidade Prematura , Definição da Elegibilidade , Internacionalidade
2.
PLoS One ; 19(4): e0300262, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38557680

RESUMO

Top managers' past experiences (e.g., foreign experience) significantly impact their decision-making behavior, which may influence firms' sustainable development. The available literature, focusing on the role of the increase in the number of top executives with foreign experience in corporate social responsibility (CSR), yields mixed results. In order to clarify the ambiguous relationship between executive foreign experience and CSR, we empirically examine the effect of the geographic diversity of top executives' foreign experience on CSR. Based on a hand-collected dataset of the top management team's (TMT's) foreign experience, we demonstrate the positive impact of the geographic diversity of returnee executives' foreign experience on firms' CSR using Chinese A-share listed firms from 2009 to 2018. Moreover, this impact is stronger in firms with political connections with the central government and in regions with good market development. Furthermore, the mechanism analysis shows that returnee executives drive firms' CSR by promoting corporate donations and green innovation. This paper offers clear policy implications by suggesting that hiring returnees with a broad geographic scope of foreign experience as corporate executives is an efficient way to enhance firms' CSR.


Assuntos
Povo Asiático , Mãos , Humanos , Governo Federal , Internacionalidade , Seleção de Pessoal , Responsabilidade Social
3.
PLoS One ; 19(4): e0299831, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38635503

RESUMO

This article examines the role of legal structure in explaining financial development in twenty-three emerging markets, which has not been explored in institutional economics literature before. This study relied on Pedroni, and Kao cointegration tests, which is followed by the renowned panel cointegration technique. The results of the Pedroni and Kao cointegration tests show that the variables understudy is cointegrated in the long-run. These findings are confirmed by the panel cointegration showing that legal structure (LS) has positive impact on financial development (FIND) in long-run that support Law and Finance, and New Institutional Economics theories in emerging markets. This study is the first to directly examine the long-run impact of LS on FIND in emerging markets, and the result remains consistent across alternative measure of FIND. The findings of this study have important policy implications for emerging markets. Policymakers should focus on creating a legal environment that is conducive to financial development. This includes strengthening the legal framework, improving regulatory regimes, and promoting market autonomy. Additionally, policymakers should work to attract foreign investment, which can help spur economic growth and development in emerging markets. The findings of the study are consistent across battery of robustness testing.


Assuntos
Dióxido de Carbono , Desenvolvimento Econômico , Dióxido de Carbono/química , Investimentos em Saúde , Internacionalidade , Políticas
4.
Artigo em Russo | MEDLINE | ID: mdl-38640222

RESUMO

The year 1992 is an important landmark in the history of Russian pharmaceutical market. It began not in January, but in December 1991, when orders of the President and the Government to open free market of medications were promulgated. The Yeltsin advisers conceived that market economy was infallible means to combat medication shortages, corruption and bureaucratic monopoly. However, panacea did not work. Moreover, it gave rise to completely new problems. The human and state security implies protection from threats of dependence. The unprepared dive into market plunged Russians and the country into deep dependence on imported medications and foreign pharmaceutical companies. The proposed study proceeds our publications in this journal and in journal "Pharmacia" in 2022. At that time, analysis of medication "famine" was implemented on basis of published sources and relied on journalistic evidences. The current study was carried out on the basis of archive documents of the Ministry of Health of the Russian Federation and authors interviews of representatives of the regulator. The first report reveals administrative mechanism that engendered crisis of medication supply in the first post-Soviet year of our country.


Assuntos
População do Leste Europeu , Internacionalidade , Humanos , Federação Russa , Preparações Farmacêuticas
5.
Global Health ; 20(1): 31, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38622631

RESUMO

BACKGROUND: On July 4, 2021, China officially introduced the drug patent linkage system, which has made more localized adjustments than have similar systems in the US and South Korea. This study describes the characteristics and outcomes of China's patent linkage system. METHODS: For this study, we used the database of China's patent information registration platform for marketed drugs to capture all listed patents and patent certifications from June 25, 2021, to June 30, 2023. We used descriptive statistics for the above data to assess the impact of patent linkage on branded drug manufacturers, generic drug manufacturers, and the public's access to medicines. RESULTS: During the study period, the patents of 632 branded drugs were listed, and 5058 ANDAs submitted patent certifications to the Registration Platform. Of these 632 branded drugs, 462 (73.1%) drugs were approved before the year of patent registration, and the average number of listed patents per drug was 1.8, with a standard deviation of 1.4. However, of these 5058 ANDAs, P1 certifications accounted for 85.1%, and P3 and P4 certifications accounted for 16% combined. In addition, according to the detailed statistics of P2 certifications, we found that the proportion of patent invalidation cases was 46.4%. The remaining validity of the patents corresponding to P3 certifications was longer, with a median value of 17 months, and the IQR was 10-30.75, ranging from - 2 to 204 months. CONCLUSIONS: China's patent linkage aims to promote the balance of multiple interests -innovation, imitation and public health-and has its own system characteristics. Patent listing and patent certification are the key indicators reflecting the implementation effect of the system. From the perspective of system outcomes, ANDAs have been connected to the patent linkage system in an orderly manner, but the growth of patent challenges is not obvious. Moreover, manufacturers of foreign branded drugs that have not yet entered the Chinese market need to pay more attention to the role of patent listing.


Assuntos
Medicamentos Genéricos , Internacionalidade , Humanos , República da Coreia , China
6.
PLoS One ; 19(4): e0300655, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38626178

RESUMO

Ports are critical centers of international trade and global logistics now that economic globalization has taken hold. The efficiency performance of port logistics is crucial to building an emerging pattern of development in which domestic and foreign dual cycles are complementary for China. This paper examines the efficiency performance of 19 ports within five major economic circles in China. It explores how their efficiency is distributed, and the configurations of efficiency improvement during the new normal of China's economy. First, the DEA-BCC model is employed to calculate the technical efficiency performance and distribution of each port from 2011 to 2020. Then, fuzzy-set qualitative comparative analysis (fsQCA) was applied to integrate and analyze the influencing factors. The results show as follows: (1) Each port group performed differently on efficiency rankings, as well as regional distributions. Among these, the port groups of the Bohai Rim region, the Yangtze River Delta region, and the Bohai Rim region continue to rank highly. (2) From the perspective of configuration analysis, the results suggest that government support is not necessary for port logistics with better economic endowments. However, it is critical for backward ones. (3) A rational industrial structure can enhance levels of infrastructure, openness, and information technology, improving port performance. The findings can provide theoretical and practical references for better promoting the development of Chinese port management.al references for better promoting the development of Chinese port management.


Assuntos
Comércio , Internacionalidade , Eficiência , Indústrias , China , Desenvolvimento Econômico
7.
Zhongguo Zhong Yao Za Zhi ; 49(5): 1137-1143, 2024 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-38621960

RESUMO

The protection, development, and utilization of medicinal plant resources are important cornerstones of maintaining human health. However, due to factors such as the reduction of high-quality land resources, deterioration of ecological environments, and excessive and disorderly resource development, medicinal plant resources are becoming scarce, and some of them are insufficiently supplied. With the proposal of "the Belt and Road" Initiative, the cooperation between China and "the Belt and Road" partners(the countries and regions involved in "the Belt and Road" Initiative)is increasingly close, which provides a new opportunity for carrying out trade of medicinal plant resources and alleviating the problem of imbalance and relative inadequacy of medicinal plant resources in countries. This study first determined the distribution and species information of plant resources in countries and regions involved in "the Belt and Road" Initiative by investigating the database of plant distribution and that of medicinal plant resources. Then, according to the published data from the International Union for Conservation of Nature(IUCN) and the Convention on International Trade in Endangered Species of Wild Fauna and Flora(CITES), this study identified the rare and endangered medicinal plants and the medicinal plants under trade control in countries and regions involved in "the Belt and Road" Initiative and finally sorted out the list of potential medicinal plant resources in countries and regions involved in "the Belt and Road" Initiative that can be used by China. This data resource can not only be used for the overall protection of important endangered species but also scientifically guide the development and utilization of medicinal resources, providing guidance and a theoretical basis for the sustainable development of medicinal plant resources in countries and regions involved in "the Belt and Road" Initiative.


Assuntos
Plantas Medicinais , Humanos , Animais , Comércio , Internacionalidade , Meio Ambiente , China , Espécies em Perigo de Extinção
8.
PLoS One ; 19(4): e0299727, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38573973

RESUMO

The effect of carbon emissions on the environment has made some of the Sustainable Development Goals difficult to achieve. Despite the efforts of international bodies, there is still a need to address the problem since the transition is not complete. Therefore, this study investigates the effect of globalization, economic growth, financial inclusion, renewable energy, and government institutions on carbon emissions from the period of 1998 to 2021. To be able to assess both the direct and indirect effects of the variables, the Partial Least Square Structural Equation Modelling is employed, where renewable energy serves as the mediator, and the Two-Stage Least Squares is employed as the robustness check. The findings of the study reveal that globalization promotes the use of renewable energy, but financial inclusion has a negative effect on renewable energy use. Renewable energy has a direct positive and significant effect on carbon emissions. Financial inclusion has an indirect negative and significant effect on carbon emissions. The results imply that more enlightenment on financial inclusion will help a smooth transition, and globalization should be embraced when all environmental regulations are enforced.


Assuntos
Carbono , Desenvolvimento Econômico , Análise de Classes Latentes , Análise dos Mínimos Quadrados , Energia Renovável , Dióxido de Carbono , Internacionalidade
9.
PLoS One ; 19(4): e0297787, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38578812

RESUMO

Protecting human, animal, and plant life or health from additives, toxins, and contaminants in agri-products and promoting green free trade are the main components of Sanitary and Phytosanitary (SPS) measures. However, the SPS measures are heterogeneous. This study examines the impact of SPS measures on the measured export quality and discusses their influence on the environmental protection of the exporting country. International heterogeneous measures do not necessarily promote quality upgrading but greatly increase transaction costs. By contrast, China's agri-product' quality upgrading and environmental pollution are in sharp contrast. Based on a heterogeneous firm-trade model, this study obtains three hypothetical propositions and conducts empirical regressions using the Tobit method. This study finds that heterogeneous SPS measures hinder quality upgrading because firms present a different quality upgrading trend, which in turn impedes the environmental protection of the exporting country; the quality upgrading made by diversified SOEs is higher than that of foreign firms and private firms; the quality upgrading made by general firms is higher than that of processing firms; and protective SPS measures have a stronger negative effect on quality upgrading and environmental protection.


Assuntos
Conservação dos Recursos Naturais , Cooperação Internacional , Animais , Humanos , Comércio , Internacionalidade , Poluição Ambiental/prevenção & controle , China
10.
PLoS One ; 19(4): e0300873, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38578821

RESUMO

In implementing the equity incentive system, this paper delves into the listed enterprises' selection of equity incentive models. While previous research has extensively covered the effects, models, and influencing factors of equity incentives, there needs to be more in-depth literature focusing on the diverse incentive models and their impact on corporate performance. Notably, there needs to be more literature on considering entrepreneurial spirit as a mechanism. It aims to explore the relationship between executives' choices under different incentive models, the entrepreneurial spirit fostered by these models, and their combined impact on corporate performance. The findings reveal that adopting the restricted stock incentive model by listed enterprises implementing the equity incentive system significantly positively affects enterprise performance. Mechanistic tests show that when a company implements the restricted stock incentive model, executives prioritize maximizing their interests, leading them to embrace more risk in their investment decisions. This behavior, in turn, stimulates the adventurous spirit of executives, positively impacting enterprise performance, particularly pronounced in companies with more concentrated executive power. Moreover, executives may be more inclined to invest in high-risk, high-reward innovative projects, a behavior indicative of innovation and more prevalent in firms with higher research and development (R&D) investment. However, the limitation of this paper is that the study evaluates the operation of the equity incentive system in China by taking listed companies in China as an example, which is not necessarily suitable for foreign developed capitalist countries. This study contributes to the study of principal-agent problems by exploring the relationship between executives, entrepreneurship and firm performance.


Assuntos
Empreendedorismo , Motivação , Capitalismo , China , Internacionalidade
12.
PLoS One ; 19(3): e0298913, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38457448

RESUMO

Foreign Direct Investment is theoretically expected to facilitate the transfer of knowledge from the home country to the host country, however, the empirical evidence on the subject is mixed. Some studies have shown that, on one hand, as competition grows, the incentive to innovate reduces with the decrease in monopoly rents (Schumpeterian effect). On the other hand, market competition can also boost investments in R&D activities incentivized by incremental profits (Escape-Competition effect). Therefore, this study aims to explore which of these two effects dominates in the selected group of countries. This study also identifies the moderators of the relationship between FDI stock and domestic innovation. It examines the role of absorptive capacity, quality of regulations, and property rights protection in the innovative activities of the host countries. Generalized Method of Moments is used to estimate the parameters of the multivariate regression equation. The analysis is based on panel data consisting of 49 countries over 14 years. The results show that FDI has a negative relationship with domestic innovation, indicating the presence of the Schumpeterian effect. The extensions of the main models show that FDI positively affects domestic innovation in countries with higher absorptive capacity, the superior quality of regulation, and stronger protection of property rights. This study shows that the positive relationship between FDI and domestic innovation is conditional on the ability to absorb knowledge and quality of governance in the recipient countries.


Assuntos
Desenvolvimento Econômico , Propriedade , Investimentos em Saúde , Internacionalidade , Dióxido de Carbono
13.
Environ Sci Technol ; 58(13): 5760-5771, 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38507818

RESUMO

Robust empirical assessments of the long-term cumulative global effects of free trade and economic globalization on the environment are limited. This account fills this gap by constructing a dynamic computable general equilibrium model to estimate the environmental effects of a milestone in the recent history of trade liberalization: China's 20-year World Trade Organization (WTO) accession. The modeling shows that China's accession could have resulted in an increase in the global cumulative greenhouse gases (GHGs), sulfur dioxide (SO2), and nitrogen oxide (NOx) emissions by roughly 14,000 Mt CO2-eq, 64 Mt, and 46 Mt, respectively. The global production scale effect contributed to most of these estimated increases. The regional total output composition effect also caused higher emissions. Meanwhile, the sectoral output composition effect helped reduce total emissions to a limited extent. Fortunately, a package of emission abatement measures led to a decrease in emission factors and a drop in the global cumulative emissions of GHGs, SO2, and NOx. The findings suggest that to enjoy the free trade and economic globalization benefits and minimize the induced emission increases, it is vitally important to systemically reduce emissions across the entire economy and nurture a low-carbon trade regime.


Assuntos
Meio Ambiente , Gases de Efeito Estufa , Dióxido de Enxofre , Internacionalidade , China , Dióxido de Carbono/análise
14.
Artigo em Inglês | MEDLINE | ID: mdl-38541335

RESUMO

Writing this Editorial for our second collection of papers on "International Perspectives on Mental Health Social Work", we reflected upon the content of our First Edition [...].


Assuntos
Internacionalidade , Saúde Mental , Humanos , Serviço Social , Redação
15.
Lancet Oncol ; 25(4): e164-e172, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38547900

RESUMO

Over the past decade, China has emerged as Africa's largest trade partner and source of foreign direct investment, with public health ranked as a top priority in China-Africa collaborations. During the same period, cancer has emerged as a leading cause of death in Africa, with more than 700 000 deaths per year and projections of more than 1 million deaths per year by 2030. In this Review, we explore the effects of increasing China-Africa collaborations on cancer control in Africa. We review the published literature on health-care assistance, research, education and training, and infrastructure and present the results of an institutional review board-approved survey of African oncology health-care professionals and institutional leaders that assessed their perception of the effects of China-Africa collaborations. From peer-reviewed articles and grey literature, we found that the number of China-Africa collaborations have grown substantially over the past decade in different areas, especially in patient care and infrastructure. Research publications have also surged in quantity in the past decade compared with previous years. However, the survey results suggest research collaborations remain infrequent and that medical professionals in African cancer centres rarely participate in direct research collaborations with Chinese institutions. The Review also highlights the challenges and benefits of increasing China-Africa collaborations. Challenges include insufficient monitoring and evaluation of the projects in Africa and poor coordination and alignment of the various initiatives. The benefits of these collaborations for Africa include improved health outcomes, strengthened health systems, and socioeconomic development. Benefits are also apparent for China, such as securing energy and resource supplies, expanded trade and investment opportunities, and improved diplomatic relations. Overall, China-Africa collaborations are increasing and having a substantial effect in both China and the African continent. Recommendations to minimise the challenges and maximise the benefits for more positive consequences on cancer control in Africa are discussed.


Assuntos
Atenção à Saúde , Neoplasias , Humanos , África/epidemiologia , Saúde Pública , Internacionalidade , China/epidemiologia , Neoplasias/epidemiologia , Neoplasias/prevenção & controle
16.
PLoS One ; 19(3): e0295505, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38551986

RESUMO

Against the backdrop of globalization, interpreting, a translation communicative activity in a verbal way, plays an increasingly important role in international communications and exchanges. In response to this world pattern, the Chinese government attaches great importance to the interpreting industry. However, due to the national condition of uneven regional development, the English interpreting level across China is also unbalanced. Confronting this circumstance, previous research only stagnates at the level of recognizing the problem, but very few studies have attempted to solve the problem. Thus, the current study aims to figure out the regional interpreting level in mainland China by establishing and utilizing an innovative indicator system based on statistics and geography technologies. Based on the literature review and empirical questionnaire survey from different stakeholders, the study proposes an indicator system containing 3 first-level factors and 7 second-level factors to measure regional English interpreting levels. The weight of each indicator and scoring method is laid down based on factor analysis and interval marking. In addition, putting the innovative indicator system into practice, a total of 38 groups of regional data are collected to rank the regional interpreting level across China. Integrating with GIS and statistical techniques, the result visually shows that the English interpreting level across China is uneven at present: higher in the southern and eastern parts of China compared to that of northern and western China, which is unfriendly to sustainable development in the future. Facing this reality, a following-up analysis has been made for offering explanations of the results and suggestions for regional interpreting sustainable development.


Assuntos
Sistemas de Informação Geográfica , Desenvolvimento Sustentável , China , Internacionalidade
17.
PLoS One ; 19(3): e0296391, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38478552

RESUMO

This study explores the impact of bank market structure on firm innovation in China using a two-way fixed effects model. Our analysis is based on a dataset comprising 2,412,316 firm-city level observations. Our findings suggest that there exists a U-shaped relationship between bank market structure and firm innovation in China. Specifically, we identify that the financing channel is a crucial pathway through which bank market structure influences firm innovation. Moreover, our results indicate that this relationship is mainly driven by small firms and innovative firms, and is more pronounced in regions with stronger intellectual property rights protection or greater openness to foreign markets. In sum, this study contributes to the existing literature by advancing our understanding of the impact of bank market structure on innovation in Chinese firms.


Assuntos
Povo Asiático , Internacionalidade , Humanos , China
18.
Zhonghua Yi Shi Za Zhi ; 54(1): 23-28, 2024 Jan 28.
Artigo em Chinês | MEDLINE | ID: mdl-38475682

RESUMO

There is a kind of historical relics called "Angdi moniu" in the Palace Museum, which looks like metal and appears frequently in the archives of the Qing Dynasty as a foreign medicine.It is stated that it can treat sores and pus in the HanXiu CaoTang Biji and it was also found in the archives of the Palace Office. However, no researcher in the academic community has yet conducted an in-depth research of what exactly is it. Through the investigation of cultural relics, in-depth research of Chinese and foreign literature, and the use of linguistic methods, this paper examines "Angdi Moniu" and its related items, and clarifies that "Angdi Moniu" is antimony, related items are antimonials and antimony cup.


Assuntos
Antimônio , Medicina , Museus , Internacionalidade , China , Medicina Tradicional Chinesa
19.
J Environ Manage ; 355: 120307, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38428178

RESUMO

Addressing global carbon inequality constitutes an important task for both international negotiations on climate-change mitigation and the achievement of sustainable development goals. Soaring international trade might become a vigorous modifier for reducing global carbon inequality through production reallocation and economic boosts in different countries. However, this effect remains largely unexplored, not only because of little awareness of the windfall benefits from international trade but also because of debates on quantifying global carbon inequality from both production- and consumption-based perspectives. To avoid incomplete implications from a single perspective, this study first adapted a producer-consumer shared responsibility to evaluate global carbon inequality using the technology-adjusted consumption-based accounting method for 189 countries from 2006 to 2016. A dynamic panel data model was developed to examine the different channels through which international trade affects global carbon inequality in developed and developing countries. The results demonstrate that even with increasing carbon emissions, less global carbon inequality was witnessed from 2006 to 2016. International trade plays an important role in reducing global carbon inequality, mostly by stimulating the economy and increasing household income in developing countries. However, production reallocation via international trade fails in reducing the emission responsibilities of developed countries, rendering this futile in alleviating global carbon inequality. Carbon leakage that transfers carbon-intensive production across borders can lead to this unintended result, and more stringent cross-border regulations such as the carbon border adjustment mechanism can be effective. This study not only highlights the pivotal role of international trade in reducing global carbon inequality but also the future direction of international cooperation on climate change mitigation in a globalized world.


Assuntos
Carbono , Comércio , Internacionalidade , Dióxido de Carbono , Mudança Climática , Desenvolvimento Econômico
20.
Med. intensiva (Madr., Ed. impr.) ; 48(3): 155-164, Mar. 2024. tab
Artigo em Inglês | IBECS | ID: ibc-231021

RESUMO

Objective To determine the prevalence of elevated mechanical power (MP) values (>17J/min) used in routine clinical practice. Design Observational, descriptive, cross-sectional, analytical, multicenter, international study conducted on November 21, 2019, from 8:00 AM to 3:00 PM. NCT03936231. Setting One hundred thirty-three Critical Care Units. Patients Patients receiving invasive mechanical ventilation for any cause. Interventions None. Main variables of interest Mechanical power. Results A population of 372 patients was analyzed. PM was significantly higher in patients under pressure-controlled ventilation (PC) compared to volume-controlled ventilation (VC) (19.20±8.44J/min vs. 16.01±6.88J/min; p<0.001), but the percentage of patients with PM>17J/min was not different (41% vs. 35%, respectively; p=0.382). The best models according to AICcw expressing PM for patients in VC are described as follows: Surrogate Strain (Driving Pressure) + PEEP+Surrogate Strain Rate (PEEP/Flow Ratio) + Respiratory Rate. For patients in PC, it is defined as: Surrogate Strain (Expiratory Tidal Volume/PEEP) + PEEP+Surrogate Strain Rate (Surrogate Strain/Ti) + Respiratory Rate+Expiratory Tidal Volume+Ti. Conclusions A substantial proportion of mechanically ventilated patients may be at risk of experiencing elevated levels of mechanical power. Despite observed differences in mechanical power values between VC and PC ventilation, they did not result in a significant disparity in the prevalence of high mechanical power values. (AU)


Objetivo Determinar la prevalencia de valores elevados de potencia mecánica (PM) (>17J/min) utilizados en la práctica clínica habitual. Diseño estudio observacional, descriptivo de corte transversal, analítico, multicéntrico e internacional, realizado el 21 de noviembre de 2019 en horario de 8 a 15 horas. NCT03936231. Ámbito Ciento treinta y tres Unidad de Cuidados Críticos. Pacientes pacientes que recibirán ventilación mecánica por cualquier causa. Intervenciones ninguna Variables de interés principales Potencia mecánica. Resultados se analizaron 372 enfermos. La PM fue significativamente mayor en pacientes en ventilación controlada por presión (PC) que en ventilación controlada por volumen (VC) (19,20+8,44J/min frente a 16,01+6,88J/min; p<0,001), pero el porcentaje de pacientes con PM>17J/min no fue diferente (41% frente a 35% respectivamente; p=0,382). Los mejores modelos según AICcw que expresan la PM para los enfermos en VC se decribe como: Strain subrogante (Presión de conducción) + PEEP+Strain Rate subrogante (PEEP/cociente de flujo) + Frecuencia respiratoria. Para los enfermos en PC se define como: Strain subrogante (Volumen tidal expiratorio/PEEP) + PEEP+Strain Rate subrogante (Strain subrogante/Ti) + Frecuencia respiratoria+Expiratory Tidal Volumen+Ti. Conclusiones Gran parte de los pacientes en ventilación mecánica en condiciones de práctica clínica habitual reciben niveles de potencia mecánica peligrosos. A pesar de las diferencias observadas en los valores de potencia mecánica entre la ventilación VC y PC, este porcentaje de riesgo fue similar en PC y VC. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Respiração Artificial , Mecânica Respiratória , Unidades de Terapia Intensiva , Epidemiologia Descritiva , Estudos Transversais , Internacionalidade
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