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1.
Pan Afr Med J ; 35(Suppl 2): 13, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32528624

RESUMO

The Coronavirus disease 2019 (Covid-19) scourge has challenged the world's health systems and presented multiple socio-economic and public health challenges to the states it has affected. Zimbabwe has been affected by the pandemic, and in response, the government has set up an array of measures, including a national lockdown, to curb transmission. While it is critical to maintain such vigorous containment measures, socio-economic pressures in Zimbabwe will challenge the sustainability of the lockdown. Given the potential for lift of the lockdown before the Covid-19 pandemic ends, we discuss the Covid-19 pandemic situation in Zimbabwe and viewpoints on important considerations and strategies for lifting the lockdown.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Controle Social Formal/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Educação em Saúde , Humanos , Espaço Pessoal , Populações Vulneráveis , Zimbábue/epidemiologia
5.
Expert Rev Med Devices ; 17(6): 483-489, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32434400

RESUMO

To predict the spread of coronavirus disease globally and consequently prepare the hospital facilities with the required technology is a challenge. The availability of essential medical equipment to support patients affected by Covid-19 is globally limited. Areas covered This perspective gives a technical view of the pandemic focusing on the main actions taken by regulatory agencies to cope with the shortage of devices. The risk/benefit assessment and the main infection control policies in the clinical practices are also looked at. Expert opinion Regulatory agencies have amended their medical devices directives to address the pandemic, but each in a different way. In this exceptional situation scientist and technology experts in collaboration with medical specialists should work together to re-assess the risk analysis on medical equipment management and their use and re-use in this context with the aim to improve global health care Every effort must be made to provide the necessary devices at least with the minimum acceptable performances for Covid-19 patients while maintaining a high standard of safety for users. The aim of the present manuscript is to highlight the technical challenges in order to prevent, through targeted actions, operating standards from falling below the standards of care due to a lack of medical devices. Abbreviations AKI: acute Kidney Injury; ARGMD: Australian Regulatory Guidelines for Medical Devices; Covid-19: Coronavirus disease; FDA: Food and Drug Administration; ECMO: Extracorporeal Membrane Oxygenation; EU: European Union; ICU: Intensive Care Unit; WHO: World Health Organization; MHRA: Medicines and Healthcare products Regulatory Agency; MDR: Medical Device Regulation; SARI: Severe Acute Respiratory Infection.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus/epidemiologia , Equipamentos e Provisões/virologia , Pneumonia Viral/epidemiologia , Humanos , Unidades de Terapia Intensiva , Pandemias , Assistência ao Paciente , Medição de Risco , Controle Social Formal
10.
Expert Rev Med Devices ; 17(4): 297-308, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32160800

RESUMO

Introduction: It is common belief that driving with an implantable cardioverter defibrillator (ICD)/pacemaker (PM) might be associated with sudden cardiac incapacitation, road traffic accidents, and chance to harm to self and others. On the other hand, the ability to drive is highly valuable in the modern era, representing a cornerstone of daily living and employment. National regulations try to balance the right to drive of ICD/PM patients and the risk they pose to public safety, but rules for granting them a driving license are considerably different worldwide. For the same subset of patients driving restrictions may vary between 1 week and 1 year depending on the local law.Areas covered: In this article we systematically review driving restrictions in ICD/PM patients in 16 countries all over the world, highlighting their differences and analyzing data from the literature that underlie their formulation.Expert opinion: Current regulations are mainly based on historical data that do not take into account improvements in ICD/PM technologies and driving environment, which have made driving with an ICD/PM is substantially safe. Newer studies and updated regulatory documents are warranted to set the best driving restrictions and reach homogeneity worldwide.


Assuntos
Condução de Veículo , Desfibriladores Implantáveis , Internacionalidade , Controle Social Formal , Desfibriladores Implantáveis/efeitos adversos , Humanos , Licenciamento , Marca-Passo Artificial
11.
Jpn J Clin Oncol ; 50(4): 399-404, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32125380

RESUMO

OBJECTIVE: To describe changes in Japanese clinical trial regulations after the implementation of the Clinical Trials Act in April 2018. METHODS: First, how to apply multiple regulations after the enforcement of Clinical Trials Act was described. Second, the changes in the number of clinical trials in the National Cancer Center Hospital under each regulation were compared before and after the implementation of Clinical Trials Act. Third, new requirements imposed by Clinical Trials Act and their influences were discussed. RESULTS: In April 2018, Clinical Trials Act was enacted and academic clinical trials were classified into the following three categories: (i) investigator-initiated registration-directed trial under the Pharmaceuticals and Medical Devices Act; (ii) clinical trial under Clinical Trials Act; and (iii) clinical trial under the Ethical Guidelines. While 90% (205/227) of interventional studies were conducted under the Ethical Guidelines before the implementation of Clinical Trials Act in 2018, 46% (94/204) were subject to Clinical Trials Act in 2019 at the National Cancer Center Hospital. Under the Clinical Trials Act, investigators receive a scientific/ethical review by a certified review board (CRB). The identification of investigators in charge is mandated and they are required to submit the conflict of interest management plan to CRB. After the CRB review, the principal investigator must submit the trial plan to the government, and the content is uploaded to the newly established clinical trial registry site, the Japan Registry of Clinical Trials. CONCLUSIONS: The enforcement of the new Clinical Trials Act was supposed to improve the reliability of academic clinical trials in Japan; however, the financial and administrative burden may reduce clinical trial activity in the years to come.


Assuntos
Ensaios Clínicos como Assunto/legislação & jurisprudência , Controle Social Formal , Ensaios Clínicos como Assunto/ética , Guias como Assunto , Serviços de Saúde , Humanos , Japão , Sistema de Registros
13.
PLoS One ; 15(2): e0228701, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32097422

RESUMO

Singapore's Antimicrobial Resistance (AMR) national strategic action plan includes inappropriate use of antimicrobials in food-producing animals as a specific priority. Although the use of antibiotics and other drugs are monitored by regulatory bodies, food fish farmers are allowed to buy and administer antimicrobials without a veterinary prescription. We conducted a qualitative study of Singaporean food fish farmers to understand patterns and determinants of antibiotic use, their knowledge of antibiotic resistance, as well as perceptions of on-farm infection prevention and control measures. During the interview, participants were asked about their farming processes, farm infrastructure, antibiotic use and any disease prevention measures. Thematic analysis of participants' interviews showed that antibiotic for growth promotion and infection prevention was uncommon among local food fish farmers. The following three main themes influenced participants' decisions to use antibiotics in their practice: 1) individual factors, 2) local regulatory factors as well as 3) market-related factors. Individual factors included their personal experience and knowledge both with antibiotics as well as with alternate options. In terms of local regulatory factors, we found that regular oversight was a strong deterrent in antibiotic use. Last, at the market level, the relatively high price of antibiotics in Singapore coupled with stiff competition was a strong disincentive for participants to use antibiotics in their farming practice. These factors were also influential in their relationships with local regulatory bodies as well as their counterparts. Although industries differ significantly across countries, lessons learnt from Singapore's food fish farming demonstrate the importance of an environment where multi-dimensional factors come together to discourage the irrational use of antibiotics in food animal production. In addition, our results allow greater insight into food fish farmers' perspectives on infection control and form a basis from which further research work can be undertaken.


Assuntos
Antibacterianos/uso terapêutico , Aquicultura/estatística & dados numéricos , Probióticos/uso terapêutico , Pesquisa Qualitativa , Singapura , Controle Social Formal
14.
Accid Anal Prev ; 137: 105428, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32004859

RESUMO

INTRODUCTION: The threat of application of legal sanctions remains the prominent approach to reduce the prevalence of drink driving in a vast array of motoring jurisdictions. However, ongoing questions remain regarding: (a) the extent that such mechanisms impact upon offending behaviours, (b) the deleterious effect alcohol consumption has on decisions to drink and drive and (c) how best to operationalise (and measure) the concept of drink driving to enhance the accurate measurement of the dependent variable. METHOD: This paper reports on an examination of 773 Queensland motorists' (across nine local government areas) perceptions of both legal and non-legal drink driving sanctions (as well as alcohol consumption) in order to gauge the deterrent impact upon a range of measures of drink driving: the driver thinking they are over the limit, the driver knowing they are over the limit, attempts to evade random breath testing, and intentions to re-offend. The sample completed an online or paper version of the questionnaire. RESULTS: The majority of participants reported "never" engaging in "possible" (74.5 %) or "acknowledged" (83.4 %) drink driving events, although a considerable proportion of the sample reported engaging in "possible" (25.5 %) or "acknowledged" (16.6 %) drink driving and attempting to evade RBT (18 %) events, as well as possible intentions to drink and drive in the future (22 %). Males were more likely to report such events. Perceptions of both legal sanctions (certainty, severity and swiftness) as well as non-legal sanctions (fear of social, internal or physical harm) were relatively high and consistent with previous research. Interestingly, non-legal sanctions were reported as stronger deterrents than legal sanctions. However, multivariate analysis revealed that legal deterrents had limited utility predicting offending behaviours, but rather, demographic characteristics (e.g., younger motorists, males) as well as risky drinking behaviour were better predictors. In regards to intentions to offend, a past conviction for drink driving was also a predictor of re-offending. PRACTICAL APPLICATIONS: These results highlight the ongoing challenges of addressing the problem of drink driving and that some motorists: (a) have entrenched behaviour and/or (b) make the decision to drink and drive before they are under the influence of alcohol.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Dirigir sob a Influência/psicologia , Dirigir sob a Influência/estatística & dados numéricos , Adulto , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Tomada de Decisões , Dirigir sob a Influência/legislação & jurisprudência , Feminino , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Prevalência , Queensland , Assunção de Riscos , Controle Social Formal , Inquéritos e Questionários , Adulto Jovem
15.
PLoS One ; 15(2): e0227808, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32023260

RESUMO

Unmanned aerial vehicles (UAVs) or drones have been used by disaster relief organizations in the United States since 2005. However, their place in the disaster response ecosystem-the standardization, utility, ethical, and legal challenges of drone use-remains largely unstudied. This case series describes how UAVs were used by two teams of responders for damage assessment purposes during the 2017 southeastern US Hurricanes Harvey and Irma. Data streams ranged from social media, direct observation, participant-observation and semi-directed interviews. Qualitative analysis was performed for thematic content derived from field observation and from post-hoc interviews. Outcomes of the qualitative analysis emphasize the barriers to deploying drones in the disaster context, their tactical implementation, programmatic integration, and ethical and legal challenges. These observations lay the groundwork for both future research on the utilization of drones and the prudent and ethical implementation of programs that employ drones in post-disaster settings.


Assuntos
Aeronaves , Tempestades Ciclônicas , Desastres , Ecossistema , Florida , Tecnologia de Sensoriamento Remoto , Controle Social Formal , Texas
17.
Accid Anal Prev ; 136: 105430, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31927451

RESUMO

In this paper, we examine the relationship between traffic enforcement (in the form of roadside breath testing for alcohol) and traffic outcomes (alcohol-related traffic crashes) to identify an optimal point of traffic enforcement. In Western Australia (WA), Police are authorised to stop any driver and measure their blood alcohol concentration via a sample of their breath. Using a metric employed by Ferris et al. (2013) and a methodology analogous to that utilised by Cameron (2013), we model the relationship between alcohol related traffic crashes and the saturation of breath testing in WA from January 2008 to April 2018. Our analysis suggests that given the saturation of breath testing in 2018 (1.2 tests per licenced driver), a 10 % increase in breath testing would be associated with a decline of 0.34 alcohol related traffic crashes (ARTC) per 100,000 drivers per month, equating to six fewer crashes per month, state-wide. In addition, using 'willingness to pay' and human capital cost metrics to approximate the social costs of ARTC, we employ a cost-benefit analysis to estimate the point at which the social costs of ARTC equal the economic costs of breath tests. Our analysis suggests that an increase in the number of tests to 143 % of all licensed WA drivers (an increase of 450,000 breath tests from the 2017/18 financial year) would be anticipated to save the state AUD$13.3 million annually in the human capital costs of ARTC. Our findings suggest that a further increase in breath tests to 154% of all licensed WA drivers (an increase of 650,000 breath tests from 2017/18) may save the state AUD$31.0 million annually in willingness to pay costs. The analytics below present a novel combination of methods to approximate the relative economic merits of increases in traffic enforcement. Furthermore, the findings outlined here have practical applications for operational policing, while providing an analytical perspective for policy makers faced with making recommendations regarding the volume and saturation of breath tests.


Assuntos
Acidentes de Trânsito/prevenção & controle , Concentração Alcoólica no Sangue , Testes Respiratórios , Dirigir sob a Influência/prevenção & controle , Controle Social Formal/métodos , Análise Custo-Benefício , Dirigir sob a Influência/legislação & jurisprudência , Humanos , Polícia/economia , Austrália Ocidental
18.
Health Psychol ; 39(2): 107-115, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31697108

RESUMO

OBJECTIVE: Social determinants may negatively affect health via Hypothalamic-Pituitary-Adrenal (HPA) axis dysfunction. The potential contribution of social determinants and related factors to HPA-axis functioning is important to study among African American adults, who are more likely to experience societal inequities and health disparities relative to other racial/ethnic groups. This study examined the relationship between depressive symptoms and perceived social control on HPA-axis functioning among African American adults. METHOD: Participants (N = 107; Mage = 50, 79% female) were administered measures including the Center for Epidemiologic Studies-Depression and Informal (neighborhood) Social Control. Study procedures included the provision of 6 saliva samples for cortisol analysis (at wakeup, 30- and 90-min post-wakeup, 2:00 PM, 5:00 PM, and prebedtime). The relationship between depression and social control on the functioning of the HPA-axis were simultaneously examined within a 2-level hierarchical linear model. RESULTS: Variability in the Cortisol Awakening Response (CAR) was accounted for by depressive symptomatology (p = .023) and perceived social control (p = .016), whereby greater depression was associated with a blunted CAR (less awakening cortisol production) and greater perceptions of neighborhood social control with a higher CAR. CONCLUSIONS: Elevated depressive symptoms and low perceptions of neighborhood social control may serve as mechanisms that help to explain within-group variability in the functioning of stress physiology among African American adults. Findings enhance understanding of how social determinants may affect African Americans' health. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Assuntos
Depressão/psicologia , Hidrocortisona/metabolismo , Sistema Hipotálamo-Hipofisário/fisiopatologia , Controle Social Formal/métodos , Adulto , Afro-Americanos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saliva , Adulto Jovem
19.
Phys Ther ; 100(2): 217-224, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-31680158

RESUMO

In the wake of globalization, proliferation of digital technologies (DTs) is rapidly changing many activities across sectors, including influencing health to "go digital." Harnessing opportunities of DTs can be a pathway for delivery of health services, such as community-based rehabilitation (CBR) to the vulnerable groups of populations, particularly those in countries with low resources where health systems are weak and experiencing a deficit of trained health workers necessary to effectively deliver a full spectrum of health services. This perspective explored how some DTs can be leveraged in delivery of CBR services in rural and remote areas of countries with low resources. This is described based on information access and exchange, social satisfaction, shortages of rehabilitation workforce, professional development, and capacity building. However, since seizing advantages of DTs can inevitably be associated with spillovers and limitations, including needs prioritization, skills and language limitations, internet addiction and censorship issues, professionalism and ethical dilemmas, and sustainability, if proper measures are not taken, a caution is made. Moreover, as DTs are revolutionizing various activities across sectors, including health, this is not meant as a substitute for traditional health care activities, including those delivered through CBR, but rather to augment their delivery in settings with low resources and elsewhere.


Assuntos
Serviços de Saúde Comunitária/métodos , Países em Desenvolvimento , Pessoas com Deficiência/reabilitação , Redes Sociais Online , Terapia Assistida por Computador/métodos , Acesso à Informação , Comportamento Aditivo/epidemiologia , Fortalecimento Institucional , Barreiras de Comunicação , Alfabetização Digital , Educação Continuada/métodos , Troca de Informação em Saúde , Pessoal de Saúde/estatística & dados numéricos , Humanos , Internacionalidade , Intervenção Baseada em Internet , Idioma , Satisfação Pessoal , Papel Profissional , Controle Social Formal , Desenvolvimento Sustentável
20.
Accid Anal Prev ; 135: 105366, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31765927

RESUMO

Speeding has been a great concern around the world due to the occurrence and severity of road crashes. This paper presents an evaluation of the effectiveness of different penalty and camera-based enforcement strategies in curbing speeding offences by professional drivers in Hong Kong. A stated preference survey approach is employed to measure the association between penalty and enforcement strategies and drivers' speed choices. Data suggest that almost all drivers comply with speed limits when they reach a camera housing section of the road. For other road sections, a panel mixed logit model is estimated and applied to understand the effectiveness of penalties and enforcement strategies on driver's speeding behaviors. Driving-offence points (DOPs) are found to be more effective than monetary fines in deterring speeding offences, albeit there is significant heterogeneity in how drivers respond to these strategies. Warning drivers of an upcoming camera-based enforcement section increased speed compliance. Several demographic and employment characteristics, driving history and perception variables also influence drivers' choices of speed compliance. Finally, besides penalty and enforcement strategies, driver education and training programs aimed at addressing aggressiveness/risk-taking traits might help reduce repeated speeding offences among drivers.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/legislação & jurisprudência , Controle Social Formal/métodos , Acidentes de Trânsito/prevenção & controle , Condução de Veículo/estatística & dados numéricos , Feminino , Hong Kong , Humanos , Modelos Logísticos , Masculino , Segurança
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